The Routine

Every Thursday (and one Friday) for the past several weeks, my "work day" has consisted of receiving chemo treatment. The appointment times and specific drugs administered may vary, but the overall routine remains remarkably the same.

I wake up and usually by this point in the week, I'm pretty hungry - my appetite has returned to some degree. But, I don't want to eat too much, because the chemo drugs will mess with my stomach. So I'm careful to stick to a bagel or a fruit-and-juice smoothie instead of scarfing down a large or spicy meal.

Before I leave the house, I put topical anesthetic on a special clear plastic bandage and put it over my port. This helps numb the area they're going to poke later. I pack my backpack with a stress squeeze ball (for when they're poking me), my iPod (fully charged), and plenty of reading material (there is a LOT of waiting time). Even getting dressed takes some special concern: the port (just below my right clavicle) needs to be accessible, so a button-down shirt or a tank top is best, to avoid stretching the neck of a t-shirt. And Parnassus is always terrifically cold and windy, no matter how hot or sunny the city is, so a sweatshirt and hat go in the backpack too.

It's about a 30-minute walk down to the UCSF shuttle bus. Sure, I could take light rail, but it wouldn't cut that much time off, and the exercise feels good. It's another 20- or 30-minute shuttle ride up the hill to Parnassus. At the hospital, after battling an overtaxed elevator system crowded with patients, doctors, nurses, techs, wheelchairs, well-wishers, etc., and waiting in line, I check in with an overworked oncology receptionist who luckily, by now, recognizes me. She slaps sheets of pre-printed personalized labels on a thick stack of papers while I fill out a "how're ya doin'?" form. This form lists a few dozen symptoms, categorized by body system (Endocrine, Neurological, etc.) and you check off "Yes" or "No" if you've experienced them in the past week. I swear nobody looks at this form but I duly check down all the boxes.

They write down your arrival and appointment times and give you two stacks of papers. One stack goes in the "vitals" box; the other goes in the blood draw box. Most patients get their blood drawn in the cattle-car room...but luckily, I have a port, so an RN has to draw my blood in private.

You then take a seat in a long and fairly crowded waiting room next to folks who are, for the most part, much older and frailer than you. They eye you with suspicion as you, bandanna'ed and sunglassed, fire up your iPod and start reading something fairly thick and heavy like a Galbraith economics book or Churchill's history of WWII.

Every few minutes, the techs emerge to shout out somebody's incredibly mangled name. It's often hard to hear, or to respond quickly, because of the long, narrow, and around-the-corner nature of the waiting area. So a lot of repetitive shouting ensues. These techs take your vitals, which at UCSF consists of your height and weight (both metric), your blood pressure and pulse, your blood oxygen (which, for me, has always suspiciously remained the exact same number), and a wrist measurement. Then you are discharged back into the waiting area until your blood is drawn. Sometimes the blood draw happens first, which is rather amusing to me, because the vitals techs aren't aware, and they shout and shout and shout for you while you're just a few steps away with lines sticking in you, unable to respond.

The RN blood draw is a ritual in itself. There is a special tray they bring in, crowded with all manner of needles, gloves, bandages, etc. They open up and spread out several of these packages, one of which has two gloves neatly folded. They remove the plastic bandage and wipe off any remaining topical anesthetic, then swab down the site with a disinfectant. They hook up the needle and the line and poke it into the port. This hurts, some times more than others. They test the blood return (it acts like a vacuum to suck your blood out), flush you with saline (which always makes your shoulder really cold), and take three vials of blood, then they leave the line in and surround the punctured area with gauze and tape.

Then you wait back in the seating area for your blood counts. It can take anywhere from thirty minutes to an hour. If it's not too foggy, which is often, there is a terrific panoramic view of the entire Bay Area from the fifth-floor oncology seating area.

Once you have the lab results, you meet with your NP. She discusses what's high or low and what actions need to be taken - shots to increase red or white blood cell production, blood transfusion, delaying treatment by a week, or going ahead with treatment. Luckily, I've been able to avoid transfusions and delays, although my blood counts have sometimes been dangerously low. (One nurse said, You probably know all your blood cells on a first-name basis by now...) This is also the opportunity to ask the NP any questions about your treatment, which I've done a lot of in the past couple weeks.

The NP then gives the pharmacy the go-ahead for your treatment, and you are ushered into either a private or shared, chair or bed, treatment room while you wait for the drugs to be concocted. You receive your "pre-meds" and the nurses offer you a selection of snacks and beverages to accompany them (I take water, on the rocks). More waiting ensues.

A lot of the drugs have short half-lives or other restrictions, so it's very important to mix and deliver them right on time. Hence the waiting. At last, the bags arrive from the pharmacy, menacingly marked with big yellow-and-black poison stickers. Then the nurses use a two-person integrity process to verify that the right person is receiving the right drugs. You have to state your name and birthday, which they compare to the drugs and paperwork. They use a calculator to double-check you are receiving the right dosage for your height and weight. And they read off the labels on the drugs while showing them to you, so you know you're receiving the right drug and dose for the right person.

Some of the drugs are administered by drip irrigation (i.e. the IV), while others require the nurse to slowly inject them via an enormous syringe. Regardless, the drugs are hooked up to one part of your line, and a saline solution flushes you from a second line. If the nurses are manually injecting you, they'll sit and talk to you, which is a pleasant social distraction, but if they're drip-irrigating you then they set the timer, equip you with a "ring-for-service" bell, and leave the room. Some drugs take a LONG time to flow into your system...as much as an hour, which passes very slowly. When the drugs run out, a very annoying timer starts beeping with increasing noise until finally a nurse notices and comes to shut off the drug and start the straight saline flush.

When it's all done, the nurses take out your line, band-aid your port, and pack you off. You might get a shot at this point if your blood counts are low - a quick and sharp poke in the back of your arm. (They offer the stomach as an alternative, but who wants a big needle poking them in the stomach?) And then the commute begins in reverse, usually after a quick stop by the restroom (a LOT of saline solution, i.e. saltwater, was pumped into your system). If you received a colorful drug then your pee might be pink, which is always a bit odd.

A cold and windy wait atop Mt. Parnassus, a sleepy shuttle ride, and then a walk back home, usually with a stop at the library, the grocery store, and/or the bank on the way. (When you are car-less, you have to combine errands!) The whole adventure has taken a good 6 or 7 hours, depending if the drugs that week were "quick" or "slow". At that point, I'm usually pretty tired, so a nice long 4 hour nap (often suffused with strange and vivid dreams) is in order.

And that's the weekly hokey pokey.