AT THE END OF THE DAY : recent observations from chemo base camp, part 2

PART OF THE THIS IS THE MOMENT SERIES

September 20th, 2018

Last Sunday, a full 11 days into my second chemo cycle, when my energy and spirits should have been restored, I tumbled into sadness again. It started in my bedroom, at day’s end, just like the previous time. It wasn’t as easily shaken off. It stayed longer. The next morning, as our paths crossed in the kitchen before he left for work, Simon asked me how I was, and I started to tell him what had come over me the previous night, and then, right there in the kitchen, with no means to stop them, the tears started pouring out again.

Imagine behaving in such a way with someone about to set off to a heavy, fairly stressful day? (there was lots going on at John Abbot College this past week). I couldn’t help it, but it didn’t last long, in part because Simon stopped and spoke to me in a way that was immensely helpful—a mixture of empathy and scientific objectivity— and also, I think, because before finally falling asleep on Sunday, I’d had time to do some self-interpreting.

I’d had a happy, gorgeous Sunday. It was warm and sunny, and my son Jeremy, daughter-in-law Anne and Penelope and Graeme, my 6 and 4-year-old grandchildren, were coming for the day.

We had fun! They were so delightful, so happy to be here with their parents and uncles and me, their grand-maman. But Penelope was nursing a cold from her first few weeks back in school (grade 1), which meant that I wouldn’t be able to touch her or hug her; and even though this was apparently explained to her easily enough, it stuck with me. It hurt.

A little later, maybe because she was watching Graeme doing something physical outside in the yard, I heard Penelope say: “Oh mama, what if this cold never goes away?”

Sigh. The flash of a child’s anxiety whose tiny echo reached me in a way that it couldn’t have reached anyone else.

And then, very soon after, Graeme retrieved a small dragon stuffie that had been left by accident in the toy box at our house after his last visit. When I told him that he could just bring it back home, he looked up at me and said: “It’s okay Grand-maman, I want to leave it here. You can take it and put it in your bed and when you wake up, you’ll think of me.”

Graeme’s stuffie

 Sigh. Well, I did it of course, and since then, I often hold it close to my chest when I’m curled up in bed. Yesterday, it travelled to chemo with me.

The prescience of children is astonishing. They know deeply, without knowing all.

My hair is falling out— “thinning” is what my nurse and my hairdresser say, but at this rate, there’ll be nothing left in a matter of days or weeks—and it’s having a demoralizing effect. On that day, it got me thinking that it’ll soon be necessary to tell P&G something about what’s happening. The thought of causing anyone I love pain is a constant torment these days.

The view from my bed

At bedtime on Sunday night, these thoughts got all tangled up with the medical experiment that my life has become, and it occurred to me that contrary to the experiences of my mum, whose chemo 5 years ago lasted 3 months; and to the journey of a former neighbour and friend, whose chemo lasted 6 months, I still had no idea when my chemo will end. In spite of all of the love and support I receive EVERY DAY, there is still a knot that forms itself inside me: a mixture of fear and fatigue and a sense of somehow still being alone in this drama, and of regret, too, that any of this might infect the wellbeing of anyone around me, and anyone who stays in touch, no matter the distance that separates us.

Haircut, in hope of saving it!

 

 

 

 

 

 

 

Receiving chemo , cycle 3

 

 

 

 

 

 

 

 

I found a Frida Kahlo quote the other day that describes the human journey perfectly:

At the end of the day, we can endure much more than we think we can.”

HERE’S MY CHEMO COCKTAIL MENU AND THE ORDER IN WHICH IT’S ADMINISTERED TO ME EVERY 2 WEEKS:

  1. Nivolumab 240 mg, IV
  2. Decadron and Zofran  : 2 capsules each, orally, pre-emptively, to control the nausea that’s cause by Avastin
  1. Avastin 320 mg , IV
  2. Leucovorin 704 mg, IV
  3. Oxaliplatin 150 mg, IV
  4. 5 FU (Fluorouracil) bolus *
  5. 5 FU (Fluorouracil) 4224 mg, IV /46 hours **

Notes:

*A bolus is a single dose of a drug or other medicinal preparation given all at once.

The infuser of 5 Fu (hidden below) is attached to the port-a-cath in my chest, with lots of bandaging to make sure it stays on.

**I also receive a huge dose of the same 5 FU. An infuser bottle is filled with it and hooked up to the port-a-cath in my upper right chest. From the moment I leave the hospital, to the moment it is removed 46 hours later at my local CLSC, it will continuously pump 5 FU into my body. So really, my chemo lasts 3 days. The infuser is with me everywhere I go for those 2 days, in a fanny pack I wear just below my breasts, in a kind of reverse-geisha look. It infuses best at body temperature and so stays very close to me, except to sleep, when I then must sling the fanny pack over the bed post, and kind of hide it behind my pillow, without moving too much and accidentally pulling on it in my sleep. This seemed like something impossible to adhere to, or at least a guaranteed insomnia inducer, but so far, it hasn’t been as bad as it sounds.

The last three drugs on the list are part of what is a standard protocol for treating colorectal cancer, nicknamed Folfox (which is less of a mouthful!).

Simon keeping me company (and correcting tests) 🙂

Because my cancer is a wanderer, I’m also being given Avastin (that’s the name it’s sold under, but it’s actually Bevacizumab, which, frankly is a terrible tongue-twister and sounds even nastier when you try to say, in rapid succession, Nivolumab / Bevacizumab, which I honestly couldn’t manage at first but which the oncology team were just whipping out like nobody’s business).

The view from my chair at chemo

But the central piece in the research protocol I’m participating in is Nivolumab, which is nothing like the other drugs, as it is an immunotherapy drug:

It is a human IgG4 anti-PD-1 monoclonal antibody. Nivolumab works as a checkpoint inhibitor, blocking a signal that would have prevented activated T cells from attacking the cancer, thus allowing the immune system to clear the cancer…” (from Wikipedia). The science on Nivolumab is high level but largely inaccessible to most people, because the papers are far too technical. I rely on my son Simon and his PhD in biology, to vulgarize it for me. What he’s read is very exciting so far.

One of the chemotherapy rooms at the CHUM

This is given to me over a 5 to 6-hour period, depending on how efficient the hospital lab is on that day. It’s a massive chemical blow, and some of it, like Oxaliplatin, is really just pure poison. Though I’m called in at 9 am and usually arrive there at 8 am to signal to the pharmacists that I’m present (and can they please get cracking preparing the prescribed drugs?), I have never begun my infusions before 11 am. It’s a long day, but I’m in such good company—with Christian, or Simon, or both, and next time, my friend Louise— and the environment itself is so bright (all the exterior walls are windows) and brand new, and actually quite convivial, that though the hours pass slowly—there’s just no getting around that—they pass peacefully. I feel that I am in good hands.

I always travel there by train, and usually get home the same way, except that Simon’s car or my car are waiting in the parking lot at one of three stations (depending on circumstances and schedule and weather and parking availability), and that’s how we finish our journey home from the CHUM. A 60 km trip from door to door.

A lot is sacrificed to the beats of a life in chemo. Work, insouciance, freedom, wellbeing, energy, personal vanity…

The days are not expansive. They are calibrated and limited by the physical energy that’s available.

The needs of the body are merciless and will not allow neglect.

I am at basecamp, in full view of the mountaintop.

Innes, James Dickson; Arenig Mountain; Glynn Vivian Art Gallery; http://www.artuk.org/artworks/arenig-mountain-227067

 

THIS IS NOT REALISM

Part of the “THIS IS THE MOMENT” series

September 11, 2018

Every time I’m at the CHUM for blood tests and examinations and chemo, I’m given some new form to fill out and more information to read. The forms are always given to me by my pivot nurse, Chantal, and are usually questionnaires designed to track the side effects of the chemotherapy protocol I’m following. Most of the questions are on a gradient—0 meaning never/none and 10 meaning severe—and are concerned with the kinds of things that I would rather never have to think about again, such as constipation, diarrhea, fever, fatigue, loss of appetite, pain, neuropathy, depression, etc.

Chantal, who is perhaps a few years younger than me, is just about the gentlest person on the planet. She’s infinitely patient and always speaks in the most soothing voice. There isn’t a speck of  distance in her attitude, or in anything she says, but rather, a deep, compassionate desire to help, to alleviate, to reassure and to bring me within reach of healing, and perhaps something more. Chantal wants to bring me to a state of health, certainly, but also to a state of peace.

Or at least, this is how she makes me feel. As she spends more time by my side, and also with Simon and Christian who have been there with me at the CHUM almost every moment, we are being transformed by her vision of cancérologie (in English, cancerology, though I think it’s used less commonly).

Chantal never uses direct verbs like beat and battle when referring to the many-diseases-with-one-name (because that’s what cancer really is). The word cancer comes up the same way fever or headache or nutrition or sickness do: they are dimensions of an experience that is simply a part living—and staying alive.

Anselm Kiefer. The Evening of All Days, the Day of All Evenings. 2014.

I have Chantal’s work email, I have her work phone number, and I have her home phone number. I’m meant to use these any time anything goes wrong or any time I’m concerned with the seriousness of a symptom, such as fever. I try never to invade her private time—her weekends and evenings—and so far, things have worked out.

What a choice she has made, to give such a crucial part of her life to the intimate, very personal treatment and well-being of cancer patients.

Since the beginning of my odyssey at the CHUM, I’ve been given forms to fill out, check lists, pamphlets, booklets and file folders full of “what to expect” information about my illness, its treatment and all of the possible hazards and side effects that may be in my future. It was, and still is, overwhelming. I’ve found it difficult to dive back into it all once I’ve left the hospital.

I did, however, read the small book on colorectal cancer. Every page I turned moved me through the stages, 1, 2, …until I had reached mine. In the treatment section, the first word I read was PALLIATIVE.

I was unprepared for that. It hit me hard. Palliative: a word I associate principally with end of life care. Which is a beautiful, valuable thing, but speaks of a destination that I know I have not reached.

It was still early on, and I hadn’t begun chemo yet, and I felt the scorch of that word as though I’d been branded. Then, I remembered the words of the surgeon who had given me the formal diagnosis: she had simply said “We’re treating a chronic illness now.” This, too, is what palliative means: the treatment of an illness that cannot be cured.

That’s my fate. To live as long and as well as I possibly can with an illness that has dug deep into my body. In this way, I am like men, women and children with diabetes, multiple sclerosis, heart disease, lupus, cystic fibrosis…Our individual situations are not identical, but I do feel that I have joined the company of people who share an awareness of the body’s vulnerabilities, of the constant possibility of suffering, of the medicalization of their lives, of the need for daily courage, and of the great good fortune of being alive.

Horner, Marguerite; Walled In by Feelings; Swindon Art Gallery; http://www.artuk.org/artworks/walled-in-by-feelings-230379

In my situation, hopefulness can look an awful lot like denial. It isn’t. Before the chemo started, especially, I had low and lonely moments when I wondered whether it wouldn’t be better to keep my bedroom in our new house as neutral as possible. It seemed better not to leave too deep a footprint in my room, or in the office I share with Christian. I wondered if I should stop ordering books online. I realized how silly it was to worry about developing a dependency on Ativan to sleep…It was the least of my worries, surely. I had become a far more subdued version of myself.

This is not realism. It’s fear and sadness and confusion. It’s what happens when these cause us to cut ourselves off, even only briefly, even only in our minds, from the sources of love and support in our lives.

One night, as I lay in bed, I closed my eyes and said: “I trust in love. I abandon myself to love”, and I forced the corners of my mouth upward just slightly, and a feeling of peace came over me.

I repeat this every night.

Ziegler, Toby; I’m Ready for Love; British Council Collection; http://www.artuk.org/artworks/im-ready-for-love-177115

MY FEAR OF ETERNITY

Artist Vincent van Gogh
Year 1889
Catalogue
F612 JH1731
Medium Oil on canvas
Dimensions 73.7 cm × 92.1 cm (29 in × ​36 1⁄4 in)
Location Museum of Modern Art, New York City

Part of the “THIS IS THE MOMENT” series

There was a time, in my childhood, when I often lay awake at night, silent as the grave, perhaps listening to the breathing of my sister Marie, asleep in the bed next to mine. Hers was against the wall of my parents’ room—which may have given her all kinds of things to dream about—and mine was against the opposite wall, right under the double window, which allowed me to push aside the flowered curtain a bit, and stare up at the night sky.

I think it’s that view of the immense darkness, into which it was still possible to glimpse an abundance of stars (there was less light pollution then), that triggered the cascades of anxious thoughts that returned to me, often, in the night.

By the time I was 8, I had experienced several deaths in the family; had seen my father break down and cry at the dinner table after his mother died (we were on summer vacation in Cape Cod when we received the news and had to pack our things up and return home); had already been to the funeral parlour more than once and witnessed an open casket. I remember feeling caught up in the distress and sadness of others, and understanding to a surprising degree the finality of my separation from those who had died.

When I stared up into the night sky from my bed, as a child, what I saw was the wondrous and terrifying possibility of eternity. Children whose upbringing includes almost any form of religious education are soon introduced to the notion of an afterlife. Their parents do this because it’s what they’ve learned and probably firmly believe, but also, because it’s immensely compelling and comforting to know in your heart that those you have lost—a parent, a dear friend, even a stranger whose accidental or violent death has shaken you, and worst of all, a child—have “passed on” to a better place and so, still exist, and remain somehow accessible to you through prayer or some form of spiritual, noetic connection.

I accepted this notion of enduring, lasting contact with those we’ve lost because of course it made separation from them less cruel. It made it endurable. It seemed to bring peace to the adults in my life who were suffering. It was part of a child’s imaginary universe of “ever after”, so beautifully laid out in the bedtime stories that are read to us in childhood.

And then, one night, as I lay quietly in bed, the idea that when I died, I, too, would go on to live forever and ever and ever, struck me as something truly disturbing and frightening. It was good to imagine the grandmother I had lost looking down at me from a vague and peaceful place, but it was entirely different to cast myself into a mode of existence that would be vast and infinite. Being with Jesus, or being with my lost relatives forever no longer felt soothing. As a school-age child, wrestling with the notion of eternity, of existence going on and on and on and on and on…in a form that my mind could not grasp—that none of our minds can grasp—it kept me awake, tossing and turning.

My photo: doorstep, Fall 2013

I’m not sure why, but I never brought this up with anyone during all of the years of my growing up. I suppose that I did what many (most?) of us do, which is: experience life, gather empirical evidence, keep asking questions and searching for answers, remain curious and open, seek out sources of illumination, recognize the people who seem to carry within them a luminous quality, and people whose effect on those around them is always positive, as though they were infused with some sort of spiritual grace; and finally, read, read, read, read all kinds of books. Books about death and dying, of the type pioneered by Elizabeth Kübler-Ross, certainly, but fiction is also full of profound storytelling on the subject that often reaches us empathetically far more quickly than most other written works, and I never shied away from those.

I can’t help but wonder, though, whether my intuition hadn’t been sending me messages for a long time, because some of the most magnetic, most affecting books I’ve read in recent years have been memoirs of the dying, the grief-stricken and the suicidal: not one of which was anything but inspiring. The first of these was Joan Didion’s acutely observed Year of Magical Thinking, followed by Matt Haig’s Reasons to Stay Alive, a brave and straightforward book about severe depression, by a favourite, sweetly funny author. There was also Paul Kalanithi’s When Breath Becomes Air, one of the most beautiful, most precious books I own. More recently, there was Cory Taylor’s Dying: A Memoir, which I read just months before my own cancer diagnosis, and lastly, Natalie Goldberg’s Let the Whole Thundering World Come Home, received as a gift a few weeks ago, a story of survival, which has galvanized me into writing about my experience, because, added to all of these other small, unassuming, important books, it helped me to see how much we need these distilled, unflinching accounts of facing illness and possibly death—our own or a loved one’s—and how there are no rules for the writing of these. Each is as unique as the experiences being recounted.

Death and dying are the only profoundly personal, individual human experience we are ALL certain to share; they are the ultimate oxymoron—the universal one-off.

I haven’t resolved the conundrum of eternity, and I don’t think I’m meant to. I no longer search for absolutes. The physicist and man of letters, Alan Lightman, speaks of a universe, a world in which all composite things, including humans and stars, eventually disintegrate and return to their component parts. Based simply on my observations of the things we build, of the natural world that still surrounds us, and of our own aging and return to the earth, this seems a good place to anchor my thinking about beginnings and endings.

What I also know now, for certain, is how much we simply need each other, to get through the tough days, the suffering and the fears; and I know that it is enough. I have received a life-threatening, ominous diagnosis, and yet I have never felt so loved, so surrounded and so grateful to be alive. A spirit, an energy connects me to others, and to life. I have always felt it, been aware of it moving through me, but never so clearly as now.

Holmes, Ashley B.; The Grieving Tree; The Royal Hospitals; http://www.artuk.org/artworks/the-grieving-tree-209739

 

 

 

 

 

 

RECENT OBSERVATIONS FROM CHEMO BASECAMP: part 1

Base Camp, Mount Everest

Part of the “This is the Moment” series

September 3rd, 2018

  1. It’s quite possible that chemotherapy requires the stamina and fortitude of an expedition to the summit of Everest

That’s how it strikes me. Chemotherapy is a campaign, a mission whose objective is a cure, or healing, or the prolongation of one’s life, or one last straw of hope held tight. And sometimes, it’s a refusal to acknowledge the end. I think that once it has begun, and for the duration, you leave what you knew to be your life, and set yourself up at the foot of that mountain that you must climb, which, like all those books and novels I’ve read about mountaineering, becomes base camp: the place where all of the “teams”— in this case, medical, psychological and scientific, as well as hovering, vigilant, mobilized friends and family—that have entered your life.

On Wednesday, August 22nd, I reached base camp: my chemotherapy treatments finally began. Chemo is that thing that I hoped I would never have to experience (at the beginning of my journey at the CHUM, this still seemed possible: Dr. Richard spoke only of radiation and surgery). Alas, it soon became the only way forward for me.

I know that my mum and other loved ones who don’t know all of the medical activity that precedes the first treatments received by a patient enrolled in a research study, probably shouted: Well, it’s about bloody time!  when things got going.

I’m still finding it hard to unpack that first experience of treatment.

Was I stressed? Well, honestly, no. I do have a prescription for Ativan to help me sleep, and I don’t shy away from taking one of those teeny tiny pills as often as I need at bedtime (if developing a dependency on Ativan is the worst thing that happens to me within the next five years, then I shall throw a party in its honour!).

I headed to the CHUM, with both Simon and Christian just a held-hand away, without so much as a drop of caffeine in my system. There was a two-and-a-half-hour delay at the hospital’s pharmacy—where each patient’s list of tailor-made concoctions is prepared— so my treatment only began at 11:30 am.

My blood pressure was taken over and over during the day and was exemplary, with readings like 116/68, 113/67, 120/70…which should tell you something about my stress levels, and a lot more about the care I received from the nurses and the atmosphere in the unit where I was; and about the profoundly soothing and reassuring effects of having my sons right there with me, through all of it.

My protocol requires that 5 different drugs be infused into my body, which took 6 hours this first time, but which may be shortened in the future, if my body shows that it can endure a faster drip of one of the drugs. But before I could leave, a special infuser (which looks a lot like a water-filled balloon inside a baby bottle) was hooked up to me, and I was sent home with it in a fanny-pack—which I wore in front, high on my waist—so that it could drip, drip, drip, drip its contents into my body for 46 more hours (it was removed, when empty, at a local clinic, and my port-a-cath cleaned out).

North Face, Mount Everest

In mountaineering, the higher the summit, the more unpredictable human physiological responses become. As I sat all of those hours on the 15th floor of the Cancérologie department of the CHUM, and watched fellow patients come and go (getting tea or coffee but mostly just using the washroom), I was reminded of the old photographs of the mountaineers of the twentieth century: people like George Mallory and Edmund Hillary and their teams—their wasted faces, their battle-weariness, their refusal to abandon their quest.

George Mallory, circa 1922

 Others observations this week

2. When your life becomes the punchline

While a guest in the home of wonderful friends a few evenings ago, which ended with us all watching the movie Crazy, Stupid Love together, there was a scene in which Steve Carrell’s character has very recently been told by his wife that she wants a divorce. He’s at his work cubicle, looking forlorn and wrecked. His worried colleague drops in to find out what’s wrong and when Carrell’s character tells him, he laughs with relief and says:

Well, at least it’s not cancer !”

I turn to my son, Simon, who’s sitting next to me and say: “This kind of thing seems to happen all the time now.”

3. A lovely friend posts the following question on her Facebook page:

Would you rather have one wish that you could have immediately or three wishes you could have in 10 years?

Most of the people who responded quickly picked the second choice. I simply commented: “Easiest question in the world for me, isn’t it, P?”

Eventually, some commenters had second thoughts, and opted for the first choice. Still, though we live in a world without magical wishes, I’m stunned by other people’s insouciance—by what they take for granted.

Eduardo Lankes, Fog Clouds, 1905