The alarm clock gives 6.30 when I decide to get up. I woke up at 4.00 with a headache and couldn’t sleep anymore. Worries about the side effects, the low neutrophil count, my dizziness and low energy levels kept me out of my sleep. I never sleep well before a chemo day and this time I’m extra worried about the effects – especially constipation – on the new stoma.
I walk to the kitchen to get a glass of water and then seat myself at the dining table. I need to sort out my medication for the day. Paxlovid, Divifarm, Furesis, Kaleorid, and Innohep – an injection, all needed to treat the Covid-19 infection that I caught a week ago. I continue with the medication for the chemo treatment, to be taken one hour before the chemo starts. Three tablets Dexamethasone, one tablet Akynzeo and one tablet and Histec. Nine tablets in two piles on the table. One by one I wash down the Covid-19 pills. Then I administer myself with the anti-blood clot injection. I leave the pre-chemo medication on the table. I will take them later, around 8.00.
To become more relaxed I decide to take a warm shower. I then get dressed, feed the cats and get my bag packed for chemo number eight. Woolly socks, my health insurance card, a protein drink, my notebook, pen, glasses and a magazine. The chemos have gradually affected my cognition. I know it’s pointless to bring a book.
*
My husband drops me off at the hospital. I will message him when the doctor has time to see me. It’s helpful to have him at my side when doctors pour out information over my forgetful brain. Luckily, he works in the building next door and can quickly hop over.
I walk into the ward, greet the secretary, scan my health insurance card and put my coat, scarf, mittens and my backpack in the locker. Familiar routines. But as soon as I walk into the room, ready to step on the scale near the door, one of the nurses tells me to go back to the hallway. “The doctor wants to see you first,” she says.
The tone is friendly but I’m puzzled by the order of things. Normally, I would first weigh myself, pick a free bed and settle in. Thereupon the nurses would measure vital functions, check the port for infusion, bring the infusion pole, ask me to check if my date of birth on the orange sticker of the infusion bags is correct. Soon after, they would offer cold socks or mittens and give me a hospital shirt. Often half an hour or forty five minutes later, before accessing the needle to the port, they would tell me to see the doctor in the room next door.
Having been told to skip the usual procedures, I feel suspicious but do what the nurses ask and walk back to the hallway. Seated on the brown bench I message my husband.
*
“We’ve decided to end your chemo treatment,” the unfamiliar doctor drops the bomb as soon as my husband and I are seated in his office. “During the last surgery no recurrence of carcinoma was shown.”
His words don't sound like a recommendation or a question. My jaw drops open. My husband looks at me in astonishment. “But I took my premedication for today’s chemo already,” is all I can stammer.
The doctor calmly explains that the results of the blood tests from yesterday are OK apart from the neutrophils (white blood cells). Also, the tumour markers measured in October are currently CA 53, thus good.
“As soon as the neutrophils are back to normal, you will receive Olaparib (Lynparza) maintenance treatment,” he explains.
Lynparza is a PARP inhibitor, I know. It’ll kill cancer cells by preventing PARP from repairing their DNA. I also remember the long list of side effects such as bone marrow problems, lung problems and blood clots.
“You can talk to your occupational health provider about returning to work and you can increase your level of exercise,” he states.
The doctor also spells out that I should consider myself a chronic cancer patient. “We will closely watch the blood test and CT scan results and you need to contact us as soon as you feel something isn't right,” he concluded.
*
After more than an hour, we’re back in the hallway looking at each other, dumbfounded. “No chemo today,” I exhale. “No more chemos at all,” corrects my husband. You’re cancer free. Come on, we’re going to celebrate. Let’s buy cake at Huovinen he says in a delighted tone.
*
Back home, fresh coffee and cake on the table, I’m almost swept away by the mix of thoughts in my head. No more chemos. I’m done with the treatment. I can barely comprehend this news. My brain immediately starts with making plans. Back to the gym, visiting my parents, continuing with the renovations in the cottage, back to my voluntary work, my study, celebrating Christmas with the family, visiting friends, maybe a holiday in Zeeland, something we had planned for a long time. In the spur of the moment I completely forget that my body will lack the necessary energy to perform such activities for months to come.
There are also doubts. Wouldn’t it be better if they had continued with the last three chemo’s, I ask my husband. Why this sudden change of plans, I think suspiciously.
Also, the 5-year survival rate for ovarian cancer stage four bothers me. Do I have reason to be too optimistic at all, I wonder.
Yet, minutes later I'm dreaming of returning to a choir, learning a new skill, something practical like tiling, or baking scones and paying a visit to the pedicure as the chemo has made my nails brittle.
My cheeks feel warm from excitement and my brain alternates between optimism, confusion, happiness, and fear.
I also think of the lively woman I met during my fourth round of chemo on the ward. She came back after two years of remission. Bone and lung cancer, that’s how she introduced herself. We chatted, got along and two weeks later her partner announced her death on Facebook.
I was upset about her passing. My friend Eija warned me: “You won’t meet cancer survivors on the ward,” she said. “You’ll find long term survivors in society, not in hospitals. Don’t listen too much to patients on the ward.” Eija is right of course. You’re getting a one-sided pessimistic view if you only talk to fellow chemo goers. But I wonder now whether I could become one of those invincible cancer survivors living her normal life.
Also, the doctor said that I should get in touch if I get health concerns. After two surgeries, seven chemo treatments and endless prodding and poking with needles, drains, tubes and whatever, I barely remember how my body should feel or behave.
However, I do realise that after ten months of treatment at the hospital, my faith in the doctors, lab technicians and nurses – all those people who have treated me – has increased. I sometimes question their shared decision-making skills (my preferences or goals are never asked for), but I do trust their medical expertise. Will they save me again if the cancer strikes back?
I’m not cured after all. “The cancer is chronic,” said the doctor. I know that quality of life should be my priority from now on.
*
Later that day I decide to walk my thoughts. It’s sunny, cold and crisp outside and I walk fast to stay warm. On the way back I decide to treat myself with a bottle of shampoo. If hair grows approximately one centimetre per month, I might have 2 or 3 centimetres of my pearly hair back in December, I figure.
With freshly washed hair at Christmas dinner: a practical, oversee-able goal. The smell of “100% natural citrus" will add to my quality of life. Something to look forward to.
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