the stranger becomes familiar

It’s so different now, entering the chemo world.  At the beginning, in June, we were crashing along in the dark, trailing our abraded fingers along the cold stone walls, straining to hear every sound, trying to get oriented.  There were words words words pouring over us in buckets, menacing and icy cold.  It all happened so fast, from cough to diagnosis to chemo a matter of two weeks.  My brain pushed everything else in life aside, trying to make room for everything I needed to know about cancer, and drugs, and nutrition.

That first chemo day we were frightened freshmen in foreign territory.  People in scrubs bustled down narrow aisles with tubes in their hands, and scrawny bald people languished all by themselves in rows in plastic reclining chairs, holding very still, gazing out the slatted blinds at the trees above the parking lot.  They put us in a tiny glass stall barely big enough for the narrow railed bed, and I sat on a cushionless folding chair trying to let it be okay that people I’d never met were putting needles in Val’s arm in order to fill her with dangerous foreign substances.

Today we are upperclassmen.  It didn’t take too long: three months, a score of visits to the oncology wing, various blood draws and counseling appointments and meetings with nurses and doctors.  I know where to park, what stairs to take, where the family room is.  I know where the best bathrooms are and how long I can expect to wait between medical conversations.  I know what numbers we’ll go over and why.

At 7:30 in the waiting room this morning Val had her coffee in a thermos and I’d brought the newspaper.  We cracked each other up with juvenile jokes and for a moment I caught a glimpse of our cold ghost selves in June, hunched into the pleather chairs, sick wtih nerves, at the mercy of a brand new beaurocracy.

It didn’t take Val long with her sassy talk to make friends with every last nurse and phlebotomist.  They high-five her good blood counts and hug her when she leaves.  Nurses (up till today) turn a blind eye to her endless stream of chatty visitors in their crowded clinic.  I know how to prop up her IV arm with rolled blankets – and where to steal the blankets from.  It’s amazing how fast something becomes familiar, and how much familiarity helps take the sting from uncertainty.

It’s also amazing how fast Val can rally strangers into members of her community.

So here’s the nitty-gritty on today’s chemo:  Val’s blood counts yesterday were completely solid.  Red blood cells, neutrophils, platelets a-plenty.  This meant chemo could proceed without a hitch, and without resorting to Neupagen.  (Val enjoyed telling the staff that her robust blood counts are due to her regimen of supplements: “It’s all that deer antler I’ve been eating!”)

I asked TerriSue to explain the chemo calendar to me, and here’s the outline:

Val will get six cycles of all four chemo drugs: Paclitaxel, Carboplatin, and Bevacizumab, plus the clinical trial drug (or its placebo) Apomab.  Today was the fourth in this series, each one lasting three weeks (except that there was a delay before starting cycle 3).  During this phase she’ll have a scan every 2 cycles, approximately every 6 weeks.  The next scan is scheduled for September 24.

At the end of the six cycles, the current plan is that Val will be done taking the traditional lung-cancer drugs, Paclitaxel and Carboplatin.  As a participant in the Apomab clinical trial, however, she has committed to completing a total of 34 cycles of Apomab (or the placebo) paired with Bevacizumab.  (The first six cycles with all four drugs count toward those 34.)  So she’ll keep going with those two drugs, approximately every three weeks.  We’re excited about this opportunity.

Apomab is a “death receptor 5” drug.  It’s purpose is to cause the cancer cells to “suicide.”  I guess normal, healthy cells serve their function and then die, but cancer cells don’t die when they are supposed to; Apomab is intended to turn them off or cause them to die.  As I understand it, Apomab’s job is to kill off the cancer cells and also the existing vascular network that feeds the tumors.

Bevacizumab is a “monoclonal antibody.”  Its job is to halt new vascular growth, preventing new blood vessels from growing to feed the tumor.

Once Val is only taking these two drugs, she should start feeling a lot better.  (Although honestly she says she hasn’t been feeling too bad, most days.  Mainly a bit tired.)  Her hair should grow back and her energy bounce back up.  After about chemo cycle 10, they will take scans only every fourth cycle, keeping tabs on the tumors.  If the tumors should at any point begin to grow again (which we simply won’t allow, and I think deer antler prevents actually), as soon as the tumors grew 30% larger than their smallest point (nadir), they would take Val off the study and get her on whatever drugs seemed best suited to her needs.  (Also if for any weird reason they found out that Apomab is more harmful than helpful, they’d cancel the study and take her off it.  This is not expected.)

So that’s the predicted timeline.  As for now, Val and the dog are heading up to the Montana ranch for a little R&R.  They leave Sunday and will be gone a week or so.  I dearly wish I could go, but I’ve got a retreat of my own scheduled: on the 12th I’m heading to Rhode Island to see my folks for a few days, and then to Raleigh for a two-day library training.

Hugs all around,

Deborah