A certain relief comes once the battle plan is laid out. I was fast becoming a professional patient, guided by a daily schedule of clinic and hospital stops that left little time for much else. During one appointment, I had my head staples removed; on another I had a post-op MRI. Then there were two more visits to the operating room to have special catheters installed through tiny incisions beneath my collarbones, one set to harvest bone marrow cells and then a port to administer chemo. Blood tests, mostly to monitor assorted blood counts, were regular events. My poor arms began to show the telltale needle marks and bruises of my patienthood.
I also had to get myself ready for the possibility of bone marrow transplantation. Chemotherapy drugs attack the replicating DNA of rapidly growing cancer cells. Because stem cells, too, grow and divide quickly in order to produce the ever refreshed white and red blood cells that circulate in our bloodstream, they are a primary victim of chemo's collateral damage. Since there was a promising experimental drug that was just being tested in patients whose tumors had failed radiation therapy (which my doctors thought might be an option if the first choice of chemo drugs bombed), we had to be ready. Thus, I had to bank healthy bone marrow stem cells before they got a whiff of the toxic chemo agents that could damage them.
The goal was to harvest 9 million stem cells over several days. All went well—until there were about 6.5 million stem cells. At that point, the number of platelets in my blood began to fall precipitously. I knew something was up when Bolwell appeared unexpectedly and said to stop the collection. He had enough cells to do a transplant, he said, and because I had just had neurosurgery, there was an increased risk of bleeding. Bolwell ordered a platelet transfusion as well. It was to be the first of several transfusions over the next several months.
A few days later, Peereboom loaded me down with a bag filled with carefully marked vials of pills. Oncologists are fond of administering cocktails, coded by the first initial of the name of each drug; my cocktail code was PCV, for procarbazine and CCNU (lomustine), to be taken orally, and vincristine, to be administered through the port.
During the first week of treatment, I had to go back to the wig lady to pick up my newly crafted hair. This experience was part of steeling myself for the many side effects of chemo that have become so deeply chiseled into cancer folklore and I, as I would soon discover, was no exception. My appetite dropped like a rock, along with my weight. Food tastes changed—everything I put into my mouth tasted metallic—and my skin dried up like a broken twig. As for my hair, about half of it did fall out. Occasionally I donned my trusty wig, but I never did really figure out how to keep the darn thing straight.
My first blast of chemo toxicity hit hard during the second week of therapy when I started the procarbazine pills for a two-week daily stint. Also on that day I had my first dose of vincristine. Unlike the other drugs that I could take in the comfort of home, vincristine required an in-person appearance at the cancer center. Whatever their value would be, these drugs didn't seem too bad—until later that night. A little after midnight, nausea, dry heaves, and vomiting hit suddenly, and they recurred like clockwork every 45 minutes, untouched by the standard antinausea medicine I'd been taking. Exhausted, I would fall asleep as each wave passed, but unfairly so, as my husband, who had a job to go to in the morning, was awake all night. This happened for several nights in a row as my body reacted, relentlessly and rhythmically trying to reject the toxic stuff seeping into it.
I vowed to take the heavier antinausea medicine. After that, queasy was the worst of it—and I have never been so grateful for queasy. How awful chemo must have been before the discovery of these more powerful medicines. The newer but more expensive drugs gave me, as they give many, a semblance of normalcy during a long stretch of toxic treatment.