Radiation therapy: What to expect

The first thing on my to-do list every morning is to get up and go to radiation.  Before I started radiation therapy, I had no idea what to expect.  For Jennifer, and anyone else who wants to know, here’s a snapshot of what it’s like to go to radiation, after the first appointment where you meet with the doctor, and the second appointment where you get all marked up and then get tattoos.  (I need to clarify here: the markings I showed in my last post are just permanent marker.  They come off.  The actual tattoos are pinpoints or dashes even smaller than that and dispersed more widely — one on my shoulder, one above my belly button, one on my side, one on the other side, and one between where my breasts used to be.  Yeah, that one’s a little awkward, but at least it’s small.)

Each morning, I park the car, pull open three sets of heavy doors, and walk into the treatment center.  I sign in, glance down the hall to the back room, and, more often than not, the technician waves me back to change.  I slip off my shirt (usually a button-down or zip-up, since it’s still hard to raise my right arm above my head), open the cabinet, and pull out one of the dozens of plastic-wrapped gowns.  Sighing, I pull it on … one more in an endless parade of pink gowns, open in the front, that I’ve had to wear this year.  I hoped to be done with them after surgery, but … no such luck.

The technician stands in the doorway, waving me in.  They’ve already got my file up on the computer screens that control the machines that will send x-rays through my skin and into my body this morning.  I walk by, trying not to look at the day’s plans, but inevitably I do.  I just can’t help it.

The technicians, Marion and Janice, are very nice to me, as I remove my arm from the pink gown and lie down on the hard platform.  The towel beneath me slips a little as I settle into the headrest, placing my head in just the right place and turning it to the side.  Janice helps me lift my arm above my head, giving a sympathetic smile at my gasp, since it still hurts (especially after a weekend without treatment) when I straighten my arm out fully.  Apparently, the surgery really did a number on me.

Once I’m settled and the lights are turned off, Janice and Marion push and pull on my body to get it lined up just right, at just the right angles.  They use the five tattoos on my body to do this, making sure that each is at the intersection of two lines of laser lights that stream across the room.  It’s easier to do this with the lights off, so the treatment is filled with flickering lights.  (Line me up, shoot x-rays at me.  Line me up, shoot x-rays at me.  Line me up, shoot x-rays at me.  And then, finally, the end, and the blessed words, “You can rest your arm now.”)

Once they get me aligned, Janice marks me again with permanent marker:  one straight line of dots, diagonally from my armpit to my neck, that I will have to wash off later.  Marion thoughtfully drapes my hospital gown back over my left side, affording me just a bit of dignity here in the cold treatment room.  The lights come back on and they leave me alone with the machine.  The machine starts to buzz, the monitor flickers, and the red box shows clearly “6 MV x-rays.”  My hair stands on end, from my skull to my fingers, and then it is over.

I don’t hear the technicians come back in the room.  Instead, I feel them, tugging and pulling on the platform, moving my upper body to a different angle than before, and then pointing the huge remote control at the machine to move its gaping eye from almost directly above me (a ten degree angle, but, from below, who can tell?) to a more diagonal position, 45 degrees off center, and then they slip a metal cover over the eye that will change the angle of radiation even further.

All these gyrations of angle and line are to accomplish one (not so) simple task:  to saturate the surface and nearby tissue with x-rays to kill any stray cancer cells without damaging too much of my lungs.  For, if they simply aimed the machine at me straight on, the damage to my lungs would be too great and I would develop other serious problems.  As it is, I may, 3 to 12 months out, but it is far from certain.

Again, they dim the lights, checking my alignment with the red beams crossing the room like a B-movie’s version of security in an art museum, restore the lights, and leave the room.

The machine hums for what seems like an eternity, but is actually only a minute or two, and then turns off.

Sometimes I hear them come back in the room at this point, but, since they are on my far side and I am still under strict orders not to move, I typically am startled by the machine moving around and above me, settling at last far below my right side, where it will shoot the x-rays up into my armpit, where my lymph nodes once were.  Again, the lights are turned off, my alignment is checked (as if I were a ’57 Chevy or something), the lights turned back on, and I am left alone.

This last sequence is the longest one, it seems, as I have been poked and prodded, moved and adjusted too many times for my taste already, and I must lie very still, not moving, not coughing, not scratching that itch that invariably appears just to taunt me … and then it is over.

The machine whirs back to its overhead position.  The platform beneath me retracts and lowers me back to the place it was when I first came in the room.  The technicians return, take my hand, and help me up, and I am expected to say something cheery as they try not to stare at my sunburned, mangled chest.

I do.  I say it, I smile, and then I’m done.  I walk to the changing area, passing the next cancer patient in the hall, put on my clothes, and leave.

Less than 15 minutes have passed.  But for me, some days, it feels much longer.

Edited to add: read also the next day’s post, about the damp towel.

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