Thursday, March 17, 2011

Safety Dance

I was released from the hospital this afternoon.  My discharge papers suggest I "indulge in creativity during this time" and "get some exercise, but not enough to make you tired." Since I am too tired to cook, bake, or run, I am calling today's writing my creative cardio.  I'm so efficient.

When I was admitted on Monday, I was chalk-full of information on radiation, exposure, and contamination.  After the email, followed by the written explanation, followed by the hour and a half long meeting with a nuclear safety officer, I was confident I knew exactly what to expect and execute during my 48 hours in bio-hazard-dome.  My admitting nurse seemed to have skipped the training.

Things weren't right from the jump.  Lab tests were missing, so they had to draw more blood and get a urine sample before they could administer the iodine.  Even as the nurse repeatedly sighed and clicked her tongue at me for having "small veins"; and blamed my recent sip of ice water for her failure to get an accurate read of my body temperature.  Really, after 10 minutes of no ice water, you still can't get it?; and forgot the kinda-vital-to-recording-vital-signs blood pressure cuff, I remained calm and compliant.  When she put me on the bed, which doubles as a scale, and announced my current weight, I said, "Um, that's incorrect."
She gave me a patronizing look and said, "Oh, ok honey, I'll subtract five pounds because of your street clothes and shoes, and what appears to be a very heavy hospital bracelet."
Listen here! I will unleash five pounds of Kiss My Ass if you don't shut your--! "Actually, what I meant is, that weight is too low.  If that is, in fact, my current weight, I have miraculously lost 35 pounds in about two weeks."
"Oh.  Well, are you at least close to that weight?"
"Uhhhh, not since about 6th grade."

Finally, all tests and vital signs were logged and I was ready for transition to my bio-hazard garb.  The safety officer had been very explicit about this part of the process: I would change out of my street clothes into a hospital gown.  All items I wanted to take home--wallet and cell phone--would be placed in plastic bags in a closet, safe from contamination.  Once all of that was completed, I would be administered the iodine.  I waited for my nurse to return with gowns and plastic bags.  Instead, my doctor arrived pushing a trolley with what appeared to be an overgrown paint can.  He explained that the radioactive iodine pill, encased in yet another internal steel cylinder, was inside.  I brought his attention to my lack of hospital gown and general unpreparedness.  He just kept repeating, "It's OK, it's OK."  His impatience was growing (understandable, in the presence of a radioactive substance), as the process had already been delayed.  "We need to give this to you right away."  So, I washed the pill down, and, as if his ass was on fire, he left the room with one final instruction.  "Start drinking water immediately!"

The water thing: during this type of radiation treatment, the iodine is sucked up by any remaining thyroid and cancer cells.  These iodine-saturated blobs then show up on a scan indicating if and where there is any remaining cancer.  The rest of the iodine leaves via bodily fluids.  Since they don't want radioactive iodine hanging out any longer than necessary, you are given one job during the 48 hours of isolation: drink yourself silly.  More specifically, drink enough water that you are peeing every hour.  Again, I was given very explicit instructions beforehand, and assured by my safety officer that before I am even administered the pill, I would have my own personal refrigerator in my room stocked with water and juice to swill until my bladder's content.  I opened the refrigerator in my room.  Empty.

So, recap:  In my street clothes.  No hospital gown.  No plastic bags.  Wallet sitting on the end of my bed.  No hydration in sight.  Radioactive.


I express my concern to the nurse that some safety protocols may have been overlooked.  She apologized, but in light of the fact that I was now radioactive, there was not much to be done.  Everything was contaminated and would have to remain at the hospital after I left.  Honestly, I was fine with my clothes not coming home with me.  And, I had the foresight to put my phone in a Ziploc, per the safety officer's instruction, so I knew it would be alright.  Also, as one who hears and understands safety instructions (am I tooting my horn, here, too much?) I did not bring any reading material or comfort items that I was not prepared to leave there.  I didn't even bring my purse.  Now, I admit, I could've left my wallet at home and brought only my ID and insurance card.  But, those would've been in the contaminated pocket of my contaminated pants.  The point is, regardless if I brought in my wallet, my purse, or the frakkin' Die Hard movie collection, all of these items were supposed to be in a plastic bag far away from me while I built a fort out of empty water bottles. 

Do you hear that?  It's the sound of someone dropping the ball.

It took an HOUR for my hospital gown to show up.  It wasn't until another nurse came on at 7pm that I was brought a large jug of water to get me through the night.  And, when I woke up the next morning with pain in my jaw and neck (to be expected, as the iodine is also picked up by the salivary glands) and asked for more water, I was kindly reminded that I was in isolation for a reason, and every time the nurse walked in, she was exposing herself to radiation.  Really!?  Boy, that sounds unsafe.  Perhaps steps could've been taken to prevent having to come in here so many times. 

At 1:00, my nuclear safety officer--my guardian of sanity--came in.  He mentioned that the nursing staff alerted him that I might have some "questions about my treatment".  When I described the events of the previous day and the morning, he confirmed I was not crazy; safety protocol had not been followed.  When I got to the part about the water he said, "You're supposed to have two dozen bottles of water in the room upon your arrival.  That prevents the nurse having to enter except for meals and emergencies."
"Thank you!" I said. 
"Miss Dunn, I'm sorry this happened at such a strange and scary time for you.  It must've been frustrating given everything we went over beforehand."  Whether it was real or just good acting, I never thought sincerity could be achieved by a man standing 6 feet away, in a yellow paper safety gown and rubber gloves, while holding a Geiger counter.  But this guy nailed it.

Five minutes after he left, my nurse returned with a case of water and six hospital buckets of ice.  "Is there anything else I can get you Miss Dunn?"
"No, thank you.  That should hold me for a while." 

The nuclear safety officer was also kind enough to scan my clothes and wallet for radiation levels.  All items were safe to take home.  Sadly, there was one casualty:  a tube of chap stick I'll never see again.

Thursday, March 10, 2011

You Gotta Respect the Blip

Today marks seven weeks that I have been sans thyroid.  I had every intention of updating after my surgery, but I felt . . . weird . . . about it.

The surgery went beautifully; my hospital experience was superb; the aftermath has been a breeze; my scar is healing well; the support and love from family and friends is the stuff of dreams.  I take a tiny pill every morning, and my day unfolds much like it did before.

Still, I feel weird about it.  Why?

I didn't respect the blip.

When my doctor called with my diagnosis, he immediately followed it with, "If you're going to get cancer, thyroid cancer is the one to get.  This will be nothing but a blip on your radar a year from now."  And I ran with that.  A "blip" sounds perfect.  I am young and healthy, so getting through this will be easy.  This is a speed bump on the road of life, and I am an excellent driver.  This will be something to survive and push me forward.  I can do this. 

Talking with a good friend on the phone, he told me that, while en route to his house for Christmas, his sister-in-law--married with a 6-year-old--received the news that she had breast cancer.  She would have to undergo a full mastectomy, chemo, and radiation.  There was no time to waste; it had to happen, like, yesterday.  They immediately returned home to begin treatment.  Evidently, cancer doesn't wait for Christmas.  My friend did not intend this story to be a comparison to my experience, but a testament to how quickly (almost absurdly so!) life can change, and how quickly we adapt.  When I hung up the phone, I was grateful that all I had was a "blip".  Some people, and their 6-year-old, don't have that luxury.

I listened to, read, and recollected my own heartbreaking and heartbolstering stories.  Stories of loss and survival in the face of cancer and other incurable, unexplainable, and destructive diseases.  Some I would recount here if it were not for the fact that they are not my stories to tell; I could never do them justice.  The cycle of loss, grief, and triumph of the human spirit is as personal and intricate as a fingerprint.  I filed them away, and whenever my chest tightened and my nose tingled with tears of "what if . . .?", I would pop one into the forefront of my brain and let the gratitude work on me like a cold glass of milk after too much peanut butter.  I even came up with a clever response whenever anyone asked me about it. "I have the paper-cut of cancers."

The days leading up to surgery were a hurricane of emotion. But on the day of, I was great.  Bases were covered, my mom was here, and D.R. and I had decided he would come back home while I was in surgery to walk Alice B.  He would be back with plenty of time to greet me in recovery.  Take that, hurricane!

A lovely orderly named Jose picked me up from the waiting room, and I swapped my street clothes for the latest in hospital couture.  I crawled into the bed and snuggled with toasty blankets fresh from the warmer.  Nurses came by to check on me, check my chart, check my bracelet. 
"Do you have any allergies, Samantha?"
"Not unless you plan on bringing a cat into the O.R."
"Your neck has a bit of rash on it.  Are you sure you're not allergic to anything?"
"I'm positive.  It happens whenever I'm nervous."
"Are you comfortable?  Can we get you anything?"
"How about a shot of tequila?  No?  Then a willing surgeon will suffice."  
The anesthesiologist with eyes like Paul Newman hooked up my IV and explained the administering of the happy juice.  It may have been the eyes, but I was supremely confident in his abilities.  My O.R. nurse came in with the chief resident and asked me to state my full name.  I did.  Date of birth?  Certainly.
"Samantha, what procedure are you having done today?"
"Do you understand why?"  I get that this line of questioning was a security and liability measure to be sure we were all on the same page, which is why my reaction was a little surprising.
"I have can--" I choked on the word, and the tears answered for me.  I laid my cold hand on my chest in an effort to soothe the heat rising up my neck and onto my cheeks, turning them red once again with nerves.
The chief resident took my other hand, and in a manner both matter-of-fact and gentle, said, "Samantha, this will never not be a scary thing.  It's OK"  For her comforting delivery of truth bombs, I will always be grateful to Dr. Cavanaugh.
I took a deep breathe and made my second approach.  "I have cancer."

It occurs to me that, while writing this, the very same nervous rash is crawling up my neck and cheeks.

I remember waking up in recovery and seeing D.R.  Like a good little Type-A, the first thing I said was, "Is the dog alright?"  My mom came in but I don't remember what we talked about.  The next thing I remember is coming out of the bathroom to see my surgeon, Dr. Margulies.  He had changed out of his scrubs into this beautiful olive green shirt and matching tie with gold and pink speckles.  I really wanted to tell him how much I loved the look, but in my drug haze I was paranoid that decorum prevented me paying my surgeon a compliment.  He grinned and told me everything went as planned.  He took out twenty lymph nodes along with my thyroid.  A bit more than he expected, but he was happy with the result.  "From a surgical standpoint, you are cancer-free."

I recovered well.  So well, in fact, my mom went back home two days earlier than planned.  At my post-op appointment, Dr. Margulies was pleased that I was energetic and happy.  He commented that my voice didn't sound gravelly or strained.  I confirmed that I had returned to perfect pitch almost immediately.  The pathology showed that eight of the twenty lymph nodes removed were cancerous including the "complex cystic structure" that started the whole thing.  He apologized for it not being caught sooner.  I told him I was just grateful that "the aliens" were removed before they became more of a nuisance.  He told me to follow-up with my endocrinologist and schedule radiation 6-8 weeks after surgery.  Just to insure we were all using the same medical lingo, I asked, "Do you think this time next year, this will be but a blip on my radar?"
"Absolutely."  Decorum be damned, I threw my arms around Dr. Margulies's neck and thanked him for his fine scalpel skills.

Feeling like the hard part was over, the relief washed over me.  Family and friends asked how I was, and I didn't lie.  "I feel great; the surgery was a breeze."  The best part was I was back to running 11 days after surgery.  I felt powerful and fulfilled during my runs.  I felt my body actively healing itself one mile at a time.

I met with my endocrinologist a few weeks after surgery.  He was pleased with my progress and response to the medication.  He explained that my upcoming radiation treatment was really more of a clean-up mission.  It would wipe out any remaining thyroid cells as well as any, uhhh "hangers on", if you will.  He went on to say that if I have "clean" scans for the next year I will be considered "cured".  Yes, he did the air quotes, and no, I did not like them.

That night, sitting on the couch, D.R. observed that I seemed quiet.  I told him that I wasn't sure why, but the use of the air quotes in the doctor's office really bugged me.  The doctor hadn't changed the plan, we were still steady as she goes.  Everything he said was good news or something I had known before.  Yet there was . . . something.

Kathy, from Nuclear Medicine, scheduled my radiation for Monday, March 14th.  She explained that I would be given a large dose of radioactive iodine, which would get rid of  . . . what needed to be gotten rid of.  The catch is that I have to stay in a stainless steel room in the hospital for two days with no visitors, as I will be radioactive.  I will have a TV and phone in my room, but all reading material must be left at the hospital to avoid contamination.  They will provide all the hospital gowns I can handle, but any clothing worn against my body must be left at the hospital and properly disposed of.  Nurses will be available if I need them, but interaction is minimal to avoid contamination.  A medical physicist will scan me periodically to measure radiation and make sure it's dropped to a safe level before I am sent home.  But the fun does not stop there.  D.R. and Alice B. cannot stay in the apartment with me for three days.  I have to eat off disposable plates and utensils, and whatever linens I use and clothing I wear has to be washed separately in very hot water.  I am not allowed around small children and pregnant women for a week after I arrive home.  Oh, and if there were plans to get pregnant (which there are not!), put that on hold for a year.  Let me explain something here:  I don't like to sleep with the door closed; I don't like it when drapes are completely shut; and you might as well give me a padded room if I can't have the windows open.  It started to feel institutional before I hung up the phone, and the fact that my own body would be a danger to other humans and creatures . . . .

Somewhere between nuclear medicine and nuclear meltdown, I figured it out.

This was not supposed to happen, goddammit!!  My father died 6 years ago of a heart attack.  I was ready for doctors to tell me I had high blood pressure, circulatory problems, etc.  I was ready for them to tell me I was at risk for diabetes if I don't keep my weight in check.  I was even ready for thyroid issues.  But cancer?!  No!  That was not on my list!  I'm a runner.  I've never taken drugs.  I don't down a bottle of Jack every night.  Barring my addiction to cake and pastries, I am a healthy, vibrant woman.  Why does this happen?!  What.  The.  Fuck?!?! 

D.R. got the business end of my spewing rage.  I left a weeping, rambling, hiccuping message on my sister's phone.  I Skyped with my stepmother, Sonjah, for an hour and a half.  I cried on the phone to my mother in the parking lot of Whole Foods.  I didn't edit myself with stories of loss and survival greater than mine.  I didn't pull myself up by my bootstraps.  I didn't let the gratitude wash over me.  I didn't use my favorite euphemisms to soften the sharp point of words like "cancer", "recurrence", and "survival rate".  And as the pounding anger quieted in my ears, I heard a very soft, rhythmic noise . . .

Blip -- blip -- blip -- blip -- blip.

Ah ha, be careful what you wish for.

I realized that when I choked on the word "cancer" in pre-op, I was choking on the truth that I wasn't fully embracing.
The truth that I didn't feel I deserve to be counted with The Real Survivors because my treatment has been pretty easy and straightforward.
The truth that CANCER will forever be on my medical record no matter how healthy I am from here on out.
The truth that I will never function at 100% without the help of modern medicine.
The truth that, while thyroid cancer patients' survival rate is 90%, my endocrinologist's air quotes were a reminder that I must make peace with that 10% of uncertainty.
The truth that life, for us all, is really a series of blips.  And if all we are doing is waiting for this unpleasant, or that unfortunate blip to pass over, we are missing a whole lotta life that surrounds it.

Respect the blip, kids.  It just might be the thing that changes your life.