Western education 2013

Monday, February 24, 2014

..... the planning appointment....

..... is booked for today at 1:30 but first, I have a divisional meeting at the Windermere Manor to start this Monday morning off.  Coffee with breakfast to begin the day, but my stomach is reflective of the anxiety I am feeling about this afternoon.  I sip on black coffee and touch base with my favourite colleagues around the table.  The laughter is infectious and I am feeling better within a few hours.  I will leave for the LRCP (London Regional Cancer Program) and meet with the team that will be documenting and planning out the radiation applications.

I arrive around 1:15 in the afternoon and walk through the main entrance and head down the stairs to the Radiation department reception desk.  I am booked in, given the all too familiar pager and sent down the hallway to patient intake reception.  My assigned nurse comes out to the small waiting vestibule and leads me to one of the interior cubicle examination rooms.  I look back at the lady who was sitting beside me and I shake her hand and wish her luck.  I look past her shoulder and note the summer garden under newly fallen snow.  I have seen that garden in all the seasons now.... a few years ago, I sat there sunning my face in the afternoon with Kim whose picture of her mastectomy is showcased on the third floor of the main building.  Down the hall is the conference room where I spoke with the Chief of the LRCP with Carol...he left his position and Carol passed away 18 months ago..... it seems like a lifetime ago.

The knock at the door and the nurse pops her head in.  I need to change into a gown while she prepares to give me an IV.  I have had enough of IV's and now is no different as she puts the IV in and shoves it the rest of the way.  The funny feeling in my elbow tells me she has missed and now she has to try again.... I suggest using a saline syringe to help convince it past the valve that constricts and refuses entry without this help.  I feel faint and the clammy sweat breaking out above my brow announces that I will vomit if I am not careful.  The nurse looks up and notes that I have paled to a pasty white.  She asks if I am OK?  I need a drink of cold water and remain quiet and calm while she finishes taping up and grabbing a cup in the cupboard above the sink.  Minutes later she brings me a cold towel for my forehead.  I take some deep breaths and can feel the warmth return into my face.  The nurse's concerned face pops back into the room a few more times to see how I am doing.  I am good to go.

A knock on the opposite door and Abby walks in and introduce herself.  Her thick accent reminds me of my Kiwi neighbor and I ask if she is an Aussie or Kiwi?  She smiles and says "Kiwi".  I tell her my sister is there right now and just recently visited Hobbiton.  She looks at me again and lets me know that she lived right near there.  It really is a small world.  We enter the specialized CT room.  All patients receiving treatments here will be charted, usually tattooed and CT'd for pin point accuracy.  Our margins are exceedingly narrow and care must be taken to tattoo the markers on the skin that will be used for positioning of the equipment for radiating the sites.  Another radiation technologist enters and she looks familiar to me.  "Your name is Lisa, right?"  It is and she smiles up at me.  Lisa and Abby will be working tandem to set up for the lesion in the liver.  My head end is bolstered with what appears to be a beanbag pillow.  I put my arms above my head while laying my head down on this pillow.  The women form the pillow around my arms to support them.  My legs are put into a foam rubber form to keep my legs still.  They move me around until they are happy with the positiion.  They are putting stickers on me, marking me with permanent marker and using laser beams strategically placed in the room to find the exact crosshairs they use for the tattoo marks.  They will use some of the tattoo marks that they used in the first radiation treatment in March 2010 and add 3 more to the compliment of 3 to make 6 total 'tattoos'. The girls tell me they like my tattoos better!!.  A wipe with an isopropyl pad, a q-tip leaving a small drop of Indian ink and a sharp tack operated by Lisa to the exact location of the crosshairs and voila.... I am polka dotted.  We joke around between scans. when they have to re-position and set-up again. 

The first scan will have me holding my breath part way on the exhale.  The liver moves when I breath and they need to find out how it moves and the range of movement.  This will help guide the beam when I am in radiation and breathing through the procedures.  Dr. Lock's intern arrives to administer to contrast to begin the scan and to see exactly what happens when the lesion 'blooms' with the absorption of contrast.  It is a headless voice behind my head as he explains what he is doing and what will happen next. This only takes about 30 seconds after administration and I can hear them booting it in the control room within seconds of administering. it.  The warm flush through the veins and the warmth in the bladder (feels like you have to go pee) diminishes as quickly as it arrives.  This part is completed.  The next step will involve the neck lesion.

The next team arrives after Lisa and Abby say bye.  Claire pops her head in and introduces herself.  Next to pass through the door is Dr. Locke, the intern who now has a face to go with the voice and Claire's partner.  He walks up to me and introduces himself as Keith..... unless of course I don't do a good job and then its 'Mark'.  His quick grin and wink as he looks over at Claire... she feels sorry for Mark who is their colleague and smiles over at me.  Dr. Locke will be in the control room preciding over the next procedure and will come to speak to me afterwards. This one involves the neck lesion and its tenuous position amongst the architecture of the nerve and artery.  My chest is bare while the two technologists marker, sticker and add tattoos.  Kevin is measuring for the tattoo dots that will need to be placed at the top of the clavical and left chest.  Claire is adjusting the beam and then walks around the CT to do the tattoos.  Kevin is joking with me and we spend moments in between just laughing.  Connecting to the techs and being cooperative and easy going is really key to taking everything that comes your way in stride.  We are almost 1.5 hours in the suite when we complete the final scan.

Dr. Locke comes back into the room with his intern.  The intern has discovered a document that supports a much lower risk approach with this neck lesion that has gotten larger since the CT scan last month.  We both acknowledge the good work done by this keen intern and I am grateful for this news. I am feeling far more optimistic and am looking forward to getting started.  With that, it is time for Keith to leave the suite.  He comes over to me and gently grasps my right hand between his and bows down.  He looks into my eyes and wishes me the best of luck.  He then crosses the room and stands with the group and blows a kiss my way and I blow one back. The group leaves the suite and now it is just Claire left to finish up the paperwork. Before I get up from the table, the door opens again, the man makes his way over to me and smiles down at me...."ah, you must be Mark?" I look back up at him. I smile back up.  He didn't say a word as he spun around and left.   She realizes I still have my IV in place and gets the nurse to come in to remove it.  Claire wishes me luck and leaves me to dress and exit on my own.  Connections with people who really care has made my journey with cancer bearable.

The radiation procedures will be done on the Tomotherapy machine.  It is specialized for the future of radiation and is specifically used for radiation trials.  It combines the use of a CT scan and the administration of radiation as an all-in-one.  It is specific to the tumor with minimal involvement of healthy tissue.  Before each dose, a CT scan will be done to ensure accuracy.  The radiation will follow.  They will then move me into the next position and again, another CT scan followed by radiation.  This is my only chance and it might be a cure..... I am holding my breath and hoping for a success that will ensure others in my position that there are options.  This is my only option right now and on March 10th I will, with my specialized team, venture forth into the future.  My doctor, the chief of Medical Oncology will be there for all my appointments to oversee the administration of radiation.  I want to thank the team for caring enough to take the time with me today to ready me for the big day.  I will go every other day for 6 doses.  

So, why do I choose to be so open, candid and approachable?  It might have something to do with raising my children.  I made a promise that I would always teach my children to be comfortable in their own skin and to accept whatever life throws their way.... to find the shiny side of the coin.  Lydia announces this evening that she wants to have 'Live, Love and Laugh' on her wall above her vanity..... a truly wonderful moment.

I am an open book with my students and the college supports the positive impact I have on them. I explain the basics to my students, much like I do with my own children in order to encourage them to ask me if they do not understand.  It has created connections with our next generation.

This is my blog.  Everything that is written has been carefully considered before posting it.  I make no apology for what I write.  It is candid, real and honest and there are lessons to be learned through my own mistakes and those of others and to learn from my personal experiences.  It in no way is an invitation for drama.  Sometimes the truth hurts and in my journey, I have learned to own who I am, what I say, what I do and to know where I belong.  Thank you to my soul mate, my family, my closest friends and my colleagues for being there!!!  Here's to a future success!!! xoxoxoxoxo

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