A Day in the Life of Chemo

What happens during chemo? Does it hurt? How long does it take? These are some of the questions I've been asked about my cancer treatments. They are great questions and I appreciate those who ask them. Before my diagnosis, I had no idea what chemotherapy really was and what people went through. My only glimpse had been through the eyes of Hollywood via TV shows or movies, which is hopefully like a lot of you. So, I decided to do a pictorial account of a day in the life of my chemo treatment, with some narrative added in to provide context.

Before I begin, let me first say that my experience is probably not representative of the care most Americans receive. I am extremely fortunate to have an exceptional health plan and to live in Seattle, one of the top cancer treatment and research cities in America. I also am a patient at what I would consider the foremost cancer treatment center in the Northwest, Seattle Cancer Care Alliance.

Here's my typical Monday.....

(short version)

8am - blood work

9am - office visit with the doctor to review my blood results and check in

10:30am - begin infusion

4pm - finish infusion & head home

(narrative and pictorial version)

I prefer beginning my day of treatment in the early morning. However, my start time varies week by week. It can be as early as 7:30am or as late as 1pm. I can't start any later than 1pm because I'm usually there for about 9 hours total and the facility closes at 10pm.

My first stop is at the "lab" for blood draw. It is very similar to any blood draw clinic. There is a big room with a bunch of curtained off sections with chairs for patients to sit in. My blood draw appointment usually takes about fifteen minutes. I go to the lab at the beginning of the day for 2 reasons. The first one is to have my blood drawn & tested. My blood is sent to the lab immediately after my appointment and the results of the tests show up in my digital file about an hour later - super efficient! The results measure whether my organs are functioning properly (comprehensive metabolic panel) and whether my blood cells and immune system (neutrophils) are strong enough to handle chemo that day (CBC). The other reason I go to the lab first is to have my port accessed. A port is surgically implanted under the skin and above the right pectoral muscle. It's about as big as a mini Reese's peanut butter cup. It has a tube that runs under the skin from the port into my artery, creating "access" to my bloodstream and in turn allowing the port to supply my blood directly with fluid and chemo (see drawing & photo of my port "accessed" after blood draw). By accessing the port, I don't have to get IV's placed in my arms or hands every week, which is awesome because repeated IV's to the arm can be very painful.

After my lab/blood draw appointment is done, I have about 45 minutes to kill before my appointment with the doctor. I don't see the doctor right away because the lab needs time to process my blood results and the doctor can't have a meaningful appointment with me unless he has the results. To pass the time, I always have a book to read. Usually the book is on my trusty Kindle. Lately, I've been reading the Jack Reacher series by the author Lee Child and my friend Andrew has been loaning the paperbacks for this series (why pay for the titles when I can borrow them for free?!), so my Kindle has been dormant for a bit. The waiting room for the doctor's office is on the 4th floor of the SCCA building and has a beautiful view overlooking Lake Union in Seattle.

At the start of each 3 week treatment cycle (2 weeks of treatment, 1 week of no treatment), I meet with my primary oncologist, Dr. Sam Whiting. On the second week of my treatment cycle I usually meet with Sam's certified physician's assistant, Charlie. During the appointment they track my weight, check my blood pressure, make sure my lymph nodes aren't swollen, and review my blood work results. We also discuss my side effects from the chemo and whether they are progressing or staying the same. Sam and Charlie essentially act as the gatekeepers to chemo - using these appointments as assessments to either send me home without chemo (which has never happened before) or send me upstairs to chemo. 99% of the time these appointments are quick and I'm out of there in less than 30 minutes, which is a good thing. The appointment rooms look like any nice doctor's offices you've been in lately.

Since the chemo drugs are so expensive and don't have a long shelf life, to avoid waste, the pharmacy at SCCA does not begin preparing them until the doctor has given me the green light to receive chemo that day. It takes the pharmacy a while to "mix" the chemo cocktails and they are usually backed up with orders so they can't get to mine right away - how rude of them! :) Therefore, my chemo treatment (also know as infusion) is scheduled to start 90 minutes after my doctors visit. Since my doctors visits are usually about 30 minutes, I have an hour to kill before being taken back to my "room" for infusion. To pass the time, I typically read or check work emails on my phone. I'm called back to the infusion area when there is a bed/room open and my nurse is ready.

SCCA has recently renovated their infusion rooms, so they are really nice and remind me of an upscale hospital recovery room. Not all of them look like this, but every room has a bed, a door or curtain, and is just for one person. In short, they are comfortable and private.

When my room and infusion nurse are ready for me, I head back to the infusion area but not before making at pit stop at the "kitchen". SCCA really tries to make the infusion experience as friendly and inviting as it can be given the circumstances. One of the ways they do this is through their kitchen. The kitchen is a self serve area that has water, juice, soda, milk, cereal, soups, mac n cheese, pot pies, PBJ, and cookies to name a few of the many options. The kitchen items are all free of charge for the patients and their care givers who come to the appointments. I pick up saltine crackers, string cheese, and water (see photo) during my pit stop because my pre-meds can't be taken with an empty stomach. I opt for the bland route with my selections from the kitchen, just to be on the safe side.

Once I have my food, I settle into the bed and the nurse comes in to get started. 80% of the time, the nurse who takes care of me during infusion is Kim. Kim is awesome - her attitude is always cheerful and positive.

Once my port is hooked up to the infusion machine, Kim starts a hydration bag - water straight to the veins - to make sure I don't get dehydrated. She then administers my 3 pre-meds. These are medications I take prior to the chemo cocktails to block any nausea or vomiting. I take a pill (dexamethasone) and have 2 administered in liquid form via my port (see photo). One of them is Aloxi. This blocks chemo induced nausea for about 48 hours. The other one is Ativan, also known as lorazepam. The Ativan makes me loopy and causes me to literally pass out about 30 or 40 minutes later. I also become very unfiltered and agreeable, so Michelle likes to joke that this is when she asks me if she can go shopping for designer shoes.

After my pre-meds are all in, depending on the time of day, I usually try to get a meal down because I know I'm about to pass out. My favorite is the organic Annie's mac n cheese from the kitchen.

After my meal and right about the time I'm getting loopy, the chemo cocktails usually show up from the pharmacy. Kim has to wear special gloves and a gown, and use extra care when hooking the chemo up to the infusion machine because of the toxicity.

Over the next 3 hours, it's a mixture of me sleeping, rolling out of bed in a stupor to go pee, and the sleeping some more. Don't forget, I had the equivalent of about 20 ounces of water direct to my veins at the beginning of this whole thing, not to mention the water I drank during the day, so my eyes are sometimes floating when I wake up! :) Since I'm hooked up to the infusion machine for the chemo, I have to wheel that around with me to the bathroom while shirtless - not a pretty site!

I typically wake up with about 30-45 minutes left of infusion to go, and pick up where I left off in my book. When the last bag is emptied and the machine starts beeping, Kim comes in to un-hook me from the infusion machine and take out my port access (see photo). That's the signal it's time to head home.

At no time during the day do I feel any pain, have any nausea (thanks to the pre-meds), or have any stress/anxiety about the treatment. It's probably because I've fallen into a routine and know what to expect, but also because I believe a person's outlook is one of the most important factors in the outcome of anything.

If any of you have any questions that have come from reading this, feel free to email or call me. I'm happy to answer anything.

Stay well,

Rhone