Guinea pigs, £9 per kilo

So Monday is the first day I have my chemo at Lincoln County Hospital. My new oncologist seems a lot sounder than the last in that he will answer questions and doesn’t appear to be having some kind of breakdown. He’s in agreement about being seen every 3 weeks and generally we are on the same page. We get there on time and I am called into the chemo suite just before my appointment time of 11am. Hurrah! They are on the ball and do my observations quickly. My nurse, Laura, asks whether I would mind if she plugs me into my portacath as she is learning the procedure. Everyone has to learn so I say it’s fine. I have had trained nurses take 3 long and unpleasant attempts to hit the centre before and I’m sure she won’t be that bad. She is observed by a senior colleague and happily hits it first time without much pain. A portacath, for those of you who don’t know, is a device sewn into your chest with one tube going into a vein near the heart and the other end sewn into the jugular vein. It’s not really visible apart from the scars where the stitches have been. The nurse feels around it and then inserts a needle into the centre of the port which has a rubbery membrane over it. If she hits the spot, the needle goes into the port and the chemo goes into the tube then the vein. It’s a great system once the incision has healed as there are relatively few risks and little chance of infection, one of the major worries with cancer.

So by 11.20 I am wired up and having a saline drip fed through, waiting for my chemo. At about 12.20, the pharmacist appears to ask me about my prescription. He is unsure (he says there is ‘some debate’) about what else to give me. Do I need steroids? NO!! What about anti-sickness meds? I tell him I manage that orally as the nausea is unpredictable and can come on at any time. He offers to give me Ondansetron, a strong anti-emetic with the chemo. I tell him this is unnecessary as I have Domperidone, a lighter version, at home and that this is fine for me. After some humming and ha-ing, he goes away saying he will go and sign the chemo off. I wait. A nice lady brings me coffee and biscuits and a bit later a sandwich. People come and go but I am still sitting there. I just feel more and more upset. I ask the nurses when the chemo will be ready and they check with pharmacy but say it isn’t ready yet and apologise again and again. I ring Mr Mason, who is waiting in the reception, and advise him to go and get a sandwich and possibly let the dogs out of the car as they are waiting patiently for us, the infusion only due to take 30 minutes.

By 2.30 I am distraught and, despite my best efforts not to, start crying. A lady sitting next to me alerts a nurse who asks what the problem is. I explain I have been there since 11am and I just want to have my treatment and go home. She promises to go and ring pharmacy again. At 3pm, the pharmacist is back on the ward having a lovely chat with a patient which seems to go on forever. I stand up and stare and stare, willing him to look at me and feel guilty that he hasn’t done what he said he would. If I was not wired up, I would go and interrupt him and ask him what he thinks he is doing. I rarely complain on the wards. The nursing staff work so hard and I know there are things that go wrong which are rarely their fault. He manages to ignore me although he must feel my laser eyes burning into him. Another nurse comes by to apologise and, seeing I am so upset, asks Mr Mason to come in and placate me. I am seriously thinking of just taking the needle out by  myself and going home. Mr Mason persuades me this is not a good course of action and goes to let the dogs out once again. I feel angry on their behalf. Eventually, at 3.30 my chemo arrives and the pharmacist has ordered Ondansetron despite our earlier conversation. The nurses call him over and ask how they can override the system as I refuse to have it. He looks at me and says “Hello” without smiling. I stare back and don’t even bother to reply.  He blusters that he has to add Ondansetron to the prescription and I repeat I neither want nor need it. He looks at me as though he has picked me up on his shoe and I dare say my face isn’t any nicer. My laser stare wins, I am plugged in and off I go. The actual treatment takes 30 minutes so even with the needle insertion and flushing of the port, the treatment should take no more than an hour. I ask the nurse whether there are very few patients on this treatment as that would explain his uncertainty but she tells me that they have quite a lot of patients on Kadcyla so why he’s been faffing around, I really don’t know. Chemo is finished and a flush is put up but on an incredibly slow drip. After 20 minutes I grab another nurse and beg her to take it down. I am done. It’s all fine. 2 of the nurses urge me to make a complaint. I explain I don’t wish to complain about them as they are doing a great job but they insist I should and that they will not take it personally. It’s next on my list today. We leave the unit at 4.30, 5 and a half hours after I arrived for a 30 minute treatment. I feel exhausted, wired and just want to get home.

Driving away from the hospital we are almost immediately in countryside which is really quite soothing. It’s a very different drive from the one home from Charing Cross. I see a sign advertising guinea pigs for sale at £9 each. I tell Mr Mason “Guinea pigs for sale, £9 a kilo”. “Really?” he says but I can’t keep the cruel joke up and tell him it’s really £9 each. Then it sets us off wondering whether it would be better value if it were per kilo. It depends on whether you are going to eat them, I suppose.

Allergy redness

It’s been a busy week. Working in Southampton, seeing Fran and Rouzbeh off to live in Bangkok, an NIHR training day and then, on Friday, a minor procedure to have my portacath removed. I’ve been here before. This is portacath number 2 which is leaving me, having done sterling service since October 2012. Portacath number 1 lasted from April to October and then gave up and now lives in a plastic pot, sometimes on the mantelpiece, sometimes in the box with all my cancer memorabilia.

The day is a glorious one and I arrive before 9am, empty and thirsty and go to 6 East, the Chemo Suite, where the oncology registrar has told me to go. It is the wrong place. Steve, the receptionist who has made my visits to the chemo suite entertaining, tells me to go to a different ward where they are expecting me and I am admitted and given a bed. My obs are done several times by different nurses who are polite but ask the same questions over and over, including asking if I am allergic to anything. I tell them I am allergic to all dressings except one called Mepilex. I am so tired from not sleeping well for the last couple of nights that my book doesn’t keep my attention so I stretch out and doze, hoping I am not drooling or snoring too much. Around 1.30 the ward sister comes to put a canula in my hand.This can be entertaining in that it is extremely difficult to canulate me but this woman means business and tuts over my veins, slapping my hands and arms repeatedly. She then fetches a bowl of very hot water and plunges my hand into it. It is way too hot for me so I pull my hand out but she pushes it back in, so we endure a little playful push and pull with me saying “Ouch” and the sister talking to another nurse and not listening to me. Eventually the water cools sufficiently for me to put my hand in and leave it there while she rushes off to deal with some emergency. When she comes back, my hand is bright red but even with a torniquet and repeated slapping, the veins in my hand won’t play. She searches my forearm intently, looking for any rogue veins which might not have hidden themselves too well. With choice of just one, she is limited. Looking in the crook of my elbow. she spies a site which was raided by the phlebotomist only the day before and swoops in. I’ve been stuck with a canula so many times now that I can pretty much tell when a needle has hit the right spot. It hurts a lot more if the vein isn’t punctured properly or if the needle passes right through. She plunges the canula into me, repeatedly withdrawing the needle almost to the skin and then wiggling it about again. She pulls the plunger and a little blood makes its way slowly into the line. She looks pleased and I can tell she thinks she has got it. She presses the plunger to push saline into me and I can feel it swelling beneath my skin. “I’m not sure it’s in properly” I say, trying not to teach her her own job. She purses her lips. “You saw blood drawn, didn’t you?” “Yeeeesss” I say, reluctantly. She says no more but proceeds to stick the canula down with almost an entire roll of sticky dressing. Not a single piece of Mepilex and I feel our relationship will deteriorate further if I mention I am allergic to it and it will make my arm red and sore.

Then the porter is there and I am whisked down to the Vascular department by chair. We chat all the way which is nice. Several nurses stop by my cubicle to say hello. Kingsley is a tall, African Caribbean nurse and he tells me he is there to take special care of me. I am looking at something on my tablet and he asks if I am a writer. I tell him I write a bit, thinking of this blog and the other things I write. He tells me he also writes but he specialises in poetry and spiritual writings. I am given a gown and eventually am taken into the operating theatre but not before one of the nurses has put a theatre hat on me. I tell her I did not wear one last time I had this procedure and she looks confused until I tell her I had no hair then.

The surgeon arrives and says a vague hello to me whilst bustling about and then counting out instruments with one of the theatre nurses. Suddenly he is all business and is giving me sharp injections in my chest. I wince. “Yes, it stings, doesn’t it?” he says cheerfully. I ask if I can have some sedation but he says it’s too late and that it won’t take long. “I’ve given you loads” he says in an admonishing tone. Shortly after this, he begins his work. I am unable to see what is happening as a theatre cloth is placed over my shoulder and covers half of my face. I’m not sure I want to twist my head to look while he is fiddling about with my jugular vein. Whilst I cannot feel pain, I do feel a lot of tugging and rough treatment. I feel him wipe blood away frequently and then, he is chatting with a colleague who appears to have just wandered in. They discuss colleagues and generally indulge in gossip while I lie there. I am hoping he is not too distracted as I don’t wish to spend my last moments listening to the surgical equivalent of boy racers. One of the nurses eventually shoos the other doctor away. “You’ll just feel a bit of pressure here” he says, pressing heavily on my neck. Afterwards I discover a large bruise there. He begins to sew me up and I ask him to make sure he does a good job to which he just grunts. The contact between us is minimal and I feel I am a bit of inconsequential meat to him. The nurses are different and want to interact. After he’s finished and the last of the sheeting has been taken away, and the huge adhesive mat he has stuck to me has been painfully peeled off, he asks for a container for my portacath which he presents me with. I am slid onto a bed, covered with a sheet and wheeled off into the recovery room.

The recovery room is a much better place to be. People (ie nurses) hang out with you, get you coffee, sandwiches and generally chat. They tell you what they are doing apart from nursing and know where the biscuits are kept. One helps me remove all the adhesive tape the nurse on the ward covered the canula with. The inside of my elbow is bright red where it has complained about the adhesive. ‘The canula wasn’t even in properly’ says the nurse as I remark they didn’t use it. They keep me for another 2 hours and then the magic hour of 5pm dawns and I am released into Mark’s care and we go home. The anaesthetic wears off and my wound hurts. A lot. It feels as though someone has taken a sharp implement and plunged it into my chest. Oh, wait… I take every painkiller I have in the house apart from morphine but it wakes me every time I move and hurts when I lie down. I wonder about the surgeon and whether he is having a good night’s sleep. The pain is so different from my previous experiences and I wonder how having something foreign removed could hurt as much as having something inserted. I also wonder why everyone asked me about allergies and then proceeded to use something I am sensitive to. As I write (Monday) the redness has gone down on my arm but the nurse taking blood from me today gasps as she sees the damage. My chest is a battlefield of scars, burns and allergy redness. Now there’s a name for the paint manufacturers to conjure with.