From The Front Lines: Rituxan and Vampires

This was written on November 25th. I've only just gotten around to typing it into the computer. (Spiral bound notebooks are my friends.)

I'm writing this from a treatment room in the UW Carbone Cancer Center in Madison, Wisconsin. Actually, "room" is not the correct word. I'm in a bay. Bay #9, if I remember right. I've been given my assortment of pre-meds, which consisted today of Tylenol, Benadryl, Prednisone, Zofran and Emend. Yep, all of that and the chemo hasn't even started yet. Except for the prednisone, I guess. That is considered a chemo drug in my situation.

I'm hooked up to an IV drip, (I've been carrying the needle around in my arm for a few hours prior to this,) and I'm waiting primarily for the Benadryl to kick in so they can get the infusion started for real. Figure about a half an hour.

The first stop will be Rituxan, a monoclonal antibody that specifically attacks B cells. It seems to be a new treatment in the oncological arsenal, and from what I hear, it kicks butt. The inconvenience of it is that it takes for-flippin'-ever to administer because too fast an infusion can bring about some major allergic reactions. (Thus, the pre-emptive Benedryl.) The Rituxan alone figures to take about three hours. The rest of the drugs combined, probably around one hour.

I'm sitting in a reclining chair. It's the first time I've been assigned to one of these. I usually get a room with a bed because of the length of my treatment. I was a little disappointed really, because I like to nap and this chair is not staying reliably reclined and I don't particularly want to be ejected from it unawares. (On the other hand, that would lend some excitement and adventure to the nurses' lives.) But, it's busy today and they did give me a room with a television. Ironically, I've never exercised the television option during out-patient treatments. Inpatient was a different story, but they kept insisting on wheeling me off to do tests and lab work during Hogan's Heroes. What was up with that?

Eh, I really can't complain. Like I said, the ol' cancer center is a bustling place. Lots and lots of folks in various states of alopecia are being shuttled along the assembly line. I even saw one in handcuffs and a uniformed escort out in the waiting area. Anyway, one of the nurses mentioned that Tuesdays are the busy days, Monday not quite as much. Today is, indeed, Tuesday.

I haven't spoken to my "neighbors" nor they to me, but that's completely normal. Wandering around and being social is not optimal when everyone is hooked up to their own IV pole. Even in the waiting room, most patients stick tight to whoever brought them here. (I drove myself.) We're not unfriendly, just a bit self-absorbed.

The woman directly across from me is about my own age, maybe a year or two younger. Her cell phone rang a little while ago and I got a kick out of the nonchalant way she said to the caller, "Actually, I'm not in my office at the moment." No further explanation given.

Across the hall on a diagonal line is a patient who I can look at directly. If our chairs were on wheels, we'd be set up for a serious game of chicken. She's very young, early twenties, if that. She has long red hair in a ponytail. Most likely a newbie. I silently wish her well and I'm glad her sister is with her.

The decor in the bay is meant to be soothing, I'm sure. The walls are white but appear slightly yellow in a nicotine hue under the fluorescent lights. The floors look like hardwood–or possibly they're that fake stuff that just looks like hardwood. They're a pleasant rich honey shade. I like the floors in this hospital.

The upholstery on the furniture is a sort of subdued teal blue and the curtains covering the windows between the rooms are multicolored in a variegated geometric patterns–blues, greens and a sort of tangerine orange. They aren't as loud or obnoxious as my description might imply. I don't think I'd use those colors in my house though. Blue and orange haven't set well together in my mind since I had a bad meal at a Howard Johnson's when I was a kid. (They always put a cookie in their sherbet though. I remember the cookies with fondness.)

The bays with beds always have some sort of art print on at least one wall. Always scenery of some sort. Pastoral or garden-ish. The chair bay is smaller though. No art.

Rituxan started now. I have a blood pressure cuff secured to my right arm. It's set to go off every fifteen minutes. Standard procedure. I'm also supposed to let them know if I get itchy or short of breath. As this is the fifth cycle, I don't anticipate a problem.

My first stop this morning was to the lab to have blood drawn and the IV put in. That's also standard procedure. Today's vampire was a very pleasant lady, older than myself, who I think has possibly not been a vampire very long. Her first instinct was to use a vein in the back of my hand. I didn't exactly argue about it, but I did mention that I'd never had one put there before for chemo. You want a really good vein for chemotherapy.

She took no offense, but willingly expanded her search for a more northerly drilling site.

For long minutes, she palpated, heated-packed and palpated some more, trying to find the mother lode. Once she'd decided on a promising location, she took even more time to assemble everything she thought she'd need for the procedure. And then we were back to the heating and palpating again. Finally, she screwed up her courage, made the jab and . . . missed.

This didn't excite me at all. Hey, I'm a notoriously hard stick. I have shy veins that like to roll away from sharp objects. The record is five pokes and that was when I was inpatient.

So, since I was already punctured, the nice vampire lady went looking for that elusive vein with the needle. She tried going up, she tried going down, she went left and right, trying to catch that sucker and spear it like a sturgeon.

Then she hit a nerve and that, my friends, was quite enough. When I say, "ouch!" I mean it.

Distraught, she apologized to me. I, in return, apologized to her. It's not her fault my veins have mad Jedi skillz. I honestly felt a lot worse for her than I did for me. She called in another technician to take over the job. Same vein, but a little higher.

Technician number two . . . also missed.

During all of this, probably three or four patients had rotated through the other chairs.

Now, I can't say I was jumping for joy and clicking my heels over two bad sticks, but a small part of me was actually relieved that the second tech, a far more poised and confident individual, couldn't get it either. I really felt bad for the first tech. She tried so hard.

Tech 2 did her best, but finally looked up and said, "We need Vlad."

Enter Tech 3.

Vlad isn't her real name, of course. I made it up. It probably should be her real name though.

Duly summoned, Tech 3 strode over, flipped my arm off the side of the chair so that it was dangling out in space, picked her spot and had that sucker in there before the words, "little poke now," hit my ears. Dang. I was impressed!

They got the blood they needed, used some gaudy purple self-adhesive bandage to secure the IV gizmo to my arm, and sent me on my way.

Anyway, I'm going to stop here for today. Benadryl always makes me abominably sleepy and I really want to get a nap in before rituxan finishes up and the nurse comes in to do the other drugs.

I just hope the chair cooperates.

Postscript: The chair cooperated.

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