(Original title – The Midnight Duel)

In recognition of my final chemo session coming up at the start of February, I thought I’d dedicate some time to demystifying what it is for someone receiving intravenous chemo like I have been.

For the two days prior to having chemo, I have to up my liquid intake to 2 – 3 litres a day. I assume this makes it easier to stick you with needles, and maybe also helps you to feel better in the chair and for the rest of the day of chemo. I also have to take meds to prevent constipation for a couple days beforehand to a couple days after chemo, because of the heavy duty anti-nausea drugs they give you, and the steroids, both of which cause some pretty severe constipation if you let it get out of control. Isn’t chemo fun?

The actual act of having chemo is, in my cousin’s words, not as scary as it looks in movies. For breast cancer, you’re not admitted to hospital and have to give up a month or more of your time to sit in a bed and stare out a window like you would be for leukemia, for example. For me, I rock up at the allocated time, and check in. I’m admitted to the day ward, given a pretty red wristband because of all my allergies (peanuts, pistachios, mussels, codeine, CT contrast, iodine, horses, and dust for all you playing along at home), and I wait to be called in.

A nurse comes out to the waiting area, and takes me to a set of scales to weigh me. I’ve never been weighed so much in my life. This place is obsessed with your weight, and the nurses are never a patients’ favourite person when The Weighening happens. Then we go through to the six chairs where I’ll be sitting for the next three hours. You settle in, fill up your water bottle, get your iPad or laptop or whatever out, and make yourself comfortable. The nurse takes your blood pressure (proof that you have a heart at least, take that ex-boyfriends!), and gets ready to insert the cannula – the needle/tubey thingo that sits in your vein for administering the chemo. You can choose to watch or not – they’re very gentle and very good at inserting these. Cancer patients have notoriously bad veins for sticking with needles, so you get staff who know exactly what they’re doing.

(Apparently, they’re only allowed to try for a vein three times before you’re deemed unsuitable and chemo has to be rescheduled.)

A bag of saline is hooked up and gives you a bit of lovely hydrating stuff before the main event begins. You can wander around dragging your IV buddy with you, and this is generally a good time to wee. Depending on your chemo, you’re not allowed to move around much when it’s being given, so since you’ll spend at least the next hour confined to a very comfortable chair, you’re guaranteed to need to go just as they hook the line of poison up, so go now. Go a couple of times. The saline will run for about half an hour.

You’re given your dose of steroids (dexamethasone, the wonder drug!) and a long-acting antiemetic (stuff to make you not puke, it’s a combination of a couple of drugs), and then you’re ready for the main event as soon as your half hour of fluids is done. Just hope that Pharmacy has already brought your poison up or else you’ll be waiting a long time.

Then the fun begins.

For me, I’m on a combination of chemo abbreviated to AC – it’s two drugs given consecutively in the same session, Adriamycin (a.k.a doxorubicin) and Cyclophosphamide. They’re always given in alphabetical order, for a good reason. Adriamycin is bright red like a tomato, and takes about 15 minutes to administer. It is gravity fed, which means it’s given through the IV machine but not pumped – gravity feeds it through the tube into your arm. Of all the chemo drugs to have, I’m pretty certain this is the most dangerous one. The nurse has to take some pretty heavy duty safety precautions with regards to goggles and gloves and gowns, and stands right next to you constantly monitoring the progress of it going into your arm. This is because it’s a fucking nasty piece of work – it’s not dangerous to the inside of your veins, but if the cannula isn’t in properly, or slips, and the drug leaks into the muscle or other tissue around the vein, it causes tissue death which is as gross and painful as it sounds (it’s called extravasation, don’t google it – the pictures are horrific). They do have a massive emergency toolbox as a kit filled with things to treat this immediately if it happens.

Something that they warn you about Adriamycin, in addition to the tissue-death-causing warning, has to do with the bright red colour, and they don’t want you to be caught unawares. If you go to the bathroom, even straight after the cannula is out, you will pee bright red. It’s very disconcerting to see if (let’s be real here, WHEN) you look down before you flush. This funness only lasts for about 24 – 48 hours after chemo.

After this, the Cyclophosphamide is hooked up. This one only takes about 30 minutes to go through, and is pumped in quite quickly. The nurse will check on you periodically or if you call them over, but this one isn’t as bad as the Adriamycin.

Usually around this time, if you’re taken in at 8:30am, the doggo visit and tea trolley arrives. Fill up on free tea and whatever and however many biscuits you want – sweet, plain, and tim tams are all there. Have some fruit and cake too. You’re allowed whatever you want, you have cancer and you’re getting chemo. Nobody is going to judge you here.

As soon as your chemo is done, the IV beeps like a maniac to say that the bag is empty. You get some more saline for about 10 minutes to flush the line, then you hear the beeping again. The nurse comes over and removes your cannula, puts a bandaid on the hole in your arm, and you’re good to go. You’re welcome to hang around a little longer if you want, but as soon as the needle is out and you’re feeling okay, you’re free to leave.

Easy.

All the worse-r stuff happens in the days after chemo.

All doped up on steroids, you feel really good. Usually by the time I get home, I still feel really normal. The last couple of rounds, I was well enough to cook dinner that night. Not everyone has my luck when it comes to recovery. The nausea starts to creep up on me the next day, but I try not to let it stop me from eating. Even my wonky, barely functional tastebuds barely stop me from eating. It’s only if the nausea is super bad that I don’t feel like eating solid food.

The first couple of days after chemo are the worst. I don’t leave the house if I can avoid it. I graze on food constantly, eating just about every two hours. The more I keep something in my stomach, usually something savoury and on the salty side, the happier my stomach is. I have a pantry full of chicken noodle cup of soups (Aldi ones are great, check ‘em out) and salt and vinegar chips and Jatz crackers for this purpose. When I wake at 3am and wee, I get a glass of milk on my way back to bed to keep nausea at bay. I can only take my antiemetics three times a day, even though I have three different types, and I try to stagger them to get maximum benefit, but nothing keeps me going through the middle of the night as they’re wearing off.

And oh my gosh. The metal mouth taste. It’s taken me 15 weeks to figure out why I don’t want to drink anything for the first few days after chemo. Water tastes bad. Things are too sweet, too citrus, too nothing. Brushing my teeth or eating chocolate helps for a while – it resets my taste-buds and I can stomach water for about an hour. Just the thought of drinking water makes me feel ill.

If food fails, I take a nap. I can’t feel sick if I’m asleep. Take that, nausea!

A few days later, usually by day 5, I’m weaning off the antiemetics. I take them as a precaution if I leave the house for more than an hour or so, and first thing in the morning, but by day 5 or 6, I’m starting to feel almost human again.

Just in time for my immune system to take a dive.

It turns out I’ve been doing chemo wrong. I would go out in the second week because I felt great. I’d go shopping, catch public transport into the city, hang out with co-workers, and basically pretend like I’m not some sort of weird hermit person with cancer. But it turns out, this is the week where I’m most prone to infections and picking up illnesses from the people around me. I found that out during session number 4, just before Christmas.

Whoops.

So now I’m being good and hermiting myself away during week two, so if you want to hang out, you’ll have to come to me, and not be sick, and not have been hanging out with sick people.

The third week, the last one before chemo happens again, is the weirdest. I have alternating days of feeling amazing and like I’m completely healthy, and then days where I am so fucking exhausted and tired I can hardly keep my eyes open. I do go out, but usually in the mornings, and then I get home and rest for the remainder of the day, otherwise I end up paying for it the following day. I can’t do late nights anymore, because the sun goes down and my body suddenly says, “SLEEP TIME!” and I have to fight to stay awake wherever I am.

All in all, the actual act of having chemo isn’t really that bad. It’s not the most fun thing in the world, and aside from the cannula insertion, constipation (and resulting haemorrhoids if you don’t stay on top of your chemo preparation), it’s not painful at all. It’s the couple of days after for me that are the worst, and even then it’s not intolerable. I’m sure other people have a totally different view on the subject, but overall I find it within the realm of okay. And of course, my opinion might change the next time I have to have chemo with a different drug – each one has its own lovely batch of side effects to experience – but given how aggressive this combination of drugs are and my tolerance of them, maybe I’m tougher than I’ve given myself credit for in the past.

To close this off, here’s some positive things:

• the nurse at session five was surprised that I’ve done four doses of AC and still have eyebrows and eyelashes;
• I only have one more session to go;
• the afternoon tea trolley still has delicious snacks on it when it comes by; and
• my hair is already starting to grow back, all super fine and fuzzy. I’ll let you pat it if you ask nicely.