A Path Through

With chemo 101 in the books, the next step on the path was to actually start the chemo treatment. Simple right? You would think, however things are not always what they seem.

Before I move forward, please allow me to share a thing or two with you so you can understand how they play into my first poke experience.

In 2012, I developed Sepsis after having abdominal surgery. I like to think that this was the primer to what I am going through and even with a few scary moments, I made it through. Spring forward 10 years and I here I am, fighting a new fight but there are a few things that have tagged along from the first battle. The most important of these are highlighted below.

First up, and I am not too proud to admit this, I have “POKE PTSD”. What is this you ask? Well, this condition comes from multiple occasions of being a human pincushion when someone was unsuccessful in starting (or restarting) an IV line. One example of this was a nervous new nurse who tried 18 times to restart an IV on me only to finally give up and reach out to another nurse for help. Her frustration was evident but it was all I could to keep myself emotionally together to not add to her stress. It took weeks for the bruising to fade. However, the emotional impacts remain fresh. To clarify, I am not afraid of needles or IV’s; however when someone starts to jab with no success, my heart will skip a beat. On a more positive note, if there is someone who can get things in the first attempt, I want to pick them up and give them a big warm SQUEEZZZYYYYY hug!

Second, since my little sepsis adventure I have started to develop allergies to things that were never an issue before. One of the more frequent reactions is to medications, and at this time I can no longer take any sulfa-based antibiotics. To add insult to injury, cashews have now become the nut of death (okay not death, but swollen itchy pre-death). When I first shared this lovely new allergy party trick with my Oncologist, she highlighted that we would want to watch for this as we moved forward.

So, after a lovely spa treatment for my hand and arm (aka – a toasty warm towel to encourage those little veins to pop) it was time for Jacine to find the vein that would welcome the multiple bags of medication waiting in the wings. It is important to share that because medications used in chemo damage the surrounding tissue if it leaks outside the vein, assuring you have a strong and sturdy line in at the start is important.

It is not at all uncommon for my veins to enjoy a game of “hide and seek” for clinicians and when I am anxious, this can be even worse. On this February morning, despite the warm towel, tourniquet, clenched fist, you name it, my little veins had decided that they were not interested in participating in ANYTHING we had planned and went fully into stealth mode. After a bit of searching and tapping, Jacine finally found a vein that had not got the memo to hide and she GOT IT…..for a minute. Yup, the vein figured things out pretty quickly and was out of there!

Jacine smiled, pulled the needle out, taped me up and quickly stepped away. I won’t lie, POKE PTSD started to fill my mind and I was fairly confident that Jacine had stepped into the broom closet to throw a fit over my stupid veins (I really wouldn’t have blamed her). However, it was that moment I got my first glimpse into how the chemo room runs, and how they put the patient first. Jacine reappeared followed by five feet of high energy, positive talking, singing confidence in the form of chemo nurse Sasha. As Sasha sat down and took my hand, she proceeded to explain that the nurses in the chemo room have a rule; no nurse will ever poke you more than twice. It is their belief that with each poke, you lose trust in them, and that is too important to maintain. For Jacine, she knew that she would most likely not get the line in if she tried again, so instead of putting me through that, she tagged in Sasha. All I can say is WOW…and share that one minute later the IV line was in and we were ready to go.

Now, a bit more education for you all. Introducing chemo meds to the body is a very prescribed process (no pun intended). For me, this means that the first 1.5 hours are focused on getting my body ready, priming it for what is to come. To do this, medications such as Benadryl and steroids are introduced in order to counteract the impacts of what is to come. Each drug is administered individually through the IV and once the little bag empties, the IV lines is flushed for about 3-5 minutes just to assure that everything is cleared before adding another medication. On day one, the pre-med primer process was very straight forward, with no issues, and I was left feeling overly confident that all would go swimmingly.

As the pre-med process was completed, things changed. Due to risks associated with the chemo medications, additional steps need to be followed for the safety of the patent and nurse.

The first step was for Jacine to put on a gown that would add an additional protective layer for her. Next, I was quizzed on my name and date of birth (passed on the first try!) . Jacine then cross referenced my documentation to the information on the bag of liquid her hand which was Paclitaxel. Once she was comfortable she had the correct medication, she hung the bag on the pole, attached the lines, set the pumps….and stopped. Why? Very simply…risk management. When delivering chemo meds, the process can not start until two nurses have confirmed every step. This is where I met Tom, whos job was to walk through the entire process again (and yes…I still passed the name test). Four minutes later the green light was given, Jacine started the pumps and opened my IV lines, and the poison that is designed to kill the cancer in me started to flow. The final step in the process was for me to remove my mask for the first 15 minutes so the nurses could watch for any reactions.

Spoiler alert….we didn’t have to wait long.

With my chemo buddy husband sitting beside me, I sat and watched each little drip from the bag, wishing it luck on its journey. However, about 3 minutes into the meds, I noticed a funny taste in my mouth which as instructed, I shared with Jacine. She asked for a bit more detail on what I was tasting, however it disappeared as quickly as it came. I am going to assume that this is because it wanted to get the heck out of dodge for what was to come next.

As Jacine turned to write a note on the taste issue, things started to happen….QUICKLY. I could feel my body reacting, however there was just so much going on that all I could say was “I feel funny”. What I didn’t know was at the same time my husband was looking at me wondering why his wife was quickly turning the color of a well cooked lobster. Yeah folks, here is the reason that each treatment area has a number and letter. It is intended to signal where you needed to run if there is a code called, and 7B had just coded. Within a second of seeing what was happening, Jacine was beside me, pushing the button to bring reinforcements and a green light above me started to flash.

Let me paint a bit of a visual to walk you through what I was experiencing. Imagine if you would; someone standing over you pouring a pot of boiling water on your head slowly and having it drip down your chest and arms, they are doing this while standing on your chest with a 50 pound weight (because you know, breathing is totally over rated), and SLOWLY reaching in to your abdomen and tearing out your stomach. Now THAT sounds like a fun Monday morning doesn’t it!?

So, before I move on I need to acknowledge the chemo buddy in the room, my incredible husband. One minute everything this going smooth and in the next he is being rushed across the room to sit and watch helplessly as his wife took on her first chemo hurdle. The fear in his eyes was clear and each time I managed to peak around someone to make eye contact with him, I was willing him to know that I was OK. The fact of the matter is, you do not go through cancer alone. The ones who love you are on this journey as well, however their pain is different.

Now back to the flashing light. Within moments, I was surrounded by nurses, each with a job to get things under control. There was a flurry of activity as a blood pressure cuff went on and started its familiar squeeze, the flow of chemo meds ceased, additional Benedryl was pushed into my IV. Every action being done was called out by the individual responsible and logged by one of the many people in the room. Questions were coming at me fast and furious as I focused on answering each clearly and as calmly as possible. Everything I was saying was then repeated back to me from Jacine to assure everyone understood. In looking back, it was clear this team was familiar with managing a reaction.

Finally, just as they were ready to bring out the Epipen, things started to change and in the direction we needed. The burning was slowly being replaced by a welcome cooling, my blood pressure was stepping back down to a point where those around me were happy, and air was now easily coming in and out of my lungs. Slowly, the people who came to my rescue started to return to their other patients, my husband had moved back to my side, and I just sat there holding his hand as my body shook with left over adrenaline. So yeah….… Paclitaxel….not a fan.

Now, when you have a reaction to you chemo meds, things take a different direction. The process is not just restarted with fingers crossed that you have all the bases covered now. No, there is actually a procedure to moving forward.

First, they needed to assure I was stable. All meds that had been introduced to help with the initial reaction needed to be fully administered.

Second, my oncologist needed to approve moving forward. Once the approval was received, the restart was not all at once. Rather, it was done in a gradual manner. They would start me again but with only 5% of the chemo meds entering my system for a period of 5 minutes and this would then go up step by step until I was at the full 100%. As we got ready for try attempt number two, the same verification process was followed, however it now included verifying flow rate/percentage going into my system. Also, there was a team of nurses standing by to manage any further issues.

With that, it was time to take the leap and start the drip again, slowly but surely the rate of meds coming into my system increased with no reaction in site. I was cool as a cucumber, breathing fine, and totally zonked out on Benedryl….yup…living my best life!

So as I sat there in my comfy chair with my warm blanket and my husband sitting beside me (who by this time was carefully planning out shots of his own…Jack Daniels, Tequila, Vodka). I successfully made it through the restart of my buddy, Paclitaxel.

With a quick flush of my IV lines, the next drug was up to bat – Carboplantin. Jacine gowned up, I was tested again (a bit slower in the response this time thanks to my drug haze), Tom popped in and did his thing, and my husband stared at me for 10 minutes waiting for the next shoe to drop. But there no was dropping of ANY shoes as I sailed through the full bag with no drama!

As the second drug dripped away, Jacine provided me with a new prescription for steroids that will need to be taken 12 hours before all treatments moving forward. Proactivity is the new name of the reaction management game. And, a short thirty minutes later, all the meds were in my system and Jacine was unhooking me from the IV. I was being set free!

So there you have it, the first poke is in the books, with only 19 more to go on on my chemo path. It was not without excitement….but what journey comes without a few hills to climb before you make it on the path through.