Welcome To The Dungeon

Workers had only recently taken down the "Abandon all hope,  ye who enter here," warning and put up the only slightly more uplifting "Radiation Oncology" sign.

Six down only twenty-four more to go.  I started radiation last week and I must acknowledge, it is one of the few things I've encountered that lives up to, or even exceeds, the hype.  Which is to say - it is pretty miserable.

It certainly doesn't help with first impressions that the radiation oncology unit is in the depths of the basement at Parnassus.  We got lost the first couple of times we had an appointment here (until I discovered this helpful if foreboding direct entrance buried behind the ambulance bay next to the ER).  One has the impression that is has been sealed away in a forgotten corner of the hospital like it is the Nevada Test Site of the University of California.  Old equipment and gurneys are strewn along the hallway like the abandoned detritus left over after the zombie apocalypse.  Arriving for my first treatment, I couldn't help wondering, "What I have signed up for?"

My treatment plan has been a moving target for the past few weeks.  The radiation plan kept expanding until it was just short of the definition of whole brain radiation.  When I looked at the 3-D rendition of the area to be radiated last Monday, I felt like the victim of a bait and switch.  It might not technically be whole brain radiation but it sure looked like "most brain" to me.  I don't want to give the impression that I am whinging about this - if this is what needs to be done then I am ready to do it.  But I feel that we backed into this - one treatment was discussed, adjusted, other doctors, unknown to me, made recommendations - until it evolved into something quite different.  I understand the process and I am thankful that I am able to tap the collective knowledge of a top notch institution like UCSF.  What I am saying, is that I would have been better prepared if this information had been laid out from the get go rather than doled out in increasingly grim samples.  Again, I realize that not all patients may want this but I do.

Receiving the treatment itself is quite surreal.  You enter the treatment room through a door that looks like it was built to contain the Hulk in a bad mood.  An array of a few dozen masks are hanging from a rack on the ceiling.  You climb onto the table, place your head in a cradle, and then the technician literally screws your personal form fitted mask on.  I think there are about six clamps ringing the mask and as each is locked into place, the mask get tighter and tighter until even the smallest movement becomes impossible.  I had to laugh the first time I looked up to find the ceiling illuminated by backlit images of a blue sky and tree tops.  I know it was placed there to relax patients during the treatment, to give you something other than machinery to focus on but for me, it seemed like a cruel joke which only highlighted the alienation.  While you may wish you were lying in a meadow in the Sierras or on a beach in Grand Canyon looking up at a pure blue sky; you are not.  You are locked into a machine that will soon begin blasting the seat of all you thoughts, memories, and emotions with enough radiation to kill cells.  Hopefully more malignant cells than healthy ones but unfortunately, radiation can't discern the difference.

Things continue down the sci-fi road as the arm of the machine begins to rotate and deliver the prescribed dose of radiation.  It is uncomfortable not painful but it is quite difficult to feel empowered or in control on the table.  You are a specimen on the mothership hoping against hope that these are benevolent aliens who plan to deposit you back in your truck no worse for the wear save for some unpleasant memories.

I had been prepped to expect the side effects to begin kicking in around week three or four but right off the bat, I started getting the "sunburn" and itching scalp that the radiation can cause.  Not the worse side effects but irritating.  I feel like my hair is now not long for this world.  I can expect it to come out in clumps as opposed to just thinning.  I think Walt may enjoy giving me the same buzz cut that I've been giving him.

It is not lost on me that my current treatment for brain cancer also happens to be the one thing that science is absolutely certain causes brain cancer.  But I can't have the treatments that may become available in the next few years.  I must make due with the best treatments in use today.  The wonderful writer David Rakoff who died on Thursday of cancer that was probably caused by radiation he received in his early twenties as a treatment for Hodgkin's lymphoma.  So the treatment may have ultimately caused his death while also giving him another twenty-five years of life.  It isn't too pleasant to contemplate but I think it is a trade that most of us would make. 

I'm not sure what to make of the final irony in of all this.  I'm hoping it signifies that life and good can emerge from something deadly and horrific.  The date I began radiation - August 6 - was sixty-seven years after the United States dropped the atomic bomb on Hiroshima.  Certainly much good has come from splitting the atom but like so many things, it has a dual nature and the potential to both destroy and heal.  I'm hoping that my time with the linear accelerator will lean towards the latter.