15. 8th and 9th June 2021 - Treatment Begins

Today is the day, although in reality it is only half ‘the day’ as I have to have my treatments separately for the initial doses. Today is the day for my Tratsuzumab injection - they give it on a separate day to the chemo in case of an allergic reaction, if they gave it on the same day they wouldn’t know which drug caused the problem.

I arrive at the Cancer Centre and I’m directed to a row of seats in the corner. I've barely sat down before an HCA calls me over to check my blood pressure, temperature and weight. I then get moved to a seat in the main waiting area and wait to be called through. I’m feeling very strange, I don’t know what to expect and no one likes injections but it still doesn’t feel like my ‘proper’ treatment is starting - that will come tomorrow when the chemotherapy begins.

My name is eventually called and I follow a lovely nurse called Harold into the treatment area. This hits me quite hard as it’s now getting real. This is just like the chemotherapy places you see on television. Lots of comfortable chairs with patients connected to drips all receiving their chemo infusions. Most people there seem to be older than me, some look really well and some not so much. All the staff are very cheery and friendly and the overall atmosphere is very calming - but I’d still rather not be there!

Harold finds me a seat and checks through all my details and explains that the injection will be given very slowly into my thigh and should take about 10 minutes. He pulls the screens around and starts to inject me, if it goes in too fast it can sting and be quite painful, so slow and steady wins the day! I have to say it was pretty painless and once completed I have to wait for 2 hours in case of an adverse reaction. The lovely hospital volunteer ladies come round with tea, biscuits and sandwiches and I settle back to watch a film on my laptop - it’s all very relaxing and easy to forget why you are actually there.

Then reality hits again. I am approached by a lady who tells me she is the pharmacist and has my drugs to take home. Now, I may be a bit naive, and I said earlier that I have avoided too much ‘googling’, but this just hadn’t crossed my mind. The bag she was holding was not huge, but was certainly very large! She sat down and handed me a printed sheet detailing how and when I was to take each drug. She ran through it briefly with me but I don’t think I really took it all in - I was just so shocked as once again this just made it all real. She handed me a bag of 7 prefilled syringes and said I had to inject myself from day 4. This was just crazy, my head was spinning - self administered injections? How is this even happening? It’s all like some horrific nightmare that just never ends.

The drugs will be the same for each cycle and are as follows:

Dexamethasone - a steroid to help make chemotherapy more effective. It is taken

twice a day for 3 days, starting on the day prior to chemotherapy.

They need to be taken before 1pm if possible as they can cause

insomnia. They may also cause a red flushed face, fluid build

up that can cause swelling of the face or limbs and weight gain.

Domperidone - An anti-sickness drug. It is taken 3 times a day, for 3 days,

although the first dose is taken at night on Day 1 of chemo.

Ondansetron - An anti-sickness drug. It is taken twice a day starting on Day 2 of

Chemo.

Filgrastim - a Granulocyte-Colony Stimulating Factor which helps to make more

white blood cells. Chemotherapy can affect your bone marrow and can

reduce your white blood cells (Neutropenia) which increases the risk of

infection. This is given on Day 4 for 7 days and is injected into the

abdomen or upper thigh. It can cause headaches, diarrhoea, nausea,

tiredness,sore mouth and pains in the joints and long bones as the bone

marrow is stimulated.

I am given the all clear so I gather my things together, pick up my drug haul and leave the department. I feel so scared about tomorrow, looking at my bag of drugs just reiterates how serious this actually is. I feel very alone despite being surrounded by love and support.

The next day I am back for my first dose of Docetaxel. I didn’t sleep well, I am just so scared. I mean, I need to have chemotherapy - How did that even happen? How can this be happening to me? How will it affect me? What are the next few weeks going to bring? I am terrified.

I follow the same routine as yesterday. I have my blood pressure, temperature and weight recorded and then sit and wait to be called through. I can’t really articulate how I am feeling, I seem to have retreated into myself - I’m functioning but nothing is really touching me emotionally. I’m on autopilot and just doing what needs to be done.

A nurse calls me through and we find a free seat. I wait while she washes her hands and sets up a cannulation tray. The atmosphere in the department is really warm, friendly and calming. All the staff are happy and caring and it’s easy to forget how ill all the patients are and why we are there.

I am notoriously difficult to cannulate as my veins like to pop up and then disappear at will. As I feared my veins are not playing ball so cannulation is postponed and a heat wrap is applied to my arm to try to bring my veins to the surface. While we are waiting I am given an anti sickness pill. We try again and have success after only 2 attempts. A second nurse comes over to check the details on the bag of Docetaxel and it is then attached to the drip and connected to my cannula. Chemotherapy has commenced. I’m still numb to it. It still seems too surreal. It just doesn’t make sense. But, it is happening. Poison is dripping through my veins. I know it will help me but it just feels mad and my brain screams again ‘what the hell is happening?’

The infusion takes an hour to go through and the lovely volunteer ladies are once again doing the tea, biscuit and sandwich run. I settle back and listen to a podcast to try to take my mind off things. The hour passes quickly and before I know it my drip is bleeping to announce it has finished. I am disconnected and have to hang around for an hour just to ensure I have no adverse reaction. I feel physically normal but I know that any side effects will start to appear over the next couple of days.

I leave the treatment area and stop off at reception to book my next cycle. I am booked in for pre-treatment bloods and a Covid test in 2 weeks time. I will also have a telephone consultation with an Advanced Practitioner Nurse the day before my next cycle to get my blood results and to discuss any problems from the last round. It is pointed out to me that I can contact the department at any time and I am given a card with the contact details of the Acute Oncology Service. I am also given an ALERT card with information to spot the signs of Neutropenic Sepsis. The card is attached to a yellow piece of paper that states in red letters

‘NEUTROPENIC SEPSIS ALERT’

Followed by instructions for the medical team to action if you present to hospital with a temperature above 37.5’ or below 36’. The list consists of just 2 actions:

1. Take bloods

2. Do not wait for results but immediately administer IV antibiotics.

This is another of those things that just make my blood run cold as it just highlights how serious my situation is and how difficult the next few months may be. I leave the department scared and anxious but also with a sense of inevitability. What will be will be - I just hope it’s not too awful. And life carries on.