(Please forgive the brevity/spelling and grammar errors of this post; I am both heavily medicated and tired)
I could hardly sleep the night before, because I was pretty nervous, but I was able to steel up and get through it. We arrived at the SCCA, signed in and got screened for cold/flu. I went in to get a blood draw and the nurse was kind enough to lie to me and gave me an IV rather than simply collecting blood (because I was so nervous) so I didn't need to get my arm pricked again. After they took my blood for examination (checking white blood cell counts, checking for anemia etc), I headed upstairs to the radiology department. I flashed my fancy green card with my identification number (like one of those FBI agents you see on TV) and got a wrist band in return. It was only a few minutes before I was called back. Rachel was my nurse and she was SO sweet. She kept me informed throughout the whole procedure; from beginning to end. She escorted me into a dressing room and got out a pair of scrubs for pants and a typical hospital gown for the top. After I got dressed and locked up my clothes and belongings, I was escorted to my gurney where I was hooked up to fluids and anti-biotics. Rachel explained using a cool realistic model what the port should look and feel like. It put me at ease to actually see one in person. Much smaller than I thought; the size of a nickle. Which was pretty impressive.
Soon after, they started me on a bag of antibiotics (since I would be receiving chemo later in the afternoon) and left to tend to another patient's surgery. Once they were finished with the other patient, I was wheeled into another room and the surgeon met with me. He was really kind and sweet; he put his palm on my shoulder and held my hand with the other. He looked directly into my eyes and talked to me about how he would be putting the port in. He brought out an ultrasound machine to examine the artery in neck, just to make sure that it was clear and healthy. He gave the okay and we discussed where the port should go in my chest. Since there is a cancerous mass on the right side of my chest, we opted to put the port in the left side instead. He marked the site for insertion with a surgical pen and then soon after, I walked into the OR after saying goodbye to David and my parents.
They escorted me to an interesting looking table. It was a lot like the PET scan table, except with a big X-Ray machine hanging over my head. The nurses and staff hooked me up to all sorts of monitoring machines. I could hear my very nervous heart beating. They were good about explaining everything, but I was really freaked out about this surgery and tears started flowing. Rachel, my nurse, stood by my side and talked to me, wiped my tears away with a tissue and made me feel really cared about. She administered the "happy drugs", which made me really relaxed and they prepped my neck for surgery using a really cold iodine solution. I was asleep pretty soon and I remembered nothing about it after wards. (I was really concerned that I would remember things, but the IV meds had an amnesic effect) They needed me to be in "twilight" (no, not the vampire books/movies) so I could take verbal directions. They need to regularly X-ray my chest throughout the surgery to be sure that the port was placed properly. I awoke and was pushed into the recovery room, of course, encouraged to eat and drink (despite the fact that I don't have any negative reactions to sedation). I was lucky because they accessed my chest port while I was still asleep, so I didn't have to be traumatized again when I needed the infusion later that day. I had some time to recover and while the pain meds were still in effect, I was allowed to dress and go directly to my doctor's appointment. The scrub pants that I wore during the surgery were really comfortable, so they ended up finding their way into my day pack. Hey!I paid for them and they're really cozy!
Here I am, with a post-surgery puffy face (and looking a little bit homeless in my hat and sweatpants...), waiting for my vital signs to be taken. You can see my recently placed port:
I met with my onco and we discussed how the chemo drugs were administered, the side effects, and how to take care of myself at home. Then, he looked at the port and agreed that it looked nice and answered a few of my questions. We also talked about keeping a record of my white blood cell counts and any symptoms that I had. With that, I was sent off with a bunch of prescriptions; two drugs for the surgery, three drugs for the nausea and side effects of chemo. We took the elevator to the 5th floor infusion rooms. I checked in, again flashing my fancy green card, and got a pink piece of paper that, I was told, was for the nurse to keep track of my medications. Mom and Dad went to fill my prescriptions at the SCCA pharmacy and I was called into get my infusion. I was feeling pretty nervous; this was my first chemo! I sat in the comfy, plastic covered recliner and waited for the staff to notice me. Soon, a nurse came in and introduced herself as Nikki and she asked me some questions about how I was feeling about my first chemo and any prior medical problems etc. Afterward, she hooked me up to a saline solution to be administered through my port. She took off some of the dressings used to keep the huber needle (a special IV needle used only for chest ports) in place. She hooked up the end to an automated machine which pushed sterile saline through the port. It was the weirdest sensation. It felt like there was cold water rushing into my heart, which was quickly warmed up and pumped into my fingers until the chill dissipated. Nurse Nikki explained that before administering chemo, my port must be cleared with saline and heparin which is a blood thinner. This prevents the port from getting clotted or blocked by the body's natural reaction to the presence of foreign objects. She explained that three of the drugs I would be receiving must be "pushed" (administered) manually and the last drug I would receive is administered via a typical drip. She gave me two pills of Zofran, a strong anti-nausea drug and I got more fluids in a drip that took 30 minutes to administer. During this time, the staff and nurses gave me a tour of the facilities while hooked up to the machine. Here's a lovely picture of me taking my stroll and a trip to the restroom (p.s. SCCA is sooo progressive! They have safe-space signs on all of the bathroom doors):
Needless to say, the infusion division was pretty posh. Each patient has their own room, cozy bed, and cable TV. The facilities also have full kitchenettes. They are completely stocked with snacks, drinks, and food. That is a huge plus because sometimes, patients are there all day without a proper meal. (I had chocolate milk)
After we returned and my anti-nausea drugs were administered, the nurse checked the port's effectiveness. In order to do this, they have to first do a "blood return". This is a fancy was of describing the process of pulling out a little bit of blood from the artery via the port's external catheter to be sure it is not blocked or painful for the patient. This felt fine, but OMG it was weird to look at running through the external catheter! I had to whistle and stare at the ceiling in order to prevent myself from running out the room. After she was satisfied that the port was accessed properly, she pushed the blood back into my artery with a little saline. Soon after, she gave me a small amount of a couple of the drugs known to cause a serious allergic reaction in a small number of cancer patients and watched for any reactions. Luckily, I showed no signs of allergy to these drugs and they moved forward with the chemo. Before the nurse could administer the chemo drugs, I had to recite my full name and birthdate and she donned a special blue gown, purple extra thick gloves and a surgical cap. When I asked her why she had to wear the gown, she explained that it can be hazardous to be exposed to chemo drugs everyday so she needed to take precautions. This had the unintended effect of making me a little nervous about my own reaction to the drugs and worried about the staff that had to handle this stuff. Anyway...
The drugs used to treat Hodgkin's lymphoma is called "ABVD", which is an acronym for 4 complicated sounding drugs that are all given to me during each infusion.
The first drug in the ABVD regimin is called, Adriamycin, and it is bright red, which freaked out David when he found out. It did look a little like blood going in. Luckily, he got over it and was a good supporter!
(Nikki warned me that upon my first bathroom break, this drug will look the same coming out, so I know ahead of time. Apparently, a lot patients don't know that the first time!) Below is a lovely picture of the gignormous needle of Adriamycin being administered if you're into that sort of thing. The blue connector is used to catch any stray bubbles. (You can imagine that a bubble of air in your heart can be a bad thing.) I felt literally nothing other than a little annoyance and chilliness in my port. I felt pretty good at this point, but it took a lot of effort to avoid thinking of how weird it felt and the fact that this TOXIC shit was going into my heart and subsequently pumped into my circulatory system. It is fascinating if you think about it, but also a little barbaric at the same time...
After the A in ABVD was pushed into my port, the nurse cleared my port again with saline, then it was time for the B drug called Bleomyacin. This drug was also pushed manually. This went fine just like the previous drug and was pushed manually by my nurse. As soon as I was hooked up to the third drug, Vinblastine, I immediately started to feel a little queasy and had a strong metallic taste in my mouth. David got the cue and broke out the little baggies of cheerios, saltines and lemon drops. The nurse had me pop an Ativan into my mouth to immediately combat the nausea. I ate a little and drank copious amounts of water and I felt sleep soon after. I closed my eyes for the rest of my chemo and fell asleep until the IV machine beeped loudly to alert staff that the bag was empty. The nurse came in and squeezed the remainder into my IV catheter and waited for it to finish dripping. Once finished, she flushed the port with saline again. Then it was time to take out the huber needle and cover up my newly inserted port with fresh dressings. This was really nerve racking since the huber needle looks something like a cross between a butterfly and thumbtack. Here is a picture of the whole system that is used to administer the drugs.
The purple thing with the long white catheter is the port; this is all underneath the skin. The rest is what is on the outside. The yellow thing is the huber needle used to access the port. The little "wings" basically lock so the needle doesn't move around too much.
Okay so.. that is IODINE. NOT blood, I promise. (photos courtesy of the blog from "Chasing Away Salt Water")
I was lucky that I didn't have to have it accessed while I'm conscious. Good Gods, that needle looks like a thumbtack, I just can't get over it. Anywho, after the huber needle was removed, Nikki put a cool bandage that was lined with a weird soft, gel. The gel covered the incision site and the skin covering the port.
I went home that night and felt not much different. I was a little queasy on the way home, I think mostly because I didn't have a full meal, but I felt fine. David helped me into my PJ's because my left side was killing me and propped me up with pillows for the night. My Ativan really helped me relax throughout the ride and in bed, but I had some of the weirdest dreams...
...yet, I slept surprisingly well.
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