Chapter 14: Go Ahead, Radiate Me

Down the hall from the Cancer Center waiting room at the University of Washington Medical Center -- through the double doors, then a left, a right, and another left -- is a world I never knew existed in all the months I've been receiving treatment for breast cancer at UW: the Radiation Treatment Area.

There's another waiting room here, filled with anxious husbands, worried mothers and the patients themselves -- some of them heartbreakingly tiny children.

Before I can begin radiation to combat a recurrence of the breast cancer I thought I had beaten five months ago, there are hours of set-up to get through. Most of it happens in what is called the simulation room, where the first thing the technician does is snap a Polaroid photo of me for my chart. I think it's to make sure they have the right patient on the table.

Next, the technician tells me, he will make what he calls an alpha cradle to hold my head to the side and my right arm crooked back over my head. I must be in this exact position on the table every day during the six-and-a-half weeks of radiation treatments to the chest wall, where my breast used to be, and to the lymph nodes under my collar bone.

As he mixes two foul-smelling chemicals together in a blue plastic bag, the technician jokes, "This looks like a garbage bag, but it's actually a medical device." I lie on the plastic bag, which is warm from the chemical reaction.

Practicing for the Real Thing

For the next two hours, I stretch out on the table under an X-ray machine, head and arm in the cradle, overhead lights dim, Christmas lights twinkling around the ceiling, music on the CD player, and red laser beams crossing my body from the sides of the room. Three or four technicians and doctors move in and out of the room, taking a series of X-rays, calling out numbers to each other, taping wires to my mastectomy scar and to other scars so they will show on the X-rays, adjusting the machine to various angles, and marking my chest with black pen and then with small tattoos.

I lie there feeling relaxed and dozy. Words and phrases run through my head as I try to decide exactly what I'm feeling. Mostly I'm bored. I'm certainly not scared. Every so often I sneeze violently from the smell of the chemicals in the alpha cradle, and the technicians emerge from behind their lead shields to reposition me.

The three scars that crisscross the right side of my chest (mastectomy and node-biopsy scars and the scar from the removal of the most recent tumor) are now overlaid by a web of black marker lines. And I now have seven small, permanent tattoos, so the technicians will always know where to set up the radiation machine.

Once we're done, I meet with my radiation oncologist, Dr. Karen Lindsley, a small, slender woman with a quiet face. She explains the procedure and side effects (fatigue and a sunburn-like redness on the skin are the two most common), and gives me a consent form to sign.

The following week I come back for a CT scan, to measure the thickness of the skin over my chest, and then there's a dry run on the radiation machine that will be used for my treatment.

Somehow I'm not much worried about the radiation; much less worried than I was about chemotherapy. My aunt had radiation last year for breast cancer, so I've heard about it from her, and it just seems less dangerous than the chemotherapy, which sends poison floating through my blood.

About a week into my radiation, I realize that I don't know how it works to kill cancer cells. I know that chemo kills fast-growing cells, which includes cancer cells, but also hair follicles, the cells in the lining of the mouth and other rapidly dividing cells. But radiation? I've been just taking it on trust.

When I ask my doctor about this, she explains that radiation kills cancer cells by scrambling their DNA. But I know radiation can cause cancer, so my second question is whether all this radiation will eventually give me skin cancer. Not skin cancer, says Dr. Lindsley, but some people do develop other cancers in the radiated area. These are likely to be tumors on the bone or muscle, but the risk is less than 1 percent 20 years after treatment. I decide that's a reasonable risk. Finally, the daily radiation treatments begin.

Taking the Cure

Radiation is boring. I go in every day, five days a week. I usually sit in the waiting room for a bit, eyeing the other patients -- who are eyeing me -- then, when my name is called, change into a gown and hop on the table. The two technicians push and pull until my body is lined up exactly where they want it. Then they exit and zap me with a minute of radiation, return to line up the next angle and repeat the process three or four times.

During the treatment, we chat, our conversations continuing from day to day -- kids, the weather, weekend plans, Halloween costumes. With my bald head I'm debating between dressing up as Mr. Clean in a white jumpsuit, and Darth Maul, the fearsome character from the new Star Wars movie.

Mostly, though, I daydream through the half-hour or so I'm on the table, looking into the huge iris of the radiation machine. I dream about trips I want to take, designs I want put on my head with henna, the beach on a rainy day.

For the first 10 days, I notice no effect from the radiation. On the eleventh day, my chest and shoulder have a light sunburn, and I have a sore throat. Dr. Lindsley adjusts my radiation to shield the throat. My right shoulder also is hurting, apparently from my position during the treatments. I ask about massage, and my doctor okays it. She also says radiation tightens the muscles and tissues in the area, so both exercise and massage are good.

Meanwhile, I order a "radiation camisole" from an American Cancer Society catalogue to wear when my skin gets too tender for a bra. And while I'm at it, I order a new hat and some headbands. And one night, just for fun, a friend and I go out and get a henna "tattoo" of a mandala painted on the side of my head. The mandala, a circular design that symbolizes totality in Hinduism or Buddhism, is a prayer for me to get through this treatment with as much grace as possible, Then, I want my life back -- changed forever by cancer, perhaps, but still my life.

Author's Note: Jeanne's Diary ends here, rather abruptly. I was fired by OnHealth.com when I was nearing the end of this round of cancer treatment. That story made national headlines (see http://seattlepi.nwsource.com/local/canc271.shtml), and I also write about it in the Cancer and Work section of this blog.

@ Jeanne Sather 2006