To the Ones Starting Treatment
Letters to my patients, day 6
Your bags are packed, loaded down with snacks and books (plural, because you never know what you will be in the mood for), a comfy but bulky blanket, and a ziplock bag overflowing with orange medication bottles.
You are directed to the infusion room before seeing the doctor and your heart starts racing. Wait! I have questions first.
“Don’t worry,” the nurse tells you, “you will see the provider before treatment, we just need to access your port for labs.”
So many “firsts” today — the first port access, the first chemo treatment, my son’s first prom. I suppose today is as good as any to jump into the unknown.
The PA (physician assistant) steps into the exam room and you turn to say hello, knocking over the bag of pills — bottles roll across the faded, blue-and-white checkered floor. She lifts a few of the medications to pronounce their names, describing what they are for before placing them into the bag. Your hands shake as you hold it open.
First day chemo jitters are less romantic than those experienced on a first date, the first day of college, or when starting a new job. This is bordering an anxiety attack.
Your PA grabs a blue sticky note, jotting down the names and reasons why you need to take these medicines. As you place the note into your folder, you feel a little better. Questions are being answered.
She gives you a spiel about what you can expect.
Every patient is different, but the most common side effects are those we discussed in our education visit.
If you feel even a hint of nausea or the word nausea crosses your mind, take the medication. It is much easier to stay ahead of it than try to play catch-up.
Just because you are getting chemo, that doesn’t mean you have to be miserable. You tell us how you’re feeling and we will talk about ways to improve the side effects — medications, home remedies, lifestyle changes, dose adjustments, and more. There are options.
Remember, as with any new medication there is a risk for allergic reaction. That is why we give these medications in the infusion room. Our nurses are excellent — just let them know if you feel any new symptoms.
I see you have the list of reasons to call or go to the ER. Our after-hours pager number will get you to one of the doc’s who can see exactly where you are at in treatment and make recommendations from there. Call if you need anything.
We will see you back in a week. Even though you will not be due for the next treatment, we want to make sure everything went okay and review some labs. Come in sooner if you need to. You know where to find us.
She offers you a reassuring smile, but you both know this is completely new territory for you. She hopes your side effects are minimal, you are expecting the worst.
As you gather up your bags, her hand rests on your shoulder. “One day a time,” she says.
Chemotherapy is an unknown territory for most. Even if you have watched someone else go through it, there are so many factors that make it different for each person.
Not all chemo causes hair loss, each one has a different risk for nausea, sometimes chemotherapy actually makes you feel better as it shrinks the cancer. Your pain might be better in a week or you’ll be able to swallow solid food again in just two weeks. We have come a long way with the supportive medications given with chemo infusions — there are long-acting nausea meds, steroids, hydration, and growth factor support to boost your red and white blood cells. And you may not be getting chemo at all, but rather an immunotherapy or targeted medication.
It is okay to be scared in the face of these unknowns.
But fears often lessen when we talk about them. Your care team is there to answer anything you want to know. And if you don’t even know what to ask, tell them that.
Take it one day at a time. As the days go by, you will settle into routine and find your rhythm. The unknown becomes less terrifying as you walk through it.
When facing the many unknowns that come with starting treatment, take what you need:
It is okay that I don’t have all the answers. They will come with time.
I can ask any question I have or ask what I need to know, my care team has seen this before.
It won’t be easy, but I can push through this.
I am not locked into this treatment, I can say no at any time.
Deep breaths, one day at a time.
Thank you for being here,
This is part of a 31-day series of letters to my patients — those undergoing a work-up, diagnosis, or treatment for cancer. Topics are also focused on those caregiving and supporting individuals affected by cancer. This is not an easy journey, but you do not have to do it alone.
This is not medical advice — please consult your healthcare team for individual medical expertise.
Let me know what topics you hope to see this month! I have many of the days filled, but not all of them. I would love to hear your thoughts, experiences, or questions.
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