round 2

monday i entered the hospital for round two of POMB-ACE chemotherapy. as a reminder, here's how it works, in more detail than some of you care about, and less detail than intrigues some others:

this round 2 of 8 cycles, each of which lasts 2 weeks. i have 3 rounds of "POMB", which consist of vincristine, methotrexate, bleomycin, cisplatin, and seemingly hundreds of liters of saline. each round of POMB starts on a monday, and i am in-patient at norris/usc cancer hospital until sometime during the day on friday. i then go home for the weekend, the week, and the following weekend, until beginning the third round of POMB on monday, december 11. on december 25, i get "ACE", which is actinomycin D, cyclophosphamide, and etoposide. this round is out-patient, though i come in every day for a 3-4h infusion (which is probably more like 8h in this hospital with all the setup). there may be some possibility of doing the ACE regimen at another hospital, which opens the intriguing idea of heading up north for a bit, but that hasn't yet been ironed out. if my tumor markers are still high (a bad thing), then i get another in-patient cycle of POMB starting january 8; if the markers are normal, i stay for the same amount of time, but they don't give me the cisplatin (the big nasty P for platinum), which makes it "OMB". on january 22, i will get the out-patient ACE regimen, with a CT scan at the end. on february 5, i get OMB, and on february 19 i get ACE. we hope that there is no "after that...".

i have been feeling pretty good for the past few days before re-entering the hospital, and feel especially happy having spent them well, with friends and fun. my belly seems to have shrunken a little, maybe, and i am able to eat larger meals, and even get hungry at odd hours (i just ate four of grandma's brownies!). i am off the time-release morphine, which i just don't need right now, and as a result i am off all of the stool softeners and laxatives that went along with it, though my bowels are beginning their re-adjustment, which involves a definite and very uncomfortable overshoot. i even took a short nap this afternoon, which hasn't happened in a long while. i still seem to need sleeping pills for the night, though maybe tonight...? it is a relief to feel that despite the extremity of the situation, in general, it is going as well as it can.

i am back in the exact same room as last time, with many of the same nurses and doctors knocking on my door at all hours. the routine of the hospital is to be humored. i chit-chat with the night nurses who come in to change the saline, give me pills, and quiet my frequently demanding IV machine which beeps its displeasure. i guess at my weight before letting the nurse who keeps all of the vital statistics put me on the scale, and once she's taken my baseline blood oxygen measurements with that little glowy red thing on my finger, i hyperventilate to see if i can get the numbers to go up (it works, after about 20 seconds). i distract the over-worked second-year resident, sam, into spending half an hour with me at a time, talking about symptoms and coping mechanisms. the orderlies who bring in my food and take away cluttered trays have to negotiate a room teeming with procrastinating medical students who have come to visit. i have hung up a japanese scroll of swimming fish that florence brought for me, and my yellow submarine magnets will surely grace my metal door soon. walking around the ward and peeking into people's rooms, it is clear that i am somewhat of a novelty as far as patients go. i don't think that treat too many young, wisecracking medical students, with french girlfriends, mothers who stay the night, requesting rooms with wireless internet so he can run his blog (no luck: the two rooms that have it by chance are already occupied; i have to mosey down to the quad to post things, which is why it can take some time to post when i am in here). i do what i can to stay amused, and part of that is amusing others.

i feel conflicted about what to do with time like this when i am feeling good. on the one hand, the proportion of time that i spend feeling bad is so large that i think that i should take advantage of my "up" time to just relax and recuperate and enjoy life. on the other hand, the administration here at the medical school has done a good job at reinforcing the idea of professionalism, that being in medical school is less about learning a bunch of facts and being able to take multiple choice tests than about learning to be effective and engaged in the health care system. with this in mind, i feel an obligation to get something out of this experience other than merely making it through to the other side. it's not fair that this is happening to me, i don't deserve it, there is no master plan that put me on this path, but nonetheless i feel like i should make the most of these circumstances, and do what i can to see it as "opportunity" every now and then. there are so many issues that are brought up by this experience: so many glaring shortcomings in the system that deserve identification and possible future investment of my time, so many drugs that i am taking which i don't know enough about, so many alternative therapies to be investigated, in short, so many "productive" things that i could be doing with this time. i even thought about interviewing applicants to medical school from my bed - what better situation in which to evaluate someone's fitness for medicine? (what an intimidating interview! they certainly wouldn't forget the experience, that's for sure!).