If ye are prepared, ye shall not fear

April 12, 2011: This morning, Linds and I make our way to the Utah Cancer Specialists Center. How many times have I driven by this building, oblivious to the people coming and going to treatments, and the doctors and nurses who are dedicated to combating this wicked disease of cancer? I have led a sheltered life, not knowing the suffering behind the walls and doors of the world. In we go, straight to the desk under the sign, "Radiation Treatments". Ouch. It hurts already.

The nurse manning the phones and the computer is Allison, and she is hilarious from the get-go. She congratulates me on my pronunciation of Dr. AVIZONIS's name, especially when she learns that this is my first visit. (Good thing she didn't ask me to spell it first - I only learned the correct way after I grabbed her business card off the counter.) She laughs and makes jokes, and I feel somewhat at ease. As I'm filling out (more) paperwork, she "hands me over" to an advocate, Sherry, who will help me with billing and insurance and all the stressful things that are non-medical. Sherry invites me and Linds into her office and goes through a booklet about the programs that are available through the center. She says, "I don't know if you have a teenager or not," and I say, "Yes, I do. She's fourteen." She proceeds to tell us about a weeknight program open to teens who have a parent diagnosed with cancer. Suddenly, I am hit with sorrow for my little girl. No one should have to go through this, and my heart aches for her. If I'm determined to survive this menace for anyone, it's for her. She needs her mom as she grows up. I shed a few tears for Janessa.

We hardly wait a minute after finishing up with Sherry before cute Allison calls us to Dr. Avizonis's office. She quips, "It's quite a maze back here - I think the designer was Dr. Seuss!" We go into a room and she takes my blood pressure. Sky high. Allison doesn't faint away - she laughs. "Considering what you're going through and the place where you sit right now, this is normal," she says. Not really, but it's comforting to know I'm not the only one with "white coat syndrome" around here. She says Dr. A is looking over my "films" and will be right in. Linds is looking at the brochures in the packet Sherry gave us, and we both get a kick out of an ad for "free housekeeping" for patients undergoing chemo and radiation treatments. "Could you come live at my house?" says Linds, but mine is definitely in need of some attention, too.

Dr. A is middle-aged and doesn't appear to look like a doctor. She's dressed casually (no white coat) and gives both Linds and I a firm handshake. I like her right away. She admits that she could have read my whole story in the time it took to download the film from my scans. She's good-natured about being a little computer illiterate, though I'm sure she is a pro at what she does, off and on the computer. She asks me to tell my tale from the beginning and then looks at my surgery wound and deftly feels my neck, back, and under my arms. We ask questions, Linds and I (but mostly Linds because everything feels overwhelming at first). Again, we ask, why am I here if melanoma is resistant to radiation and chemo? Dr. A says, "That's an old wives' tale." Really? Then, she clarifies. Melanoma comes in many, many diverse strands and some are very resistant to radiation and some are highly sensitive to it. Even my own melanoma cells could be mashed up to pieces and put in separate petrie dishes, and some would grow very slowly and some would spread like wildfire; some would shrivel up and die with the radiation gun pointed at them and some would thumb their noses at it. That's why it's so hard to treat - the uniqueness of each strand is its own strength and weakness. Quite simply, she tells me that because 6-7 of my lymph nodes tested positive for cancer, there is a 50% chance that I'll have a recurrence in my neck; with radiation treatments, that chance goes down to 10-15%. I like that much better. That's why I'm here.

She is happy to learn that I'm seeing Dr. Ken Grossman at the Huntsman Center Thursday. She says he's a younger doctor, a melanoma specialist, up to date on all the newest and latest. She says he'll make recommendations and throws around words like "systemic treatment" and "immunity therapy", and I have to ask what that all means. Systemic treatment will work for my entire body, from the bottoms of my feet to the tips of my hair, the whole "system". She mentions chemotherapy, which makes me cringe, and she also says "infuron" (not sure how to spell), which also makes me uneasy, since Dr. Bradley (and my friend, Judy Terry) has told me that it is a tough drug that "wipes you out". Don't want that. Now I'm thinking radiation sounds pretty good. It's all relative, huh?

Now, we get down to what radiation treatments will be like: 5X a week, Monday through Friday; 15 minutes, 30 treatments (or 6 weeks). She says to begin with, they put you on the table and position you exactly how you'll be for the treatments. To keep you still, they make a "cast" of your neck and head and shoulders and chest out of a material that acts a little like paper mache with little net-like holes in it. After they mold it to you, it hardens and becomes the "guide" to keep you still. Dr. A will also make a "map" of me to show the computer exactly where to put the radiation and how intense the dosage should be in certain areas - more in the vicinity of where the initial tumors were and less in places like my vocal cords (yes, thank you, I'd still like to be able to sing!). She said the mapping is a week-long procedure, which involves several other specialists and technicians to get everything just right - because, as she says, "We don't want to have any 'oops' in radiation treatment." I'm stunned. It all sounds so interesting, it's hard to believe it will really happen to me someday in the near future.

Then, she does her doctor-ly duty and explains the side effects. Yippee. Sunburn-type burn in area of treatment, usually starts after the third week. Sore throat, usually starts after the second week. Loss of taste, due to taste buds dying. (Linds and I joke that it's a great diet, but Dr. A is quick to explain that she will nag me to eat and not lose too much weight, as the body heals faster and better when it's not in "starvation mode". Okay. Right.) Some hair loss, mostly in the area where the radiation hits; so, in my case, it will be in the back at my neckline. She says I won't lose any on top and that it shouldn't be that noticeable. If so, I'm definitely looking into wigs. Saliva may become thick and goopy - doesn't that sound wonderful? But worse, because of the loss of saliva and its power of washing bacteria and germs off my TEETH (did I know saliva did that??), I may be susceptible to more cavities and even tooth loss. Holy cow. I feel myself crumbling before my eyes. She advises that I see a dentist and get some extra attention to the right side of my mouth - extra fluoride treatments, extra fluoride toothpaste, more frequent exams and cleanings. Here goes my thought process again - how much is THAT going to cost? Yikes. And of course, physical and emotional weariness - that by the end of a week of treatments, I'll feel like I've been run over, again and again and again. Delightful. What a great thing to look forward to.

But, here comes that hope again. Dr. A reassures me that, along with Dr. Grossman, we are a TEAM. We'll take what he suggests and we'll combine it with the radiation treatments - and she says, "Someday this will all be a bad story you'll tell your grandchildren." I leave her office feeling hopeful. It all sounds scary, but she has prepared me so well, I really have no fear. She has explained everything so thoroughly and precisely that I now know exactly what's going to happen - the unknown is known, the plan is made, the path is clear. My prayer tonight is that Dr. Grossman's part of the team plan will be just as clear, just as hopeful, and just as fearless. And that together, we'll all - and that's not just me and my doctors, but my whole fantastic family and all my faithful friends - will conquer the giant looming over us and smash him down flat, never to rise again. I've seen miracles and I know there are more out there for me. One step at a time. Thankfully, I've got people like Dr. Bradley, Dr. Avizonis, and Dr. Grossman leading the way with their bright torches of knowledge and experience - and compassion - held high. Lead on...