My Dutch Oncologist

October 10, 2013

It is a cold, rainy day when Nicole, Maarten and I enter the hospital, typical Dutch weather.

I can’t keep myself from thinking back at the quick goodbye we had with the kids. We were lucky enough that we could leave them with a sweet friend of ours. She would take good care of the boys during the next few weeks until Maarten returns. She is an amazing person with a great heart and I am very grateful to have her in my life. Actually, I am grateful for everybody in my life. All our friends reacted very friendly and helpfully when we told them the news.

This past weekend went by so quickly. Actually, I would have loved to hold hands with the boys the entire weekend; I had the strong urge to feel and smell them every second of the weekend. I am going to miss them like crazy. For how long? I shouldn’t think about that. Funny enough, the boys had a different opinion about this weekend because the whole weekend was filled with parties and friends! Maybe better for all of us. A perfect way for them to forget about everything and enjoy life. If I would be in their place and if I could choose between staying home with my sad parents or going to a party, you would probably find me at every existing party! I have to keep in mind that my boys are bigger now, 12 and 13 years old. They have other things that keep them busy.

The waiting room of the oncology department is serene and very clean. It looks like a living room; everything breathes the sense of warmth. It smells like coffee and there are nice magazines everywhere. Not even after 5 minutes a nice young doctor meets us. He could have been the brother of our king Willem Alexander. He asks us who is Renate. For the first time in my life I don’t feel proud to say that I am Renate. In the room of the oncologist we actually have a nice chat. I am a bit septic; I know myself and see that this is a tactic diversion. Not much later he tells me how he planned the treatment for me. Actually, not funny at all; a treatment of six sessions of chemo therapy, with a break of 3 weeks between each session. The chemo therapy treatment consists of 3 different medications: TAC Docetaxel/ Taxotère (the biggest evil), Cyclosfosfamide and Doxorubicine/ Adriamycine and will take about 4 to 5 hours.

He tells me that he was hesitating between 9 or 6 treatments and I wonder on which base he took his decision. Thank God he choose the last option. Anyway, I feel safe and comfortable with him.

’18 weeks’, I immediately calculate after hearing the treatment. Íf I make it, because before every next treatment they need to check my blood. Depending on the values of my blood, they will decide if I am strong enough to deal with the next treatment. The doctor continued, telling me that these 6 chemo treatments will be followed by 23 or 25 daily radiations. I immediately put a stop on this. I resolutely explain to my oncologist why I don’t want to have radiations. I want a double mastectomy, amputation of both breasts. I noticed that he is surprised but he immediately replies that we need to discuss this matter once more after we have finished the chemo treatments. When that time is near, he will arrange meetings with the responsible doctors so they can properly inform me. First thing to focus on right now is the chemo therapy.

‘I am going to check a date regarding the PICC-line (*)’, I hear him telling me. ‘A PICC-line?’, I hear myself wondering out loud. He explains to us that this is a new method to enter the infusion of the chemo. PICC stands for Peripheral Entered Central Cathether. A PICC-line is a small, slim, long silicone tube that they will enter in your upper arm by a keyhole surgery. The tube is long enough to reach the big vein nearby your heart. The PICC-line is much more newer than the Port-a-cath (PAC), which is also often used with patients who have to go through a longer treatment or which have difficulties with being injected. Something he already noticed. He’s right, my veins are really hard to find. Without realizing it, I see my sweet Bitch in my imagination holding the big needle in her hand. From a far distance I hear my oncologist juggling with some times and dates. Thank God I pop out of my daydream when he asks me if I would be ready to have the PICC-line entered next week. One day after this operation I will start my first treatment. After my approval of the dates, he lets me meet my 24/7 nurse; a nurse that will be available 24 hours a day, 7 days a week. This nurse informs me about the medication I need to take before I start the treatment and the ones I need to take after my treatment, about the nurse that will visit me at home after the treatment for a boost-injection and the side effects of the chemotherapy. Complete loss of my hair, diarrhea or constipation, skin rash, decrease of your white and red blood cells, nerve damage, change in the structure and strength of your nails and sometimes even losing your nails, allergic reactions, infections, muscle and joint pains, a general feeling of weakness and being tired, nausea, vomiting, change in your sense of taste, infection of your oral mucosa, lack of menstruation, etc. (**) Next to that, I am not allowed to share a toilet the first week after my treatment and my clothes need to be washed separately so that others will not get in contact with the chemo that I have in my body.

Pfff, this doesn’t make me happy at all. It would have been better to tell me the things that will NOT happen to me, than we could have already left an hour ago!

At last the nurse tells us that there will be a big event for everybody who is or has been affected (in) directly by cancer, organized by a foundation, knowing ‘Adamas Inloophuis’: A foot or hand massage will be offered, there will be classes of painting, yoga and mindfulness; a writer will explain her book where she writes about her cancer experience, etc. This event will take place in a building not far from the hospital. It’s called ‘seize the day’.

With a dizzy head and rosy cheeks we walk out of the hospital. Being outside again I realize that the only positive thing that have happened is that it stopped raining; the sun is shining.

 (*) A PICC-line is a central based drip that has been placed in the vein of the upper arm. The end of the line enters the big hollow vein in the chest, just above the heart.

Why a PICC-line? A PICC line is used when blood needs to be taken for research or medication needs to be administered. A drip causes damage to the veins. The PICC-line can be a good alternative when there needs to be an often administering of medication or blood needs to be taken, to prevent damage to the veins.

– Medication can be administrered in a safe and pain free way

– The body can hold the PICC-line up to 12 months

-The contrast liquid used with a CT-scan can also be administered through the PICC-line

Inserting and taking care

A radiologist will enter the PICC-line. The end of the line will be taped off with a special bandage to keep it clean. The nurse in the hospital will take care of the PICC-line

Source: www.olvg.nl

(**) A port-a-cath is a little hollow injection space, a little cap that is placed under the skin. On top of the cap there is a self-closing silicone membrane. Attached to the injection room there is a thin catheter attached. This catheter is entered into a vein. This will make it possible to enter the medication and liquids into the vein. A port-a-cath is used often for people that need to be injected often and/ or people who have a higher risk for vessel irritation (like with cytostatic). Also for people that have difficulties being injected a port-a-cath can be the right solution. By using a port-a-cath the inflows of medication will be less sensitive and painful.

Source: www.borstkanker.nl