SEVEN WEEKS OF VISITS TO THE RADIATION ONCOLOGY UNIT.
This week marks the end of the seven-week, thirty-session, radiation therapy treatment. It has become part of the routine of our lives: a 35 minute drive in the late morning, maybe Mass at the hospital chapel or lunchtime sandwiches in Cafe Hoz, and another 35 minute return trip. As the treatment has progressed Marg has become more tired day by day.
Some other patients look extremely happy when they complete their last session. They smile at everyone as they quickly make their departure. For us the treatment has been reassuring - to know that something is being done. More than one medical person has said to Marg that for gbms radiation therapy is the "gold standard", by this they mean that next to surgery it is the major form of treatment available.
The staff at the Oncology Unit at Canberra Hospital are very kind and professional. It must be a difficult job. Perhaps some of them cope with what they encounter daily by keeping an invisible barrier between themselves and the patients but, at the same time, demonstrating genuine concern and interest.
There are three supervising radiation oncologists. Marg's is Dr T, a cheerful woman who wears unusual stockings, on one occasion they featured patterned spiders crawling up her legs. We have a mutual friend, Scott, who is a fitness guide where Dr T trains.
We once asked a staff member what were the differences among the other staff (meaning to say, what was an "operator", a "technician" and so on) and she said jokingly "money"! I doubt if anyone works at this place for money alone.
There are two Linac (linear accelerator) machines and those coming for treatment are assigned to one or the other. Each person is given a blue-green cardboard book - like a post-War ration book for those who are old enough to remember. Come to think of it, many of the clients are of an age who would remember. The book contains your name and your program of treatments.
When you arrive you pass it through a window, so the staff will know you are present and ready for your session. Many clients need to undress for their treatment and they are allocated a white terry towling dressing gown. They put on their gown in the change area and wait. Every now and then a staff member will come to the waiting room and say "Margaret, will you come half-way please". This means that you don't go completely to the treatment area, but "half way", to wait for the person ahead of you to come out.
Sometimes patients are discreetly wheeled into the treatment areas on beds or wheechairs by the unit's porter Maha. One time a patient sitting near me was receiving chemo from a container suspended above his wheechair and it started beeping, so I told him jokingly that his mobile phone was ringing. He smiled - it was the dispenser indicating that the liquid was running out but when I looked carefully the chemo bag was itself covered with a shield. Was it radiated, or did it look so vile that this was a concession to the public's squeamishness?
Our time visiting the Unit has given Marg and me plenty of time to think about brain tumours and cancers. The brain is isolated by the blood-brain barrier and the protective capsule of the skull, so primary BTs are mostly treated by surgery and radiation; however, most cancers in other parts of the body are more accessible to a wider range of treatments. Depending on how you view it, there are pluses and minuses in both situations - in terms of pain, effectiveness, and quantity and quality of life.
The nurses who sit behind the counter seem to know exactly what is going on everywhere - who has turned up, who is missing, who needs to be weighed, who has left early. In lowered voices they dispense advice about how to deal with the side effects encountered by the clients, drawing on an armoury of gels and linaments. There is Morag, whose eyes and ears are constantly scanning the area and has a penchant for 'organising' the paper forms behind the counter; Jackie, who knows that the fears behind most queries can be dealt with by a smile; Wendy who is full of good advice; Josie the newcomer (or new to us); and Jillian who seems to move between the main reception area and the treatment area. Each Thursday they take blood from Marg to test for her glucose and Dilantin levels. They have plenty of experience and know how to do it effectively and gently. Marg once told a male nurse (a look-alike to Phil V who once worked in Brian Harradine's Hobart office) that he should show the other nurses, male and female, how to draw blood correctly. Every now and then a person, wearing a tunic and carrying an insulated bag, visits from the Pathology area and collects the latest blood samples just as if they were collecting envelopes from an office out-tray.
It is reassuring to simply be in the waiting room, in the presence of a group of people who could conceivably deal with any emergency you are now likely to encounter as a BT patient or caregiver. On the wall behind the nurses is a large red button labled "Code 5 Medical Emergency Only" and in front of the desk is a portable medical care unit with oxygen mask and cylinder. In 1987 when Marg had a cardiac arrest at Calvary Hospital one of the nurses activated a nearby Code 5 alarm to summon help.
The controlled apprehension which the family of someone with a BT experiences is always present. The other Friday Gregory was on his regular milk run and an ambulance drove down Kerrigan Street, which is the route an ambulance would follow to arrive at our house. He wondered immediately if it might be Marg having another seizure. He knows someone would always come for him, as they did at school when Marg was gravely ill in hospital. No one came for him after twenty minutes, so the ambulance must have been for someone else. There was a time when you didn't think apprehensively about an ambulance and its siren in the neighbourhood.
Occasionally, the nurses are supported by the medical Registrars who will deal with the more complicated queries. There are two trays on the counter "Treatment Records of Patients to be reviewed" and "Treatment Records of Patients just reviewed". The Registrars or Doctors will often dip into these trays and call for the client. Further up the corridor is the planning area with an efficient operator Janelle, and Brett, who was once cheerfully chided by other staff about declining to participate in an office Lotto ticket. He was warned that one day he would be the only person who turned up for work! There are two more technicians in that area.
The technicians (and that is probably not their correct title) in the treatment areas have the most direct contact with the clients. There is Wendy, with her ever-present smile and cheerful banter; Dell, who wears smart waistcoats; Kim, who recently had an encounter with a spider and changed into being a patient for several hours; Carl, of the purposeful stride; Julia, who looks like a fit middle distance runner; Serge, who was on a short-term contract; Margaret, who I once saw gently holding the hand of a very elderly woman walking to the treatment area, and others, whose names are unknown. One of the operators Bev, in the other Linac area, actually knows Marg's sister Frances in Melbourne.
Marg once asked Dr T about the numbers the technicians call out when positioning her for treatment. These are something to do with coordinates for the machine. I wondered if they might be conducting an illegal Starting Price betting shop? Dr T doubted it. Hearing those numbers requires a 'leap of faith' by Marg - that they know what they are doing, that they have the correct numbers, and that they are targeting the correct area.
We have friends who have opted for radiation treatment at the bigger institutions interstate but Canberra suits us. After Friday we will be on our own waiting for an MRI in January or February to tell us whether these thirty days of treatment have had any beneficial effect whatsoever.
Marg says she feels good, despite the draining fatigue which envelops her every now and then.
Sunday, 29 October 2000.