Sunday, February 28, 2010

Why Me? Why Not Me? Part Five

This is part five in Alison's saga with bladder cancer treatment. You can find the earlier installments if you search for Alison or Why Me? Why Not Me?

One More to Go

By Alison

I have one more treatment left of my BCG regimen. I have already had the treatment seven times. I have asked my doctor what, exactly, happens during and after BCG instillation to make nascent cancer cells – or for that matter fully-grown cancer cells not captured in surgery – die off.

He gave me one of those answers that makes sense for the moment but quickly fades away. It has something to do with the inflammation that the BCG causes my normal cells to develop in its presence. Cancer cells do not respond to inflammation the way normal cells do; they just die.

He said that similarly, radiation (in careful amounts and in the right spot) does not kill all the normal cells; some may become injured, but heal. Cancer cells do not heal, they die from radiation. They have no self-healing mechanism. At least, I think that is what he said.

The workable thing about bladder cancer is that it is inside a self-enclosed and thick organ, so what is in effect a topical treatment can be used.

I have read this week in the New York Times about the near-miraculous healing of end-stage melanoma that takes place with a new preparation that blocks the signals of a certain gene that drives the melanoma’s growth.

Patients who were filled with tumors and who had days to live, have lived for weeks and months either tumor-free or virtually tumor-free after this treatment. That is, they did for a while. Many have now relapsed and died. The cancer cells apparently figured out how to use another gene to do the same thing they had been doing with the first gene. The tumors came back. The researchers now think it will take a drug cocktail – rather like with HIV – to get the job done.

It is hard not to personify cancer. Think of something so ruthless, so aggressive, so – well, malignant – as to go to such lengths to stay alive. It is hard not to give it an evil face. Yet the will to live is in everything alive, in all of us. Wanting to live is not evil. But when the wanting-to-live is also foolish, such as growing so fast and in such damaging ways as to kill off one’s host, then it is easy to call it evil and stupid as well. But cancer is, in fact, mindless. It is simply unfolding as it must once it gets a good hold.

The treatments go like this. I get there on time (I have about a 20-minute drive to the doctor’s office) and wait a bit after signing in. All my treatments are in the late afternoon so I won’t miss too much work. Then a nurse calls me to the back and takes my blood pressure, pulse, and temp; she asks me how I have been doing. By now I know the two nurses who have cared for me a little, so we can chat and be nice to each other as we get ready.

The doctor comes in and asks the same questions and says he is pleased with how things are going. I do not have a fever; I do not have painful urination; I do have mild occasional twinges in my belly which I assume are from my bladder. Then he expresses encouragement, leaves, and the nurses stay.

I strip below the waist and cover myself with a blanket. I lie down on a table. They do not put me in stirrups, which surprised me at first. I just put the soles of my feet together and bend my knees out; that is all the room they need to do the procedure. After a swipe with an iodine cleanser, they empty me out with a catheter. They leave the catheter in and hook it up to a small bottle of a clear liquid. This is the BCG. They hold it up high and open the valve; I feel the cool liquid inside me as it flows in, a very odd sensation indeed.

They are gloved up and using sterile technique. Everything the BCG touches will get thrown away as dangerous medical waste.

When the bottle is empty, that is it. Now my instructions are to not urinate for an hour or an hour or a half; also, no drinking water or anything for the same length of time. After the hour and a half, I am to pee and drink drink drink. I get up, get dressed, and go.

The nurses are performing a special ministry with me. They are kind and helpful. They explain everything they are doing as they do it. They make this intimate touching seem quite matter-of-fact. Not just as something they do all the time, not indifferent: more like a comfortable laying on of hands that we women can do for one another when it is needed. In childbirth, say, or with nursing; or with illness.

When I first urinate after each treatment I am told I must pour undiluted chlorine bleach in the commode, afterwards. This is to prevent any TB bacilli jumping up and infecting someone else; also to prevent live TB entering the municipal water system. I joked with some friends that I am probably should hold up a bottle of bleach and a toilet brush as I walk everywhere, chanting, “Unclean! Unclean!”

Next up: About Positive Thinking


  1. Alison, you rock! Great piece - again! And this wonderfully defined observation: "He gave me one of those answers that makes sense for the moment but quickly fades away" - sent me right back to how I experienced it, too. Huge hang-in-there-klem from Anne

  2. Hi Anne, thank you so much for your comment. I am glad you are enjoying my series. Klems back to you!