Two Lines

Two lines to say that my CT scan from November 18th was clean, my CA-125 blood test number is low (which is good), and I got a very cheerful No Evidence of Disease pronouncement from my chemo doctor at my visit on November 22nd. 

He says I won't have to get another scan until six months out.  With my cancer having been caught so early and treated so aggressively, there's no point in exposing me to the radiation at quarterly intervals.  I'll have another blood test and visit in February, but that's all.

Unless the CA-125 levels are up.  But we won't invite trouble and expect that.

My head hair is about 3/16" long now, all white, or maybe it's platinum blond?  The eyebrows are returning, too, in a pale gray.  I hope that's won't be their final color.  Not sure about the eyelashes-- I'm so farsighted I can't see if they're coming back yet, even looking in the magnifying mirror!  I'll have to get somebody to look for me.

So now if I can get the rest of the copay bills discharged, I'll be on my way to putting this behind me.

God willing, of course.

Getting Lit Up

Today I embark on the next stage of my cancer cure journey.

Though maybe I don't want to use the words "next stage" in regard to cancer, since it implies things getting worse, not better.  Which, God willing, is not the case.

I'm presently sitting in the waiting room of the radiation oncology department of my local hospital, slurping iodine water to light me up for my baseline CT scan. 

Now that my chemotherapy's over, I get the exquisite pleasure (!) of going in for a CT scan every three months for two years to make sure the cancer zombies aren't coming back.  Then once every six months for three years after that.  The baseline scan today should-- no, blast it, will establish that I'm free of all abdominal and pelvic masses, tumors, lumps, bumps, and other execrences that could even vaguely be construed as cancer.

Coincidentally, yesterday my friend Ruth* (also a cancer survivor) sent me a link to an NPR feature about an oncologist who has just published a book called The Emperor of All Maladies: A Biography of Cancer.   In it he writes about the manifestations of cancer throughout human history, coupled with his own experience treating patients suffering from it today.  The excerpt seemed well-written and compelling.  I may read the book when the subject becomes less . . . personal.

But at the bottom of the book article were links to other NPR items, including a rather alarming one about increased risk of secondary cancers from both diagnostic and follow-up CT scans and other radiology techniques.  There is a particular danger, it said, for women in my age group who undergo repeated scans.  The author says that the amount of radiation varies from hospital to hospital, machine to machine, but in some the dosage is as high as what the survivors at Hiroshima and Nagasaki suffered . . . and we know what happened to them later in life.

Oh, joy.  Isn't this just designed to inspire confidence!  But as I understand it, I have to have these tests, because if despite everything the ovarian cancer manages to come back, it has to be found as soon as possible.  So a few minutes ago, when the nurse brought out the iodine water and the clipboard with the form to fill out, I mentioned the radiation risk.  And happily, she agreed that in my case, with the repeated scans scheduled, they should assuredly put me in the low-dose machine.  And happily again, that turns out to be the one they used on me last March.

So here we go.  God grant that I will now and hereafter be dancing with NED (No Evidence of Disease) and all this will be strictly routine.

Coming Through

This past Monday was my last chemo session!  GodwillingGodwillingGodwil-ling that's the last of the Taxel and the Carboplatin.

I should have been done the last Monday in September, but my persistently-low white cell counts made it necessary that my treatments have four weeks between them, not three, after the second infusion in early July.

Anyway, all six are past now, and I've really come through it pretty well, considering.  My eyelashes, eyebrows, and most of my head hair are gone, but I expected that.  I never lost my sense of taste and actually gained about three pounds.  My luck, right?  It's just that every time I'd think of eating raw vegetables out of my garden, I'd get a scratchy feeling in my tummy and headed for the bread and pasta instead.  Everybody says my color is good (whatever that means), and with the wigs I manage to pass for healthy with people who don't know me well.

I am being annoyed with a spot of peripheral neuropathy in my fingers and toes, since my fifth treatment the end of September.  My toes feel continually like there's crud between them, and my fingertips sometimes feel like sausages.  But they don't actually hurt and I do all right, regardless.  I mean, I can still fasten my jewelry and obviously, I can use a keyboard.

About the only thing that's bugging me in any real way just now is a bronchial infection I developed about a week and a half ago when I overdid it raking leaves a few days in a row and can't seem to shake.  This is a real joy (not), since I'm heading into my lowest white cell count.  I wasn't able to come in to teach when I was called this past week, and won't be able to until this clears up.

Here's the funny thing, though:  It really looks like my head hair is already trying to come back!  I noticed this on Tuesday, the day after No. Six.  Little white or light blonde spikes, all over my head.  They say it's supposed to grow in baby-soft and fine, but this definitely feels prickly to me.

Oh, well.  At least it's not red, like some bright soul suggested.  Not that I have anything against redheads; I just don't have the coloring for it.

I'm Not Sure

I had my first stint substitute teaching today since before my surgery last April, and I'm not sure I have the stamina for it.

If I were a better cat-herder-- I mean, a more proficient emergency teacher of 2nd graders-- I might think differently.  But by the end of the school day I was nearly weeping from exhaustion.  And now it's almost 7:00 PM and I'm sitting here still in my work clothes starving to death because I'm too shattered to get out of my desk chair.

Except for one child, who was so obstreperous early on that he started kicking the aide and had to have Security called on him, the kids weren't malicious or bad . . .  they just didn't know how to stay in their seats quietly doing their work.  They didn't understand that finishing a test early didn't give them the license to walk around the room bothering those who were still working.  They didn't realize that the end-of-the-day leaving chaos was not a good time for them to blindside me with fundraising forms, saying they had to take them to the office. And as my limited energy ran out, so did my creativity.  By 3:00 PM I was reduced to saying, "I know nothing about that.  Ask your teacher on Monday."

I'd just say No to substituting until the chemo treatments are over, except that a) I need the money; and b) I'm on a tiny bit of Unemployment Compensation, based on the subbing I did last fall and winter, and if I turn down work it's deducted from my benefit amount.  I don't know: the full possible benefit is equivalent only to two days of work and may not be worth demolishing my health over.  But again, anything coming in helps and it seems wrong to forfeit it.

My throat is sore, my sinuses are blocked, and I need to go eat. But I'm on to preach on Sunday with a sermon still to write so I won't exactly be resting this weekend.  We'll see what my blood counts look like when I go in for my chemo Monday morning.  The way my body feels now, I'm frankly glad I can't accept any teaching work that day, whether they can infuse me then or not.

Well, All Right

A friend who follows this blog mentioned on Facebook this evening that I'd been leaving all three of you dangling for several weeks.

All right, let's do a highlight reel.

1) Not sure what was wrong with the car, but it hasn't done it since.  The garage thinks maybe a piece of dirt stopped the fan and that's why it overheated.  They didn't charge me for checking it, which was nice.

2)  On the 19th of July I attended one of the American Cancer Society's "Look Good, Feel Better" makeup sessions.  It wasn't exactly what I expected.  I thought it'd deal specifically with how to mask the visible effects of chemotherapy, but it was more like basic this-is-how-you-put-on-makeup.  Good grief, I've known that since high school.  Well, I came home with some products I could use, so that's something.

3)  Twice now I've had to postpone my chemo treatment a week because my blood counts were too low.  I don't have much leeway to begin with, so it's not surprising that my white counts, especially, have taken a hit.  Thank God, they've come back up in time for me to get my infusions at a four week interval, with no supplementary blood-boosting drugs.  But the delays mean I won't  be finished until the 11th of October-- if I'm lucky.  It could stretch out to nearly Halloween.

4)  As far as effects go, tiredness is the main one.  It's hard to tell if I'm being lazy or if it's just chemo effect.  I know I don't get as much work done as I'd like to.  The hair, even after four treatments, isn't 100% gone, though alas, the eyebrows are flaking out a bit.  I admit I look in the mirror and see my little-old-man pate and think, "This is stupid!  I could have gone the rest of my life without this!"  But there it is.  And fortunately, I do okay with the wigs when I go out.  Otherwise, I let my head hang out around the house. And sometimes in the yard.  And the neighbors' yards.  Unless it's too hot or too chilly, that is. 

Everyone tells me how healthy I look.  This is good, I know, but sometimes I crave a little sympathy.

Or maybe I don't.  I don't like it when people patronize me over the chemo.


5)  I've been getting a shot at four different interim pastor positions the past three or four weeks.  "Three" I should say now, since one of the churches phoned me today and said they'd decided to hire someone else.  And that's the church that's given me the only real interview so far; the rest of them have been informal look-sees when I've come to supply preach.  I spent a week obsessing about that interview and getting really depressed about my prospects-- how to cover what happened in the past without making me or my former church or my presbytery look lame--, but I felt it went well on the day.  Not well enough, obviously.  But maybe it wasn't the right position for me anyway.  That church is in the middle of a worship war, with "contemporary" currently in the ascendency, and if there's anything I find to be a non-edifying, crashing bore, it's so-called contemporary worship.  I would not have been neutral, no matter how hard I tried!

I hope and pray something comes of one of these churches, since I can't support myself on substitute teaching.  (School year started here this past Tuesday, but I haven't been called in yet.)

That's good enough.  I'll try to be more diligent about posting in the future.  Besides, when you're in my position and you go silent, people might begin to worry.  I know I do.

Hair Conditioning

I know what I said the other day about systematically brushing it all out; nevertheless, this past week I've been treating my hair like each separate strand was a silver penny slipping through my fingers.  At night I've been sleeping in weird positions to avoid rubbing any more out than absolutely necessary.  I dream about how to keep from losing it any faster than I have to, and keep myself semi-awake in the process.  The other night I had myself convinced-- in my dreams-- that if I slept in the guest bedroom, I wouldn't lose so much of my hair.

Maybe if I'd been satisfied about my wig situation, but I wasn't, not yet.  Thursday evening I modelled the new wigs for the neighbors, and they said the blonde one made me look like Marilyn Monroe and the dark one like Joan Jett.  All very well, but neither of those women are me and I don't want to be running around in a costume.

But Friday night I got a call from my friend Ruth* in Kansas City.  Ruth has been through breast cancer, twice, and chemo, twice.  Both times, she lost her hair. 

"Ruth, the first time, you had a wig, didn't you?  I mean, I don't remember any between time when you looked any different, really."

Yes, she'd had her surgery in October, started chemo in November, and started wearing her wig pretty much right away.

"Did you get your head shaved, or what did you do?"

"I just let it fall out whenever it would."

Not sure why, but this was a revelation.  Suddenly I felt I could stop babying my hair; I could let it go.  And whatever remains for however long it remains, I can stick it under my wig and let it be. 

So yesterday morning I got in the shower and washed my hair.  Same routine as always:  shampoo, scalp massage, creme rinse, the whole process.  And big wads of hair came out and had to be kept from going down the drain.  Upstairs before the bathroom mirror, I brushed what was left and more came loose.  And glad I was for that, since for awhile there I looked like the Charles Emerson Winchester III character from M*A*S*H.  It's not totally gone, far from it, though from the back the righthand side of my head is a lot more denuded than the left.  But what's gone is gone and what remains, remains.

And I put on my Laura Ashley flower print dress, pulled on one of the wigs Frieda* passed on to me, donned a straw hat over that, and attended the annual Beaver Library Garden Tour.  And no one who saw me there knew a darned bit of difference.

Round Two, Week One

Received my second chemotherapy infusion yesterday.  Nurse Nell* was willing to forego trying to put the cannula into the back of my left hand this time, but the first wrist vein we tried eluded the needle when she put it in.  So it was back to the tried and true sites on the inside of my wrist.

No flashbacks to the keg parties at the college dorm from the Benadryl this time.  When I told Nurse Nell it hadn't made me feel sleepy, just drunkish, she gave it to me more slowly.  And as the afternoon wore on, I was certainly tempted to catch some ZZZZs!

I exercised some discipline and used the first hours mending two more sweaters.  I will not have the schoolchildren next fall laughing at the holes under the arms of my cardies!  That wasn't a penance, despite the heat outdoors.  They do an excellent job at the Cancer Center keeping the interior climate controlled, not too chilly and not too warm.  Haven't needed to use the quilt I brought yet.

This time, though, I didn't get as much Western Civ literature read.  Brought my laptop and wasted a lot of time trying to get online via the fragile guest wireless signal they provide.  Managed to make a couple of Facebook status reports, but otherwise I was refreshing and refreshing and trying, trying, trying to reconnect more than I was working or surfing.

My pod mates were all older gentlemen.  One being treated for abdominal cancer (Eh.  That's the metastasis from my ovarian cancer I'm trying to avoid), one getting chemo for colon cancer, and the other one, I didn't ask.  The colon cancer guy was on infusion eight in a course of twelve.  Wow.  He told me that people "sail through the first one or two treatments, but it gets rougher after that."  Uh, yes, I've heard that can happen . . . meaning that every good day or week I have is to be received with conscious gratitude.

(I'm on to preach at least three times this summer.  Wonder if I should write those sermons now, while I'm still feeling half-decent?)

They must all have been getting different medications than I, because none of them were sporting chrome domes.  Me, I'm thinning out more every day.  (More on that below.)

It was interesting, too, that I was the first one in the pod and the last one out.  I started my pre-meds a little after 11:00 AM and finished up my chemo at 4:30.  Only one other woman was there getting chemo after me. 

My report time was actually 9:45, but I saw the doctor and had my bloodwork done first.  Found out from him that yes, I may take my beta-blocker pill if I need it; yes, I can have a glass of wine or a beer if I want it; and the reason I've had the munchies the past week and a half is because that's what Decadron, the steroid they give me pre-chemo, works.  It has been weird:  First ten days post-chemo, I've craved small meals of very healthy food.  Then bang! my blood sugar was crashing at the most unexpected times and I wanted chips!  donuts!  cornbread!  hot dogs!  at all hours.  And don't show me a piece of lettuce, though every lettuce plant in my garden should bolt from neglect!  I gained nearly a pound and a half since the 21st.

Today I'm back to the healthy eating phase.  At the moment I'm consuming a nice salad of lettuce, shelled snow peas, purple sweet peppers, mushrooms, and shredded cheese, the first three ingredients all from my garden.

Last night, I ground up some more leaves and mulched more of the vegetable garden.  I'm feeling quite normal today, too, maybe because I'm heeding the instructions and taking my anti-nausea pills even when I feel just slightly queasy.

My American Cancer Society wigs have come in and the best of them is the "halo" (tonsure!) you have to wear under a hat or scarf because it has no pate to it.  All of them need the bangs feathered out and thinned down, and I'm wondering if I've been a little too daring in ordering the Sabrina model in the golden blonde.  Though I've historically been on the blonde side, the dark brown of the Caitlin looks more "me," somehow.  And whichever one we're talking about, I think I have to get used to more bulk at the top.  Must be the Current Style.  But these aren't so bulky and wiggy as my "official" cancer wig is.  It still looks awful.  I tried it on for Frieda* when she came to pick me up yesterday morning and she thinks it definitely needs major pruning.

Oh, well.  I'm thinking of taking my whole wig wardrobe over next door the next time everybody gathers on the neighbors' porch and letting them say what they think.  If the golden blonde is agreed to be Too Much, I can always try again in my usual dark brownish (aka "dirty") blonde.

Once I'm satisfied I have at least one whole wig I won't be embarrassed to be seen walking about wearing in public, I'm going to drape a towel around my shoulders, take my hog-bristle hairbrush, and brush, brush, brush my hair right outta my head.

Transitional Hairdo

Here's what I had done to my hair last Tuesday, after which my friend Frieda* and I went and gorged ourselves at the Chinese buffet.  Now I'm no longer leaving bits of myself on the shrubs in the yard, and my hair doesn't feel so much like an alien entity perching on my head.

We didn't get any After shots that evening, because my stoopy camera was eating brand-new batteries like my dog would gobble up a piece of dropped raw meat.  But here's one I took in the bathroom mirror this evening.

Oh, yes, the problem-child wig is the one you see on the styrofoam head on the left in the background.  Looks better on it than it does on me!

Shedding

Oh, if I ever lose my hair,
If my pate goes bald and bare,
Oh if I ever lose my hair,
Oh, if,
Oh, if,
I won't have to  brush!

I've been getting preliminary scalp twinges the past couple weeks, and the stray hair began floating out now and again for a few days now.  But this past Sunday evening, the shedding began in earnest.

I drove to evening service with the window rolled down, enjoying the wind in my hair (since I soon won't have that for awhile!). In the church parking lot, I ran a brush through my locks to put them back in order, hit a tangle, and a whole bunch of strands came out with it.  Yep, two weeks since the treatment, right on schedule!

Monday morning in the shower, a lot more emerged on my fingers after the conditioner.  I read online a month or so ago about a woman who, when her chemotherapy made her hair come out in the shower, collapsed on the shower floor and cried "for hours" until her husband came and rescued her.  Me, I don't have a husband (unfortunately) and none of my animals, brilliant as they are, have figured out how to work the doorknob.  So I was forced to be philosophical about the phenomenon and just towel-dry my hair as gently as possible and make sure the sheddings didn't clog the drain.

Actually, if I'm going to get horribly upset about all this, it'd be from reflecting on the fact that I've never had the privilege of identifying myself with my looks.  But that'd be a different post.

Upstairs, more strands in the hairbrush, more big wads for the wastebin.  I've also read of women who say their hair came out "in clumps."  Either they don't define clumps the way I do, or my hair's just thinning out hair after hair after hair, all over.  I was expecting to see big patches of scalp right away.  Nope, and thank God for that.  That would be disconcerting.

Until last night I kept my hair bound up in a highly-unfashionable but effective scrunchie.  Last night, I went to SuperCuts and got myself a short pixie cut, as documented by my friend Frieda.*  Transitional stage, as my long hair was starting to feel like an alien creature camped out on my head, but I just can't see myself doing the razor thing.  It reminds me too much of concentration camp prisoners and early church era shorn prostitutes and other shudder-worthy associations.  The new cut looks pretty good and it's too bad I won't get to keep for more than a week or two. 

Tomorrow I go pick up the new wig.  I had more trenchant and funny things to say on this subject, but I spent the whole day hauling river rock out of my west border and turning the compost pile, and I am exhausted.

Some Observations

I'm thinking it might be useful for me to say a few things about my first chemo session this past Monday.

(Note photo of me in back yard afterwards, with bandaged wrist. And with hair, still. Very messy hair, since the photographer had to leave and didn't have time for me to find my brush.)

• In the first place, getting chemo was a full day's work! From the time I arrived in the waiting room to the time my friend Frieda* came to pick me up, it was eight hours or more.
  
• The treatment pods have four recliners in them with four IV stands and two TVs. I was the second patient in mine Monday morning. The lady who was in before me was on her final round for colon cancer.
  
• The nurse who took care of me-- I'll call her Nell*-- was really patient and thorough in telling me exactly what was going to go on in my chemo and what side effects I could expect over the course of it. She answered questions as long as I had them. What I don't get is, why, considering that I heard all that before the drugs began to flow, I seem to have retained so little of it!? I'll be glad for Frieda's notes, when I get them.
  
• On the other hand, Nurse Nell wasn't so proficient at getting the IV started in the back of my hand. Blew up the vein-- ow! and had to go for the wrist. It doesn't look so bad today, and I wonder if they'll be able to try again there the next time.
  
• I was not at all thrilled to learn that my pre-chemo blood counts fall around the 33 percentile of what's considered adequate and healthy. I kept asking her if I could improve that by eating better. No, she kept insisting, my baseline is perfectly healthy and normal for me. It is what it is. Yeah, maybe, but I dislike having so little leeway. They have drugs they can give you to get your counts up so you can go on with treatment, but still. (I've been eating iron-rich food since Monday, anyway. Makes me feel I'm doing something for the cause.)
  
• I got four anti-side effect drugs, fifteen minutes per bag, before the cancer-killing drugs proper begin. I can't quite remember what each of them does, but the most impressive one was the liquid Benadryl. Yikes! They say it puts you to sleep; it made me feel like I'd just come from a residence hall kegger! I brought in a sweater to mend, and was taking the last few stitches when the deck, so to speak, began to roll. "Shall I give into it?" I asked myself. Decided not. So I kept my eyes open and my posture semi-upright and went on to read Sophocles' Oedipus at Colonus, even if I had to use the bookmark under the lines to keep from reading the same sentences over and over!
  
• The chemo drugs took longer Monday than they will at subsequent treatments, because Nurse Nell started them slowly to make sure I wouldn't have a bad reaction. Not sure what that would have been. Swelling up? Turning purple? Suddenly sprouting legs on top and walking on my head? Whatever it was, it didn't happen, and things proceeded according to plan.
  
• Three hours and ten minutes of the Taxol gave way to about an hour and fifteen minutes of the Carboplatin. Kept reading Sophocles through it (finished Oedipus at Colonus and went on to Antigone), even though the TV had been turned on long since by a lady who was in with her husband. Medical shows and Dr. Phil most of the day. Did you know they have an operation where they can remove half a person's brain and leave them with fairly normal function? Didn't catch what this is supposed to cure, but it's fascinating what you learn.
  
• I learned also that with all the liquid being pumped into you, if you feel like you gotta go, you gotta go. With the drug-induced unsteadiness and the shopping-cart perversity of the IV stand wheels, I couldn't help but feel I was about to be pulled over and busted for DUI on the way to the unisex can. But it was nice how nurses and other patients' caregivers would step back and let me use the bathroom ahead of them, even if they were there first.
  
• Plowed through my patient's binder, as much as I could. Every damn last possible side effect is in there, it seems, and what to do about them seemed confusing and contradictory. Emphasis on seemed. Clearly (as clear as anything was the other day!) there was no point in memorizing it all. Wait and see what happens, and go from there.
  
• Frieda and I prayed in the car before going in; my request was that God would somehow use me in this to minister to other people at the Cancer Center. Didn't think I had, really, but as I was waiting for Frieda to pick me up I got to talking to the lady there with her lung-cancer-fighting husband. Me, I thought I was just passing time and maybe being a little nosy. But when I was bidding her goodbye, she told me what a great comfort and help my words had been to her, and how much better she felt having talked with me. I suppose I shouldn't be surprised at what God can do, but I never cease to be amazed when He does it through me.
  

I've been doing pretty well since Monday. A little queasiness now and again but nothing alarming or eruptive. Some suppression of my sense of taste and appetite, but nothing that keeps me from eating anything sufficiently savory. I've gone to a continuing education session at the Presbytery office and done a decent amount of gardening; I get tired maybe before I would ordinarily, and have to remind myself that this isn't "ordinarily" and stop and do something sedentary.

I know it'll get more challenging as it goes along, but I'll jump off that bridge when I get to it.

Zombie Wars

I've often wondered why people have such an instinctual dread of cancer. It can't be simply because up till recent times it was pretty much always fatal. Tuberculosis, for instance, was just as much a death sentence and people didn't go around talking about it in whispers. My grandfather's first wife died in her 20s of consumption and from their letters I know they both knew she was doomed even before they got engaged. Everyone around her knew she had TB. Everyone was open about it; it was a fact of her life until she had no life left.

And I don't think cancer's basic horror is that it involves your own body turning traitor on you. Auto-immune diseases do that, too. So do infections. I remember a line from a Bill Cosby routine where he's recreating the scene when his mother took him to the doctor to see about getting his tonsils taken out. Doc says something like, "Kid, your tonsils are like sentries that're supposed to keep the bad stuff out. But in your case, they're fighting for the other side."

True, there is a mystery to cancer in that its cause is often so hard to trace. Otherwise perfectly healthy people (like me!) can pop up with it. It's not like you catch it from Aunt Martha at the family reunion-- in all due respect to an old lady I heard of, who kept the photo of a family member who'd died of melanoma securely wrapped in plastic, "Because it might be contagious."

But still, I don't think that's the font of the primal fear of cancer. I think it has to do with our dread and loathing of zombies.

Yes, zombies. Ever notice how our society's sick fascination with those monsters has grown along with our rising cancer statistics?

Anyway, I'm no expert on the Undead, but cancer cells and zombies have a lot in common. Both are mindless. Both have no "purpose" but to devour and assimilate the living. Both replicate themselves in fast and horrendous ways. Neither contribute to the good of the body (politic), but rather, feed on it and destroy it. And worst of all, both zombies and cancer cells are frighteningly difficult to kill.

Speaking seriously on cancer, I read someplace recently that that's what makes cancer, cancer. Ordinary helpful healthy body cells do their jobs then die off and are replaced. Cancer cells have mutated so they don't know it's time for them to die. They're so biologically brain dead, they don't even know they're damaging the body they infest from the word Go.

The idea of something mindless and destructive and horrendously hard to kill growing in you and taking over your system is inherently creepy. No wonder people have traditionally feared cancer and not wanted to mention its name. You don't want it to be true, and at the same time, you don't dare ignore it, unless you want your innards to be the physiological equivalent of those popular zombie-apocalypse films.

We are told on Very Good Authority (Wikipedia, right?) that the only way to destroy a zombie is by going after its brains before it goes after yours. Fighting cancer, we have a few more weapons, which is good, because this battle is real.

And I, tomorrow I'm engaging in front number two in my own zombie wars. We had the cutting-out campaign in late April; in the morning we begin the chemical warfare. I expect to be a bit battered before it's over this September: you have to expect to take a few hits when you're combatting the Undead. But fight I shall, and by God and St. George*, I expect to win.
________________________
*You'd think I'd invoke St. David, wouldn't you, if I'm going to invoke a saint at all. But St. David isn't known for his military prowess, and St. George is. Besides (should my fellow-Reformed object), I'm being more literary than religious. 'k?

Too Much Drama

A rant, with a moral in the tail:

Got a call early this afternoon from the mechanic's, saying my car was done and I could come get it.

I've known since late Saturday afternoon that my neighbor was right, the front brake rotors needed replaced. And since I pulled the codes off the car myself on Thursday, I knew that the check engine light was on because of something wrong with the knock sensor and because the car was misfiring on all cylinders. Yesterday, the mechanic called and said he'd located a Technical Service Bulletin from Chrysler describing this problem and recommending tackling it by replacing the sparkplugs and wires and installing (reflashing) an update onto the engine computer. This turned out to work, and now the car was fixed.

I'd picked this local garage-- I'll call them O'Brien's*-- over the dealership because the latter is several miles up the Interstate and I was nervous about driving the Little Red Dragon far and fast with an undetermined misfiring problem. True, last time I dealt with this mechanic, he'd expressed some odd and alarming opinions on the moral wrongness of customers bringing in parts for him to install, on the principle that to deprive an auto serviceman of the markup was to take food out of his children's mouths. He thought the same about shade tree mechanics who fix friends' cars very cheaply or for free: not that it might not be wise in terms of getting a good repair, but that it was actual theft from the professionals. But this time there was no question of bringing in pre-purchased parts or letting an amateur have a go at it; I needed a shop that had Chrysler diagnostic equipment and didn't require too much driving to get to, and O'Brien's fit the bill.

So I walked over to pick up my car. As I wrote out the check to pay the bill, I asked Mr. O'Brien some questions about what had been done so I understood it. Everything seemed to be amicable and informative. One thing I inquired about just before I went was, should I expect anything different about the way my PT drove at first, since I'd read that a computer reflash could necessitate its needing to "relearn" some things about how you drive and all. He told me it might be a little rough on idle for a bit, or maybe stall out when I stopped at intersections. But it'd get over that soon.

Good, that's the kind of information I needed. I took my keys and my paperwork and went out and got into my little red car. No check engine light on, great! but it was making a high-pitched jingling sort of noise!

What is this? I know it wasn't doing it when I brought it in. Was this part of the computer's relearning things? I nearly reparked it and went back into the shop to ask, but thought well, maybe it was.

I had to go by the Post Office to get stamps, and by the time I got over there I decided I had to find out. The noise could be heard on idle or while driving, and it wasn't going away. I got out my cell phone and called.

Mr. O'Brien was put on, and when I comfirmed that yes, it sounded like crickets, he said, "That's probably a belt."

"Is that part of the computer relearning things? It wasn't doing it before."

No, he said, it wouldn't have anything to do with reprogramming the computer, and I should bring it back and he could take a look at it.

So I did. By the time I got there, it wasn't jingling at idle anymore (maybe because there had been slightly-rough idle, which now had settled out), but when I revved the engine, there it was. He located the problem belt for me (found out a little later it's the one for the alternator), and that's when things got very bizarre.

I can't guarantee the chronology of the conversation, and maybe it doesn't matter. But Mr. O'Brien proceeded to inform me that he'd been very offended when I'd told him that "It wasn't doing it before," because that was as much as to accuse him of having caused the belt noise himself. That it probably was doing it before, I just hadn't noticed, and now I was noticing only because he'd worked on it. That when he used to work for a dealership, customers would bring cars back with issues like this and they'd put a new belt in for free, but he couldn't afford to lose that kind of money on things that most likely had been going on before anyway; indeed, he said, he'd noticed the noise but I hadn't mentioned it for repair, so far be it from him to run up my bill by being like the dealerships and suggesting it be replaced! And, he said, he has Asperger's Syndrome so he's very precise and does everything in a very set, determined way and now I was bringing my car back and implying that he'd done something wrong by-- by what, I'm not quite sure. Close as I could tell, he thought I was accusing him of some incompetence that made the belt suddenly start to jingle and chirp.

All through this, I'm in conciliation mode, telling him no, not at all, it's just that it was new to me and that I wanted to make sure all was well with my car before I got it too far away. I tried to adduce an example of a time when something unrelated did go wrong with a car just after I'd picked it up from the repair shop, thinking to say, "Hey, it happens, that time I was glad I brought the car back, I learned from that experience, so now I'm doing the same."

He wouldn't hear it. "That makes as much sense," Mr. O'Brien said, "as me saying I had a bad experience at the dentist when I was five years old and now I won't go to the dentist." I could not get him off his idee fixe that by noticing the belt noise I was somehow insulting or condemning him and his work. And once he mentioned his Asperger's, I went into pastoral care mode. Let's be understanding and gentle and all the rest of it.

It did no good. He kept insisting the noise had been there all along and to "prove" it, told a story of how his sister-- his own sister!-- had started hearing some noise or other right after he'd fixed her car for something, and the noise and the repair had been totally unrelated! If his own sister could do that, why then, certainly I--!

His anecdote was even less to the point than my story about my old Mazda twelve years ago in Fremont, Nebraska, but no use in mentioning that. Especially not when he was growing ever more defensively emphatic that I had deliberately insulted him by bringing the car back when he'd said it was the belt. There was nothing wrong with the belt, he said; his own car has been making noises like that for a long time, and, he was sure, so had mine!

I nearly got angry back at him as he kept on like this, imputing thoughts and motivations to me that were grossly unfair and untrue. But I remembered who I am, and I considered his Asperger's, and kept my anger down. But when he wound up by saying that he's a trained professional and he knows what he's talking about, I couldn't help it-- I said, "Well, I'm a singer, and I would notice if my car was making a high-pitched noise like that."

"You're a singer?" he said. "So am I." And he goes back into the shop and brings me a CD of country-western tunes penned and sung by his brother and himself. I haven't listened to it yet.

But back there on the street, I was so busy playing pastoral counsellor that I never got around to saying, "Never mind when the noise started, how much would it be for you to make it go away? How much just to replace the belt right now?" Maybe since he thought it was actually still good . . . He certainly never suggested that solution, he was too busy questioning my motives and assumptions.

So I took the CD in the PT and drove away. I had errands to run. The belt noise was a maddening, headache-inducing whine. At the supermarket, I decided, no, I didn't want perishables in the car until I'd dealt with this. Screw Mr. O'Brien's attitude towards customer- bought parts, I was going to the neighborhood AutoZone to do something about it.

The nice clerk there first tried to set me up with a can of belt conditioner. He even came out with me and sprayed it on.

It didn't work. The belt chirped and jingled as much as ever.

He looked more closely at it. "It could cut soon," he said. (The clerk, by his nametag and appearance, seemed Persian in origin. So it didn't surprise me that his English was a little creative.)

"You mean, break?"

"Yes. Break, cut. Especially out on the highway. It's getting worn."

Now, you could say this is just the opinion of a guy at the auto parts store. But let's say he's right. Mr. O'Brien said he didn't do anything with the belt because I hadn't mentioned it. Well, I originally booked the repair session because of the engine light only. I only mentioned the brakes because my neighbor said something to me about it later on. You mean if I hadn't said anything about the brakes, Mr. O'Brien wouldn't've fixed them, either? I'd been thinking I wouldn't go back to him because I can do without the defensiveness and the drama, but if he's going to use his Asperger's as an excuse to overlook unsafe situations, I don't want to go anywhere near his shop again.

I bought a replacement belt. The auto parts guy said it would be easy to put on, pointed out how under the hood, and even printed me out a diagram on how to do it. He said the area repair shops get their parts from them anyway, so it'd save me time if I had it already. And if the shop preferred to get it themselves, I can bring it back. Sounds fair to me.

Then I called another repair shop in town. They didn't seem to mind me bringing the belt, but they couldn't get to it till Friday. Friday! I've got places I have to get to! Maybe I know some guy that'll put it on for me?

After that, more errands (no highway driving). Noise still there, drilling into my brain. And the feeling of depression, weighing into my soul. Damn! a week later, and my car still isn't fixed, I'm having to spend more money on it, and here I can't insist on sensible treatment from the repair shop because the owner has an autism spectrum disorder? Why don't I just start whining about having cancer? (Oh, yeah. Because I don't want to go on the assumption that I still "have" cancer-- the chemo is only for "just in case"). Or maybe I can justify being a pain in the ass because I'm going in for chemo this next Monday? Does having Asperger's absolve a person from trying to see something from another's point of view, especially when the one who has it is aware of his condition? I hated being falsely accused! I hate being broke! I hate that my hair won't lie right and looks awful all the time! I got more and more depressed and had to make a special effort to smile and be kind to the people I encountered as I finished my shopping.

Getting home and making a meal of lots of fresh fruit and tons of (homegrown) lettuce elevated my mood. But now that I've had my rant, I have to remember that defensiveness is not pretty or productive, no matter what causes it. I have to buck up and remember that in the weeks to come, my feeling pleh from chemo will give me no license to inflict my discomfort on other people. It's not their fault I'm fighting cancer. May I refrain from doing drama unto others, as I would not have them do drama unto me.

Something Really Silly . . .

. . . and then I'll go deadhead roses.

I was being a little negative in my last post about the chemo baldness covering catalog the Cancer Center gave me on Thursday. But I have to admit that the models all looked very nice in their hats and turbans and scarves. And I don't think it's just because they're all young and high-cheekboned and wrinkle-free.

I have some scarves in my wardrobe, and I was online last night looking up tying techniques. I found some really cute ones here. But I found one site, which I will not link to out of consideration for the cancer-patient model, where the look was depressing and just plain awful, no matter how many twists and tails she gave it.

Was it because she was older and chubbier and jowlier than the girls in the paper catalog? Was I looking at her and thinking, "Oy vey, is that the best I'm going to look in a scarf? Yuck!"

But then I discovered what was wrong. The model in question had a low forehead to start with. And then she had tied every last one of her scarf styles tight, tight, tight to her head, just a little below her (former) hairline. No matter what style she sported, she looked as if somebody had sliced off the top of her head à la Thomas à Becket and the scarf was just bandaging the gory wound.

Give the paper catalog company credit. All their hats and turbans are built up in the crown, all their pre-tied scarves are worn down just above the eyebrows, and they all look stylish and cute. What's more, they sell a little quilted cotton cap and a padded scarf liner you can wear under your scarves and kerchiefs to add height and volume. Good thinking!

I'll keep this in mind. High and tight-- tacky. Low and loose, lovely.

Now I really go gotta deadhead roses!

Some Nice Straightforward Dithering

Yesterday I had my introductory appointment with my chemo doctor, Dr. L. My friend Frieda*, who'd been to the same practice when she was being treated for breast cancer, went with me and took notes.

There weren't really any major surprises about this part of the deal. I'll be getting my chemo through an IV, not through a port as I'd thought (thanks to the UPMC radio ads/public service announcements that've been running lately)-- my Stage 1 cancer doesn't warrant the big-gun doses that come with a port. Half hour of Carboplatin each time, then three hours of Taxol. I could have sworn the doctor said it was the other way around, but that's what Frieda's notes say and that's why I had her there taking them.

I'll have pills against nausea and Benadryl against some of the chemo side effects. Yep, this will all make me drowsy/spacy, and yep, not a good idea to try to drive myself home afterwards.

They'll check my blood cells and CA-125 levels each time. If the cells counts remain sufficient, the every-three-week schedule will continue; otherwise, I'll have to hold off a bit till they come back up.

I asked about supplements. A regular multi-vitamin might be okay, Dr. L said, but dosing up on one nutrient or another won't do me any good and may do actual harm. Better to do my best to maintain a healthy, balanced diet.

What about hydrocortisone creams? I'd read somewhere you can't apply steroids like that during chemo, but what am I supposed to do, mosquito season is here! No, he said, there's no problem with that, I can use them all I need to.

But speaking of skin care . . . I'd hoped my Sun Protection Factor 15 face cream would do, smeared on the top of my soon-to-be-bald (sob!) head. Nope, he said. SPF 50, at least. Wear it all the time outside, whether I have a hat on or not. "I'll get you some," said Frieda, who's recently started a job at a drugstore. "We have it on sale."

As to post-chemo-session side effects, they may not kick in till two days after. If five days afterward I'm still losing my lunch (or throwing up my immortal soul, as Mark Twain once memorably put it), that's the time to call the Cancer Center or the ER.

As I said, this was pretty much all fine-tuning and logistics. I didn't exactly thrill to the thought when Dr. L tole me what his mentor in med school, who is "an ovarian cancer guru" would have said about the fluid-filled capsule that ruptured in me. Dr. O, he said, would have classified my cancer as a Stage 2 because the sac was stuck to the abdominal lining, the peritoneum. "Hey! I don't need that!" I protested, doing the anti-vampire finger cross at him. "1C is bad enough!"

"No, I'm not saying you're Stage 2. Just emphasizing that you've absolutely made the right decision to go for chemo."

Oh, all right. Besides, no cancer was found in the solid areas of that capsule. Or in the scrapings of the peritoneum (taken from where it was stuck to, I should think???)-- they came up negative, as well. So there.

I mentioned that I'd learned online that my particular form of tumor is very rare as ovarian masses go, and that in 95% of those cases (or some number like that), it's benign. Just my luck to come out on the other side of the odds!

Yes, that's true, but at my stage and grade it will respond well to the chemo-- if there's any cells that escaped at all. Nice to hear, since I'd been on a cancer support chatroom where a couple of patients had said they'd been told that this mucinous kind is resistant to chemotherapy. Bugger that. If-- if!-- there's anything there, we gonna kill it dead.

We scheduled the first treatment for June 14th, after my birthday on the 12th and after school's out on the 9th. I'm doing mine on Mondays, so I'll (God willing!) be recovered enough to preach on any given Sunday this summer. The 7th was the date Dr. L suggested at first, but with my case, he said, another week wouldn't matter.

After I got dressed, it was off to the blood lab to give a sample so my base count could be determined (Frieda didn't have the nerve to stay in the room and watch-- shades of her own treatment), then to the scheduling desk, then to an interview with the financial aid counselor, concerning which I shall maintain a discrete silence.

Still all pretty darn straightforward. The dithering part begins with the brochures and pamphlets and certificates the scheduling nurse gave me about wigs and turbans and other headcoverings.

My hair should start falling out two to three weeks after the first treatment. I'm going to have to have some covering options, because this kid is not going "bold and bald." The world is not ready for the horror, nor am I. And laugh if you like, but I have gut-level religious objections against going around shaven and shorn, even chemically. But last night I'm looking at the wig catalog they gave me, and I'm thinking, these are inexpensive, that's good, a lot of them are cute on these young, high-cheekboned models, but I'm not madly in love with any of these styles for me, and none of the available hair colors really match mine, and do I really want to get something like this mail-order? And don't ask me why, but the fact that this company has given all their wigs girls' names really gets on my nerves. "Oh, golly, the best-looking wig is named 'Esmerelda' and a girl named Esmerelda was my worst enemy in grade school and now I gotta go round with her on the top of my head??!!!"

What I want to do is go to a local shop and have somebody advise me. Actually, the cancer center did give me a reimbursement certificate worth $200 that's good at a couple of area wigmakers. But there's still the question of real vs. synthetic and maybe real is way out of my price range and they say that it's harder to care for anyway, but what if synthetic is plastic and fake-looking and-- and-- and--!!!

OK, kid. Calme-toi, m'amie. Frieda has offered to bring me her wigs to show me what they're like, and I'll take her up on that. And I have the number of the nearest wig shop where I can redeem this certificate, and I can call tomorrow and make an appointment.

It. will. all. be. fine!

It may sound weird, but it's important for me to have this hair/head covering thing worked out before I start chemo. People are sympathetic enough already without me running around looking like "that poor cancer patient." And while I can forget and ignore the hysterectomy scar that's healing very nicely on my belly, every mirror will remind me that something in my body turned zombie traitor on me. I prefer to spend as little time as possible the next few months with my hopefully ex-cancer getting in my face.

Do You Want to Go for a Ride?

I am two years and six weeks old. I am lying on a strange, high bed set outside a door in a long, gray corridor full of doors. Suddenly, a dark-haired young man in a white coat looms over me. His face is marked by disapproval, and a little alarm. His expression voicelessly rebukes me: "Why aren't you asleep?" (I know this grownup look.) He recovers himself, applies a smirk, and says to me, "Little girl, do you want to go for a ride?"

"Do I have any choice?" I think to myself.

I don't. I'm about to be taken to surgery to remove a benign cyst that has closed my left eye. I am not aware of this, or I had forgotten it, but I yield where I cannot rebel. More young men in white coats come, the high bed turns out to have wheels, and off I go.


Yesterday afternoon I had my first follow-up appointment with Dr. C, my gynecologic oncologist. Though nobody told me this ahead of time, I figured the agenda would cover checking up on how I'm doing post-op and discussing my further treatment.

I've been remarkably free of what is called "cancerhead"-- uncontrolled and fearful obsessing over one's cancer and its implications. But going into this appointment, I had three things I hoped would happen or that I would not have to face.

First, that I could ask my surgeon how my ovarian tumor came to rupture without coming across as judgemental or as casting aspersions on his competence.

Second, that he would not, in anywise, suggest or recommend radiation therapy. It's one thing if you're fighting breast cancer, but there's too much essential equipment in the abdomen that can get permanently fried. And according to accounts I've read online written by women who have gotten radiation for ovarian cancer, at some point in the process they administer the treatment by way of rods put up your . . . well, you know. O noes!! Du nawt want!!!

And third, that it would all be straightforward and conventional and I wouldn't have to make any hard choices. Did I want to go for a ride? I don't know, you're the prominent gynecologic oncologist, you tell me!


It worked out well that Ellen*, the friend who drove me to the doctor's office, is a Registered Nurse-- not in oncology, true, but knowledgeable and able to take notes while I asked questions. Did I want her in the exam room with me? You better believe I did.

So there we are, waiting, and in comes Dr. C wearing a bolo tie. Don't mess with Texas? He grins and says, "Boy, you just have to cause trouble!"

"Yeah, gotta be original!" I quipped back.

How original I am, he was about to tell me, right after my exam. Seems that when they got me open, they found that the tumorous ovary was lying on top of a sac of clear yellow serous fluid-- "It looked like pee, if you want to know." The ovary was adhered to it and it was adhered to the tissue below/anterior to it-- "Like endometriosis-- I had a terrible time getting it all off." It was this sac of liquid that ruptured; the problem ovary itself came away whole. And the quandary is, was that sac part of the tumor or something entirely separate stuck to it? The serum in it looked nothing like what was in the ovary (which Dr. C said "Was full of brown sludge.") And when the lab tested some of the serous fluid, it came up clear of cancer cells.

So that took care of concern No. 1. I'd figured adhesions came into it . . . Could that have been the septation Dr. P my gynecologist had shown me on the sonogram in February? "Oh, that ovary was full of septations. Like a bunch of grapes inside." But attached like a bubble head out the end of it? No, Dr. C didn't see anything like that. "Could what we saw have been this sac behind the ovary and on the sonogram it looked like it was in the same plane?" "Very possibly."

Which led us to the question of what to do about it all. "You've got a choice," my surgeon said, "And there's no right answer." **

Oh, no!!! You're just supposed to tell me what to dooooo!!!!! . . . Take me and my gurney and just wheel me down the hall!!

"Here's your choices. We can assume that the fluid under the ovary had nothing to do with it and the cancer was restricted to the ovary. The lab had to take several sections before they found the cancer in it. That would put you at Stage 1A. The tumor was Grade 1, very well differentiated, and that's the least aggressive kind. Chemotherapy would make no difference in your prognosis, the surgery took care of it all. We'd just monitor you every three months with a CT scan, an office exam, and a CA-125 test. And you'd watch to see how you felt and if you had any symptoms. Then we'd go to six months if there was no sign of recurrence, until you were five years out.

"Or . . . we can assume that the sac we found was part of the tumor, and since it ruptured, that puts you at 1C. A third of the time a test of fluids can come up showing no cancer cells but cancer is present. You can do chemotherapy to make sure there's no cancer in you, and again, we'd do the tests and watch and see."

He paused. "So what do you want to do?"

Oh, phooey. So this time I have a choice whether I want it or not.

Dr. C said that even at Stage 1C, the recurrence rate is really low, only 10% - 15%. "The probability is that you are cured."

He went on to say, "Now, chemo is poison. It's there to kill the cancer cells. It will kill healthy cells as well. But if you do chemo, things go back to normal. But with radiation, the damage is done and can't be undone. And there's a lot in your abdomen that can be damaged." In other words, radiation is not indicated for me-- yay!!!!

"It's up to you whether you want to do chemo or just watch and see."

I felt myself poised at the brink. I flirted with the idea that I could take my chances and not have to undergo the expense and rigors of chemotherapy after all. A reprieve?

But what if I was wrong?

I asked more questions and Ellen did, too. Dr. C said, "Have you ever heard of the term 'analysis of errors'?"

Ellen had; I had not. "No . . . is that like Worst-Case Scenario?"

"Not exactly. It's considering what could happen if you make the wrong decision. If you do chemo and there was no cancer there anyway, you've gone through all the stress of chemo for nothing. But you'll never know that."

"Like, 'See how great my elephant repellant works-- we never have elephants around here at all!'"

"Exactly. And if you don't do chemo and the cancer does come back . . . We couldn't talk about a cure anymore. The cure rate for recurrance is only 3 to 5%. "

Oh! I'd say that was a piece of information I needed . . .

"I'd be in remission only?"

"Yes, and remission for ovarian cancer would probably get you only two and a half more years. We can't just go in and take a tumor out. When ovarian cancer remanifests itself, it's all over the abdomen. Have you ever seen algae on a pond?"

"Yes."

"It looks like pond scum. It covers everything. We can do our best, but we can't get it all." And if I understood him right, at that stage you can't use the first line platinum-based chemo drugs, because the cancer will have developed a resistance. Or was he conflating this with what happens if one does chemo and it comes back anyway?

He explained that the metastasized cancer covers the organs and keeps them from reasbsorbing the four to five liters of fluid that wash through everyone's bellies every day. Which is why women with advanced ovarian cancer bloat up. "It's called ascites."

"Was that sac of fluid you found in me ascites?"

"No, no sign of ascites in you."

We asked more questions. He said they've developed good anti-nausea drugs that you get before chemo. "They make you drowsy, so most women just sleep through the therapy. Afterwards-- it depends on each person, you'll probably feel like you're getting over the flu for the next couple of days."

Ellen said, "I've had patients who've asked me, 'Is there alternative medicine for this?'"

"If there was, we'd give it," Dr. C answered her. "The alternative is, you can die."

More questions, more answers, more going over and clarifying what had been said before. Talked about statistics: Every year (in America?), about 20,000 women get ovarian cancer and in the same year 16,000 or so will succumb to it. And about odds and percentages. One can play them when dealing with large groups, but when it comes down to oneself, the odds are either 0 or 100%.

If it were to come back, my kind of ovarian cancer would recur somewhere in the abdomen. It isn't metastasized through the bloodstream, so it wouldn't go to the brain or bones or wherever.

Some comfort, when you consider all the damage it would do in one's midsection! Though maybe it's good to limit the twinges one could get cancerhead about.

For me, though, the fact that my cancer was caught at Stage 1 weighs heavily towards total cure, whichever way I would decide. Unlike for 80% of ovarian cancer patients, who aren't detected until they're Stage 3 or 4.

Finally, Dr. C looked me in the eye and said, "All right, do you want to do chemotherapy?"

I looked back at him and said slowly (and I thought, meaningfully), "I don't want to do chemo . . . "

"All right," he said briskly. "That's your decision."

"No, listen--"

"No 'buts'!"

"No, listen! Do I want to do chemotherapy? No, I do not. Do I think it might be wise to do chemo? Yes. Do I think the consequences of not doing it now and wishing later I had are too great? Yes, I do. So yeah, even though I don't want to, yeah, I'm going to do it."

Sheesh! Enough with the drama already! I didn't want to get ovarian cancer, either, but I've got it-- or at least, I need to make damn sure I've no longer got it-- so I have to deal with it, whether I want to or not.

Dr. C told me what it would be, and it was very familiar from my on-line reading. Six courses of Carboplatin/Taxol, one every three weeks. Happily, there's a UPMC chemo center a mile and a half from me, so I won't have to get a ride downtown. "The chemo's the same everywhere in the hospital system, no matter where you get it." He'd have his nurse look up the number and get in touch with the chemo doctors to set up an initial appointment.

I asked, oh yes, what about leukemia as a side effect? Ah. That's a danger for very young women, in their teens and early twenties, whose blood cells are still developing. (Or something of the sort.) "You're still young," he allowed, "but I think you're a little past that!"

Yeah, I'm not a little girl anymore. And this time, when the medical guy asked did I want to go for a ride, I did have a choice in the matter. Later this summer when my hair has fallen out and I'm feeling groggy and grotty and my mouth tastes like old aluminum, I may temporarily regret my decision. But given the fact that I've got my support system and my financial aid in place and my momentum's going, and given the consequences of being wrong, I think I've made the right one.

___________________________________
**Some dialogue word-for-word; other parts reconstructed or conflated.