What It Looks Like

Prior to last August, I think I did not have much visual image of cancer or oncology. I understood cancer at a technical level, in fact I enjoyed finding cancers in non-animal systems: witche's broom trees, for instance, or certain kinds of computer errors. But I had no particular idea what cancer treatment looked like.

Perhaps this is unusual, but it was my experience. Cancer is no longer the unspeakable, deviant illness it used to be, and in the last few years, Livestrong bracelets and pink ribbons and the like have become so common as to be clichéd. But I was not that familiar with oncology as a life event, and I think it's likely that many of my age peers aren't, either. In the last few months, we have heard from scores of people who have been through cancer, either their own or a loved one's. The experience is very common, then, but it is still in some degree mysterious.

I knew that cancers were typically treated with chemotherapy, radiation, and surgery. I knew that the first two strategies targeted more proliferative cells, causing substantial collateral damage throughout the body. I knew that this was still (very) dirty medicine, but that it could also be incredibly efficacious. But, again, I had no idea what those treatments actually looked like. So, in the spirit of demystification, here they are. This is (very heavy) chemotherapy:



The cytoxan is the little plastic bag with the blue tag up on the right, I believe. The other small bags are an anti-nausea medication and some potassium. The larger bags are just saline: the chemo agent chemically burns tissue, so it's imperative to pee a great deal when you're getting it, and for a long time afterwards. The chemotherapy regimen, in this case, is two rounds of that little blue bag, 24 hours apart. It take about an hour to drip in and doesn't typically cause any immediate side effects beyond nausea.

We have been discussing appropriate visualizations for the effect chemotherapy has on the body. Susannah likes to visualize falling snow, but this is not so much a direct metaphor for the chemo as a meditative technique. The issue of just what the chemo is doing is an important one, psychosomatically. Unlike most medicines, chemotherapy is unquestionably toxic and it is easy to fall into the language of it “killing you;” it is, indeed, designed to kill her currently malfunctioning immune system. But visualizing medicine as poison sets oneself up for a nocebo effect. The usual metaphors for chemotherapy (like so many metaphors for struggle aginst adversity) are martial ones. But again, this becomes problematic for a Quaker and a pacifist. As Ellie Daniels pointed out to Susannah, substituting a sociopathological metaphor against a physiopathological disease is...well...complicated to the point of not being helpful.

The metaphor I've proposed is that chemotherapy is like a maître d’ who has to deal with very boisterous, obnoxious guests. And he (or she) has come up to the table and is saying “Excuse me, sirs, I'm afraid I have to ask you to leave. You're disturbing our other customers.” It's kind of ugly; it spoils everyone's evening a bit. But it isn't warfare. Susannah's metaphor is that chemotherapy is like trying to corral a difficult house-guest, who insists on doing the wrong things. In fact, she has a particular one in mind: a five-year-old Albanian kid who visited us once, drew all over the walls, and proceeded to lodge himself forever in our memories. Ahem.

So. This is radiotherapy, the tele- kind rather than the brachy- kind where you drink radioactive agents:




The guys at Dana Farber / Brigham are really pleased with this radiation unit, which is apparently unique in all the world. In spite of that, or, indeed, because of that, it looks like kind of a hack job when you're up close. The plastic covers are sort of taped in place, and the frames—especially the one on the floor—looks like something someone knocked together in their garage. And there's a lot of, well, string. Because, of course, it's one of a kind. I've seen the Grenoble synchrotron, and that didn't look mass-produced either.

So, basically, it's two X-Ray cameras with extra dials and no film, all inside a sort of bank vault looking place. Susannah got a preliminary X-ray to have the outlines of her lungs traced, on her body, in alcohol pen. (The lungs, being much less dense than the rest of the body, need shielding. They are smaller and less symettrical than I would have thought.) Lead cutouts get taped to her, front and back, and then she lies on this bed and gets zapped for, in this instance, 18 minutes. Seven times, at intervals of 6 and 18 hours. She just finished that this morning.

(Macintosh immodestly points out that Cheryl sent me this picture on her iPhone. But she only sent it about a foot and a half, so I'm not too impressed.) The TV on the left of the earlier picture, which I believe only plays VHS, comes pre-loaded with Star Wars. More on that later. She's wearing a mask and gloves in this picture because she's outside her isolation room, so there's a risk of her picking up stray bacteria. More on that still later.

The side effects of radiotherapy are, of course, radiation sickness. And there is no better way for we Americans (with our penchant for war metaphors) to understand radiation sickness than through our handiwork at Hiroshima and Nagasaki. And so, apropos of something or nothing, I want to recommend two rather grim novels from the Japanese canon, one text and one graphic. Masuji's Black Rain, and Nakazawa's Barefoot Gen. I want to especially recommend the later to those of you who think graphic novels are a descent into illiterate anti-intellectualism, like the satanic rock-and-roll music the young people listen to these days, etc. Check it out. I'll lend you my copy.

And that is what chemotherapy and radiotherapy look like. In this instance.