See the Alpha Male Oncologist, hear him ROAR!

Day 115 

General status update

Neutrophils: all present and correct, surprisingly.

Fatigue/weakness: profound

Anxiety level/insane euphoria (+/- 1-10,000): expect sharp upwards progression towards the insane euphoria end of the spectrum after the delivery of the Dexamethasone prescription tomorrow. CAN’T WAIT.

Nausea demon: he’s getting an early night before going back on duty for FEC6 tomorrow. He can’t wait, either.

Chemo Muse: she can’t wait  for me to give over with all the feebleness and wimpish flopping about in exhausted attitudes on the sofa, and get back to bouncing off the walls and writing up a storm in the post-FEC Dexy Frenzy. And I'm with her on this one.

Despair Demon: looking all moony again, and seems to be writing sonnets back in his den in the airing-cupboard – can there be anything more tiresome than a Chemo Demon in love?

Chemo Brian: reading what he describes as an ‘urban fantasy’ novel. I’m thinking it’s probably not Plato’s Republic.

State of mind: not testosterone-friendly, tonight.

Hair: readying itself for some snood action tomorrow. Talking of which, Vicki sent me a dog-in-snood photo this morning, to cheer me up, and it made me laugh immoderately. JOB WELL DONE.

I came across a new sub-species of doctor today, down at the oncology clinic at the Charing Cross Hospital: the Alpha Male Oncologist. That’s an important new sighting for my I-Spy Book of Oncologists; I’m close to completing the full set now.

My heart sinks this morning when I am called in for my final pre-chemo appointment by yet another new registrar who doesn’t know me or my history; during my six pre-chemo appointments, I have seen 4 different oncologists, three of whom have been sprung on me unannounced. It doesn’t really matter: they’re all skilled and efficient, they all tick the boxes required to ensure you are fit and ready for your next dose of chemo, and they all prescribe the appropriate drugs, but it’s very wearing having to both explain yourself anew to, and try to establish some kind of rapport with, a new doctor before every dose of chemo.

I have at least seen  (Her Blessed Holiness) Matron Becky beforehand, as she offered to take my bloods early so they would be ready in time for the appointment with the oncologist.

Becky is inclined to think that postponing the chemo for a few days, say until Monday, might not be a bad idea, whatever the level of my neutrophils, given just how weak I have been for the last few days.  The 3 week chemo cycle, she says, is designed to give your body enough time to recover your strength before your next dose of chemo, and it is obvious that I am currently nowhere near full strength, possibly because of the virus last week, or perhaps because my body has now been battered by 5 doses of poison. Maybe listening to my body might be a good idea, whatever the neutrophils say. Or perhaps they could give me a slightly smaller dose this time - this often happens. She will email the registrar about it, the nice registrar Dr V, who gave me all the extra steroids last time.

At the oncology clinic a little later on, however, I get to see the holiday relief registrar, Dr S, instead.

I’m still feeling so rotten that I’m half-inclined to agree with Matron Becky about a short delay, despite my intense desire to get FEC6 over with tomorrow. In the interests of full disclosure, and because it is probable Dr S won’t have seen Becky’s email (it not having been sent to him), I mention this conversation, after he asks me a couple of questions about nausea which are really no longer relevant, as we are totally on top of the anti-emetic medication now, after 5 doses of FEC. He doesn’t know this, of course, because he’s never met me before.

I am half way through a sentence beginning ‘Becky suggested it might be a good idea for me to delay the chemo for a few days, and I think..’ when Dr S interrupts me.

‘That’s a decision I will make’ he says ‘when you have answered all my questions.’

There is a very strong emphasis on the ‘I’.

Well, that puts Matron Becky and me firmly in our places, then.

I’m deeply unimpressed that this man chooses to dismiss out of hand the view of his colleague the Chemotherapy Matron, who knows me well and who has personally been looking after me for the last few cycles of FEC, after the many problems occurring during my chemotherapy treatment, but it’s clear that neither Becky’s or my opinion counts here. What counts is whether, in his judgement, I fulfil the clinical criteria for being physically fit enough to withstand another dose of chemo. Other input is not welcome.

And you know what? I am just too weak, too mentally and physically exhausted after 7 months of cancer, and 4 months of chemo, to argue any more with yet another AMA (Arrogant Medical A******).

Yeah, whatever.

So, quite uncharacteristically, I shut up, answer the questions, offer no further unsolicited remarks and await Dr S’s clinical judgement, which is that I am perfectly fit to undergo the last dose of FEC, so long as my neutrophils are in order (which, an hour after our meeting, the blood results show that they are).

I have been efficiently processed through the system, and the requisite boxes have been ticked.

We have come full circle now, from my first day at Charing Cross Hospital last September, the day of my biopsy, when the spectacularly discourteous consultant breast surgeon, Mr G, failed to introduce himself to me at the start of our meeting and only gave me his name, with reluctant surprise, when I demanded it before leaving the room. Now, seven very long months later, I am confronted by a complete stranger, not previously involved in my care, telling me that any decisions about my final dose of chemotherapy are his, and his alone, to make.

The fact that I feel like s*** is neither here nor there.

Patient/nurse input not necessary.

*     *     *

I did discuss all this further with Becky later, on the phone. Between us we decided that even though I am feeling so rotten, the psychological boost of having the final chemo on schedule probably outweighs the further physical battering FEC6 is about to give me. She did warn me, however, to take it very, very easy after the chemo, as it may take me longer to recover this time, given how weak I currently am even before they pump the toxins into my system again tomorrow. I would no doubt have reached the same conclusion with Dr S, had he been inclined to open the matter up for discussion; I feel a whole better about it now, though, having been given the opportunity to talk it through with God’s Own Matron. I am SO going to miss Becky as I stride off into the sunlit uplands of my post-chemo future, but she has said I can call her any time.

That’s what chemo patients need, ye Gods of Charing Cross Hospital – someone they can talk to, who knows them, and who cares. Matron Becky, unfortunately, can’t do it for everyone – she gets to troubleshoot for patients like me, who have problems. But it makes me think that the move towards nurse-led pre-chemo meetings for patients will probably be a very, very good thing.

Far better 30 minutes with an expert nurse who knows you, and has time to talk through your issues, if any, than 10 minutes with an oncologist whom you may not have previously met, who may or may not be familiar with any of your history, and whose clinic is probably running more than an hour behind (oncology clinics almost always run at least an hour behind, in my experience).