day 157 – last dance with FAC

Today is a momentous day – my last chemo, certainly for now and hopefully for ever.

It is only my fourth FAC, the drug combo that is the second phase of my treatment, following the 11 cycles of taxol. It is the last step in a 142 day, 15 treatment dance that has left me tired, hairless, with feet that manage to be numb and sore at the same time, with unsightly finger nails and above all very happy to be done.

I think the biggest, happiest surprise was that I managed to get through without really acute nausea, and next to no vomiting. These were the the classic symptoms that I feared, especially having seen Irene struggle with them 5 years ago, when she battled the exact same disease with the same treatment. In the intervening years the management of nausea has made significant progress, and we also know that I tend to do better with such medications than Irene, and that individual experiences vary. I certainly steer away from food for several days after the chemo subsisting on diluted gatorade, and return gradually via bland soups and crackers. I mostly feel tired and that my digestive system is on a break, and there is also a sense of dampened nausea. Overall, it feels to me that my whole system is knocked sideways, and not much functions quite right.

The worst part, particularly during the FAC phase, I think has been mental. There are two aspects to this, for me: the feeling of profound revulsion, quite distinct from nausea, that is the residue of exposing your body to what is essentially poison. The first time I recall feeling this was when as a much younger man, and for reasons that are now mysterious to me, drank an excess of vermouth. After I recovered from the acute effects I was left with a profound sense of revulsion, and the mere smell of vermouth, or even sight of a bottle, induced a shiver and gag reflex. As a biologist I interpret this as the appropriate activity of a brain circuit designed to keep us away from things that make us feel ill, built by millions of years of evolution. Mine works pretty well – I have never touched vermouth since that day! But with chemo you can’t do that, and this is where the second mental aspect comes in. There is clearly an internal battle, where the part of you that realizes that chemo can save your life has to subdue the part of you that just wants to run in the opposite direction at the mere thought of it. You have to collaborate in the poisoning of your body in order to get rid of the cancer.

For the two weeks after my last FAC the mere thought of chemo triggered a pronounced wave of revulsion in me. These feelings were so close, they seemed to me to be right there, next to me all day and I could reach out and touch them at will. During these two weeks I just couldn’t imagine going back to the infusion unit, even just one more time. I had fantasies about just not showing up. I was probing these thoughts constantly, like a loose tooth, and am relieved that in the last day or two they have receded noticeably. They have been replaced with a sense of defiance and determination, and now I can imagine going back for that last treatment, this afternoon. The revulsion is much less palpable and I am able to concentrate on what I will feel like in a couple of weeks, and how good it will be to look back on this, with the emphasis on the looking back part. Its lucky that FAC treatments are spaced three weeks apart, not only to let your blood counts recover, but also to let your mind forget just enough of what it was like to let you go back in there.