Another Bullet Dodged

by NotDownOrOut

So far so good in the battle against cancer.

I tried to arrive after the elevators are unlocked at 7 a.m., but the police forgot to be at the elevators at 7:00 a.m. Patients were still in line at 7:15 a.m. By the time the police unlocked the elevators patients were impatient. Although I waited near the end of the line, it took some time for me to make it up to the second floor. People who arrived later than I shoved for places in the elevators, in some cases unaware of the fact that there was a line. When it was my turn to enter, one person gave me her elbow in my side as she shoved past me. I tried to take it in stride, but there was a moment when I could not help thinking she looked spry enough to take the stairs. Once she was inside the elevator she learned that the elevators at that end of the building only go to the second floor, first floor, and basement. She huffed over this until the man to my right took out his handkerchief and pressed it over his nose and mouth. When the huffy puffy woman stared at him, he said, through folds of cotton, “What did you have for breakfast, woman? Dog food?” I stared straight ahead and did not smile as I exited the elevator and headed for Clinic H.

I saw Dr. H again today. She ordered a new scan of my abdomen to look for cancerous growths. I will also have some blood tests prior to my next appointment. We spent most of my appointment discussing my bladder and my blood pressure.

She prescribed an alternative to Vesicare as I tried that drug back in January without having any response to it. She phoned the urology department to discuss this course of action and took the department’s recommendation that we continue to address this with meds rather than the hyperbaric chamber. Despite the endorsement of the hyperbaric chamber by the American Cancer Society, there is some reservation that has yet to be articulated. I inquired whether or not the fact that oxygenation of blood might also spur growth of cancer cells when it spurs replacement of damaged bladder cells. Dr. H just nodded, then tilted her head and smiled. It was not so much an answer as an acknowledgement that I was asking a valid question. She already had commented on the fact that I was reading The Emperor of All Maladies: A Biography of Cancer, by Siddhartha Mukherjee, M.D. (Scribner 2010). It may be wise to learn as much about one’s enemy as one can. However, this history of cancer is more frightening than the trailers on TV for the new movie Chernobyl Diaries. In the illustrations there is a drawing of the medieval “physician’s” approach to breast cancer. Acids, burns, and leather bindings–conducted without painkillers. Id. at 300. In much later periods, surgery was performed in “theaters” in which women were strapped down for painful, disfiguring, crippling, and, ultimately, fatal surgeries that sought to make breast surgery more and more “radical.” Id. at 62-66. The doctors operated in this manner for some time before they observed that survival related more to the stage of cancer than the “radical” nature of the surgery. Id. at 66-69. The idea of carving past the chest and deeply into the neck, sometimes removing the clavicle, regardless of the cancer’s “staging,” reminds me of the cliche “throwing out the baby with the bath water.”

This is a field that tested early chemotherapy and its precursors, with somewhat greater success, on children with cancer. Id. at 92. The fact that it seemingly was “women and children first” is ironic, but, according to the National Cancer Institute, 2010 federal spending on breast cancer research was the top draw for funding. That seems fair when you consider how many women participated in early experiments in cancer treatment. However, even these numbers indicate that we could do much better. Uterine cancer, the kind of cancer I had, is the fourth most common type of cancer among women. Its share of the budget is relatively quite small. Moreover, within the broad field of breast cancer research, research of metastasized breast cancer draws less than 1% of the National Cancer Institute’s research budget. This means that we spend minimally to address the most lethal of these breast-related cancers. Metastasized cancer is what we fear most. My mother’s sister suffers from such a cancer. If you want to read more about this or want to direct your cancer donations to this critical area of breast cancer research, check the blog of Yvonne, a fellow cancer survivor.

No one suggested that I continue treatment by undergoing internal radiation therapy. Dr. H read aloud from her notes Dr. T’s statement that further radiation could cause the loss of my bladder. So I will try another anti-spasmodic drug and hope that it will help my bladder heal from five weeks of external radiation. Dr. H also prescribed a water pill to help me hold down my blood pressure. She thought it was pretty good today–146/71.

It took almost one hour to drop off my prescriptions. You have to take a number and wait to drop off a prescription. The room is half-filled with people waiting. When they call a number, they do so in English and Spanish: “Number G081 please go to window 7. Numero G081 por favor ven a ventana 7.”

When I was called, I waited while the clerk paged my doctor to inform her that the bladder med was not available in extended release form. Then I had to talk to the doctor to hear how to adjust dosing. Then I went back to window 7. It takes three hours to fill my two prescriptions. I could not wait until after 2 p.m. so will have to return on another day. When I need a refill I will need to pick that up at another building’s pharmacy. That pharmacy has a waiting room large enough to fill a commercial airline. I have sat there for hours waiting to be called for a blood or urine test. The alternative is to take my prescriptions to the pharmacy at Walgreens. I did that when the urologist prescribed Vesicare and a month’s supply cost me over $400. I can make the time to return tomorrow to pick up my prescriptions.

My hour’s wait to turn in my prescriptions gave me ample time to study my surroundings. There were five windows open. Two took prescriptions, two gave them out, and one took money. There is a $4 per prescription fee even if the county’s charitable program covers the service. The woman taking money seemed bored. She came out from behind the wall of glass windows and nosed about. She stopped one woman and asked, “You here to fill a prescription?” The patient nodded, spoke unintelligibly, then handed over her prescription. The clerk looked at it, then returned it. The patient tried to communicate, without a word of English, her desire for some help. The clerk pointed toward empty seats and said, “Wait til someone calls you.”

Signs instructed us to take seats until called to a window, but there also was a line. Some people waited in the line and tried to approach windows as they became open. They were shooed away. Some people left after taking numbers so there were periods when a number was called, no one came, someone from the line tried to approach, the clerks shooed such folks away, and another number would be called. Sometimes it took the announcement system longer to call a number in English and Spanish than it did for the clerk to process the prescription. Numbers appeared over windows and on a board like an airline’s arrivals and departures board, sometimes out of time with the oral announcements. Some patients were sick and tired. One woman stood at the counter saying the same thing over and over for several long minutes, “No, I didn’t get no pills here already. No, I didn’t get no pills here already.” After repeating this enough times for all of us to get the message, she shook her head and said, “Oh, yes, I do remember being told to pick up refills at the Fantus Clinic.” She wandered out in the wrong direction if she meant to next go to the Fantus Clinic.

At one point, the clerk who had joined us in the waiting room tried to collect cash from a patient for his prescription. He kept trying to say in Spanish that he would pay the clerk when she returned to window 4. The clerk kept saying to pay her. He acted like this was a shakedown or a request for a bribe. People lined up behind him, thinking this was a good place to ask questions. As others got up close to him, the patient got nervous. He took out his $4 and placed it on the counter like he was paying under protest. Then the clerk took out a stamp and stamp pad and marked his receipt paid and gave him his receipt. He shrugged, finally seeming to understand the system.

The clerk ignored the five people behind him and turned back toward the office’s door. She disappeared inside and eventually returned to window #4. The line dissipated when the clerk disappeared. A man sat next to me, even though there were many empty seats. “This is how things work here in Cook County,” he whispered from behind his hand. Then he laughed at his own humor. He pulled four chocolate bars from his pocket and asked me if I wanted to buy one. “This stuff is better than what’s in the machines downstairs,” he said. I shook my head to decline. He repeated his pitch. “Better than medicine,” he promised. He eventually approached someone else.

As I walked out to my car, I felt pretty good about the whole experience. On the one hand, I had been thinking this was going to be an appointment when I actually got tested for the recurrence of cancer. Nothing like that happened. I was thinking that if I had health insurance I might have been examined. Don’t they have an equivalent to the Pap smear for women without cervixes? I haven’t been examined much at all since Dr. D removed my staples five days after surgery. I have had one internal examination since then, given when my bladder was congested with blood clots. It was horrific. I still remember being unable to hold back a scream as the ER doctor opened the speculum. I don’t think you could call that an examination. I immediately started bleeding and the whole thing ended swiftly with an apology for the necessity of “checking.” Dr. H once looked at my scar and pronounced it healed.

I did not have blood work today. No needles whatsoever. My next blood test will take place in July right before my CT exam. The blood test order doesn’t even call for a test of cancer markers.

I’d like the peace of mind that would come from some test results, but I felt like a college student who is delighted to get out of class early even if she’ll be paying the school loans down for thirty years in the future. I dodged a bullet today. I’ll worry about it tomorrow.