Sunday, 2 April 2017

Head over heart?...and collateral damage

At various points in our lives we all confront difficult decisions in which the heart and its emotive
tendencies pitch themselves against the more rational and considered mental faculties of the brain.

It’s always a tough call. Follow your heart, or follow your head?

There is not necessarily a right choice, but what if both your heart and head are saying the same thing, and yet still you know it’s the wrong choice?

With each passing session of chemotherapy my body screams at me. ‘Make it stop. Make it stop. Don’t put me through this again.’

I am particularly vulnerable to listening to this voice as active chemotherapy ends and the lull between pain and recovery drags on. The voice is even louder in the wee small hours of the morning when darkness prevails. (Friday night to Sunday night after Chemo Wednesday are dark indeed.)

My heart cries out against further treatments. It wails like an emergency siren denoting a red alert. It warns that next time my body may not be strong enough to withstand the drugs, that I may not recover.  It is hard to ignore its warnings.

My brain kicks in to hush that emotive voice. To reason that many millions endure and survive chemotherapy each year. That billions of pounds spent on pharmaceutical research, proving efficacy and weighing the risks cannot be wrong. As someone who spent a happy decade within the industry and has a better grasp than most of clinical trials and an ability to read the evidence for myself, I know that the facts stack up.

Yet it’s impossible to ignore one’s own body. Not listening to my body and paying heed to those early twinges of my gut is what landed me in emergency surgery. I refuse to play the ‘what if’ game in regards to diagnosis. That path leads nowhere good. But I am listening now.

For nearly a week each fortnight my body does not feel like my own. Spasms, twinges, fevers, wretching, fatigue, fug, it all points to the damage the drugs doing.

Increasingly the phrase ‘collateral damage’ comes to mind. It flashes up light one of those fluorescent neon tubes that more customarily denote fast food outlets or motels. It is not a helpful phrase, especially at night.

‘Collateral damage’ smacks of innocent casualties of warfare. Unintended victims of a greater act.

And so it feels with me. Rationally I know that chemotherapy is for the greater good. To stand a chance of ridding my body of any remaining malignant cells I must endure systemic cleansing of all cells that exhibit growth, healthy or not.

Whilst radiotherapy and surgery can more effectively target suspect tumours and growths, chemotherapy is by its very nature intended to be systemic. If what is left after surgery is microscopic, defective cancerous cells cunningly lurking in lymph nodes and post-operative margins, then modern medicine’s best option is full on warfare.

As the weeks go by the evidence of ‘collateral damage’ accumulates. The immune system is often first hit, dramatically. I can see it with each passing blood test. My counts of red and white blood cells, platelets and neutrophils exist well below normal levels, yet each fortnight I am desperate for my blood counts to be high enough for treatment to proceed on schedule. Psychologically the idea of delay, and of prolonging this grim routine is torture in itself.

So each week I pray that the additional injections I take to artificially boost and restart my stunned bone marrow have done their work. Thus far they have. More drugs to prop me up and partially repair the damage of their predecessors, yet they come with bone pain, fevers, chills and a host of other effects. Without them my system could not tolerate the chemotherapy, with them I can continue my toxic schedule. Not much I can argue with there.

Beyond the blood counts I watch my temperature neurotically. This was not helped this week by my toddler’s decision to plonk my electronic thermometer in the toilet. I’m sure it made a wonderful and satisfying splosh, but it necessitated the rapid purchase of an equally effective replacement whilst I wait to see if the first one can be revived in a bowl of rice.

On Friday after chemo my temperature always seems to spike up. No-one has yet come up with a reasonable explanation for this, but it seems to be the combined impact of three days of chemo drugs, plus anti-emetics AND the addition of my GCSF injection (the one that helps my immune system). Maybe my liver is running hot from having to process so much toxic stuff? Maybe it’s just my body quaking and rebelling at such vile treatment? A feverish forehead and dragon breath,( as I affectionately call that feeling like you’re exhaling fire), have landed me in hospital once. The sword of infection hangs, Damacles-esque in the air like a threat. I’ve learned to wait before I call in with my readings. If I wait, my temperature usually comes down and I can evade admission. (Clearly if it stayed high I’d go in. I may dread a hospital bed, but I’m not foolish enough not to listen to advice and protocol).

My most recent addition to the list of casualties is a deeply personal one. I shall offer no details other than to mention my reproductive system. I feel incredibly conflicted about this as on the one hand I have been profoundly blessed in my life so far. I know I have been incredibly lucky. I have two wonderful children. I want no more. My beliefs on this were set long before cancer reared its maleficent head.

But it pains me greatly at a deep, inner level to know that I have voluntarily agreed to damage a system that has hitherto been a source of great joy and pride. Destroying something that was working perfectly eats at my soul. Permanent or temporary no one can predict. Either way, it feels wrong, and counterintuitive.

My brain aims to soothe with advice that it changes nothing about my hopes for the future. Indeed, I made a sound and considered decision not to freeze any eggs, just in case. Yet it hurts and reinforces all the increasingly vocal murmurings of my heart, that this sucks. How can I voluntarily agree to harming myself in this way? My heart queries ‘what will fail next?’ my brain wavers in its resolve to continue. For a time the heart and head concur that this is madness.

And so I return to the phrase ‘collateral damage.’

As the dawn breaks I force myself to zoom out and examine the bigger picture. The bigger picture is cleansing my entire system of malignant cells that might seek to grab a toehold elsewhere and replicate out of control. Again.

The big picture waves the volume of medical evidence at me, like a giant sheaf of papers shoved in my face. ‘This is your best shot’ reminds my brain. ‘This is your best chance of ensuring it doesn’t come back.’

I know there are no guarantees. I can read the evidence first-hand about recurrence. But saying ‘no’ to further treatments is like increasing the odds and rolling the dice. It’s foolish.

As a teenager I used to have a slogan on my wall. A headline clipped from a magazine, diligently covered in sticky-back plastic along with other images, mottos and icons of my teenage years. It read ‘No pain, no gain.

It appears I have written myself into a corner wherein my head wins again. I don’t like it, but I can live with it.

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