Oligodendroglioma, Radiotherapy

Radio 1

What I most hope radiotherapy will do is turn me in to a superhero. Most likely the Incredible Hulk, because Bruce Banner got zapped by gamma rays and it happened to him. Surely radiotherapy will look exactly like this? Crosshairs, weird contraption chair? It IS a given.

To say I spend an inordinate amount of time wondering whether, when a lady turns in to the Hulk she at least gets to keep her bra on, might be unfair, but it’s probably not an ordinate amount of time either. Also, right, how do the hems of the Hulk’s jeans, where they’re baggiest, rip to shreds, but he never splits the bum bit where you’d expect it to get tight? It’s almost like they made this stuff up.  If I don’t turn in to the Hulk, then I will be forced to smuggle a spider in to treatment, and encourage it to bite me, so I can be Spider Lady.  Failing that, just becoming a common or garden Evil Genius will have to do.  But let’s aim high, yeah?

Arriving at the radiotherapy department, the place is hotter than Hades. Yes, there are poorly people here, but there’s no need to cook them for flip’s sake. I sit down with my back facing reception and nearly have an unseemly accident when there’s a sudden loud noise. It’s The Bell. Next to reception, there’s a bell.  THE bell. You get to ring the bell after your last radiotherapy session. Everyone in the waiting area claps and cheers with delight when someone rings the bell. It’s such a simple idea, but it’s ridiculously emotional. A single noise to make you so desperately pleased for someone you’ve never met, and probably won’t ever see again, to understand something of what they’ve been through, without even speaking a word, and to know that one day, it’ll be you ringing that bell.

The bell patients ring at the end of their radiotherapy course
You shall be mine. Oh yes, you shall be mine.

The bell ringers themselves look more relieved than triumphant. Pleased yes, but so very knackered and weak. It’s only their family members who have the energy to be jubilant. A man comes out with his three grown up daughters. They all film on their phones as he rings the bell. “Go on dad, give it some proper welly!” they shout. He smiles feebly and tries. He just doesn’t have any welly to give. I fully intend to whack the shit out of that bell, but wonder whether that will be possible by the time I’m in his place.

John calls me in for a pre-radiotherapy chat. I don’t remember it that well, but the gist of it was to reiterate the likely side effects, give me some special moisturising cream for the skin that will be affected by the beams, offer me a wig voucher and answer any questions. Short term radiotherapy side effects, should you suffer any (but most people do) build up cumulatively with the sessions. On the plus side, this means you feel fine for the first couple of weeks. On the the down side, they will to continue to build and peak a couple of weeks after you finish. All the booklets say to ask your radiographer where you’ll lose your hair, so you can plan how to deal with it. I ask, but John doesn’t know. He says it used to be much easier to predict when a static beam went in one side and came out the other, but the new machines arc around the treatment area, with a modulating intensity, so essentially ¯\_(ツ)_/¯.  Oh. OK. My only other question is how they can be sure they won’t miss. A 2mm tumour amongst a rich, fruity sea of good brain matter is a tricky target. I can’t remember John’s answer, but it can’t have been that convincing, because I’m still not 100% sure they won’t set my ear on fire or something.

He takes me round to the smaller waiting area for my designated room, Room 2. I’ll come here every day, Monday to Friday for the next 6 weeks. A loud mechanical noise suddenly starts up and I jump again. Blimey! Is that the noise that radiotherapy makes?  It’s noisier than I expected. No. It’s not the noise that radiotherapy makes. It’s the fan on the water cooler kicking in.  Maybe I need to just chill the flip out.

And then it’s my turn. Today the room is staffed by two ladies, both called Rachel, which is good news for my memory. We walk down a small corridor into the treatment area. The radiotherapy machine dominates the room. To my mind, it looks a bit like a lily; the patient couch is the stamen and the movable scanning and zapping parts are the petals.

 

There’s a big cupboard full of moulded foam cushions to support various parts of the body, depending what’s being treated, and the personalised moulds for people who need them (mine is on the right, above). There are several screens, one showing live video of us in the room, another with my name, date of birth and dosage information on, and various other paraphernalia such as laser crosshairs for lining patients up correctly. There are also more calculators in that one room than I’ve seen since my GCSE maths exam. Different, shapes, sizes and colours. Some serious calculating is about to go down. Good.  Let’s hope they’re not just showing each other the BOOBLESS trick that had to pass for hand held device fun before iPhones got invented.

I hop on to the couch, one Rachel puts the swimming cap on me and I lie down in to the eggcup, then the mask is put on and secured to the table with poppers at the top and on both sides.  It’s really not that bad, especially as I now discover I can open my eyes in the mask! If I’ve got mascara on, my eyelashes get in the way a bit, but it’s possible to see a little of what’s going on through the small holes in the mask, which makes me much happier.

What goes on is that the lights are dimmed so the laser crosshairs can easily be seen and aligned with the marks on the mask. What sounds like rulers are put against the side of the mask to take measurements and the Rachels call numbers like “89.3 supra” and “90 dorsal” to each other. The other replies “good” to each number. Yes, the mask is tight, but there’s probably 2mm of movement in there. Shit. I try to stay as still as humanly possible to help them not miss. The lights come back up and the Rachels then announce that they’re leaving the room, and will be back very soon.

The petals rotate to perform a scan to double check and perfect positioning.  This takes around a minute. At the same time, I can hear the treatment petal create the correct beam shape for the tumour. The aperture is formed by a series of metal plates that slide independently to make the shape, which constantly changes as the machine moves, to match the shape of your tumour in 3D no matter the angle. The changing angle means that whilst the tumour is always directly in the beam’s path, it’s not always travelling through the same healthy tissue. I never got past convex and concave mirrors in Physics, so this just all seems like magic to me.

Once the scan is done, and the thunk thunk of the metal plates sliding in to place stops, the bed automatically makes a final adjustment; in my case tilting diagonally down towards my left foot. (It took me DAYS to work out which way it was moving). The treatment then starts. The petals move slowly around my head. Whenever it goes past my face, I close my eyes. Because of course eyelids are well known for being a robust defence against high powered x-rays. 🙄 In no time, the Rachels are back, freeing me from the mask. The treatment takes around 30 seconds and is completely painless. It’s not dissimilar to a normal x-ray.  There’s a good video here of a BBC presenter having radiotherapy for breast cancer that shows how easy it is.

Disappointingly, I’m not green and my jeans are still intact. It’s only on the way out that I notice that what I had thought was a short corridor on the way in is actually the door. It’s at least 3 or 4 foot thick. Yikes. That’s a lot of gamma rays, Bruce. Still. 1 down, 29 to go.

Radiotherapy treatment room door. It's THICK.
HULK SMASH WORRYINGLY MASSIVE DOOR!

 

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