Monday, November 13, 2006

Nurse KC's Diary

Here's a long post chronicling my visit with Teena during her first round of chemo therapy:


I hopped a morning flight from Oakland to Portland. I left the sunny Bay Area and landed in the midst of a record breaking storm. My favorite source of satellite imagery of natural disasters had a great picture of this freakish sub-tropical storm that just happened to be sitting off the Oregon coast -- hardly where sub-tropical storms are supposed to develop. But there it was, pumping record breaking buckets of rain on top of Teena.

And Teena is looking just like Teena. Moving a bit slow from the surgery, but for now she's doing well and feeling relatively good. In the back of my mind I was unsure what to expect. From afar it's hard not to fear what is happening to my sister. As soon as we met I felt a quiet relief. Teena is strong and doing well. As this story progresses we know it will take a toll. Now that I'm here with her, I'm loving the chance to have a nice vacation with TT.

We got out of the airport and headed over check out an acupuncture / massage clinic that Kaiser referred her to -- in the oh-so-hip Hawthorne district. We grab a sandwich at the Grand Central Bakery Cafe and I feel like I'm still in SF. This place is definitely on the map. I'm trying to subtly influence Teena to stay with the acupuncture -- because I really think it will be worthwhile -- but also to make sure this place becomes part of the routine.

We dropped in on the clinic and got Teena hooked up with an appointment for the next day. The women there fit the bill perfectly. Definitely good feng shui. And the price is right. Turns out their practice is somehow funded by research into the benefits of alternate practices working with the chemo regimen. Teena has her doubts about the Chinese herbs, and truth be told I do too.

Next we're off to Longview and it's dumping. The highway is a blur of rain and fog and spray from the cars and trucks. This has been going on for days. The rivers are swollen. When we get to Longview, the road to Terri's (and now Teena's) house runs along the Cowlitz river and the river looks menacingly close to flood stage. You'd swear that the water is flush level with the river. Hmmm....

One of my jobs here is to cook, so I start out with a risotto which is a good way to make something out of whatever is on hand. The rice was not perfect, so it came out a bit gloopy. Pretty typical for my risottos. But it tasted good.

We're feeling good. No election news tonight. So we decide to take in a movie. Teena surveys the listings and we agree to check out the Scorsese flick "The Departed". Whoa. We expected violent, but this goes above and beyond. The cast is great. The acting is great. I recommend it. But if you see it, know that it is way, way violent and graphic. Happily it didn't inhabit our dreams. It's just Scorsese doing what he does.


Nice leisurely morning. Still raining. Hard. We don't have to be in Portland until 11:00, and while we're lounging we get a call moving that to 11:30. Plenty of time to sip coffee and linger before another drive through the deluge. The weather news is bleak, and that river sure looks angry, so we pack our bags expecting to spend the night in Portland. Tomorrow is show time and there is no way Teena is going to let some natural disaster delay things any longer.

The first appointment has Teena getting some blood taken, then getting a PICC line inserted to ease future blood work. This is at the Kaiser Interstate clinic where most of the oncology visits will take place. The IP happens in a different facility -- a hospital? -- but today she's getting worked on in the non-oncology-specific end of the facility. I'm just along for the ride. Unfortunately, there is no Wifi in the public spaces here, so I mostly hang around and read. Yawn.

The PICC line takes longer than expected, so we have to rush back to the acupuncture appointment. We quickly grab another sandwich at the bakery. Yup. This place is definitely worth a return trip.

While Teena gets the needles, I wander the neighborhood in search of a WiFi hotspot. In this neighborhood you just know its out there. Sure enough I'm directed to Red and Black cafe, a worker co-op coffee house where I get my Internet fix. Meanwhile I've explored the Hawthorne area. The clouds break, and I find some very cool fall foliage that looks extra vivid after the rains.

Teena is underwhelmed by the acupuncture. How can you tell if it is beneficial when you're undergoing such a severe treatment regimen? The effects are subtle, and if you don't have prior experience with acupuncture's benefits, how can you tell if it is working or not? We'll keep talking about this. I'm a believer. But it is subtle. And, aside from the hipness of the locale and the nice lunch choices, this location is not convenient for her. The massage was a hit. So we'll see.

Another wet ride home to Longview. This time not so wet, but still the rain is coming down. The breaks in the clouds give us the confidence to go home and not bother staying in Portland. Good call.

Election night? We all know how good that was. What a massive relief after so many dark election days! One complaint though -- CNN was so wishy washy. MSNBC put them to shame, calling the 30+ seats changing in the house much earlier and much more accurately. How sad to see how badly CNN has fallen. Thank goodness for MSNBC and Olberman -- and the Daily Show. How deliciously freakish that Stewart has some of the best coverage -- and has Dan Rather on his show! I liked Colbert's catastophometer with its Jesus <--> Bin Laden scale.

Whatever else comes from all of this, it has been great to spend some time together. No other plans, no kids, no distractions other than the business at hand. It is a gift. Even if we'd do anything to give it back and undo it.


Early wake up today for Teena's 9:00 am appointment for her first IV chemo at Interstate. No trepidation getting ready, at least none that I could sense. Time to get the show on the road.

The road is clear. It is really beautiful here now. The mists, the dramatic clouds, and the bright yellow foliage are lovely. For some reason there is no traffic either. Smooth sailing.

Into the clinic we go. It all seems so routine. Until we are visited by the counselor and the pharmacist. Some of the info is due diligence warnings about anything and everything that might happen. But some of it is a rude awakening. I know a lot more now about the specifics of her treatment regimen. The IV Taxol is very routine. The side effects are manageable and well known. The IP Cisplatin is the nasty beast. Many different people had assured Teena that nausea is a thing of the past. "If you're nauseous, we're doing something wrong." Not so for the IP Cisplatin treatment. I'm learning that Cisplatin has been around for a long time, predating Taxol. So it is well known too, and the hazards are Kidney damage, and nausea which can heighten the kidney risks via dehydration.

We get a ton of info about the strategies for confronting the side effects. Hydration is numero uno. Gotta keep the fluids coming and going. Going is key. Constipation can be a problem. Lots of meds. Lots of advice. That is my/our job in the hours and days after each treatment. I'm trying to absorb as much as possible. There's alot of written information too. Teena is ready for it with files and binders to absorb it all -- even as she is getting drowsy from the Benedryl their pumping into her to ward off any Taxol side effects.

The staff at the Interstate clinic are fabulous. I can't praise them enough. The counselor nurse was sharp, helpful, clear... a total pro. Sure, there was a lot of sobering info to absorb, and Teena was maybe not in the best shape to absorb it all, with the meds flowing. But nurse did a great job of laying out everything Teena and the rest of us need to know, both verbally and in handouts. Best of all she has her set up with all the phone numbers and contact strategies we'll need when the time comes.

Gayla, the pharmacist, was a total trip. She is the queen of her domain in the chemo injection facility. She could not be more vibrant and energizing and more full of infectious zeal. Very cool woman who really makes Teena feel cared for. Just a wonderful ally to have looking out for her.

Right now Teena is getting the Taxol and napping while I tap away. I realize that I need to be recording this. It's not just info I need to know for this visit. This is what we all need to know going forward, for when we are here with her and for those anxious times to come where we will be so far away and feeling helpless. We're not really. We need to know all this so we can keep tabs on her progress and know what to be alert for to do and what do.

I'll stop now to get back to her. My job is now pretty clear. Help keep her hydrated. Lots of soups. Nothing fatty or spicy or acidic. So the chicken soup I made last night is right on target. The chemo will change her taste buds and make everything unappetizing -- even water. No matter -- the fluids must keep going in -- and out. Some symptoms can be expected and dealt with easily. Others, like even the slightest fever, or constipation beyond certain limits, need to raise the alarms.

We're equipped with a lot of knowledge now. Finally the treatments have begun. It's no picnic from here out. All the good wishes and all Teena's optimism and healthy living are now put to the test. Under the unwanted circumstances, we're in a good space.

Stay tuned.

Wednesday night and all is well. The Taxol IV has been a breeze. We shop for printers at Office Depot, have dinner at home, and relax. Nothing notable to report, just uneventful good news.


Today we drive to the Kaiser Sunnyside Medial Center in Clackamas, south of Portland. This is the hospital where the hysterectomy surgery took place and where the IP port was inserted. Some familiar faces for Teena, but nothing as warm and fuzzy as the Interstate clinic. By the time Teena gets a room and starts treatment it is clear she is once again in good hands.

The Sunnyside hospital facility is no where near as warm and fuzzy as the Interstate clinic. It is a hospital, so it is just not possible for the experience to be anything like the outpatient clinic. You are on a hospital ward with all kinds of other patients with all kinds of maladies. Hospitals suck, OK? At insterstate you're with other chemo patients and there is some sort of solidarity there.

The other problem about Sunnyside is the hospital food. Teena will need a lunch courier on her IP days. There is a big mall across the highway that really should have some food options, but forget it. The whole mall is being rebuilt, the parking is a mess, and frankly I didn't see much food there. Nice Barnes & Noble, if you need someplace to hang. Across the street, closer to the hospital, there is a Baja Fresh that I ate at and where I got Teena a quesadilla. That's decent. There is also a Thai BBQ joint that looks promising. I found a quiet Starbucks in more or less the same place that had what I needed -- a hot spot.

For a hospital, Sunnyside was very nice. Teena won the lottery and got a private room -- because it was the only bed available. And her nursing staff was great. Nurse Anna was the point person and she did a great job of focusing in on Teena and making us feel well cared for. Sounds like we will see more of Anna too, which will really help cut through the institutional suckiness of the hospital.

I can't repeat it enough. Everything went perfectly. OK, maybe Teena could tell you about the catheter if she wants to get clinical, but that worked out and then it was just sitting in the bed while the meds flowed in. Occasional beeping and checking, and a machine to take Teena's vitals every few minutes. Six hours that passed by without problems. Then again, this was expected. The unknown parts were to come in the hours and days ahead.

Gayla kept impressing on Teena that nausea was to be expected, and there were things we needed to be ready to do to prevent "launching". Teena has some pills that need to be in her purse at all times that she can take at any time, that she need not worry about any interactions with other meds. There are backups for post launch conditions too. Gayla has it all covered for Teena, including the phone numbers. With the nausea issue in mind, I made sure there was some kind of bucket or barf bag in the car. Gotta think like that. Nothing happened, but the bucket is now permanently in Teena's trunk.

So we got home to Kelso and settled in. The rain continued, with the temperature dropping, but it wasn't so bad. In a short visit I'm already adjusting my idea of what good weather is. If the clouds are light in color, if the rain tapers off to a mist or intermittent showers, it's a good day. Pretty stark contrast the Bay Area. A total world of difference to our Cabo sister. This is just the start of the dark wetness too. Let's hope Teena is able to make an escape to the sun a few times during this 6-cycle treatment. The cold, wet, darkness could become a real drag. She's used to it. She's lived through it. But she is a Cabo girl now. She needs the sun and blue sky to keep that light in her eyes.

There I go, carrying on again.

But there really is not much to report. Lots of phone calls from Teena's rich network of friends all over. Keep 'em coming. Lots of ways of reaching her too. We need to get Teena to publish a directory of the many phone numbers and where and when they are useful.

Dinner was late and light. More homemade chicken soup, which figures to become a staple. Her belly full of fluids and the late quesadilla put the focus was on liquid intake -- and apprehensively waiting to see how the chemo would sit. Which it did OK. We tried taking a walk. Teena is not one to take all this sitting or laying down. But in reality she was in no shape for walking, so we turned back pretty quickly. Gotta love the attitude that got her out there. It would be too easy to passively wait for the chemo to work. But not Teena.

The main after effects came at night. Some of the anti-nausea meds they dripped into her were steroids that kept here up. Gayla was very colorful, as always, describing how she'd wake up at 2:00am ready to "mow the lawn". Sure enough, Teena's sleep was totally interrupted. Can't mow the lawn in the rain, but she was up working on the computer all night. Filing info and starting her diary that hopefully will start her blog. Oh well. Sleep sure would be nice. But wakefulness is better than hurling, for sure.


Friday is a time for rest. Nothing on the calendar, so I sleep in. Teena? No sleep at night, but by the time I wake up she is dead tired and not feeling that great. I muff my first nursing assignment. Teena crawls into bed feeling like the nausea could be coming. I did not get her pill to her before she's under the sheet and nearly napping. Damn. Gotta tighten that up. She needs to have those pills with her at all time and pop them at times like this.

Oh well, she got lucky. The nap works. The stomach settled. We had worked out a shopping list, so I went to town and stocked up. When I got home Teena was sleeping. Yay.

Missy arrived from Portland and injected a welcome dose of laughter and light. Originally I was going to fly home today, but I'm so glad I chose to overlap with Missy. This a key time to make sure Teena had no distractions from resting and recovering. And I got to meet Missy and make contact with another branch of Teena's family tree. For those of you feeling any guilt about not being there this time -- forget it. We had her covered and trust me, we are both grateful for the chance to be there.

She also arrived with bags of pure goodness from Whole Foods in Portland. Take a note. The grocery scene in Kelso / Longview is Safeway all the way. We should locate that Whole Foods in Portalnd or some other groovy grocery and make it part of the commute circuit on the many trips to Portland.

Dinner was local wild Salmon from the river, courtesy of Terri's AA sponsor. Throw in some asparagus, pasta and pesto, and we finally had a break from the endless soups. Yum.

Teena, of course, won't sit still. She's feeling good again so she and Missy are off to a meeting. It's a short drop in, but Jay calls and we marvel at how well it's going.

I spend the rest of the night trying to get Teena's iPod and iTunes set up -- and fail. I cannot get the music from my laptop to hers. Between the Leapfrog VPN and Terri's VPN there is no way to break down the walls. Dang. But I do work with Teena to launch the blog. We use her diary from the night before to get things going. It could work. We will see.


Another quiet morning at 235 Sparks Drive. Teena slept better, if not soundly. No nausea! As Teena keeps saying, the first round is a good indicator of how it will go in the future. So she is psyched. This really looks good. So far. The Interstate crew was clear that the danger zone lasts a few days, so knock on wood. But really -- this feels doable to Teena.

We drive Missy's big honkin truck to the airport. My turn is done.

Sorry to ramble on at such length. I had plenty of time on my hands during my visit, and I felt the need to write it all down. Hopefully some of the notes will be relevant to one or two of you who follow after me.



Greg said...

Way to go KC! Way to go Teena! Keep up the spirits, and keep up the detailed reporting. It doesn't make us who are contributing nothing feel any less guilty, but we are at least well informed. Thanks.

Anonymous said...

Hi -- Ruth Barton, Honorary Jones, here. Teena, you are much in my thoughts. You sure have your mother's courage and grace. I don't know anything about how blogs work (Kiffer sent me this one), but I hope I can be kept in the information loop. Hang in there, all -- you are so lucky to be such a close and mutually helpful family.