50. Broken

Tuesday 18th to Friday 28th February, 2014

This is the bit where you find out how I was slammed by IVAC. Things went downhill pretty quickly after I got home from hospital. I was so looking forward to a good nights sleep in my own bed. I thought that would make the world of difference after a week of very little sleep, and I thought I would wake up feeling a bit more energetic. Not so.

I think I slept pretty well on the Monday night but on Tuesday I woke up feeling utterly exhausted. I was worn out and short of breath just getting up to go to the toilet (about 3 metres away from my bed) and having a shower felt like running a marathon (not that I ever have or will run a marathon, but I’m sure that’s how it feels). I was barely eating or drinking, although my mum always made sure there was a drink beside me and did her best to force me to drink it. I weighed myself and I’d lost 5 kg in about 10 days. Bloody effective weight loss program but I wouldn’t recommend it. The rash I had developed in hospital was getting worse and was starting to get a bit itchy.

On Wednesday, I felt even worse. If I had to describe how I felt, the word that came to mind was ‘broken’. I have never felt so completely drained and exhausted. If I could have stayed in bed all day, I would have, but I had to get up and leave the house to go into hospital for a blood test. All I can say, is thank God I didn’t have to go to the city and could go to the local private hospital which was 10 minutes away. I really don’t know if I could have made it into the city.

I was so sure I would need a blood transfusion that day and I was looking forward to it as I thought it might make me feel better. My mum and dad drove me in and I staggered around to the day infusion ward, the place I had received 6 months of chemotherapy that didn’t work. The nurses noticed immediately that I looked like crap and put me straight into a chair. They took some obs and other than a ridiculously elevated heart rate of 140 beats per minute, they were fine. Blood was taken from my Hickman line and sent off to pathology. The nurse who took it was pretty sure I’d need a blood transfusion too. She decided to give me a litre of intravenous fluid while we were waiting for the results because she thought I looked very dehydrated.

While I was there, my old haematologist (the unsympathetic one) came down to the day infusion ward to see his patients who were there. He asked if I was having fun. Ummm, no! I took the opportunity to show him my rash and asked him if he thought it was due to the cytarabine, as that can cause a rash. His response; “Yeah, but it’s pretty mild”. Such a hard arse.

The results came back and my Haemoglobin was 93 (normal for a female is 115 to 116). 93 is low but not low enough to require a blood transfusion. When the nurse told me the result I just said, “I don’t believe it, it must be wrong”. How the hell could I feel so completely drained, exhausted, short of breath and have a heart rate of 140 if I didn’t need a blood transfusion? I thought she either hadn’t drawn enough blood out of my Hickman line to discard before taking the blood for the blood test or I was so dehydrated that my haemoglobin was artificially elevated due to haemoconcentration. I will attempt to explain that for the non-medical readers. Imagine a glass of cordial. The cordial is the haemoglobin and the water is the rest of the fluid in the blood stream. If there’s not much water in the glass (dehydrated), the concentration of the cordial will be strong (high haemoglobin). If you add water, that will dilute the cordial so the concentration will be lower (low haemoglobin). So I figured if they gave me some intravenous fluid, which I needed because I was dehydrated, that would dilute or lower the haemoglobin to a more realistic value.

I can’t remember my platelet count but it was low, maybe in the 20’s. Normal is 150-400 so mine was pretty low but not low enough to need a transfusion. I was also neutropaenic so I scored an injection of G-CSF, my old friend. When the intravenous fluid finished, the nurse offered to repeat the blood test to see what my haemoglobin was but I felt a bit better and couldn’t be bothered waiting around any longer. I just wanted to go home and go to bed. She did my obs again and my heart rate was up to 140 again so she called the doctor but she didn’t appear to be concerned. It was pretty apparent that I wasn’t going to be going to any conference in the city on Friday so my follow-up appointment in the city hospital was cancelled and changed to the local hospital I was currently at. Then, I was on my way home and back to bed.

On Thursday, I felt much the same – drained and short of breath going to the toilet, so it was another day in bed. My good friend and ex-work colleague, Moggy, who now lives about 4 hours away, came to stay for a few days to help out with entertaining the children and driving me around. I think she was pretty shocked by how crap I looked and how hard this chemo had hit me. In happier days, we’d been on a couple of holidays to Bali together. They were the good old days, pre-cancer. When she fell pregnant with her first child about seven weeks after I fell pregnant with my second, I joked that she was copying me and wanted to be me. Well, I’m pretty sure she doesn’t want to be me now.

The one disappointing thing about Moggy’s visit was that we missed out on a photo opportunity so she could appear pictorially in the blog! Next time. There have been a lot of missed opportunities on this adventure so I just have to fill in the spaces with words.

Moggy drove me to my appointment for blood tests etc on Friday and spent the day with me while I received two units of blood and a unit of platelets. I think my haemoglobin was in the low 80’s and my platelet count was 7. I’m pretty sure my neutrophil count was zero too. I remember scratching myself the night before, as my rash was quite itchy, and I started bleeding, just in one tiny spot, but it would not stop bleeding. So I was not at all surprised by the need for a platelet transfusion. The pathology conference I had registered for went from Friday to Sunday. Even if I’d felt up to going on Friday, the transfusions I needed would have made that impossible as they took most of the day. I still thought I might go on Saturday if I woke up feeling better after the transfusions.

By that Friday my rash had got much worse. It was dark red and becoming quite confluent. The nurses were quite shocked by it as they’d never seen anything like it. If only my old haematologist had popped down that day. I might have even got some sympathy.

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I don’t think the rash is funny. I think I was laughing because I’m flashing half of my boob. And yes, that’s my Hickman line hanging out in the middle.

The blood transfusions didn’t give me the energy boost I was hoping for. When I woke up on Saturday the thought of even packing a suitcase (I had a hotel booked in the city) to go to the conference seemed too much so attending the conference was out of the question. My hair started falling out in big clumps that day. I had been pulling at it every day, wondering when it was going to start falling out. Only the day before it seemed to be firmly attached. My hair was about the same length as my dog’s hair and was making a real mess so as soon it started falling out, I asked Jenni to come over and shave it off. My daughter even got involved with the shaving this time.

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Good bye for the second time, hair. Even the dog got in on the action.

I’d been feeling the lymph nodes in my neck just about every day since I started IVAC, waiting hopefully for them to melt away. They didn’t change while I was in hospital and they probably weren’t expected to, but I was put on that medication, allopurinol, which I’d been put on when I first started ABVD. It is given to prevent tumour lysis syndrome which can occur when there is death of a large number of cancer cells, usually at the commencement of chemotherapy. Again, I’d been told I had small volume disease but again I’d been put on this medication. So I figured maybe the lymph nodes should disappear pretty quickly if the treatment was working. I didn’t ask the Professor that question when I was in hospital, just in case the answer was yes. I kept feeling my lymph nodes when I got home from hospital, and initially they actually got bigger! I didn’t panic though, as some other lymph nodes in my neck that I knew didn’t have lymphoma in them also got bigger. Maybe it was just inflammation from those cancer cells having their butts whipped; that’s what I hoped anyway. A few days later, I can’t remember exactly when, the lymphomatous lymph nodes did start to melt away. I think they were almost gone, or maybe even completely gone, by the time I was ready to be slammed with IVAC again. I was very grateful for that. I couldn’t imagine suffering through that chemotherapy and it not working. But that does happen to some people. Soul destroying.

The next thing on the agenda was Barb’s funeral on Monday 24th February. I was really hoping I would be well enough to attend but the way I felt over the weekend, I really wasn’t sure if I would make it. It would have been easy to spend the day in bed but I did feel marginally better so I rested in the morning and cousin Sonya picked me up in the early afternoon.  A few days earlier I had been given a beautiful gift that elicited tears when it was given to me.

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A treasured gift.

I wore the necklace with pride to Barb’s funeral. It really meant a lot to me that her family had chosen to give it to me. The service was very sad, but beautiful, and was attended by an enormous number of people wishing to pay their respects to such a lovely lady, and to show their  support to her family. Barb’s granddaughter, Daisy, showed amazing strength, getting up to sing ‘In the arms of an angel’ without faltering. Jenni read a letter she had written to Barb several weeks before she died and her son, Brendan, delivered a heartfelt eulogy. Another granddaughter, Ruby, also did a touching reading. There wasn’t a dry eye in the house during all of this. It was a fitting farewell to a beautiful person loved by so many.

During the service, seeing the heartbreak around the room, especially amongst those closest to Barb, I couldn’t help wondering if it would be my funeral next, and my devastated family and friends looking up at my coffin, asking why I’d been taken so young. I had to push those thoughts aside though, as the day wasn’t about me (although I did get a mention in Brendan’s eulogy). My daughter, who is 6, had met Barb a few times and asked me if she could come to the funeral. I don’t think she really understood death and what a funeral was and I didn’t really think it was appropriate for her to go. The thought did cross my mind however, that maybe I should let her go so that my funeral wouldn’t be the first one she attended.

After the service, a lady came and spoke to me about my cancer. When I told her I had Hodgkin’s lymphoma, she told me I was “lucky” I had a curable cancer. I could feel my friends who were beside me, go tense and hold their breath, wondering how I was going to respond. I bit my tongue and said nothing. A funeral was certainly not the place to let rip with all the reasons I didn’t feel lucky.

I just need to add one more thing about Barb. In my last post, I mentioned how Jenni and Brendan had tried to get her to say “Fuck you cancer”, but being the lady that she is, she refused. I also mentioned that although her death was supposedly expected, it was expected in a timeframe of weeks or months. In the end she went very suddenly and unexpectedly. I think that was her way of saying “Fuck you cancer”. She went on her terms, with dignity and didn’t allow cancer to call the shots.

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I clearly don’t have a problem saying it!

When I woke up on Tuesday, it was like somebody had flicked a switch and I almost felt normal. Well, it was probably far from normal, but I felt comparatively great. I even put some makeup on for my trip into hospital for blood tests and the nurses commented that I had colour and looked so much healthier than I had on previous visits. Blood was taken from my Hickman line and I was again given a top up of a litre of fluid while waiting for the results.

I had some very special visitors that day. Yeliena, a fellow forensic pathologist and member of ‘The Good Tittie Team’, and Eve. Eve is the Events and Sponsorship Manager of the Royal College of Pathologists of Australasia (RCPA); the college I am a fellow of. Among many many other things, Eve organises the annual Pathology Update Conference; the conference I had been planning to attend on the weekend. I had met Eve, or at least had spoken to her, at this conference in previous years. I’m sure she didn’t remember me but I knew who she was. I can’t recall exactly when I became aware, maybe late last year or early this year, that Eve had also had an adventure with Hodgkin’s lymphoma. When she found out I had it, she commented on my blog, called, texted and emailed.  She wasn’t stalking me, she was just desperate to get in touch with me to lend her support, as she knew exactly what I was going through.  As she said, there is a special bond between people with or who have had cancer, especially between those with the same cancer.

I’d had a lot of contact with Eve leading up to the hospital visit, as we had hoped to catch up with each other at the conference (she is from Sydney so was in Melbourne for a few days only). I think I provided her with daily updates of my condition and my hopes to be able to attend, but by Saturday it was clear that it wasn’t going to happen. She said she would sort something out and come to see me and Tuesday was the day. She lined up Yeliena to be her chauffeur and they made the trip to see me, probably about an hour away. Both her and Yeliena were surprised at how well I looked. I was surprised at how well I felt; like I said, it was like someone had flicked a switch.

Eve is a very unique kind of person. Very funny and straight to the point. She doesn’t take any crap from anyone and if she wants something or if you want something done and she can help, she’s on to it immediately. No mucking around. She’s quite crazy really, in a good kind of way. I don’t think she’ll mind me calling her crazy and if she does mind, she will let me know! When Eve arrived she said hello and quickly got updated on my situation and then she was off to get some food as she didn’t want me starving. She wanted to know how she could join the club of calling each other by surnames, as that’s what a lot of us do at work; I don’t actually know how or why that started, but we do. So she became a member of that club immediately and we now pretty much only call each other our surnames. If she calls me Melissa, I know it’s serious.

Like me, Eve likes to joke about being the centre of attention so she made sure she’d get a mention in my blog when I got back to writing. We decided we had better take a photo to put in the blog so we asked a nurse to take a photo of us all.

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This is Eve, touching up her make up before having her photo taken for this blog. I thought that was hilarious so I took a photo of it.

 

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Clowns to the left of me (Eve), jokers to the right (Yeliena), here I am…… (That’s left and right of me, not left and right in the photo). You can see the chips and drinks provided by Eve on the table in front of me, along with the food provided by the hospital. I wasn’t going hungry that day.

So to Eve, I say thank you. Not just for visiting me that day, but for everything. She has constantly kept in contact, mostly to ask when I am going to blog about her – no that’s a joke, although she has asked a few times. She has been an overwhelmingly wonderful support and has also been very useful with her contacts! Many of you may have read the article about me in ePathWay, the online magazine for the Royal College of Pathologists of Australasia (RCPA). That was of course, facilitated by Eve. If you haven’t read the article, you can read it here. You’ll just have to scroll down to the fourth story.

There will be many more mentions of Eve in the posts ahead (but no accompanying photos) but I hope this blog debut has been worth the wait for her. Eve recently marked 4 years of kicking Hodgkin’s butt (or was she just “lucky” and got the good version of the good cancer?). Either way, she endured some tough treatment; she achieved remission, and has stayed there, after first line treatment with some ABVD and BEACOPP (maybe I should have tried that). It was a tough gig but she got through it and now she’s giving something back. She’s on the board of the Prince of Wales Hospital Foundation, she’s a volunteer for Lymphoma Australia AND she’s a consumer representative on the Quality and Clinical Effectiveness Advisory Committee for the Cancer Institute of NSW. And then there’s that full-time job with the RCPA I mentioned. You’d have to be a little bit crazy to fit all that in your life! She’s a pretty special kind of person. Given my competitive nature, I’m now going to have to try to get on more boards and be a volunteer for more organisations than Eve! But first, there are bigger fish for me to fry.

Oh, I forgot to mention the results of the blood tests. I can’t remember numbers but they were all fine (for someone with cancer) – no need for blood and platelet transfusions and my neutrophils were back over 0.5. My haematologist came to see me and she said that my blood counts had started to recover, I would be back in hospital next week for the next cycle of chemotherapy. The results of blood tests on Friday would determine if that would be earlier or later in the week.

Over the next few days, I felt a little bit better each day, which was very fortunate, as ‘The Weekend to End Women’s Cancers’ was that weekend. It had been looking like I wouldn’t even be well enough to turn up to the event, but when I started feeling better, I knew I’d be there, I just wouldn’t be walking 60 km. The next few days were spent making sure every member of our team raised the $2000 required to allow them to walk. We all got there in the end and we were the highest fundraising team to have all their members qualify. Most people in our team chose to stay in the provided tents on the Saturday night. I hadn’t been too keen on that idea. My camping days ended after spending 46 days in a tent around Europe on a Contiki tour in 1997. Still having cancer was my green light to book a hotel. I booked it for the Friday night too as there was a very early start on Saturday and a team dinner in the city on the Friday night. I also had to go to hospital on Friday for more blood tests. Again I can’t remember the results but my counts were stable so I didn’t need any transfusions. A few people had expressed concern about me going to ‘The Weekend’ as it was going to be a very crowded place and perhaps not ideal for someone with a compromised immune system. I was quite confident my neutrophil count would be OK as I’d had some pretty decent bone pain from the G-CSF injection. My neutrophil count was 16.1 (that’s high), so I had enough neutrophils to share around with a few others. That provided some relief to worried family and friends. After the hospital visit, I went home to pack while Jenni collected (that’s putting it nicely) our team uniforms.

It was a phenomenal weekend, but that’s for another post.

49. IVAC – Slam 1

Monday 10th to Monday 17th February, 2014

Just in case you’ve forgotten, IVAC is the ‘salvage chemotherapy’ I would be receiving. I’ve called this slam 1, as opposed to round 1, the term I used for the rounds of ABVD, for very good reason.

In the lead up to my admission to hospital I received a phone call from a haematology registrar on the Friday prior, to inform me that a bed had been booked for me to be admitted on Monday 10th February. At that point I had no idea how long I’d be in hospital for so I thought I’d take the opportunity to try to get some information from her. It quickly became apparent that she really did not have much of an idea of what was going on and I was not impressed. She used terms like induction chemotherapy and told me I’d need a bone marrow biopsy to assess my response to the chemo. A bone marrow biopsy? WTF? I asked her why I would be having a bone marrow biopsy when I didn’t have cancer in my bone marrow. How can you assess how cancer is responding to treatment by doing a biopsy in a place where there is no cancer? She explained that she was new to this hospital and different hospitals have different protocols. I also asked about the Hickman line being put in and it seemed that hadn’t been booked.

I got off the phone and left a message for my haematologist to call me back. She called me soon after and I asked her about the bone marrow biopsy – no, I wouldn’t be having one. I also asked her about the Hickman line as that was the first thing that needed to happen when I got to hospital. She said the registrar must have misunderstood the instructions and that she would call me back. The registrar called me again and told me I was on the list for insertion of a Hickman line on Monday morning and I would need to be admitted at 7 am. I asked what time the procedure would be and explained that I lived about an hour away so I didn’t want to come that early if I didn’t need to. She said the procedure would take place before lunch but I needed to be there at 7 am. Why? To get the ball rolling.

I wasn’t intentionally being difficult but I know how public hospitals work. I knew if I got there at 7 am there would be a very good chance I would sit around for a few hours before I had the Hickman line inserted. To get in at 7 am would involve getting someone to look after my kids and take them to school and childcare, and also getting someone to look after Jenni’s kids and taking them to school, as she was going to drive me into hospital. If I had to be there at 7 am, so be it, but I didn’t want to get in there that early for no good reason.

Another phone call to my consultant followed by another phone call from the registrar and I was told the Hickman line would be put in at about 11 am so I needed to be there by 10 am. That was much better as it meant Jenni and I could drop our kids at school in the morning and then go straight into the hospital. I think I had already become a typical doctor making a bad patient and I hadn’t even been admitted to hospital. I also sensed that the registrar and I were not going to get along. I had ascertained that I would be given chemotherapy over 5 days so if I was admitted on Monday, I expected to be in hospital until Friday.

I went to a trivia night organised by members of ‘The Good Tittie Team’ that night. It was a great night and from memory around $4000 was raised for our team. On Sunday, I had morning tea with friends at my house and I got to eat some red velvet star cheesecake, the dessert I had missed out on at a Christmas get together last year, after throwing up in my friends back yard and going home early. Thanks Lisa.

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The famous red velvet star cheesecake. Yum!

Soon enough it was Monday morning. Jenni and I dropped our kids at school and headed into hospital. The admission process took a while. I was admitted as a private patient and was told that I would not be guaranteed a single room (as would be the case if I was admitted to a private hospital) but that if a single room was available I would be given it upon request. I eventually got to the ward and very quickly realised that I was a stuck up private patient. I went to a public high school and when I started my medical degree, I was in the minority, as most people came from private schools. I thought they were all a bit stuck up. Now I was one of them.

The room was a double room and it was not nice at all. It was tiny, dated and just did not seem like a nice place to endure five days of chemotherapy. I immediately wanted to go back to my local private hospital. Jenni said she would fix it for me by telling the nurses I was a private patient and asking if I could be transferred to a private room. She was told I had no chance. There weren’t many private rooms on the ward and they were used for patients who needed to be isolated. It was going to be a long week.

Not at all surprisingly, my Hickman line that was supposed to go in at 11 am went in at about 2 pm, by which time I was starving as I had been told to fast. The procedure took place in the radiology department and I was apparently sedated with fentanyl. I called it a public hospital dose of fantanyl as I didn’t feel at all sedated and didn’t find the experience particularly pleasant. The line was inserted in my right upper chest and then tunnelled under my skin to my neck, right under by perfect scar from the lymph node biopsy last year. That bit was particularly painful as the radiologist had to get it through the underlying scar tissue. In approximately that area, a small incision was made and the line was inserted into a vein in my neck and fed down towards my heart.

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This is not me, but this is what a Hickman line looks like.

 

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And this picture shows where it tunnels under the skin and enters a vein in the neck

 

 

 

 

 

 

 

 

 

By the time I got back to the ward, the nurses had decided it was too late to start chemo that day so I would be starting tomorrow, so my Friday discharge was now pushed out to Saturday. I decided to escape from hospital that night and go out for dinner with friends. I didn’t technically escape, I just liked to use that term as I felt like I was going to be ‘locked up’ for the next week. I got permission to leave and I returned at the requested time so I could start pre hydration for the chemotherapy – that basically refers to giving me a lot of intravenous fluid to protect my kidneys from the chemotherapy drugs. I also met the registrar that day and she was actually lovely. We were going to get along OK after all, I just wasn’t going to ask her or the resident any questions about my treatment. I would direct all my questions to the consultant.

I had very little sleep that first night due to my room being close to automatic doors that constantly opened and closed, rather loud nurses (just doing their job), overnight observations, constant announcements over the hospital loud speaker system, constant beeping of intravenous infusion pumps and a room mate who snored, talked in her sleep and grabbed hold of my bed and gave it a good shake every time she got up to go the toilet. Have I said it was going to be a long week?

On Tuesday morning the chemotherapy started. I kept asking the nurses what side effects I should expect as I was expecting it to be pretty horrendous spending much of the time throwing up. They told me I shouldn’t really experience any major side effects while I was in hospital and that any nausea or vomiting could be controlled with a cocktail of drugs.

I was given some education about the drugs I would be receiving and the side effects each one would cause. As I’ve said the regimen I was being given was called IVAC  and consisted of 3 chemotherapy drugs:

  • I for Ifosfamide
  • V for Etopside. Hang on, Etoposide doesn’t start with V but it’s also called VP-16
  • AC for Ara-C or Cytarabine

The side effects are pretty similar for all of the drugs and include hair loss, nausea and vomiting, diarrhoea, loss of appetite, drop in blood counts and more! The loss of appetite was pretty quick to hit, partly due to the chemotherapy and partly due to the disgraceful stuff served up that was supposed to be food. It all smelt the same and was truly horrendous. I promise I am not exaggerating. For the first few days I was offered tea and coffee for morning and afternoon tea. I don’t drink coffee and I was told to avoid hot drinks to reduce the risk of developing mouth ulcers. My room mate however, was being delivered Big M’s, muesli bars, cheese and biscuits etc. I asked one day if I could have something other than tea or coffee. Apparently I had to see a dietician first. So after several days of basically not eating, I was finally referred to a dietician. My diet was changed to ‘high energy, high protein’ and I too could order Big M’s and all sorts of other things for morning and afternoon tea. I was also provided with a supplemental menu items list so I could order things that weren’t on the standard menu; different meals, soft drink, hot food for breakfast for example. It would have been nice to know about that a bit earlier!

I would also be given a continuous infusion of a drug called Mesna to protect my bladder from haemorrhagic cystitis (bleeding into the bladder) which is caused by the Ifosfamide. Oh, and then there was the steroid eyedrops that I had to put in my eyes EVERY two hours to prevent eye problems caused by cytarabine. I was lucky enough to have that frequency reduced to every four hours overnight.

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The very appropriately named eye drops. In case you don’t know, FML = Fuck My Life.

I didn’t have every drug, every day but to be honest, I can’t remember what I had. I think the Etoposide and Ifosfamide might have been every day but the cytarabine was only given on 2 days so I could stop the lovely eyedrops 48 hours after that finished. Once the chemotherapy started, extra infusion pumps and bags of fluid kept getting added to my IV pole, the IV pole that I was permanently attached to for the next few days, until it looked like this:

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I was weighed every day and if my weight went up by more than 1 kg I had to have frusemide, which is a diuretic to make me pee. As if I wasn’t peeing enough with all the fluid they were pumping into me! After a dose of frusemide I would seriously go to the toilet and pass very large volumes of urine every 10-15 minutes. Quite inconvenient when you’re feeling like crap and just want to stay in bed. At some point I was informed that the Mesna would need to run for 24 hours after the chemotherapy finished so my Friday discharge that became Saturday was now Sunday! I hoped it didn’t get extended again.

I met my room mate but we didn’t talk too much as she was going through a very difficult time. I think she was in her 50’s and she had leukaemia. She had a stem cell transplant last year (from a donor) and had just found out that her leukaemia was back and she was out of options. She was going to die in a few months. There were apparently a couple of clinical trials she could take part in but she was told they would probably do more harm than good and she needed to think about the quality of her life. She chose to not try any further treatment. Because the rooms are so small, I overheard every conversation she had telling people she was dying. That was obviously nowhere near as hard for me as it was for her, but it was not nice to listen to. At one point, when I was in the midst of chemo, in bed and feeling particularly crappy, a social worker asked me to leave the room so they could have a private family meeting. I thought that was rather inappropriate.

Her sister came in to visit her one day and told her she had to “keep fighting” and she couldn’t “give up”. I felt like slapping her. My room mate had accepted she had done all she could to try to overcome the cancer. I’m sure she’d been to hell and back with the treatment she had endured and she didn’t want to endure anymore if the chances of success were minimal. Understandable. So did she “give up”? I don’t think so. I think she accepted her situation.

I’ve always hated the language used around cancer, even before I was diagnosed. If someone dies, they “lost their battle”. Did they not fight hard enough? No, they just didn’t stand a chance against this bastard of a disease. I’ve just never liked the connotation of ‘losing’, but maybe that’s my competitive streak. Whilst a positive attitude and determination are probably good qualities to have, clearly they are not enough or death rates from cancer would be pretty low. Take Jim Stynes for example. He had a huge number of operations and I think he tried every type of treatment known to man kind, including some very alternative ones. He died. Why? Not because he didn’t fight hard enough, because he had metastatic melanoma and he didn’t stand a chance from the moment he was diagnosed.

If I die, it won’t be because I didn’t “fight” hard enough, it will because the treatment I endured didn’t work like we were hoping. If I go into remission or I’m cured, everyone will tell me how I kicked cancer’s butt, and how strong and determined I was. I will accept those comments and I’ll probably like hearing them but they won’t really be true. It will be the chemotherapy that whipped the cancer’s arse, along with mine along the way. I suppose you have to be pretty strong to endure chemotherapy but strength alone will not cure cancer.

I could go on but I won’t. Instead I will refer you to a very eloquently written post in my friend Lisey’s blog, about the language used around cancer. I loved it when she wrote it, before I knew I had cancer, and I still love it now. You can read it here.

Well, I’ve digressed again. How did the chemo affect me? I have to say that overall, it was not as bad as I thought it would be. I think the unknown is always worse than reality. I had some nausea but got straight onto that with drugs the moment it appeared. I think I only threw up once or twice. After having no sleep the first night in hospital due to noise, I sourced some ear plugs but then the next night, or maybe it was the one after, I was awake most of the night with cramps in my thighs. My magnesium had been low and that was replaced during the day. Low magnesium can cause cramps so they decided to give me a bit more overnight. When that hadn’t caused any relief after two hours, I looked at the pump and realised it wasn’t even running. I then resorted to endone which did the trick and I got some sleep. At one point during the night I was standing up beside my bed as that was the most comfortable position to be in. A nurse came in asked why I was standing up and when I told him, his response was “whatever works”. Overwhelmed by the sympathy!

In general, I found the nurses to be friendly, efficient, caring and very knowledgable. I also noticed there were a lot of accents amongst them; American, English, Scottish, Irish. I mentioned this observation to a male nurse with an English accent and asked him if they all lived here or they were on working holidays. His response, “I’m from Brisbane”. OK, picked a good nurse to ask that question. One of my visitors did agree with me though; he definitely sounded like he had an English accent.

I started spiking fevers on about day 3 of chemo, which could have been due to the cytarabine (a known side effect) or an infection. Since an infection was the most concerning possibility, I had to have a number of tests to exclude that and I was started on broad spectrum antibiotics which in turn caused diarrhoea and a generalised rash. Oh the joys.

I had quite a few visitors, which was nice, including some work colleagues, one of whom walked in and exclaimed, “You look like shit!” I was actually quite happy with that observation as I’d been telling people for months that I do look like shit sometimes. Most people only ever saw me when I was out and about after recovering from chemo and were always surprised at how well I looked. Another work colleague, Natalie, made a number of visits, bringing me in lollies and lemonade (before I got changed to the special diet) as that was about all I could manage to eat and drink. She also bought in a box full of cards, notes, gifts, DVD’s and more lollies which she had collected from the generous souls at my workplace. I also had a visit from cousin Sonya who brought my daughter in to see me. She gave me a flower for Valentine’s Day and had drawn me a picture (my daughter, not Sonya, that would be weird if Sonya drew a picture for me), with a gorgeous note on the back, to brighten up my room. We decided it probably wasn’t wise to bring the nearly two year old son in given the size of the rooms and the lines going in to me that I’m sure he would have loved to have pulled out, or tripped over.

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I think the most  unusual visit I had was from Jenni and her husband, Brendan, after they’d been out for dinner in the city. It was 1 am! I was awake so they didn’t wake me but I did it suggest it probably wasn’t an entirely appropriate time to visit. “It’s OK”, said Jenni, “I already checked with nurses and there are no set visiting hours on this ward”. Never mind my room mate in our very intimate room. I think she was a heavy sleeper so I don’t think they woke her and it was a nice surprise visit.

The next morning, Sunday 16th February, I remember all too well, unfortunately. I had a shower and in the process of doing so, managed to make a mess of the dressing on my Hickman line such that it would need to be replaced. I got back into bed and there was a text message on my phone. It was from Jenni, telling me her mother-in-law, Barb, had died. My male nurse walked into the room soon after and I was crying. I told him why I was crying and also showed him the dressing over my Hickman line to let him know he’d need to redress it. Because I was quite shaken, I’m pretty sure I exposed my entire right breast to him when I was showing him the dressing.

I’ve talked about Barb before in this blog. She was diagnosed with advanced ovarian cancer a couple of months after I was diagnosed with cancer and she was one of the people we were doing the walk for. After initially responding well to treatment, her cancer recurred early this year and she and her family were told there was nothing more that could be done. She accepted the news with dignity. She constantly told me that I deserved to get better more than she did, but I did not agree with her.

Barb is one of the most beautiful people I have ever met, probably the most beautiful. She never had a bad word to say about anybody and she never swore. Even when she knew she was dying of cancer, Brendan and Jenni tried to make her say “Fuck you cancer”. It had always been a challenge to make her swear and nobody ever succeeded. She still wouldn’t say it and the best they got was “Damn you, cancer”. When Barb had initially been admitted to hospital, her beloved and devoted husband, Len, who is just as beautiful as her, was also in hospital undergoing major heart surgery. Not only was it an extremely traumatic time for her children, having both of their parents very unwell in two different hospitals, there was a real concern that Len and Barb may never see each other again. Fortunately Len bounced back from surgery extremely well and Barb’s condition improved so they were able to spend some time together before she died.

When Jenni and Brendan came to visit me at 1 am the night before, which was actually only a few hours earlier, they told me they had been to see Barb that evening before they went out for tea, and she was doing well. Although her death was supposedly expected, in the end it was very quick and completely unexpected. Fortunately, Len was by her side.

Jenni and I visiting Barb in hospital

Jenni and I visiting Barb in hospital. She told me I looked better without a scarf on.

During my admission, I had several visits from the consultant on ward service. I was very pleased he was a Professor. I like Professors. In general, they’ve been around for a while and they know their stuff. I had saved all my questions for him. Obviously now I can’t remember all the questions I asked him but I know he ran through what my planned treatment would involve. He talked about the fact I’d be having an autologous stem cell transplant (if the lymphoma responded to the ‘salvage chemotherapy’ of course) and also asked if I had any siblings so they could be tested to see if they were a match for me and could donate their stem cells to me. I asked why he was doing that if I was having a transplant with my own stem cells. He said he wanted all available information and made it clear that whilst there was a plan at the moment, that plan could change along the way. Never a truer word spoken.

During the first visit, he told me that it is very uncommon to die from Hodgkin’s lymphoma and he told me I had more than a 50% chance of being cured by the treatment I was about to receive. I liked hearing that word cure as the haematologist I’d seen the week before seemed very determined not to use it; she would only talk about a durable remission. During the next visit, I pointed that out to him and said I was a bit confused by the terminology. Was the goal really to cure me? He was adamant he was aiming for cure and I was happy to hear that, of course. He even said the other haematologist was a wuss.

I remember asking why IVAC had been chosen as the ‘salvage chemotherapy’ regime as I was aware, (although certainly didn’t know the details of), that were a large number of regimens available. He reeled of the names of a number of other regimens and said he had used them but he always tended to end up with IVAC, so he was just cutting to the chase. I liked that answer. When I saw him on Friday, I asked if I would be able to go home on Sunday as that is when the Mesna would be finished. He said it would depend how I was but that he’d prefer I went home on Monday as he would like to see me before I went. Another night in hospital.

I had a visit from the transplant nurse to get the details of my siblings so they could be sent information about being tested to see if they matched me. She asked if I thought they’d be willing to do it. Of course they would! It would be a competition and if anybody matched they would claim that as a victory for sure. I asked her how the stem cells would be collected as I had assumed it would be from a bloody big needle in the hip, like a bone marrow biopsy, and therefore rather painful. This was not the case however. Injections would be given to mobilise bone marrow stem cells and send them out into the peripheral blood. They would then be collected in a manner similar to donating blood, so it would be relatively painless. I did tell Jenni that I was a little disappointed that if she did ever have to donate her stem cells to me, she wouldn’t have to experience much pain in doing so.

I think the Mesna finished pretty late on Sunday so I probably needed to stay until Monday anyway. The registrar and resident came around early in the morning and then I had to wait for them to come back with the consultant. I was dressed, packed and ready to go. When he came around he made sure all my follow up appointments had been organised.  I would go to my local private hospital for a blood test and transfusion if I needed it on Wednesday and then on Friday I would come back to this hospital, as I was planning to be in the city for a conference. I asked him how I should expect to feel in the next few days and he said I’d probably feel a bit washed out but that’s about it. That didn’t sound too bad to me. I had registered to go to a pathology conference that coming weekend so I asked him if it would be OK to go to that given that my immune system would probably be non-existent by then. He said if I felt OK, I could go and also told me that I was more likely to develop an infection from the bugs that lived on and in me, than I was to get sick from a bunch of pathologists coughing over me.

I was given the OK to go home and soon after got kicked out of my bed as it was needed for another patient. Joanne (the other favourite sister) came to pick me up. We had to wait a while for my drug supply from pharmacy but eventually we were on our way. So, whilst that 8 days in hospital wasn’t the most fun I have ever had, and it was a long time to be away from my kids, it wasn’t as bad as I had thought it would be. So, why did I call it slam 1? Well, things got a bit worse after I got home.

I did have a nice welcome home however, finding this message pinned to the door.

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Well there’s a lazy 4700 words; now three and half months behind.

48. The new plan

Tuesday 4th February, 2014

On 25th January, when I finally got up to date with this blog, I wrote “So, the blog posts will be up to date and live from now on”. I then posted on 28th January, with shitty news (about the positive PET scan), and on 6th February, with some truthful news (knowing the PET scan would be positive). Then, as you know, nothing. So I now find myself four months behind on writing about my adventure. I will now try to catch up as quickly as I can, which will be difficult given how much has happened and how much I write. As you read the posts that follow, I am sure you will understand why I haven’t written for a while.

I last wrote about receiving the news that my PET scan following 6 months of chemotherapy didn’t show the result we had all been hoping for, and I still had cancer. At that point, I didn’t know exactly what that meant in terms of further treatment required, as I didn’t see my haematologist until a week later.

 

My appointment with my haematologist was on Tuesday 4th February, one week after the PET scan. You may recall that the last time I went to see a haematologist after a PET scan, someone in the car park gave me their parking ticket which still had time left on it and that was one of three good things that happened that day. Well on this day, I was again given a parking ticket with time left on it, but this time I knew it wasn’t going to be one of three good things to happen as I was not going inside to get good news. Unless of course my radiologist friend had looked at the wrong PET scan and I really was in remission. Now that would have been good news.

My appointment with my haematologist was actually pretty brief. I had spent the whole week thinking of questions I wanted to ask him but I didn’t write them down. My main goal had been to see if I could get any sympathy from him, because he’s a bit of a hard arse. I was going to ask for it, but I forgot. When he called me in, I quickly reassured him that I already knew the results of the PET scan so he didn’t have to break shocking news to me, not that I think it would have been difficult for him.  Cancer doctors are pretty used to it I think. He said “that’s a bit of a bummer isn’t it?” which I thought was putting it nicely.  Jenni had asked me if I thought he would be shocked. I said I thought he’d be surprised but not shocked. So I asked him if he was surprised and his response was that “we are always surprised when patients don’t behave in Hodgkin’s disease”. Well I think I behaved, it was the stupid cancer that didn’t.

He went on to say that looking back, the one thing that was not “super dooper” was that the re-staging PET scan after 4 hits of chemo, although showing “improvement plus plus”, wasn’t negative. You might recall I asked him about this after the scan because he told me from the outset he expected that scan to be negative. He said that while it was never going to influence anything he did at the time, it always remained a question mark for him. He didn’t tell me that when I asked him at the time. He was very non-committal, as he is. I wonder if he had have told me about this question mark for him, would I have pushed him to change my chemo regime? Even if he did change it, who knows if it would have changed the outcome. I might have just had the pleasure of more extreme side effects and still had cancer at the end of it.

He explained the most recent PET scan showed low bulk disease, all above the diaphragm but in multiple sites so it was not amenable to treatment with radiotherapy, which is sometimes considered if there is just one troublesome spot.

“So, you get to score yourself some stronger therapy”, he said. I asked what that meant. Was he talking about BEACOPP (the one the German’s tend to use instead of ABVD) or a stem cell transplant? He said the first step would be some ‘salvage chemotherapy’  which would be upper grade in intensity  compared to the ABVD I had just had. He had constantly told me how well tolerated ABVD is and it constantly annoyed me because I hated it, although in hindsight I probably did tolerate it well. “The next step is definitely tougher” he said. Coming from him it must be bloody tough. He explained that following the salvage chemotherapy, the response to it would be assessed and then it would be followed by an autologous stem cell transplant.

I wanted a name for this chemo I would be having but he couldn’t tell me because, as he informed me at that point, he wouldn’t be delivering it. He had referred me to the doctor I had seen to get the results of my re-staging PET scan (when he was on holidays), the one who I thought I had been overly positive, as she also worked at a larger hospital in the city where this further treatment would take place. He asked if I was happy to be referred there. I said I didn’t really have a preference but I just wanted to know that no matter where I was referred, the same treatment would be recommended. He said everyone would recommend salvage chemotherapy followed by an autologous stem cell transplant, but the salvage chemotherapy regimes might differ slightly.

I didn’t know a lot about stem cell transplants at that stage; I just knew there were two types – autologous (using your own stem cells) and allogeneic (using stem cells from a donor).

I asked him what the success rate of treatment was now given that I hadn’t responded to the initial chemotherapy. He said we were still looking at curative treatment, which was nice to hear, “we had just hoped it would be a bit easier”. Aint that the truth.

I left that appointment still feeling OK about things, probably because the word cure had been used. It’s a nice word to hear. I then sat in the waiting room, sent a few texts to people to let them know I’d have to see another doctor to find out what was going to happen next, and waited to see this doctor, who I had previously thought was too positive. That was about to change. As I waited and saw her come out of her room to call in other patients, I noticed that she was pregnant. I joked with cousin Sonya that I thought that was a bit inconsiderate of her as it wouldn’t do much for the continuity of my care!

I was called into her room and the conversation started with her saying my PET scan didn’t look as good as the last one. “That’s a bit shit!” she said. Talking my language. She explained that I would require “salvage chemotherapy”, followed by stem cell collection, followed by an autologous stem cell transplant (using my own stem cells) and that they could only proceed with the transplant if I responded to the salvage chemotherapy (50% improvement or better on PET scan). She further explained that the stem cell transplant is a BIG dose of chemotherapy which wipes out my bone marrow and would take me months and months to recover from. Hence, my stem cells would be collected prior to the big dose of chemotherapy and then put back in after the chemotherapy so my bone marrow could regrow and I could recover from the huge dose of chemotherapy in weeks as opposed to months.

Take home message number 1: An autologous stem cell transplant is actually a MASSIVE dose of chemotherapy! The stem cell transplant bit is just managing a side effect of that massive dose of chemo (wiping out the bone marrow).

She said I would need to be in hospital for a few weeks to manage side effects of the big dose of chemotherapy. I asked at that point why a bone marrow transplant isn’t done as first line treatment. I would find out the answer to that question myself in a few months! Her answer was that it is very intense and that most people with my type of lymphoma respond well to the initial chemotherapy that I had (ABVD) and go into remission and stay in remission. Not me.

She said that when I was initially diagnosed, I had a 60-70% chance of going into remission with ABVD (I’d been given better odds than that but that’s irrelevant). She said ABVD is tough because it takes 6 months but that it is more manageable than high dose chemo. She explained that Hodgkin’s lymphoma is usually very chemosensitive and even with very advanced and bulky disease, remission can be achieved in most people with ABVD, so that’s why they don’t use high dose chemotherapy upfront, because most people don’t need it. I didn’t have expected outcome with ABVD so I needed ‘salvage chemotherapy’. This would involve giving me a combination of drugs I hadn’t already been exposed to, the aim of which was to shrink down what was there prior to transplant. The less disease you have on board at the time of transplant, the better the outcome.

She went on to explain that ‘salvage chemotherapy’ is done to debulk and demonstrate that even more intensive chemotherapy (the stem cell transplant bit) is going to be worthwhile. If the cancer is completely resistant to the ‘salvage chemotherapy’ there is no point doing the transplant as it would just cause side effects with only a small chance of benefit. She said I would need to demonstrate a response to the salvage chemo in order to go on to have the transplant, but that I didn’t need to be in complete remission. She also explained that I was unlikely to be cured with ‘salvage chemotherapy’ alone but that after a transplant, remission was much more likely to be long term. I asked what would happen if the ‘salvage chemotherapy’ didn’t work and she said we could try a different type of ‘salvage chemotherapy’ and then go on to transplant but the chances of having a long term benefit from transplant go down if the lymphoma doesn’t respond initially.

I was told the chance of success with ‘salvage chemotherapy’ and stem cell transplant was in the order of 50-75%; success being defined as the likelihood of getting into a “good durable remission”. Hmmm, not using the word cure. I then asked if it was the case that because I hadn’t responded to the initial chemotherapy (the ABVD), if I did then achieve remission following the transplant, was the lymphoma more likely to come back in a few years. “Yep!” She said that if you need additional chemotherapy at this stage, there is a higher long term risk of relapse than if you just go into remission with standard chemotherapy.

She then injected some positivity into the conversation and said that my lymphoma was likely to be chemoresponsive and I was likely to go into remission. “You’re not stuffed”, she said. I was told that there are other types of lymphoma where I would be stuffed if I was in this situation I found myself in now; not responding to initial standard chemotherapy.

The salvage chemotherapy was then explained in more detail. I would have two cycles and would be in hospital for about a week each time as the chemotherapy would be given over a few days. My blood counts would drop after I was discharged and I would need transfusions. The next cycle of chemotherapy would start when my blood counts recovered, which would probably be about two to three weeks after I was discharged from hospital. There was no set schedule like there had been with ABVD (given fortnightly); it would depend how long my blood counts took to recover. The ‘salvage chemotherapy’ part of the treatment would take about 2 months, then I’d have another PET scan to assess response, then stem cell collection and transplant if the PET scan looked at least 50% better.

Take home message number 2: There are no set dates for this type of treatment, making it very difficult to plan anything and to know whether I would be in or out of hospital at any given time.

I asked when this treatment would start. She said there would be a bone marrow transplant meeting the next day at the hospital in the city, where my case would be discussed to make sure everyone agreed on the planned treatment. I could then be admitted later that week or early next week but I could delay it for a week or two if I had something special on. I mentioned the walk (The Weekend to End Women’s Cancers) I had signed up for along with a team of 29 other people, including two uncles who were flying over from Perth. That was about a month away and she advised me that it would not be wise to wait that long. I don’t think I was really considering waiting until after the walk but the prospect of not being able to walk with my team was not a pleasant one. She said the longer we waited, the more progression there would be and the more work the chemotherapy would have to do. “We are hoping for a very good result so it’s best to just get on with it!” I decided I would prefer to start treatment next week as that way I knew I had the next few days and the weekend clear and I could attend a trivia night on Friday night that had been organised by members of ‘The Good Tittie Team’.

I asked what drugs I would be having and she said the protocol was called IVAC. Low blood counts were the main side effect, along with the usual hair loss, mouth ulcers, diarrhoea etc. I would also need a Hickman line inserted which is a means of having permanent intravascular access, similar to a PICC line but  there is less risk of infection with a Hickman line and it can stay in for longer. I would need regular blood tests and transfusions after being discharged from hospital following chemotherapy and the dressing on the Hickman line would also need to be changed weekly. My neutrophil count would be zero for a while after the chemotherapy and if I got sick or had a fever I would have to go back to the hospital in the city, quickly, but fortunately the blood tests, transfusions and dressings could be done at the private hospital close to home where I had had all my previous treatment.

It was made clear to me that this treatment would completely take over my life and be a priority. “It is shit and has to be dealt with” she said. I then mentioned the trips to Bali and New Zealand that I booked on the day of my supposed last chemo infusion on 30th December last year. She said she didn’t know if I would make it and that trips in May/June might be pushing it. She said that I might be finished treatment and be out of hospital but I might not feel up to an overseas trip.

I then asked the hard question. “Will I die from Hodgkin’s?” She told me I had more than a 50% chance of going into remission with this treatment, so I should be OK in short term. She went on to explain that people often go into remission after a transplant and stay in remission for many years but there was probably a 50% chance of long term relapse, as opposed to 20% if remission had been achieved after ABVD. If I was to relapse down the track, there would a good chance of getting into remission again but not as good as now. With each relapse, the likelihood of achieving remission worsens. It wasn’t sounding great to me but as my haematologist told me on day 1 of chemo last year, “statistics are for statisticians”.

I also asked if it would have made a difference if we’d realised ABVD wasn’t working earlier and changed the chemotherapy regime to BEACOPP. She said it is possible I would have benefited from changing to BEACOPP but nobody would have done it based on my PET scan. I wonder if the German’s would have. Having very chemoresistant disease is not as good in the long term so it wouldn’t have been better if the early PET scan didn’t show such a good response and fool everyone into thinking the chemotherapy was going to work.

So was all that chemotherapy I had last year a waste of time? She said the goal was to get me in to remission and it didn’t achieve that but she didn’t want to tell me “6 months of shit chemotherapy” was a waste of time. She said that if I hadn’t had that chemotherapy I’d probably be dead by now. I’m not sure if that’s true but it’s one way of making it feel like it wasn’t a complete waste of time.

She then asked about what support I had. I would be in hospital for large blocks of time and if I got a fever or felt unwell when I was out of hospital, I would have to go straight back to the hospital in the city, even if that was in the middle of the night, so I would need someone to look after my kids at the drop of a hat, and someone to take me to hospital or call an ambulance. I think anybody reading this blog knows that I have a fairly good support network. Understatement of the century!

I asked about work and she told me I wouldn’t be able to work during this treatment. I would need at least anther 4-5 months off. She said people need at least 8 weeks off after a stem cell transplant and then usually go back to work part time initially.

The hospital I would be admitted to in the city is a public hospital. I could be admitted as a private patient but she told me that wouldn’t make any difference to my day to day care. I would be seen daily by the registrar and resident and reviewed several times a week by which ever consultant happened to be on ward service that month. I would have preferred daily review by the same consultant (of my choice) but there wasn’t much I could do about it in a public hospital.

She then felt the lymph nodes in my neck and commented that they were “piddly little things”. If only they’d caused a piddly little problem.

The consultation ended with her saying, “You’re still in with a chance so we’ll just proceed with the expectation that you’ll get into remission”. She reiterated that I needed to have things sorted out at home and needed people to be able to help in the middle of the night, at short notice, if I became unwell.

Take home message number 3: I would need A LOT of support and would be relying on people for A LOT of help during this treatment.

I know you’re wondering how on earth I remembered these consultations in such detail if they occurred 4 months ago. I’d like to say it’s because I’m brilliant but I recorded them. It’s interesting listening to them again to write this post. I walked out of the second consultation thinking that this haematologist who I had previously thought was overly positive, was not positive at all. She would not use the word cure and would only talk about achieving a “durable remission”. In hindsight, I don’t think she was being negative, she was just telling me how it is, and that’s how I like it. At the time though, I left with the feeling that if this salvage chemotherapy and stem cell transplant didn’t work, I was stuffed and I was going to die. I didn’t remember the bit about there being a 50-75% chance it would work and there being further treatment options down the line. I told a few people of my opinion about my future (that I was stuffed it this didn’t work), but nobody in the family of course. And again, I’m glad I protected them from that because I’m certain it would have sent them into a state of panic and I now know that it is not necessarily true.

After the appointments, I picked up my daughter from school and took her to her swimming lesson. On the way to swimming, she asked me how people get to heaven – gotta love the timing of that question! I can’t remember what I told her but I asked her why she had asked that question, wondering if she thought I was going to die. The reason she gave for asking is actually pretty funny. She told me that she went to the toilet at school that day and that reminded her of when she went to the toilet at home and there was a dead moth on the floor. That it turn reminded her of the dead lizard her papa had found when he and her cousins were at our place and I think they had had a conversation about heaven then. Love the way kids minds work.

I knew I had a tough few months ahead of me, but I had no idea how tough they would be. It was all a bit of a shock really and I felt like I’d gone from having a cancer that really wasn’t a huge deal (although not good) and I’d be cured with a bit of chemotherapy, to things suddenly becoming very, very serious. This so called ‘good cancer’ had turned to shit overnight. I think Lisey told me I had the fucked up version of the good cancer and that sounded about right to me. Maybe I need to change the title of this blog.

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3700 words and I’m still 4 months behind. Better keep writing.