Today is oncology again, for radiotherapy planning. Derriford Hospital is built into a hill so that level 6 is ground level at the front, while oncology is tucked at the rear into a cul de sac on level 2, with the weight of the full 12 stories pressing down; a 1970s brutalist hobbit hole.
Inside it’s pinched in the middle, so the café, manned by a friendly young man, bulges to the left as you enter then narrows before opening out at the far end. There is a semi-circular reception area with an office behind, from which fan sets of doors through to other areas, offices, CT, bloods, and treatment rooms, stairs to the Mustard Tree. Gaggles of people sit either in the café around low tables, or along the walls on metal and leatherette chairs. Some are talking, some just sit; the old hands look at home, others look as Alice in Wonderland as I feel. Some are trying to be cheerful; there are out bald heads, and jaunty turban scarves covering baldness. Staff nip up and down, calling people through, sometimes catching sight of someone they know and having a cheery chat. Every so often a tannoy echoes; Julie Brown for treatment please!
Today I get tea and a rock bun – the size of my stomach and clearly home-made. This is the trick; to buy your buns before the nice stuff has been eaten. A Bakewell tart stares at me from its wrapper, jaunty cherry and white icing hiding the truth, and I laugh in its face.
I’m called through to a small room by two people who are going to make my mask. Now this sounds pretty simple, and I wonder whether this is all they do. I discover that they are dosimetrists. Their role is to plan radiotherapy for all areas of the body, and the making of the mask for me is but one tiny fragment of their work. I had no idea such people existed. The man tells me that patients sometimes get cross with them because there’s a two or three week wait between the initial meeting and the first radiotherapy session; they recently held an open day and a couple of their patients commented that they’d had no idea how much critical detail and planning was involved. The complexity and accuracy of course is key. It pays to ask questions, always. I’m very happy to know these professionals are going to be planning the anti-Hunt missiles with such care and precision.
They show me a mask, and the thermoplastic mesh form that will become mine while explaining the process from the heating of the form in hot water to the fifteen minutes’ wait for it to harden. Then I’m cannulated ready for the CT scan that will follow the mask fitting; the radiographer will inject a dye in order to identify where the blood vessels are in the area of Hunt’s Cheshire Cat smirk. This is what the dosimetrists will use to focus the radiation.
I’ve never had a problem with needles before, though I’ve met many people who do. The surprise is that scores of them are bullet-holed by body and facial piercings, which goes some way to noting that the psychology of needles is far from obvious. I used to be pretty good at talking phobics through cannulation. Now, since the arterial line problem prior to my op, I’m in a similar place. My muscles tense, shoulders jerk up as I inhale. I try to let it go, partially relax, then jolt again as the needle begins to pierce the skin. The tensing makes the cannulation more difficult. Is it loss of control? I’m going to have to have weekly bloods taken, but hopefully no more than that.
Then there’s the claustrophobia. I’ve always had it, and I’ve never liked heights, although I’ve always climbed trees and enjoyed the thrill. When I had to teach on the climbing wall as an outdoor activities instructor I got over the problem pretty fast; on the crag it was different and I would freeze, not far up, and be unable to move. Then I worked out the reason was not the height; it was claustrophobia from the rock against my face so if I turned my head to one side I was magically freed. There’s a similar trick for caves, to which I’m fatally attracted, yet I could never leopard crawl through a tight one. I can, however, swim through as long as I go under the water when the space at the top gets too narrow for comfort. So how will I feel, held by my head to a board, the mask pressing against my face?
I’m laid flat on a shiny black glass table, with a neck rest behind my head, a gel pad under my bum and a knee rest. The giant polo of the CT scanner is haloed above my head. The staff fiddle with different neck rests, move me up and down, tweak, change the knee rest, and finally decide I’m in the right place.
The mask touches my face, soothing like a hot flannel, and Radio Gaga begins to play on the radio. Flash Gordon approaching! The mask, soft and warm, drapes over my nose, cheeks and chin, while the dosimetrist pats it into the contours. I hear a click, smell something sterile, like surgical spirit, with a fruity whiff – some kind of long forgotten sweets perhaps. The frame has been attached now, and the sides begin to cool. A cold dampness across my cheeks and jaw spreads forwards. I open my eyes, cream stripes and blurs, eyelashes touching, no real definition. A gradual awareness of something in the way of my breathing, and the pressure builds on my lips and nose. I shut my eyes, fast, try to breathe calmly. My face begins to pulse against the increasing resistance, leaving the ghost of the whooshing sound to escape my ears. It’s going some, maybe 100 beats per minute. I try to slow it. Radio Gaga clap clap. Flash Gordon I love you, but we only have 18 hours to save the earth!
The dosimetrists are still talking to me, and I think I’m answering. They begin to apply pieces of tape and to mark points on the mask with a pen. Spider scrabbling. Always spiders. There’s about seven minutes to go Lynne, do you want to wait and have a break before the scan? Or we can do the scan while the mask finishes cooling if you would like?
A snap decision – do the scan now. They prepare, set me up, and the radiographer injects the dye into my cannula. I don’t get the metallic taste she’s warned me about, but my mouth goes dry. Then the urge to urinate, which passes pretty quickly. She checks I’m okay, flushes the cannula, then tells me that they’re leaving the room, but if I need her she can hear me. Queen has been replaced by an insipid boy band who thinks you’re amazing…just the way you are.
A faint whirring, washing machine, jerking back and forth as the table slides…or is it the polo? The washing machine reaches full amplitude and swirls around the pulsing in my face which has now reached the top of my head. The grey dots behind my eyes turn to a royal blue splodge, that fades and bulges purple then grey as the polo blocks the light. I could move my body, but not my head. The man at the side of my bed is ready, I can sense him, the return of the night terrors of the past eight months which were my mind’s attempts to alert me to Hunt before I knew he was there. I banish him. He’s just a Cheshire Cat smirk and this mask will give me more time.
It’s over, I’m through it. Clicks, some more fiddling, then the mask is lifted and I open my eyes to the bright squares of light in the ceiling. The dosimetrists are back, and make some more marks on the neck rests before I’m helped to sit. I feel woozy and distant, but able to stand and walk to the chair. I take some photos of the mask which has hamster cheeks and the air of an alien egg.
The radiographer removes my cannula, and tells me to drink lots of water over the next 24 hours. I’m to stay in the area for a while till I’m sure I feel well enough to leave. It’s becoming normal for me to feel wonky and to not know how much is real and how much is in my head.
Later I talk to Kari who says I need to find a place to go in my head, somewhere to get through it.
It takes 36 hours for the effects to pass, the worst of which is a constant headache. Not a Hunt headache, just a nagging, generalised ugh and a shakiness. I should hear within 2 weeks when my treatment is to start.