Friday, November 23, 2018

Your Personalized Fulvestrant Shot: Every Nurse Has Her Own Style

Each nurse, I have learned, is unique. Each knows just how comfortable she feels about giving shots in general and that shot in particular, the one with the very long needle and the fluid that has to enter excruciatingly slowly.
"Wouldn't you like to stand?" said one nurse. "All the other ladies do!" She gestured to a medical machine sporting a small, apparently decorative railing where I might rest my hands as I waited, pants down, feeling very dignified as she drew imaginary lines on my buttocks with a finger, trying to find the exact right spot pictured on the diagram she was probably holding in her other hand.
Neither of us anticipated me needing that railing for support when I started to faint. The only thing that prevented my doing so as everything went black before my eyes was awareness of that dagger-length needle deeply embedded in my right gluteus maximus.
Next time, I asked "the other ladies" which nurse knew how to give the shot. Two nurses are reputed to be particularly skilled and they have the same name, let's say Susy. One is short, the other tall, so they're known as Big Susy and Little Susy. 
When I go for my monthly shot I ask if either is around and if I'm lucky I get to lie on my stomach and forget the shot after the initial brief stab. 
That was before I read some medical literature and discovered that many nurses don't know that Fulvestrant is supposed to be administered intra-muscularly, not sub-cutaneously. In the muscle, not just under the skin. This is just one of the several worrying info-sheets I discovered on the topic: https://voice.ons.org/conferences/best-practices-for-im-injection-of-fulvestrant
Every time I go for my shot, I introduce the term "intra-muscular" into the conversation, but of course I have no way of telling whether the shot's being served up that way. 
My last CT scan was clear.  Is that a clear sign the medicine's muscling its way through, well, muscle?
Meanwhile, yesterday's nurse insisted I lie on my side with one leg, the one with the targeted buttock, in front of me. I've been told to lie on my side before, but the leg-in-front was a first.
"But this is the correct way!" insisted the nurse. "This way, the muscle is relaxed!" If you say so, nurse. Definitely hurt more that way. As she administered the shot (takes a few minutes) she noted that I seemed to have very strong muscles. She seemed rather surprised. The other ladies don't do, or didn't do, ballet. I did do ballet. My muscles are not the relaxed muscles she was expecting to see. But then who's relaxed while experiencing a needle halfway up her butt cheek, through which a liquid battling cancer cells is pinching its way forward?

Sunday, November 18, 2018

American Optimism and Breast Cancer Commercials

I can't imagine more of a fun challenge than metastatic breast cancer--going by the various American commercials advertising Ibrance, the stuff that's keeping me alive (oh, with the shot of Fulvestrant in each buttock every month, the needle as long as a chopstick). I should be grateful, and I am--all this is much nicer than the chemo infusions I had before, which made me sleepy and nonfunctional and are allegedly chemically cousin to mustard gas. But the idea that cancer is merely pesky, that you can forget all about it--ahh, the commercials make that seem possible: "Alice calls it her new normal . . . because a lot has changed--but a lot hasn't." Or this line: "Metastatic breast cancer never quits . . . so neither do I!" Go, prizefighter! The voice-over tells you the stuff is great at "delaying disease progression" but no one can tell you how many golden drops of life that delay contains. Eight ounces? Just a teaspoon? How about the Atlantic ocean? I'm reminded of Thor getting tricked into saying he could finish off a whole drinking horn . . . only to discover that it was attached to the sea. I want that ocean--the ocean of life. The days when I never thought in terms of limited time, but in terms of forevers. I assumed a great deal. I assumed I'd live to see my children married, to become a grandma, to write a few more books, to get some second honeymoons with my husband. But what if the Ibrance only works for another few months? Then there's the Verzenio:
Yeah, cancer's tough, but so am I! Okay, got the message. You can look young and gorgeous even though all these meds are for postmenopausal women. Meanwhile, enjoy forgetting all about cancer. If I forget something that big, it's likelier a sign of brain rot, one of the side effects listed on the back of the package. The drug companies don't use that term, but when your estrogen's chemically compelled to dry up the first thing to go is memory. Am I complaining that big Pharma is really inventing big ways to prolong my life? Of course not. I'm inclined to find perkiness suspect, is all. I'd go for a commercial with dark humor or wit. I'd go for anything that doesn't call cancer "a journey." I'd go for something other than battle imagery, with the women as the lone fighter against the big bad monster. The underdog kicking the giant "to the curb." That American underdog stuff is old. I want something new: in the meds department it should be sweet, chewable, painless and entirely lacking in side effects. In the cure department it should be, well, complete.

Wednesday, November 7, 2018

On Renting Rooms

There's nothing people lie about more than their romantic and erotic past. Except, maybe, real estate. That's the conclusion toward which my husband and I have been tending, as we committed the classic error of landlords: we wanted to be friendly enough to ignore a dubious first impression and give the guy a chance. We should have been all business--at least until we got to know him. But we like to like people. We're university teachers--in the interest of squeezing a better essay out of a (lazy? distracted? indifferent? traumatized?) head, we sometimes ignore a deadline and encourage the kid to try again. Occasionally that works. After all, we're modeling what we wish for students to emulate: tolerance, perseverance and hard work. We follow that formula much of the time, but such second chances don't fly with candidates for rented rooms.
After my husband painted and renovated the room and bathroom our last (lovely) tenant had inhabited for nine years, we advertised and got a call from a distracted-sounding young man who seemed very interested. He reminded me, over the phone, of a marathon runner who'd forgotten which direction his feet were facing. But I figured he was charging around between work and potential rentals. I'm acquainted with stress, and figured his condition was temporary.
In person, he made a better impression. He told us where he worked and what he did, he convincingly assured--by whipping out his asthma inhaler--that he wouldn't be a smoker, he said he didn't cook much and worked long hours, and when we figured out he'd mainly be using the room to sleep and have a cup of coffee, and return to his large extended family over the weekend, we decided to offer him the place.
He wanted to pay in cash, right then and there.
That was when I should have asked myself whether he had a bank account. We didn't accept that offer, suggesting instead that he return to sign the lease when he could also bring proof of employment. 
In the States, I could ask for three references, including an employer, and phone them. Folks don't do that here, but I figured a letter or even an email from his employer would be a reasonable request. 
We made an appointment for our prospective renter to bring said proof and sign the lease. Instead, when he was supposed to be there, he phoned saying he was in a traffic jam. Could he come two hours later? Sure, we said. Another phone call: Could he come another day? Too much traffic. 
We settled on another day and a definite time. He wasn't there. He wasn't there half an hour after the appointed time, nor an hour later. We went to the movies. When we returned we found he'd called more than three and a half hours after our appointment and left the following message: "I had an emergency. Please call me." We didn't, instead emailing him that we'd given the apartment to someone else, figuring he was no longer interested. He then phoned three or four times in as many minutes insisting that we had to give him another chance because he had no other options and besides, he'd ordered furniture. We told him to cancel the furniture. Emails followed--all insisting he couldn't understand our position, none offering any proof of employment or explanation. 
I wish I'd trusted my first impression, and I hope the young person finds a suitable place. I'm so very glad it's not ours.