Zach vs. Chemo: Rounds 1, 2 & 3

Zelda: Chemo is like a prize fight. If you win, the prize is this: You get to live a little longer (though you might not enjoy it). And if you lose, well, you don’t. 

Zach’s fight with chemo is scheduled for 8 rounds: One infusion every 3 weeks from July to November. And while I won’t bore you with the blow-by-blow, I do want to give you a sense of how he did in rounds 1, 2, and 3. And how I did too, as his caregiver, partner, and “corner woman.” So let’s start with the introductions.

Announcer voice: 

“In the near corner, The former heavyweight champ, ZACH “The Hammer” PRIME. Prime is now competing in the light heavyweight class after dropping more than 40 lbs. in a training camp described as grueling and profoundly gut-wretching.

“And in the far corner: The brawler known for low blows, Chemo “The Rascal” Docetaxel. 

“Odds makers have Prime as a 10-point underdog, but give him a puncher’s chance in this scheduled 8-round match dubbed, “The Bruisin’ at the Infusion.”

Zelda: Round 1 began like a normal visit to the oncologist. An aid took vitals, and we had a meet & greet with a nurse practitioner (NP). Then I was sent to the lobby to wait while Zach got his first infusion. In the past, patients could have a friend, a caregiver, or an emotional support whatever with them during the treatment. But they stopped that during COVID, and they never went back.

The infusion went well and Zach felt fine on the drive home. The next day, he felt great—like Superman—thanks to the Prednisone in his infusion. But on the 3rd day, Docetaxel hit hard, and Zach got all the expected symptoms (nausea, vomiting, chills, tremors, diarrhea, loss of appetite, extreme fatigue, mouth sores, etc.). I started a diary to record them and track his medications. It’s surprisingly difficult to remember how you've felt and what meds you've taken in the blur of chemo therapy. It helps to have it all written down.

His symptoms continued, and at the 2-week mark, his hair started coming out in clumps, so I helped him shave his head. Zach has always had good hair, though he’s showing more forehead now than he did when we first met. But I’d never seen him without hair, and his head looked so much smaller than I expected. And since he hasn't been eating much, or working out, the rest of his body has literally been shrinking, too. He's lost muscle, and his arms and legs seem impossibly skinny.

And he's started zoning out a lot. I found him sitting near the front door one day, just staring toward the floor. 

“Whatcha doing?” I asked. 

“Day dreaming,” he replied. Then he went on to describe his dream: An intruder had come through the door, and he was forced to defend himself. He grabbed a club and hit them: First one knee, then the other. And when the intruder doubled over, he whacked them on the back of their head. 

And I thought, that’s just what the chemo is doing to all the cells in your body.

A few days before his second infusion, he was feeling OK. Not fantastic, but not as bad as before. He even got out and mowed the lawn, watered some plants, and made an amazing from-scratch Mac ‘n’ Cheese for dinner. Never mind that he took one bite and pushed it aside (it didn’t taste right); I felt like I was starting to get my Zach back. 

Three days before his second infusion, he had a setback. While getting out of bed, he lost his balance and fell, hitting his head on the nightstand and landing on his back, hard. When we finally got him to his feet, it was clear he was in pain, but he refused to go to the emergency room. He wanted to tough-it-out.

If it hadn’t been for the fall, he probably would have been feeling good going into round 2. But he was feeling awful. His care team suggested postponing the second infusion, but Zach decided to stick with the schedule. He didn't want to drag it out. 

The Round 2 infusion went well. Zach’s biggest complaint: The care team is slow. In his words, it takes them 3 hours to do something they could do in 30 minutes. After the infusion, he felt a little better. Then all the rotten symptoms returned. Only this time, he was also in severe pain from the fall. We tried all the normal tricks to deal with injury: Ice, rest, heat, topical pain relievers, over-the-counter remedies like Alieve—even some old prescription pain pills. Only one, an Oxycodone, gave any kind of relief. He spent most of round 2 on the couch. 

When he showed up for Round 3, the NP asked him how he was doing. Zach didn’t just give his standard, “Fine.” He said, “Shitty.” It took a lot for him to say that out loud—to admit he was having a hard time—and I was proud of him, though it made us both a little misty.

I told the NP that Zach had a lot of bruising on his hand after round 2. She said it was because they didn’t get enough pressure on the spot when they removed the IV, and they promised to do better this time. 

We also got an X-ray of Zach’s back and hip. Thankfully, it didn't show any breaks. But the only thing they would recommend was physical therapy. That’s out of the question, of course. Zach is in so much pain he can hardly walk or stand.

Later, we met with Zach’s oncologist, who gave us a script for more Oxy. He also recommended an MRI to see what’s causing all the pain, and figure out how to address it. He's suspicious of tumor activity in the hip and pelvis area. Hopefully, we’ll get the MRI scheduled this week.

What I learned from Zach’s first 3 rounds of chemo: 

1. Don’t panic if the person going through chemo forgets things: They might be with you at the store, and you buy milk together. The next day, they might ask when you’re going to the store to buy milk. If you say something like, “Don’t you remember? We did that yesterday.” It starts an argument: “No we didn’t.” “Yes, we did.” To avoid that, I’m trying this approach: “Good news! We bought milk yesterday. Want some?” The response has been much more positive.

2. Keep a diary for each day of each round: At first, I was writing things down every day in sequence as a record. I had a beautiful table with columns for meds, symptoms, food, activities—all the biggies. But when I wanted to compare how Zach was doing on day 5 in each of the previous rounds, I had to keep paging back and forth. I realized that what I really needed was a sheet for each day of the treatment cycle—Day 1, rounds 1-8—not a continuous diary. Now I can see day 1 to 21 for all 8 rounds to better track his progress. 

Zach: So my days are numbered now?

Zelda: No, chemo’s days are numbered.

3. Chemo doesn’t have to destroy a sense of humor: One of Zach's doctors was 40 minutes late for an appointment and seemed irritated when they finally got to our exam room. They didn't take time to apologize for keeping us waiting, either. They just rushed through the details of our appointment. Here's what Zach said to the doc as we were leaving:  

Zach: Do you like your job?

Doctor: Yes, I do.

Zach: Funny. I never would have guessed that.

Fortunately, we don't have plans to see that doc again.