Science Write Now | Free cheese and crackers

The treatment facility has CANCER CENTRE written in big letters on the façade. Cheers, thanks for the reminder.

There’s a receptionist in charge of welcoming me and other patients, and showing us to our allocated chairs. We carry our own luggage – books, earphones, knitting. Emotional baggage is optional.

“Come this way, please,” says the woman, with a smile.

There are TVs on the walls. Fancy cushioned chairs. Endless tea and coffee, plus cheese and crackers and individually-wrapped cream biscuits. For free! I take a selfie of me doing the thumbs up in front of the small kitchen area, and send it to the kids. I’m not sure if it’s for their benefit, or mine.

It’s almost like we’re here for a holiday, for a massage, for a pedicure at the local beauty clinic. But there’s no swimming pool. No nail colour selection. No exfoliation or buffing.

We sit in the chairs so our veins can be connected to clear tubes and plastic bags. Bags full of drugs that slowly drip, drip, drip, while our hearts slowly beat, beat, beat, pushing the medication around our bodies.

The drugs I’m receiving are designed to kill – not my whole body, but a part of me nonetheless. The target is a B cell lymphoma, a cancer of the immune cells that normally make antibodies. The lymphoma is living uninvited in a lymph node in my abdomen, detected initially as a lump and characterised fully through scans and biopsies.

The diagnosis feels a bit ironic, as my postgraduate degree was in immunology.

“That's a pretty extreme practical project; I think the PhD was probably enough,” a friend messages me.

Indeed.

Understanding the science does create a degree of comfort though. It makes sense to me that B cell lymphomas are relatively common (about 1500 new patients are diagnosed in Australia every year), because I know B cells are constantly rearranging immunoglobulin genes to create antibodies that bind to their targets more specifically. Moving bits of genes around creates a high chance of mistakes, and unrepaired errors in DNA are what makes cancer.

My treatment protocol is double-barrelled: chemotherapy plus immunotherapy. I’ll receive chemotherapy for two days in a row each month, for six months. The immunotherapy will be administered once a month for six months, and then once every two months over a longer period.

It's day one of this month’s cycle, so today I’m here for both drugs. Immunotherapy first up – it will take about five hours (it’s a very slow infusion to reduce the risk of adverse reaction), with chemotherapy an additional hour after that.

Before they insert my intravenous line, I need oral drugs too. I swallow a steroid tablet, an antihistamine and two paracetamols, and sit back for thirty minutes to let them take effect. Controlling my body’s response to the treatments is a delicate balancing act.

I put my headphones in, as I don’t want to talk to anyone. But I do spy on people.

Mostly the patients are old. Much older than me, at least. Some are frail, some are large and strong. They watch me too; I see them mutter at each other, “Oh look, she’s quite young.”

(I’m 47, but everyone tells me I look younger. It’s good for dramatic effect, I suppose).

The patients with Italian heritage never come alone. They’re loud, unapologetic.

“Dio, Dio, Dio,” the woman next to me sighs, as she sinks into her chair. Her two companions hover about, watching every step the nurses take. They’re probably in the way, but nobody minds. It’s important they’re there. It’s clear the patient benefits.

Señora plays with the seat controller, like Homer Simpson in his well-known hospital bed scene. She’s pressing random buttons; seat goes up, seat goes down.

“Whicha one?!” she shouts. She gets the giggles. “My chair!” She’s sliding, and her feet will be higher than her head before too long.

The stern supervising nurse tells her to stop messing around, “You might get hurt!”

The patient doesn’t seem fazed, as presumably she’s there to have her life saved. She will receive two units of blood over the next couple of hours to treat anaemia resulting from chemotherapy.

The nurse talks her through the parts of the controller, pointing at symbols and arrows with her finger.

“See? The head and the feet. Up and down.”

“I don’ta understand,” the patient insists.

“Yes, you do,” instructs the nurse. “Yes, you do.”

The nurse’s name is Noriko. She tells a colleague sometimes she wishes she could just speak to everyone in Japanese, that it would be easier.

“Not for me, it wouldn’t!” her companion laughs.

It’s time for my warm blanket, retrieved from an oven on the wall. Noriko wraps layers of the soft, grey cloth around my arm to coax the veins to push themselves up towards my epidermis. I’ve been drinking gallons of water to achieve the same effect, knowing from bitter experience the pain of multiple punctures when a ‘good’ vein isn’t evident.

On this occasion she hits the jackpot straight away. After a tourniquet near the elbow, followed by the standard whack-whack-whack of her finger tapping the vein into obedience, the needle goes in with just a few seconds of sharp pain. Noriko applies a bit of backwards pressure to confirm a steady stream of blood, and then attaches the canula. A flush with saline disappears immediately into the vein: yep, we’re ready for immunotherapy.

It’s a lab-manufactured immunoglobin – yes, irony again, I’m being treated with an antibody to get rid of cells that make antibodies – that binds to a molecule on the surface of B cells called CD20. The rest of my immune system then sees those immunoglobulin-labelled B cells as targets for destruction. Both my lymphoma cells and normal mature B cells will be killed by this immunotherapy, because they both express CD20 on their cell membranes. I won’t be able to make any of my own normal antibodies for a while. But the collateral damage is worth it: if they don’t kill the lymphoma, it will spread.

Comfortable and pleased with today’s progress, I settle back and check the room.

There’s a new elderly patient next to the wall. When he spots nurse Noriko, it becomes clear he has been in the clinic many times before.

“Hey Karaoke,” he calls out. I stare at him in shock.

“What you want now?” she answers him.

“Only kidding Yoko Ono,” he says.

Outrageous. I think of The Book of Mormon stage show, in which a missionary never bothers to really know the African women and instead reels off various names of well-known people who have brown skin.

This guy getting treatment calls out more Japanese words. She takes it in her stride. I guess you get away with a lot when you have cancer.

A new patient arrives. He’s my age, and strides confidently towards the chair next to me.

“Gudday,” he says. “Here we all are, huh.”

“Yep,” I say. We’re here alright.

He has a pleasant open face, a muscular body. But he’s bald. Chemo has already had an impact.

It’s impossible not to eavesdrop on his conversations with the nurses. He’s come down from regional South Australia. He had Influenza A last week — and was in hospital.

“Yeah, the whole family had it,” he says. “Nasty.”

I assume he’s no longer infectious, but I throw in a reflex alcohol hand pump just to be safe.

He has advanced cancer; it’s in multiple places in his body. He describes this to today’s nurse factually, unemotionally. He’s doing lots of exercise: cycling and weights.

I admire him. I wonder about his family. How are they coping, back in his home town? Dad’s gone to Adelaide for some chemo. We don’t know if it will work.

The bag of dilute immunoglobulin connected to my arm is now empty. Nurse Noriko puts on her gloves and purple protective gown, and retrieves my bag of cytotoxic chemotherapy. There’s no need for another needle – with a quick switch, the new drug feeds into the same treatment line and I’m away again.

This drug acts directly on the lymphoma DNA, creating abnormal bonds and breaks in the double helix to stop the cells from reproducing themselves.

The lady further down to my right is about 80, and has leukaemia. She is accompanied by a daughter, who is in a wheelchair.

I think the older woman also has dementia.

“What’s that on the table?” she asks the daughter.

“There’s a timer, there’s a drink, there’s your file.”

“That thing, that thing in the middle, what is it?”

“It’s the timer, Mum,” her daughter says patiently. “The timer.”

All of us are set like ovens, with each new beep indicating the need for an IV line flush, or an upping of the rate of drug delivery, or time for some observations to be taken –– blood pressure, temperature, heart rate.

Free cheese and crackers

Sarah Keenihan