My first patient is a cycle 1. I walk over and introduce myself to my patient, a middle aged woman who has come for her very first chemo treatment. I take in the anxious smile, the once well-fitting clothes that are now slightly too big for her (a sign of the insidious weight loss that often precedes a cancer diagnosis). I sit with her and her daughter and ask how they are feeling, whether they have any particular anxieties about the day (often the unknown). I explain that she will be here most of the day- hers is a long treatment- and what to expect during the day. I hope I’ve managed to take away some of their fear by removing some of the unknown element. I place a cannula in her vein and start a drip explaining that I’ll be back later to check on her.
‘Oh no, here’s trouble’ is my greeting to my next patient. An older man with a cheeky glint in his eye, we all look forward to seeing him and the banter we have. Being a chemo nurse means being the nurse the patient needs you to be. Some people need reassurance and TLC, while others want a bit of gentle ribbing. In a few more weeks his chemo will be over. We might see him again, we might not. When you’ve not seen a patient for a while it can either mean something good has happened, or something very bad. We often never find out.
With my second patient up and running, I head back over to my new lady. I hope that with a bit of time, the initial nerves are starting to dissipate, and now might be a good time to sit and go through the side effects of her chemo with her. It’s a difficult balance between telling her enough so that she’s well informed, without completing terrifying the poor woman; the list of side effects for each drug is pretty extensive. The one message I really want to get across to her is that she needs to ring our emergency phone number straight away if she has any signs of infection. Chemo suppresses the immune system meaning that the slightest bug could kill her within hours without treatment.
While I’m talking to my lady, something I notice out of the corner of my eye catches my attention. A movement quicker than usual, the tension in my colleague’s voice. I look over and see the reason, a patient who has turned an impressive beetroot shade. He’s having a severe allergic reaction to his chemo. I abandon my education session and join several other colleagues who are converging on the frightened looking man. Several things happen at once. Someone is drawing up the piriton and dexamethasone, the standard treatment for chemo reactions. Someone else is checking the patient’s observations, another is running to get the doctor. I grab a bag of saline and start running it through an infusion set. The patient’s eyes are silently pleading for help. I explain to him that I know he feels awful but this is something we regularly deal with and that we’ll be giving him drugs to make him feel better. The adrenaline is pumping and I can feel my hands shaking slightly.
With all the commotion going on, the other patients can’t help but watch. I’m aware that there are many eyes on us including my new patient- this will not help her feel more calm about her treatment.
The drugs have been given but the patient doesn’t seem to be improving. In fact, despite the redness of his face, he’s starting to look distinctly pale. Someone grabs the oxygen cylinder while myself and another nurse wheel a bed over to him. We help him onto the bed. He should be looking better by now. No one says it, but we’re all beginning to wonder whether this could be anaphylaxis, a more severe form of allergic reaction that is life-threatening.
But then, slowly but surely, his face returns to a normal colour. The relief is palpable as we start cracking jokes with the patient before I head back to my cycle 1 lady to finish her talk.
The unit is getting full now, we’re running out of chairs to treat patients in. Another patient arrives, a plump middle aged lady who has been coming to us for some time. I ask her about her daughter whose baby was due any day, but there’s still no sign. Certain patients come back to us again and again either for maintenance treatment or for further rounds of chemo. These are patients whose cancer can’t be cured but has become a chronic condition that they live with for many years. Current research into new cancer drugs is aiming to achieve this for more people with the goal of turning cancer into a chronic condition rather than a fatal one, much like what has happened with diabetes over the last 100 years.
The man who reacted to his chemo is being re-challenged with the drug meaning that it has been restarted very slowly and with careful observation. As there are a limited number of drugs available for treating each cancer we don’t let a little thing like a severe allergic reaction prevent us from giving someone’s treatment. Nine times out of ten they will be fine following the initial reaction.
I notice that my cycle 1 lady has struck up a conversation with the man next to her, a seasoned chemo patient. They are laughing and joking as he gives her advice on how to cope with her treatment and recommends a visit to the Maggie’s centre where they provide a friendly ear and a cup of tea as well as access to benefits experts and clinical psychologists. I can see she’s finally starting to relax a bit.
My last patient of the day is a girl my age. She has a son a similar age to T. She’s not going to see him grow up. I try not to think about it too much as I feel a lump rising in my throat. She’s always so cheerful when she comes in. We chat about our boys and what they’ve been up to, she shows me videos of her gorgeous son with a head full of chestnut coloured ringlets.
As the unit starts to empty out, my cycle 1 lady’s treatment finally ends. She was one of the first patients in this morning and one of the last to leave. She and her daughter thank me for what I’ve done for them. I wish her luck and, as she leaves, I hope she remembers some of what I’ve told her today and wonder what kind of experience she will have with her treatment. We can never predict which patients will have severe side effects and which will sail through their treatment. I’ll find out in 3 weeks when she comes back for her second cycle.
With the last stragglers finishing their treatment, I tackle the mountain of paperwork that I’m left with. I’ve treated 5 patients today and need to ensure I’ve fully documented exactly what I’ve done for each of them. We then go round restocking the unit, cleaning all the chairs and making the beds, ready to do it all again tomorrow.