Thursday, March 05, 2020

It's Linear Acceleration Time! - The SEQUEL - updated 3-24-2020


PROLOGUE
Three weeks after an all clear in the left ocular adnexa, there appeared a familiar discoloration in the right eye.  A strip of eyelid to the lab later, a wee bit of a lid lift as an unintended consequence, and the U of M tumor board said, "You're One In A Million Again!" This time, the ping pong of labs, unneeded biopsies, bone marrows and PET scans were eliminated, so treatment could begin in weeks, rather than months, after the initial suspicions arose.

Behold the Halcyon above, a shiny machine with that fresh new linear accelerator smell.  It comes with its own observation camera, disconcertingly placed between one's legs.  It brought to mind an image from Goldfinger - 



That being said, a new mask was created, as the previous bit of creepiness was vanquished from the home offices as being just another dust catcher, to the chagrin of the radiology physician.  The good (I shall say very good) doctor wanted to use it for calibration.  Nevertheless, a new mask was needed anyway, as the focus was on a different side of the noggin.

ABOUT THE MASK
If anyone gets one of these face masks, a forewarning - it gets heated for pliability first, and then it generally takes a pair of technicians to apply and fold it onto and around the entire front of your head to guarantee immobility.  IT IS VERY WARM.  ONE COULD ALMOST SAY NEARLY PAINFULLY HOT.  However, the heat quickly dissipates.  For the sake of later use in the radiation process, another suggestion - leave your jaw somewhat slack (unless that's the location being irradiated) because the mask presses HEAVILY on your mouth and lips, and breathing through the mouth can become challenging, especially since the nostrils tend to get pinched in the mask making process.

You must lie still for about 30 minutes while it sets up, and the technicians and physician make little calibration marks and apply some protective faux-flesh to protect the surrounding tissues when the radiation begins.  And, as in a dentist's office, you get asked questions while your face is fairly frozen in place.  I suggest a few lessons in ventriloquism before embarking on the process.

The left eye had some of this protective material in place last year, but it was only around the immediate area of the left eye.  This time, the clinic jumped for a generous layer that covered the eye, the eyebrow, and the cheek beneath the eye.

When the mask is removed, be prepared to notice the imprint of the plastic weave on parts of your face.  My expanding forehead had a live webinar going on, and some of the remaining hairs in that vicinity were lost in the name of SCIENCE!

THE SESSIONS BEGIN
The first drive had to begin in a snow flurry along the interstate, as the cliche demands.  The shiny, new Halcyon was introduced (the homophone to the drug Halcion being brought up), legs bent for comfort (after being assured that Dr. Goldfinger was not in attendance that day), the mask appropriately placed, and everyone was cleared from the room so the bombardment could begin - bring on the Grey Units!
Appearing as Jason soon in a Halloween near you...
Session One - March 4 - one-two, one-two, one-two....
The machine hummed very softly, and once in the required position, the familiar blue cycles began, quickly in 15 second cycles, for a total of three runs.  There was a slight smell of ozone, a minor sensation of warmth, and then the nurses and technicians quickly reappeared, unsnapped the mask, made sure my face hadn't melted in the process, and then examined the inside of the mask, discovering a bit of extraneous material from the masking process that hadn't been noticed until the radiation began.  It and a stray eyebrow hair were removed, I was directed to the waiting room for my darling travel companion to accompany me on the return to the Surreal City.  We stopped at a Denny's along the way and discovered the joys of sauteed Brussels Sprouts.  Actually, that was the best part of the whole morning.

Session Two: March 5
The initial calibration session was in mid-morning, but the daily sessions were scheduled an hour earlier, a bit of a relief, since the round trip is about 90 minutes and that can be an incredible time suck if placed in mid-day.  The second visit was quick, efficient, some brief right-eye "floatie" action afterwards for about an hour, but pretty much the same.  A whiff of ozone, the three cycles of 15 seconds, and some mild warmth afterwards.  The radiology staff has Pandora playing, and it was a folk tune interrupted by an advertisement for a pillow that tried to distract me from counting the duration of the cycles.  Two down, 12 to go.

Session Three: March 6
The radiology staff runs Pandora for musical distraction during the treatments.  Last year as well as this, the "Billy Joel" channel is the preferred choice, probably to align with the general age of the visitors to Halcyon.  Today, the channel featured Bob Seger's, Old Time Rock and Roll rebooted back in the day by Risky Business, so the reference it to at least 1983, with associated memories that are worthy of a discussion in itself; and, Kodachrome by Paul Simon, calling back another decade, to 1973, when the 45rpm cost 88 cents.  Of course, I still have the record.
          (However, to demonstrate that I can let things go, I brought the staff the entire collection of the 1990s Journal of Nursing Jocularity that was being too-long ignored in the attic.)
          Another three cycles of 15 seconds, another whiff of ozone, and this time, a slightest bit of inflammation nudged from the upper eyelid.
          Through the expected snow squall on the freeway, leading to a second Denny diner breakfast, with the same waitress -- who somehow remembered not only us, but the meals we selected two days earlier.
          (And, finally amid all of this, the CoVid-19 broke its 100,000 documented cases worldwide.  We have bundles of hand sanitizers to lend our hands a hand, in perfumed splendor.  Note to self: it's hard to sanitize hands if your fingers are crossed...)

Session Four: - March 9
There's nothing quite as rousing at 5:45am (when it still feels like 4:45am, thank you Daylight Savings) as the sound of a 7 year old Sheltie regurgitating in front of the bedroom door.  So began the morning of session four, with the promise of a full moon, somehow described as a "worm moon," and a week of adjusting to the aforementioned time change.
          The drive to the clinic was uneventful, but the volume on the interstate seemed notably less than usual (or was it a projection of expectations for when Der Mittenstadt adds its name to the CoVid-19 charts).  The Halcyon did its task with purred efficiently, the zaps were the customary 3 rounds of 15 seconds, and the weekly post-session survey provided a calming blood pressure and heart rate. 
          The clinic is working up contingency plans should the outbreak manifest itself through its staff, and the soap and sanitizer dispensers were enjoying greater attention on both sides of the lobby counter.
          Hoping now for a quieter canine gastrointestinal day.  The things that ultimately matter....

Session Five: March 10
With the markets playing ping pong with our retirement plans, and with the CoVid-19 tests not all that available in Michigan, according to the clinic here, session five went smoothly, with the one minute of immobility being distracted by a snippet of Mike and the Mechanics' Living Years, which seemed oddly appropriate...then back to the workaday whirl'd, what a whirl'd...what a whirl'd... (did manage to vote - #78)

Session Six: March 11
The markets continue to tumble, Der Mittenstadt has two CoVid-19 cases now, and on the morrow, the students at nearby WMU return from their spring break from "Bob" knows where, so the session today was barely a blip on the morning consciousness.  Even the one minute clip of some folk group of the 70s (could be 1870s for all I would know) that ran during the bursts of blue didn't register long enough to note a lyric.
A bit more burn to the upper lid, but not enough to dissuade from the search for a lock-down amount of pet food to satisfy the real bosses at home.  Time to hunker in to more spring cleaning!  We counted six state trooper cars along the 40 mile interstate run east, and five on the return drive - a bit unusual, even for seeking lead-footed drivers.

Session Seven - The Midway Point! - March 12
A single state trooper edged the interstate route to the clinic this morning, and the face mask was attached to the truncated tune of "Landslide" by Stevie Nicks in the radiation suite.  A bit more burning sensation, and a quick return home with a stop to get batteries and echinacea.  We are pretty much ready for a two week hunker down should it be necessary.   And since we aren't the Hanks family or are planning a visit anytime soon to Australia, we won't know our own CoVid19 for certain.   Interruptions at this point will result in treatment resumption when possible with a visit or two added at the end for good measure.

Session Eight - Friday the Thirteenth! (March)
A slight adjustment to prevent unintentional radiation leakage to the left eye notwithstanding, the visit today went quickly.  The Halcyon makes a deceleration noise like an old Buick burning cheap gasoline when things wrap up.  The music du jour - "Sweet Home Alabama."  The trainee from a nearby for-profit college noted my retro glasses, as I noted hers.  A dozen CoVid-19 patients in Michigan now, but at least there is a list of places they were at, to give some information on the possible spread.  Cudos to our governor!
Grumpos to the return of a pair of large, comma-shaped floaters in my right eye.  I'm swatting at bugs that aren't there, and at 65, that's not a habit you want others noticing...
But I digress now into the weekend, hopeful that sessions nine through fourteen will not be postponed for any extent of illness anywhere...

Session Nine - The Skies Are Darkening -March 16
Over the weekend, the CoVid-19 began its expected, but ignored, explosion.  To help with the non-direction at a Federal Level, local hospitals have begun taking on the responsibility.  This morning, we were met by the MA who instructed both of us to get our symptoms checked before we could remain in the lobby.  Our temperatures were fine, our contacts unremarkable, so we were allowed to remain as the Halcyon was prepped.  My lovely wife was instructed that from here on, she would have to remain in the car while the treatments were performed.
          The hospital itself has begun drive-up testing, 8am-8pm, with call-ahead appointments required at this point.  At 10am, the line today was impressive.
          The radiation treatment went well, the radiology physician was beset with additional procedures for patient encounters, so the wait was longer than usual for the weekly evaluation, which, too, was unremarkable.  However, she and the trainee from a nearby college kept a six foot distance from me for all of our sakes,  I had washed my hands three times and used the hand cleaner twice while waiting.
          Returning to the Surreal City, some staples were needed.  We topped off the gas tank, proceeded to the store, and noted the generous stacks of toilet paper there for sale (being in Michigan, near Wisconsin where the TP is made, has its advantages sometimes), but a lack of hand sanitizers or wipes.  The store was crowded, the people focused but not angry or impatient; however, there was a strong sense of unease.
          We returned home for a glut of disturbing information at the health and economic level.   All restaurants, bars, theatres, and gyms were set to close at 3pm, per gubernatorial decree.  Canada has announced closed borders except for returning Canadian citizens or visitors from America.  However, those coming into Canada must agree to a 14 day self-quarantine before moving about the country.
          Session ten approaches.  At this point, there is no anticipated interruption in the treatment.

Session Ten - "It has a Thin Eerie Voice, Reminds me of poor Marsden..." - March 17
Essential supplies remaining intact, the journey to the clinic was a singular roadtrip, and the music during Halcyon's linear acceleration was by Buffalo Springfield - an oddly appropriate tune from 1966, "For What It's Worth:"


There's something happening here
But what it is ain't exactly clear
There's a man with a gun over there
Telling me I got to beware

I think it's time we stop
Children, what's that sound?
Everybody look - what's going down?

There's battle lines being drawn
Nobody's right if everybody's wrong
Young people speaking' their minds
Getting so much resistance from behind (chorus)

What a field day for the heat
A thousand people in the street
Singing songs and carrying signs
Mostly saying, "hooray for our side" (chorus)

Paranoia strikes deep
Into your life it will creep
It starts when you're always afraid
Step out of line, the men come and take you away

We better stop
Hey, what's that sound?
Everybody look - what's going down?

(repeat until you feel really, really spooked out and disturbed)
(c) 1966 Buffalo Springfield, ASCAP, SONY, any million of copyright lawyers, Columbia records, maybe even Stephen Stills

          And the clinic was updating its cleaning and viral reporting practices, trying to keep only one patient in the waiting room at a time.  I wear "out to clinic" clothes, return to my "home clothes" and hunker inside.  The Michigan CoVid-19 cases continue to climb, and with the clinic actually performing tests, those numbers continue upward.  
          I do hope for completion of the treatment, but Plan B is in the works, should the clinic get placed in "lock down" mode.
          Some signs of warmth along the upper right cheek, but much less dramatic than the process (following the identical protocol) of last year.
          The interesting improvement radiation had on the vision of my left eye last year is not being replicated in the treatment on my right eye.
          AND, to add a spectral level to the travel, an owl was perched atop the exit guide across the freeway as we headed back.
          Four to go....

Session Eleven - In the Realm of the Quieter Freeway - March 18
A joyful morning moment on the freeway

A single State trooper was on the median for the 42 mile stretch to the clinic today.   Semi traffic seemed halved, the roadside casino continued its closure announcement with a "stay well" message.
The clinic's city had its first announced CoVid-19 case yesterday, so the clinic was on a heightened alert, with oral thermometry replacing the head and jaw swipe.  Despite the chill (34 degrees), I left my jacket and sweatshirt in the car before entering.  The newly installed infection control nurse with the bright blue eyes of innocence complimented my retro spectacles, putting the probe in my mouth before I could extend my thanks.
          All staff present were in face masks, of a surgical, non R-95 variety (oddly, the hospital coordinator and overseer in the lobby, was not), including the generally chatty pair who align my head and offer comfort to my knees.  Today, they were quick and moved efficiently.  The session was complete in 90 seconds.  There was no music today.   With the lack of any consistent guidance from above, they are feeling their way on a daily basis.
          Chilled and reset into warmer clothes, the freeway beckoned, with businesses and roads approaching its access quieter.  Many Michigan counties have suspended face to face governmental business in the area.
          A non-chain bulk food store had one other customer, leaving as we entered.  We were quick in the search of frozen bread loaves among some other forgotten essentials, but those were not to be found (we have flour and yeast, should the need arise 😁).  The cashier was friendly and helpful, but I made certain that she didn't have to handle the products we purchased.  She provided us with boxes to take them to the car.
          I now slug myself for not having refilled the car's gas tank coming home.  Coming home at that point was a psychological imperative.
          Three to go.

(note to self - explore options in this blog system - only today did I notice the availability of emojis)

Session Twelve - Survival Through Shellac - March 19
Awoke to a state with 110 CoVid-19 cases.
Driving to the clinic was tense, with semis sliding off to the rumble strips, with one enormous carrier with 8 foot sewage pipes nudging my right lane while a large truck barreled upon our rear fender.  Before we could accelerate, the truck straddled both lanes behind us - and before we could really try to get away from this pair, the truck went ablaze in police lights and took the sewage pipes to the side of the road.  Sparrow curled in the back seat, refusing to accept this interstate drama.
The clinic remained in a state of alert, with staff released by closed departments, such as dermatology, being rotated into the role of door temperature monitor.  I was the fourth entry since 8am, when the current nurse took over.  At least the hospital antiviral coordinator was in face mask and gown this time, but she did a lot of ungloved face touching and hair arrangement.
I awaited my summons to the back, enjoyed two rounds of hand sanitizer along the way, and stretched out for the treatment.  Two minutes and back to the car.
          Today is supposed to reach 61 degrees in celebration of the arrival of spring, an earlier anomaly this year; however, the street was devoid of foot traffic.
          By 3pm, the 100 CoVid-19 cases became 179.  Michigan ranked #12 among the states struggling to identify, test, and treat the virus.  Three casualties thus far.
          My lovely wife thought I should know that folks with Type A blood seem more susceptible to the consequences of meeting the virus.
          Yes, I am Type A.
          For comfort, I turned to an attic filled with shellac recordings and worked on preserving them in a more easily transported format.  Audacity is a wonderful (free!) program and Audio-Technica is a workhorse of a turntable, accepting the challenge of a 70 year old disc, ravaged as it might be by generations of improper storage.   I wince at the prospects of vinyl in the attic.
          ♫ Take me away, Nathaniel Shilkret! ♫
          Two to go...
My Canadian ancestors offer moral support from 1890.  This jpg appeared as the sole file on a floppy disc from 1999.  Five daughters for great-great grandfather Jim, all posing as if they were living a Louisa May Alcott novel.
Session Thirteen - Rounding the last corner - March 20
The freeway seemed to have lighter traffic this morning, and it seemed that there were fewer semis trying to run us off the road, or perhaps it was all perceptual.  The clinic entry was staffed by a surgical nurse, realigned to thermometry duty because the hospital had closed off all but emergency surgeries.   She put on her dangling face mask as I entered, but had no eye guard.
          Entrants this time were given an official sticker noting time of entry.  I stood alone in the lobby, awaiting my turn at the Halcyon, and had an at-distance conversation on university management techniques, as her daughter had just entered into speech pathology program with my old employer; she was concerned about the odd environment there and whether other locations in the state may have a tighter focus on student needs. The conversation was interrupted when I was summoned to my spot on the linear accelerator table.  One of the clinicians was wearing a home-made mask, since the hospital was NOT receiving promised supplies.  She said that the hospital auxiliary was busy making masks for its employees.  The treatment went quickly, without music.  The redness is becoming more pronounced now, and the orbital area is increasingly tender.  The burn is not extending as far down my face as last year.
          I asked the clinicians if they knew how many tests have been run in the area, since they had one positive at their nearby courthouse for CoVid-19.  Nobody knew.
          Reports of over 500 positive tests in Michigan are based on about 2500 total tests having been performed.
          My home base of Calhoun County, with no confirmed cases, only owns that distinction from having no performed tests.  Its space includes a large VA hospital, but one can wonder if results from the VA will be kept silent, as controlled substance usage data has been removed from the discussion on local opiate consumption.
          Online commentary says Calhoun County is the "West Virginia of Michigan."  To that we can include Kalamazoo County and its flow of spring break returnees to its universities.
          Driving through the town to the freeway seemed more like a Sunday excursion, not a Friday morning event.  Gas was an issue nearing home, and the local stations were charging $1.79 per gallon.  As my wife retreated north to more rural locations, reports of $1.69, $1.61, and ultimately, $1.60 per gallon became the norm.  Supply and demand, where the demand is increasingly becoming, "Stay Put!"
       
          I found comfort in Keith Olbermann reading two short tales by James Thurber this evening.  He said it will happen on Twitter every evening at 8pm, so long as he and the stories last.  At that point, he said he'll either start over, or switch to H. L. Mencken.  Makes me want to do something similar with these little essays by Dorothy Parker.

          One more session.  Three days away.  Fingers crossed, with temperatures being taken about 40 times a day (only a slight exaggeration).

Session Fourteen - Good Day, Good Bye, Good Luck!  March 23
It was a snowy morning, of course - nearly two inches begging to be converted into snow forts.  The open road beckoned.  The session was quick, another young nurse from the dermatology department, wearing eyeglasses with "blue lenses" as a fashion statement, indicated my temperature was not an issue of contagion, and the last triad of blue bursts scalded the offending lymphoma.  Bells were run, albeit quietly and gloved, and a final farewell from the radiology department set us out on the vacated streets of Jackson.

          Follow up visits in April will be by phone.
          Returning home, Jackson's CoVid numbers jumped from one to five.  Calhoun County's went to four.  And Kalamazoo county joined its neighbors.
          Naps all around.


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