First Person: The Club No One Wants To Join

Every day, you wait for the squeak. It means you’re one step closer to the end of treatment.

A linear accelerator, or LINAC, dominates the treatment room; it looms in the shadows just behind the slab, all science-fiction and imminent potential. The slab itself is actually called a ‘bed’ or ‘couch’, but ‘slab’ is more accurate, low and flat and bathed in bright light. The theatre of operation, so to speak.

There’s a red-laser crosshair projected onto the slab, right where your head will be. You don’t necessarily want to think too much about the ‘target’ aspect: sure, it’s called “radio-therapy”, but that doesn’t quite hide the fact that it’s still radiation at work.

You sit on the slab and peel off the top of your hospital gown. Then you lay down with your head resting in a cradle under the crosshair. If the cancer is in your throat, as mine was, the slab slowly rises to waist height so that the LINAC can shoot upward when necessary.

The two radiation technologists begin their prep, lining up the LINAC with the registration markers tattooed on my shoulders. Aligning the target, so to speak. The markers had been needled into my skin a few days previously, during the fitting of the mask.

That had been a procedure in itself. The ‘calibration mask’ is a plastic mesh that fits over your head, neck and shoulders; it’s designed to keep you immobile so the LINAC can precisely target cancer cells. The mask is soft to the touch, but there’s no give to it. It is contoured to your face so that everything is held in a precise position as the LINAC does its work. To get that fit, they heat the plastic, then lower it onto your face and upper torso. When it sets, it’s such an exact fit that you can sometimes feel the throb of blood coursing through your veins. 

The mask is waiting on a nearby bench as the technologists continue their preparation. They are friendly and efficient, all professional calm because they do this a lot. There might be the occasional “Head up”, or “Chin down, please” as they position you even more precisely. And you wait for the phrase that is more a warning than a question: “Ready for the mask?”.

I don’t suffer from claustrophobia - I worked in a mine in my youth – but for me, wearing a mask under a LINAC is an interesting exercise in… thought control. Because when the technologist snaps down the mask, you can’t move. And you’re laying on a slab about to slide into the maw of a machine.

The thing is, you’re still processing news that underlines the uncertainty of not just life in general, but your life. As a thinking, rational adult, you have an arm’s length relationship with your own mortality, but now it’s no longer arms length. And the mind whirls. You wonder about the ‘whys’ and ‘hows’, as in ‘why did this happen’, and ‘how did I get here’? Wasn’t smoking, wasn’t drinking - not a whole lot of that over the years. Maybe bad luck in the genetic lottery, maybe HPV, maybe free radicals at work. All immaterial anyway: it is fact, a done deal.

It’s the other part that you really dwell on as you prepare for treatment: what next? You will literally hear the process at work, but you wonder where the process is headed. ‘Why’ is close-ended, but you want the result to be open-ended, for as long as possible. Because you kind of enjoy this mortal coil.

When everything is ready – aligning the registration marks and placing the mask takes a few minutes – the technologists will say something along the lines of “Ready to start.” or “We begin.”, and then leave the room. Because they treat multiple patients a day, technologists have to be protected from the radiation. The LINAC sits in a large, lead-shielded room with a heavy-duty door similar to a bank vault. When that heavy door swings shut, you are alone with the machines.

And the mental counter begins to tick as you wait for the squeak.

On the slab, you settle in to control your breathing. You could look through the mesh if you wanted, but I learned to keep my eyes closed as treatment began. With your eyes closed, you can project anything you want onto the big screen of your imagination: flying over Elysian fields, tai chi on the beach, hanging out with friends.  

The slab shakes as it aligns with your tattoos. Then things ramp up with the first of many mechanical sounds as shadows pass over you. Various clicks, whirrs and shutters come from different places; you can literally feel the LINAC moving around as it does its work.

As shadows move across your eyelids, the slab occasionally shakes to realign the ‘phasers’ (as I thought of them). After the first few sessions, I got to know the pattern of sound and movement, and I would listen for the next step in the process, because it seemed to make the time go more quickly. And as you lay there, regulating your breathing, unable to move, you listen to all the sounds that define your future. Try not thinking about that.

You calibrate your progress: this whirr means a shadow, that click means you’re at the halfway mark. And you think about the increments: a few minutes left today, three more treatments left this week, twelve more this month. You focus on the day-to-day, at least as much as you can.

Toward the end of treatment, with the effects of radiation tugging at your energy and your morale, it’s easy to lose sight of the immediate goal, which is to get through the treatment and reset as much of your body as you can. And in the low points, you wonder if it’s worth it. You feel lousy. You choke when you swallow, food tastes like cardboard, or tastes terrible, or doesn’t taste of anything at all. You can’t carry on a conversation for more than 30 seconds without having to excuse yourself to gargle and spit. The burn on your neck starts to peel. The fatigue, the weight loss, the psychological tension of being strapped down and immobile, the possibilities that may play out in the future. And sometimes you don’t have the mental energy to resist some of the darker thoughts

And you’re so damn thankful that you have the support you have, someone to share the load. Because when you are alone, lying on the slab, there’s always that place in your mind where the doubts swirl, seeking weak points in your resolve. So you concentrate on the sounds, and the mechanics of what’s happening on the slab.

After ten or fifteen minutes, you recognize the final series of movements, as if the LINAC was resetting to its original position.

Silence for a few seconds, and then you hear what you’ve been waiting for, the soft squeal of the huge shielded door being opened. Only then can you relax, because within another few seconds, the technologists are there to free you. You’re done for the day.

They unsnap the mask, and you can literally breathe more easily. And you realize that sometimes it’s easy to lose sight of the immediate goal, which is to annihilate nasty cells doing nasty things to your body. So you brace up again, because the process will repeat the next day, for 35 days spread over two months. And this: you know that there are other patients with more dire diagnoses, going through more difficult treatment regimes. I did not have chemotherapy; I did not have a feeding tube. For some people, those are part of the equation. And so is the support you get from the practitioners, and the support you need from those close to you.

Because the low points fade - not quickly, and not smoothly, but they fade. That’s what you hold onto, because the rest of it, however long the ‘rest of it’ may be, is still there.  

 Tom New Fall 2021