On 9/9/07, Jonathan B. Britten <jbrit...@cc.nakamura-u.ac.jp> wrote: > Regarding chemotherapy: a recent issue of Harper's Magazine had an > utterly horrifying essay by a chemo nurse. I recommend it to everyone. > > Chemo world: > Surviving the cancer unit by Sally Tisdale. > > Tisdale is fine essayist, whose work I have admired for more than ten > years, yet she seems incapable of seeing that the work she does as an > oncology nurse, as she herself describes it, is insane. When you read > about the handling of the toxins put into the bodies of dying patients > you simply won't believe it. > > Sorry there is no online version yet, only PDF downloads restricted to > password holders. Maybe soon someone will put it up . . . . > > JBB ~~~~~~~~~~~~~~~~~~ Here's something on the topic I found=
Publication: Harper's Magazine Publication Date: 01-JUN-07 Delivery: Immediate Online Access Author: Tisdale, Sallie Article Excerpt Several years ago, I began working on a small oncology unit at Providence Portland Medical Center in Portland, Oregon. The unit, known as 5-K, is shaped like a T and can hold twenty patients at a time. Its small size, the closely knit team, the long relationships with returning patients, felt exactly right. Nurses who come to 5-K usually stay a long time. The work is complex, challenging, intimate. To do it well requires me to be at my best. There is, too, the vague pleasure of feeling competentin a place where most people can't imagine working. The world of cancer is a world unto itself. Double doors at each end shut out the rest of the hospital in a kind of quarantine--keeping germs out but also keeping the cancer in. So many people in my circle of family and friends have had cancer that not to be one of them feels strange at times. On 5-K, this circle has expanded to include many strangers. Sometimes it seems as if everyone has cancer, that having cancer is normal, and we're all just used to it. I know a lot of healthy survivors, but often the magnitude of the disease asserts itself. My mother's early death from breast cancer raises my risk of the disease significantly, so I have a mammogram every year. Last year, the technician took my films and left me in my drafty gown. She came back a few minutes later and said I needed to go down the hall for an ultrasound as well. She couldn't explain why; I'm sure she didn't really know. The ultrasound technician would only tell me there was a "shadow," and then she left with her own set of pictures. I waited in the dim, cramped room; I waited in a quivering fear that had a life of its own. When the young physician arrived, I almost tackled him. "Look," I said. "Look, I work on 5-K. You tell me what the hell is going on, right now." "Oh, we're not thinking a malignancy," he said, surprised. I wanted to hit him. I wanted to yell: You tell me that first." "Cancer" is a catchword for a group of diseases defined by the cell in which they originate. Different cancers have different courses, prognoses, and treatments; they are different diseases. Some are fast and some are slow, some are relatively easy to treat and others almost impossible. They all involve abnormal cells without a useful function, cells that are not orderly and are not controlled by the normal mechanisms that manage cell growth. Tumors can double in size in two to three months. By the time of diagnosis, many have metastasized to new sites. The cancer is loose, it has broken free, and the second-generation tumors are often genetically evolved, with new properties. With each move, the cells become more primitive, evolving into a kind of ur-cell. There are cancers called "unknown primary"--the cells are so plain their origin can't be identified. These are cells as psychopaths: twisted, clever, self-destructive, taking victims down along the way. The number of cells involved is difficult to grasp. By the time cancer is detected, many millions of abnormal cells are present, and they are usually dividing rapidly. Treatment is a matter of killing as many of these abnormal cells as possible, as fast as possible, without killing the patient in the bargain. Most oncologists are reluctant to use the word "cure," and tend to speak of cancer as a chronic disease. The goal of treatment is remission, a state in which the cancer can't be detected. Remission doesn't mean there is no cancer in the body. Animal studies suggest that millions of cancer cells remain hidden in the person considered "cancer free." The immune surveillance theory of cancer holds that in a way we all do have cancer, that a healthy immune system fights off rogue cells as they appear. (New research indicates that cancer in turn can shut off crucial parts of the immune system, actively dismantling what might attack it.) A person's immune system may be able to eliminate those remaining cells one by one, the way one fights a cold, and the remission will be durable. As with other chronic diseases, in theory cancer patients could simply continue to take anticancer drugs their entire lives--if the drugs were not so toxic. 5-K is on the same floor as the Robert W. Franz Cancer Research Center, and at any given time almost every cancer treatment is represented there. (1) Patients are receiving various kinds of immunotherapy and chemotherapy, having radiation treatments, and recovering from surgery. There is often at least one person having a stem-cell transplant. Others are there because of the kinds of problems that tend to accompany cancer and its treatments, like infections. 5-K is a regional center for peripheral stem-cell transplants and one of only a few dozen centers for high-dose Interleukin-2 (IL-2) therapy in the United States. (2) When I first started in the unit, I was told by more than one nurse, "If you can work on 5-K, you can work anywhere." As a population, 5-K patients are sicker than most in the hospital, skirting the edge of instability and crisis repeatedly. They may stay for weeks at a time and return again and again over a period of years. Quite a few die there. Assignments on the three daily nursing shifts are doled out partly according to the level of care each patient requires and partly on the level of training of the nurses. My training as a 5-K floor nurse took more than a year and will never stop; it includes special instruction in chemotherapy, transplants, immunotherapy, and cardiac monitoring, and studying for my national certification as an oncology nurse. In the time I've worked there, we've had a wedding, a number of birthday parties, some anniversaries, many deaths, many emergencies, several resuscitations, the occasional family fight. There is no cancer demographic, no particular population: this is everyone, from everywhere. This is the musician who hauls her IV pole down five flights so she can play the grand piano. This is the young man covered in tattoos who was turned away from two emergency rooms for lack of money before he came to Providence and was diagnosed with leukemia. This is the young Mexican father who has no papers and has been treated without cost for years. This is the ice-skating instructor who had been a Sweetheart of Sigma Chi, the avid hiker who can no longer walk, the lawyer who likes to have whole pizzas delivered to his room from the joint down the street. They range in age from eighteen into the nineties, are all races, many nationalities, all degrees of wealth and lack of it. Christa, a forty-four-year-old woman now in remission, told me that when she was first diagnosed with lymphoma, everything happened terribly fast. "I was carried along in this urgent wave," she said. "People kept talking about getting second opinions, but it was so urgent I was just swept along." People with cancer are overwhelmed first by fear, then by information, then by noise and change, and finally by continual tiny losses that etch away at their sense of self like water on a stone. Modesty is one of the first things to go, and privacy hardly exists. People sometimes are admitted to the unit directly from the doctor's office, having just heard the news. There's no time to pack a bag; they are literally stripped before the day is done. I remember a man who buried his wife on December 22, and on Christmas Eve was admitted to 5-K, having been diagnosed with leukemia that morning. He sat up in bed with an unfocused, sagging shock in his face, barely answering my questions. He was facing a brand-new life, which had arrived without warning. I think this is why most of my 5-K patients prefer... NOTE: All illustrations and photos have been removed from this article. Looking for additional articles? Click here to search our database of over 3 million articles. Looking for more in-depth information on this industry? Click here to search our complete database of Industry & Market reports by text, subject, publication name or publication date. 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