Let's Not Call It Poison

Foxy is ready to make her return

Chemical compound for Oxaliplatin

Dear Friends —

Many of you may remember that after lots of back and forth with the smartest smarties I’ve ever known, I made a decision to step back into chemotherapy treatments in October. So here we are. October. It’s time.

On Wednesday morning I’ll get up early, take a long, hot shower, change into my most comfortable yoga pants and soft tshirt, pull out my Bag for Life, and drive to the Palo Alto Medical Foundation. There I will see the warm smiles from my favorite receptionists, nod in solidarity with other patients in the waiting room who live on Planet Cancer, and wait my turn.

I’ll stare at the fish tank for a minute or two. I’ll glance at the glass case that holds an assortment of knitted caps, assembled by someone who knits under the pseudonym Knitted Knocker (I couldn’t make this up if I tried), and remind myself that what this waiting room needs more than anything is a brochure for the Lash Bar. And maybe a hotline to my girl Shaleen, who knows the most delicious hacks for hair when long locks become collateral damage on the mountain trek for life.

I’ll reset my phone to tap into the medical center’s wifi, because the radiation area is just down the hall. Cell coverage is scant here in the basement of the Palo Alto Medical Foundation.

After a few minutes, Amanda will call my name. She’ll smile, and she’ll say it’s so good to see me again. And then she’ll say she’s sorry she has to see me again. And we’ll sort out the paradox on our way down the hall to a little room where she’ll take my vitals. We’ll small talk about my year, and how well I feel. She’ll commiserate with me that small and lazy lung mets are part of the jam, and we’ll agree that I’m doing the right thing. I’ll ask about life in the infusion center, and we’ll both nod at how bananas it is that it’s always so busy.

Then Amanda will walk me into a large room outfitted with a dozen or so recliners, each with a little curtain to help patients think their recliner time is somewhat private. There’s nothing private at all about this room, but it’s fun to pretend. She’ll tell me that they’ve saved me a lovely recliner, right near the window, which has no view. I’ll say, “Oh you all are the best. First class. How thoughtful.”

A few minutes later my nurse for the morning will arrive. Her name will likely be Tammy, Barbara, or Jane. I imagine in the past year new nurses have been hired, so I might meet someone with a name I do not know.

Whoever I have, she’ll access my port — a small nickel-sized saucer that was placed just under my collar bone back in 2019. It’s a fast prick, and once the line is in place, she’ll remind me she’ll be back in a few minutes with the first round of medications. She’ll offer me a warm blanket and water. I’ll say yes to both.

I’ll glance around the room. I’ll see that I’m the youngest person there. I’ll see grandpas who might be in their 80s, who don’t own yoga pants. I’ll see a lady without hair, and she’ll have a girlfriend with her, and they’ll be getting settled. I’ll see a man sleeping with an IV in his arm.

I’ll open my laptop, and remind myself there’s still time to respond to a few emails before it all begins. I’ll reply to a few, and then decide this is no time to work. Instead it’s time to breathe. I’ll fuss with my phone, and find some music that will take me out of this room, and into places with more joy.

My nurse will return and begin what she calls my “pre-meds,” a cocktail of anti-nausea infusions, with a kicker of what I think is high octane Benadryl, because one time back in 2019 I had the most bizarre little breakout of hives midway through my time in the recliner, so a note was put in my chart. And once the Benadryl kicks in, I will float into a drowsy float.

My nurse will come back and announce it’s time for a drug called Avastin, part of the protocol that years ago a team of brilliant chemists and oncologists sorted out would be help the drugs to come do their best work. I’ll watch the clear drips hanging near me on an IV pole in wonder.

About 45 minutes later my nurse will come back and announce that it’s time for me to receive Oxaliplatin, the “ox” in Foxy. Oxaliplatin was discovered in 1976 by Professor Yoshinori Kidani at Nagoya City University in Japan. The drug was granted U.S. Patent 4,169,846 in 1979, and gained FDA approval in 2002.

Here is the fine print about Oxaliplatin:

The compound features a square planar platinum(II) center. In contrast to other drugs of the platinum-based antineoplastic class of drugs cisplatin and carboplatin, oxaliplatin features the bidentate ligand trans-1,2-diaminocyclohexane in place of the two monodentate ammine ligands. It also features a bidentate oxalate group.[5] The three-dimensional structure of the molecule has been elucidated by X-ray crystallography, although the presence of pseudosymmetry in the crystal structure has caused confusion in its interpretation.[21]

According to in vivo studies, oxaliplatin fights carcinoma of the colon through non-targeted cytotoxic effects. Like other platinum compounds, its cytotoxicity is thought to result from inhibition of DNA synthesis in cells. In particular, oxaliplatin forms both inter- and intra-strand cross links in DNA,[22] which prevent DNA replication and transcription, causing cell death.

I understand barely any of it. I’m in awe of all of it. Back when I was kindergarten Yoshinori Kidani did something remarkable. When I was sorting out how to sound out my letters to understand how the letters would form words, Yoshinori was toiling in his lab, sorting out how a chemical compound might stop invasive cells from replicating inside my body. Did he think of me when he looked up from his microscope some impossible Wednesday in 1974, wiping away the sweat from his brow? I think he might have.

I’ll look up again at the drips and know that something miraculous is happening, and I’ll know it will come with a hard cost. In a few days, my hands and feet will have small pin pricks sensations. And in a few weeks, those pin pricks will graduate to frustrating and annoying realities — I’ll have trouble opening bottles, taking my earrings out a night, walking on cold tile in the morning.

The magical work of Oxaliplatin often results in neuropathy, and it can be brutal. There will be other brutal quirks to come, but the neuropathy will come first.

Midway through Oxaliplatin’s infusion I will become restless and look around the room again. I’ll say prayers for all the other recliner friends. I’ll wonder how this ever happened to me.

I’ll think of Connor in his sophomore year in college. He’ll be in class on Wednesday morning and I’ll bet he’ll be raising his hand as I’m staring out the window. He’ll be offering an insight, and it might change the conversation in his lecture hall.

I’ll think of Lucy, who’s now a senior. She might be racing to her next class, ready for whatever comes next. I’ll remember she has a dentist appointment that afternoon, and even though chemo is happening, I’ll find a way to pick her up on time.

I’ll know that on this day, hundreds of souls woke up and remembered me in their prayers. I’ll cry a little then. A moment when gratitude and grief meet, which is maybe the most tender place of all.

Three hours later, my nurse will come back and say it’s nearly time to move the line to something called Five FU, which will never not be hilarious to me. She’ll change the IV line to a small box that has a pump inside, a pump that will distribute an eye-dropper’s combination of Leucovorin Calcium and Fluorouracil over the next 48 hours. She’ll place the box into a terrible velcro pack, and I’ll place the pack into my beautiful Bag for Life.

I’ll stand up from the recliner, open the heavy door, and walk down the long hallway to the garage, feeling exhausted. But I’ll hold my head high, thinking Audrey Hepburn and Ruth Bader Ginsburg once did the same thing. I’ll wonder if they both had lovely handbags hanging off of their shoulders.

I’ll climb into my car and drive home, which isn’t far. I’ll open the door and Bonnie will be there, delighted that I’m home. I’ll find some vitamin water in my kitchen and nibble on something healthy. I’ll climb the stairs and fall into bed.

I’ll stare at the ceiling, and it will be quiet. So I’ll hear the the little pump, a small whirl every 45 seconds or so. I’ll remember that my friend David once told me this: “What we call things has extraordinary power. It can change its very essence.”

And so with each whirl, I’ll remind myself what’s moving within me is not poison.

Instead, what’s pulsing inside of me is a miracle. A hard miracle, but a miracle nonetheless. And I’m its recipient.

I’ll remember that I took naps after kindergarten. I’ll think of Yoshinori Kidani, and I will take yet another afternoon nap in his honor.

I’ll close my eyes in gratitude for each of you.

xoxo