Every weekday I drive to a hospital, go down the stairs to a lobby in the basement, and scan a red ID card they gave me. Then I sit in the waiting room for a short period of time before they call me on the intercom.
“Mr. Chick, come on back. Mr. Chick.”
Down the hall past the nurses’ station and the examination rooms are rooms for machines called Tomos. They look like giant donuts. Tomo is short for tomotherapy, which is a relatively new type of machine that delivers more specifically targeted radiation to a tumor than machines that don’t look like giant donuts.
I wait at the door until they come get me. They ask my birthday as part of the identification protocol, even though we all know each other by now. Melinda, Barb, Na, Jenae, Chris, Jerrica. On any given day, I’m not sure who will be there. Melinda is probably my favorite.
The rooms are decorated to look welcoming and non-medical. They look to me like I’m being tricked into thinking I’m going to get a massage. Tasteful wood paneling. A big fake plant. The ceiling is a giant backlit image of cherry blossoms and sky. Inside the donut, someone has taped pictures of a garden. There’s no music. Just the persistent hum of the machine at rest.
I kick off my flip-flops, take off my shirt, and lay on my back on a gurney in front of the giant donut They give me a foam ring I can grasp to make it easier to hold my hands in front of me, although I suspect there’s a bit of a security blanket thing the with the foam ring. It’s easier to have something in your hands than to just fold them in front of you like a corpse in a coffin. They drape a warmed blanket — yes, it’s warmed — over me and then here comes the worst part.
Radiation therapy requires carefully aiming radiation at the tumor. It takes precision and consistency. Some people get marked with little tattoos to help aim the beams. But rather than tattoo my neck, and to make sure my head is positioned the same way every time and doesn’t move, a mesh mask that lies flat against my skin is put over my face and bolted onto the gurney. It presses my head firmly into a bracket that cradles the back of my skull. I can breathe just fine, and I can even see through it, but I can’t so much as wiggle my head. When I blink, I can feel my eyelashes brush the mask. When I inhale, my throat presses against the mesh and I can feel my own heartbeat. Because of the extent of my cancer, my mask extends down my shoulders to my chest. It’s like being closed in the top half of an iron maiden. Minus the spikes, of course.
When I got fitted with the mesh mask the first time, when it was a soft warm wet sheet of plastic pressed down around my head and cooled to harden and fix its shape around my face, I panicked. Well, I didn’t panic. But I decided I was panicking. “I think I’m panicking,” I announced. They held my hand and finished as quickly as they could. I’ve never really experienced claustrophobia before, but this felt like claustrophobia. It was a pitched conversation between two voices in my head. One tells me that I really really need to move, to turn my head, to sit up, to get free. The other tells me to settle down, that I’ll be fine. It’s an argument of lizard brain vs. intellect. It’s anxiety vs. calm. Being told you have cancer uses up a lot of your calm. That might be why the anxiety got the better part of me as the mask hardened around my face, fixing it in place. “I think I’m panicking,” I announced, and then continued to lie there, very still, breathing, focusing on the hand in my hand.
When I told my radiation oncologist about this, he nodded sympathetically and said it wasn’t uncommon. He gave me a prescription for Ativan. “Take it an hour before you come in for the treatment,” he said. I took the Ativan a few times but I’m not sure it helped. The voices were still there, each telling me something different, but with a slightly dreamier timbre. I finally decided to just tough it out. It got easier and easier. Now I’ve learned to drive the argument. It’s almost a form of meditation, letting the calm prevail. I can almost take a nap with that mask pressed against my face.
“Here we go, Mr. Chick,” one of the technicians on duty says once I’m bolted down and tucked under the warm blanket. Then they leave the room because, you know, radiation. But they’re watching from the control room. Some of them talk me through the process. My favorite is Na, who makes it sound like a ride at Six Flags. “Just four more minutes to go,” she’ll announce as if I’m not going to want to get off the machine when the time is up. I don’t think she’s trying to make it sound that way. It’s just the way she talks.
The gurney slides me into the donut and the treatment is preceded by a five minutes computer topography scan to line everything up. The machine makes no more noise than its usual idling hum at this point. You’d almost think they’d forgotten me. But then the gurney slides me out again and there’s another pause while they look at the scans to make sure it’s all lined up. So far, I’ve only had to be readjusted once. Barb came into the room and scooched me a tad to the right and they did it over again. But mostly, someone says over the intercom, “Okay, it looks good. Now we’re beginning your treatment.”
The gurney jerks slightly and feeds me back into the donut. The machine makes a mechanical fluttering noise, as if in anticipation. I am looking through the mesh at the pictures of gardens taped on the inside surface of the donut slide into view. Gardens. Why gardens? Why not oceans? Too turbulent? Why not sunsets? Too final? Gardens are the most inoffensive possible thing. Who could take issue with a garden? I close my eyes. I appreciate that these pictures are here, but I don’t want to look at a garden.
The machine flutters again. The fluttering starts moving around my head, coming from various points in the donut, playful and erratic, like a faerie. I smell a strange acrid odor, like smoke. It reminds me of being a kid and having a cap gun. We used to have cap guns that unspooled paper rolls with little bubbles of gunpowder like beads at regular intervals. When you pulled the trigger, it would advance the rolls to the next bubble and slam a hammer onto it. Pop, pop, pop. The smell I smell when the machine starts up is like the smell of those paper caps after they’ve been fired.
Jerrica tells me there is no such odor in the room. She says if they were to stand in there during my treatment, they wouldn’t smell any such thing. It’s a response some people have to the radiation, she says. She says she’s heard of the smell. The more common one, she says, is a flash of light. Some patients see a streak of light when it begins. I tell her I’d rather have that one. I tell her a streak of light would be more fun. But I only later realize that my mine recalls summers in Arkansas as a boy with a gun that makes a pop like a real gun, chasing my friends Guise and Anthony around the apartment complex, jumping into the pool real quick, then we climb the fence and run across the street to the 7-11 in our bathing suits, barefoot, our hair still wet, with a handful of change in our chlorine smelling and pruned hands, change we’ll use to buy a Slurpee or play the pinball machine. The Tomo’s machine noises flutter around my head.
This part of the treatment lasts about ten minutes. All told, on a typical treatment, my head is bolted under the mask for about twenty minutes, tops. It’s my new routine. I get weekends off. Today I had the 15th out of 35 treatments. 20 more to go. The skin around my neck is starting to darken. It hurts to swallow. I have no appetite. Eating is a chore. I can’t quite get my calorie intake as high as it needs to be. My voice is weak and raspy. I’m not producing saliva normally. I wake up in the middle of the night choked with phlegm, my breath rattling through my ragged throat like a grotesque snore. “What’s that noise?” I think as my eyes open. “Who’s doing that?” It’s me. It’s only me. It’s me.
“It’s going to get more challenging,” the doctor’s assistant said today during my weekly meeting. I knew I shouldn’t have, but I asked her to elaborate. I should have just left it as “more challenging”. It was kind of cruel for me to ask, to make her specify how much harder it will get to eat, to swallow, to speak. But I’m terrified of people not telling me things. The worst of it, and what I have to fight against when I’m pinned under the mask, is the idea that I will go through all this and I will still have cancer. It’s all for naught, says the voice that used to tell me I need to move, to turn my head, to sit up. It’s all for naught and when this is done, you will be as you were before. That voice is going to take longer to stifle.