I begin with a correction: the hysterectomy promised in the last installment was put off until the fall, after I finish chemo and radiation. So obviously I did decide to do chemo, after much waffling, but the doctors reassure me I will never know if it helped, so that’s something.

This installment is about chemo, as well as a brief chronicle of the visit of my sister-in-law Peggy, who came to coach me through my various procedures. Moral support, it would turn out, was all she could offer me because I could not get anything scheduled until after she left, except chemo class, which we attended together. Peggy is a very nurturing person who takes care of everyone, including strays like me with no real claim to her kindness except that my brother was sometimes mean to her (and of course, sometimes not) before he died. She also likes to buy books so large that they will not fit on airplanes, and get lost looking for liquor stores, and start loud funny conversations with anyone.

But first, a digression about how the hysterectomy got delayed. I had the good fortune to have a surgeon in Atlanta with whom I could email questions. No aspect of my many treatments, procedures, and physician encounters was more comforting and humane than having the ability to ask her questions and have her answer, even on the weekends. I realized how great that was when, after the oncological gynecologist in Asheville promised my surgery could be scheduled quickly, she failed to file the necessary paperwork for two weeks. Perhaps she assumed that, because my blood test didn’t show any especially alarming cancer markers, I would want to wait until after chemo. I don’t know, because I could not communicate with her in any way no matter how I tried. When she finally gave me a date I realized it would push back chemo too far, which I’d already decided to do. So then I embarked on a journey to speak to my oncologist, who was either working at another site or on vacation. I tried hunting her down at one of her satellite locations, and two days later she left me a message that I missed by seconds. Nothing I could do could produce a second phone call until I planted myself in the lobby of the cancer center and said I would not leave until I relayed a message to her. Finally, rather than come out to speak with me, she called me from her phone in the office section of this manufactured building. I could hear the booming human voice shaking all those rickety partitions blending with the cackling phone voice, but she would not come out.

This was typical of my doctor encounters here. I realize doctors need to be able to decompress at the end of the day, and maybe answering a hundred emails from frantic cancer patients would make that impossible. But I hate it. I hate that everything happens on the doctor’s schedule and you cannot leave a message and expect a response. I hate that as much as 2-10 days pass before your doctor gets your message because she is (a) at another location (b) on vacation (c) just unavailable. I hate that they won’t give me my test results, and to try to get them I enter into process a little like navigating a roundabout: a. Doctor: Sure, just ask my assistant. b. Assistant: I’m sorry, I don’t have permission to give out records. c. Doctor: Well, why do you want them? d. Ask Carol the endlessly resourceful Navigator. And if you, gentle reader, get a chance to go to a doctor who will actually communicate with you, seize it—it makes everything else tolerable.

Okay, rant slightly over. So rather than tell you all about Peggy’s visit, her various adventures and citations for disturbing the peace, etc. (I’m just kidding, Peggy!), I will begin at Chemo class. Chemo class is where a nurse practitioner with your same name sits down and opens a giant binder between you. The giant binder is all about possible side effects of chemo, possible interactions with other drugs, possible organs that may or may not explode and teeth that will possibly fall out, and possible fatal diseases that could happen down the road because of chemotherapy. It turns out that I actually have a bigger chance of getting leukemia and lymphoma from the chemo than the chemo has of curing my cancer. (The kind of thinking that makes you do it anyway can be distilled to a maxim: “In general, it is better to die later than now.” Doctors learn this in med school right after the first one, “I am a god.”) My nurse practitioner with my same name then explained all the things I would not want to eat, and all the nice solutions for the discomfort that would inevitably ensue: “Take your temperature.” “Buy mouthwash.” “Exercise.” “Do not go outside in the sun.” “Do not drink.” “Watch out for mouth sores.” Also, about wigs. They cannot write you a prescription for a wig, but they can write one for a “cranial prosthesis.” So don’t go asking for a wig—you will simply reveal your ignorance. Peggy tried hard to lighten the mood, but binder discussions are always very serious. Binder discussions, of course, are the preferred method of discussing any aspect of cancer: “You have a 2.8 cm mass.” (Turn laminated page.) I have accrued at least seven binders.

Chemo itself is a little like going to those old-timey hairdressers. There are rows of long, vinyl, reclining chairs that look just like the ones at the hairdresser, only instead of hair dryers there are IV stands. I was warned to bring food, but in fact they keep crackers and sodas around for you, and a television hangs from the ceiling playing Andy Griffith episodes too softly to help those who haven’t already memorized them. Most of the denizens of the chemo room are women, but each is curled into her individual fear and resignation, and there is little gossiping or female bonding like in Steel Magnolias. Fortunately, my friend Allison Padgett came to keep me company and lighten the mood. She just had knee surgery, so she did PT exercises to pass the time, hopping up and down on her chair until most people were laughing except one alarmed lady, who kept alternating, “Are you okay, honey?” and “Bless your heart!”

The routine is that you get a CBC (full blood panel) which is secret, so they won’t show you your results. Then you get an IV drip of steroids (I also had to prepare for chemo by taking steroids orally). My steroid drip was disobedient, so that added an hour to the proceedings. Then they put one infusion into you and then a second one. It takes about four hours.

All anyone tells you when they talk about chemo is that you will feel nauseated and lose hair. My first week of it was less awful and yet somehow more icky than I anticipated. Ickiness permeated the world I looked at the first few days, as if I were seeing it through a lens of ground glass and antifreeze. Everything seemed brighter and harsher and, somehow, louder. I took the anti-nausea pills until I realized they were giving me terrible headaches, the kind at your temples when your brain is trying to escape with a small hammer, and by the end of the week I had several visual migraines, which made it feel like the ground glass was dancing around me.

The other major side effect was due to the white-cell booster you get a couple days after treatment. It’s called Neulasta, and on its white paper it says, “This medicine is used to stimulate the growth of ‘healthy’ white blood cells in the bone marrow.“ Now, why the quotes around “healthy”? To me, it’s the same as saying “so-called,” with a strong sense that the opposite meaning is the true one. It’s like the white blood cells are only pretending to be healthy.  Perhaps that’s because it’s accompanied by a list of side-effects that makes the chemo sound like an aspirin—exploding spleen, pain in your “upper left stomach,” and bone pain. I don’t usually feel pain, so the awful pain in my lower back four days later induced me to call the help line. “It’s really bad,” I said, panting. “This is a little late to have these symptoms,” the doctor replied skeptically. “Ow,” I replied. “Take three ibuprofen then, or go the ER.” “I thought I wasn’t allowed to have ibuprofen,” I gasped, on my knees (my supper companions were inside watching through a big storefront window, so I imagine I looked like a dying character in a Chaplin movie). The doctor laughed. “Oh, that’s just something we like to tell people.”

Of course, I have a very light course of chemo compared to many. My cocktail is Taxotere and Cytoxan, which I once used to treat my dog’s lymphoma (did not work). If you google Taxotere, the first thing you will see are ads for lawyers who will help you sue the manufacturers of Taxotere. That’s because a certain percentage of people never really get their hair back after treatment. I asked the nurse practitioner with my same name about that, and she promised it would not happen, so I bet I have some grounds for participating in a large, Dickensian class-action lawsuit that lasts for generations—that is, if my hair doesn’t come back. But I’m rooting for it. Heh! See what I did there? Rooting?

And speaking of rooting, I visited a wig shop called Secrets of a Duchess, which really does sound like a bodice ripper. This place has lots of wigs, though very few fit me. It turns out that I have a Giant Head, stuffed with names I can’t remember, but wigs are made in Asia where apparently women seldom suffer from Giant Head.  More interesting than the wigs were the hats with hair. You buy a hat—let’s say a baseball cap—and then underneath you put a ring of netting that looks like a medieval monk’s tonsure, from which hangs locks of various colors, so when you put the  hat on it looks like some hair is just peeking out the bottom. The store’s proprietors are a chihuahua and a somewhat elderly British ex-patriot who likes to change wigs frequently. Though I found her a bit cranky, she did bring me pretzels. She traveled to the area with the handsome guy stylist, who convinced her to open the business.

I hadn’t realized how many women suffer from various kinds of alopecia, which is a specific illness but also a general code-word for female baldness. One younger woman, like me in the midst of chemo, was sobbing because she didn’t think her husband would love her anymore without her hair. Other more seasoned veterans dashed into the store, wigs in hand, demanding a styling, and there was a line for buzz cuts and moussings. (It turns out wigs, because they are not hair, have their own diverse set of cleaning and styling products). It made me wonder about the women I see every day, hiding some perceived imperfection with dignity and a little shame. We bear so many prostheses between us—stick-on boobs, implants, wigs, spanx and girdles, makeup, gel eyebrows, push-up bras, compression bras, contact lenses, deodorant for all our private places—even surgery for our ugly chins and hoo-hoos. We all know this—we all know each woman is haunted from infancy lest her secret ugliness be discovered, that thing that keeps her from ideal beauty like a missing password to the human race party in the cafeteria. A good wig store—even one with coffee and pretzels–isn’t your ticket out of the freak show; it’s just a rare look into the faces living gracefully with what you’re hiding with all your heart. “Guts,” as my friend Maida used to say. “That’s what it takes to be a pumpkin.”