Wednesday, April 22, 2015

Treatment Day

Thought I would chronicle a day in the life of the Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario.

This description of a cancer treatment day is written as I have experienced it, receiving the immunotherapy (ipilimumab) for melanoma that I am:

7:45 a.m. - Arriving early ensures a good parking spot in the lot closest to the north entrance of Odette, not mandatory, but helpful to the heavy leg hike outta there at the end of the day.  Register at main reception, and put red hospital card in line with others waiting at the Lab for bloodwork. Drink lots of water day before and all morning, helps nurses get a good vein. No fasting required, in fact, a decent breakfast is recommended (in my case anyway).

(Nice and bright - the girls say it looks more like a mall than a hospital. 
That is Main Reception.)

8:00 a.m. - Lab opens, wait time varies. There are about half a dozen chairs and lab technicians taking blood so it goes pretty quickly, usually under half an hour?

After bloodwork is drawn, or while waiting for the vampires, fill out the online "How Are You Feeling?" symptom screening questionnaire to have ready for oncologists' records. 

Also check in at the Chemotherapy Unit with white hospital card.  

9:00 - 10:00 a.m., varies - Get called in to waiting room to meet with medical oncologist. There are several waiting areas with rooms/offices, all labeled A, B, C, D etc. These clinics line the one side of the centre on the main floor, and the chemotherapy unit is on the other side.  Downstairs is the radiation unit and the Druxy's cafe.  

Wait for oncologist to come in, have vitals recorded by research associate for the trial paperwork, update nurse and/or resident Dr. as to side-effects and any news related to treatment.  Meet with the Boss (more on this weeks' consultation in a subsequent post), look over results from bloodwork, discuss symptoms and latest CT scan reports as well as any other health details applicable.  Pending good bloodwork and discussion, medical oncologist sends through Approval for Treatment.

My oncologist and family physician keep in touch; patients can request all notes/results be sent to any other physician in the Ontario health care system.  My family doc and dermatologist as well as oncology team at RVH in Barrie all receive updates from Sunnybrook whenever I am there. 

10:30 - 11:00ish? - Register with nurses at the Chemo nurses' station, get banded with a white plastic hospital bracelet.

Get comfortable in the seating area in front of the giant tv screen update board.  Depending on my mood I may sit facing the screen to watch my number in line for a chair.  This screen changes very frequently, with patients identified by their numbers only, you can see when you have checked in, when your medication has been approved, when your medication has arrived, and when your chair comes available for you to receive treatment.

The time in this space has been different each time I have gone through it.  Sometimes the medication is approved quickly, and sometimes not.  Usually the pharmacy is the lengthy part, as they are processing many chemo orders - plus mine has high security as it is protected by trial regulations (and an expensive price tag).  Once the drugs are ready, they are delivered to the chemo unit by pharmacy porters.

I haven't calculated how many patients might be treated in a day?  But there must be at least ten wards with four chairs or beds each?  Some treatments last hours and some just part of a morning or afternoon, people move through the place quickly, for the most part.  

You can get a buzzer/pager if you need to leave the centre for any time while you are waiting for your treatment.  On Monday for example we zipped down to CT scan to ask nurse Pat how I should proceed Tuesday morning when I had endocrinologist appointment at 9:15 a.m. in H Wing and CT at 11:00 a.m. back in the basement?    Then we got sandwiches, fruit and juice at the cafe to munch on before or during treatment. 

11:15 a.m. Poof!  Called to the chair already, good thing we didn't linger in CT or the cafe!  (a couple of times before I wasn't called to the chair until 2-3:00 p.m.... that's a long stare at the big screen)

Settle in and small talk with nurse on duty in my chair/room, get hooked up to saline IV, wrap up in blanket and sip apple juice, wait for the drugs to arrive from pharmacy.  (Odette has their own pharmacy, independent of the main hospital)


See small pink spot there close to the top tape?  That is scar from last mole excision; shave-off and two stitches from dermatologist in February ---------------------------------->

12:00 p.m. - begin ipilimumab treatment.  Mine is a 90-minute infusion, with vitals being taken every half hour, and for an hour afterward.  Go pee before treatment to avoid having to take the pole to the bathroom!  Given the length of treatment itself plus the saline in the lines, bladder is always full by the end of this leg of the day.  

During treatment it is permissible to eat whatever you need, some people nibble on sweets to help with side-effects they experience during treatment.  I don't have any problems during my infusion, just hungry/munchy throughout the day.  I usually have a turkey or salmon sandwich on rye (nice and soft to eat while reclined, and not too noisy so as to not bother other patients). 

Patients are permitted one visitor during treatment, they can stay for the duration, which is helpful for reaching those sandwiches.  Cell phones, laptops etc. are also allowed, on quiet of course.  I have more than once charged my cell while taking in pacmen.  

Comfortable, bright rooms with view of the north entrance of Odette and the Wellness Way entrance to Sunnybrook.  I am amazed more people do not get run over by those huge buses!

2:45 p.m. - unhooked from IV and free to go.

Not a bad days' work I guess... 8a.m.-3p.m., some needle holes, and a suitable sense of accomplishment.  

Exhausted but functional, I made my way to my hotel room and had a huge nap until I woke up starving and got some dinner.  Immediately back to bed and dreaming of pacmen doing their melanoma-hunting job, I slept like a rock until early the next morning when I had to get back over to Sunnybrook for endocrinologist and CT before driving home. 
All I was missing was my cat pillow: 

PS - Thank you Sonya for joining me on this day, your calm approach and easygoing friendship made me feel secure and comfortable.  I am looking forward to our next visit, when it's more like this...............  :-) 

Article & Photos (unlinked) © Natalie Richardson 2015

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