Apr. 20--First in a series.
As the oncology nurse swabbed Susan Nolen's forearm with alcohol and jabbed her with an intravenous needle, the 51-year-old thought of how many times she has gone through the process.
This time, it was completely different, or rather, reversed.
April 10 was the first time Nolen, an oncology nurse at Clearview Cancer Institute in Huntsville, received chemotherapy.
"I'd much rather be on the other end," said Nolen, who on a typical day prepares 10 patients for their chemo treatments.
For years, she has helped cancer patients through the difficult time, alleviating fears of known side effects and the uncertainty of how their bodies will respond.
But would all her experience help Nolen now, or mostly be a reminder that there is much to fear? Her first treatment brought surprises.
Though chemotherapy is new to Nolen, the former Hartselle resident is a veteran cancer combatant.
She was first diagnosed with breast cancer in November 1999. She opted for a double mastectomy, performed by Dr. Ken Chandler at Decatur General Hospital.
All was well until last winter when a tumor re-emerged in her left breast, the same side it first appeared in 1999. She thought it was a problem with her saline implant, so she returned to her plastic surgeon in Decatur. He determined it was cancer and confirmed it with a biopsy.
Four surgeries
Since February, Nolen has had four surgeries, including the biopsy. Doctors removed a breast implant, some outer skin and pectoral muscles. Then she also had her left ovary removed to reduce estrogen production.
Now it was time for chemotherapy.
Nolen maintained a wide grin as the first of her two chemo medicines started attacking the cells of her 114-pound body. Her confidence, she said, came from her experience of working with the doctors, nurses and other staff.
She confided, however, that she was filled with dread when she awoke that morning.
"I know it's just going to be a long year," Nolen said.
She will receive four treatments, once every two weeks, with two medicines called Cytoxan and Adriamycin. After that, she will receive another chemo drug called Taxol once a week for another eight weeks. Then she finishes with six weeks of radiation.
Chemotherapy works by destroying the body's cells, the building blocks of all organs and tissues. The catch is that the drugs attack all cells. The damage to normal cells can result in side effects.
The more sensitive cells, particularly stomach and hair cells, generally have the most side effects. That's why most chemo patients experience nausea and hair loss.
Nolen said she's not too worried about the hair loss. She has a wig picked out and she knows the hair grows back.
As for nausea, Nolen figured she'd get through the first round without feeling sick.
As part of chemo treatment, patients receive anti-nausea medication, which includes steroids. Nolen said these have made a big difference for patients in the past 10 to 20 years.
At 4 a.m. the next day, she got her first surprise.
"I was praying to the porcelain goddess. Oh, it was awful," Nolen said, able to laugh at it a couple days later.
The vomiting occurred once more that morning, but she said the nausea has not returned.
Her next surprise came that night when she prepared tomato soup for dinner. It tasted like metal.
"Wow. I didn't think that came until much later," Nolen said. "And so I starting thinking, 'This is all in my head. Maybe I know too much.' "
A pot of homemade soup she made afterward tasted fine. Visits from former patients
Several former patients, including Patricia Godwin of Athens, visited Nolen during her first chemo treatment. They all wondered jokingly if the energetic Nolen would be able to stay in her chair during the treatment.
Nolen's first treatment lasted a couple of hours. It started with the anti-nausea medication in her intravenous line that took about 20 minutes. Then she received the first of her two chemo drugs, Cytoxan, which took more than an hour to drip into her arm. That was followed by Adriamycin, which was pushed through her intravenous line in about 10 minutes. The last step involved getting fluids intravenously to help flush the medicines.
Some patients sit in their recliners for more than five hours. They use books, laptop computers, MP3 players, portable DVD players, cell phones, friends and family to pass the time.
Nolen's husband, Ken, was alongside as a quiet companion, while Godwin and Nolen talked about what to expect.
Nolen talked of returning to work the next day, but Godwin kept assuring her friend to take the next day to rest.
It's sort of ironic that Nolen, by sitting in that chair, is "having to walk in my shoes," Godwin said, making light of their role reversal.
"You can talk all you want, but you don't know until you go through it," she said.
Godwin finished her chemo two years ago and said the experience made her feel stronger. She was full of smiles and encouragement, but she had to turn her head from seeing the red liquid of Adriamycin, which patients call "Red Devil."
This is the drug that causes the hair loss, nausea and loss of appetite.
"Seriously, it makes me nauseous to see it over there, Godwin said. "It is the Red Devil."
Nolen, however, didn't let her friend's recollection and the lightheaded feeling from the Cytoxan remove her smile. And even a few days later, after experiencing vomiting, she said she still felt upbeat.
"I've got to think positive. I've got one down," she said. "I'm not afraid. I would be afraid if I wasn't getting chemo."
A woman's fight
Susan Nolen, 51, is an oncology nurse at Clearview Cancer Institute in Huntsville. Doctors diagnosed the former Hartselle resident with breast cancer in 1999, and she had a double mastectomy. The cancer returned this winter, and April 10 she began chemotherapy. This is the first in a series of articles The Daily will publish about Nolen's experience with chemotherapy and battle against cancer.
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