It’s different for each patient. Here’s what it’s like for me.
First you go to the Lab. This is a huge waiting area full of people early to their appointment who are sitting well past the time of their appointment. You are also early to your appointment. You will also be sitting here awhile.
Eventually you get called in and a lab tech will walk you into a maze of small cubbies and sit you down in one, jab a needle into you, and suck out an astonishing amount of blood before you even know what happened.
After that you shuffle over to the clinic, check in, and wait roughly 2.5 minutes before one of the kindest nurses on Earth calls you in, weighs you (101.3 kg and holding steady), measures BP and pulseox and other vitals, and sticks you in a room to wait for a doctor. The room usually has one Target-grade print of a focus-grouped non-offensive painting, and one or more illustrations of the digestive system on the walls.
The doctor and/or PA comes in and asks you about your experiences with side effects, suggests things to help, talks about possible modifications to chemo (double the infusion time at half the loading speed), listens gamely to your lame jokes, and makes small talk until the lab results come in and you’re borderline good to go for infusion. If I was not on chemo my blood work would indicate I was dealing with sepsis or maybe serious burns over much of my body. Nope. Just poisoned. Time to go upstairs for more poison.
First you have some food. It’s lunchtime so you eat the PBJ your breathtakingly astounding partner brought for you, and you eat a banana purchased from the little cantina thing next to the wig shop. It’s a good banana even though it’s not in a pie.
After eating you go upstairs and check in at the Day Hospital, which is a funny name for a torture dungeon. They cut off your wristband and give you a new one for some reason. You wait some more. A volunteer comes by at least 3 times and asks if you want a ginger ale or anything. You stare at your phone.
Eventually your name is called and your brought back to a room with a bed and an industrial-grade recliner and a few office chairs. There’s also a poison robot here. It does not care about you.
A very nice nurse starts pre-medicating you by injecting various steroids and anti-nausea meds into the port on your chest. In a fun new twist they also slam in some pepcid and some benadryl to see if that helps you not lose the ability to speak during the infusion. Spoiler: didn’t work, still had trouble slurring later.
Now you are tired and confused and you really have to pee just in time for the pharmacy to send down the first sack of drugs. This is Oxaliplatin. It takes 2 hours to pump in. It makes you feel like absolute shit.
Neuropathy, nausea, fatigue. No fun. You sit there and play mini-metro on your phone and drink warm water and occasionally munch a cracker. You stare at your ever-patient and caring partner sitting across the room in an uncomfortable chair taking care of business. You wait.
A dietician breezes into the room and calls you a rockstar for eating and drinking so well. Tells you milkshakes are good if you can handle the cold. Calories and protein most important. Nice. This helps you make a stupid decision in a little bit.
After about 1.5 hours, a new bag gets attached to the robot. This contains a massive dose of a vitamin that helps the other drugs work more effectively. It does not seem to add any noticeable side effects. It takes 2 hours to pump. Now you are getting up to disconnect thee robot from then wall and roll it into the restroom to pee every 20 minutes.
You do a dumb thing and ask your wonderful partner to bring you a grilled cheese sandwich from the cafeteria. You idiot! Who eats cheese during a chemo infusion?!?! You do.
30 more minutes pass and the oxaliplatin is done. A normal person might think this is a happy milestone in the process. It’s not. Only because they replace it with irinotecan. Often referred to as I-Ran-To-The-Can. It causes nausea and diarrhea so quickly that the nurse gives you a shot of atropine before they hook it up, and schedules a second shot 30 minutes in. Irinotecan takes 90 minutes to pump. This should align everything so that the robot is done as the sun sets.
You start to feel worse. Cramping, indigestion, why did you eat that sandwich? A second shot of atropine should help. It doesn’t. 10 minutes after the shot you hit the call button because you are definitely redlining on the nausea meter. They stop the robot and give you zofran into your port. You are entering another dimension in your mind. It feels like your body is trying to turn inside-out slowly.
The nausea passes eventually. The feeling that your consciousness is about 1″ to the right of your physical body does not. You make some weird noises. They restart the robot. It’s only 40 more minutes to go. It’s a long 40 minutes.
The bags all empty and the robot starts crying it’s robot whines for an adult. The nurses come in and disconnect the robot from the tube going into your chest. They take a new tiny robot and hook it up to the tube. “See you in 47 hours!” the nurse says cheerfully. Nice.
You shuffle step to the parking garage and get in the car and get chauffeured home where you look at this mess you typed and paste it into various websites while working out what your medication schedule is going to look like for the next 6 days. It’s time for bed. I love you all so much.