Did you think the tale of cancer treatments had ended? I understand where you’re coming from. I mean, the cancer is gone, right? right? I know how you feel. I feel the same, but more so - I’ve seen enough of the drab beige corridors of the hospital. But I still need radiotherapy.

Discussion with the oncologist

My first question at the appointment with the oncologist’s was “given the treatments worked, do I really still need the radiotherapy?” She explained to me that having radiotherapy means 17% less chance of it coming back - a convincing argument for sure.

She then proceeds to draw on her notebook a cross section of a bust outline with breasts, and blobs for lungs, ribs and heart. She draws a couple of lines across the left breast: this is where the radiation is going to come in.

“You’ll have a calibration session where we make scans to know where the beam is going to go” she says. “we’ll make tattoos to guide us” “tattoos as in actual tattoos?” I ask. She nods. “not very interesting ones” she says “Just dots”

But she’s not done. “We wouldn’t beam it straight in, or your left lung would become a fibrotic useless mass” she said. OK then.

“We will do our best not to hit your heart, because that would significantly increase your chances of having a heart attack. If your heart is close to your ribs, you might have to take a deep breath and hold it to create some space”

“We’ll touch a little bit of your lung, which will mean you’ll lose about 2% lung capity for the left lung, but you shouldn’t notice”

“Your ribs on your left side will be a bit more brittle, so if you have an accident they’ll be more likely to break on the left side”

My eyebrows are creeping up and by now they’ve reached my hairline, and my stomach feels tight.

“The inside of your breast will feel different, so you’ll have to get familiar with it so you can feel if there’s anything out of the ordinary”

“You need to moisturize the area at least two times a day, if not three”. Three times? I moisturize, but only face and hands. Moisturizing one breast three times a day is sort of funny.

It’s not reassuring, but it’s not Chernobyl bad. Unlike with a dirty bomb or a dirty nuclear incident, no radioactive isotopes stay in my body. Instead, a high-energy ray is focused on the area and knocks out the DNA of the cells inside. The cancerous ones die, the healthy ones regrow - which sounds familiar - like chemo only more local.

I won’t feel side effects immediately, but after a week or so I’ll feel tired, because my body is working overtime to heal itself. Not as tired as with the chemotherapy though, so there’s that - I’ll be able to function more or less normally. Drinking lots of water and staying active will help.

Calibration

As I’ve gathered by now, the x-rays are no joke. I have an appointment dedicated just to get everything right - using a CT scanner to image the inside of my torso, to make very sure that the radiotherapy rays won’t touch my heart.

It takes about an hour of my lying under the CT scan, the two technicians making pen marks on my rib cage, measuring thing, taping a white plastic box on my skin, having discussions, and asking me repeatedly to breathe normally and to hold my breath, before they pronounced themselves satisfied. They then make three minuscule tattoos - pin pricks really - one on both sides of the rib cage and one on my breastbone.

The sessions

There are four people present for my first session. I’ve shown my breasts to many medical people since the start of this process, but I must say, lying exposed for an hour while four medical personnel were discussing things around me feels awkward. I have no issue with nudity in itself, but there’s a vulnerability to being the only (half-)naked person in a room of full clothed people. Even if those people are friendly and intent on making me feel comfortable.

The next couple of times there’s only two lady technicians, which is better.

The radiotherapy machine is like a gigantic arm with a large flat cylinder attached to it. The cylinder has measurements and a lit up opening window, makes mechanical noises, and is, I gather, where the radiation will come from. It’s easy to tell when it isn’t because everyone has to have left the room for anything to happen.

The machine is a part of a whole setup: a line of green light is projected on the machine and on me, providing some sort of baseline. A red lit camera is used to monitor my breathing, using a white plastic box taped to my breast - the white plastic box has two recognizable dots which I’m guessing a computer vision algorithms can follow.

To be fair, it’s a hard problem: positioning a person, whatever their shape and build, in exactly the right place for the therapy. I get the impression that the machine doesn’t have a whole lot of freedom of movement, so it’s down to the medical staff to position the people in exactly the right location and in the right position for the rays. A big responsibility, and if it takes time to do it right, then maybe it’s the right thing to do.

That first time it takes a fair amount of time to get round to the actual point, with again, people measuring things with (cold) rulers, scribbling on my breastbone, shifting me around. I’m told that the next times will be faster, as I get used to things and know how much to breathe in exactly.

Finally everyone leaves, and a siren sounds. I’m told to take a deep breath and hold over the microphone. One of the people comes in again to rotate the arm to the right position, leaves again, and I breathe and hold. And then they come back in, I’m told I did a good job, and I can get dressed and go home.

For the next 4 weeks, the whole of August, I’ll go in every weekday morning and lie down in the machine to get my dose of radiation. I know I’m lucky. Only 4 weeks to go, and I’m home free, with only a few scars, blue dye and some minuscule tattoos to show for it. It could be much worse. The idea is to keep cancer away, and given the stakes, the minor inconveniences are a small price to pay.