Did you know that they serve radioactive pills to you on a silver platter?
Did you also know that a nurse (who moments ago asked “How do you like your job?” and “Do you have any pets?”) must expertly maneuver a small pair of tongs in her industrial-gloved hand to retrieve the pill from a canister with inch-thick walls?
You may be disappointed to learn that after all that, the pill is dropped into a standard-issue plastic cup as the physician in the corner jokes with your girlfriend about what superpower you’re most likely to get from ingesting said pill. “My bet’s on X-Ray Vision,” he’ll say. Your girlfriend will counter that it’d be cooler if you could read minds or fly.
Everyone falls silent at once to watch as you bring the cup to your lips. You struggle to swallow not just because the pill is larger than you thought it would be, but also because you’re suddenly embarrassed by the undivided attention. After a few seconds, it goes down: and for the next week, you are a medically-sanctioned hazard to the environment and to others.
…
I remember thinking that all clinic rooms should be like the one I found myself in that day, with soft light and a large, extra-cushy exam chair. The AC unit hummed above us, probably having just kicked on for the first time after a particularly rough Philadelphia winter. (I was grateful for the chill. Honestly, I was never good at regulating my own temperature even before I had to kiss my thyroid goodbye.) Kezia stood next to me and skirted her fingers back and forth across my right forearm. She’d be sleeping at her dad’s for the next six days. Doctor’s orders.
Before receiving radioiodine for the treatment of thyroid cancer, one must simultaneously reduce the level of iodine — an essential mineral for thyroid function — and thyroid hormone in the body to make sure the cancer gets zapped to the fullest extent. To lower iodine levels: eat a special diet for ten days prior to radiation and three days after radiation. Not super fun, but doable for a short time. Adjusting thyroid hormone levels is a little trickier.
It’s important that the patient is in a state of hypothyroidism for radioiodine to have the best impact. Low levels of thyroid hormone encourage the body to produce more Thyroid Stimulating Hormone (TSH), and high levels of TSH encourage thyroid/cancer cells to absorb the radioiodine, thus making the treatment more effective. Back in the day, patients slowly weaned off their dose of thyroid medication over the course of four to six weeks. This is referred to as Thyroid Hormone Withdrawal. If you’re thinking this sounds awful-with-a-capital-A…you’d be correct! Thanks to my insurance, I was fresh off two shots of Thyrogen, a new synthetic form of TSH administered on a strictly-timed schedule beginning 48 hours prior to the consumption of radioiodine. I still felt like garbage, but it seemed more merciful than a month and a half of screwing with my medication.
The physician on call talked through the isolation protocol I’d have to follow after leaving the hospital. I had been briefed on this a few weeks prior when my treatment was scheduled, but what the hell. I was half asleep from the Thyrogen, and we were waiting for the results of a full-body scan to identify where thyroid cancer remained in my body before they sent me on my nuclear way, so the recap was appreciated. Radioiodine leaves the body as salt, so anything that any of my fluids touched (sweat, saliva, urine) had to be cleaned thoroughly before Kezia returned to our apartment. “Make sure to flush twice after you pee,” the physician said. “And run sheets and towels through the wash twice, too.” Kezia made a comment about the water bill, and everyone laughed.
It was refreshing that everyone seemed to relish in how bonkers the whole ordeal felt. The energy in the room was “fuck it, we ball” — an attitude I had generally adopted from Cancer Day One to varying levels of success/understanding from those around me. I thought back to a biopsy appointment a few months prior, where I’d burst out laughing as the doctor entered the room to take a tissue sample wielding the largest needle I have ever seen (and hope to ever see) in my life.
This was, apparently, not something that happened very often.
At a follow-up after my surgery, I asked the same doctor how things went. Was it better than he expected? Worse? His eyes widened a little, and he bobbed his head from side to side a few times before responding, “Yeah. It was pretty gnarly.”
…
The nurse poked her head in with an update, interrupting my daydream and Kezia’s banter with the physician. My scan results were live.
The physician pulled everything up on the computer in the room, and he was pleased to see that there was no metastasis beyond my neck and head. (Me too, dude!) “I’ll go get the treatment,” the nurse said. “Back in a few.” I complimented her sneakers as she slipped out the door, purple and blue and coordinated perfectly with her navy scrubs.
At this point it was mid-morning, and we’d been at the hospital for a while. I fidgeted, cracking my knuckles and a few other joints that felt stiff. I had been pinned in place like a velcro-wrapped burrito for the hour-long scan. My head hurt, mouth dry. I was hungry, but none of the iodine-free food at home sounded appetizing. I was…so tired.
Kezia was talking about flying now. I remembered the first time we were on a plane together, heading west to New Mexico to visit her family. She slept with her head on my shoulder. Her curly hair spilled onto the pages of the book I was reading.
The next time the door opened, I snorted at the sight of the nurse wheeling in a tray with a cover on it. “Didn’t know this was gourmet,” I quipped. She chuckled as she offered me a cup of cold water. It was go time.
I kissed Kezia goodbye and watched as the nurse carefully removed the pill from its nuclear-safe container and placed it onto the tray for me to consume at my leisure. “Try not to hold it in your mouth for too long,” the physician reminded me. (This could cause undue damage to my salivary glands.) We had also discussed the risk of future recurrence and other cancers that could develop in the future because of the calculated exposure necessary to put me in remission. Right. Right.
“You got it.”
This was all easier said than done because as I’ve already mentioned, the pill was HUGE. I’d taken my share of horse pill supplements in my 24 years of life, but damn! My stomach churned. This was the last step in my treatment plan for now. I’d take the pill, wait and see, keep on following up. I wanted nothing more than to go home and melt into bed. This was really all the motivation I needed to bring the pill to my lips and chase it with a huge gulp of water.
I didn’t realize everyone else was in conversation until the voices dulled, like putting on a really expensive pair of noise-cancelling headphones. I swallowed once, then again, locking eyes down the line with the physician, nurse, and Kezia. “Yeehaw.” Mouth empty, I smiled. Everyone applauded politely.
There were approximately 30 minutes on the clock before my body started digesting the treatment. Just enough time for Kezia and I to drive back to our apartment. I grabbed the discharge paperwork and followed the team out of the room, keeping six feet of distance between us as instructed. “See you in a week,” the nurse said. I’d be getting another full-body scan to make sure the radioiodine showed uptake in the right places.
As we walked down the long hallway and out of the hospital into the bright street, Kezia checked behind her every so often to make sure I was still standing. I don’t remember the car ride home, or the rest of that day. I faded in and out of sleep and listened to my two cats, Bill and Bird, make messes in the living room that I would have to wait several days to clean up.
…
At the end of my time in quarantine, I hadn’t developed any new skills other than microwaving cups of cold tea to exactly the correct sipping temperature. Bill and Bird were confused as to why they themselves had been quarantined in the living room, but they didn’t seem to notice anything different about me when I freed them on the morning of day five. They took turns supervising as I completed the dishes, then the laundry, then tidied up remnants of a cardboard box that they had decimated for enrichment. We eagerly awaited Kezia’s return together on the couch.
Kezia and I went back to the hospital for that final scan, and we were thrilled to learn that the nurse who had been there last week was on the floor. She let Kezia sit in the room with me while I was Velcroed to the table this time. When it was finished, the nurse asked about our favorite Philly neighborhoods as we waited for the results. Her lease was ending, and she was thinking about moving from South Philly to West. “Couldn’t love West Philly more,” we said.
The scan showed no further abnormalities, so I was officially turned back over to my endocrinologist, who would handle next steps. More watching, more waiting.
Our new friend walked us down the hallway to the exit. “Maybe we’ll be neighbors soon,” she said. I genuinely hoped we would be. Kezia grabbed my hand as we walked out the door.