Cancer Treatment Discussion

It’s three days later, Thursday morning. There’s a bright sun shining and it’s ten-thirty in the morning in the Urology clinic. Today I’m to get more specifics about the treatment before we start it.
“Mr. New.”
I rise and head to the doorway. Standing beside the door is a different smiling technician dressed in blue scrubs.
“Good morning, Mr. New. I’m the tech for the start of your treatment today. But first, we need to talk a little bit about what is involved and what you should expect. Okay?”
“Sure. Where are we going?”
“First room on your left.”
Great, the Foley extraction room. Why do we always return to this room?
I take my usual seat next to the sink cabinet. Tech Number 2 retrieves a rolling stool with her foot and sits on it, facing me.
“So, Mr. New. I see from Surgeon’s notes that you are doing very well. Your progress is normal and he expects everything to proceed just fine. How do you feel? Are you able to urinate adequately?”
I smile, trying to stay calm. After all, Tech 2 is just asking questions to determine my progress. I hope. “Well, I feel fine. I’m back on the job. I can urinate okay, except before the flow starts, it feels like some pressure has to be overcome.”
“Pressure. As you urinate, does it feel like a burning instead?”
I think about it. What I feel seems minimal at best, although, there is something there. Could it be a burning sensation? “I’m not sure. I guess it could be a burning, but it also feels like pressure—maybe something not completely settled down from the Foley removal?”
“Hmm, perhaps,” Tech 2 says. “Well, we’ll check it out later. Do you have access to a controlled restroom?”
“Do you have access to a restroom that can be secured against use for fifteen minutes after you use it?”
I raise an eyebrow. What’s this? “There are the regular restrooms outside the lab and others for public use off the hallways. Why?”
“But not one that you can lock against immediate use?”
“Umm, no.”
Tech 2 frowns. “Well, after I administer the treatment, you need to hold it for two hours before you urinate. Once you do, the water in that toilet bowl becomes Hazardous Waste. To kill the BCG, two cups of straight Bleach get poured into it, which sits for fifteen minutes, before flushing down the drain. Each time you urinate—for up to six hours afterwards—the water gets treated. Can you provide for that here at work?”
Oh, yeah, I can just see myself standing outside a restroom, waving off potential users for fifteen minutes every time I’ve had to go. And the idea of toting around a Bleach bottle each time sounds ludicrous.
“No, I don’t think so.”
“Hmm. Okay then,” says Tech 2. “So we can’t administer the treatment at ten-thirty on Thursday mornings. What time do you get off work?”
“Three pm.”
“And you can be over here by what time?”
“Oh, three-ten, three-fifteen, somewhere around there.”
“How far away do you live from here?”
“About thirty-forty minutes.”
“Well, that should work fine then. Providing, of course, you head straight home after the treatment.”
“Okay. I can do that. So, I come back this afternoon after I clock out to start the treatment?”
“Yes, Mr. New. I’ll advise the front desk of the change in plans. Just let them know when you get here.”
There is a knock at the door and Surgeon pokes his head in. “May I intrude?” He continues into the room, as Tech 2 leaves. “Hi, Mr. New. I just wanted to see if you had any questions I or my staff had not answered yet.”
“Well, I do have one. Can you tell me where, or how deep, the cancer was?”
“I can give you a good idea.”
“That’d help.”
“All right, then.” Surgeon draws three concentric circles on a white board mounted to the wall behind him; the middle circle is a heavy line. “The bladder is made up of three layers. The inside layer is called the Transitional Epithelium, which are the cell type that mutated into your cancerous tumor growth. Just outside of that, is the Lamina, a very thin layer. Next, is the thicker Submucosa, followed by muscle layers outside of that.”
Surgeon tapped the first layer. “Seventy percent of the time, your kind of bladder tumor is easily removed with possible reoccurrence maybe happening within five years. Or, not at all. However, because the ‘pickings’ I took from the surgery site indicated additional suspicion, the ‘high grade aggressive,’ well, I decided to go for the next level of care. Tech 2 talked to you about this BCG.”
“So did PA 2. She called it Bacillus of something.”
“Yes, Bacillus of Calmette and Guerin, a weakened strain of Mycobacterium bovis. This is an intravesical therapy, which means ‘within the urinary bladder,’ or an immunotherapy, if you like.”
“Used to stimulate white blood cell and antibody production on site, to track down and eradicate any suspicious, umm, tissue,” I say.
“Exactly, Mr. New. It’s like we’re calling in the cellular bloodhounds to sniff out any trespassers. And instead of just pointing to it, they themselves will eradicate it.”
“Sounds good. That is what we start this afternoon after I get off work.”
“Splendid. I’m sure you’ll do fine.”
Final Result: come back after work.


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