Cancer in the Time of Coronavirus

I’m a cancer-riddled germophobe with one neutrophil, so I’ve been preparing for this for the past ten years. Purell? Stocked. Lysol wipes? Come to my house, and I will hook you up. Masks, ranging from simple surgical masks to the slightly fancier Respokare models? In stock. I’ve also worked from home since 2008, which is its own quarantine. But now you’re all like me!

Coping with Quarantine

Work from home setups are personal. I like a desk and to pretend I’m in a real office. I draw the line at work clothes and dress for the gym. I have a friend who lounges on the couch with My 600-Pound Life playing in the background, muted as needed. Most of us probably listen to CNBC with the laptop on the kitchen table, only to be lured away when you smell someone in the house cooking some food.

Go outside. I get some fresh air a couple of times a day, even if it’s just a lap around the block. This is one of the joys of working from home; taking your phone and going outside, and not having to feel guilty. Plus most of us feel like we have somewhere to walk from our front doors, while the neighborhood around my old office at 59th and Park was not exactly amenable to a peaceful lunchtime stroll.

When I do have to go into the office or travel for a meeting, I try on all my work clothes in a panic to make sure I haven’t gotten too fat for them. Remember this for when this is all over and we return en masse to the office: athleisure offers a lot of stretch.

Infection

I don’t know how people imagine getting sick, how specific it is. The virus still seems to be seen as something other; every time someone clears their throat it’s quickly accompanied by, “Don’t worry, it’s not that.” On a flight a few weeks ago the idiot in the seat in front of me thought it was hilarious to tell both of his seatmates as they boarded that he “hasn’t been to China in weeks, heh heh.” I jammed my Smartwater into the seatback pocket nice and hard.

It does seem suspect to me that the early stages of COVID-19 would feel like, you know, just a cold. Little bit of a scratchy throat, cough cough, whatever. A few years ago, I had some totally treatable bacterial pneumonia and the back pain was ungodly. I thought I had shattered a disc and had some simultaneous upper respiratory drama. I’m thinking this virus is going to hurt, even in mild cases. You need it anyway for fever reduction, so make sure you have Tylenol.

I’m afraid of what will happen to me if I get sick, when I get sick (since the estimates are that about 50% of the U.S. population will ultimately be infected). I’m immunocompromised, but I’m a woman in my 30s. I have lung mets, but my lung function is perfect, and my blood O2 is 100%. I should have a mild to moderate case, treatable at home. There are people so much sicker than me that should statistically push me out of the bad side of the curve. But what if the curve does not unfurl in my favor, and how much more careful can I be? I take all the immune supplements in the world, so what else is left? Drink more water?

These calculations are familiar to patients who have cancer. The question is always, even secretly, What are the odds? What are my odds? There are recurrence rates, response rates, adverse event rates, measures of duration of response. There are no perfect prediction models, but you’re always running the numbers, adjusting and re-adjusting for a bad scan, a good scan, bad data, new drugs. You eyeball everyone in the waiting room, most of whom are early-stage patients, looking for someone like you (or close enough, since most people assume I’m there with my mom) and judging where they fall on the curve. How do I lock in my spot?

There’s more, each scenario bending into a progressively darker turn. Will I be able to keep my appointment for a chest CT, or do they need the scanner? Do I want to be in imaging with these coughing patients? My treatment could be delayed. What if they’re reserving saline for the sickest hospital patients and can’t mix drug? What if there are drug shortages? Nursing shortages? What if they stop treatment as a containment mechanism, to keep patients out of the hospital, or cut back schedules so patients aren’t so crowded together in the waiting rooms and in the infusion rooms? I need my drug every three weeks, don’t have the luxury of a delay. (Who does?) What if they only treat early-stage patients, the curable ones?

Would I get a ventilator? Do I deserve one?

In the Hospital

I’ve been lucky in that I haven’t been hospitalized a lot. But it’s been enough that I can say that if you end up in the hospital, these will be the worst days of your life. An open-ended hospitalization for something like an infection is nothing like spending a night or two in the hospital after surgery. The sickness itself becomes almost secondary, because time has no meaning. Nothing has meaning. You sleep and stare at your iPad. You wake up for blood draws. That’s the only reason you wake up. Blood draws and imaging. The first time I was in the hospital, I understood why pets help old people live longer. All I thought about was my dog. Not just that I missed her company, but the structure and value she gave to my time. Suddenly I didn’t have to wake up to feed her. I didn’t have to walk her. I didn’t have to take her for her shots. It didn’t matter if I got out of bed. I thought about killing myself. I’ve only ever had that feeling in the hospital, and it came back on subsequent visits. The last time I was in, I had a reason to get up and walk around the floor, an actual direction: there was a bulletin board at the end of the hall that had pictures of dogs. I used to go and stare at it, and all I could think about was going home to take care of my little girl.

Of course, all this changes in the ICU and under sedation. My experiences have been easy; I could get up and brush my teeth. I could have visitors and send e-mails. Let’s skip over alternate, severe scenarios, like the ones involving a ventilator. No one needs to think about it. And most of us, myself included, have the reassurance of knowing it’s unlikely. The numbers are clear on that, even when there’s still so much uncertainty.

Recovery

We have so much to fix, and we’re just getting started. ‘Til then, stay home, and since we’re on a human affection diet for the foreseeable future, give your dog all the kisses and snuggles. He can’t give you COVID.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s