MEDICAL NITTY-GRITTY

In this visit I had my ninth chemoembolisation. I realise I haven’t gone into much detail about this procedure so I thought I’d explain what it involves – I promise it's not too graphic!

In the morning a car from the clinic takes me the hour or so to Frankfurt’s University Hospital. I have to fast from the night before, so I try to avoid the breakfast room! When I arrive I pay for the procedure, then take the receipt to the Radiology reception and check in (in my fumbling German). 

I think a number of people are all booked for each timeslot so there can be a wait of up to an hour before I’m called and taken to a little cubicle to change into one of those horrible hospital gowns that leave your dignity entirely unprotected. A doctor comes round and checks for any changes to medical conditions, allergies or contraindications, and I sign a consent form. Then I wait to be called for an MRI scan, which, although not detailed enough to compare progress from one time to another, is what the Professor uses to plan his line of attack later.

I then wait again in the cubicle till I’m taken to the operating theatre, where I get hooked up to a drip containing saline (for hydration) and anti-sickness medication. My groin is liberally sprayed with cold (and bright orange) antiseptic, and a kind of surgical-blanket-with-a-hole-in-it is positioned over me so that just the inside top of my thigh is exposed (no space for modesty in this game!)

There can be quite a delay at this point, as there are at least 2 operating theatres on the go at any time, with Professor Vogl going between them (he carries out up to 18 of these procedures a day, impressively). Once he arrives it’s an efficient 10-15 minute process: he anaesthetises the top of my leg and inserts a canula into my femoral artery in the groin (it still hurts though!). With a scanning machine above me projecting my insides onto an LCD screen beside the table, he feeds 10 or 15 cm of thin tubing through the femoral, and then the hepatic, artery until it reaches the main tumour mass in the liver. A mixture of the three chemo drugs is injected in, along with steroids (these make me flushed and hot for a day or two afterwards and disrupt my sleep, but they prevent an allergic reaction to the drugs which can be fatal, so they’re non-negotiable!) I clearly feel the drugs going in – it’s a very weird sensation. Sometimes they burn or create momentary nausea, but it’s not too bad. The tubing is all removed, the wound is cauterised and dressed, and I’m transferred onto a bed.

I then have to lie still for 3-4 hours to prevent any bleeding (which, because an artery has been punctured, would be very serious). To be honest I generally feel pretty wiped out and it’s no hardship, except for getting stiff lying in the same position. As I’m flat on my back I can’t read, so I listen to music on my iPod. For some reason classical music is all I want – at the risk of sounding utterly pretentious, it feels like the interweaving of the different instruments, all responding to and balancing with each other to produce something greater than the sum of their parts, works as a kind of metaphor for coordination and healing in my body, as though aligning each organ and system into harmony with the others. Whether that’s the case or not, I find pop music a bit too jarring but classical pieces absorbing and soothing. Current favourites are Mozart’s Sinfonia Concertante, Schubert’s String Quintet in C, and Mendelssohn’s Octet.

After an hour I’m allowed to eat, and I nibble gingerly at whatever I’ve brought with me  – usually a protein bar from a health food shop or some almonds (the hospital doesn't provide any food, though once or twice I've been offered a packet of sweet biscuits). At the end of the 3 or 4 hours a nurse helps me up and I get dressed again (feeling a bit sore and creaky), and go back to the waiting room till I’m called for the CT scan. This is just to check that the embolisation material (which temporarily blocks the blood vessels in order to hold the chemo drugs in place a bit longer) has dispersed as it should - unless I specifically request it they don't use contrast dye, so the scans aren't very detailed in terms of charting the state of the disease. I do ask for a more detailed scan every few months, but it has to be specially authorised and takes quite a bit longer, so it's not ideal to do every time. 

Once the scan's over I wait to have a quick debrief with the Professor; then I wait for his secretary to type up a discharge summary and make a copy of the scans. If all’s gone to plan a driver from the clinic will by now have arrived to take me back – if not, there’s yet more waiting around.

So as you can see it’s a long day - typically leaving the clinic at around 10 a.m. and getting back between 7 and 8 p.m. I have some dinner at the clinic (I ask them in advance to keep some back for me in case I miss the official meal time) and then make my way back to the guesthouse and go straight to bed. By the next morning I generally feel lots better, with a reasonable appetite. After each treatment I have infusions (drips) of various remedies, to help the body detox from the chemo, and these seem to help a lot in recovering quickly. 

After so many of these procedures I’m getting better at dealing with the hanging around – burying myself in a book and avoiding looking at the time too often – but of course it’s pretty tiring, even without the impact of the intervention. I think I’ve tended to minimise it to people at home, describing it as "injecting chemo into the liver" - which is technically accurate, but definitely not the full story! It’s not an awful experience (in the grand scheme of unpleasant medical / surgical probings), but I’m always relieved when it’s over.