Making It Go Away
Yep, you read today’s headline right. No more of this malignant foolishness. We’re gonna kick those damned cancerous nodes right the hell outta my neck. Starting today.
I went in for my first radiation session this AM. These machines cost a sweet $3 million dollars apiece, minimum, which means the most excruciating pain a cancer patient experiences is when s/he looks at her/his bill.
But wait, there’s a hell of a lot more expense to running these gadgets. Many, if not most, radiation centers have two or more machines in operation. It’s not just a matter of having U-Haul dump the machine on the center’s loading dock, moving it into place, and plugging it it. Oh, hell no. There’s ancillary hardware, personnel protection, lasers, secondary machinery, staffing…, well, dig these little line items:
- Treatment rooms must be built broad and tall enough to house the machine and allow patients and personnel ample room to scurry about
- Each treatment room must be shielded so that stray radiation doesn’t turn everyone working in the place into a human reading lamp
- Target laser placements must be calculated and positioned at an unforgiving precision level
- Getting the machine approved by various accrediting authorities
- More computers than you can count to run the operation
- Video cameras galore
- Assigning at least two radiation technologists to every machine for every session, at yearly salaries of upwards of $80,000 apiece (a fully-staffed center with two machines probably would have six or seven RTs.
- One or two dosimetrists per machine at some $100,000 a year apiece to do the calculations for each patient’s radiation dosage
- One radiation physicist per machine who is, essentially, the super high-tech mechanic of the shop, making up to $250,000 a year
- All the oncology nurses, dietitians, office staff, social workers, medical records specialists, etc. at varying and presumably attractive salaries
- Each machine is sold with a manufacturer’s service contract, typically a million or so dollars a year
- At least one and usually more radiation oncologists, each making scads of dough
Somebody’s got to pay for all that. Medical insurance pays a certain percentage. The patient is on the hook for the rest. Ah well, it’s only money.
Anyway, zapping a tumor with one of these machines is called external beam radiation therapy, meaning the radioactive stuff remains outside the body and its powerful rays are focused on the offending masses. (Other radiation therapies entail introducing radioactive material directly into the body; for instance, patients with thyroid cancer have radioactive iodine inserted into them.) The guts of these machines are linear accelerators, complex machines that supercharge the energy output of subatomic ions, causing them to emit X-rays. Other types of accelerators stimulate protons or electrons.
Now, the linear beam aspect of these machines describes their ability to focus the radiation into a direct line so it can be aimed at a tumor. Normally, particle radiation travels 360º outward (think of the sun, radiating in all directions). The idea is to get the most radiation aimed at the tumor and the least diffusing around, doing damage to surrounding tissues.
BTW: Among the most advanced radiation treatments these days is proton therapy. Proton treatment is super-focused and does a lot less collateral damage than, for instance, the machine I lie under today. Bloomington not long ago was home to one of the very few proton radiation centers in the country. In fact, when it opened in 2004, there were only two other such facilities in this holy land. Sweet, huh? Then Indiana University and IU Health officials decided it would be in humanity’s best interests to close the center back in 2014.
Funny thing is, acc’d’g to the National Association for Proton Therapy, there are now 20 centers in operation in the US with some 15 more being planned or under construction. One of the primary reasons the IU center was shuttered was the recent trend of medical insurers to scream bloody murder when presented with the bill for proton therapy and, in many cases, flat-out refusing to cover such treatment.
Makes you feel proud to live in a nation that has the world’s best health care system, no?
Not that I’m ungrateful for my own access to this costly treatment. In so many ways, I’m the luckiest guy imaginable, starting with The Loved One standing beside me (or sitting in the waiting room).
So, today I checked in at the cancer radiation center across Tapp Rd. from World Wide Automotive Service. I flashed my patient ID under the scanner and noticed a sign warning me and others that one of the center’s machines was down for the day, a not-uncommon occurrence in this business. Lucky the center has its million-dollar-a-year service contract. I cooled my heels for a few minutes before one of the Radiation Therapists who did last week’s staging and simulation on me appeared to lead me into the treatment room.
It’s funny, it seems everyone who works in the treatment rooms is bubbly, bright, and quick with a joke. I can think of two reasons who all these people seem so chirpy:
- It takes a special person to work with people who may be dying or suffering greatly every day, and
- Seeing the daily parade of cancer patients and realizing they don’t have cancer is a constant reminder that they’re the luckiest ducks around
There’s probably an element of truth in both.
The RT’s locked me into my personalized chocks and blocks, my mask, my leg restraints (they don’t want me inadvertently crossing my legs), my shoulder brackets, and other paraphernalia. Then they positioned me just so under the room’s targeting lasers. Honestly, they’d nudge me a millimeter this way and two millimeters that way, the precision is so demanding.
Then they did a CAT scan on me to verify the exact location of my cancerous nodes and did several X-ray images to make sure my neck was in perfect alignment and my jaw was out of the beam’s path. All this took some 20 to 25 minutes. The actual shooting of the linear beam into me lasted a mere five minutes. In the meantime, I had to lie motionless under my mesh mask (my RT told me she’d yell at me over the intercom if I dared to move). All the RTs and their assistants and interns remain in a control area outside the room, natch, otherwise they’d begin to glow all night long.
I tried to while away the minutes by scoping each surface that would appear above my face (various beam shooters, X-ray imagers, scanners, and other doodads were arrayed around my head attached to so many stout arms; the whole contraption throughout the process whirred, hissed, beeped, flashed, and clicked as each module was moved into position). I followed all the action visually — fortunately I was allowed to move my eyes. I concluded that $3 million for this complicated apparatus was prob. a bargain.
And then, I was finished.
More accurately, I’m just beginning.