Radiation is like a job: five days a week with weekends and holidays like Labor Day off.
Unlike a job, radiation doesn’t require eight hours. I’m at the clinic for 10 to 45 minutes. Also unlike a job, I lie down most of the time and am naked from the waist up.
The longer days are Thursdays, when I do my weekly check-in with my radiation oncologist and also have X-rays taken to make sure they’re still radiating the correct areas. Mondays, Tuesdays, Wednesdays and Fridays — and that occasional Saturday — are 10-minute days.
Every weekday I bike or run 2 miles from our rented room to my appointment. The first three weeks it was at 11 a.m. The past four weeks it’s been at 7:30 a.m. Each appointment is noted in my calendar like any work assignment or interview would be. Right now radiation is like showering: part of the daily maintenance of my body.
But let’s take a few steps back: The first step of radiation, in early August, involved no radiation. I got tattoos. Five of them.
When I was in college there was a brief period when I wanted a tattoo. Of a Smurf. In the small of my back. Thank God I never pulled that trigger.
Radiation tattoos are not a choice. But neither are they as obtrusive as a bright blue cartoon character inches above your butt.
Two days before my first treatment a nurse named Shannon tattooed me: five inky blue dots. I had asked if I had a choice of color. If dental hygienists offer you a choice of tooth polish flavor, I didn’t think it outlandish. No choice, though.
Three dots make a straight line between my breasts. The lowest of these is at the bottom of my sternum. That was the first tattoo Shannon did, and it is the biggest of the five. It is about half the size of a ladybug.
The middle dot is just below the level of my nipples.
The top dot is about 3 inches below the top of my sternum. It is the smallest of the five, which I’m happy about because it is the only one seen when I wear regular clothing, like a V-neck T-shirt. It’s so small you cannot see it unless you’re really close and specifically looking. Otherwise you’d just think it was a mole.
The last two dots are on each side of my rib cage at the level of my nipples.
Getting each of these tattoos felt like a pinprick.
The purpose of them is to allow the radiation technicians to line me up the exact same way every time I lie down, always face up, on the radiation “bed.” It’s not a bed in any sense of the word other than the fact it’s something you lie on. You could never fall asleep on it, it’s so hard. It’s good radiation only lasts 10 minutes because that’s when my coccyx begins to throb.
Directly above this coccyx-bruiser, from a laser recessed in the ceiling, green crosshairs project down. Radiation technicians, one on either side, pull the thin white sheet beneath me back and forth, moving me along with it, until my dots line up in these crosshairs. There’s a bolster under my knees. My arms are above my head, elbows bent, resting in a hard-form cast made at the same time Shannon tattooed me. My head is turned slightly to the left.
When I’m done with radiation I could get the tattoos removed. Because my body has been through enough and they aren’t obtrusive, I’m not going to bother. Besides, no one will notice them, given all the scars from my double mastectomy, from the four drains I had in for a week postsurgery and from the two chest tubes I had in January after I got a pneumothorax from the installation of my chemo port.
Tattoos aren’t the only way radiation physically marks you.
It was on my 22nd day of radiation that the skin in the area being radiated began blistering. The first blister appeared on the outside lower half of my right breast in an area I can’t see without a mirror. Because I couldn’t see the area I wasn’t the first one to spot it. A nurse saw it at the beginning of my weekly Thursday check-in. Friday, several more blisters appeared.
These blisters are not like the ones I get on my feet after a 20-mile hike — quarter-size, deep and buried beneath 39 years’ worth of calluses. The largest of the radiation blisters so far are no bigger than half a dime. They are superficial. The layer of skin on top of them is paper thin. And I’m not talking 30-pound printer paper. Remember the gauzy paper that used to be used for airmail? That’s how superficial these blisters are. I get the feeling that if I look at them too intensely they will shred.
Because I no longer have any feeling in my breasts — a result of the double mastectomy — if these blisters do shred it won’t be painful. Still, I treat them gently. I’ve been instructed that, when showering, not to use any scrubber or washcloth in the radiation area and to use only a bar of Dove soap. I pat the area dry.
There were still more blisters Saturday, and the earliest ones were no longer filled with fluid and they were red. They hadn’t popped, but it looked like they had. The red was the beginning of them scabbing over.
Over the next couple of days more and more blisters grew on my right breast. They were concentrated between my nipple and my armpit and went from the bottom of my breast to the top. The life span of each is the same: born small and superficial and growing into red scabs. As I type this, one week after the first blister appeared, none of the blisters has progressed beyond the scab phase.
If I wasn’t rubbing the radiation field with emu oil several times a day on the recommendation of previously radiated women it is possible the scabs would harden.
The Tuesday after my first breast blister I woke up with the first blister on my back, on my scapula. Like lightning, radiation has entry and exit points. It is my right breast and armpit the radiation is aimed at. Radiation that enters at my breast exits through my back.
Tuesday morning was also the first that I woke up with a small amount of blood and fluid on the part of my nightgown that covers my right breast. Some blisters had popped. And oozed.
While I can’t feel the breast blisters it is too early to tell how the back blister will feel.
My skin has to survive only three more full-field radiations. Still, I am expecting there to soon to be more back blisters. My radiation regimen includes 28 sessions of the full field and then five final sessions that target the area of my mastectomy scar. My scar runs around the top of my right nipple and about 2 inches out toward my armpit.
Aside from the blisters, the entire area receiving radiation is swollen and red. My right breast looks like a giant, irritated mosquito bite. It feels like one, too. The areas above my breast where I do have feeling itch.
While the blisters might soon come to be painful, the radiation itself, as promised, is not.
After the technicians position me just so and place a swatch of brass mesh over the radiation field — this keeps the radiation at a more superficial level — they leave the room. Two minutes later the lights in the open hallway outside the room click twice and then dim. A second or so later the first of four bursts of radiation in the initial series starts. I don’t feel anything, but hear it, a lethargic buzzing at about the pitch of middle C. That zap lasts about eight seconds. It is quickly followed by three more zaps. Two and three are about a second each. The fourth is about two seconds. They all sound the same.
The arm the radiation comes out of then rotates over to my right side and out of sight. Over there it does four more bursts. One of the technicians comes back in and removes the mesh so that the next series of zaps penetrates more deeply. These are the rays that are now making my back blister.
Without the mesh I get only two zaps. The first one is to my side and lasts about six seconds. The arm then returns overhead for my final zap of the day. That is about six seconds too.
Even though I now have the routine down, and my coccyx is usually throbbing and my arms falling asleep by this point, I do not move anything until a tech walks back into the room. What if the routine has changed? I don’t want to start to get up only to have some part of me that is not meant to be radiated get zapped.
I have been told to expect my skin to continue to blister and deteriorate for about seven to 10 days after the last radiation treatment. It will then begin to improve but will never regain its preradiation elasticity or color. If my skin recovers well it will forever look like I’ve got a tan, shiny right breast. If it does not recover well, it will be darker and possibly resemble alligator skin. The skin will most likely still be shiny. I do not know what it is about radiation that makes the skin receiving it become shiny.
For years after radiation I’ll be on the lookout for signs of hypothyroidism. Included in my field of radiation are the lymph nodes at the base of my neck on the right side. That area also happens to be where the thyroid lives. Radiation can damage the thyroid. The symptoms of hypothyroidism include fatigue, constipation, dry skin, weight gain, puffy face — as per the Mayo Clinic’s website — and muscle weakness.
Also, there is a 7 percent chance radiation can give me cancer.