A Pretty Nurse Makes Mark Feel Better (picture taken April 2006, 8th floor, Bumrungrad Hospital, Bangkok, Thailand - Just before discharge after two days of a three day chemo regimen).
Every 3 to 4 weeks, Mr. Mark has a 24 hour urine done for catacholamines and a CBC. If all are good, he does 3 days of chemo. He is admitted on the 1st day to an inpatient room, but insists on staying dressed. He then goes to Horizon Cancer Outpatient Center for chemo. In the evening he is wheeled back to his inpatient room and his IVs infuse through the night. The nurses insist he put on a hospital shirt at least. Hospital clothing is a hospital shirt and pajama bottoms. This is much more dignified than the backless gowns of most US hospitals. Mark overnights in a hospital room and then goes back to outpatient for his 2nd day of chemotherapy. The 2nd evening he is discharged and comes back the 3rd day as an outpatient to get chemotherapy . The hospital stay drives up his cost but one type of chemo drug he takes requires the overnight stay, by Bumrungrad Hospital policy. The inpatient nurses all wear white uniforms and a nurse's cap. Some wear white high heeled shoes. They are very professional, knowlegeable, skilled, and feminine. They are totally polite and gracious. When Mark ring for the nurse, one comes immediately and gives the impression she has all the time in the world to help him. Nurses in Thailand are much like nurses were in the 1950's and 1960's in the United States. The doctor is like this too. As long as you have another question, he or she takes the time to answer. Review of your case is thorough at every visit.
Mark is always scheduled for a CBC a few days after chemotherapy. If his RBCs or WBCs are low, he gets an injection of erythropoeiten (RBCs low) or neupogen (WBCs low) and either one is costly. Mom gives Mark the injection to save money when she is in Bangkok.
A New Set of Problems Mark is not in as much pain and takes less pain medication. He has less nausea due to taking more nausea medication including a new one more expensive than the last expensive one which he also still takes along with licorice supplied by friends. While chemo still takes a toll for a few days with odd side effects creeping up at other times, Mark is much more energetic and full of thanks for all that others do to support him. The doctor tells him to take good care of himself now that he might win the battle against cancer. Mark shared with me that this takes some getting used to as he had prepared to die. Given a prognosis of three months to live, a person is told towork through the stages of death and dying and accept death. No one mentions that if you happen to live, that requires a whole new process to reverse your total acceptance and welcoming of death. Since Mark still has liver cancer, even if it is improving, he is in the twilight zone where he has to still be prepared to die and yet be exhuberant about life and prepare to live. Cancer is truly a roller coaster ride.
Mark tells me the problems when he was told he might live seem quite different from those when he was going to die. Living brings with it a whole new set of problems. Having run out of money and having no job was not a problem when he was going to die, but now he has to think about where he will live and work, and how to get such things as a job, health insurance, continuing education and licenses up to date, and a new pair of glasses, etc. We put our obituary writing session on hold to have time to think about problems associated with living.