Wednesday, June 16, 2010

For The Very First Time - "The PUMP"!

The first thing that happened after we arrived for our appointment was that we were packed off in search of some food! We were told that as the chemo session was going to start at 1245 and would take about five hours; we should put some food in our tummies.


Kopitiam, Singapore's ubiquitous "coffee shop experience", has a lock on many institutions as it facilitates the feeding of the hungry crowds. However, for the consumer, it has made hawker food much less tasty and if I could eat elsewhere, I would.


I sampled a bowl of fishball tanghoon (fish balls in a soup base with transparent mung bean noodles); so much soup was ladled out it that it overflowed onto the tray. Very clear, very bland. So Lin and I shared a poh piah (fresh spring roll) - somewhat more taste. His main dish, if one can call it that, was a small quiche from Delifrance (not very good he said).


That being done we sauntered back to the Cancer Center just in time to be ushered to his little cubicle where I also had a chair.


We were entertained to a short introductory video (chemotherapy 101) which covered all the bits and pieces we had heard, seen and read about in the past few weeks.


After that a cute Chinese nurse (from Hunan province, here for two years) explained what she was going to do, warned us of pitfalls such as falling, what could happen after chemotherapy and where we should call or go if certain conditions manifested themselves. This included avoiding crowds, gargling with salt water, avoiding certain foods, being careful with cold drinks and foods, being careful with very hot drinks and foods and avoiding supplements.


As we knew all this before I had no problems following her explanation which was well executed except for her accent (Lin had difficulties with it). In talking to her I discovered she had been sent to Hong Kong for training so she is a bright and able young person; she just needs more practice in speaking, no matter whether English or Singlish.


NUH has a veritable United Nations of employees and should have classes and or tapes for them to improve their spoken English. This is not a complaint but an observation. Those from certain areas of the PRC generally roll their R's and this makes it difficult to understand what they say.


Anyway, it was quite an experience watching her work. She removed the dressing protecting the portacath and told Lin that his incisions were healing very nicely and she seemed genuinely pleased. Then she inserted what looked like a big, barbless fish hook into the portacath.


This was followed by some flushing of tubes (cannulas?) and so on. It was quite confusing as she prepared medications for various things and it seemed like a lot was going on. One of the early liquids was dexmethasone and perhaps other stuff as I could not catch the names.


In oncology, it is given to cancer patients undergoing chemotherapy, to counteract certain side-effects of their antitumor treatment. Dexamethasone can augment the antiemetic effect of 5-HT3 receptor antagonists like ondansetron


Finally what we had come for, Oxaliplatin and Leucovorin.


At each step of the way she or someone else would ask Lin for his identity card number; at least it started that way but was modified to his birthday as that was easier for him. Before an important drug, two nurses would check the details - one reading to the other.


Once the main cocktail was being given, I took off for a break at Ikea and returned in time for the last few minutes and subsequent attachment of "The Pump". 


But not before the pharmacist's talk about the pump, side effects, what to do and what not to do. A similar talk ensued with our little nurse although a few details were sightly different. Both were essentially the same but to my mind one was a mandatory standard procedure while the other was the Cancer Center's spiel, based on experience and what in fact works. They were equally well presented by the charming staff who were patient with answering questions and having to repeat what they said.


"The Pump" was started up and observed for half an hour to make sure it was working properly before we were allowed to head home.


After we had returned to deal with the Hitachi washing machine horror story, I had Lin take one of the medications we had been dispensed a few days earlier. This is metoclopramide hcl. I had been told it was better to start him on it than to wait for him to feel nauseous.


We went to bed with "The Pump" between us and because I'd had a few glasses of red wine (Lin was teetotal) it was not until the early hours of the morning that I thought my iPhone was behaving strangely, buzzing me every so often.


It turned out to be "The Pump"; I suppose if Lin had strapped it to his torso, it would have been muffled. Anyway, no one mentioned it so we will find out later today when we go to have "The Pump" detached.


Thus far, apart from feeling cold, especially in his extremities, a headache and fatigue he has not complained of any other side effects.

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