Rosemary Kirstein

They told me three things, over and over:

1. You won’t feel anything at all.

2. The treatment is over very quickly — the actual radiation part just takes a few minutes.

3. The machine will never touch you.

They said that so often (the radiation oncologist, the radiation therapy nurse, the RT techs, the books and websites I consulted), that I realized that these were the three things that most people found most scary. Will it hurt? How soon can I get out of here? What is that thing, and what is it going to do to me?

Those reassurances got said a lot because they usually need to be said a lot.

To the average person off the street, radiation mostly means atomic bombs, and possibly nuclear power stations melting down and poisoning everything, and people dying in horrible, agonizing ways.

The healthcare providers had to work against those preconceptions. They explained, reassured, and tried to make everything as non-threatening as possible.

And I figured, even as geeky as I am, I probably had a lot of those same preconceptions and negative associations stuck way down deep in my psyche, absorbed from the general culture, where they might leap out at me unexpectedly — and, say, cause me to completely freak out during treatment.

Which I did not want to have happen. I’d be getting radiation therapy five days a week for eight weeks, and it would be great if my lizard-brain wasn’t trying to kick me into flee-in-terror mode every time.

Forewarned is forearmed, so I reviewed all the info I was given, read up on the events that would take place during treatment, did a little deep breathing, and reminded myself that all this was happening because things were going better than expected.

According to my original treatment plan, I was going to have two kinds of chemotherapy, a mastectomy, and then some more, lighter chemo (Herceptin only) — and the timing even would even allow me to get to the World Science Fiction Convention in London in August.

But (as my regular blog readers will recall) the two rounds of heavy-duty chemo worked brilliantly.  My tumor shrank and shrank, and eventually became undetectable by x-ray and ultrasound.  In fact, a biopsy (remember that unplanned biopsy?) actually showed no sign whatsoever of any cancer remaining in the area.

So, no mastectomy after all, gladly. Just a “lumpectomy” (more accurately called a partial mastectomy). A fairly large one, but nothing like a full mastectomy.

But with a lumpectomy, you get radiation. This, to chase down any random cancer cells that might have stayed behind after the surgery, and zap them dead before they do their out-of-control reproduction trick. I knew that there would be side effects to the radiation, and the effects would accumulate (and might become pretty nasty), but the delivery of the radiation doses would not actually hurt, or even be felt at all.

So, I went through all the preliminaries: the CAT scan to identify the exact measurements of the treatment area (so they don’t irradiate more of your body than needs it); the simulation, where they test out the aiming; the tattooing of tiny dots to help with the precise aiming; getting my body position exactly right, and making the custom brace to hold me in that one right position, so that everything is the same each time, no variation — all that.

Eventually we got down to the real deal, and I found myself being led down the little corridor with the large sign saying PATIENTS ONLY IN THIS AREA; and the other sign with the light, saying RADIATION IN USE WHEN LIT; when I noticed another, little sign on the wall by the entrance, reading:

LINEAR ACCELERATOR

Wait, what? I said to myself as we passed it by and continued down the hall.

In the treatment room, the radiation techs ran over everything one last time, including reminding me: I wouldn’t feel a thing; the actual radiation part would be over quickly; and the machine itself would never touch me.

Them: So, that’s about it. Now, before we start, do you have any questi —

Me: Yes. Yes, I do.

Them: Oh — Okay, what’s your ques —

Me: Is this really a linear accelerator?

Them: Well… yes. Yes, it is.

Me: THAT IS SO COOL!

Them: (pause) …what?

Me: Seriously? A linear accelerator? So, subatomic particles are going to be sped up to, like, 99 percent of the speed of light? Right here?

Them: … yes…

Me: For me?  To zap my cancer? An actual linear accelerator?

Them: Well, yes —

Me: THAT IS SO COOL!

Them: (big pause) … really?

Me: Yes.

Them: Well… you know what else is cool? This whole thing is computer driven, with all your measurements stored, along with the treatment plan and digital control of the specific gantry movements …  and we work it from this console over here… there’s a digital 3D mockup of your treatment area, and — would you like to see?

Me: YES, PLEASE.

So they brought me over to the console and showed me the mockup of my treatment area: an exact and precise little bit o’ me, color-coded, rotatable in three dimensions on the screen, and it was also so extremely cool.

Me: This is one slick machine.

Them: It’s amazing.

And it was.

 

Come on — what sci-fi nerd wouldn’t love this? With all the calibration circles, and the sleek cowling, and the way the gantry completely rotates all around the patient, so once you’re in place you don’t have to reposition at all.  Minimal fuss.  It’s not just pretty — it’s such a smart design.

Possibly sometime before this point, it had been mentioned to me that a linear accelerator was used, and I just missed it.  But, I don’t think so.

I had been told what to do during treatment, and the fact that a machine would be used to deliver the radiation.  But somehow I got the idea that they had some, I don’t know, radioactive substance in a container, and they’d point it at me and open a little window of some sort, allowing the radiation to escape and wash across my cells.

But no, nothing of the sort.  The linear accelerator uses radio waves to speed up a stream of electrons to close to the speed of light; and magnets control the stream and focus it; and the beam hits a tungsten plate, and the plate spits out x-rays.  On demand.  A beam of x-rays, which then gets focused and further refined and shaped before reaching the patient.

There’s only radiation when the machine is actually being used. And only the exact amount that you need.  And carefully focused, and precisely aimed — it’s a thing of beauty.

Plus: linear particle accelerator?  That’s the same thing that feeds the initial particle stream into the Large Hadron Collider.

Okay, they’re using protons and we’re using electrons… but hey, same damn concept, right? How is this not cool?

I let the techs know that I was a science fiction writer, which helped explain to them my deep delight in this wonderful machine.  They loved it too!  They were proud of their machine, and proud of how it helped people — and they were resigned to the fact that most people were going to be afraid of it.  And they did their best to calm the fears, and reassure their patients.  But these ladies (and they were ladies — all the radiation techs were women), they knew what a fine technological accomplishment this machine was, and they were glad to be the ones using it to help save their patients lives.

And I was (and they told me this) the only patient to ever actually like the Elekta Infinity Linear Accelerator as much as they did.

Them:  Do you want to see behind the scenes?

Me:  Do I? YES.

 

Me: Well. Now it looks like a particle accelerator.

Them: (giving me the side-eye) And how many particle accelerators have you seen?

Me: Um. I took the tour of Fermilab, back when the Tevatron was operating. And of course I’ve seen any number of photographs of the Large Hadron Collider…

Them: (amused) Okay…

Yeah, it doesn’t look exactly like either one of those… but I feel I detect a sort of family resemblance.

 

 

So, what’s the point?

Cool trumps scary.

Eight weeks, five days a week, I’d sit in the waiting room with all the other patients scheduled before and after me.  And when my name was called, I’d stroll on into the treatment room, cracking jokes with the techs, slide into position, let the techs micro-slide me into a more precise position; and the lights would dim, and the women would speak quietly to each other for a while, chanting numbers; and the laser aiming light would locate my position even more precisely… And the techs would step out of the room.  And the gantry would hum and move about. And pause, and click a bit, and pause; doing its job, accelerating electrons up toward the speed of light…

I didn’t feel a thing.

It was over very quickly.

The machine never touched me.

But I had to resist the impulse to give it a little friendly pat on my way out…

 

(Here’s a video by the company that makes the Elekta LINAC, that explains it all.)

 

(Added later: I’ve collected  most of the posts about my cancer experience in one list here, if you’re interested and don’t feel like searching through the archives.)

Just a quick post to stay in touch. I’m still singin’ the radiation fatigue blues, and so haven’t blogged as much as I’d wanted.

Today I had an echocardiogram. Because I’m still on Herceptin infusions every three weeks, they keep a close watch on the state of my heart, as heart trouble is one of the possible (not likely, just possible) side effects. So, every three months they check on things.

Nerd that I am, I endeared myself to the echo tech by being fascinated with the whole process. It’s done with ultrasound (the same technique they use to look at fetuses and babies in the womb), and I was positioned so I could see the monitor.

I was able to look at my own heart in action! Pumping away like anything, valves a-flappin’. It seemed quite enthusiastic in its task. A sight cool beyond belief.

At one point the image was a perfect black-and-white version of the classic anatomy text cross-section, and I said, “Hey, isn’t that upside down?” The tech was impressed, and said that I was the first patient who recognized what they were seeing. But heck — that particular image could not have been clearer! Others were fuzzier, and at odd angles, but that one could not be missed by anyone with the slightest sense of their internal geography. Except for being upside down, due to the angle of the transducer.

Oh, I do love me some science.  Here’s a cool little infographic that has some animation, showing one of the angles I saw on the monitor.

Meanwhile: back to the Day Job for Thursday and Friday.   I expect some serious power-napping when I get home…

 

 

Poll results are in!

Actually, poll results are still slowly trickling in, but I have to call a halt at some point.

I had 77 responders, including comments here, on Facebook and  via Twitter.

Yes, this is not a good statistical sample.   But it’s what we’ve got.

It’s clear that most people who read my books don’t read the blog, or follow me in social media.   That’s fine!   Reading books is much more important than reading about writers.   And according to Amazon’s cool reporting features, I know that since December 24th when I first released it,   I’ve sold 2,618 copies of The Steerswoman alone just on Amazon (setting aside for the moment the sales of the other books — because they are the same readers who bought The Steerswoman). So… no complaints.

Here’s the breakdown:

19.48% Recommended by a friend : 15

19.48% Found in a bookstore (either randomly, or because you worked there): 15

12.99% Because of Jo Walton’s review: 10

10.39% Because of James Nicoll’s review: 8

10.39% Found in the library: 8

10.39% Found via some other website: 8

10.39% Found by searching specifically for feminist or non-stereotypical treatment of female characters: 8

3.9% Recommended by Amazon’s algorithm: 3

2.6% Random or uncategorizable: 2

So, let’s play a math game.  Let’s assume that this distribution holds across the board, and apply it to my Amazon numbers for The Steerswoman.

There’s no reason to assume the distribution would be the same!  (For example, people who were influenced by James and Jo are self-selected as people who are tapped in to the SF/F fandom grapevine, and go online regularly for news and reviews — whereas most people who purchase on Amazon probably don’t do that.) But let’s try it and see what comes up, out of curiosity.

19.48% Recommended by a friend: 510

19.48% Found in a bookstore (and then, we assume, subsequently bought in ebook form from Amazon): 510

12.99% Because of Jo Walton’s review: 340

10.39% Because of James Nicoll’s review: 272

10.39% Found in the library (and then, we assume, subsequently bought in ebook form from Amazon): 272

10.39% Found via some other website: 272

10.39% Found by searching specifically for feminist or non-stereotypical treatment of female characters: 272

3.9% Recommended by Amazon’s algorithm: 102

2.6% Random or uncategorizable: 68

Yeah, that was a mostly useless exercise.

Because the Amazon info is purely for ebook sales, and  the “bookstore” and “library” categories don’t directly translate to ebooks.  And I’m only using sales numbers from Amazon, because Smashwords alone is a  much smaller number, and the other retailer’s reports are delayed by months.

Hm.

My actual gut feeling is that, for sales on Amazon, the recommendation algorithm is responsible for a lot.    This is where people who read a lot of SF/F, but who don’t participate in fandom or follow the biz news, are likely to hear about me.   As in: If you like X, you’ll like The Steerswoman plus it’s only $2.99, what have you got to lose?  They click on the link, and see the many very positive reader reviews — and hey, worth a try, right?

After that, recommendations from friends, probably.

And for people who follow SF/F in general, I’m betting that James Nicoll and Jo Walton have a lot of clout.  Walton’s review was back in 2008, but people are still talking about it; and when James’ new reviews came out recently, it did look like my daily sales increased in response.

Well that was interesting.   To me, anyway!

In other news: Ow.

My radiation therapy ended on the 18th.  I had some side-effects, a lot of redness and discomfort, and was deeply grateful that it was no worse.  Considering how bad some other people had it, I got off comparatively easy, thought I!

However, as part of my final visit, the nurse reviewed a few things.  And at one point:

Nurse: And you realize that your side-effects will continue for a while.

Perky Chipper Me: Oh, yes, I’ve been told about that.  (Thinks: Been told that over and over.  But, no problem, I can put up with it, piece of cake!)

Nurse: Good. So, for the next ten days or so, things will get worse…

Slightly Less Perky Chipper Me: Wait, what?

Nurse: Oh, yes.  It’ll continue.

Dubious Me: Well, yes, continue … but, worse?  Even though we’re done now?  No more radiation?

Nurse:  It’s cumulative.  And delayed, like a sunburn.  You know how in the morning you don’t think you got that much sun?  But by the evening you’re going “Ouch, what did I do to myself?”  It’s like that.

Assimilating New Information Me: … Okay…. (Thinks: Yes, everyone said it would continue, but I assumed that “continue” meant persist.  Not continue to increase in severity.)… so, if my skin starts peeling and stuff —

Nurse: Oh, you’re already peeling, right there.

Adjusting to Situation Me:  Oh, yeah, look at that!

Nurse: So, that’s going to get worse.   And probably over here, too.

Fully Adjusted to the New Normal Me: Okay… so, what if [describes really gross situation, of which I will spare you the details and trust me, you’d thank me if you knew] happens?

Nurse: Well, yes, you’ll probably get some of that.

Plain Old Me:   Good to know.  So, what do we do?

At which point she provided me with more instructions, and some special gel-type wound dressings, and I thanked her, shook her hand, shook everyone’s hand, gave a few techs some hugs, and walked out the door, done with my radiation therapy.

Later: yep.  Ow. WOW ow.

It got worse pretty fast, and I’ll tell you, those hydrogel dressings are From Heaven.  Fortunately, I had no commitments, and did not even need to leave the house (a good thing because Ladies Foundational Garments were NOT an option).  I plied all my ointments, unguents and dressings, took a lot of Tylenol, and did not do much at all for the better part of a week.  I am now fully informed on all things having to do with Buffy the Vampire Slayer.

Much improved now, thanks.   As I say to medical personnel (whenever they jab me with something, and I automatically jump and make a noise): That wasn’t a complaint, that was just a report.

Because, you know: Still on the plus side of things, where the plus side is labeled: YOU GET TO LIVE.

So, basically… I’m fine!

Other other news: I want to talk about the Casting Call comments, but this post has become too long, so I’ll do it separately later…

Even more other news: Yes, I am working on Book 5.