So it’s time to talk about it. Enough weeks have passed that I can distance myself from the experience enough to be able to tell the tale objectively and honestly. After 28 doses of external pelvic radiotherapy, and 5 rounds of chemotherapy, the time had finally come. The treatment I had been dreading even more than chemo was only a few days away: Bracytherapy. The Bracy. In my imagination I had characterised it as a huge and monstrous beast, like the Kraken - a horrific and aggressive mysterious creature, which lurked in the depths and preyed on unwitting souls - like me.
But before it all gets messy, let’s do a quick vocab check, for those of you who aren’t intimately acquainted with gynaecological cancer treatments - lucky you, frankly. Anyway, cervical cancer is tricky, as anything beyond the very earliest stage can’t usually be fixed by the “whip it out” approach of a hysterectomy (if that wasn't bad enough). So the treatment for any stage after that is usually Chemoradiation, which is a combination of: (my translations in green)
Chemotherapy uses drugs, given intravenously, to destroy cancer cells. The drugs travel in the bloodstream around the body and help stop cancer cells growing.
Trans: Horrific ungodly ass-kicking drugs are fed into your veins, which make you feel the sickest you have ever felt in your life. They also make you lose control of your bodily functions and are basically a huge dose of poison. Side effects are a total shit storm. Ensure your bathroom floor is warm, comfortable and wipe-clean before starting chemo, as you will be spending a lot of time lying on it, curled up in a ball.
External Radiotherapy destroys cervical cancer cells using high energy x-rays.
Trans: You lie on a trolley every day for weeks, in a big empty room while a huge white machine whirrs and clicks its way round you, delivering beams of radiation at the cancer. It doesn't hurt at the time but the fun comes later. Depending on where your tumour is, it will also affect the tissues and organs nearby. Pelvic radiotherapy will usually hit the bladder and bowel, causing damage to both. Often, this recovers in time, but in a significant number of cases, some residual damage is permanent and life-changing. Think holes in your bowel, stents, permanent diarrhoea, incontinence and more.
Internal Radiotherapy - Brachytherapy gives radiation directly to the cervix and the area close by. One or more hollow tubes, called applicators, are put into the vagina. The radiotherapy is given through these tubes. Applicators are passed up through the cervix into the womb. Padding is placed inside the vagina to help protect the rectum and prevent the applicators moving. A catheter is put into the bladder to drain urine.
Trans: Hell. On Earth. Say goodbye to your last shred of dignity and enter a horror story of the most personally invasive treatment yet. This is what I have coming up. This is how it panned out.
I’d seen my oncologist a few days before and she had told me that my tumour had halved in size after the chemo and external radiotherapy (which goes on working for weeks afterwards) so that was a great response. We whooped silently because, well, britishness, and she went on to talk me through brachytherapy from a medical point of view. The applicators, padding and catheter would be inserted (up your fanny) under general anaesthetic on the first morning of my 2 day in-patient hospital stay. I’d have an MRI after that (I really hate those things) and the first bracy session would be later that day.
I’d have to stay in hospital overnight, as the rods and packing stay inside throughout (yes, still up your fanny) and I would have to lie flat and still for 48 hours to stop the rods from moving. Apparently my cervix is very mobile, which is great, as it reduces the risk that one of the rods will get poked into my womb by mistake. (Hoorah for me). The catheter would take care of the need to wee, but I’d need to take tablets to suspend bowel movement (sounds like a great day out so far, right?) and painkillers, because the procedure can be ‘uncomfortable’.
Her response to ‘uncomfortable’ translates into a prescription for painkillers, which I am to take the night before I go in, and then during the stay and after, as needed. I toddle off to the chemist to get the prescription filled and as the chemist hands me a package she tells me these tablets are very strong indeed, and I’m to take them with care and not operate any heavy machinery. (One day, just one day, I’m going to get hold of the heaviest machinery I can and find out what all the fun is about, but for now I accept my limitations.)
When I get home it turns out I have been prescribed 4 packs of Dihydrocodeine. That’s 122 very strong pain killing tablets! That’s a fuck load of tablets, and therefore a fuckload of pain in store for me! Marvellous.
Two days later and I’m on my way to hospital for the standard pre-op checks; blood pressure, ECG, temperature, covid and MRSA swab, the usual stuff. Should take about half an hour. Five hours later and I’ve had 3 ECGs, and chest Xray, CT scan, 9 failed attempts to insert a canula and numerous very concerned junior doctors trying to work out why my heart rate was 122. At first they thought I had a blood clot in my heart, then my lung, then they explored the possibility of the cancer having spread to my lungs or heart, but thankfully, after one of the most stressful afternoons of my life, a senior doctor gives me the all-clear and tells me my high heart rate was probably just due to anxiety. (Which, incidentally, I did tell them 2 minutes after the first ECG, but what do I know, eh?)
Anyway, knowing I have a perfectly normal heart, no blood clots, no heart or lung metastasis and no imminent death situations coming up, I go home and well, frankly sob myself into an exhausted heap. Thankfully, as ever, my glorious, wonderful friend Darcey was there every step of the way, holding my virtual, bruised hand, making my cry with laughter and seeing me safely out the other side.
One of the reasons why up to 30% of women don’t attend cervical screening tests is the invasive nature of the test itself, and I’m no exception - it’s horrible. But one of the reasons that I am sharing the intimate details of my treatment is to let people know the reality of how horrible cervical cancer treatment is. A two minute test with your GP is nothing compared to the alternative so do, please, take every possible chance you have of avoiding this nightmare of a disease.
So the day dawned, and I’m up at 5.30am for a 6am departure. Darcey, god love her, has set her alarm so she’s there alongside me keeping me sane and holding on tight via Whatsapp. After checking in and identifying a potential new love interest for Darcey (Carlos, doctor, extremely acceptable apparently) I’m sent down to the theatre ward with my case of things-I-might-need-in-hospital clutched firmly in my hand. I had packed a packet of Malted Milk biscuits, in case the hospital food wasn’t up to scratch, but it was starting to dawn on me that in a very short space of time I’d have so much stuff shoved tightly up my foof that I wouldn't be able to reach out of the bed to get them. Damn cancer!
A short while later I’m gowned up and laying on a trolley waiting to be wheeled into theatre. I have no recollection at all of Recovery, but it must have happened, because I arrive on the gynae ward and am wheeled, supine, into a corner of a 4 bed side ward. Darcey’s support texts are waiting for me and she asks how I feel. I reply that it feels like I’ve shagged a cheese grater, so clearly the anaesthetic is wearing off. The nurse asks if I want a cup of tea, and I say yes, having no idea at all how I’ll manage to drink a cup of tea lying at a 20 degree angle. But the NHS is one step ahead of me, behold the hot sippy cup!
The sippy cup and I become very good friends over the next 48 hours. One of the few advantages of having a catheter is that you can drink as much tea as you like without having to worry about going to the loo. It’s not much, I know, but I’m taking my wins where I can.
The next few hours are a bit blurry. Laying still didn't hurt too much, but when the time came to be wheeled down to the MRI suite, things got trickier. As I couldn't move, I had to be transferred from the bed onto a trolley on a sliding board. This happened every time I had to go for a scan, or for bracy treatment, and no matter how gentle the staff tried to be, being yanked from one body board to another, when your vagina is over-stuffed full of wadding and plastic rods, hurts like heck. Over the next 2 days I got to meet most of the porters, and to know which of them understood how to move the trolley gently over bumpy bits on the floor as you go into the lift, and which ones thought that saying “sorry love” as you winced in pain, was a viable alternative.
At 4pm I found myself heading down for my first brachytherapy session. I was met by two female radiographers and was wheeled into the treatment room. They showed me the device that held the radioactive source and, frankly, it looked disappointingly like Henry Hoover’s older brother Darren. Apparently the radioactive bit was deep inside, the size of a small grain of rice, and it had been delivering radiation all day, every day for 5 years so far. That’s some powerful rice.
The two ladies put me as much at ease as they could, they were absolutely lovely and we talked a lot over the next 2 days as we waited for porters to turn up and take me back to the ward (average wait - 90 minutes. I missed the hot dinner on both days whilst waiting for them, and those Malted Milks would have come in very handy. Not bitter, they are cleared understaffed and pushed to the limit, but my inner School Business Manager was just itching to get my hands of their work rotas).
For the actual treatment, all that happened was that they connected two wires to the ends of the rods that were sticking out of me, then they left the room, switched on the machine and it whirred and clicked for about 10 minutes. After that they came back in, unhooked me, and that was it. The treatment itself was painless and quick, but heck, the preparation was a piece of work.
Finding The Funny
By the time I got back on the ward it was 7pm so I was given a sandwich and a jelly and left to my own devices to work out how to eat them whilst supine. The sandwich was easy enough to tear and swallow, but the gravitation issues of getting the food from my mouth into my belly meant that my stomach was complaining very loudly at being so cruelly denied what my mouth had told it was on its way. The jelly nearly beat me, but at the last moment I devised a sneaky lip sucking, spoon shovelled method which saw the whole thing off in seconds. Nailed it!
I’ve screenshotted my conversation with Darcey to give a flavour of our friendship and of the way that cancer patients manage to find the funny in the most awful of situations. I honestly don’t know how I would have got through these last few months without her.
I do love Darcey.
Sleep was difficult, if not impossible, partly because of the discomfort and odd laying position, but after some more painkillers I finally drifted off for a couple of hours, after seeing death eaters and severed heads in the shadows on the curtains (heavy drugs indeed).
A Windy Problem
Next morning I was wheeled down for another bracy session which was much the same as the one before, but with custard creams and tea this time - those women really were amazing, and clearly knew their market. The bumpy rides didn’t get any better, and the 2nd MRI was just as horrible as the first. I spent the afternoon snoozing and chatting to Darcey, as we tried to work out how I could fart without making a noise. The radiographer had told me that it would get windy, and that I absolutely shouldn't hold it in, as it would distort the position of my bowel. But letting rip in a room with 3 other sick strangers, not knowing if what might come out might not be what I was expecting, wasn’t going to be easy.
Options included coughing loudly, letting go and hoping for the best, playing Black Sabbath loudly in an “oh no my headphones have fallen off” attempt to disguise the sound scenario, or just trying to squeeze it out quietly, bit by bit. I went, somewhat disappointingly I admit, for the latter option and it worked like a dream. A slightly odd smelling, jerky dream, but a silent, and definitely unattributable one.
The Final Hurdle
My final Bracy session was at 5pm, and everything went smoothly (apart from the journey down there). Once that was done we waited for my oncologist to arrive to remove the rods and the packing. My two guardian angel radiographers stayed with me the whole time, chatting, making tea and just being lovely. We developed a plan to open a miniature zoo, making a fortune out of it and retiring to the caribbean. We talked about family, and life, and normal things and I felt like a valid person again, instead of a patient. Looking back, I can see that conversation was the very start of me coming out the other side of a dark and horrible place, and those two ladies will never know how much they helped me start to feel like maybe, just maybe, this was going to be OK.
My wonderful onco arrived and the three of them removed a sack full of oily gauze and a plastic contraption which housed the dreaded rods. My onco told me that everything had gone really, really, well, and that she’d see me in a few weeks. Having 3 women leaning over the end of your bed whilst pulling wadding out of your vagina now felt almost normal, but the relief of having it out was so great, I couldn't have cared less who did it.
After being wheeled back to the ward (bump me as much as you like, porters, I’ve got an empty fanny there’s nothing you can do about it) (I realise that sounded wrong), I was allowed to sit upright and get myself off the trolley and on to the bed. The relief was astonishing. I could move!
I was finally allowed to go home at a quarter to midnight, after having 2 wees that passed the matron’s strict testing criteria. I could have stayed another night, but I knew Mr G was playing golf at 8am the following day, and much as I like to think he would have come to collect me, and cancelled golf, I wasn’t prepared to risk my marriage by finding out.
Once safely home, I slept the sleep that only the exhausted, traumatised and drug-filled cancer patient can fully understand. It was good to be home, but even better to be at the end of my active treatment.
Brachytherapy was by far the most unpleasant and traumatising physical experience I have ever had, but it was 48 hours out of my life that I very much hope will have saved it.
If you take one thing from my experience, take this:
Nothing is more important than your life. Go for your smear tests, go for your mammograms, check your body regularly and never find excuses not to seek help for anything that feels odd. Screening doesn’t always find cancer, and early detection doesn’t always make a difference, but give yourself the best chance you can. Honestly, this is one experience you really don’t want to share.