November 10th and 11th, 2008: On and off on Monday, I had hiccups. Nothing intrusive, they would last for five to ten minutes then go away. By mid-afternoon, I began to realize that my bowel movements which had been stellar through the past months that I’ve been on pain meds (since mid-July), were slowing down. People on pain meds learn to watch for constipation because the meds slow down peristalsis, the ongoing rhythm that pulses through the intestinal tract and moves bile. The task is to remain pain free and continue to defecate. I was out of balance, and with no more on my mind than answering the call of nature to urinate, I unplugged the tower and headed into the bathroom. Sat on the toilet and then, in a climax of releasing, proceeded to urinate, defecate profusely and vomit. The vomiting threw me logistically. The toilet was already too busy, and I couldn’t imagine pretzeling myself between my legs. So, I reached for a bath towel and for another couple of unpleasant minutes proceeded to empty, empty, empty.

Unfortunately, that visit to the bathroom turned a corner that had not been anticipated. In a few minutes, I went from a comfortable, adapting-well patient to an increasingly nauseated, unable to retain food or water sack of misery that lasted until today (mid-Thursday). Three days of unexpected exhaustion and nausea.

There are many pitfalls to chemo: fevers, headaches, fatigue, nausea, diarrhea, tremors, constipation, etc. You don’t want to play any of the cards in that hand. And I held on to two of those symptoms—nausea and fatigue—for a very long time. So, what happened in that time? For one thing, I stopped eating. I could not eat. Smelling food was a serious challenge. Thinking about food became an obsession and a bother. If I tried to eat anything, I would stay down for as little as a minute, as long as half an hour. But always the same result. After I lost all the food in my stomach, it was time to vomit bile which continued for another day or so until even the bile was evacuated. I am not horrified by vomiting. I can do it easily and when I have to. But sequential vomiting was clearly depleting; sequential, by the way, means every two hours or so. Throughout this time, my good cheer and energy evaporated. I could barely read the daily paper, let along the more challenging books I’d brought for entertainment. DVDs were also too complicated for me to follow, so I rather quickly shut down. Hospital staff continued to give me anti nausea pills, but I dispatched them quickly. Also, I could not drink water. This was not an immediate problem because I was getting a giant drink from the hydration bottle on my tower, but once I came home, it was more problematic.

In retrospect, I would be more emphatic about my distress. As happened back when I was learning that my definition of “uncomfortable” could also mean “pain,” I was caught in one of those personal limitations where I relied on my old strategies. How do I get through a stomach flu or food poisoning? Just stay in bed and rest. My old examples failed me. This time I was in the middle of a major round of chemotherapy.

My entrance to the hospital was full of anticipation and hope; my exit was a blur of exhaustion. I felt like oatmeal. But my hour of delivery from Mt Parnassus did happen, and on Tuesday evening almost five full days from entry time, my dear Eileen arrived, hailed a cab and we took the ride down the hill to my home. “Well,” Eileen said with a ring of admiration, “You’ve gotten through your first course of chemo!”