A Heath Robinson affair

On Fri 11 May, I went to the radiotherapy department for a planning session for the Total Body Irradiation (TBI) that I would have the following Tuesday.

At City Hospital there seem to be a number of Radiology departments. Where I had the Hickman and PICC lines inserted and various x-rays is upstairs on West corridor and is used for diagnostic x-ray imaging and interventional radiology, i.e. using x-ray images to guide minimally invasive procedures, such as inserting Hickman/PICC lines.

The Radiotherapy area I went to on Friday was downstairs, just opposite the renal ward where I started this whole journey. They deal with using radiation as therapy for cancers. But I saw on the hospital map that there’s another area over the other side of the hospital. You’d think they’d put them all in the same place, but maybe that’s just too much radiation…?

Aha! I’ve just found out that the other place is the new state-of-the-art Radiotherapy Centre which was opened in Jan 2011. It certainly looks a lot smarter than the place I went to. I also read that the radiotherapy facilities in Nottingham are currently the busiest in the country. Blimey! Does that mean we have more cancer patients in this area?

Anyway, back to my appointment… Firstly, to stop anyone from accidentally walking into dangerous rays, the short piece of corridor from the waiting room to the radiotherapy room is cordoned off by one of those tape barriers they use in airports and Post Offices.

Having been called in and the barrier unhooked and re-hooked again behind me, I walked into a windowless room with a gurney-style bed against a wall, facing a huge piece of machinery on the opposite side of the room – the radiation machine.

The radiographer introduced herself as Louise and explained what was going to happen. There were two other radiographers/nurses/assistants in the room; they didn’t introduce themselves, so I don’t know what their roles were. Louise then asked me to get undressed, apart from my knickers, but there was no changing area, gown or hooks to hang my clothes, but she did offer me a chair to put them on.

Then I was asked to lie down on the bed, on my back. They gave me a pillow to put under my raised knees. I was just about covered by a sheet, but because they wanted me to get all the radiation without any physical barriers, the sheet had to be just on top of me, not covering my side. This also explained the lack of gown.

They asked me what music I wanted to listen to on a portable CD player, offering me a very odd choice of CDs, the oddness of which was explained by being a selection of free give-aways from Sunday newspapers. I chose a Motown compilation for want of anything better.

Louise positioned and re-positioned my arm until she was satisfied, then checked with the Medical Physicist, who was called Pete – not Dr Pete Something, just Pete – that he also thought it was in the right place. He blithely walked in, a very ordinary-looking man – I mean looking/behaving like much more of a scientist/engineer than a doctor – and not showing any sign of noticing my breast peeking out of the sheet, which I would hope and expect and he’s certainly done that a few times before I appeared, enough to be habituated, but it did feel quite odd, even surreal and very different to being examined/treated by a doctor.

The right place for my arm meant that my elbow was cupped around my breast and covering the upper part of my left side. The idea is to compensate with extra body density (my arm) to (and this is my vocabulary) soak up some of the radiation in order to protect the lungs, which if you recall, I was told the other day, are the most vulnerable/sensitive to the irradiation.

Once they were both happy with my placement, Pete left the room. The next bit entailed Louise using a purple marker pen to mark me down my side with X’s, one on the side of my head, one on my neck and about four down my side to my pelvis. Again Pete checked he was happy with the marks and there was some discussion about one needing to move a little bit, so she crossed out the incorrect one and marked me again a centimetre or so away. My side was looking like a very odd game of tic-tac-toe.

Next, Pete unwound some very thick cables, which were attached to the radiation machine and divided into smaller cables at the ends, with a probe on the end of each small cable. He brought the ends over to me on the gurney and Louise attached each of the probes to each of the X marks on me with sticky tape, making a note of which number probe was where, with Pete behind her advising and nodding at various moments.

This planning session would consist of four very short ‘test’ blasts of radiation, two on each side, one each with my arm cupped around my breast, protecting my lungs, and one with my arms up and hands clasped on top of my head, to compensate for my head and neck being narrower than the rest of my body. The probes measure how much radiation hits each spot, so Pete could then work out how much radiation to use for the main event. I think it entails lots of complex Physics calculations.

According to Wiki, “Total body irradiation in the setting of stem cell transplantation serves to destroy or suppress the recipient’s immune system, preventing immunologic rejection of transplanted donor blood stem cells.”

A large vertical piece of perspex on a stand, creating a transparent screen, is used to ensure an even dose. When they were ready to irradiate me, they wheeled it in front of the trolley bed, enclosing me next to the wall on my right-hand side.

Having affixed the probes, a last minute check that I was still in the correct position and putting the screen in place, they all left the room, to a series of warning beeps. The machine whirred for about 30 seconds, then the radiographers returned. By this time, the vaguely known Motown music was more irritating than relaxing, especially as there were so many other noises, so I asked them to turn it off. The performance was then repeated with my arms above my head.

When it came to doing my other side, two of the three radiographers in the room moved the screen out of the way and took one end each of the gurney and gently turned it 180° so my right side, which had been facing the wall, was now facing the machine. I’m not sure exactly why the third person was there – perhaps to put the CD in the player? :) . We went through the same process with my hands on my head, then with my arm at my side shielding my lungs, but without the pen marks this time.

Once that was done, Louise measured the spaces between the various X marks and across my shoulders and hips, using a calliper, which looked like a metal ruler with two long perpendicular pieces that hung down and slid along the ruler. While she did the measuring and called out the numbers, one of the other women noted them down. I assume that these too would come into play in the Physics calculations.

The only thing left to do was to make permanent one of the X marks, so they would have a place to take all other measurements from for the real irradiation session on Tuesday. So, despite having never been at all inclined to have a tattoo, I now have one… Admittedly, it’s only the tiniest, barely visible ink dot in a rarely seen place on my side, but nonetheless, I can now boast of having a tattoo. How cool is that?!

After all that, I was invited to get dressed. Meanwhile Pete came in and began to roll up his cables again. When he realised that I was dressing, he apologised and departed, which I found quite amusing, given that I was virtually naked lying down, but somehow he must have felt that me standing up was more embarrassing… for him or me, I’m not sure.

All done in Radiotherapy, I made my way up to Fletcher ward in the Haematology Department to be admitted. A doctor listened to my chest with a stethoscope and asked a few health history questions, but I didn’t need to complete any paperwork until I was going to be staying in for real, so I was free to leave for the day.

Cultural Note: Heath Robinson was a British cartoonist and illustrator who drew unlikely, eccentric contraptions. Rube Goldberg and Storm Petersen are the U.S. and Danish equivalents. I am sure that these cartoonists must have inspired Nick Park of Aardman Animations for some of the contraptions in Wallace and Gromit.

In the UK, the term “Heath Robinson” has entered the language as a description of any improbable, rickety machine barely kept going by incessant tinkering, often used in relation to temporary fixes using ingenuity and whatever is to hand, such as string and tape, or unlikely cannibalisations.