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Monday, June 18, 2012

Chemo Cocktail

Last week was pretty rough.  I went in for my for my first chemo session in early June and have been home recovering ever since.  Yesterday was the first day in the last two weeks that I have felt quasi-normal and was able to get out and do a bit of jardinage (gardening) in the Flophouse garden.  I had all of the effets secondaires (side effects):  nausea, fatigue and other fun stuff.  For the first few days I lived on biscuits and lemonade (the French version is nice and fizzy but has much less sugar then the equivalent in the U.S.)  The first thing I did after the nausea started subsiding was to stuff myself with fresh fruits and vegetables.  I have never been so happy to see slightly crunchy steamed broccoli on my plate...

That said, it could have much worse.  I seem to be in the mid-range as far as side effects go.  The anti-nausea medication I was given worked pretty well.  I was warned ahead of time that the nausea would last from 2-5 days and I started being able to eat normally about day 3.  All to the good.  Now I just have to do it 5 more times every 3 weeks or so. :-)

About the chemo.  First session was on June 7th.  I arrived at the hospital en temps et en heure (in good time and in good order) and waited for about an hour in the waiting room.  I had a lot of company - the room was filled with folks in various stages of treatment, young and old.  I had a very nice conversation with an older woman who noticed my Ipad and asked to have a look because her son wanted to get her one. I felt a lot of solidarity in that room and the French (who are not normally very chatty with strangers) were striking up conversations right and left.

I was finally called in and since it was my first time I saw a new doctor who examined me and we had a little "get to know each other" chat.  This did not go very well and to understand why I need to give you some information about something I don't talk about much in general conversation and have never discussed on my blog.  My cancer is not the first life-threatening illness I have experienced - it is the second.   I am a recovering alcoholic.  I am a very lucky woman because I recognized I had a problem and got myself into treatment.  These days I do not drink and I believe that my health and sanity are contingent on my never ever picking up another glass of wine again.  That may sound scary to those of you who think that it's not possible to live in the country of fine wine and delicious cheese and not drink alcohol but, hey, there is a lot more to France than that and, yes, it is entirely possible to have a very good time here without having to sit in bistros and drink kir.  If you have any doubts or if you are someone who is afraid to come here because you have a problem with alcohol and you think France is too dangerous for your sobriety, send me an email and I'll put you in touch with the people who helped (and are still helping) me.

Why am I talking about this?  Because I think there is an important lesson in here about cultural bias and medical care.  Alcoholism is a recognized problem in France but there are some important cultural barriers to getting treatment through the system. Let's start with the language. In English there are words and terms that have come into common usage that simply do not translate well into French.  Terms like "recovering alcoholic" and "high-functioning alcoholic."  My experience has been that if you tell a French person that you are an alcoholic who doesn't drink, he/she has a moment of cognitive dissonance.  How can you be an alcoholic and not drink?  The mere fact that you are able to be abstinent is for many a clear sign that you are not.  Nothing could be farther from the truth but I've had a very hard time getting this message across to the extent that very well-meaning people who sincerely care about me still try to push drinks on me because, in their minds, I have proven that I don't have a problem with alcohol because I have been sober for so long.

There is also a stigma associated with the word "alcoholic."  It tends to bring up visions of bums sleeping in the metro with a bottle of cheap red dangling from their fingertips.  When you, female middle-class professional with a high income, nice clothes and a Gucci purse talk about this, frequently you are simply not taken very seriously.  And finally the doctors I have seen here about this seem to be more oriented toward to getting you back to a place where you can drink again.  Not one French doctor I've seen over the years ever seriously considered abstinence from alcohol as a realistic or desirable possibility.  I was given tranquilizers and told that if I could abstain for 30 days I would be "cured" and able to drink again.  I've talked to people here about my experience with French healthcare on this topic and this seems to be pretty standard.  In fact many of these folks (French and foreign) said that the outcome of this treatment for them was that they ended up hooked on prescription drugs (tranquilizers and other anti-anxiety medication) AND alcohol.  I ended up seeking an alternative to standard medical care and so did they.

In all the consultations I've had with the hospital I have talked openly about my situation and have made it very clear that I do not want the doctors to prescribe any mood-altering substances. Not only is this deadly for my health, it is also about my wishes which I want respected.  My morale is good, I don't need them and there is no medical reason to give them to me - tranks do not cure cancer.

However, tranquilizers are a standard component in the Chemo Cocktail here in France and you have to ask to have it removed.  I not only did this but I asked that it be put on my chart.  For the most part the doctors have been very supportive but it was just my bad luck that for my first chemo session I stumbled upon one who looked me up and down and simply didn't believe me. When I looked at the list of medications in my personalized chemo cocktail and had questions about one line that looked suspicious to me, she simply told me it was part of the treatment and I should not be concerned about it.   It was the nurse who caught it.  She had started preparing the medication, looked at my chart, looked again, and then came over to talk with me.  Madame, you are an alcoholic?  Yes.  You don't want the tranquilizers?  That's right.  Did you tell the doctor?  Yes.  Well, they are still in the prescription.  Do you confirm that you don't want them?  Yes, I absolutely do NOT want them.  She then pursed her lips, marched out the door and, I presume, went to have a chat with the doctor.  When she came back she dumped everything she had prepared up to that point and started over.  When she started the drip she assured me that the tranquilizers had been removed.  Everything went just fine from that point on and I thanked the nurse profusely many times during the session and after just before I left to go home.

This experience was a conjunction of two things which have nothing really to do with medical care and everything to do with cultural attitudes.  The first was a doctor who, I believe, truly thought that she was giving good care.  The tranquilizers are standard because they want patients to be comfortable and not ridden with anxiety.  In the balance between my wishes and what she thought was in my best interests, she made a determination that it was better to give them to me even if I didn't want them.  The second (which was also about the doctor) was an inability to square this well-dressed, nearing middle-age, professional lady with something like alcoholism.  She simply didn't believe me and the clincher was, I think, when she asked me if I had ever had liver failure and I said, "No."  All's well that ends well and fortunately there was another medical professional who took the time to double-check my chart and went to bat for me.

A few months ago I came across an EU report on alcohol abuse in Europe.  I can't find the report in my archives so I am unable to quote from it directly but here were the messages I remember.  Alcohol abuse is a serious problem in Europe which is not confined to the East.  Contrary to the myth that the French don't abuse alcohol because they have learned to drink normally from the cradle, alcoholism is a serious health issue here.  In addition to problems like liver failure and certain forms of cancer it is an important factor in the high number of automobile accidents.  The report called for better treatment for alcoholism through the national healthcare systems and it said that if the French (and other Europeans) would just drink a little bit less, it would go a long way toward filling the "trou" (hole) in the budget of the sécurité sociale.  The conclusions of the report were met with skepticism and outright hostility by the alcohol industry here (that includes the winemakers and their associations) and was promptly buried deep.  About the only thing you see these days that shows some concern about this on the part of the state is a message on wine and other liquor bottles that mildly advises us all to "Drink moderately."  A step in the right direction that nonetheless does not take into account those who can't and we are legion.  Even in France.

When I first went into treatment, I was a bit annoyed by my fellow sufferers who insisted that they were "grateful" to be here and in recovery.  What, in heaven's name, I asked myself, is there to be grateful for?  Ah, how quickly things change.  These days, I am on-my-knees grateful.  I could not imagine the nightmare of going through cancer treatment as an active alcoholic.  Through the program I joined, I was given tools that saved my life.  All these tools are turning out to be very useful as I fight my second life-threatening condition.

So today when folks ask me how I'm coping with cancer, I have the answer:

 One day at a time, folks, one day at a time.


Shirl and Rowan said...

Victoria, thank you so much for sharing. I had been wondering how you were doing. First, congratulations on getting through 17% of your chemo! Second, I cannot believe that the chemotherapy solution actually *includes* tranquilizers. Good on you for seeing it and good on the nurse who was your advocate. Nurses are the conscience of the health care system. I remember having a very similar conversation several years ago with a French doctor who didn't believe anyone could quit drinking and wished they could. I told him I did and that others could, too. I think he learned something from me in that conversation. Thank you for opening up about your first disease, alcoholism. It will help someone reading this blog, I am sure.
Love and grateful and recovering too,
we are Rowan and Shirl

Bella said...

Wow, just wow.

I've been a silent reader since 2010 as a young hopeful girl who fell in love with paris and have been wanting to move there ever since. since then i had your blog bookmarked and i keep on coming back reading everything from visa to travel and this time, about life.

Thank you for being an inspiration to me, and to others for sure. consider each day as a blessing to you and to the people that you inspire through your writing.

Bonne journée alors ! :-)

Christophe said...

Kudos to that nurse. The situation you run into highlight one of the problems that is probably shared by different countries: doctors don't like when patients disagree or question their judgement, and they're not nice to them when that happens. We're labelled good and bad patients. Most well educated people are bad patients.

And patients definitely should double check what they're given in the hospital. My late grandma hated that at the hospital, they are removing the pills from the box. She liked to know what she was taking. She was under blood thining medication, and during one hospital stay, she noticed that one of the pills was different than the one she was usually taking at home. They had made a mistake and given her a much stronger blood thinner. Hadn't she noticed it, it might have had pretty bad consequences.

I am glad you've been feeling well for the past couple days.



CarnetsdeSeattle said...

Thanks for sharing.

Just to offer a different point of view, my mother is an oncologist, specialised in lung cancer, and for ex smokers, she insists on total abstinence, and she does the same with alcoholics.

So as always, not everybody is so laid back about it. But I understand what you are saying. Yes many people are biased and have a sense of normality that is not exactly in the right place (for french people it's wine, for americans it is sugar...). It can get annoying to deal with that.


One day at a time!

Victoria FERAUGE said...

@Rowan and Shirl, So good to hear from you! I see that you folks are celebrating your first year of travel. That is indeed something to celebrate. Looking forward to reading more about Italy. You two are just amazing and a real inspiration. I now know what I want to do when I retire. :-)

@Bella, Thank you so much for your note and for being a long-time reader of the Flophouse. You're absolutely right - every day is a blessing. One of the great gifts of sobriety is presence. Waking up and looking around you and being open to all the possibilities. Even the mundane stuff is special when you start looking at it with clear eyes and a Beginner's Mind. Take good care.

@Christophe, Good point. There are places where the doctor/patient relationship is as you described and the doctor speaks "down" to the person he treats. My French mother-in-law had breast cancer 20 years ago (she is an amazing lady and a great support and comfort to me these days) and that was how she experienced her treatment back then. Today it is much different here and one reason for that is the government's Plan Cancer which has as one of its goals getting patients more involved in their own care. Good for your grandmother. Hey, doctors are human, right? :-)

@Loic, You're right and things are changing. The oncologists I've met at the center have (except for that one doctor) really supportive and thrilled that I got into recovery. The radiologist that gave me my initial diagnosis was a *huge* fan of Alcoholics Anonymous. I think they, more than the medecins traitants, see the ravages of diseases like alcoholism and other addictions up close. I loved what you said about normality and not being able to get past biases. It is the thing that prevents people from seeing all the possibilities in a situation and opening the mind to new information. That may be one of the most important benefits of migration - you are *forced* to open your mind as you encounter up close and personal someone else's "normal." ;-)

Anonymous said...

This was a very inspirational read. Your courage and humility are exemplary. Those who succeed at overcoming major life challenges are much stronger for it, often much wiser and, I believe, a more humane person because they know better than to judge others.
God bless.

Victoria FERAUGE said...

@Anonymous, Thank you so much for your note. I'm very glad your liked the post and I deeply appreciate your writing and telling me so. One of the most comforting words I hard in the program I'm in was, "Progress, not perfection." Stuff happens in life and we can either shut down and rail against the whims of fate or we can use our experiences to open up and feel empathy and a connection to all the other people in the world going through similar things. I have had a few days when I have angrily asked the universe, "Why me?" This kind of thinking is deadly for an alcoholic because, as the saying goes, "Poor me, poor me, pour me a drink...." :-) So I try to do better and my program isn't asking me to be perfect, it's just asking me to try. A work in progress.....

All the best to you,


Anonymous said...

I followed a link to your blog that had to do with the Petit Godin, of which we have two. Perfect stoves, botth wood and coal. I browsed thru the list on the right and saw the word cancer, and was quite amazed to find you with some writing about that tx process, of which I have had two. In reading slowly through the entries, I then found you considering the French attitudes toward alcoholism, and elaborating on the peculiar logic that if one can maintain abstinence, then one must not have alcoholism! I have worked as an addictions counselor for thirty years, and laud any and all public acknowledgements of recovery. Not much has changed in the last three decades, as the industry is so influencial in how we frame high risk alcohol or drug use. But every time a smart, capable, honorable individual clarifies that the treatment for alcoholism is abstinence, something positive happens. Thanks for risking, and for telling the truth. I will surely follow Flop House now!

Victoria FERAUGE said...

Hi Mame. Thank you so much for reading here and for your comments. You have TWO Godins? How wonderful. As soon as the weather clears up here and we can get the mason in to do the work, we'll have one too. :-)

The abstinence thing is a constant struggle because where the societal frame is "controlled drinking" you get a lot of push back (as you point out) from the industry and from regular folks, who can't imagine a life without alcohol.

I reply that I can't imagine going back to a life with it. It was so awful to be a slave to it and so painful to try to control it to no avail. Sounds like you've seen the desperation and insanity of this firsthand. It's horrible and that's true for ALL of us whatever our socioeconomic status.

I really look forward to reading more of your comments. Welcome to the Flophouse!