中The side effects of radiotherapy of course weren’t limited to just disturbing my absolute pitch and causing mayhem in my mouth or throat. None of the tissues and organs in the path and field of radiation were spared.
Take trismus —— that’s the stiffening and swelling of my left jaw muscle. It’s the second time in the space of two months that the muscle was hurt. I got away with it lightly the first time round with stretching exercises, but not quite as easily this time, partly because the skin was scorched too. Adopting the “ladylike” manners with restricted mouth movements wasn’t the main issue actually, since I couldn’t really eat much anyway. What’s more concerning was that trismus couldn’t be left to its own devices; regular stretching exercises were needed to prevent the onset of fibrosis, which would otherwise lead to permanent stiffness with no cure. For the sake of my future oral health, general feeding and speech, I had to keep trismus at bay. Yet, at the same time I was reluctant to have the exercises pulling open the mucositis wounds which were stubbornly unhealed. Damned if I did, damned if I didn’t......
The perturbations of my absolute pitch was unexpected. In contrast, the onset of tinnitus wasn’t a surprise when the Eustachian tube that links up the middle ear and throat collapsed, like a badly kinked drinking straw, resulting in a persistent half-blocked ear. Next was the nasal mucosa, again damaged by radiation, leading to occasional bleeds. Even my lips took a hit. They, thankfully, looked normal on the outside, but were definitely swollen inside like two thin sausages, readily noticeable when I smacked my lips after putting on some balm. Oh, there’s eczema too, itchy patches around my body but away from the head, for the first time in my life. It’s probably my immune system’s way of telling me that the body’s homeostasis has been disturbed by the two traumas in relatively quick succession —— the operation and radiotherapy.
The least concerning side effect had to be hair loss. Not only did it not hurt or itch, it was also barely noticeable by anyone. How come? Well, I normally wear my hair short, and the bottommost layer near my neck always requires professional attention every six weeks or so to thin out and keep tidy. So it’s “helpful” that this very layer was eliminated by radiation. The hair follicles seemed to have ganged up to “jump ship” together, and completed their exodus in just a few days! The strong X-rays were a precise blade —— one can’t miss the dead straight horizontal line of attack it left. Only hair below that line was shedded. How convenient was it that the normal, exuberant top layers covered the bald regions nicely! It would often take a swoosh of winter side wind and the shiver that ensued to remind me of my half-baldness, ha!
Lazing around at home with no zoom calls sounds like the ideal life? Well, it’s as ideal as the “life-saving” ice-cream was to my diet. Sleeping or napping should at least be easy, as that has nothing to do with the mouth, right? Not when one’s dealing with mucus-like saliva that is good for nothing. Lying down was an invitation for trouble —— the sticky mucus would crawl to the throat, get stuck on some open wounds, and trigger some bad coughs. Coughs would open new wounds, which caused more irritation and further coughs. How to break this vicious cycle? Simply sit up, like how one takes a nap in an economy class seat on the plane. What a way to “experience” flying long-haul in times of lockdown!
Oh, I would keep a bucket in front of me too. That’s of course not for travel sickness, but for spitting out that mucus so it stood less chance of reaching my throat. Several times a night, my back would hurt, and I had to change posture by lying down on my side, the sticky saliva seeping onto layers of awaiting towels on my pillow. Yes, I know this all sounds gross, but I found no other solutions that kept the coughs at bay. Intriguingly, the secretions would dry up a bit by dawn usually, and I would steal this small time window to rest. It’s as if the injured glands had their own circadian rhythm too?
Having covered so much about the side effects, how about the thirty radiotherapy sessions themselves —— what were they like? They were quite uneventful and uniform actually. First, the radiographers would confirm my identity before asking me to get on the CT scanner’s table (bed) with my top off (but kept as a “blanket” to keep me warm). Once lied down, two radiographers would fit the bespoke mask on me and send me into the scanner. Before administering the radiation dose, there would be one final quick CT scan, the image of which would be superimposed onto the one captured on the mask-making day (“day 0”). This is important because the physicists used the “day 0” image and data when calculating my radiation dose, that’s why the radiographers tried to keep my head’s positioning as close as possible to that on “day 0”. Once it’s all set, X-rays would be fired for 220 or 225 seconds. (They calibrated the duration to account for the slight differences between two CT scanners in different rooms.)
The treatment room was dimly lit and it was pretty dark inside the scanner. I knew the X-ray was nothing like the kind used by dentists, since I could sense the flickering or sparks of bright lights brushing off my face even with my eyes closed. What was the best way to stay still and keep calm during those 200-odd seconds with daggers of radiation being thrown across the scanner tube? In earlier sessions, I would review beautiful scenes from my foreign travels or think of all the nice foods that I used to enjoy, but that didn’t help with time-keeping. How far did I have to “travel”, or how many dishes should I “taste”, before the radiation would stop?
An idea came to mind —— why not play some music? Not humming or singing inside the scanner, of course, but I could “play” the piano in my head. As long as I kept the pace more or less the same from day to day, then I should be able to anticipate a radiotherapy session to end when I had reached a certain phrase in the musical piece. So I picked one of my own compositions as the “timer” —— it lasts for roughly three minutes, is quite calming and has a simple melody line. Usually a session would be completed by the time I was half-way through “playing” the last chorus, just like how a school bell’s ring sets pupils free. Since then, this piece, which I originally wrote for a friend’s birthday, has become entwined with my radiotherapy experience.
This strong association caught me off guard one day post-radiotherapy. I was playing the piano in the dark one quiet evening and nonchalantly picked up this piece. What triggered the flashbacks on this digital piano were the weak laser flickering under and in between the keys, as well as some blinking lights on the control panel. This piece is now reserved for daytime......
There wasn’t much else I could do to my physical health in this “tsunami 2.0”, apart from setting my hopes on post-treatment recovery. The darkness of radiotherapy, both literally and metaphorically, shall pass. My mental health, on the other hand, thanks to everyone’s rallying, was pretty unscathed, for which I can’t be more grateful.