Topo Gigio

     And the winner is... topotecan! Yes, it was a late entry into the lineup, a definite dark horse, a come-from-behind, an upset. To flog the flimsy metaphor until it wimpers, the wimpy little has-been outpaced the rest of the pack to win decisively in the final stretch.

     We start tomorrow.

     Let's think about topotecan. It's been around forever, forever comprising my direct experience: at least eleven years. (Before me, beyond me, there was nothing.) Its side effects are said to be relatively minimal. It attacks cells by interfering with their growth; they don't grow, they die. It whacks out the blood counts, but I don't know of a drug that doesn't. And its most appealing feature is that it is a quick infusion of thirty minutes -- none of that hours-long Gemzar nonsense -- meaning I should be out of the infusion center in a few hours tops (it all depends on how quickly the lab can do the CBC, which varies wildly at the hospital where the party happens.) Three weeks on, one week off, restart. 

     The bad news is that I have an illogical (I'm sure) regard for topotecan as a lightweight, last-ditch, ineffective hail mary that only gets pulled out when it's pouring rain under the stadium lights, the fans have left the bleachers, and the coach from the visiting team refuses to just run out the clock so we can go the fuck home already.  

     In my head it's the... wait for it... Sarah Palin of chemotherapy.

     Why? How can I have such a strong opinion and weak expectation of a drug with which I've never rumbled? It originates with the very, very bad idea (for us) to attend a cancer support group/information session in March 1997 at the hospital. You know who goes to those things? People who've just been diagnosed, and people who are on their way out the door. I'd had surgery on Valentine's Day; I don't even think my hair had left me yet. Anyway, M and I were young -- I was 35, he was only 26 -- and we didn't realize how fresh we were into this thing. Compared to us, everyone else looked old, sick, scared, and angry as hell. 

     I remember this woman sitting next to me, fiftyish, having been through the fuggin' mill, skin blotchy and hair thin, who was firing questions at the doctor as though it were a private consultation the rest of us were being allowed to sit in on. She wanted to know about intraperitoneal chemotherapy (the "bellywash" where they skip the veins and put the weed killer directly into the abdomen, yik, never had that done), she wanted to know about why her CA125 wouldn't come down below 62 (I remember this very clearly, curiously), she wanted to know how she could lose the extra sixteen pounds she'd put on, and she wanted to know how long the topotecan would work. I remember the oncologists' answers: it's not appropriate for the type of tumor you have; I don't know; eat better and get exercise; I don't know. There was another woman, there with her husband, the two of them looked desperate in different ways, she impossibly thin, with waxy skin and wide sunken eyes, he with twitches and stutters and a voice so soft it didn't matter, in the purest sense, that he was asking questions. "Topotecan. We're moving in that direction. It's the last thing we're going to try; it's our last option. What are the chances?" Meaning what were her chances. 

     These are questions I will never ask; statements I will never make. I know now what I didn't know then -- that the white coats are just for show. Oncologists are alchemists, fooling around with beakers and calculations and elements and hoping they don't blow up the lab. They don't have any way of knowing, so why ask? Why let someone else plant the idea in my head that I have some percentage of life left in me? They don't know. It's a good thing I know they don't know.

     So, yes. Topotecan. Henceforth to be thought of and referred to in our house as Topo Gigio, everyone's favorite imp of an Italian clown. See his antics? What a scamp!