Treatment Day One

Another cold, cold rainy day in Taipei. Together we rode the taxi to the hospital in the south of the city. The meter clocked over sixteen kilometers, and we were still within the city boundaries. We were a little late when we arrived, but the radiation technician kindly smiled and told us not to hurry.
 

The noise of a siren behind the closed thick metallic door warns people not to get close. Radiation in progress, treatment in progress.

The tumour, as suspected, is indeed difficult to locate and treat. From the initial diagnosis of two days of treatment three weeks ago, it's now doubled to four. Which means, except for Sunday, we will have to be at the hospital almost every day this week.

At the end of the robotic arm is a giant pod-like structure, to which a highly focused laser lens is attached at the end. It is through this that the burst of radiation is emitted at key locations to kill off the tumour. The robotic arm moves around the patient, and with the aid of x-rays and infra-red scans which are constantly calculated to ensure the laser is targeted at the precise location of the tumour as previously determined by various scans that were conducted prior to the treatment.



I watched from a work station outside the operation room. On a screen, I could see four cameras displaying the room from various angles, each with mum's body on the "operating table" in view. The robotic arm moved around mum, slowly, and every few minutes or so a red light would come on indicating "BEAM ON", followed by a green light indicating "BEAM OFF". A myriad of numbers would flash across one of the screens, which I presume is the computer calibrating the location of the tumour to be targeted. Earlier, the technician explained that the device is actually derived from the automated assembly line of automobiles, which requires very precise instruments to ensure the metallic parts of a car are well welded together. In this case, the robotic arm ensures that the undesirable parts of the body, the tumour thus, can be 'zapped' away using intense bursts of gamma radiation. The technology uses 6-D (as opposed to the convention 3-D) imagining, so that the computer can 'see' from all possible conceivable angles and send the robotic arm to within an millimeters of the intended location.


He led us into the chamber, and upon turning a corner I saw the massive device which to this moment I had only seen in pictures and simulations. It was more futuristic than I imagined it, a gigantic robotic arm with a laser attached to the end of the arm. There were  with the capability of turning at any angle.

I watched the four little screens carefully. Other than the robotic arm moving in very close to mum's body, there was nothing happening. "Does it hurt?

"No, not a bit. She doesn't feel a thing," the technician explained, "Most patients get very bored and fall asleep." If the patient's body and target area is aligned well with the scanned image stored in the computer (to ensure accuracy in the laser targeting during the treatment), then the procedure should not take more than an hour, or an hour and a half at the most.

I sat outside the 'operating room' next to brother and waited. He took out his phone and began playing a game, while I got up and paced around a bit, occasionally peering my behind the technician to look a the various displays of the operating room and of mum's high-precision scan. It sounded and looked like something out of some sci-fi series, but it was very real, and it could very well be a life safer...

There was a moment, I felt like crying... At one point the technician sympathetically said: "I can understand your anxiety. My dad also had cancer. Hang on there..."
So much waiting, and the treatment has finally begun. How effective will it really be? Will it really clear away all traces of tumour in mum's spine? The doctor explained that scans the day before revealed two concentrations of cancerous cells, one in the lower spine, somewhere behind the intestines, and another higher up, somewhere behind the lungs and immediately below where an artificial spinal column was installed after the surgery. Other than that, there are no other traces, as far as they can tell, or at least, as far as the instruments can determine. However advanced and high-tech the technology is, there are limitations, for it cannot detect cancerous cells smaller than 1.25mm. If there are other traces, then further follow-up scans will reveal them...

Mum left the operating room within forty minutes, a speed which surprised both my brother and I that made us wonder whether something went wrong. We went inside the 'operating room' to greet mum, who lay on the 'operating table' and smiled at us as we entered. "Did you bring [my grandson]?" she asked, "I heard a baby crying outsie!" It was actually another baby in the corridor, perhaps not much older than my nephew. But I could tell, mum wanted to see her grandson, and I can only imagine it's because he brings her so much joy.

I looked at the CyberKnife machine from close up. Quietly I thanked it, even though we do not yet know how effective it is. It seemed silly, was it not, to thank a cold inanimate machine. But as I left the room, I imagined the dozens, hundreds of people who have laid there on the same 'operating table' and who have looked at as the machine quietly slid over their bodies and one by one killed off unwanted tumours. And now my own mother is one of these people, whose health and life depends on such a sophisticated piece of technology, who hope depends on the technicians and doctors who operate the machine from the room next door...

Treatment one ended. Three more to go.