The Mask

imagesThe fitting of my radiotherapy mask was, I imagine, a bit like going to a beauty spa for a facial. At least for the first minute or two.

Two very polite, immaculately – even clinically – dressed staff welcome me into their treatment room, and invite me to lie gently on a bed. They shift me around, to make sure I’m absolutely comfortable, and manoeuvre my head to get a nice angle. In a beauty spa, there would be whale music or pan pipes wafting on the airwaves.

The uniformed assistants talk to me gently as they lift a large sagging flannel from a bath of hot water, and rest it on my face. It’s just a tad too hot, but it’s lovely. My eyes are covered, but I can see through the material at the smoothly glowing lights above. Why have I never had a facial before?

Crunch, crunch, crunch, crunch.

One of the staff leans down on one side of the flannel, and crunches some clips in place.

Crunch, crunch, crunch, crunch.

Now the other side gets pinned down too, with an equally disturbing noise. I feel my face pulled back into the bed.

It’s all gone a bit Stephen King. The material is covering my whole head, from under my chin to above my hair line, and right over the back of my skull. On either side it goes down past my ears onto the hard board behind.

I feel one of the mould technicians reach into the small gap left for my mouth, and stretch the material until it shapes into some kind of manic smile that uncovers my nostrils and allows my nose to poke through.

Then the fans start, one either side. As they whir, I feel the mask tighten up, shrink slightly, clinging closer still to my face.

It’s less a fitting of a mask than of a whole facial encasing. But in two minutes, the mask is rigid and cool. The process is done.

I make it sound scary, but it wasn’t at all. They unclip me and I’m soon sitting up on the bed looking at a blank-plastic copy of me. That’s the head people see every day, only without the ginger eyebrows and carelessly shaven chin.

After a ten minute wait, I’m led into another room where I’m set up under a CT scanner. The radiographers need to make some rough marks on my mask, to correspond to where x-rays show them my brain is.

They lie me down on the bed and pin me back into the mask, forcing my head back onto the table and crunching me into place. I cannot move my face, nor open my mouth to allow out a ‘yes’ when I’m asked if I’m OK. A dull positive ‘mmm-mmm’ seems to do the trick, and the radiographers leave the room.

The machine clicks and whirs around me, and I see red and green laser-like lights passing up and down my head. They come back into the room a couple of times and write on the mask with their marker pens and apply some sticking tape.

Once again, I’m comfortable and the whole exercise is over in about five minutes before I’m unbolted. My radiotherapy mask is made. A copy of me, only with marker all over my face.

I’m sent away (which in my case means going on a cycling holiday in Mallorca), while the real science goes on. Radiotherapists and oncologists will now take the mask and the CT scans, and those get married up with the MRI scans that have been previously taken of my brain.

Some serious computer firepower, plus a generous heap of neuro-oncology expertise and brainwork will be brought together to create a day-by-day plan of how the radiotherapy machine will, over thirty days, work away at zapping my tumour with radiation waves.

The very thought of it is awesome and exciting. I imagine a science fiction movie, with a holographic projection of my head rotating, while scientists line up their laser beams at the offending areas of my brain. I’m sure it’s far more mundane than that.

So, I go on holiday. Just over a week later I am back in Belfast City Hospital’s Cancer Centre. With the cycling out of the way, that word ‘cancer’ above the doorway seems somehow more significant. It’s a word I’ll be walking under to enter the building more than 30 times over the coming months, and perhaps a hundred before April next year.

I am here for my radiotherapy planning. I am to have thirty sessions of ‘radical radiotherapy’ directly to my brain, every weekday for the next six weeks. The neuro-oncology nurse hands me a kind of ‘pass’ to the radiotherapy centre, and on the back are the appointments for my treatment. I need to come to the centre every day, mostly in the afternoons.

Today, though, I’m here to further plan the work the radiotherapy machines will do for me. That means more radiotherapy mask.

I’m generally good with confined spaces. MRIs over the last four years have not bothered me one bit, even though the plastic surrounding you is an inch from your face and you know most of your body is squeezed into a narrow tube. As a kid I went potholing, and forced my body through rock crevices deep in the pitch black crust in the French sub soil and was more elated than fearful.

But somehow the fitting of the radiotherapy mask felt different this time. As the crunches went down, it was as if the plastic had slightly shrunk (or maybe I’d put on some facial weight from all the unlimited buffets I’d enjoyed in Spain).

The mask was close and uncomfortable to wear. At first, I welcomed the whirring of the machine and the reassuring footsteps of the radiographers as they came and went with their pens and tape, scrawling on my mask. Being held so still almost allowed me to fall asleep, knowing I wouldn’t disturb their work if I did. There was nowhere for me to go.

But gradually, being held down there so rigidly began to grind me down. I felt places in the mask that seemed too tight, and they irritated me. I didn’t like the way I couldn’t blink without the tips of my eyelashes brushing the inside of the mask.

I couldn’t move my jaw, and my teeth felt uncomfortably pinned together in an unnatural grimace. My ears felt pressed into my head, creating that pain you get when you wear a too-tight wooly hat. But worst was the back of my head. The pressure of the mask pushed my whole skull onto the bench which now felt far harder than I had remembered.

Finally, after a long scan, a radiographer came in to release me. Or that’s what I told myself. Then she spoke the words I feared: “OK, we’re just about half way through. Everything OK?”

Half way? Could I cope with this?

“Mmm-mmm,” I replied.

I knew I could give a little wave if I wanted them to stop, maybe take a break. But I also knew I wouldn’t. It wasn’t claustrophobia or panic, just discomfort and a little pain. I knew I’d sit it out.

But a thought occurred to me, and it was one of sadness. Even despite the biopsy I had in London, where they had drilled out part of my skull, this was the most discomfort my brain tumour had yet brought.

I couldn’t help lying there wondering if this was just the beginning. I began thinking of the radiotherapy treatment, the possible sickness, ‘sunburn’ and cracked skin, possible uncontrollable fatigue. I couldn’t help thinking about the chemotherapy I’ll need once the radiotherapy is done. Intravenous chemo fed into my arm. Endless drugs to take. Constipation. Headaches. Possible stomach problems.

Every other side effect the leaflets list as probable, possible and unlikely but you might as well think about them because you’re pinned to a stiff board by your face, in pain, with nothing else to consider except yet more pain that this brain tumour – this cancer – will put you through over the coming year and then in later years too.

The machine comes to a final stop and I’m relieved to hear the door open and the clunk, clunk, clunk of the bolts being released from around my head. The mask is lifted off, and I massage and stretch my jaw as if I’ve just been punched in it.

“You did really well,” one of the radiologists says to me, “many patients can’t take the whole half hour.” And I feel like a fake, because I don’t think I did take it very well at all.

But the stiffness in my face dissipates, and as I’m collecting my bag I’m told that each of my radiotherapy sessions will be just a fraction of that amount of time. Around ten minutes on average. Mostly “having radiotherapy” will entail my daily traveling to and from my appointments, and then waiting for my turn on the machine.

I consult my appointment list. My first is on Monday, 4.20pm sharp. I’ll also see my oncologist once a week, to see how I am getting on. We’re not even discussing chemotherapy yet, though the plan is to begin chemo about four to six weeks after radiotherapy is finished.

I leave the cancer centre and blink my eyes. The sun has unexpectedly come out while I’ve been pinned to the table. All the pain has gone now, and suddenly I’m in better spirits. Of course I can do this. It’s nearly a year of treatments, but if everything goes well – and there’s a very strong likelihood that it will – then my brain tumour will be something that can be relegated; returned to the back of my mind for many many years.

I meet my friends in the well kept grounds of Queens University, where the sun is beating off the buildings making them glow. It reminds me of sitting in the grounds of my own university on a sunny day.

They hand me my four month old baby. She smiles at me as if I’ve been gone for a week. I don’t hold her close or hug her with any particular extra meaning. All thoughts of cancer and treatment and the testing times to come have quickly washed away from my whole body, like the sea rushing off the back of a breaching whale.

My friends and I continue our conversation pretty much where we left off before. Then we go in search of quality Chinese food before it’s time to pick up other children from school.