Here are three views of “the alien.” It’s the bright thing.

(There’s a tiny icon in the bottom-left corner of each image showing its orientation: from the feet, from the left, and face-on looking straight in. Each image is a thin slice so only those organs “in the slice” are seen. Those above and below that layer are not visible.)

The cancer is bright in the PET scan because it has gobbled up the radioactive sugar water they injected an hour earlier. Everything else is dimmer because it’s not as voracious. (Some organs, the liver and kidneys for example, are squeezing some of the sugar out so they are a little brighter, but not as bright as the tumor.)

I think of the malignancy as about the size–and character–of a big cockroach that’s stuck halfway down my throat.

If that seems revolting, then you understand my attitude toward it.

We are poisoning it along with any little parts that may have broken off. That’s the Chemotherapy I’ve received over the past five weeks. Chemotherapy’s goal is to kill any cells floating around elsewhere. (If it helps kill the cockroach, that’s a good thing.)

And we’re burning the main carcass with a high-energy beam of protons. That’s the Proton Beam radiation I get five times a week, Monday through Friday, for a total of twenty-five whacks.

In the left-most image, you can imagine the stream of particles coming in and up from the bottom left through the black (air in the lung) and passing under the big round pink blob to reach the tumor. The beam passes just above the spine and the protons are powered up to the exact amount of energy so they penetrate skin, bone and whatever, but then stop–come to a complete halt–inside the tumor. The energy in the beam accumulates in the tumor and literally cooks it.

(No, I don’t taste or smell anything at any time.)

That’s the first half of the radiation treatment.

The bed is then swung around 180 degrees and a second treatment, this time from the right, shoots in and burns the tumor from that side.

Each “zap” is a series of brush strokes that, a line at a time, “paint” the cancer with high-energy particles. The beam is very tightly focused and is directed–stroked–across the tumor until the whole thing, and every level within it, has been exposed.

During treatment, I can hear each stroke. (The sound comes from several feet away–it’s not protons hitting flesh.)

The staff Physicist who does the energy calculations was surprised when I correctly reported they do fifty-seven strokes from each side. He didn’t know there was a sound and he was mystified as to its origin. (For safety reasons, no one is in the treatment room except me when the beam is on.)

Each stroke sounds like someone clearing their throat. The technicians who run the equipment said they’ve never heard it either but, at my description, they nodded and said other patients have given similar reports.

There’s a one-second stroke and then a two-second silence. That repeats, for me, fifty-seven times. Then the bed is spun around and the process repeats with another fifty-seven strokes.

The Physicist noted each batch of protons takes about two seconds to accelerate to the correct energy level inside the synchrotron down the hall. I presume that’s the pause.

If I had to guess, the sound might be the protons passing through a cover plate. Or perhaps it’s the sound of the electromagnetic wiring at the end of the beam as the protons are steered with great precision into the tumor.

This coming Tuesday, that cockroach should be dead, dead, dead.

All that remains will be to surgically remove the carcass along with anything it may have pooped on, and then restructure the undamaged plumbing so it functions in a somewhat normal manner.

Will the cockroach be dead? The pathology report during surgery will let the surgeon know.

Did the cockroach poop into the nearby lymph nodes by which cancer cells could then have traveled (metastasized) to other parts of the body? The surgeon will take them out and, again, the Pathology Department will let him know.

Sometime in March.

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