Off to Washington. I got us first class tickets again. It may seem over indulgent, but Jackie really gets nervous, and it seems worth it to make her a little more comfortable. This time we're taking the 8:15 AM, flight based on the fact that we don't have to be there until 11:00 AM, or at least so they told me. The flight was on time, but we took a wrong turn and ended up driving through a large part of the greater metropolitan Washington area to get there. We were still only fifteen minutes late.

As old hands at this -- this was our second visit after all -- we knew where to park, we didn't have to go to the admitting area, we couldn't figure out why we'd need a chest x-ray or anything ( maybe blood, but you don't see an oncologist if you have cancer without giving blood -- I think I know where the vampires would work). So we went right up and signed in.

The person behind the desk said "Oh, here you are. You're late. We've been looking for you." I mentioned that we were only supposed to be there 15 minutes ago.

Within about 10 minutes the doctor showed up looking for us. She told us that she wasn't the regular doctor, but he was off today and she was filling in, and, we would probably never see her again. This was great. We'd only have to repeat our life history an extra time. So Jackie started out by telling her the usual stuff (I guess it never made it over from the other department).

This doctor seemed pretty sharp. We spent a long time answering questions and going through the usual type of exam. No problems this time. It looked like Jackie was OK for the Taxol program, with the caveat that she had to check with her regular doctor.

Let me explain the setup at the NIH. The NIH is made up of institutes, like the NCI. In these institutes, there are permanent doctors. They are the ones that do the research. Then there are a lot of other doctors (called fellows), and it seems they are all pretty much new, though no doubt they all did well in school. These fellows are there for one year -- June through May. Then they are gone. There are also permanent nurses and administrative people, and the social workers are permanent as well.

They are qualified, but the doctors who are your primary contact are new. As with any organization, and especially with a government controlled one, it takes them a while to figure out the system. About the time they do, their year is up. There must be a better way. The good thing about this is that a large number of doctors are exposed to what is going on at the NIH. Maybe each patient should be assigned to a permanent physician's assistant, who would work with each fellow.

Anyway, the doctor explained the protocol. We had seen and heard all the press about Taxol. New wonder drug -- cancer cure. Well, she explained that it wasn't quite so wonderful as the press would have you believe.

And immediately blows it out of proportion. The point is, don't get too excited about the "miracle" cures that are in the press all the time -- and that's the regular press, not the tabloids.

Since we were pretty up to date on Taxol, she filled us in on the statistics and the real side effects. The statistics were that it worked for about 20% of the people who sort of seemed like Jackie. Not as great as the papers would have you believe. For side effects, the vast majority of people reported only mild side effects and tiredness. Now that would be very nice -- an effective chemo that didn't make you feel bad. On the other hand, your hair fell out (Oh Oh, I'd better get prepared for this battle). The real experimental part of this protocol wasn't Taxol -- it was just about to be released for general use. The experimental part was the R-Verapamil part. This drug was an isomer (a look alike) of the drug Verapamil, which is a high blood pressure medicine. You might recall Jackie had read about Verapamil right after her mastectomy.

The doctors had a theory. It seems that cancer cells learn how to "fight" chemo. Cancer cells pump the chemo out faster than it comes in, meaning that the chemo never has a chance to do its job of killing the cell. It's sort of like insects that become resistant to certain pesticides. This R-Verapamil was supposed to turn this "pump" off, leaving the Taxol in the cell to do the killing. They had to use R-Verapamil instead of Verapamil, because the R kind did the same thing to the tumor cell as the regular kind, but the regular kind in high doses could kill you.

That all sounded pretty much OK (although I knew the hair part would be a problem). I still asked the question "Is this the best thing for Jackie?" She said the other doctor would answer. He came in after a little bit and asked me to leave. Really made me mad. Why did I need to leave for the exam? It wasn't like I hadn't seen Jackie undressed before. I almost made a big deal out of it, but what the heck, by now I was figuring out what was really important in life.

When I came back into the room, he said Jackie was eligible. What a relief. I sort of got the feeling that the calls from Senator Nunn's office may have smoothed the way. We had certainly received very expedient service.

On the very annoying side, he gave us a list of things that had to be done before Jackie could start. CAT scan, bone scan, etc. We said that we already had all of them. However, he said "Well they are four and 1/2 weeks old. We need fresh ones." What a waste. If these people could only communicate, and we had gotten up there when we were supposed to, we would have had tests from within the time frame. I was so annoyed that Jackie had to go through them. Even worse, they wanted Jackie's Hickman out. For reasonable reasons, like they didn't want to take a chance with infection, but she had kept it for over a year now in case someone needed it. And after all the trouble of keeping it clean, and then having to deal with the tumor growing around it -- very annoying. They said she could either have a temporary catheter put in her neck each time, or get some kind of under the skin one like the Port-a-cat. I told them that she had pretty much run out of good places to put one, but of course I'm not a doctor, so I couldn't know what I was talking about. At any rate, it needed to be out before starting.

We were ready to go -- early. I quick changed our flight to leave two hours earlier and we were pretty excited, but I knew the tests, port and hair were bothering Jackie.

The last piece of business was the social worker, but she was going home sick, and we had talked to the other one on our last visit, so we decided to put it off.

The last good news from the NCI was that Jackie's airfare would be paid for, and her hotel. That would leave me with the problem of buying my ticket, getting the car, and handling food. I even figured I could upgrade both of us and still have the comfort of first class.