Who Wants to be First?

After much preparation, we opened our new radiation therapy department in September 2008.  Many many elements and “players” had to come together to produce a new state of the art community cancer center.  No detail was overlooked– the existing space had to be renovated  to create a more “zen-like” work flow and feel; the front office staff  had to be selected whose faces and voices would materialize as the “first impression” that our new patients would form as they entered a “brave new world”. My nurse had to be hired, who would play a critical role in the education and management of the patients.  Radiation therapists were recruited who would see the patients daily for up to eight weeks of treatment, directing the beams with the utmost precision while acting as “parents”, confidants, psychiatrists, social workers and otherwise infinite sources of knowledge, gossip and entertainment.  The physics staff– the dosimetrist who does the actual treatment planning and the medical physicist, ultimately responsible for the function of the machines and the safety of the patient—were chosen first, because in order to get a new radiation therapy department going, the linear accelerator must first be installed, and then “commissioned”.

A Linac is a very complex piece of equipment, housed in its own “vault”, a lead shielded room in the department.  Long ago, and far away, for precisely 24 hours before my written board exam, I could tell you EXACTLY how one works.  Now when a patient (and it is nearly ALWAYS an engineer!) asks me, “How does that thing produce radiation?”, I take his arm, and escort him to the office of my physicist who will gladly  explain everything (and I do mean EVERYTHING) to the patient.  Usually the patient emerges an hour later, with eyes slightly glazed over, and I am never asked another question.  And when it comes to explaining, and commissioning a linear accelerator, my physicist is simply the best.

The process of commissioning takes up to six weeks.  The company provides the “specs” of how the machine is supposed to perform, however we don’t just take the manufacturer’s word for it and plug it in and run with it.  After all, this is radiation, dangerous stuff if applied incorrectly.  The physicist uses his equipment to measure the output of the beam, at every different energy, at every different depth, for every different radiation field size.  Internal shields and beam adjustors and compensators are put through rigorous use to try to find faults. Computer connections are tested; video systems are monitored, and no stone is left unturned.  It is an arduous process, producing reams of data. At the end, when all is said and done, the machine must produce beams of sufficient strength, and fields of precise shape, or there will be no “acceptance”, and back it goes to the manufacturer.

So it was with great excitement and anticipation that we finally were ready to treat our first patient.  She was a lovely elderly woman with breast cancer, diminutive in size but full of personality!  She wore a royal blue boucle suit to her first treatment, replete with a silver flower brooch that she had made herself in her eldercare silversmithing class. She took tiny steps on her kitten heels down the ramp leading inside the vault.  Her hair and make up were perfect.  She was composed and polite to the staff.  She beamed at me.  As directed by the therapists, she changed into her gown.  They positioned her on the table, five feet off the ground.  They set the machine to its assigned position.  Everything was ready, so I pronounced, in my most important special occasion voice:  “Mrs. B, you are about to be the very first, number one patient EVER to be treated in this department on this machine.”

There was a moment of silence, and then Mrs. B EXPLODED into action, causing all of us, the therapists and me, to take a step backwards in surprise then forwards in alarm since she was at a height which could practically guarantee not only orthopedic but also neurosurgical injuries, should she fall.  She sat bolt upright and began to climb off the table, all the while exclaiming:  “The first?  THE FIRST??!!!  You never told me that I was the FIRST!   YOU GET ME DOWN FROM HERE AND EXPERIMENT ON SOMEONE ELSE FIRST!  I am not your guinea pig!  I’m going home RIGHT NOW!”

Okay…..would anyone else like to be first?