Drug side effects and horror film characters: Turning normal people into crazy serial killers.

Cancer won’t go away nicely, so I’m back on full chemo

I am now in my fourth month of active chemo in Round Two of my adventure with this blood cancer called Multiple Myeloma. So far, things seem to be going well.

Although I am being given exactly the same triple cocktail regimen—namely Velcade, Cytoxan, and Dexamethasone (i.e., Bortezomib, Cyclophosphamide, and Decadron)—that I got in my First Round of chemo two years ago when I was first diagnosed at Stage 3-B of this plasma cell blood cancer, my body is responding well to the drugs. 

Side effects are minimal, but I still ride the Dexamethasone roller coaster

Just as significantly, my body is also tolerating the side effects of the chemo quite well—even better than the first time around. I am not experiencing any of the neuropathy, or tingling in my fingers, which occurred the first time around. Food tastes great: there are no more weird, metallic flavors messing up my taste buds. And the roller coaster rides of weekly energy highs and fatigue lows that I rode throughout the entire course of Round One chemo is significantly mitigated in this round, although, as another blog testifies, I still do get a hell of an energy kick from the steroid Dexamethasone.

In fact, soon after getting my doses of Dexamethasone—it is spread out evenly over two consecutive days—I find myself physically and intellectually boosted into a realm of high energy that can keep me awake and alert for two or three days at a shot. When the effects of the drug wear off, some fatigue does set in, but nothing like the order of magnitude which turned me into a couch potato for the second half of each weekly administration in Round One. 

Forever chasing the goddess of sleep

I get my sleep OK, not in any normal diurnal fashion, but piecemeal, throughout the week, in chunks of abnormal time that could involve deep, four-hour naps at any time of the day or night in between bursts of activity. As I noticed the first time around, when I find that my eyes droop uncontrollably, or when I can no longer concentrate on completing the tasks I am working on at my computer, or when the movie I was watching ends and I can’t remember seeing how it all turned out, then I know that my brain is exhausted and I have to crawl into bed to get some long-overdue sleep. 

As far as I am concerned, though, having insomnia or a disrupted sleep pattern is a relatively small price to pay to get the much larger benefit of knocking down the cancer burden in my body. I’d rather suffer the loss of Small Sleep due to the steroid’s effects on my mind and body than be relegated to the Big Sleep too soon due to the effects of the cancer on my body. So, for my money, the Dexamethasone roller coaster is still the most exciting ride you can climb aboard if you happen to have the ticket of admission that all Multiple Myeloma patients are given upon entering the chemotherapy amusement park.

How long before I become psychotic?

Of course, all drugs have their long-term side effects. One of the long-term liabilities of taking Dexamethasone, as I gathered from an app called Medscape, which I downloaded to my iPad, is psychosis. The drug can literally drive you crazy! 

I remember coming across that rather unsettling information back in the first week of Round Two of my treatment, when I was in the infusion center at the Roswell Park Cancer Institute. I wanted to refresh my memory regarding all the side effects that I might be heir to as a result of resuming a full course of chemo. 

Since lab results at the end of 2013 were indicating that the cancer was creeping back into my bone marrow and blood stream to make life difficult for me, my doctor reached the conclusion that the maintenance regimen of Revlimid had apparently failed to give me the same duration of benefits that other stem-cell transplant patients were receiving. Statistically speaking, my case had fallen at the short end of the longevity scale. Within only one year of getting a stem-cell transplant, blood work indicated that the maintenance level dosage of Revlimid was not able to stop the spread of malignant plasma cells above the guideline at which full chemotherapeutic treatment should be commenced.

What make a serial killer tick?

Anyway, with the prospect of facing several months—perhaps a lifetime—of active chemo again, I was sitting in a chemo chair, going through the Medscape app and reading aloud selections of the side effects to which I was about to be subjected. Naturally, to make the whole experience entertaining for my nurse and the staff who wandered by, I was cherry-picking side effects from the excessively long lists in order to combine them into patterns that were especially interesting or amusing. 

“Oh, look,” I said, as I scanned through the list of side effects you can get from taking Dexamethasone, “this steroid I’m going to take can not only cause insomnia, but it can also make me psychotic. “That’s cool! Everyone thought I was crazy a long time ago: now I am going to have an actual medical excuse.”

One of the nurses, Grace, is a horror film fan. She chimed in by saying that the reason why a serial killer in one of her favorite horror film franchises knocked people off was because his doctor had over-prescribed steroids. 

“Great! Whoever wrote those scripts was quite a clever scriptwriter!,” I declared. He got viewers hooked on the blood and the gore and the suspense involved in figuring out who the supposedly amoral killer might be, but what he was really doing was dramatizing the abuses inherent in our drug-obsessed health system when doctors give the wrong meds to the wrong people.”

No one wanted to touch that insight, except me, eagerly sitting there, waiting for my package of pharmaceutical wonder drugs to come along and rescue me from the agonizingly painful death which my cancer would inevitably bring me without the relief—however temporary—which my chemo could offer me. But I wasn’t quite done yet going through that Medscape list and milking it for all it was worth.

“So, Grace,” I said, “since you’re such a horror film fan, maybe we should collaborate on writing a screenplay for a horror movie. Let’s see now, what should our killer’s character and motivation be based on?,” I said, as I looked over the list of side effects associated with taking Dexamethasone. “It says here that, among the many adverse effects one can get from taking this steroid are: acne, depression, emotional instability, glucose intolerance, increased intracranial pressure, insomnia, perianal pruitus, rash, seizure, weight gain, menstrual irregularity, and psychosis.”

“That’s a hell of a selection you picked out,” laughed Grace.

“Well,” I said, “if you don’t like those, there are plenty more we can choose from.”

“No, those will do fine,” she acknowledged.

“OK, great. I agree. We can save the rest for the sequels. But, for the pilot movie, this set of will be more than enough to get us started. Hmmm, as I see it, our main character could be a lonely, obese, pimply-faced teen-age girl who can’t buy a date come hell or high-water. She’s got an itchy ass, she can’t sleep, and she feels like her head is about to explode. No one understands her; no one can figure out what’s wrong with her.”

“You got all that from the list of side effects?” wondered Grace.

“Sure.” I answered. “It’s all here. This poor girl just wants to be loved, but because she’s over-medicated on some steroid that makes her crazy, she can’t help herself. She finds creative ways to off the popular kids at her high school who ignore her and make fun of her.”

 “So, it’s not her fault. It’s the drugs,” Grace deduced.

“Exactly,” I said. “She is merely an innocent victim of the system, just like the kids she kills are innocent victims of her drug-induced psychosis. What do you think? Will it sell? We can make it a thriller.”

“I’ve watched worse,” Grace admitted.

Of course, neither Grace nor I have begun any work on yet another serial killer slasher movie that contributes absolutely nothing to the current literature on ghouls, ghosts, and goblins I’d sooner forget. Yet, when you look over the laundry list of ailments that can befall you on your way to find a cure for an allegedly more serious health condition, it does make one pause to imagine what could conceivably happen, given a certain set of circumstances. 

Unless we take their drugs, on what grounds can we judge someone else?

It also makes me hesitant to make any moral judgements on people, who, through no fault of their own, commit actions that we would normally consider reprehensible. Although we may detest their behavior, we have no absolute right to judge those who find themselves victimized, trapped, or controlled in a system that they did not design.

You could say that such things are far-fetched. You could claim that people’s characters are not shaped by influences like side effects of drugs. You could even assert that such things only happen in the movies. But none of that is not quite true, for there are plenty of things which happen in real life that never get developed into fictional movies, because, in a pitch session, they get rejected as unrealistic. We only eventually hear about them when they finally make the news. Then we are compelled to extend our scope of reality to include those horrifying portions of our imagination that we would rather not think about. Imagination does not exist outside of the realm of reality, and it never will.

There is very little certainty when the world goes crazy, or when it seems to, from any individual’s perspective. Not to worry. If and when I go crazy, the one thing you can count on is that I won’t also suffer from menstrual cramps. I  would just hope that I don’t get perianal pruitus again. Something like that can drive you nuts.