The instructions were clear: “Temperature higher than 38.0 degrees Celsius, go to the hospital, regardless of how you feel.”
These instructions have been communicated by my nurses and doctors repeatedly before chemotherapy, to the point where I was in no danger of forgetting one simple message: a fever during chemotherapy is life-threatening.
So why is a fever concerning to a cancer patient?
When a normal individual has an infection, the immune system fights the infection, setting the body on fire. Symptoms appear because of this internal battle. Patients with pneumonia would cough nasty phlegm. Someone with a skin infection would have red, hot, swollen, painful skin. These clues are very useful to doctors to help find and eliminate the infection.
In someone without an immune system, there is no internal battle, and so symptoms are minimized or even absent. Bacteria covertly takes over, with no resistance in its way, until either enough damage has been silently done to kill someone, or antibiotics are started and the infection is treated. The only alarm triggered is a fever. The patient otherwise feels just fine initially.
The night of hot sweats and panic
A week into my first chemotherapy session, something didn’t seem right. I was more tired than usual, and felt feverish.
At 7 PM, I check my temperature: 37.6 degrees. Higher than the normal body temperature which is supposed to be around 37.0. I tell myself that I’m just tired.
At 7:30 PM, I’m still feeling hot. My temperature reads 37.8. Trending up, but not at 38 yet.
8 PM strikes. Temperature 38.0. I am in denial, but am starting to feel concerned. I get Stephanie to test out the thermometre on herself, hoping that it is defective. She gets a cool 36.5. While I try to calm down, Stephanie packs my escape bag: enough clothes, snacks, and toiletries to last for a potential 5-day hospital stay.
8:20 PM: Temperature 37.8. My escape bag is ready, the car is ready, the dog has been walked, but we’re staying put. Still hoping to avoid going to the hospital.
8:40 PM: Temperature 37.7. Maybe the tide is turning.
9:00 PM: Temperature 38.0. Stephanie insists we go to the hospital, but I stubbornly tell her that it’s not yet higher than 38.0.
At that moment, I wasn’t thinking that I was putting my life in danger because of my stubbornness. I was thinking about the 5-day disruption that will probably follow if I get admitted.
9:15 PM: Temperature 37.8. Some breathing room.
….And this goes on until midnight, with my temperature grazing, but never exceeding, that 38.0 mark. At this point, I decide to go to bed, setting a timer to wake up every 30 mins to check my temperature. By 5 AM, the temperature trended down to 36.5, and I managed to sleep soundly afterwards.
My panic facing a fever can be explained as follows:
- In the best-case scenario, I get admitted for 3 to 5 days, no infection is found, and my fever goes away.
- In the worst-case scenario, I die of infection.
While I managed to dodge the bullet this time, there is a good chance that I will be faced with a real fever during my 4 months of chemotherapy. If I do cross that bridge, I simply need to accept that as annoying as it is to go to the hospital in the middle of the night, it needs to be done without hesitation. I must remember that this is part of what I signed up for when agreeing to receive chemotherapy. The risks of staying home are far too high.
I still struggle to distinguish apart things that I can and cannot control. My battle with the thermometer, by checking my temperature every 15 minutes, was an example of trying to exert control over something uncontrollable, secretly hoping that the fever wouldn’t appear. I had no control over my temperature, but did have control over how I respond to a fever. I’m hoping that over time it will be easier for me to accept that I cannot control everything. The sooner I find acceptance, the less I will struggle.