Thoughts On + An Ode To: Vomit
Barf, emesis, heave, hork, hurl, puke, purge, ralph, regurgitate, spew, upchuck, vomit, vom, yartz, blow chunks, lose your lunch, pray to the porcelain god, throw up, toss your cookies. The list goes on.
I’ve become well acquainted with the feeling of nausea, defined as “an uneasiness of the stomach that often comes before vomiting,” as well as the action of vomiting, defined as “the forcible voluntary or involuntary emptying of stomach contents through the mouth.” It is a sensation I fear almost more than any other.
I’ve forced alcohol, despair, fear, food, nothing, pills, PTSD, and water out of my stomach. You feel utterly hijacked when it’s involuntary. What if you were hijacked not by alcohol, but by the very drugs you were taking to save your life? Sometimes it’s not anything you put there yourself, but the actual cells in your digestive tract. Chemo targets the rapidly dividing cells, and while those include cancer cells, it also includes hair follicles, skin cells, nails, blood cells in the bone marrow, in addition to cells of the gastrointestinal tract. This is why chemo patients also experience hair loss, lack in nail growth and poor skin quality. Mechanically, you understand that chemo targets cells that divide rapidly, logically it makes sense why the nausea occurs, but when you are no longer in control of your own body there is nothing but the illogical. It’s lying on the bathroom floor with a sweating brow and a freezing back. It’s knowing that something within you was so offensive to your body, that it rejected it with violent force.
Our body sends signals to communicate that we’re about to throw up. It’s a feeling, not in your bones, but in your flesh. One that you recognize instantly. That’s the power of the puke; it makes you recognize just how much of a passenger your consciousness is in your body. Throwing up is wanting your mom to call through the door and ask if you’re ok, but also not wanting any human to touch or talk or look at you ever again. It is a uniquely singular and independent action, like any pain. We tend to have more empathy for nausea though than we do for more direct types of pain. Because not only has literally everyone has experienced it, but nausea also has a physical action that validates it, proving your pain.
My vomit history is made up of three distinct periods: pre-21, post-21, and post-cancer.
My earliest memory of throwing up is around 1994, when I was in pre-K. I was randomly sick in daycare after school. I was so embarrassed, but I was able to swallow enough back down to ask a teacher to go to the bathroom. In 2000 during 5th grade, I experienced true #SocialSuicide. “She barfed in class,” was how my friend explained it as she accompanied me to the nurse. My reaction: Ouch, ok. Talk about a fucking knife to the heart Courtney. How dare you tell the school nurse so succinctly and plainly what just happened?!
Graduating to drinking age shifted the narrative of throwing up onto a guilt track. I’ve thrown up in more places around Los Angeles than I should be able to count.
But cancer was the sea change in my relationship of reacquainting myself with my stomach’s contents. Nausea (along with fatigue) is maybe one of the only universal cancer experiences; crossing ages, grades and stages, types and treatments. My first experience of cancer-related vomit was when I was still in the hospital. I’d just gotten through my first surgery and the nurse was preparing to do bloodwork. As I’ve learned since, I have very tiny, rolling veins and it takes an average of 3–5 sticks to actually connect. I was apparently not in the mood post brain surgery; so as the nurse approached I had a severe physiological response, which was to throw up everything in my system, including the red Jell-O I’d had earlier. It was a full on Exorcist #PeaSoup moment.
I luckily only experienced minor nausea around my treatment. That’s except for my second cycle when they essentially doubled my dose of Temozolomide (TMZ, Temodar). For a week I could not get out of bed from nausea so severe, I had to bring a bucket with me when I went to the bathroom. Other than that, my relationship to nausea was more anxiety based than anything else during treatment; my chemo was oral and I was terrified of possibly throwing up and losing not only my meds, but the couple of hundreds of dollars encased in that little pill.
The attention to and frequency with which you acquaint yourself with your body and all of its functions during cancer is profound. Before, throwing up was an occasion! One that you took note of- “Wow, I was really sick!” Now, it’s an event so provincial as to approach the likes of a sneeze. And if you wanna talk about a universal symptom, mention Zofran and cancer patients will pop up like goddamn meerkats, either looking for it or offering it up to a fellow cancer person.
Fun cancer fact: Anticipatory Nausea and Vomiting (ANV) is a vaguely unknown side-effect of cancer treatment. At present, it is understood to be a learned psychological response to chemotherapy that occurs in roughly 25% of cancer patients, especially women and people under 50. (Go figure.) While it is typically experienced by the fourth cycle and occurs before starting a new cycle, it is also known to occur long after treatment has been completed. I get it in the morning standing in line to get my coffee, I get it during the day at work, I get it when I’m getting down with a partner, I get it sitting on the couch by myself. It’s a rogue wave with a high, but short lived crest, that has left me unable to trust my body for any amount of time without the possibility of incident or escape.
But there are treasures to draw out of the proverbial trash that is cancer. The first night of our last AYA retreat, I slipped into the cabin after the evening’s events. My roommate was there resting, but after a few minutes she ran to the bathroom to get sick. I let her and her body have their private time, but after she came out I cautiously called across the room, “Amanda*, you ok? Can I get you anything?” She asked if I could grab the camp doctor and a staff member to help clean up and I booked it out of the cabin on my mission. Minutes later the camp doctor and program coordinator were there, along with the rest of our roommates. Everyone was at the ready to help. We offered up anti-nausea drugs, therapeutic techniques, humorous stories about our own barf; anything that might assist our fellow human.
I think about this constantly and I feel such a deep, coursing love for my cancer community. Had this been a different group of people of any sort, there would have been embarrassment or shame around a bodily function; stigma attached for the entire weekend. But there, in the cabins in Idyllwild, it catalyzed only empathy.
Dedicated to Amanda, who showed me the true meaning of empathy and love. Rest In Power.
*Name has been changed