What to Expect When You’re Expecting the Worst

I cried during chemo class.

Chemo class is exactly what it sounds like—if your worst-case scenario were written like a school syllabus by Kafka and sponsored by Clorox. It’s a one-on-one orientation where they teach you how to survive the thing that might still kill you. There’s no diploma. Just a massive folder full of side effects, a walk-through of your future nausea, a warning about mouth sores, and a briefing on the type of diarrhea that should send you straight to the ER. They hand you your new rulebook for staying alive, and it reads more like appliance instructions for a body that’s about to malfunction.

My chemo class took place at the Teton Cancer Institute in Idaho Falls. I was met by a woman named Teresa—warm, no-nonsense, unshakeably grounded. The kind of person who doesn’t flinch when you cry, which I did. A lot. Teresa had long dark curls, light blue pants, and the calm energy of someone who’s walked more than a few people through hell and knows how to do it gently. She sat across from me with my scans in one hand and my future in the other. No fluff. No fake optimism. Just the facts, delivered like they mattered—because they did.

She showed me the tumor.

A few days before, I’d left my oncologist a voicemail that could only be described as lovingly feral. I told them, clearly and without apology, that I would not be moving forward with any treatment until someone showed me the scans. I wanted to see it. I needed to see it. I wasn’t going to let something ruin my body if I didn’t know what it looked like first. Plus with insurance not covering all of them, I felt it duly important for me to see the results of the scans that was considered “not medically necessary” even though my oncologist had ordered it—that I was now expected to pay for.

So there I sat, in that tan-and-beige room, staring at a black-and-white image of a 13.1 centimeter semiannular tumor curled up inside my rectum. That’s the length of a dollar bill. Or a birthday candle. Or a small curling iron. It’s considered “locally advanced,” which means it hasn’t packed its bags and spread to my liver or lungs just yet, but it’s invasive. It has entered the muscularis propria, a deep tissue layer that sounds vaguely like a failed Roman republic. It’s hugging my rectal wall like a parasite with attachment issues. And worst of all—it looks exactly like a turd.

This is what we’re dealing with. And the response? Full-time chemotherapy.

My treatment plan involves a drug called Fluorouracil, which I have rebranded (for emotional accuracy) as Fuck-You-Racil. I’ll receive it 24/7 through a port that will be surgically installed under the skin of my chest. That port will connect to a portable pump—basically a chemo purse I’ll wear around the clock. It goes with me to bed, to the grocery store, to therapy. It will pump medication into my body as I sleep, cry, shower, and try to convince myself this is survivable.

This isn’t just treatment. It’s my new full-time job. It doesn’t come with benefits, paid time off, or promotional opportunities. It only come with side effects. Fatigue. Nausea. Diarrhea and constipation, often in unpredictable succession. Hair loss that isn’t even merciful—my scalp might go bald while my chin hairs cling for dear life, pubs TBD. There are memory problems. Nerve pain. Bleeding risks. Skin rashes. Mouth sores. Fevers that can kill you. My welcome to chemo packet is 44 pages double sided and comes with an indexed glossary of terms at the end. Lucky me. And because I’m on Medicaid, the honor of surviving it all still comes with a hefty shopping list.

This is where the cancer registry comes in.

I’ve started building one because surviving cancer isn’t just a mental game—it’s logistical. It’s financial. It’s a thousand tiny medical purchases that no one warns you about being out-of-pocket expenses but are somehow essential. Like a medical-grade digital thermometer to check for neutropenic fevers every day. An electric razor because shaving is now a bleeding risk. Special lotion that won’t burn raw skin. Flushable wipes and cream for when diarrhea hits five times in one day and you’ve already cried twice in the bathroom. High-protein snacks for the days when my appetite is gone but I still need calories. I even had to budget for nausea bands and electrolyte tablets. Every item is survival, and every item costs.

And no, Medicaid doesn’t cover electric razors. Or dignity. Or backup underwear for when your colon decides to stage a protest in the cereal aisle.

I cried during chemo class because Teresa told me the truth. And because nobody really prepares you for what it means to live while dying. Not the soft-dying, not the existential-dying, but the hands-on, clinical, here’s-your-poison-and-your-port kind of dying. And no one tells you how to keep going while managing your own side effects like a project manager with a clipboard full of consequences.

This week, I’ll get my port installed. A small plastic disc under my skin that will become part of my daily silhouette. It will bruise. It will sting. It will remind me—visibly and unavoidably—that I am not the person I used to be. I’ll have to carry a card explaining what’s inside my chest. I’ll have to let it heal before I can raise my arms over my head. I’ll have to live with it like it’s always been there.

And then there’s The Hunter, my partner whom I just broke up with this week. Who I love. Who I know loves me. But who hasn’t quite been able to look this thing in the eye yet. His denial is gentle, but loud. It shows up in the way he changes the subject when I talk about my treatment. In the way he stares at me sometimes like he’s waiting for someone to come out and tell him this was all just a terrible misunderstanding.

It’s not. So I record my appointments. I recorded chemo class. Not to post it. Not for clicks. But so I can rewatch it myself when I forget everything that Teresa mentioned and so I can show it to The Hunter and say, “Watch this. Listen to Teresa explain what’s happening to me. Hear her voice. Look at the scans. This is real. This is me. This is what staying looks like.” Spoiler alert, I’m already staying, and stuck here in Idaho while I undergo treatments—more on that situation soon.

This isn’t a comeback story. There’s no triumphant music playing in the background. Just a woman in a chair, holding a rainbow folder, staring at a screen that shows her body isn’t hers anymore.

This is cancer. This is my job now. And this is me, clocking in. Early, on time, and a little late to the game.

A blog post by Rachel Smak on grief, loss, and lessons from stage 3C rectal cancer