What I Wish I Knew Before Starting Doxorubicin (AKA the ‘Red Devil’)

The surprising thing that got me through my first chemo—and what the following days actually felt like

Back in 2022, Clea Shearer, co-founder of the Home Edit, shared on Instagram that she had been diagnosed with breast cancer. I was struck by her honesty and bravery in pulling back the curtain on her treatment.

This is hard to admit now but I remember thinking, “I’m glad that’s not me,” especially when she detailed her experience with doxorubicin, a particularly brutal chemo nicknamed the “Red Devil”—“red” for its cherry Kool-Aid color and “devil,” well, you can hazard a guess. The side effects can be excruciating, and they get progressively worse each session.

So when I received my own breast cancer diagnosis a little over a year later, I remembered her stories about the Red Devil, and I hoped I wouldn’t have to endure it too.

Cold water swimming with friends in the Mediterranean, because I really didn’t want to start this post with an image of a hospital room

But after my mastectomy, and the discovery that my cancer had spread to 8 out of 10 lymph nodes, and that my tumor was a whopping 16cm (I still struggle to comprehend that it was that big), I knew there was no way I wasn’t heading for chemo, and likely the Red Devil, too.

I was right.

Before cancer, I avoided even basic pain meds unless absolutely necessary. So the thought of slowly dripping poison into my veins filled me with panic. But I had no choice. Or rather, I did have a choice, but it was between choosing to live or die. When I framed it that way, the decision was easy.

The First Session

December 13, 2023. The day of my first chemo infusion. I had to be at the hospital early, so my husband and I dropped the kids off at a friend when it was still dark, at 7 a.m.

The hospital was in Marseille, about a half hour drive from where we live in Aix-en-Provence. I had carefully chosen my clothes the night before, putting comfort first, based on what I had read from others who had gone through this already. Gray sweatpants, a black cotton camisole, a knitted cardigan, thick socks (socks come up a lot in advice for cancer patients), and slip-on Birkenstocks.

Chemo makes you cold, I was told. I’d packed a bag with a blanket, a water bottle, some snacks (granola bars, an apple), and my Kindle. The infusion would take around four hours, which seemed like an impossibly long time. Maybe I would just sleep?

I remember feeling a sense of foreboding when we parked at the hospital. There were a handful of other women in the waiting room, all of them a lot older than I was, most of them with scarves wrapped around their heads. One wore a noticeable wig. In 15 days, that will be me, I thought. That’s when my hair would start to fall out, my oncologist had said.

I was led into a room full of what looked like La-Z-Boy chairs. Women (and a smattering of men) were seated in them, hooked up to drips. Again, I was struck by how much older everyone was compared to me. I remember feeling a wave of self-pity—I wasn’t meant to be here, why was here? I was too young for this.

The hospital had a good reputation, but it was hardly luxurious. The room was drab and worn. I noticed a small tear in the leather of my chair, the foam stuffing visible. My husband, who speaks French, conversed with the nurse, and I closed my eyes and leaned my head back, allowing the sounds to waft over me.

One breath in, one breath out…

When I had my mastectomy, the surgeon inserted a port in my chest on my left side. I had no idea what a port even was. Basically, it’s a tiny device under your skin that connects directly into a large central vein. It protects your smaller veins and makes treatment safer and easier.

I’m squeamish and I hated thinking there was this thing I could feel right under my skin. But I supposed it was better than being poked and prodded in my arm. I had placed a numbing patch over the port that morning, so when it came time for the nurse to insert the IV line, I felt no pain, only a slight pressure. I took that as a small win.

First, they would treat me with anti-nausea medication. That would take about an hour, and then it would be swapped out for chemo drugs. The room felt hot, the air stale. Why did everyone say I would be cold? I felt the opposite.

The hospital didn’t allow friends or family into the chemo ward, a holdover from Covid times, but we managed to convince them to allow my husband to accompany me for the beginning stages, what with it being my first time, and that I spoke only a little French back then. He sat in a chair next to me. We did some of the NY Times Spelling Bee. We looked at some funny TikTok videos. He kissed my forehead and reminded me that I was the general in this battle against the cancer, and the chemo was my army. It was on my side, fighting the good fight.

Red like cherry Kool-Aid

It’s what I needed to hold onto as I watched the nurse wheel over the IV, the bag fat with bright red liquid. Soon that entire bag would be traveling through my veins. The thought was enough to make me want to rip the needle from my chest and run out of that hospital room, leap down the stairs and out into the fresh air, far far away from there.

But I still had cancer in my chest wall, even after the mastectomy, and we were counting on the chemo to destroy it. I had no choice. I had to stay seated, and watch as the nurse attached the chemo bag to the IV.

I took a big breath in, looked at my husband, and said, “Here we go.” I watched as the red liquid slowly traveled down the tube, inching closer and closer until it reached my port and that first drop entered my body.

It had begun.

Read on for more, including…

• The serendipitous thing that got me through my first chemo session (Taylor Swift played a role…)

• What I did immediately following the session that became a habit throughout my treatment

• What Days 1–7 actually felt like

• What I ate to curb nausea

The Red Devil

Quick note: I was treated in France, where they use epirubicin—a close cousin of doxorubicin. It works the same way and causes similar side effects, so everything I describe here applies to anyone getting the “red devil,” doxorubicin or epirubicin.