Working Through Chemotherapy When My Body Wanted to Sleep

Flexible Hours, Metallic-Tasting Food, Chemo Brain, and the Fear of Returning for My Second Treatment

Chemotherapy did not affect me the same way every day.

For the first couple of days after treatment, the steroids and other pretreatment medicines seemed to keep me going. I had more energy than I expected, and I could almost convince myself that chemotherapy might not be as difficult as I had feared.

Then the extra energy disappeared.

The fatigue arrived.

My body became heavy, my mind became foggy, and all I wanted to do was sleep.

I was also still working.

Chemotherapy Affects Every Person Differently

Two patients can receive the same chemotherapy drug and have very different experiences.

One person may have severe nausea.

Another may struggle more with exhaustion.

One patient may develop mouth sores, nerve pain, constipation, or diarrhea.

Another may experience several side effects at once.

The effects may also change during each chemotherapy cycle. A patient can feel reasonably well for the first day or two and then become much more tired after the medicines used before treatment wear off.

Chemotherapy side effects depend on the medicines, doses, schedule, other health conditions, and the individual patient. Common effects may include fatigue, nausea, appetite changes, taste changes, low blood counts, infections, mouth problems, and changes in memory or concentration.

My experience followed its own pattern.

The Steroids Helped Before the Crash

The first couple of days after chemotherapy were often affected by the steroids I received as part of the treatment plan.

Steroids are sometimes used before or after chemotherapy to help reduce nausea, allergic or infusion reactions, swelling, or other treatment effects. They can also cause temporary energy, wakefulness, increased appetite, restlessness, or sleep problems.

When that temporary boost wore off, the change could feel dramatic.

I went from feeling as though I might manage the week fairly well to feeling overwhelmingly tired.

It was not ordinary tiredness.

It was the kind of exhaustion that made staying awake feel like work.

Cancer Fatigue Is More Than Needing a Good Night's Sleep

Before cancer, being tired usually meant I had stayed up too late, worked too many hours, or needed a quiet weekend.

Chemotherapy fatigue was different.

Sleep did not always make it disappear.

The National Cancer Institute describes cancer-related fatigue as extreme physical, emotional, or mental tiredness that may not improve completely with rest. It can be caused by cancer, treatment, anemia, poor nutrition, sleep problems, pain, emotional distress, medications, or several factors together.

In my case, there were many possible contributors.

I had undergone two surgeries.

I had experienced serious anemia and required a blood transfusion.

I was receiving chemotherapy.

I was trying to eat enough despite nausea and taste changes.

I was also continuing to work.

I Returned to Work Soon After the Second Surgery

I had taken time off for the major abdominal surgery.

After the second operation on my back, I returned to work within a few days.

That would not have been possible if I had needed to commute to an office.

Because of COVID, I was teleworking.

My office was inside my home, and I could move between my desk, couch, kitchen, and recovery area without getting dressed for work, driving, parking, or walking through a large building.

Telework did not remove the effects of cancer treatment.

It made it possible for me to work around them.

My Boss Gave Me Flexibility

My boss told me that the important thing was completing my required hours and getting my work done.

He trusted me.

That trust allowed me to adjust my workday around what my body could manage.

Some days I worked four hours, slept for two hours, and returned to work for another four.

Other times I worked part of the day and made up hours later.

If necessary, I could work a few hours over the weekend.

When the side effects were extremely bad, I did not work.

I was grateful that my supervisor focused on the work rather than demanding that every hour fit into one rigid block.

Flexible Work Helped Me Keep My Income

I was a single parent.

I needed my paycheck.

Cancer had already created expenses I had never planned for, and I did not have an unlimited amount of vacation or sick leave.

Most people do not save their leave expecting to develop cancer.

Vacation time may have been used for family needs, illness, appointments, or ordinary life before the diagnosis ever arrived.

Then cancer suddenly requires:

• Specialist appointments

• Tests

• Port placement

• Surgery

• Follow-up visits

• Chemotherapy

• Recovery days

• Emergency care

• Blood transfusions

• Future scans

Even a person who has responsibly saved leave may use it quickly.

I Wanted to Be Worthy of My Boss's Trust

My boss was willing to work with me.

I wanted to honor that trust.

I made sure my customers were supported and my assignments were completed.

Our customers operated twenty-four hours a day, so the team normally tried to provide broader coverage than a standard eight-hour shift.

That type of work gave me some ability to move my hours.

I worked hard to keep everything going because I knew many cancer patients did not have the option to continue working.

Some jobs cannot be completed from a couch or home office.

A surgeon, factory worker, cashier, nurse, driver, food-service employee, construction worker, or warehouse employee may not be able to divide the workday around a nap.

I understood that my flexibility was a blessing.

Workplace Flexibility Can Be a Meaningful Accommodation

Depending on the job and circumstances, workplace adjustments for an employee with cancer may include:

• Telework

• Flexible start and stop times

• Rest breaks

• A reduced schedule

• Time off for treatment

• Temporary reassignment of certain duties

• Changes to physically demanding tasks

• A quieter work area

• Permission to work additional hours at another time

• Intermittent medical leave

Under the Americans with Disabilities Act, an eligible worker with a disability may request reasonable accommodations that help the person perform essential job duties, unless the accommodation would create an undue hardship for the employer. Eligible workers may also be able to use FMLA leave in separate blocks or on a reduced schedule when medically necessary.

The exact protections depend on the worker, employer, job, medical condition, and applicable laws.

Not Every Patient Should Keep Working

Working helped me financially and mentally.

That does not mean every cancer patient should continue working through chemotherapy.

Some patients are too ill.

Some treatments suppress blood counts severely.

Some people experience dangerous infections, uncontrolled nausea, weakness, confusion, pain, or other problems.

Some jobs are physically unsafe during treatment.

The right decision may be:

• Full leave

• Reduced hours

• Intermittent leave

• Temporary telework

• Disability leave

• A gradual return

• Continuing the normal schedule

A patient's ability to work is not proof of how strong she is.

Needing leave is not weakness.

My Brain Did Not Always Work Normally

I experienced some brain fog during chemotherapy.

I could become mentally slow, tired, or less focused.

People often call these changes "chemo brain," although cognitive problems during cancer can have many possible causes besides chemotherapy.

The American Cancer Society explains that people with cancer may experience difficulties with memory, attention, concentration, processing information, or finding words. These problems may be related to treatment, cancer itself, anemia, fatigue, sleep loss, stress, depression, anxiety, medications, or other medical issues.

My experience was not as severe as what some patients describe.

I could still perform my work.

I had to work around the fatigue and occasional mental fog.

Did Working Protect Me From Severe Chemo Brain?

Part of me believes that continuing to work may have helped keep my mind active.

I had to solve problems, communicate with customers, remember tasks, and complete assignments.

I was not able to sleep the entire day because I had responsibilities.

That may have helped me maintain routine and mental engagement.

However, I cannot say that working prevented serious cognitive problems.

Research does not support a guarantee that continuing to work will prevent chemo brain.

Staying mentally and physically active may be helpful for some people, but cognitive changes are complex and may occur even in active patients.

My experience was personal.

Another patient may work throughout treatment and still experience severe cognitive problems.

Rest Was Still Necessary

Continuing to work did not mean forcing myself to stay awake without limits.

When my body needed a two-hour nap, I took one.

When I could not function safely, I stopped working.

The flexible arrangement allowed me to balance activity with recovery.

The goal was not to prove that cancer could not slow me down.

It was to keep my income and responsibilities going without completely ignoring what my body was telling me.

I Lived According to My Bloodwork

Every time I went to the cancer center, the medical team checked my blood.

Because of my earlier anemia, iron-related levels remained important.

The team also needed to evaluate whether my blood cells and organs were strong enough for the next chemotherapy treatment.

I began thinking of myself as living for my laboratory results.

When something moved toward the low side, I wanted to know what I could safely do.

I continued eating a high-protein and high-iron diet because my body was healing from surgery and undergoing chemotherapy.

I knew food could not control every number.

I wanted to provide the nutrients my body needed whenever possible.

Then Everything Began Tasting Like Metal

Eating became difficult because chemotherapy changed the taste of food.

Many foods tasted metallic.

Others had little flavor.

Something I had enjoyed before treatment might suddenly taste unpleasant.

Chemotherapy may cause an unpleasant chemical or metallic taste, and changes in taste and smell can reduce appetite and make it harder to eat enough for healing.

Food was no longer about enjoyment.

It became another treatment responsibility.

I Ate Even When I Did Not Want Food

I was often tired, nauseated, and uninterested in eating.

Nothing tasted good.

I ate anyway.

My thinking was simple:

My body had been cut open twice.

It was being given powerful medicine.

It was trying to rebuild blood, heal wounds, maintain muscle, and fight cancer.

If I did not give it nutrients, how could I expect it to recover?

I decided that even if I became sick afterward, I would continue trying to eat.

I would not recommend that someone repeatedly force large meals during uncontrolled vomiting. Persistent vomiting can cause dehydration and requires medical attention. Antinausea medicines and nutrition guidance should be discussed with the oncology team.

My determination to eat needed to work alongside medical treatment, not replace it.

I Ate for Nutrition Rather Than Taste

When flavor failed, I used texture.

Nuts gave me something crunchy.

Soup gave me warmth.

Broth gave me something I could sip.

I could boil bones and vegetables to make an old-fashioned broth.

I could add protein when tolerated.

I looked for foods that gave my body something useful even when my mouth gave me no pleasure in return.

The National Cancer Institute recommends experimenting with different foods, temperatures, seasonings, textures, and utensils when treatment changes taste. Cold or room-temperature foods may be easier for some people, and plastic utensils may reduce a metallic taste for certain patients.

My Food Plan Was Built Around Healing

I continued focusing on:

• Protein

• Iron-rich foods

• Vegetables

• Planned fruit

• Broths and soups

• Nuts

• Foods with tolerable textures

• Fluids

• Small meals and snacks

Some days, eating a full plate was unrealistic.

A few bites were better than nothing.

A snack could be easier than a meal.

A drink could be easier than chewing.

Cancer nutrition often requires flexibility rather than following one perfect plan.

My Doctor Said I Was Her Healthiest Chemotherapy Patient

During treatment, my cancer doctor told me that I was one of the healthiest-looking chemotherapy patients she had seen.

That did not match how I felt inside.

I felt terrible.

I was tired, nauseated, miserable, and forcing myself to eat food that often tasted wrong.

Looking healthy did not mean treatment was easy.

It meant that my efforts to maintain nutrition, work, movement, and routine were showing on the outside, even while I was struggling privately.

I was proud of that.

I also knew not every patient could do what I was doing.

Looking Well Can Hide How Sick Someone Feels

A cancer patient may look better than people expect.

She may wear makeup.

She may put on earrings.

She may wear an attractive hat.

She may smile during a video call.

She may continue working.

None of that proves she feels well.

Invisible symptoms may include:

• Exhaustion

• Nausea

• Pain

• Fear

• Cognitive fog

• Insomnia

• Taste changes

• Weakness

• Depression

• Anxiety

Do not assume a person is fine because she looks healthy.

The Second Treatment Brought Back the Fear

My first chemotherapy appointment included a frightening reaction to a pretreatment medicine.

I suddenly could not breathe.

The counselor alerted the nurses.

The oncology pharmacist arrived.

The medicine was stopped, and emergency treatment helped me breathe again.

When I returned for the second chemotherapy treatment, my body remembered.

I was in panic mode.

I Was Afraid It Would Happen Again

As the nurses accessed my port and prepared the medicines, I watched everything.

I waited for my breathing to change.

I wondered:

"What if I stop breathing again?"

"What if no one notices quickly enough?"

"What if the replacement medicine causes another reaction?"

The fear was not irrational.

It was connected to something that had actually happened.

A frightening medical event can create fear before later appointments, procedures, medications, or hospital visits. The sights, smells, equipment, or sounds of the treatment center may remind the patient of the earlier emergency.

I described it as feeling like post-traumatic stress.

Whether it met the formal medical definition of PTSD would require professional assessment, but the panic and fear were real.

Medical Trauma Can Follow the Patient Back Into the Treatment Room

A patient may experience intense fear after:

• Difficulty breathing

• A severe infusion reaction

• Emergency surgery

• Intensive care

• A painful biopsy

• A frightening scan

• Unexpected bleeding

• A blood clot

• A serious infection

Returning to the place where it happened may trigger:

• Racing thoughts

• Sweating

• Shaking

• Rapid heartbeat

• Trouble breathing

• Crying

• An urge to leave

• Constant watching for symptoms

Patients should tell the care team about this fear.

The team may be able to explain the changed medication plan, monitor more closely, adjust the environment, involve a counselor, or offer other appropriate support.

I Watched the Second Infusion Closely

The second time, I knew more about the process.

I knew which part of the day frightened me most.

I knew the team had changed the pretreatment plan.

Still, knowing did not remove the anxiety.

I waited while the medicine entered my body.

I paid attention to every breath.

I looked for tightness, wheezing, or the feeling that something was wrong.

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I made it through.

Then I Made It Through the Rest of Chemotherapy

The second treatment did not repeat the first emergency.

I continued with the remaining chemotherapy cycles.

That did not make the process easy.

There were still hard days, fatigue, brain fog, nausea, taste changes, blood tests, and fear.

But I completed the treatment.

Each successful infusion helped rebuild a little of the trust that the first reaction had taken away.

What I Wish Someone Had Told Me

I wish someone had explained that steroids might make the first days feel easier before the fatigue arrived.

I wish I had known that chemotherapy exhaustion could require dividing my workday around naps.

I wish more employees knew that flexible schedules and intermittent leave may sometimes be available.

I wish people understood that working through chemotherapy does not mean a patient feels well.

I wish someone had warned me that food could taste like metal.

I wish every patient had access to a cancer dietitian before eating became difficult.

I wish someone had prepared me for the fear of returning after an infusion reaction.

Most of all, I wish someone had told me that adapting was not the same as pretending everything was normal.

Questions to Ask About Working During Chemotherapy

Ask your medical team:

• Is it medically safe for me to work?

• When are my side effects likely to be worst?

• When might my blood counts be lowest?

• Are there activities or exposures I should avoid?

• Can you provide medical documentation for accommodations?

• Should I reduce my hours?

• Should I avoid driving or operating equipment?

• What symptoms mean I should stop working?

Ask your employer or benefits office:

• Is telework available?

• Can my schedule be flexible?

• May I work split shifts?

• Can I take intermittent FMLA leave?

• Can I temporarily reduce my schedule?

• How will leave affect pay and insurance?

• Do I have short-term disability coverage?

• Is donated leave available?

• What paperwork is required?

• Who will have access to my medical information?

Tips for Managing Brain Fog

Patients may find it helpful to:

• Keep one calendar

• Write down appointments

• Use alarms and reminders

• Complete difficult tasks when energy is highest

• Work on one task at a time

• Reduce distractions

• Take short breaks

• Keep frequently used items in one place

• Ask for written instructions

• Tell the medical team when cognitive changes interfere with safety or daily life

Problems involving memory, thinking, or concentration should be reported because anemia, infection, medication effects, sleep problems, depression, or other treatable issues may contribute.

Tips for Eating With a Metallic Taste

Discuss these possibilities with the oncology team or dietitian:

• Try plastic utensils instead of metal ones.

• Serve foods cold or at room temperature.

• Experiment with tart flavors when medically appropriate.

• Use marinades, herbs, or mild seasonings.

• Try different protein sources if meat tastes unpleasant.

• Use soups, smoothies, yogurt, eggs, beans, or nut butters.

• Rinse the mouth before eating.

• Keep the mouth clean according to the oncology team's instructions.

• Eat small meals more often.

• Use texture when flavor is unappealing.

• Avoid favorite foods on the worst nausea days so they do not become permanent aversions.

Report difficulty eating, ongoing vomiting, dehydration, mouth sores, swallowing problems, or unintended weight loss.

Questions After a Previous Infusion Reaction

Before the next treatment, ask:

• Which medicine caused or may have caused the reaction?

• Is it listed in my record?

• What has been changed for the next infusion?

• Will different pretreatment be used?

• Will the medicine run more slowly?

• Will I be monitored more closely?

• What emergency treatment will be available?

• Can a counselor or support person remain nearby?

• Which symptoms should I report immediately?

• Should I carry information about the reaction?

Knowing the plan may not remove fear, but it can reduce some uncertainty.

Hope for Today

Chemotherapy forced me to organize my life around cycles.

For a couple of days, the steroids helped me function.

Then the fatigue arrived.

I worked for a few hours.

I slept.

I woke up and worked again.

I ate food that tasted like metal.

I used texture when taste failed.

I watched my bloodwork.

I kept trying to give my body what it needed.

Then I returned to the infusion center carrying the memory of not being able to breathe.

I was afraid.

I went anyway.

Working did not make me stronger than patients who needed full leave.

Eating did not guarantee good bloodwork.

Staying mentally active did not prove I had prevented chemo brain.

Those were simply the tools available to me.

I used them because I was a single parent, because I needed my income, and because I wanted to give my body every possible chance.

I felt terrible.

I kept going.

And eventually, I completed chemotherapy.

Frequently Asked Questions

Why do some people feel more energetic immediately after chemotherapy?

Steroids and other pretreatment medicines may temporarily increase energy or cause wakefulness. Fatigue may become stronger after those effects wear off.

Is chemotherapy fatigue relieved by sleep?

Not always. Cancer-related fatigue may continue despite rest and can have several causes, including treatment, anemia, poor nutrition, pain, emotional distress, and sleep disruption.

Can someone work during chemotherapy?

Some people can continue working full time or part time, while others cannot. The decision depends on treatment effects, job duties, health, finances, workplace flexibility, and medical advice.

Can a worker take intermittent FMLA leave for chemotherapy?

Eligible workers may be able to take FMLA leave in separate blocks or on a reduced schedule when medically necessary. Requirements apply.

Does working prevent chemo brain?

There is no guarantee that working or mental activity will prevent cognitive changes. Activity and routine may help some people function, but chemo brain has many possible causes.

Why does food taste metallic during chemotherapy?

Chemotherapy can affect taste receptors, saliva, the mouth, and smell, producing chemical or metallic tastes.

Should a patient force herself to eat during nausea?

Patients need nutrition, but uncontrolled nausea or vomiting should be treated medically. Small meals, snacks, liquids, and prescribed antinausea medicine may help. Contact the care team when eating or drinking becomes difficult.

Is fear before another infusion normal after a reaction?

A previous breathing emergency or infusion reaction can understandably create strong anxiety. Tell the treatment team so additional explanation, monitoring, counseling, or other support can be considered.

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References

• National Cancer Institute. "Nutrition During Cancer Treatment."https://www.cancer.gov/about-cancer/treatment/side-effects/nutrition

• National Cancer Institute. "Mouth and Throat Problems and Cancer Treatment."https://www.cancer.gov/about-cancer/treatment/side-effects/mouth-throat

• National Cancer Institute. "Nausea and Vomiting and Cancer Treatment."https://www.cancer.gov/about-cancer/treatment/side-effects/nausea-vomiting

• National Cancer Institute. "Weight Changes and Cancer."https://www.cancer.gov/about-cancer/treatment/side-effects/appetite-loss

• National Cancer Institute. "Eating Hints: Before, During, and After Cancer Treatment."https://www.cancer.gov/publications/patient-education/eating-hints

• National Cancer Institute. "Oral Complications of Cancer Therapies."https://www.cancer.gov/about-cancer/treatment/side-effects/mouth-throat/oral-complications-pdq

• American Cancer Society. "Chemotherapy Side Effects."https://www.cancer.org/cancer/managing-cancer/treatment-types/chemotherapy/chemotherapy-side-effects.html

• American Cancer Society. "Changes in Memory, Thinking, and Focus—Chemo Brain."https://www.cancer.org/cancer/managing-cancer/side-effects/changes-in-mood-or-thinking/chemo-brain.html

• American Cancer Society. "Taste and Smell Changes."https://www.cancer.org/cancer/managing-cancer/side-effects/eating-problems/taste-smell-changes.html

• American Cancer Society. "Eating Problems Caused by Cancer Treatments."https://www.cancer.org/cancer/supportive-care/nutrition-activity-with-cancer/common-problems.html

• American Cancer Society. "Infusion or Immune Reactions."https://www.cancer.org/cancer/managing-cancer/side-effects/infusion-immune-reactions.html

• U.S. Department of Labor. "Workplace Protections for Individuals Impacted by Cancer."https://www.dol.gov/agencies/whd/fmla/workplace-protections-for-individuals-cancer

• U.S. Department of Labor. "Fact Sheet #28F: Qualifying Reasons for Leave Under the Family and Medical Leave Act."https://www.dol.gov/agencies/whd/fact-sheets/28f-fmla-qualifying-reasons

• U.S. Department of Labor. "FMLA Frequently Asked Questions."https://www.dol.gov/agencies/whd/fmla/faq

• U.S. Department of Labor. "Employment Laws: Medical and Disability-Related Leave."https://www.dol.gov/agencies/odep/publications/fact-sheets/employment-laws-medical-and-disability-related-leave

About the Author:

Deborah Ann Martin is the founder of Surviving Life Lessons, a published author, poet, speaker, and trainer with over 20 years of management experience across multiple industries. An MBA graduate, U.S. veteran, single mother, and rare cancer survivor, Deborah brings both professional expertise and lived experience to her writing on resilience, leadership, personal growth, and overcoming adversity. Her mission is to empower others with practical wisdom and real-life insight to navigate life’s challenges with strength and purpose.