Sunday, March 7, 2010

Hot Stuff

Well my bad day on Wednesday spiraled even further down. I guess my tears weren't for nought. I really was feeling awful evidenced by the 100.6 temp that registered on my thermometer late that afternoon. I took my temp at 2pm and it was 100 then every half hour after that it kept increasing until I hit the "scary" point of 100.5. When I surpassed that I knew I had to call the Cancer Center, though I dreaded it knowing what they would tell me. As I suspected they told me to immediately head to the Emergency Room. Do not pass GO. Do not collect $200.

I stayed calm and packed a bag of random clothes and random books, magazines and gadgets to keep me busy as I had no idea if I would be admitted and if so, how long I might be kept there. Craig packed me a snack bag and we were on our way, dodging through traffic down 91 at the peak of rush hour.

The on-call oncologist had called ahead to the ER for me so when I arrived it was from triage right to a room - one of only two private rooms in the ER. Being neutropenic was good for something I guess. I was a paranoid wreck knowing how many strange germs are floating around in an ER, nevermind the busiest one in New England. I wouldn't touch anything and was constantly Purelling myself. I was given a mask for anytime I had to leave the room and once they finally put up the neutropenic precautions signs outside my door, nurses began wearing masks before entering my room.

Plain and simple, being in any ER is not a pleasant experience. The "bed" that was put in the room for me was a black mattressed stretcher that felt like a body board. The thin sheet that covered it wasn't long enough and kept sliding down so that my head would touch the exposed plastic. Craig was stuck on the equivalent of a folding chair. All of this would be fine if we were there for just a couple hours, which you would hope would be a normal ER stay. But 6, 8, .... 12 hours. Not so much. The one solace was the flat screen TV on the wall. A gift donated for each of the ER rooms at Hartford Hospital from a man who spent some time there as well. I can't even explain what a difference having that piece of comfort and I am forever grateful for his generosity.

I was seen very quickly by a resident who checked me over with lots of stethoscope listening, symptom questioning and physical examination. As I already knew, besides being feveral, I didn't have any other symptoms. I was only there because I had no immune system and running a temp meant that I was likely on the brink of some kind of infection. I was sent for a chest x-ray then had to pee in a cup - all normal results. Bloodwork was next.

The nurse wanted to stick me in the arm to draw my blood and run an IV so that they could start antibiotics if necessary, but I was persistent that they use my port. I have a port in my chest for a reason. I explained that my veins are full of scar tissue and recounted how many times I had to get stuck last time I had surgery before they could find a viable vein. Well, she didn't know how to access a port and said how long it usually takes to find someone who can. I did not care and told her that she needed to find someone who knew how to do it. Especially if I was going to be admitted, I did not want to have to sleep with a needle in my arm and I didn't want to have to get stuck again when someone could access my port. My relationship with the nurse from that point on was rigid at best. It didn't get any better when she sprayed saline all over me trying to set up the IV fluid pump. She must have been having a bad night.

So we waited. Not too long after, another nurse came in who was an expert in port access and - what are the chances - graduated high school with Craig. They remembered each other immediately. She was one of those girls who was an EMT since forever ago and Craig said that he certainly wasn't surprised to see here working in the ER. That made me feel comfortable and she accessed my port with ease ... though more tape than I've ever seen used. My skin is still red and irritated from it days later. Ah, well. You take what you can get.

At the same time this was happening, another woman came to draw my blood. They both came at me at once as one of the cultures can't be pulled from my port. This means I had to get stuck twice anyway. As I laid there I had this one lab technician on my left pulling tubes full of blood from a needle she stuck in my arm while the other nurse stood over me on my right side and pulled a turkey baster-sized tube of blood from my port. For some reason she held this turkey baster clearly in my line of vision. No matter which way I looked blood was coming out of me and my left arm ached and pulsed from how tightly wound the lab tech had tied the turnicat.

"Oh, my back," the tech groaned as she reached for her chair to hold up her huge, bulging body pulling my blood-filled tubing taunt.

"Ohhhh, my back is killing, phew" she moaned again. I was so disgusted with her lack of tact that if my arms weren't occupied I may have punched her in the face.

Craig noted my anxiety and deep, loud breaths and stood at my feet and squeezed them. These are the situations where inner strength kicks in. And these are the situations that I think back on later and realize if I got through that I can get through anything. I don't know how I didn't pass out. Finally, the vampires left with their viles.

More hours passed. Another doctor came in and told me that he spoke to the oncologist on-call and that the plan was to hold off on the IV antibiotics until it was decided whether I will be admitted. This would be decided by the results of my lab work. They would look at my granulocytes, a type of white blood cell. Because my overall WBC count was so low, the phlebologists would have to do a manual smear, meaning they would have to count the cells by eye as no machine would be able to detect them. If my count was more than 500 I could go home and follow up with Dr. Dailey in the morning. If they were under, I would be admitted.

So, we waited some more ... got to watch The Office baby episode and roll right into late-night TV. Somehow Craig was able to fall asleep in his rigid chair with his head sharing half the pillow from under my head. It was close to midnight when they came back with the verdict: a count of 143 granulocytes - not even close. Damn it. Knowing that he wouldn't have to take me home Craig left so at least one of us could get a good night's sleep.

So it was me alone in my little ER room until my new nurse, Jim, came in and things were a million times better. He was so nice, so attentive and so friendly. I immediately lit up and knew that the rest of the night would be so much improved. He hooked me up with the super strong IV antibiotics that would flow through my port throughout the night. He brought me three styrofoam cups of water and finally the Tylenol that I had been aching for for my pounding headache. We talked about his daughter, West Hartford, snowboarding and he kept checking in on me throughout the night, yes, the night. It wasn't until 6:30 a.m. that a bed opened up on the oncology unit and Jim himself brought me up there. I think he was just as excited for me as I was to be out of there and away from the germs and noise.

Trying to sleep in the ER was an impossible feat as every few minutes you hear calls over the loud speaker like "active trauma five minutes out", "environmental needed in red pod for mop up," "active stroke rolling in," "EKG needed stat" ... etc. People are at the brink of death and the ER staff is frantically busy saving their lives. It's not a place for a cancer patient with a high fever. I can't imagine how those doctors and nurses do what they do. I found out later that the ER was so packed that night that there were 47 people on stretchers waiting for beds - every inch of the place was taken up. It's no wonder with so many people using the ER as their place of primary care, especially in a city as poor as Hartford. And they say we don't need health care reform? I digress ... .

The welcoming wagon was there when I was brought up to the fifth floor. The nurses and PCAs recognized me right away and many said they weren't surprised to see me back there knowing what high doses of chemo I received. I was put in the same room I was in during my stay the week before and there was a lot of comfort in that. I asked for a breakfast tray which came right away and after they took my vitals I reclined my bed flat and fell right asleep.

Dr. Dailey came by to check on me and he decided it best to keep me one more night to receive some more strong antibiotics to kick whatever might be brewing. So my mom came to spend some time, we played Scrabble Slam then I slept through most of her visit (at her insistence). A co-worker came with a smile and some great magazines. Craig came that evening and we hung out, took some masked walks around the floor, Skyped with my brother and sister-in-law, and he stayed until I fell asleep for the night (at my insistence). Though much deeper than in the ER, a full sleep is still hard to come by in a hospital. I had to be woken every few hours for a vitals check and because my blood pressure was very low they kept increasing my fluid drip meaning nature calls were another cause of frequent wake ups.

All-in-all I felt much better on Saturday morning and I was so, so eager to be released home, but I knew that it was all conditional on my white blood cell levels. I showered wearing my socks because I forgot flip-flops - hell no was a stepping in the communal shower barefooted - I know a thin layer of cotton probably didn't offer any protection, but it was a mental thing. I wolfed down my breakfast - quite delicious cinnamon French toast, and kept my ear to the nursing station for Dr. Dailey's arrival. Finally it came and he asked:

"So, are you excited to go home?"

"Yes ..... ," I replied with a goofy smile.

"Well, you can. Your counts are up to 7.5," he said. This is normal range meaning no more neutropenia, no more masks. My heart lifted.

Since my release it's been sunny and nearly 50 degrees every day and I've been relishing every minute of it - seeing friends, hiking, working out outside, running, reading on my lounge chair in the sun. Fantastic.

I really feel great. Such a huge turnaround from last Wednesday it's unbelievable to me. Besides the rash of red raised dots I've developed all over my hands, arms, and legs as a reaction either to one of the drugs or to my WBCs increasing so quickly, and the bloody tissue I keep blowing out, you might actually mistake me for a healthy person. And I'll continue to relish these feelings until I go back in for Round 2 next Monday. I have one week to get myself psyched up for it and that is my sole life mission at the moment.

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