Day 2 of the NIH Campath trial started at 5:30 am, when the mobile phlebotomist brought by his cart and left with thirteen tubes of my limited blood supply.
The early start wasn't too big a shock to the system, since I was already awake -- and had been all night, as a result of a last-minute roomy change that left me with an elderly "sundowner," who kept his television on all night and kept the nurses hopping with constant calls for more meds. That's one of the liabilities of the "semi-private room concept: there's no "semi" about the lack of privacy, not to mention the lack of dark and noise. It's tough for a country boy to sleep in the "urban" environment of a hospital ward.
Ultimately, I plugged in my iPhone earbuds and hit shuffle for my extensive Van Morrison collection. That drowned out the TV, and I got about four hours of restless sleep.
[I should say that I include this only in the interest of completeness and full disclosure, for the benefit of other folks who might be considering this or other trials, not as whining (or whinging). A man rescued from a shipwreck should not complain about the freshness of the beef on the schooner that plucked him from the briny deep.]
I had an ambitious night nurse determined to get my PICC line placed early, instead of mid-morning, as scheduled. So it was over to the procedures area, which is run with a great deal of energy by a mustachioed charge nurse named "Mash." [Think Robin Williams as Adrian Cronauer in "Good Morning, Vietnam" and you'll have a good picture of the atmosphere.] After I refused Mash's demand for a five dollar tip for slipping me in early, he set me up with Elmer, the nurse who would be inserting my PICC line.
Elmer was very thorough in describing the procedure -- and in warning me that he tended to hum and sing under his breath while he worked. I was treated to a medley of Filipino folks songs and a rousing hummed version of "Love is a Many Splendored Thing."
Though the PICC Line insertion is typically a 20-minute job, mine took 90 minutes, because the catheter, or my circulatory system, was stubborn. Elmer used ultrasound to find the right vein on the inside of my upper arm, marked it, and measured the length over to my heart using a paper tape. After gowning up and numbing me with a little lidocaine, he started the insertion. All went very smoothly and we were about to do the chest X-ray to verify placement, when he decided to check the jugular vein in my neck with the ultrsound. Sure enough, the catheter had taken a wrong turn and would up in my neck.
So, we pulled it out a ways, bent my head over, and tried again. After a couple of false starts, we found the vein that leads to my heart. Unfortunately, Elmer met with resistance three centimeters short of his target length for the catheter. Chest Xray confirmed we were short -- and showed that the tip of the catheter had acquired a little upwards bend. Another problem seemed to be that the vein in my arm had grown angry at all of the attention and showed its pique by spasming. Or, as Elmer said, "Your vein is biting me."
After consultations with colleagues, we pulled the catheter back five centimeters and flushed it several times to straighten out the kink. Though we were still three centimeters short of the target measurement, another Xray showed an acceptable placement. We got some gauze, tape, and a transparent plastic bandage over the entire thing, as well as a wrap of that cool slightly sticky Ace bandage-like wrap they use here. That dressing is changed the next day, and then again a week later. A thick plastic barrier is placed over it for showering. (I think I should have shaved the hair from my arms before coming here! It would have been less painful.)
IMG_0479 by
hankins.greg, on Flickr
I have a two-port PICC, one for the meds and one for extracting blood, which the nurses can do with a very strange-looking plastic contraption.
Among other pre-Campath events, we detached my 24-hour Holter monitor and its leads (maybe I should have shaved my chest as well). And, because I had recently had what I took to be a kidney stone attack, we went down to radiology for a kidney ultrsound, which found no stone. We are going to let that mystery be until I return home.
I also had my first 500 mg Valtrex tablet in the morning. That's the anti-viral that I will be taking for many months to ward off infections.
In the late afternoon the nurse hooked me up a bag of saline and the Campath. The latter bears warning labels about being a dangerous drug, and the nurse has to gown up before messing with it.
After a little saline appetizer, the 1 mg test dose of Campath was started and administered over a one-hour time period. Even though this is a "test" dose, and far less than the 10 mg dose I will get for the next ten days, Dr. Olnes, the PI, told me the test dose kills off about 90 percent of the CD4 and CD8 T cells.
Right at the end of the test dose, I began to get the chills and shakes (rigors). Warm blankets were piled on and demerol was offered. The demerol is strictly to control the rigors. I hate taking narcotics unless absolutely necessary, so I asked to wait a bit. The nurse and I agreed we'd give it 30 minutes and then re-evaluate. About five minutes before my grace period expired, the shakes stopped.
I was utterly exhausted, from lack of sleep and the rigors, so I dozed off. Three or four hours later, the nurse, on a routine check, found I had a temp of 38.6C [101.5F]. This, she indicated, is to be expected with Campath. We lowered the room temp a bit (it had been raised during my chills) and took a couple of 325 mg Acetaminophen. I dozed off again, but another routine check in a couple of hours found my temp back to normal.
And that was that. I slept all night like a baby. No hangover the next morning from Campath or the Demerol I didn't take.