You’ve been in the hospital too darned long. The hospital Johnny, for those of you who haven’t had the pleasure, is a dress-like garment that wraps around you, tying at the neck and roughly at the waist, famously leaving way too much of your skin or undergarments exposed.
Worse, it has snaps running up both sleeves. These allow easy access to, for example, the lumens of a Hickman catheter implanted in the chest. But it is maddeningly difficult to figure out how to snap those snaps in the proper order.
Well, after 53 days in hospital, I have it down cold — which means it is time to go.
Fortunately, my doctors think so, too.
I don’t have a copy of my most recent bone marrow biopsy pathology report, but I have the gist of it. My marrow is very scarred — very “fibrotic” — and the pathologist’s report from staining the marrow finds ten percent blasts, up from five percent last time. Again, that number needs to be taken with a bit of salt, because I have very few cells to speak of overall. Unfortunately, without the report in my hands, I can’t speak to exactly how hypo-cellular my marrow is.
In any case, based on those results, Dr. DeCastro and Dr. Horwitz put their heads together and decided the best course of action is to send me home for some R&R.
DeCastro sees that 53 days in the hospital has taken its toll on me, so he’s not ready to do more chemo.
Horwitz probably feels the same about transplanting someone with that much time in hospital, and may be skittish about transplanting someone with ten percent blasts.
So, if Horwitz is not going to transplant me, and DeCastro is not going to give me more chemo, what am I doing here?
There are really two key factors to getting me home:
Getting the nearly nightly fevers I have been having under control. DeCastro’s team has pretty well determined, through an abundance of blood cultures, chest X-rays, CT scans, and so on, that the fevers are caused by my disease, not by an infection. So, we need to stop them from happening, so that, if I am at home two hours away in Mt. Gilead, Marcy is not schlepping me to Durham every night with a fever. Tylenol alone didn’t make this happen, so they’ve added low dose prednisone.
Keeping the platelets above 10 for seven days. Under 10, platelets present a serious risk for a bleed. For instance, falling and hitting your head could cause a brain bleed. We are making real progress in this regard. I appear to be making platelets. I haven’t gotten to a seven day transfusion interval, but I have done six. Seems likely we’d want to do a mid-week check at the local cancer center anyway, just to be safe — so, six may be good enough.
All of this should be resolved this week, or the next. Keep your fingers crossed!