Tuesday, August 30, 2011

August 30: Biopsies, Scary Nurses, and Schedule Updates

We had a very rapid morning, even though there was a lot of waiting.

Blood was drawn. My white blood cell count and my neutrophil count were both way down but still in the normal range. The doctor told me the numbers were really good, as my red blood cells are still returning. They, too, are almost to the normal range.

The pathologist gets the marrow right at bedside
So I asked him about the effects of the "consolidation" chemo, which is meant just meant to prevent relapse. I had no idea how intense it was. I just knew it was less intense than the original "induction" round, which was meant to put the leukemia in remission.

Dr. Strickland explained that the consolidation round would be strong enough to make me neutropenic again, which means it's pretty intense. My 2150 neutrophils, the immune cells that fight bacteria, will drop below 500. That's a lot of blood destruction.

So be it.

There will not, however, be a second consolidation round. This next chemo, if everything goes as planned, is the end. We're going straight to transplant from there, and Dr. Strickland expects it to happen before December 31.

When he said that, he added, "What a Christmas present, huh?"

I think he meant it was a terrible Christmas present, as far as the side effects. There is the potential for a lot of them. The chemotherapy leading up to the transplant will be short and intense, completely wiping out my bone marrow and blood system, and then there's the issues involved with my body accommodating the new immune system.

Recovery from the transplant takes three months, and then there's all the potential graft-versus-host issues (see August 4 post).

Of course, we all know it's not really a terrible Christmas present. Yes, on my end, it could get rough. The bottom line, though, is that it is the gift of life, and what can be better than that?

Lol, what can be better than that is dying (Philippians 1:21); however, I don't think that's meant to be, and it's not best for anyone but me, so it's not best at all.

Ok, enough of that. Let me tell you about the biopsy and scary nurses.

Biopsies and Frightening Nurses

When I was told the name of the person who was doing my biopsy today, I thought it was the doctor in charge of my transplant because of where I'd seen her name on paperwork.

It wasn't. It was a nurse, and I'd met her once before.

I'm going to leave her name out because of the start of this story. The end's pretty good, though, so I don't mind telling it.

Also, it's all true.

The first time I met this nurse—let's call her Lisa—was when Dr. Strickland ordered the lesions on my back biopsied. He really wanted to send me to some other clinic (Radiology?), but they couldn't take me on short notice. So he had Lisa do it in the hematology clinic.

She was very sweet. She came in, chattering away, and put her stuff on the computer desk in the room. In the process, she knocked a box of paper clips onto the floor.

"Shoot," she said. "You'd think I'd learn. Those paper clips are always sitting there in the way, and I knock them over every time I come in here!"

She picked up the papers, took two small sections of the lesions on my back with only one mishap, then gathered all her stuff in one large blue napkin-looking thing. As she wrapped it all up, she said, "Ow!"

Something in the wrapped up blue napkin had stuck her.

No problem, she threw it all away, and we left.

Vanderbilt has a really nice service, which is valet parking. It's free. You just drive up to the front, take a ticket from the service guy (or gal), and they park your car, then return it later when you give them your ticket.

We went downstairs, waited for them to get the car, got the doors open, and ... my cell phone rang. I answered it standing outside the car with the door already opened.

It was Lisa, the nurse.

She asked if we could come back upstairs, and she didn't say why. Generally, I'm a pretty compliant guy. I just do what I'm told. (People who know me are laughing as they read that last sentence, but don't pay any attention to them. At least in situations like this, what I just said is true.)

We went upstairs, and Lisa met us at the elevator. She was terribly embarrassed. She explained that she told Dr. Strickland about how she got pricked with something when she was wrapping up, and he ordered her to stick to protocol.

Protocol, apparently, is to take blood from the patient and make sure he or she has no infectious diseases.

As I said, she was terribly embarrassed, and she chattered all the way in about how this never happens, and she's so sorry that we had to come back.

They drew the blood, testing only for hepatitis because they had tested for just about everything else in the process of diagnosing my leukemia, and then everything was okay.

We left the building, feeling a sense of peace settle over us which had been missing since the phone call downstairs. As we did, I laughed, and I told my wife, "Do you think that lady is Don Knotts' sister?"

We saw her again a week or two later, and I can't remember what happened. I just remember telling my wife, "See, I told you. That's Don Knotts' sister!"

That was all very funny until today.

Today, she came walking into the room as I was laying with my shorts about as low on my rear end as is fashionable in younger circles nowadays. ("Sagging," as I heard a younger friend of mine once say.)

She was the biopsy practitioner.

She would be taking a tiny hand drill, poking a hole in my pelvis, drawing out a couple very large syringes of marrow, then yanking a tiny bone core out.

They took my blood pressure, and it was 15 points higher than it had been an hour earlier. I tried to relax.

I thought back to Dr. Lammers, who is over six foot tall and surely approaches 200 pounds, leaning over my pelvis, trying to get through my bone. Then I looked at Lisa, who is no more than about 130 pounds. How was she going to do it?

Dr. Lammers prepares for biopsy
"I'm surprised they don't provide y'all with a power drill," I said. "It would make this job easier."

"They do!" She retorted. "But do you really want us operating a power drill over your pelvis?"

Then she added. "You know, my husband won't even let me use a power drill in my garage. You certainly don't want me using one on you!"

She started laughing. I started my Lamaze breathing.

Don Knotts' sister.

At least she didn't actually have the power drill.

The surprise? The only thing I felt was the first shot of Lidocaine. I didn't feel any of the other shots. She never leaned over once. I never felt much pressure on my hip at all. She got through the bone in less than half the time that either Dr. Lammers or Dr. Vesh (back in Corinth, MS) had done. She got marrow on the first try. It took Dr. Lammers two tries, and Dr. Vesh never got any.

When she got done, she said, "Tell Dr. Lammers he's a wimp. I'm stronger than he is."

I told her, "He's going to feel great. First, Dr. Strickland wants me to make sure and tell people that he's more handsome than Dr. Lammers, and now you want me to tell him you're stronger than he is."

Dr. Strickland on left; Dr. Lammers on right
She laughed. Then she said it was probably just luck.

Maybe, but as for me, I take back the comments about Don Knotts' sister. Even now, 4 hours later, my pelvis is not even sore. For now, she's unparalleled; queen of her class.


  1. Transplant around Christmas????? I want a plane ticket please for Christmas, I don't think I want to ride over on the bike that time of the year!

  2. I just about choked when you mentioned the Lamaze breathing. I could just picture you doing that. I was ROTFL!!!

    I'm very glad she turned into such a pleasant surprise for you!

  3. Well, that's encouraging. I threw that in for comedy, although it was true!

    Unlike living room comedy, which the huge majority of us participate in, a blogger can't tell whether anyone is laughing at his jokes or snappy comments. So I'm glad to hear that tickled you!