Recap II

Monday morning was an early start. Because of how far things had progressed, and because there was just so much to be done, Dr. McDonald prescribed that we be back on the ward by eight thirty that morning. Fear of the combined dangers of rush hour and general McKernan incompetence got us up that bit earlier, though, got us in comfortably at 8am.

Not that anything was happening at 8am, of course. I had a couple of blood samples taken, a couple of meetings with the staff, and read a bit of Salmon Fishing in the Yemen. Things started picking up at about 11am, when Dr. Tansy -- the consultant who'd be handling my care for the next month -- finished up with his morning rounds and came to have a chat with us. The day, for me, was to be one of tests and scans, to check just how riddled with cancer I actually was; the day for the doctors was to be one of finalising a treatment plan, in preparation for my un-riddling.

By this point, I really was starting to be quite unwell; it's doubtful I'd have spent another day without going to see the doctor, by Monday morning's state of paleness and breathlessness and lymph-node-ness. Blood counts came back with the expected huge increases in white cell counts and hints of anemia, none of the bits they listen to with a stethoscope sounded terribly good. A couple of chest X-rays later, and I was proud in the knowledge that I had litres of fluid compressing my lungs and a whole lot of something filling the top of my chest cavity. This pretty much put an end to any possibility of another night at home, so I was put up in a four-room ward for my first night of proper hospitalisation ever.

Tuesday morning came bright and early, at a slightly more reasonable 9am. Mum came up quite early to sit with me, and we went through the familiar routine of blood sampling and takings of vital statistics. Counts elevated a little bit further, neutrophils down, breathing a little bit worse, temperature maybe a little too high. I still didn't feel like I was dying, but the numbers told a different story. The doctors collated their notes and set to work, and mum headed off to tend to her own patients.

First order of business: isolation. Leukaemia is a disease of the white blood cells, specifically of the overproduction of non- or poorly-functioning ones at the expense of the rest. My strain in particular is caused by the massive overproduction of T-type lymphoblasts, which are an immature form of the T-type lymphocytes which should form pretty much the backbone of a healthy immune system. The treatment, the chemotherapy, works by killing lymphoblasts; unfortunately, this also kills all of the ones which should develop into healthy lymphocytes. The obvious end result is that my immune system gets nuked, and I get locked in a small clean room.

Once situated in my new digs (which are, it should be mentioned, actually quite pleasant), it was time to be getting on with the serious business of doctoring. My first 'proper' intervention of the week was the draining of my pulmonary effusion, a delightful little sack of about 1400ml of straw-coloured fluid which had leaked from my lymph nodes and crushed my left lung into a rather uncomfortably small space. As big a deal as it sounds, this was a straightforwards enough procedure that it could be done under a local anaesthetic and with me draped across my desk; twenty minutes and a huge measuring cylinder later, it was all over. Ta-da.

We'd been aware that I would be going into isolation for a while, but neither myself nor anyone else around was quite prepared for how rapid the transition would be. Personally I'd been expecting about a week, perhaps, during which I could invite my various friends up to see me before the long haul really got underway. It quickly became obvious that this wasn't actually in any way what reality would be looking like, so I texted Michelle to get her to organise a wee visit from some of the folks at University. Several hours later, she showed up with James and a slightly ill-looking Ewan. Ewan, as it turned out, had some weird but rather severe anemia brought on from drinking too much while flu-ridden, so he had to rush off to the A&E on doctor's orders. The rest of us just sat about and chatted about nothing in particular for a while, James sat on a beer can which he'd had knocking about inside of his bag, and everyone decided it would be a good idea to maybe go home. We'd be useless at organising meetings on anything of actual importance.

After that, it was bed time. Busy day.

... Though not, as it happened, nearly as busy as Wednesday. While draining the pulmonary effusion had helped a little, it wasn't nearly as pronounced in its effect as had been hoped; I was still coughing and panting and not looking so good. Next step: cardiology. The scans for this one were actually pretty cool; I got a contrast CT scan early in the afternoon, to get a proper look at the huge invisible hulks of my chest-cavity lymph nodes. Though I never personally viewed the images, I gather they were suitably impressive. After that, I got an echocardiogram done on my heart by the cardiology team who'd be working with me; it really was quite fascinating to see just how worried they were by the results, you know, from a scientific point of view.

Before anything could be done about my heart, however, it was time to get started on the infamous chemotherapy. My first appointment was with methotrexane, which is administered by intrathecal injection. To save you googling, that means by sticking a needle into my spine. How hardcore is that? Apparently there's been mix-ups in the past which led to another drug, vincristine, being given into the spine; this is invariably and rather ghoulishly fatal, and is regarded as a very important mistake to avoid. Accordingly, modern cancer units have a special room set aside just for methotrexane ITs, during which three doctors must be present to double- and triple-check the drug and dosage. There hasn't been a mistake in years.

For all the drama of the IT, it was over in twenty minutes and I was placed back in the terrified hands of the cardiologists. After some discussion over whether I was more likely to die in the short term of infection or heart failure, it was decided to go ahead with draining my pericardial effusion -- the fluid around my heart -- which had to be performed in a cardiology procedure room and monitored on the general coronary care ward. Due to the nature of the procedure, wherein a needle is inserted into the fluid sac around my beating heart, it is deemed necessary that the patient be conscious and delivering feedback detailing, to put it bluntly, whether it feels as though they've been stabbed in the heart. Thus it was that I found myself up to the gills on morphine and, mercifully, a memory suppressant whose name I don't recall. Ha ha.

I was still quite groggy due to the morphine, so I don't remember a lot of Wednesday night. Mum and dad hung around for a bit to make sure I didn't die unexpectedly (I didn't) and that the coronary care night staff knew how to deal with borderline neutropenic patients (they did), and went home. I slept until 10am the next morning, with rusty-looking pericardial fluid still draining into a bag by by side. Sweet dreams.