Day Zero Plus Twenty – “770”

This morning I was positively giddy over the possibility that today could be the day -  Jeff’s first post-transplant day with an ANC over 500.  Jeff said he “knows better” than to count on it so he tempered my enthusiasm with realism.  The morning dragged on.  

I stepped out of the room at one point and Nurse Alana introduced me to Jeff’s neighbor, Barry, who had a transplant one week after Jeff.  Barry also has girly marrow; his donor is a 25-year-old woman.  I spoke to him from the hallway for several minutes.  Finally, I asked if I could go into his room since I had already put on gloves and gown to go back into Jeff’s room.  Barry looked good and was sitting in a chair reading a book.  He describes himself as a loner so he is fairly content spending his days alone.  His wife is still recuperating from a double mastectomy so he doesn’t like her to drive from Hatfield too often.  They have two children 44- and 45-years old who have not made the trip very often either.  Alana told me she tries to get him to open his interior curtain but Barry says he feels like an animal in a zoo with the big window open to the busy hallway, no privacy.  I told him how much bigger the room feels when the curtain is opened and that it provides a change of scenery.  Besides, his good condition is good advertising; people should see it!  Alana told me later that Barry opened the curtains.  I will try to visit him again tomorrow.  His transplant had been delayed three times and required a change of donor.  The delays enabled him to spend time with, and then bury, his father. 

Jeff has had some changes in his skin which is not surprising.  Recent, very small break-outs are itchy and Dr. Ahmedi thought it was possible it was very mild GVHD.  Dr. Ahmedi reported Jeff’s monocytes were very high and said that usually precedes engraftment.  He was more reserved this time, guessing “Today, tomorrow…”  Dr. Porter visited later and was unimpressed with the spots/rash.  He also said Jeff would go home “early next week” as long as Jeff doesn’t have a fever in the meantime.

I went to lunch wondering when the ANC would come back.  While I was eating, Jeff texted, “770.”  I cried with relief!  I returned to the floor and saw Nurse Kristin and asked, “Can I kiss him?”  She said they didn’t have the go-ahead yet from the doctor and reminded me that usually they wait until engraftment is official, two days with an ANC over 500.  I told her Dr. Ahmedi was going to bend the rules and allow recontamination the afternoon of the first day since Jeff had been showing steady progress.  We never got the word so I just kissed his legs and arms on top of his clothes – a lot.  I think almost every one of the nurses assigned to Jeff since his arrival stuck her/his head in to congratulate Jeff.  For the staff here, engraftment is a regular occurrence, yet everyone seems genuinely pleased. 

Allo patients are not discharged on the weekends due to the many special discharge instructions that must be given.  We were told about that in our patient care class.  However, one of the residents (or a new intern?) came in to tell us that although he doesn’t make the decisions, he is pushing for discharge on Friday afternoon or Saturday, with a visit to the Transplant Coordinator scheduled for Monday in the office.  Later the pharmacist came to give us discharge instructions for the at-home meds.  He said he has seen patients discharged on Friday afternoon rather than waiting for Monday.  Once again, I began to imagine the best case scenario while Jeff stayed on an even keel. 

I left a voicemail for Dr. Lee, the man who is conducting a study on the effects of exercise in BMT patients.  Jeff did not want the study to impede his discharge one minute!  When Kerry spoke to his father tonight, he couldn’t talk long because Dr. Lee was there (at 9 p.m.!) to do Jeff’s assessment.  Only one more assessment will be done, after two or three months, I think. 

Keith came this afternoon for a visit and we realized it would make sense for him to take me home tonight so that I can begin to put the house back together following last weekend’s allo-cleaning extravaganza.  Then I’d be able to drive back tomorrow just in case Jeff is discharged.

Patience, patience...