Cycle 3 Begins

Question 1:  In a quiet voice I asked Jeff, “Why do you think you tolerated the second cycle so much better than the first?”

Like me, he did not want to jinx it.  He whispered, “I don’t know.  I was wondering that, too.”  

During the first cycle we borrowed a shower stool and a wheelchair when things were bad.  They gave umbrella-like comfort – better to have it and not need it than need it and not have it.

Question 2:  “Does Jeff need Cycles 3 and 4?  Or are the blasts in his marrow below 5%?”

Thanksgiving Week - Monday

Oncology Nurse Heather, always the cheerleader, addressed Question 1 prior to performing the bone marrow biopsy.  Jeff was with her in the office and they called me - in the parking garage – to include me in the discussion.  Heather thought maybe the Vidaza/Venetoclax combo was working and lots of cancer cells were dying and clogging the bloodstream, causing Jeff problems during the first cycle.  Cycle 2, things settled out a bit.  Heather was so encouraged by Jeff’s blood work (red and white cells low but holding steady, platelet count still low but rising) that she gushed her hope that the marrow would show improvement, too

Having a bone marrow biopsy on the Monday of Thanksgiving week means the usual “results back in two or three days” might not apply.  The wait was made much more bearable by Heather’s encouragement and enthusiasm.  We waited without dread and only a little anxiety.

Labs drawn at this appointment did not indicate a blood transfusion was needed.  Jeff was disappointed because he’d hoped to have a little zip to make for a productive Tuesday in his shop.

Tuesday – Jeff worked in his shop on a walnut floor lamp he sketched while in the hospital in October.  He turned the parts on the lathe a little bit at a time when he felt up to it.  (We’d bought the lathe when he was diagnosed in 2010 to provide a less strenuous woodworking activity.)

Wednesday - Jeff’s labs were drawn at home, centrifuged, and picked up by 1 p.m. but because of the holiday on Thursday we didn’t expect to get results until Friday.

Thursday – We’d debated strictly heeding expert advice about COVID safety at Thanksgiving gatherings, “People in your household only.”   We decided to invite our children and grandchildren, our quarantine circle, the only people we see outside of doctors.  As always, it was a mask-on visit.  Our children suggested a kids’ table for dinner.  We put a tablecloth and centerpiece on the kitchen table and assured Granddaughter Rosie that if she said, “I’d like to say something,” we would hear her in the next room. 

Friday - The blood counts were still not posted on Penn’s portal in the morning but we needed to know whether a blood transfusion was necessary before the weekend.  Eventually, Heather called to discuss his biopsy and the answer to Question 2 (8% blasts – better but not good enough; yes, another two rounds of chemo).  She also wondered whether he ought to have a transfusion.  His hemoglobin wasn’t yet low enough to warrant a transfusion but she calculated that if it continued to drop at the current rate, he was going to feel pretty lousy by Monday.  She scheduled a 2 p.m. appointment for a blood draw and crossmatching and a 4:30 p.m. transfusion. (Matching donor blood is time-consuming because Jeff has a history of antibodies in his blood.)  We drove to the city.

When it was time for Jeff’s transfusion, he was directed to a room with a bed instead of the usual recliner.  He asked whether that was really his room.  The nurses assured him it was.  He took off his shoes and shirt (for access to his PICC line) and climbed into bed.  They brought him a warm blanket.  He began to drift off to sleep, anticipating that he would be snuggled in for an hour or more.

The nurse returned in a few minutes with bad news.  No match.

“What?!”  This was the first time Jeff needed blood and couldn’t get it. 

The trip was a bust except that we did get to see my sister, Nancy, and her husband, Ken, for a short visit and a shared elevator ride to parking level P3.  Someday we will meet somewhere besides the cancer center. 

Over the weekend we wondered whether there would be a problem getting blood on Monday.  An appointment was set for 10 a.m. Monday morning to stay within the 72-hour window for the crossmatch that was done on Friday afternoon.  Unfortunately, the treatment appointment was for 4:30 in the afternoon.  We worried that Monday would be a very long day if the treatment appointment could not be moved forward. 

On Monday morning we drove to the city without confirmation that there was blood waiting for Jeff.  We made the trip record time.  No slow-downs on I-95, no accidents, very little traffic.  Plenty of parking at the Perelman Center.  All good.  We had time for coffee/tea before I headed to the garage to work in the car and Jeff went upstairs to Infusion.

The COVID surge has sent me back to my car in the garage of the Perelman Center to avoid the public areas as much as possible while Jeff has his appointments.  We’d parked on P3, the third level underground.  I prefer P2, especially if I am working, because P3 has the giant air handler for the garage.  It is very loud.  If I have a Zoom meeting on P3 I have to stay muted until I need to speak.  My coworkers told me it isn’t too bad but if I spend too much time down there it drives me bonkers.  Sometimes I move to P2 later in the day when it looks like spots are opening up.  For Cycle 3, Day One, instead of a steady LOUD, the air handler sounded like it was revving up for lift-off.  I alerted Jeff by text that the whole building might soon take off.

Heather called Jeff while he sat in the Infusion waiting room.  She suggested a new order of events:  blood draw, Vidaza infusion, red blood transfusion.  That makes sense!  Everyone involved was very accommodating, the pharmacist who mixed his Vidaza, the infusion nurses, Nurse Heather. 

Jeff texted to let me know what was happening and to give an estimate of the time it would take to finish.  About half-way through he texted, “Did you go to the pharmacy for my meds?” 

 Me:  “No.  I’ll do that now.”

Jeff:  “My window looks out at the atrium over the pharmacy.”

…  Me:  “I’m there now.  Can you wave?”

He went to the window and waved.  Small joy.  I went to the pharmacy then back to the garage. 

Treatment took about half an hour, blood transfusion took an hour and half and when all was finished, a nurse said, “I’ll see you tomorrow.” 

He replied, “As a comedian might say, ‘I’ll be here all week.’” 

Everything went well and we were on our way before 2 p.m.  The trip home was as uneventful as the trip down.  What we thought would be a stressful, long day turned out to be a good day. 

Family and friends responded to my FB post about blood shortages around the holidays.  We loved seeing which of our family and friends were regular donors and thanked each of them.  We are grateful for all blood donors.  Find a drive here:  https://www.redcross.org/give-blood.html