Sunday, August 03, 2008

So Many Infections, So Little Time, Part 2

When you go into hospital, every new doctor you meet asks about your condition and does some kind of exam. I'm generally in favour of this; not every doctor asks exactly the same questions in the same way, and each one picks up on different words or comments you make, so everyone backs each other up. But I meet a lot of doctors on these occasions; at least one in emergency, and when I get to the ward there's the team of senior and junior residents, a med student, the doctor in rotation, and of course my hematologist at minimum. Sometimes they come alone, or in groups, and at least when they're in groups only one does the physical exam. Like I said, normally not a problem. But when your sinuses are in agony and each exam involves someone pressing their fingers or thumbs against them or tapping them, you just want to shout, "Enough already!"

So it turned out that what was plaguing me was sinusitis. Some bacteria had gotten in there and was making my life miserable. The antibiotics regimen was helping, but what was really needed was to drain the mucus and other crud from the sinuses and keep them clear so the antibiotics could work most effectively. That meant irrigating them on a regular basis—taking 5 mL of saline, squirting it up one nostril, and then letting it drain out the other. You have to tilt your head back as you squirt with reasonable force, and slowly rotate and eventually raise your head to guide the saline through the sinuses, then let it run out, snorting a bit at the end to release any gunk that was loosened. It's not pleasant; it feels a bit like standing on your hands at the bottom of a pool and deliberately letting water get in, and you have to alter your breathing a bit so you don't close everything off, but you don't let it drain uselessly down your throat either. I have to do this every three hours. For best results, that includes during the middle of the night.

Whenever I was able to focus a bit, I read and did puzzles to keep my mind off my discomforts. One book I read was Soon I Will Be Invincible, a story set in a world of superhereos and super-villains, told through the alternating narratives of the arch-villain and a rookie superhero. It's a fun and loving deconstruction of comics, but there's a part where the villain is relating the lab accident that gave him his powers. I read it the morning after a vicious late-night coughing fit, one where I was still in a half-dream state at the same time, which was too strange for words. The passage read: "I wanted to faint, leave my body. When you can't bear something but it goes on anyway, the person who survives isn't you anymore; you've changed and become someone else, a new person, the one who did bear it after all." I've been thinking a lot about that passage as it applies to my different experiences since my diagnosis.

I had to be given daily injections of Lovenox, a blood thinner. The injections were in the abdomen, which aren't as bothersome as I thought they'd be, but unlike earlier promises they didn't sting that much less than in the thigh. I broke one of my cardinal rules and made a joke about the name (pronouncing it "Love-nox" in a Barry White voice), which made the nurse laugh while the needle was still in. Not smart.

One morning I woke up and I finally felt like a human being again. Not a particularly energetic one, but human nonetheless. Like old times, I got up, put on a mask and gloves and did a tour of the floor. I decided to stop at the computer room to check my e-mail—I had closed an eBay sale during my previous hospital visit and wanted to reassure the buyer that I hadn't disappeared with his money—and of course the community computer wasn't working. I ran into an orderly who was just starting his first day and we chatted a bit. I welcomed him to the floor, and not for the first time reflected on how much the ward felt like home now.

I was eventually moved to a smaller private room, one with its own air treatment unit (99.97% HEPA, it said), a great view, and a George Jetson chair next to the bed. Later I walked the floor again and realized I'd stayed in 10 of the 20 rooms over the last eight months.

My hematologist and I talked about how drastically things had changed. My white blood count was stabilizing to normal levels and my neutrophils were okay, but they clearly weren't doing their job; I'd had three infections (cellulitis, pneumonia and sinusitis) in two months, the last two very close together. In earlier weeks we'd spoken to the transplant specialist in Ottawa, and my approximate transplant date had been moved from late July/early August to sometime in September because of logistical issues plus the fact that my leukemia was stable. The latter factor no longer being the case, my hematologist worked with them to move things up a little. My donor has been activated (i.e., notified and beginning further tests in preparation for the stem cell harvest), and I should be receiving my transplant at the beginning of September. Until then, I've got to keep from catching another infection, so she prepared a new drug regimen, built on top of the old one.

Early Friday afternoon I was finally discharged. I could walk on my own power, but with frequent rest stops. Vicky and I went to the pharmacy to pick up my next month's worth of medication:

- Allopurinol, to prevent gout and keep my kidneys clear (once a day)
- Ativan, if I need help sleeping at night
- Clavulin, an antibiotic (twice a day)
- Desmopressin, for my diabetes insipidus (twice a day)
- Hydrea, to keep my white blood count down to normal (twice a day)
- Magic mouthwash, to ease the discomfort in my mouth (the Hydrea has been stripping the mucus from my mouth over time, making eating harder; four times a day)
- Pantoloc, to help with my reflux (once a day)
- Saline, to continue irrigating my sinuses (every three hours)
- Vitamin D, as part of a med student's lab I volunteered for (twice a day)

It took an hour for the pharmacist to prepare everything.

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