Friday 21 June 2013

Apherisis





To pass the time I was given a personal DVD player and a choice of movies. I always wanted to see Black Swan and it was a good way to waste a couple of hours when I couldn’t move my head very far. It wasn’t as good as I was expecting after all the rave reviews. I guessed the whole plot pretty early on. But that didn’t stop me wanting to share all the details with Alex. I was a little too enthusiastic in my description though and the apheresis machine started beeping with an error message. The Asian technician narrowed her eyes.
      “Could you not talk?”
      I felt like I was a school child being reprimanded for talking during an important lesson. I shut up and read a magazine for the next couple of hours.
      The good thing was that before I left, the technician took the tubes dangling from my neck, wrapped them in white gauze then tucked them inside the tan elastic bandage I got at the hospital, so they wouldn’t bounce. It was much more comfortable. At home I sat in a big arm chair and tried to keep my neck in a comfortable position. There wasn’t any sharp pain, just a dull ache. I imagined it was like whiplash would feel.
      The next day was Saturday. The blood service was closed so we had to go to Auckland hospital for more harvesting. The technician who told me to be quiet the day before arrived soon after we did. Before she even said hello she asked loudly:
      “Where’s my machine?”
      The apheresis machine should have been delivered to the ward. Before I could worry that the day was going to be a complete failure, the machine was wheeled in on a hand trolley by a beefy delivery man. In a flash the small woman had opened packages of sterile tubes and bags. She drew blood out of both tubes on my neck with large syringes then threw them in a bin she brought with her. Seeing my blood spattering around the bin was a little disturbing but she was on automatic. The machine was threaded and turned on. She worked so fast I thought she must be missing a hair appointment. The tubes that led from my neck were taped to the pillow behind me. I was like a dog on a short leash. I only had centimetres to move in. But I wasn’t going to complain. I collected 2.1million cells at the blood service the previous day and I was hoping for similar success.
      Alex set up his laptop to get some work done, I opened a book and we were off again for another long day. I refused offers of drinks because I didn’t want to stop the collection process to go to the toilet. But the technician convinced me to have a drink. Not surprisingly just before lunch I needed the bedpan. She put it on a chair, untaped my neck, pulled the curtain closed and stood on the other side of it. Relieving yourself when someone is waiting for you on the other side of a thin curtain is intimidating. I performed admirably under the circumstances.
      After the collection she put my bags of stem cells and blood samples into a Styrofoam bin with ice. She loaded her boxes up on to a luggage trolley. She said goodbye and hurried off as if she was about to miss a flight.
      We were allowed to go home and soon after Charlotte arrived from Wellington. When she saw the position I was holding my neck in, she joked that I was like Batman in his mask with no peripheral vision. I had to turn my whole body to see sideways. A blood services doctor rang about 6.30pm. I had collected 1.4 million cells. I was to go back to the hospital the next morning for a blood test to see if they were able to squeeze any more out of me.
      The next morning I was over it, all of it. I wanted a day to myself. I wanted to stay in bed and wallow all day long.  But I couldn’t. Alex came in to the bedroom with another GCSF shot, and at 7.45am we were on our way again. I had felt like Frankenstein for the last three nights. I couldn’t turn my head with the tubes hanging out of my neck and there was always a dull ache at the site. From a high of fourteen my count was now down to four. But they still wanted to drain my blood and see what they could get. We started at 1pm. The first three hours were okay. I read and did puzzles. Then I needed the bedpan. When I was reconnected to the apheresis machine it went nuts. The alarm and error message wouldn’t stop no matter what the technician did. Finally she made me lean back farther into the pillow. The machine stopped beeping and she taped me into this position. My eyes could only stare at the trim between the top of the wall and the ceiling. I put my knees up and tried balancing a book on them to read. I stayed in that precarious position for two hours. When I finished, the technician packed her Styrofoam box again and left. I had to stay at the hospital and get a transfusion of platelets before I was allowed to go home.  A low platelet count is a fairly common side effect of stem cell harvesting. A male nurse told me the side effects of a platelet transfusion could be severe, with chills or a rash. I rolled my eyes. Great! It was just another day at the office. But after half an hour the machine bonged to say I was done and I didn’t encounter any of the dreaded ill effects. It was 7.45pm. We had been at the hospital for nearly twelve hours.
      The first call I got the next morning was from a bone marrow nurse specialist. I had collected only .25 million cells in the five hours I spent on the machine the previous day. All together I had collected a total of 3.75 million cells. It was not the five million targeted for me. The nurse sensed my disappointment.
      “It’s fine. It’s enough. The target of five million was high and often patients don’t reach the target amount,” she said.
      “Mmm.”
I felt like a child who had come in second in the hundred metre sprint. “You tried your best.” It wasn’t good enough. I wanted those extra cells on hand in case I needed them.
      Getting the central line out was far easier than putting it in. I was back at Auckland hospital for what I thought would be another surgical procedure followed by jokes from the funny Brit. Instead I was pointed towards a day stay bed. The young male registrar came to see me. He examined my neck, cleaned it, removed the stitches and said:
      “Breathe in until I say stop”. 
I filled my lungs and imagined the amount of blood that would pour out of my neck when the massive central line came out. I felt a little tug.
      “Breathe normally.”
      He put pressure on the cut for a few minutes then put a little white bandage on it. The incision was only the size of his pinky fingernail. I couldn’t believe it. For four days it felt like I had a huge piece of dried cannelloni stuck inside my neck and now it was gone in one deep breath, leaving only a tiny cut.

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