Thursday 20 June 2013

The Harvesting





After my fifth GCSF shot on Wednesday, we had an appointment to see if I had enough stem cells in my blood to start collecting them. We waited for my blood results in the four-bed haematology day stay ward room. For the next two hours the beds filled up with bald women on IV drips. I overheard that the nurse could not get a needle into one woman’s arm. She asked another nurse to try. My arms crawled with the pain of stabbing needles as I listened to them. We finally got word that I did not have enough stem cells to collect. I was told I was a “two” and needed to be a “ten”. I didn’t know what that meant but it was clear they weren’t going to be collecting any cells today. By 6pm that evening I felt pain in my lower back. It came in waves. The pain reminded me of when I slipped on the ice and landed on my back about twenty years earlier. I couldn’t straighten or sit properly because my lower back wouldn’t bear the weight. It was a sign that the GCSF was taking effect. 
      The next day my result was fourteen. I was ready to harvest. The corn crop was in. First I needed a central line. A vein assessment I had on May 8th at the New Zealand Blood Service in Epsom determined that the veins in my arms would not support the volume of blood that would leave and re-enter my body during the stem cell collection. From all the trouble I experienced with getting blood taken and having needles inserted, it was no surprise. We waited for hours in the family room in the haematology ward. We turned on the 6pm news. Shortly afterwards a man walked in and sat on a sofa near us. It was hard to tell how old he was. He was bald, wore a hospital gown and was attached to an IV pole. He watched the news with us and made amusing comments at the current events. We laughed with him. When he stood and left, slowly moving out the door dragging the IV pole behind him, I saw that he had no fat on him at all. I wondered what his affliction was. I thought how unfair and how sad that this was his world, this ward, these hallways, while others moan about such trivial things in life. I know it’s a cliché to say it makes you think but it does. It made me sad and hopeless that the giant foot stepped on so many nice people. It also made me realise that would be me soon. I would be that bald-headed patient attached to an IV pole, dragging myself down the hallway with a backless gown on.
      At nearly 8pm I was finally wheeled to the surgery ward on a gurney where a South African anaesthetist introduced herself. She asked me some identity questions then wheeled me to another area of the room. A young doctor walked up to my bed but kept his eyes on a clipboard. He spoke a little nervously:
      “I will be happy to put in your central venous line.”
      That seemed a little odd. It sounded like: “I will be happy to be your waiter tonight.” But then an older man approached with much more confidence and an easy smile and I realised this was a learning session. They instructed me to turn on my side with my head to the left. A large blue plastic sheet was put over my head. The anaesthetist made a tent out of it so I could see towards the wall. Every couple of minutes the older man and the anaesthetist put their head in the tent and asked me if I was alright. After a local anaesthetic the procedure began. It felt like the top of a pen being forced into my neck, followed by another one. Once the “pen tops” were in I could feel them being manipulated and pushed into place. It was uncomfortable as hell but when the older doctor put his head in the tent, I smiled and nodded to show I was fine, as you do. When they finished, two plastic tubes, about 12 cm (4 inches) long each, hung from the incision in my neck and dangled on the top of my shoulder. The young doctor wrapped a tan elastic bandage around my neck but left the tubes hanging on the outside.
      The older doctor and his protégé left my side. The South African woman stayed and a British man in scrubs walked over. I didn’t know who he was but he made some good jokes. I thought maybe the hospital provided a little light relief to relax the patients. The tubes bobbed on my shoulder when I laughed. It turned out the funny Brit was the partner of the anaesthetist. I guessed he entertained her patients to impress her. He could have done stand-up. But then maybe he liked the idea of a captive audience. You couldn’t get more captive than being flat on your back with two plastic spouts sewn into your neck. I waved goodbye as I was wheeled back down to the haematology ward. I had left Alex waiting for an hour. He didn’t grimace when he saw the half-machine they had turned me into. In fact he got it completely right. He didn’t react at all. It was 9pm by the time we got out of the hospital. Alex volunteered to go get the car and pick me up but I wanted to get away from there as fast as possible. He had parked a few minutes’ walk away on Grafton Road. As we walked towards the car the two plastic tubes banged up and down against my shoulder. I must have looked like an alien with feeding tubes hanging out of my neck. I was glad it was dark.
      I woke up on May 18th to another shot of GCSF. After seven days, Alex was an old pro. His hands no longer shook. He was so good, he began to wonder if he missed his calling and should have trained for a job in the medical profession. I wasn’t sure if there was much call for a middle-aged stomach subcutaneous injection specialist, but you never knew.
      It was stem cell collection day. It was the last item on my peripheral blood stem cell collection schedule. At the blood service in Epsom, they were ready for me. I was put in a bed in the corner of a large room. I had a curtain pulled across the end of my bed but the rest of my bed was exposed. There were lots of lazy boy type chairs throughout the room for blood donors. The chairs filled and emptied throughout the day. No one stared for too long at the strange woman in the corner with tubes coming out of her neck attached to a machine the size of a refrigerator. The refrigerator was called an apheresis machine for those who like such detail. I was told the number of stem cells needed for a transplant was two million per kilogram of body weight. The target for me was to collect five million. I was willing my body to make it happen.
      I couldn’t turn my head much because of the tubes hanging out of my neck so I just had to lean back against the pillows and wait patiently for the five hours it took for the blood to leave my body through one tube and return through another. Plastic IV bags hanging from the top of the machine were filling up with a pink-tinged liquid and I was hopeful that I was doing well. The only strange effect was when my blood pressure was taken.  Every time the automatic arm cuff of the blood pressure machine tightened, my hand would get an extreme bout of pins and needles. I mean so extreme it was like I had put my hand into an electric socket and left it there getting zapped with 240 volts. One time the machine misfired and pumped the arm band up twice as hard. I felt like my hand was going to explode. I wanted to scream. But since I didn’t want to disturb the good people donating blood around me I gritted my teeth.

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