Everyone said the actual transplant is anticlimactic and they are correct. There are no big switches being pulled dramatically, no lightning, Rich’s bed, disappointingly, does not rise through the roof into the night skies. There is no Frau Blucher and any horses whinnying are on the Animal Planet station on cable. Igor is sadly absent.
But as Dr. Frederick Frankenstein said, “From that fateful day when stinking bits of slime first crawled from the sea and shouted to the cold stars, ‘I am man.’, our greatest dread has always been the knowledge of our mortality. But tonight, we shall hurl the gauntlet of science into the frightful face of death itself. Tonight, we shall ascend into the heavens. We shall mock the earthquake. We shall command the thunders, and penetrate into the very womb of impervious nature herself.”
There is that feeling of playing god with this process. Like the youngest of Frankensteins, we are recreating life from life. We breathe a sigh of relief that these cells don’t come from a guy called Abby Normal.
For the most part, things are fairly normal. Other than when the night nurses, as they leave in the morning poke their head in your room and call out a Happy Birthday and wish you luck this feels like any other day.
The Patient Care Associate, what used to be called orderlies, encourages you to shower before the procedure. During that time, they clean and disinfect your room from top to bottom. Your sheets other bedding are changed.
You come from the spotless shower back to your spotless room. During rounds, the doctors, residents and interns all congratulate you on your progress. Your nurse administers the pre- meds… for nausea, headache, allergic reactions, for infections, for mouth sores… a shot glass of them followed by a few more infusions. The stage is set but it’s all still fairly standard stuff.
Suddenly there is a crowd in your room…. A gaggle of nurses first ask the required spelling of your name and date of birth. You are handed a Ziploc and within that bag is another, an IV bag, with liquid as red as blood. Everyone look on. This is your life in your hands… literally. Without these you will die… you are too immunosuppressed to sustain yourself. You have no more means of creating new stem cells and these stem cells have a job to do. They need to become the red cells, white cells and platelets. This is your body’s main goal in the coming days, weeks, months. Make more red blood cells… same for white, same for platelets. Without them, you have no chance of survival.
One nurse takes the bag from your hand and hangs it on your IV pole. Another hands you a small stuffed animal all decked out in party gear… press the tummy and it sings Happy Birthday, everyone joins in song. We all watch as the first drops drip from the bag into the tubing that ultimately connects to your triple lumen and into your artery. We’re on our way.
The doctor and nurses disperse. The translucent fluid slowly changes from the clear of the saline to the life-giving salmon color of the blood product that includes your stem cells. It feels like a singular moment in time when that color hits into the port and continues on its way. We’ve begun.
Your vitals are checked throughout the hour that it takes for the bag to empty. When it gets close to that point, the nurse squishes the bag to ensure that they will stay mixed and not a single stem cell will be left behind. Finally the last of the red fluid is gone from the bag. Quickly the nurse switches out the empty bag for one of saline. This will push the last of the valuable fluid in the line through to the port. We now watch the reverse of the beginning…. The translucent red fluid is now being replaced by clear. Once it reaches the port, the procedure is done.
You’re tired. The night before is full of interruptions for meds and vitals checks. Tonight promises to be more as they monitor your reactions… or lack thereof… to the transplant. When it is autologous as this one is, since these are your own cells, there’s very little reaction to be had. There is no Graft vs Host complication. But these same cells have been preserved with chemicals and frozen. They have been thawed and washed. Reactions can happen. They’ve given you meds to counter these but monitoring is necessary. You taste garlic in your mouth. They said that would happen. Dinner options will have to be chosen appropriately to complement this self-seasoning.
There are smiles during the day… gifts of laughter. Photos of our little ones. An absurd bouquet of balloons from our family of friends at work. You give in to the exhaustion and close your eyes. Your rest is long and deep. You’re only woken to take more post-transplant meds. You don’t quite feel yourself but a little “off” which is to be expected. For all the unremarkable effects of the day, it’s still been a very busy day for your body.
And that will hold true for the next few weeks and next few months. Outwardly there will seem to be not much going on, but in reality, your body is working overtime. Today was the first of three weeks of daily Neupogen injections. This lesser cousin of Neulasta will help build the necessary blood components to allow you to ultimately go home. Claritin is our companion once more. We find ourselves telling the nurses the benefits of the brand name version of Loratadine and they take note. We hope that word continues to get out that this is an important component of this treatment.
Meds now have changed from those that break you down to those that will build you up. There are side effects to these as well but manageable. Digestive tract disruptions are not severe but exist. We work on solutions. Since the week of chemo was an intense blast of beneficial poisons, the effects will not dissipate as quickly. The next ten days are supposed to be the point where counts are at their lowest… fevers, mouth sores, digestive upsets…. These are all expected but not guaranteed. Again, we hope to be outside the norm and dodge those bullets. After dinner, there is a sense of discomfort… something just not quite right. A muddle of side effects, nothing overt, but still there, combine to give a restlessness. Discussions on current meds, possible meds, timing of meds and a consensus of what to try is reached. They kick in and another night begins.
This is the first night of a new beginning. We are by no means at the end of our journey, but we’re closer to that goal each day.