They know what they are doing, but its not a science

Good Morning All:

I must say that I'm amazed at how much of a BUZZ my picture with Santa is generating. Marla comes home from just about every place she goes with someone reporting to have seen the picture and how glad they were to see me smiling. Rest assured, I am smiling fairly frequently and hopefully the picture helps convey to all that physically I am still in good shape (albeit a bit more chubby than usual since I've been told to eat protein and calories).

I wanted to share a brief story about my out-patient visit yesterday that underscores just how complicated this whole cancer treatment business is and the sorts of things that can fall through the cracks. As I go along I'm learning to 'game' the system and yesterday was yet another lesson on what areas need to be 'gamed'.

I went to Hopkins yesterday with my father. I brought my library book and little else to occupy my mind. I just left the inpatient hospital stage and didn't feel like I would need a transfusion, wasn't in line for any spinal taps or other procedures, so there wasn't any reason to believe that the visit would take any longer than to complete the routine blood tests. WRONG!!! As it turned out I was borderline in needing a blood transfusion and as an inducement they offered to allow me to skip Wednesday's out-patient visit. So, I said 'OK' and they started the process for getting some new blood into my veins.

You might think that this is a fairly routine process. They know my blood type, the blood bank is in the hospital . . . just pull the blood from the correct bin on the shelf, put it on a cart, deliver it to my nurse and away we go! Well, no, it isn't that way. You see, the blood bank will not issue blood unless it has tested my blood type within the past three days. Your reaction to this might be similar to mine when I first learned of this (but . . . once you know someone's blood type . . .) but when I asked I was reminded that many patients where I am being treated have had bone marrow transplants. In such circumstances a patient's blood type may well change and the issuance of the incorrect blood type would be devastating--so now I know and understand the policy.

When I first was made aware of this policy it was conveyed to me that my blood had simply not been drawn in the past three days and for that reason my blood type needed to be confirmed: a two-hour process. So, yesterday I pulled the ace out of my sleeve only to learn it came from the wrong deck of cards. "But I just left the inpatient ward. My blood was drawn two days ago" I smugly reminded my nurse (there is often confusion as the handoff occurs between in- and out-patient wards, usually in the form of discrepancies in appointment times, etc.). Nurse Nicole gave it right back and further informed me that just because my blood was drawn and tested for the normal blood chemistry does not mean that they tested the blood type. She went on to say that it was not routine for the in-patient nurses to request such a test since it isn't always needed and the two-hour delay in the instances where it is needed is acceptable since they have a captive audience! Nurse Nicole and I devised a scheme on the spot that I will need to enact in rounds 5 through 8 whereby I request that my blood type be tested on my final day of my inpatient stay so that the information is updated in the system in advance of my out-patient processes.

So, the blood drawn yesterday at 10:00 showed at 11:00 I needed a transfusion. The typing of my blood took two hours (or more). Nurse Nicole hounded the blood bank throughout the lunch hours and Dad and I sat waiting for the blood until 2:30. I needed two pints but they only release one at a time. A transfusion of a pint takes roughly 1.5 hours so the resourceful Nurse Nicole called down to the blood bank after 1 hours of transfusion to request the next pint of blood. For once the timing worked and the second pint showed up only about 5 or 10 minutes after the first pint had been completely transfused. Around 4:00 the second pint was hooked up. I got my blood and Dad and I strolled out of the inpatient office around 5:30--a very long time to sit in a doctor's office. It was not completely unproductive, however. I was able to confirm the complete lack of programming on daytime television, had fun laughing each and every time I watched President Bush duck a pair of Hushpuppies and my dad completed 16 sudoku puzzles (mostly easy ones I might point out) in about 4 hours.

New topic, briefly. In today's sports section of the Washington Post is an article about the Olympic swimmer who participated in the Olympics despite his diagnosis of testicular cancer prior to the games. The article (or should I say the swimmer) does a good job of capturing some of the newest shifts in my thinking and mental state as I go through my current process. I have not yet written about the safety net that surrounds a cancer patient during the process of achieving remission--but I will. This swimmer is now where I hope to be in a few months. No cancer in the body and undergoing periodic treatment to discourage its return. But the vast majority of the article focuses on the not-knowing and the general lack of a safety net when the cancer patient moves beyond the induction phase of his/her treatment. If you would like to gain insight into some of my thoughts/concerns as I progress and move toward remission this article will quickly give you an understanding.

Thanks for hanging in there on one my longer recent posts!

--Russ.