Tuesday, 5 July 2011

Back on the sauce

Written Monday 4 July 2011

Today my wife and I went to University College Hospital for the first stage of the treatment designed to mobilise my stem cells (aka haematopoietic cells or HPC) and coax, or maybe bully, them out out into my blood vessels for harvesting.

The journey also involved carrying my pee—diligently collected over the 24 hours beginning at 6.56am yesterday in the vessels provided by the hospital—on public transport in the rush hour. Surprisingly heavy, not that I’m boasting. The experience also prompted the not entirely pleasant thought that we have no idea what our fellow passengers are taking with them on the trips we share every day in such close proximity. I was quite glad when the moment came, soon after we arrived at Haematology Day Care, to hand over this particular cargo in its blandly grey carrier bag printed with those hallowed words—so beloved of anyone who has had to wear those horrible shapeless NHS gowns that open at the back—“hospital property”. By means unknown to me they would be analysing  my offering to assess the health of my kidneys. Quite enough on that subject for now, but I hope of course for a good report.

We were then shown by the young nurse who would be attending to me into the treatment room where outpatient chemotherapy is administered. The chair allocated was in a corner so I had a good view of the whole space. It was a bigger facility than at my local hospital and the chairs were a bit more spacious and squashily comfortable. I tried and failed to work out the significance of the various different coloured scrubs the staff were wearing: guess there will be plenty of time for that over the coming days and weeks.

I was to receive a single two-hour infusion (a noxious drip, not a herbal tea) of cyclophosphamide, an agent I have had before, it being the “C” in the R-CHOP chemo I received in the four months between October and February last. Not my favourite stuff and my son, the medical student, says he has heard it referred to as “Cillit Bang” (note for non-UK readers: CB is a well known all-purpose domestic cleaning product). The role of this stuff in HPC mobilisation is not, I have to say, entirely clear to me, even after a couple of careful explanations by the medical team, but from what I have been able to gather from online search, there is a much better chance of harvesting enough stems cells to store and subsequently pass back to me than if it were not used.

In due course a cannula was inserted for the drip, pretty painlessly by the standard of these things—the words the kind nurses always use are, invariably, “sharp scratch now”. The first task after a short dose of saline was to provide, via the drip, anti-emetic medication against the nausea and its evil twin, vomiting, that would otherwise invariably follow chemo. Next down the line was Mesna, designed to protect my bladder against the irritation that would otherwise be caused to its lining by the waste products of the relatively high dose of cyclophosphamide that was on its way. “Mesna”: sounds a bit like a Middle Eastern sacred site. How do they dream up these names?

Now for (today’s) moment of truth: the Cillit Bang. As is required protocol before the administration of any chemo, the nurse enlisted the help of another to cross check the inscrutable contents of the large bag that was about to be attached to the drip. I was also asked to confirm my name and date of birth against those recorded on the bag. The bag was duly hung on the drip stand, the nurse, by pressing buttons on the battery-powered “brain” attached to the stand, set up the rate of the drip and that, essentially, was it for now. In due course, she checked my blood pressure, temperature, pulse and blood oxygen level but my wife and I were largely left to our own devices to read, reflect and observe over the next two hours or so.

The word “devices” is used advisedly, as my wife is enjoying the Kindle I gave her for her birthday a few weeks ago and I have my iPhone loaded with listening material. While I was aware of the creeping sinusy sensation in the bridge of my nose and forehead that is the trade mark of the drug, it did not prevent my enjoyment of a recorded series of seminars given by two philosophers from Oxford University in response to The God Delusion by Richard Dawkins. I had started listening to this while hospitalised last September, but it had been elbowed out of my attention for a while by the likes of The Sopranos, Mad Men, The Killing and Spiral (the last two being police dramas recently televised by Auntie Beeb, one Danish one French, both superior to much of what is offered in our native tongue, whether British or American). For some reason the measured responses to Dawkins—one sympathetic, the other respectful but at variance with The Great Atheist—were the perfect entertainment for these moments. Not escapism, I venture to plead, as I was completely aware of my surroundings; it felt more like an assertion of mental independence against the constant pressure to think of my disease and its immediate and longer-term ramifications.

I am not going to break the confidentiality of my fellow patients, of whom there were quite a number on this busy Monday, but will just note that a well-run care unit such as the one—thank you, thank you, thank you—I was fortunate enough to be treated in today is a powerful place to observe human interaction and interdependence. There was a diversity of ages, backgrounds, confidence, temperament and need among the patients; the staff are in turn very mixed in race, age and expertise (although it was notable that many of the staff were in their twenties). It was very apparent that a number of patients had had a more bruising encounter with The Big C than has (so far) been my experience and their fortitude was a powerful encouragement to press ahead with my care plan over the next weeks and months. The staff went about their work with quiet efficiency and great personal warmth. I wished I could have used my camera to capture, say, the intent angle, of a nurse’s head and neck as she bent to inspect a patient’s arm or came down to eye level with someone who was having a particularly rough time with side effects.

Don't go it alone – we need each other!

It was all over soon enough and I was unhooked and given some anti-emetic pills to help me through the next couple of days when nausea is at its height. I also took some more Mesna in tablet form and was given another dose to have at home at 5.30pm (the timing of this drug is precise). In the goody bag was also a number of pre-filled syringes to give myself a daily injection of G-CSF between now and the time of cell harvest next week. This stuff, you will remember, stimulates the production of stem cells in such numbers that the little fellows just can’t wait to escape the confines of the bone marrow and swim in the flowing channels of the blood. Unfortunately, as they mass in the marrow there is the likelihood that they will cause pain in my bones as well as lead to swelling of the spleen and I have been particularly warned to watch out for pain on my left side. I will keep you posted. My next scheduled visit to Day Care is for a blood test on Tuesday 12 July.

I had been given an NHS sandwich and cup of tea (not great; they did the trick though) but my wife was famished and so we took a detour via Sainsbury’s in Tottenham Court Road to buy a rather more appetising sandwich for her, together with some crisps for me (yes, I did share) and some fruit juice. We sat in the shade in Euston Square and relaxed a bit before taking the trains home.

Euston Square today.
Your blogger's feet and goody bag are visible as is a Big Issue seller by the lamppost right of centre.

My sister-in-law called by on her way home from work, having only yesterday got back from a trip to her parents in Australia. She told us about a fascinating guided train journey she had taken with her folks and one of her sisters on NW Queensland and extolled the virtues of Melbourne, nearer to her native South Australia, where her son is currently working in medical research. Sitting in the warm early evening sunshine was a good way to unwind. We also spoke of our son’s wedding, that took place on Friday 24 June. Here is a picture of the happy couple.

A symbolic representation, you understand.
They are standing on one of the number of to-do lists that appeared in our house as the great day drew near.

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