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Thursday, August 15, 2019

DAY 072 -- "Get ON With It!"



Triage.

Simple definition?

“The assignment of degrees of urgency.”

The core of my professional life in medicine has always been thus; it’s the crux of my work in the nursing biz.


Triage.

Where should I start, where should I end, and how can I do the least amount of harm along the way.

Today, as a cancer patient, it’s moved from crux to credo.

Recent degrees of urgencies:

Constant pain in my right side, bad enough to send me to the emergency room. After the mandatory (necessary or not, but always done) ECG, then a CT scan of the offending flank.

Bad news from the scan, and now the hit single at the top of my reverse-order billboard: spots/shadows on my liver that weren’t there a few weeks ago. My oncologist arrived to discuss it. Not a good doctor-face.

Some of my pain could be from constipation, along with the fresh tumors. And, because of these “inoperable” liver urgencies, we’ll probably not radiate the lung/lymph node, and will instead shift to other courses of chemo drugs.

I felt like a fisherman who’d run out of his favorite doughball bait, and would have to settle for dead worms.

Fast forward a few days running in place (easy, if you’ve ever hit the brake and accelerator simultaneously):


Back to the hospital lab after calling-in my signs & symptoms to the Doc: a low-grade fever, concentrated urine, increasing fatigue, muscle weakness, some shortness of breath. He said to come in and drop off blood and urine. The pee came easy; the blood took a few sticks. (We had to postpone the IV port earlier due to some other little urgencies, so the repeated probings and pokings go on.)

I received a phone call an hour after leaving the lab: please return to the emergency room for blood cultures, more x-rays,  and a transfusion.

Well, hell, why not.

How about a brainectomy while we’re at it. And, let’s throw in an awfulplasty and a fuckinostomy to be on the safe side.

Yes, I’m discouraged. I don’t like shifting gears on a horse of a different color in the mid-stream of a mixed metaphor.

Dammit. Before today, I’d thought I’d known where I wasn’t going; now I don’t, and my timetable is yesterday’s no-news.

One transfusion and a few more reassigned and revamped urgencies later, I went home to hang up a new mental triage game board, the kind that I hope will accommodate doughball darts.

(Point of order: my computer's spellchecker wants to keep correcting "urgencies" to "insurgencies." Smart computer.)

Next week, when we get the latest MRI results of my brain tumor, along with the CT scans and new x-rays of my lung and liver tumors, the docs and I will have to switch chemo baits again and move my bull’s-eye.


My top takeaway from all this: “A compromised immune system can mask symptoms.”

Great. Now I’ll also need some new disguises.

Right now (for the Monty Pythoners among us), I’m Graham Chapman’s Colonel, interrupting myself in this increasingly improbable skit, pronouncing me and these fracturing metaphors as “Too silly! Get ON with it!”

More as we go, El



Thursday, July 25, 2019

DAY 071 -- "Under My Wings"


Before chemo infusion today came the three-month follow-up look-see at my upper innards.

Whenever my oncology Doc wheels out these before and after tumor comparison studies, I feel like an anti-advertisement for quack medicine wrinkle cream:

Yes, folks, there it is:

Before treatment? This big.

After treatment? Bigger.

But, as we found in the pre-findings on Day Seventy, there are no NEW spots in there, so we’re at least keeping it localized for now. Doc points at the screen to the trained-eye visible nuance of change in the tumor; I pretend that I see it. Sometimes, progress is when the horizon moves closer as I sit still.

Sometimes … what we see and what we want to see is a quiet tantrum in the background.

The chemo drug side effects are more of a nuisance and more tolerable now, perhaps because they’re less mysterious. I’m a friend with fatigue, a buddy to my bowels & bruises, an ally with my appetite, and mentor to my moods.

The latter have become pesky, as my emotions don’t always listen to my advice. They’ve trusted me up ‘til now, but they’ve become quirky, sometimes raring up when they should rest, and going dark when they should be bright-eyed.

It’s become the main event in my counseling sessions.

Yes, I’m being unfairly sidetracked by chemically-induced interlopers who make up their own rules. My job? Change the playing field.


Next up? Looks like more radiation treatments in the offing, and we’re having another MRI look at my brain tumor in two weeks, just to see if it’s remaining a miniature sleeping giant as my lung keeps center stage.

I’m also getting a power injectable IV port because of these repeated failed and/or difficult IV sticks. For the infusions, blood draws and contrast mediums needed, it’s time for a handy one-size-fits-all site, into a vein in my chest below the collarbone, near my one and only tattoo.


It will be inserted next week, and I’m hoping they can place it in the fading Pegasus.

Just under my wings.

More as we go, El   



Thursday, July 18, 2019

DAY 070 -- "A Radiant New Garden Plot"


Today, I’m going with a few simple language quotes on my lung tumor follow-up CT scan results. No flowery phrases. Let’s get right into the weeds:

The preliminary results were delivered via phone message recording from my oncologist Doc (I was out in the garden when he called).

Mixed results. Some roses, some buckthorn:


·        “Not a whole lot of change.”
·        “Still a large lymph node, but slightly larger.”
·        “No new spots.”
·        “Results sent to radiation oncologist.”

Diane later spoke with him, and he whacked the weeds down a bit:

There hadn’t been a big difference in my lymph node cancer site since the last scan, and though it had increased slightly in size, there was no apparent NEW growth in the garden (metastasis anywhere else). He is getting a consult from radiation Doc, who administered my first round of treatments that began on DayTwo.

Seems like only a million perennial gardens ago.

I can’t remember who said it, but I was once told that “a flower garden should undulate, not march.”

I’ve tried to live my life that way, though I’ve been known to rigidly walk in lockstep when I should’ve romped, pinwheel with abandon when steady pacing was called for, or follow the leader when taking the point was the better part of valor.

Today, yes, I’m taking a moment to stop, smell the weeds and pick a few flowers.

Along with the chemotherapy, a targeted one-shot radiation treatment might also help to plant and cultivate because of how my tumor is now presenting.

I choose to think of it as an anti-fertilizer.

It just might keep me marching along in open field formation, but still undulating in my own closed yard cadence.

Next week, another round of chemo … and designing a radiant new garden plot.

More as we go, El




Monday, July 1, 2019

DAY 069 --"Hippocratic Magic"


Sometimes, when it’s me, it’s me.


It’s not someone else’s negligence. It’s not the neighbor’s pranking kid. It’s not a falling anvil. It’s not the notion of an act of God (and notions are about as far as I ever get with Godly notions of wispy divine interventions).

No, sometimes, I just screw up. This wasn’t a big boner, but when she saw the bloody dressing from my chemo treatment today, it did bother the bejeebers out of Diane. “You could have exsanguinated! That’s not funny!”

I attempted a classic soothe: “Oooh, I love it when you talk bigly, but you know I’m a good clotter.” (True, lately my blood counts, especially what I call the blue values of my reds & whites have been on the low & high sides, and we should honorably mention my daily home blood thinner belly injections. Any bleed needs a little extra attention).

Then, my bridge-too-far personality took hold, and despite me I had to add: “And, whoosh, honey, it could’ve bled through the new Harley jacket. Oh, the horror! I checked my sleeve, though. All okay!”

She surrendered with a classic eye-roll, knowing that I was incapable right then of seriously taking her seriously taking me serious serious (I know … clunky, but grammatically correct.)

And, just as an inkblot whatzit away, when I look at it I see a red puppy chasing an oversized hairy egg. Diane sees a moose backing up. Neither helps this case either way.


Since my last chemo, I’ve had some outboarding innards with a little too much wake; some tidal fatigue, a few sidebar headaches, but otherwise I and my daily pursuits (and evasions) have been largely unreportable as being driven by anything cancer-ly. I’ve passed the days and nights as part of the minor majority.

Today at chemo infusion, my oncologist instructs and informs:

--Down-tweak daily prednisone dose.

--Status quo everything else.

--Repeat CT scan of my lung tumor in ten days.

--Up-tweak chemo doses at next treatment

--For the lab rats, my fucking magnesium is 1.6. mg/dl.

--For me, I’ll never again use “status quo” as a verb.

I did press him today about THE issue: where is my Stage IV cancer and where am I in it? He recoiled invisibly. I saw it, because I’ve done decades of nursing care for terminally ill patients and I’m old friends with what isn’t seen or heard at beginnings and endings.

I asked him all the lethal questions that all Docs don’t want to answer and patients don’t want to ask. I know. It was unfair all around:

Unfair to him, because Hippocratic magic is always cloudy. Unfair to myself, because my need-to-know brain lately has been pounding the ground of my worried heart.

He’s a good doctor. He answered through the clouds.

I’m a good patient. I listened in the earth.

More as we go,
   El



Monday, June 10, 2019

DAY 068 -- "Bantu The Sailor Man"


Ta-Da! (just because life needs more “ta-da’s!” these days).

Returned to chemotherapy today, and we did resume the regimen with a couple of med dose changes (as we’ve discussed, doc is playing it conservatively, onco-walking the I&I tightrope (Immunosupression or Infection), and my side-effected innards are almost back to normally outwards.

Some of my lab numbers are low, some high, but we needn’t get specific, unless you’re med-geek driven by hard data. For those amongst you who simply must know, let’s take my basophils, one of the several types of white blood cells we all have.

My basophils count today is 0.0 (it should register between one percent and two percent of my WBC (white blood count), coming in at zero to 0.3 cubic millimeters.

Basophils too low? Higher risk of infections.
Too high?  Lower immune power.

That’s the I&I highwire: my always walking and sitting two-tiered pyramid.

One backstroke bug in the soup today, as my IV insertion site blew (it happens) and the site infiltrated quickly. The fluid went off into the tissues, and because I was distracted at the time, wracking my brain for the five-letter answer to my ever-present infusion unit crossword puzzle, the clue for “Zulu language group,” I didn’t notice my arm until it looked like half a topside Popeye.

But, strong to the finich, and without the spinach, I recovered. Hot packs were applied, and a new site, opposite arm (four attempts and three nurses later), was inserted. Pre-meds and chemo drugs finished running-in successfully, and before I left  the unit (for the crossword geeks who I’m sure were one hand and arm ahead of me here), “Bantu” popped in my head and I finished the puzzle.


I took the rap for the arm bomb. I’m guilty of not drinking enough overall (more important when cancer and cancer treatments are in the big mix), thus my blood plumbing isn’t as optimal as it might be.

BUT, we’re back in the treatment groove, balancing in the air.

I biffs ‘em and buffs ‘em
and always out roughs ‘em
and none of ‘em gets nowhere

… I’m Bantu the Sailor Man.

More as we go,
   El






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