I apologize for getting off schedule this week. I have another pesky viral episode – head cold, sinus infection. When I haven’t been chilling, I’ve been sleeping. So I am just going to slip in an episode from my journal. I hope to be back on schedule in a day or two.
JOURNAL: MAY 2002
Monday morning, April 8, finally came. I had called the doctor’s office on Friday to inquire if I was scheduled for labs. I was told there were no labs ordered and that Dr. Markham did not typically order labs for a bone marrow biopsy. I suggested politely that Ray was out of town when I made the appointment and that we needed to monitor my blood count at the very least. They said that they would call him but cautioned that it would be late in the day. Later they called to say that indeed Dr. Markham had added a number of labs: complete blood count, serum creatinine, liver function tests and LDH.
After the labs Tish and I went to sit in the waiting area, but Donna the Peach soon took us back to the “bone marrow room”. Ray did a quick interview and exam. Then I lay prone on the exam table. Donna, who had wanted to help me in the bathroom months earlier, was there to assist. Ray asked Tish if she planned to stay in the room. He agreed that she could stay but only if she did not get up from the chair during the procedure.
The lidocaine stung as it always does. I tell every physician now about adding sodium bicarb solution to the lidocaine to reduce the stinging effect. I was not particularly anxious about the procedure. I myself had assisted with hundreds of them. Throughout most of the biopsy I was only aware of dull pressure sensations. The first real pang of pain that patients feel is when the physician pulls back quickly on the large syringe in order to draw out the marrow. Ray warned me as he was ready to aspirate but I felt almost nothing. I heard him ask Donna for another syringe which signaled some small technical problem. He did not get much marrow he explained which is why I felt nothing. I knew that his next attempt was more successful because the short but sharp pain arrived as promised.
Having my doctor as a captive audience, I talked and asked questions throughout – not to distract myself, but because of the real though ironic social aspects of the situation. The last part of the procedure involves withdrawing the long aspiration needle – this is when I was aware of blood dripping down my side – and replacing it with a hollow needle about the size of a large nail. This device has a T-shaped plastic handle that gives the clinician leverage to torque and twist the sharpened point down through the hard surface of the bone into the more porous marrow itself. As the needle found its way home, the pain returned sharper still. The clinician withdraws the needle, holds it over the solution-containing cylinder the nurse is holding, then with a thin rod pushes the core of marrow out the hollow end. Ray described this specimen as “spectacular” which indeed it was, measuring nearly an inch in length. A dressing to the puncture site and I am instructed to lie quietly on my back for fifteen minutes in order to apply pressure to stop any further bleeding. Before she leaves the room, Donna squeezes my hand and assures me that the results of the biopsy will be good.
My counts have come back by the time I am ready to leave. Ray returns to the room to tell me that my hemoglobin is 7.9, below the arbitrary level of 8.0 at which transfusions are typically ordered. I agree with Ray that the Procrit is not producing stellar results. I have been off treatment for nearly a month and have taken a Procrit injection each Monday since. While arrangements are being made for my transfusions, I go to the treatment area to be weighed. We see several patients that I know including my candy lady with the knit cap and talk with them. I talk with Brenda, the other clinic nurse. Donna tells me news of Susan’s husband who has been in ill health.