Friday, October 15, 2010

#265: Blood Will Have Blood

My niece is reading the Scottish Play in high school. She's hating it, which leads me to think that she needs a better teacher. We read R&J in school, and Hamlet, but I think we would have all preferred Mr and Mrs M.

Blood has been an ongoing theme for me during my illness. They started drawing blood from me back in March, and I don't think I've gone a week since then without giving up at least a vial of the stuff. Funny thing is, they aren't looking for cancer, they're looking for the damage that the treatment might be doing. I have come to trust the phlebotomists at the Markey Center. We know one another and joke together. They are real pros. Now and then I get someone new. Before they stick me, I always ask the same question. "Are you a good shot?" I have found that the confidence level in the answer is a pretty good indicator of how things are going to go. One tech who answered, "The best!" was so smooth that I didn't even feel the needle prick. Another who answered, "I think so," stuck the back of my hand 6 times before calling for help from a nurse who slipped the butterfly into place on the first gentle shot.

For about a year, I've been taking medicine to regulate my "blood pressure." I confess, I have no idea what that expression means. Since I don't have more or fewer vessels, it seems like high blood pressure must mean I have too much blood, but leeches have never been prescribed. They just give me these tiny little pills. One of the most severe symptoms that led to the diagnosis of my pulmonary embolus was that my blood pressure crashed when I stood up. It dropped about twenty points. That's what convinced the docs to send me for the CT scan that revealed the clot. Now, I find that dehydration can affect my blood pressure. If I don't eat and drink enough, I can get dizzy and even pass out. After years of therapy to teach me to deal with too much pressure, I find out that not enough pressure can be just as bad.

For a couple of weeks, I was going in every day to receive two injections of blood thinners in my belly. Dee, the cancer team leader, started calling me "My little pin cushion." Here, too, different techniques had different effects. Sometimes there was no sensation at all. Other times, the shots burned as if they were shooting anti-freeze into me. My stomach was covered with tiny bruises, an effect of the blood thinner they were using to break up the blood clot. The nurses who made a big deal about the shot, warning me when they were about to stick me and being careful not to inject it too fast were usually the ones whose shots were the most painful. I finally asked them to stop saying, "One, Two, Three, Little Stick." because I always clenched up my muscles on "Three." I'm not sure why they do this. It always makes it worse for me.

There was also some blood in places where it didn't belong. When I woke up after my surgery, there was dried blood in the hair on the back of my neck. Mrs P told me that they had some trouble controlling my bleeding on the table. There was also a little plastic bottle attached to a tube that was sutured into my incision. This was a drain to allow excess fluid to escape. A nurse would come in every few hours and empty the bloody stuff and replace the bottle. There was plenty when they pulled all my teeth out. As they were rolling me out after the extraction, I upchucked in the hall and left a bloody trail all the way to the men's room. That happened again a few weeks later in the chemo infusion room, though I'm not sure we ever established why. I leaked around the PEG tube, when it was new. And the little incision where they put in my IVC filter stained a couple pairs of drawers.

Though the cancer didn't do much to my blood chemistry, the medicine has. During Chemo and Radiation, my white blood count plummeted. It was so bad that they had to cancel the last Chemo treatment. Since they found the clot in my chest, they've been using drugs to manipulate my platelet count so my blood doesn't clot so easily. The bad news here is that I now bleed with the greatest of ease. The slightest bump leaves me black and blue, and the bruise stays for a long time.

On Tuesday, a new nurse drew my blood. She assured me that she was a good shot, and she was, hitting the vein on the first try. Thing is, she forgot to close the end of the butterfly and I started bleeding out through the needle. By the time she had the cap in place, there was blood running down my forearm and pooling in the  vinyl pillow under my elbow. After removing the cushion, she cleaned me up carefully. No harm done. While she worked, I contemplated the little puddle of fluid on the plastic pillow. Such a lot of fuss over something so simple. This was the juice that carried nutrition and oxygen throughout my body. It served to cleanse new wounds and to heal old ones. It had helped me to fight off infection during my treatments. It had almost killed me by clotting up in my legs and nearly blocking the blood flow to my heart. My own blood had brought me closer to death than the cancer ever did. All that power in a tiny red puddle.

Today, my blood is still pretty unstable. They can't remove the PEG tube until my platelets are right. No sense in pulling out the hose and causing massive internal bleeding. They check me weekly and adjust the medicine accordingly. Sooner or later, we'll get it right. Yesterday they shot me with a radioactive isotope of some kind for my PET scan. I'll have results from the scan on Monday. Meantime, my famous blood can be found with a Geiger counter. My blood continues to be a topic of great interest to my caregivers. They'll probably keep taking it and studying it for as long as I live. A friendly nurse draws a vial or two or three or four. Those are sent to an anonymous stranger in "the lab." A few minutes later, a sheet full of numbers comes back to my doctors who are able to tell many things from the columns of figures. It's a mysterious process.

Almost as mysterious as the fluid whose secrets it is meant to unravel.

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