No Fair

BOX SCORE
Element	Current	Std. Range	Trend
Hemoglobin	10.7	13-17	v
Platelets	38	140-375	^
ANC	190	1800-8300	v

There is a scene in an episode of the classic TV sit-com M*A*S*H where Major Burns learns that, after a brief time as Commanding Officer of the 4077 when Lt. Col. Blake left, he is about to be replaced. Company clerk Corporal "Radar" O'Reilly, who is the company mail carrier, is in a panic about presenting the new orders to Maj. Burns, who a) doesn't like enlisted personnel and b) has been champing at the bit for the opportunity to remake the 4077 into a strictly G.I. unit, ruled by his iron fist. Capt. BJ Hunnicut, and Capt. "Hawkeye" Pierce, two of the camp surgeons, who are very protective of Radar, go with him when he presents the orders to Maj. Burns. 

They encounter Maj. Burns and Maj. "Hot Lips" Houlihan, the head nurse who is cut from the same cloth, in the mess tent. (The two majors believe no one is aware that they are having a torrid romance. Everyone else in camp knows all about it.) To everyone's surprise, Maj. Burns is perfectly calm upon reading the orders. "Hot Lips" expresses her outrage at this turn of events. Maj. Burns calmly explains to her that "this kind of thing is not uncommon" because "we are just cogs in the military machine" who are expected to follow orders blindly. 

As Burns and Hot Lips leave the mess tent so that Burns can "prepare for the change of command," Hot Lips tells him how proud she is of him for handling this disappointment so calmly and professionally. They proceed to her tent, where Burns sits down, takes off his helmet and throws it on the floor. Then he stomps his feet violently, like a toddler throwing a tantrum,  and loudly whines, "It's not fair, it's not fair, it's not fair."

Sometimes, I am very much able to identify with that emotion. A case in point is my lab results during this chemo cycle. With the exception of a 4 day period during the injection phase of my chemo therapy, when my platelets climbed into the "standard" range, my labs have all been below normal. It's frustrating, because when my platelets are low, I feel unsteady on my feet, and when my ANC is low I need to be quarantined. (I have grown accustomed to being a bit anemic.) My knee jerk reaction is, "It's not fair, it's not fair, it's not fair." I so want to be able to visit with friends and keep up my habit of walking two miles daily. 

God is so gentle with me at these times. He reminds me that he has delivered me from 99% of the awful side effects that the oncology team has promised that I would have. I have never once, in a year and a half, had a temperature over 98.6. I have not experienced nausea and/or vomiting. Never have had sores in my mouth which are common with the types of chemo therapy I have had. I was warned on day one to expect to deal with all of these things from time to time. And so, along with the Psalmist, I am able to refocus on the fact that 

The Lord is my rock and my fortress and my deliverer, my God, my rock, in whom I take refuge, my shield, and the horn of my salvation, my stronghold. (Psalm 118:2)

Occasionally, God allows me to experience an episode that, perhaps, is designed to keep me humble. After all, things have gone so well for me with all of these treatments, that I sometimes think I am invincible. This past week brought one of those times. 

On Wednesday I noticed that some skin came off of the scar where my vascular access port (VAP) was inserted under my skin. I didn't think too much about it and covered it with neosporin and a Band Aid. I knew I was going to see a nurse the next day who could check it out, in case something needed to be done. At that appointment, the area looked much worse. It was larger and kind of cratered out. The skin around the perimeter appeared to be sloughing off. Nurse Francisco and Jill were pretty alarmed. 

Francisco took some photos to send to the infusion surgery department (ISD) for evaluation, dressed the wound and told me to expect a call from ISD. By Friday morning, the wound looked much better to me, but still was a concern. You may be aware that staphylococcus infections are very common in hospitals, mainly because so many of the patients are immunocompromised and because eveyone's skin is covered with this strain of bacteria to one extent or another. In my case, with my ANC at the extremely low level of 200 and no call from ISD (remember this was on Friday), I decided to call the oncology office. Around 10 AM I left a message for Suzanne, Dr. Brow's case manager RN. She finally was able to return my call at 3:45 PM. 

I was instructed to go the ER to have the wound evaluated by a physician. Jill and I are no strangers to ERs, since I have needed several transfusions after hours in the past. We find the Salem Hospital ER kind of frightening, because although the clinical staff are all capable and professional and upbeat, they are usually overwhelmed with patients in a facility that is showing its age. Typically, we have been registered there immediately, only to wait several hours to be escorted to a treatment room. In the meantime, we are thinking, "What's wrong with this picture? Tom is immunocompromised, sitting in a room full of people coughing and sneezing. What could possibly go wrong?" 

So, on Friday we opted to make the hour+ drive to Kaiser's Sunnyside Hospital in Clackamas. Fortunately, the oncology department called ahead and told the ER staff to be expecting us. We were checked in quickly, and before we could find a seat in the waiting area I was called for vital signs and escorted to a treatment room. A blood sample was drawn, and Dr. Holly came in to look at the wound. She contacted the oncologist on call, and the decision was made to give me a dose of IV antibiotic medication and a two week course of oral antibiotics. These medicines are expected to prevent a staphylococcus infection, or worse, septicemia, a potentially fatal infection of the bloodstream. Since there was no palpable sign of infection, the wound was dressed, and Jill was able to take me home. 

The next morning, the wound looked a bit better, like something that would heal up in time. I replaced the dressing, after cleansing the area with Betadine, per Dr. Holly's instructions. Sunday morning the wound looked OK, but the scab came off with the bandage followed by some minor bleeding. I dressed the wound again, as instructed. 

Monday morning is blood draw day. The nurse this morning took more pictures and put a new dressing on the wound. She contacted oncology and they advised not to use the port until the wound heals up. Off we went to the lab, where blood was drawn from a vein in my arm. The results are posted in the Box Score.

So, the week that we expected to include two blood draws as our only medical obligations morphed into something more complicated. Until the wound heals, my port will be in mothballs. But you know what; in the bigger scheme of things that seems fair.