T+24 Humility

BOX SCORE
Element	Current	Std. Range	Trend
Hemoglobin	9.6	13-17	v
Platelets	114	140-375	v
ANC	1000	1800-8300	^

Once in a while, things that happen are just, you know, not what you would choose. The more years that pass, it seems like those things happen twice in a while, or even more frequently. Have you ever noticed how that kind of day seems to start with one little error and then builds on itself? Take yesterday, for example. 

Well, let me back up a bit. Yesterday was Day T+23, twenty three days since my transplant was completed. Since then I have been taking more pills than I can count, except for the days when, for what ever reason, I didn't put all the pills in the pill box chamber. That has happened a few times. I realized on Day T+22 that I was having trouble managing all of those pills, and my supplies are running low. To make things a little more challenging, I am navigating two health care systems, Kaiser and OHSU. 

Kaiser has a great oncology department, but they don't have any transplant oncologists. Consequently, when bone marrow transplant (BMT) became an option, Kaiser authorized the care to be done at OHSU, a teaching and research university program. The partnership works really well, but after the initial month of treatment, during which OHSU provides everything needed, the responsibility for pharmacy services and drug provision reverts back to Kaiser. That means all of those prescriptions have to be transferred to the Kaiser pharmacy. My OHSU oncologist can write the prescriptions, but they must be filled at a Kaiser pharmacy. The changeover is happening now. 

In order to manage not only the changeover but also the 14 or 15 different medications, I decided to make a spreadsheet on my computer to keep track of things; things like which drug to take, when to take it, how many tablets to take for each dose, and how many doses of each drug remain. It is bad policy to run out of critical drugs and have to wait 3-5 business days for them to be delivered. The spreadsheet is helping...kinda. 

Yesterday was the first day I tracked each pill that went into my mouth on the spreadsheet. In the morning, as I took each pill, I entered it. The spreadsheet keeps track for me of how many pills I take and how many should be left in each bottle. What it doesn't do is tell me special instructions. 

There is one medication, Tacrolimus, an anti rejection med, that comes in two different dosages, hence there are two different pills. I take one pill in the morning and one at night. On mornings when I have blood draws, usually Mondays and Thursdays, I am supposed to hold my morning dose until AFTER the blood draw, so that the lab can measure the level of that drug when it is at its lowest. But yesterday, as I focused on using the spreadsheet, I forgot and took the morning dose. When I realized it, I felt like a real stoop. Did you know it is impossible to undo taking a pill? 

We went to the clinic, where I explained what I had done to the RN who was caring for me. Edd was very understanding and assured me this happens and is not a disaster. He arranged for me to return to the clinic this morning and have the blood draw redone. 

Nevertheless, I was upset with myself, which of course only made things worse. Now at this juncture, you may want the children to leave the room before continuing to read. 

Edd asked me to take a little bottle to the rest room and provide a urine sample. The instructions were to release a little urine into the toilet, stop, fill the bottle, stop, and release the rest into the toilet. East peasey, right? 

Well, here's my rendition. Grasp bottle in left hand, release a little urine into the toilet, stop...no STOP... OK there, almost. Now...what the? Why didn't I take the lid off the bottle? Quickly remove lid...drop it in the toilet...release a little onto the right hand.., no, no... in the bottle, stop...STOP; fill the bottle; release remainder into the toilet. Carefully remain in front of the sensor for the automatic flush mechanism so the lid doesn't go down the drain. While holding full bottle in left hand, retrieve lid from toilet bowl with right hand...no, don't spill. Place lid on bottle (Notice flushing sound...at least I got the lid in time) wash bottle, wash hands. Step to automatic towel dispenser; wave hand to start towel deliv...wave hand to start tow...Retrieve shredded paper towel remnants and place them in waste basket. Return to treatment room; wash bottle; wash hands; wave hand in front of towel dispenser. Tear off towel; dry bottle; tear off another towel; dry hands. As I said, "Easy peasey." But not what I imagined for my morning. 

Thank the Lord, "God opposes the proud but gives grace to the humble." (James 4:6)  Trust me, I was humbled, baby. I was humbled.

After this interlude, I received 4 grams of magnesium via IV. Dr. Meyers came in to review my progress, with which she seems very pleased. She had me pick up an OTC magnesium supplement to reduce the need for so many magnesium infusions. Tomorrow after online church, we plan to make a trip to the Kaiser pharmacy to pick up the meds that Dr. Meyers has ordered for me. I will tweak the spreadsheet to help me remember to hold the Tacrolimus dose in the morning before labs! Should be a lovely day... if we don't drown during the 1"+ rainstorm!