Letters from Israel II

HAPPY 33rd ANNYVERSARY, Hon!!!!! First one celebrated apart and hopefully never again (apart, I mean ;-) )
MONDAY Dec. 22nd, 3AM – WHERE DID THE WEEKEND GO?

One of the highlights of the trip to-date was breakfast.
The breakfast buffet in the hotel is a welcome experience. A copious array of salads and cheeses along with freshly-scrambled eggs, scones and small cakes stuffed with herbs and chicken greeted us. Apples, oranges, grapes and persimmons along with about 5 different types of cereals flanked by jars of different teas graced another serving table. We are told this is a typical Jewish/Mediterranean breakfast and a definite treat for all guests. A great way to gather momentum through the day and did we ever need the pick-up and energy boosts.

One take-away for the ages from these past three days is to understand the meaning of patience – in terms of Titi’s illness as well as the modus operandi of the hospital staff with a healthy side-helping of Murphy’s Law thrown in for good measure.

We did not trek to Jerusalem on Friday as planned. Titi’s external pain centered on his buttocks returned and he’d rather take it easy and rest, staying put in room 23 and get adjusted to his surroundings. It turned out to be a beautiful day, about 23degC and sunny so the rest of us decided to walk the half-hour or so to the sea shore where the Mediterranean awaits.
( see picture)
The azure waters that greeted us on arrival was as calm as the panorama was wide. Sailboats dotted the horizon like fluffs of cotton and grew bigger as we hurried on down through the park to the shore.
Mimi and Nicky and I opted to walk along the shore in the cool water while Lek decided to stroll ahead on the pavement and wait for us at the pier rest stop. After a respite of water and sodas, Nicky wanted to go one more round to collect the remainder of the seashells he might have missed and to select the best one for his Papa.
We stopped for lunch at a corner restaurant where bottles of ketchup and mustard were sighted – sure sign of hamburgers and other familiar food. Servings of salads and burgers turned out to be huge to assuage the price of each order. The pasta given to us for tasting turned out good so we ordered one to go for Titi. The excuse to take a cab was there to get the food back to the hospital while still hot and indeed we arrived in good time and Titi was in good spirits although the nagging ‘pain in the ass’ was persistent. Jet lag finally caught up on Friday afternoon.

Saturday morning, we made plans to attend mass. It was the anniversary of Malika’s death as well as Shabat here in Israel. Titi was dressed and determined to come along – it was his first outing in more than 3 months. The church, St. Anthony’s, was in Jaffe- a ten minute cab ride away. There are no Catholic churches in Tel Aviv – a relatively new city some two hundred years young while Jaffe, also a port, existed a couple thousand years ago, an Arabic cab driver residing in Jaffe told us.
The exterior of the church seemed imposing but friendly while the interior retained the traditional gothic structure with high-domed ceilings and tall stained glass windows. The parish was ninety percent African, Asians comprised the rest of the church goers that day. During the offertory, accompanying the cruet of wine and chalice being walked up to the altar was a long possession of people carrying baskets of fruits amidst a joyous and raucous African hymn accompanied by bongo drums and cymbals. A truly moving and thoroughly in the mood experience.
The church gradually became packed and the some people started coughing in the pew in front of Titi so we decided to leave after receiving Holy Communion. The host was dipped in wine and offered directly to the mouth. I tried to initially receive it in my palm first but was denied the acknowledgement. Hopefully Titi did not catch any extra germs when he received the host, I thought.
After mass, we started walking back to the center of Jaffe and stopped at a bakery where bread of all sizes and types and pizza slices streamed endlessly out of three ovens and efficiently passed onto waiting patrons. We got a smattering of everything that looked and smelled good and ducked into a cab back to the hotel where lunch was summarily served by Lek and Mimi. I taught Nicky ‘kitchen patrol’ (I washed and he dried) the night before and he good-naturedly resumed his initiated role.
Ti developed a sore throat in the afternoon to accompany the insistent nagging pain. He mentioned it to the attending doctor/intern.
At about 3am Sunday, the pains in the throat and butt was so severe that he could not sleep. The hospital could not do anything about it because his protocol had not been drawn up and no drugs could be prescribed as such. Patience in this case was accompanied by extreme discomfort.
Sunday morning saw Titi’s extreme discomfort continue amidst the start of the work week for the hospital – government run and consequently a mad-house of activity with a shortage of doctors and nurses overwhelmed by the onslaught of patients post-weekend medical needs. He was sent downstairs in a wheelchair to the ground floor to see an ENT specialist for his nagging throat pains.
The patience here was evident as he was made to wait for his turn amidst scores of patients with coughing and sniffling fits.
He had developed a fever of 38degC accompanied with chills (the teeth chattering kind) which precipitated a flurry of blood checks and pain-reducing drugs. His protocol will start in the planning stages when his condition is stable and fever-free. The main things to accomplish for the next few days is to check from his blood and bone-marrow that he is free from sepsis and internal infection (one and the same, I think), a ‘hickson’ (central line) be installed and protocol method selected among the attending staff. Accordingly, the road map outlining and explaining his protocol would have to wait.
However, my donor protocol would begin on Christmas day- would be four days of Neupogen shots (2/day – 12 hours apart) and 2 days of apheresis (external harvesting) PLUS a bone marrow harvest for good measure (not looking forward to that last one).
In the pm, after his bone marrow biopsy, he remained blurry and out of touch for a while and even though hungry, could not bring himself to swallow because of the pain in the throat. He was given additional and new external gel appliques and drugs to try to counter the growing pains. After dinner, about 8pm, Lek called me to say that Titi’s fever had returned and the attending doctors seemed nonchalant on hearing about Titi’s developing condition.
( I was previously ‘advised’ by Prof. Slavin that afternoon for being too strident in my advocacy of Titi’s treatment and that he had every confidence in his team as well as their experience in dealing with such critical cases and that we were ‘on the same team’.)
Nevertheless, I went over to his room after the phone call and found him shaking and shivering and wanting to know what his temperature was. I walked back out into the nurses’ station and found all of them sitting around, some seemingly busy, others obviously relaxing. One of them, Ashraf, got up after I told them of Titi’s condition, went inside and asked whether Titi can take solids. Very difficult was the answer, so Ashraf said he would come back with a liquid drug and stuck a thermometer under his left armpit and said that he would be back in TEN minutes to look at it. In the meantime, Titi had draped and kicked off layers of blankets, went to the bathroom (with the thermometer in tow) and layered and kicked off some more blankets. About twenty minutes in total, I estimated.
I walked outside. There was only one nurse around, Ashraf was no where – presumably to get the drugs, I told myself. I walked inside and took out the thermometer and glanced at it. 40.5degC was what I saw.
In a daze, I walked outside with the thermometer and told the nurse the reading. Oh, was the calm reply and for the next endless 3-5 minutes, I watched her try to find Ashraf, dialed a few numbers and hung up on all of them. NO interest in answering whatever the condition, I thought. Just then, Ashraf came through the doors with another intern, break over, ten minutes (or was it over twenty) up and back to work. He grunted when I showed him the thermometer and proceeded to go inside to administer the pain killer he had . Titi had requested to take Tylenol but he had to take what was prescribed.
After a while, Titi was peacefully resting and I left, all numbed from the extremely high temperature reading and the seemingly non-chalance of the hospital staff. They have seen and experienced so much more of this than I, so I thought and that is why things seemed under control to them while all hell was breaking loose in my mind.
Lek was supposed to call re new developments, if any, later on tonight.
It is now 4:30 am. Think I will draw down that second cup of coffee and walk over to see how he rested.
Does patience have any limits?
Sabai, sabai