GRADUATION

January 2nd.,2009

Yesterday Titi completed his 6-day chemo courses capped with a low-radiation treatment in the evening. He is now pronounced ready for the next leg of this trek – the two-day transplant starting on Sunday the 4th.
His six-day course was not without the usual travails of the side effects of chemotherapy – it was once described to me as ‘hell on earth’. The body rebels and does all sorts of strange things the mind cannot accept. The mind is used to being in control and simply cannot accept the facts of uncontrolled bodily functions as well as loss of appetite for prolonged periods.
Titi weathered the ordeal with minimal fuss BUT, as Prof. Naparsteck – the department chair said, be prepared for next week (post-transplant). It will not be a Sunday walk in the park either.
She went on to map out the rest of the quest here in Tel Aviv.
Engraftment (transplant acceptance by his system) would be in about a three- week timeframe.
After 4-5 weeks, he would be able to move into separate housing and return for tests and non-oral treatments (about three times / week).
About 10-15 weeks later, he would then be able to return to Bangkok under local care and supervision.
There are always two primary concerns post-transplant: infection and recurrence. Infection will depend on how strong his immune system will grow and counter the various and numerous types of infection. Prof. Slavin, being an immunologist, will be the key person in looking and preventing infection.
Recurrence is something every cancer patient lives under the shadow of but in this case, haploidentically mismatched donor, the odds work for the patient. The patient uses his own immune system along with that of the donor which makes the total system more stronger in fighting the blast leukemia cells.
She said the patient will be declared to achieve total remission after 2-3 years. CML does not come back after that.
Meanwhile, graduation for the donor will be Saturday night after my last Neupogen shot - 8 in all – 2 a day 12 hours apart. My back and joints are already aching 50% through the shots – similar to the day after an average joe runs a mini-marathon. Normal and a good sign… the doctors say.
You are on your own here in a public hospital – the patient is taken to where he needs to go by an attendant and once at the destination, he locks the wheelchair or bed and WALKS away! If the patient was there unaccompanied and/or not aggressive enough to go up to the front of the line and ask, he is definitely at the mercy of his surroundings.
Last night, for his radiation, he was wheeled away on a bed from the ninth floor to the second level of the basement – me walking briskly behind. We went through so many turns and long tunnels that by the time we got there, I was hopelessly lost. No problem , I thought, just follow the bed. When we got there, the radiologist looked around the bed, now sans attendant, and asked me where the patient’s file was. Upstairs, if it is not here, I said.
“Could you go and get it?’ she asked.
“OK,” I answered immediately, “please draw me a map on how to get there.”
She looked at me for a while and after mumbling under her breath, picked up the phone and found an option. There was apparently no cohesive process. One department does not help out another but the work gets done and the results end up in the right hands.
My two shots of neupogen a day ended up being another constant search for somebody to give me the shots. At the start, I was given 8 packs of the prepackaged shots along with a card with a list of the times and dosages for each shot and was told I was on my own. The shots should be refrigerated and each shot should be recorded and signed.
Not a problem, I thought, until last night , when I took the package and card and went in search of a doctor or nurse to show me some merciful consideration. I was palmed off by the first two nurses and saw my ‘package’ dropped off at the desk of a male intern who was taking care of my brother during his shift. Apparently, it was HIS job and not to be assisted. Wonder which gentle soul will help me tomorrow…
The waiting period before the transplant is almost over… the transplant being the event that represents the milestone that we traveled so far and sacrificed so much to attain. We are all aware that this is just the first step in a two-year journey to shake this deadly sickness and can be assured that with the support as shown to-date from family and friends, that it is a healing and revealing journey – one that is rarely traveled in peace and comfort.
By the way, 'Happy New Year" was never once wished or uttered during the past week here. Then I found out that Roshashana (sic?) was the equivalent of the Jewish New Year and that their calendars run from September of one year to August of the next. So, there you go, I learn something new every day.
Sabai, sabai