Post-Chemo Testing

Sometimes, in a case like mine, I feel badly for the doctor.  She was young and cheerful, anxious to do a good job for me.  Dr. Yu is a Fellow in Hematology/Oncology under my wonderful Dr. Siegel and I trust her completely.  This was not my first time meeting her and every time I’ve seen her, she has been competent, thorough and respectful.

My chemotherapy is now finished, and while Dr. Siegel is pretty sure that everything worked well, we have to go in and double check.  By going in, I mean scans and another dreaded bone marrow biopsy.  In June when I was first sick, I went into the hospital and spent the entire first day in testing.  In one day, they put in a port, did a bone marrow biopsy, and took an EKG, chest x-ray, CT and PET scan.  There might have been more; I just can’t remember.  The Lymphoma was in my bone marrow, making it a stage four disease.  With Lymphoma, there isn’t a different protocol for a different stage of disease, but they want to know the exact details before starting and want to know for sure that it’s gone at the end. Now that I’ve been through six rounds of chemotherapy, Dr. Siegel went ahead and ordered another bone marrow biopsy and CT and PET scan. He told me Dr. Yu is the biopsy expert and we scheduled it.

The first time I had the bone marrow biopsy, I was supposedly in “twilight” sedation, but I remember the entire thing and how horrible it was.  I also bled a lot afterward because the doctor didn’t put enough pressure on it or bandage it well.  The experience was awful and I was not looking forward to the repeat.  In fact, the idea of it was keeping me up at night worrying.  The night before the big day, I took an Ativan, a muscle relaxant, to ensure I would sleep.  I didn’t sleep a lot, but even a little bit was better than nothing.  I took another pill an hour before the test, and then one more a few minutes prior – I wanted to be as relaxed as possible.  In addition, my chemo nurse, Katy, gave me a shot of morphine to dull pain.

There was another doctor in the room to assist Dr. Yu, but I barely remember him.  It was clear from the beginning, however, that he had never done this before and Dr. Yu was teaching him.  That’s the thing about a teaching hospital: there’s always someone learning “on” you. It is a little odd at times, but generally it doesn’t bother me; it’s worth it to be under Dr. Siegel’s care – he’s teaching his interns and fellows his wonderful technique and bedside manner.  This doctor assisted Dr. Yu by handing her instruments and vials, but I never heard his voice like I heard Dr. Yu instructing him and speaking reassuringly to me.  Bonnie said he was a little green – it can’t be fun to watch this procedure from any point of view.

To do a bone marrow biopsy, the doctor has to numb the hip on the surface, then numb inside, right down to the surface of the bone.  Then she has to put a needle into the bone to draw out some blood and marrow – four vials worth –and then she has to use the needle to take off and hold a chip of bone, pulling the chip all the way out with the needle. In June it had taken the doctor two tries to get the bone out.  As we joked, I am a literal hard-ass.  But the joke was a cover; I was white with fear – and by that I mean that my brain felt like a cloud of white.  I couldn’t think; I could barely form a word in response to a question.  I felt blank and just focused on the task at hand.  I’m not sure if that was fear or medication, but emotion went out the window, replaced by determined action.

Katy was there for a few minutes and had given me an encouraging hug and wink.  Ellie was there, too, just outside the room, and she did her reassurance move where she looked me in the eye and nodded. Bonnie was in the room with me and she positioned herself by my head as I curled into the fetal position, as instructed, on the bed in the little room in the corner of the chemo center.  I just wanted to get it done.  I focused on getting through it to done.

As Dr. Yu started, she told me she would talk me through the entire procedure.  Bonnie wove both of her hands through my left hand and my right hand held tight to the bar against the wall.  We commenced.

I squeezed my eyes shut.  The initial numbing wasn’t a problem, and the numbing of the bone, while mildly painful, wasn’t a big deal.  I used a lot of Yoga breathing techniques to get through the collection of the marrow as Bonnie did her best to chat us through it, talking about TV shows, funny kid stories, some of my writing experiences, and anything else that came into her head.  Dr. Yu, for lack of a better word, had to wiggle the needle to get the bone chip off and out.  The pain referred from my right hip where she was working, directly to my left hip.  A little whimpering, a lot of Yoga breathing.  Then the worst thing: it didn’t work – she didn’t get the bone chip out.  We had to do it again.  “Just do it,” I said, gritting my teeth. “Don’t talk about it; just do it.”

Dr. Yu numbed another spot on the bone. This time, however, when she wiggled the needle, she hit a nerve and pain flashed relentlessly down my right leg.  That was the only scream I let out completely.  I couldn’t help it.  I actually swung my right hand toward it and Bonnie had to grab my hand so I wouldn’t accidentally hit the doctor.  She murmured and stroked my head and Dr. Yu told us she was going as quickly as she could.  The pain rumbled up my leg and into my back.  It seemed like ten minutes, but in reality it was only another second or two until Dr. Yu cried out, “Got it!” She quickly pulled out the needle, pressured the wound and covered it.

“You’re okay,” Bonnie murmured again, still stroking my head.  “It’s done.”

“Is it done?” I asked, “Because I really need to cry now.”  And I finally proceeded to cry, Bonnie’s voice in my ear telling me it was all right.  All done.  I let all of the angst and fear out, just allowing the tears fall.  All done.  I did it.

Bonnie and Dr. Yu helped me move from my side to my back to further pressurize the wound and I was still breathing hard as Dr. Yu was cleaning up.  She apologized again for needing to take two tries, but I knew it wasn’t her fault.  I am a hard ass right to the end. She left with a smile for Bonnie and me, telling me she’d see me next week with Dr. Siegel to give me results of the tests.

Trying to get up a few minutes later, I realized I couldn’t walk well because of the nerve hit on the right leg – it was like my leg was made of spaghetti and I couldn’t put pressure on it.  However, once I started using it and just moving the leg, the nerve calmed down and started working again.  It took a few hours, but my leg was fine.

I had a long day ahead of me with scans that needed contrast dye, and Katy was able access my port so I wouldn’t have to have an IV inserted. I had to drink that yucky barium, but then I could just rest and lie down on a table that moved me in and out of a machine. In the end I walked out of the hospital on my own steam, tired, but really just fine.  Bonnie was with me for the entire biopsy.  I still can’t believe what a rock she has been.  I wouldn’t be getting through all this without her. Ellie was there all day – the entire day – holding my arm to walk me back to the car so I wouldn’t fall.  She takes excellent care of me every day.

Dr. Yu is a compassionate and careful physician.  Her patients are lucky to have her skill and grace. I wish I hadn’t been so much trouble for her, and while I hope I don’t have to meet her often in the future, I know she will have a very bright career as a doctor.  I’m glad to have experienced her art and skill.

I’ll get back to you next week with results…