Oct 13 2012

Neutropenic Fever

I’m stuck in a double airlock.

Yesterday, my neutrophil count dropped to 0.037 (white blood cells, of which the neutrophil is the biggest and most prolific fighter, “should” have counts between 5 and 10).  Which is exceptionally low, but usually not that much of a problem as long as I take care of myself and stay home.  Last night, Michael and I were cuddled up on the couch watching Alias (yes, I have the box set — I’ve always wanted to be a kick-ass girl spy) and we both noticed that I was cold.

Before I got cancer, I was always cold.  Seriously cold.  I wore cashmere sweaters in the summer and had sweatshirts and cuddly blankets strategically placed around the apartment.  Since diagnosis and starting chemo, it has switched.  I run warm and then get hot flashes on top of it, so being cold is not something I’ve truly experienced since June.

“Are you okay?”
“I think I’m having chills.”
“Get the thermometer.”

I teared up.

When I first went neutropenic, my doctor gave me four instructions:

1. Go home.
2. Stay there.
3. Open window.
4. If you’re temperature goes up to 100.3, call me and start planning a trip to the ER.

Therefore, a temperature (and I knew I had one before even getting the thermometer) means a trip to the ER, at least a night in lockdown in the hospital, and generally being forced to remember that “yes, Lydia, you have cancer and are taking chemo and sometimes that forces you to be poked and prodded and be continuously interrupted while sleeping in an uncomfortable bed and cancel fun plans with friends and it can rise up at any moment.”  So I had a small weepy moment while taking my temperature. Which was actually a little difficult to do with a thermometer in my mouth.

101.  Fuck.

I waited a few minutes and took it again.  100.9.  Double fuck.

I texted my doctor and called her service.  One of her partners called me back:
“Hi, my counts are 0.037 and my temperature is 100.9.”
“I’ll call the ER and warn them that you’re coming in with a neutropenic fever.”

Why would she call the hospital, you ask?  Because going to a hospital emergency room is quite possibly the WORST thing I could do with no immune system (well, a very small one).  Unless everyone is there on a Friday night because they’re drunk (oh, and one guy was spectacularly drunk, passed out in a wheelchair, and wearing a fur coat and sunglasses. Amazing.  We wanted to take a picture but figured that security would tackle us.) or suffering from a broken leg or a gunshot wound, someone is bound to have some kind of infection and sneezing or puking bacteria all over the place.

We got to the ER, I promptly put on a mask, and told them that my doctor should have just called about me.

“Oh are you Lydia?  An isolation ER room just opened up; I’ll have Vic the volunteer take you up now.”
“Huh, first advantage to having cancer!  Fast track through the ER!”  I laughed.  Michael laughed.  Vic looked at us like we were insane.

“Hi Lydia, we’re going to draw a bunch of blood, take cultures from both the access through your port and a vein on your arm (AWESOME.  I LOVE having someone poke one of my poor veins with a sharp, but not quite sharp enough, needle, especially at 11pm on a Friday.), and then stuff you full of antibiotics until your counts rebound.  We’re finding you a bed over in oncology now.”
Teeth gritting…”Thank you.  Remember I’m allergic to penicillin.”
“One of the drugs we typically use sometimes causes an allergic reaction in people allergic to penicillin.  About ten percent of the time.  But if you haven’t had it before, the you should be fine.”
“Yeeeeaaaaah, no.  Let’s not do that.  If there’s a chance that I could be allergic to something, it typically works out that I am.  Plus I don’t think any of us, especially me, wants to deal with full body, throat included, hives tonight.”
“Okay, we’ll try something else.  You’ll get one bag of Aztreonam every eight hours and a bag of Vancomycin every twelve.”
“Could I also get a bunch of fluids?  My mouth sores are making drinking incredibly painful, so I’m not drinking very much water, and as long as you’ve got me hooked up, can we hydrate me?”
“Sure.”
“Thanks doctor.”

Michael gives me a kiss, disappears for a bit, comes back with a coffee for him, a mini apple pie for me (YAY!), and my pre-packed, always ready to go, hospital bags.

Around two in the morning, someone from patient transport shows up with a wheelchair and off we go, back to Prentice, for an unscheduled hospital weekend.

“Which room on 14 do I have?”
“None of them, you’re on 15.”
“Oh, crap.  I don’t know any of the nurses on 15!”  Michael squeezes my hand.

We get to 15, and all of a sudden I actually get a little nervous.  15 is where the stem cell patients are, as well as where they typically put the blood cancer (lymphoma and leukemia) patients.  Apparently it’s a little odd that I’ve only ever been on 14.

To get to the patient rooms on 15, we go through an airlock (go through one set of doors, wait for those to close, then go through another set of doors).  To get to my room on 15, we go through another one.  My nurse and the night doctor eventually appear to take vitals and generally go through the admit checklist (“Are you depressed?  Are you in any pain?  Do you have a living will?”  It’s fun, especially at two in the morning.).

“Um, am I really this sick?  Or in danger of being super sick?  This room is a little, ah, intense.”
“Yeah, each floor of the hospital has two of these negative air-flow rooms, just in case.”
“But why am I in one?”
“Because you have a neutropenic fever, and we’re not taking any chances.”

Oh chemo…if you save my life, thank you.  Try not to kill me first, though.


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