The option of Bone Marrow Transplantation as a treatment was a topic they had touched earlier, before he had gotten so sick with a collapsed lung. Before the virus had made its entrance. Just hearing the words made his skin crawl. The mere thought of having someone drawing body tissue with a long needle was starting to make him ill. Heīd seen it on TV. The Discovery channel and the sight had etched on his cornea since it had looked absolutely gross.
"Your blood tests have come back," she explained briefly, "They show a low count of white blood cells and weīre getting a bit concerned over this." Her tone was serious, "When you do chemotherapy treatments like this there is a small risk of getting a form of Leukemia. Especially while being treated with Non Hodgkin's disease and we..."
"Leukemia! What the hell are you saying?" Nick lashed out unnaturally loud. "Do I have that shit now too?"
"No Nick..No calm down." She held her hand against his chest so that he would relax. "Right now itīs nothing that would point to that, yet there is a risk, a small risk I might add, that if we donīt continue with further treatments that this can happen. We also want to eliminate further risks for the cancer to spread to other vital organs through the lymphatic system" She paused before saying, "This is the reason why weīre considering a bone marrow transplantation this time."
Nick could hear himself moan. Why oh why did he have to be the one that every bad thing would happen too? No matter what he said or did life would always come up and bite him in the ass.
"What do you know about bone marrow transplantation?" The doctor's voice jerked him back to reality
"Not much," he mumbled, staring down at his hands. The little he knew came from a TV documentary heīd watched ages ago when he was home sick with the stomach flu. The rest of the guys were in New York, doing TV on MTV's TRL while his sorry ass had gotten the most violent flu that was known to mankind and had to spend his time at home, zapping through channels. Then after finally getting a bit better and being totally bored out of his skull after having to watch all the soaps and day time talk shows, he turned to the Discovery channel. Just to notice that it was a medical documentary about cancer. At first he had thought it was gross then interesting and then gross again when they had showed this bone marrow test with a needle that looked about 6 feet long!
After a while it had gotten so disgusting that he had to turn the program off or he would have redecorated the upholstery on the sofa. To that he didnīt think his mom would have been too pleased. Another place where he found out about bone marrow transplantation was on the net. What heīd found hadnīt looked too tempting. It was actually kind of nasty.
Sensing her patients fear she smiled. "You know Nick, The procedure itself isnīt all that painful. But I wonīt hide the fact that there might be some discomfort with this kind of treatment too. Your immune system gets very run down and this can cause you to feel sick.." She didnīt have to end the sentence before Nick filled in.
"Like what? Sickness? Weakness?" He groaned inwardly. When would he ever be able to face the world feeling fine again? Possibly never?"
"Yes, that can occur." There was a hint of sadness in her eyes as she continued, "Even so Nick I think you should go on with this treatment since it might be your only chance at a remission."
The words hit him hard in the chest, making his throat constrict. Never had that subject been touched in this way before. Sheīd actually told him that this was his only chance for survival. He had suspected this bit now when it came to reality all he felt was fright. Maybe it had been better to quit. To give it all up and not live in a situation like this when he didnīt know if he would make it or not. Maybe this was the same feeling that had almost driven him to stop the treatment all for once and then hope for the best and that he would survive in the end?
She smiled softly to him. "I know that it can be scary but I think that you are very brave man and I think that you will manage this."
He said nothing in response.
Not waiting for him to say anything further she told him. "Nick I would like to tell you about this treatment if you donīt mind."
He nodded. "Go ahead."
"There are different ways of doing a Bone Marrow Transplantation. First you have to do a bone marrow biopsy. It's a small procedure..." We stick a needle into your spine, drawing out some bone marrow tissue. Afterwards we take it to a lab to examine how good a chance you have to a recovery judging from the result." Noticing the young man's scared _expression she added, "Itīs done very quickly. Some say it doesnīt hurt. Itīs more of a discomfort.
"Yeah Iīve read about it on the net!" He shivered.
"Yes? And what did you read?" Her tone was soft.
"It says it hurts like a mother fu..I mean really bad" He stopped himself. "One man even described it like he felt like his spinal cord was being ripped out! Ouch"
Dr. Andersen smiled briefly. "No Nick, itīs not that bad. I wonīt tell you that itīs pleasant. That would be lying to you, but like I said before itīs done quickly and.."
"Canīt you do that while I sleep? Under anesthesia you know." He knew he sounded whiny yet he didnīt care. This was his only hope.
"No, you have to be awake for this procedure, but if you want you can have someone by your side. A friend or a relative that holds your hand while the procedure is being done. That sometimes helps.
Somebody at his side? Who? A woman? But when he didnīt have a woman who would that be then? And did she think he was really such a baby? The questions were many and he was about to open his mouth to object when a thought suddenly struck his mind. Maybe it wouldnīt be so bad if he had someone there. One of the guys perhaps. Brian? Nah he dismissed the thought quickly, after all he was with his wife. And he felt much too stupid to ask one of the other guys. "Nah thatīs Ok. Iīm fine." He smiled weakly.
"You know Nick, itīs not childish or immature to want to have someone by your side when youīre hurting" She looked at him calmly. "That person can help you calm down. Relax."
Nick shrugged. He didnīt have anyone to ask anyway. "Iīll handle it."
"Iīm sure you will. But I still think you should reconsider the possibilities of someone being at your side. Itīs not such a bad idea."
"Whatever." He pretended to be relaxed, uninterested when in reality, he was so nervous that he felt like his stomach was filled with butterflies. Maybe he could talk to one of the guys afterall...
"Nick youīll be fine You have been through so many hard things this last year and this bone marrow test is nothing compared to that."
"But I hate needles." There now he was starting to sound like a baby too.
Ignoring that last comment the doctor went on, "Once weīve found the results of the tests we can decide what bone marrow transplantation is the best for you."
"I thought there was only one.."
"No", Dr. Andersen shook her head, "actually there are three ways to do a Bone Marrow Transplantation and it all depends on a lot of things. How good the bone marrow is or what the patients condition is. There is one that is called an Autologous bone marrow transplantation. This is when we take bone marrow from your body and then freeze it down for further use. We treat the cancer cells with drugs to kill them off and meanwhile you get a higher dose of chemotherapy..."
"Oh swell" Nick interrupted from his bed. "Even more chemo!"
Ignoring this last comment the doctor continued, "As I said earlier you will get a high dose of chemotherapy so all damaged bone marrow cells will be destroyed so.."
"Doesnīt this mean that I have all my good bone marrow cells being destroyed too? Not just the cancer ones?"
"Yes Nick" she sighed. "And as a result this means that your white blood counts will drop and your immune system will be very low." Noticing her patient frown she quickly added, "But this is just temporary"
"Is this why I can get so sick?"
Nodding Dr. Andersen said, "Yes but everyone responds differently to the treatment and maybe youīre lucky not to have that many side effects."
"I doubt that" Nick mumbled with a sigh.
"I know that this is effecting you very much but can I please go on and explain about the treatments? So you know what options you have" Dr. Andersen was talking as softly as possible, feeling sorry for her young patient.
"Sure," Nick muttered quietly, "What other options do I have anyway?"
"After we have treated your bone marrow in the lab we will inject it back to your body through a needle in your vein and with that we can replace the bone marrow that was destroyed by the cancer."
"Great..even more needles."
Ignoring this last comment the doctor went on with her explanation. "There is also another type of transplantation that Iīm sure you have heard of before. Itīs when you need a matching donor for your bone marrow and your sick bone marrow is replaced with a fresh and healthy one. Usually from a close relative, like someone in your family. This is called Allogenic Bone Marrow transplantation and ...
"And itīs something Iīll never do" Nick stated quickly.
"Really?" The doctor was taking her young patients words with a light touch.
"Yeah because I donīt want anyone else to go through the same shit as Iīm doing right now. You know the needles and stuff." He shivered. "Besides that first treatment sounds good enough for me."
"Nick I wish that I could tell you that it was ok but that is not up to you to decide. We have to do the treatment that is best for you and where you have the best chance of going into remission."
"Yeah?" Nick said sternly, "And if I refuse?"
There was a loud sigh, "Then I canīt guarantee that you get the best of help." She had just been waiting for this to happen. For her young charge to back out of it all.
"That doesnīt matter." He looked sternly at her. "Donīt worry Iīll do this shit but itīs my call what kind of treatment that Iīm gonna do. You either to the first stuff or Iīm out of here. After all itīs my bone marrow isnīt it?" Nick sounded very hostile all at once.
"Yes, Yes." Dr. Andersen did her best to calm her agitated patient down, once again. "Iīm just telling you about what options you have."
"Ok that is cool, but wait.." Nick stopped for a moment, "You said there was a third option too. Didnīt you?"
"I will come to that but first I need to explain to you about this bone marrow transplant.
"The one with a donor? Donīt bother. Iīm not interested," Nick muttered.
"I heard that but Nick I really think you should listen to what I have to say."
"Well I donīt think so, besides there is not a chance that I am letting anyone in MY family going through the same shit as I am so you can just quit talking about it."
"Nick itīs not dangerous for that other person.."
"Still not an option" the young man interrupted, "So are you going to tell me about that other stuff or not?"
Sensing that there was no way she could get her stubborn patient to listen to what she had to say she sighed deeply, "Ok Nick..well anyway the procedure is about the same that I mentioned and then we have the third option."
"Ok bring it on. Iīm listening."
"Itīs called Pherpheral Blood Stem Transplant and the patients blood is being passed through a machine that removes the stem cells. That is your immature cells from which all blood cells develop, and then the machine returns the blood to the patient again."
"Sounds kind of bloody" Nick joked lightly.
Dr. Andersen smiled, "Then after that procedure is done we freeze the blood cells and then transplant them to you. Sometimes this procedure is done together with the first option."
"Ok and which one do I have a better chance to survive from?" Nick asked frankly as he had listened to his doctor talking. He noticed the same troubled _expression on the doctor's face as Kevin used to have when he was asking something that he either didnīt want to answer or felt uncomfortable answering.
But he got his answer. "Nick I wish I could tell you but I donīt know. Like I said before all patients respond differently to the methods and what is good for one isnīt for the other. But since you are so against the donor transplantation."
"Yup I am." he said quickly.
"Yes, so Iīve heard." For once the doctor looked slightly annoyed. "Iīll suggest, but that is before I have taken all of the tests, that we should try the first option, possible with the third option depending on how your cell counts are doing right now. Especially since youīre so against the donor part."
"Yeah I am." He rolled up his shirt sleeve. "Ok lets get this shit over and done than shall we?"
"What are you doing?" The doctor looked surprised.
"Rolling up my sleeve so you can take all those tests that you so desperately want."
There was a deep sigh. "No Nick that is not how it works. I wish it was that easy but itīs not. Since you have decided to go ahead with the biopsy I will change the plans. You will get started on the chemo after the biopsy has been done instead."
"Why not before?" He was a bit surprised over her sudden change in attitude. Not that he complained but she had seemed so eager at first.
"Because it can't be hurt by the chemo."
"Hasnīt it already?" Nick muttered sullenly.
"Come again?" She rose her eyebrows.
"Oh nothing" Nick added, "Just rambling you know. Talking crap."
"Oh Ok." She looked suddenly very tired. "As I said we need to get you started on chemo again since I want to see how you respond to the treatment now when you have been away from it a while. Iīm also eager to see how you respond on the new nausea medication."
"Yeah thatīll be fun." He knew he sounded sarcastic but couldnīt help it. Hadnīt they seen enough of what side effects did to him?
"I know that itīs hard on you," she sounded apologetic, "but it wonīt help you if you have a bad attitude."
"Sorry." There was no use in fighting. He was too tired.
"Nick" she looked at him. "There is something more I came to talk to you about."
"Oh." More bad news he was sure.
"No itīs not bad..itīs actually something good. Something you will like.."
"Fat chance," he grumbled before adding in a more irritated tone than he was intended, "What?"
"Since you have been here for nearly a month and doing further treatment with the transplantation will have you spend here even more time I have decided to.."
"I donīt want to.."
She cut him off, holding up a hand. "No wait Nick. Listen to what I have to say."
A loud groan could be heard.
"Iīm willing to let you go home to your house with permission over the weekend."
Those words were the best heīd heard in a very long time. "You are?" He nearly shouted. Did he hear what he was hearing? Did she actually say that he could go home for the weekend? This was the best of news ever. Surprised he sat up straighter in bed. "Are you actually saying what I think youīre saying? That I can go home over the weekend?"
"Yes." She laughed. "Thatīs what Iīm suggesting..because you have managed to eat solid food and that the dizziness that youīre experiencing is a bit better."
"This is great!" Nick shouted out like he had won the first prize in a lottery and then hugged his doctor unexpectedly. "Are you sure? Is it really true?"
"Yup."
"That is sooo great, thank you doc!" The young man was simply radiant with happiness. Then his _expression suddenly darkened, "Are you doing this just because you know that I might not come back home again?"
Startled over this sudden change in _expression the doctor felt unprepared. "No" she said after she had recovered, "No itīs nothing like that. But I wonīt say that you donīt have to spend some time in the hospital after the bone marrow transplantation but also before itīs being done. It's a dangerous procedure that you are going through and we wonīt have any complications"
"'k." Nick seemed to think for a while before adding, "You know I have another idea. Why donīt you let me go home for like a week and during that time I donīt have to use any chemo or anything?" It was a long shot.
"A week?" The woman looked doubtful, "You want me to let you off for a whole week without any sort of treatment. That could be dangerous."
"My whole life is so fucked up anyway besides what can be worse than having that bone marrow transplant? Or chemo?"
Dr. Andersen stroke her hand over he cheek like she was thinking deeply, then she said slowly, "Nick I wish I could let you go home that long but we canīt risk your immune system becoming any worse because that could danger the transplantation severely"
"Please.." Nick begged, "Pretty please. Just let me go back to my family and friends for once. Let me stay at my house. I promise I will be back after a week. Promise." He was whining like a kid and really making up an act.
Something in his approach most have softened the doctor as she said after thinking carefully. "Ok Nick.."
He shouted loud from happiness.
"No wait" her tone was serious "I need you first to do the bone marrow test as well as start another 4 days round of chemotherapy. If everything then goes as planned, I will let you go. For a week."
"Done deal." Nick slapped his doctors hand in a high five. Then he stopped himself. "No chemo during that time either?"
"No," she laughed, "No chemo either." This patient was really something special to her.
"Thank you..Thank you..Thank you." Nick shone like a light bulb. "You wonīt regret this." She had rarely seen her patient this happy
"I hope so too."
"Promise."
"Good because you still have a weak immune system and if you show any signs of sickness or a cold or something like that I want you to come to the hospital. Is that understood?"
"Sure," he mumbled but the doctor wasnīt sure he had heard anything she was saying.
"Nick that is important."
"OK..but when can I go back home then?"
"Iīm thinking the end of this week. If everything is going according to plan and you respond on the chemotherapy dose that I will give tomorrow and for the following days.
He groaned, "Why not tomorrow?"
"Because Iīm starting you on the chemo today or the latest tomorrow judging how you respond to that new anti nausea medication..you remember."
He nodded. How could he forget.
"I also donīt think it would be wise for you to go in the condition that you are right now. Especially since you havenīt been eating properly."
"Give me that Wheat stuff..hell even give me Jello. I donīt care." He grinned like a cat that had caught a bird.
"No Nick." She chuckled to him again. "No can do. We have to take one step at a time. "
"Ok." Suddenly it was like all air had gone from the young man in front of her. He looked at once very exhausted and she was sincerely starting to think that maybe it had been a bad decision of hers. Maybe he was weaker than she had thought he was.
"Yes, hon..I mean Nick," the doctor corrected quickly. "Like I said before we have to see how you respond to this batch with chemo and.."
"There is no need for that" Nick added quickly. " I can tell you how it is..Puky." He laughed despite the pain showing on his face. "But that doesn't matter anyway since I can be just as sick at home as I can here."
Dr. Andersen felt a bit bad. Why she felt like this for the young man was beyond her comprehension. It was like he had started to touch her personally and this was something that she usually didnīt allow. Instead she always tried to act professional. "Nick I know that this is upsetting you."
"Iīm not upset. Iīm just tired of laying here, feeling like crap all the time" he bit back his anger.
She nodded in sympathy. "I can understand that." Standing up she said, "I have to go for now but I will order a nurse to come in with the anti nausea meds as soon as possible so you will feel sleepy and relaxed. Then if youīre feeling up to it we will start up on the chemotherapy..if not we will wait until tomorrow after you had your bone marrow biopsy
He nodded. Tears in his eyes again.
"I will also order some more tests to be done as well as let the nurse come up with a bowl of cremed Wheat."
Nick looked disgusted.
"Itīs not that bad." She walked towards the door. "Now you know that if there is anything that you wanna talk or ask me about just press the button and tell the nurse and I will come as long as Iīm on my shift." She had to mentally slap herself for saying this. This wasnīt professional yet this was exactly what she felt for the young man. "Otherwise I see you tomorrow." She smiled to him. "Now try to relax. Everything will be just fine."
Nick stared at the door long after she had left. It had been easy for her to say. She wasnīt the one that was going to get a six foot needle stuck up her spine!
