John has come down with “chemo brain” and finds his flow of insightful thoughts and words temporarily halted. Those of you who are cancer survivors or family members may be well aware of “chemo brain”, a very real side effect of chemotherapy that can cause memory loss and difficulty concentrating. His blood counts are all predictably dropping as well, as we wait for the melphalan to do its work of killing the bone marrow. We have daily blood draws and clinic visits to monitor this “wait and watch” process. At each appointment John is assured that “pretty soon you’ll really start feeling crappy”. As of today he is still functioning fairly well – no serious mucositis (the most dreaded of melphalan side effects), no fever, but decreasing appetite and increasing fatigue.
The actual stem cell transplant took only 20 minutes but was nonetheless a historic occasion. Many patients observe the date as their “new” birthday, and indeed John received congratulatory wishes from
members of the staff. We arrived at the clinic 2 hours prior to the transplant for all the preparatory steps: IV hydration as well as pre medications including Tylenol, Benadryl, and hydrocortisone. The transplant itself is precisely timed (it has to be done within 48 hours of the melphalan dose), and the nurse called for delivery of John’s stem cells at 11:30.
Sure enough, two lab techs showed up at the appointed hour with a steaming canister holding the bag of stem cells, and a tub of warm water. Once the nurse gave the high sign, the tech took out the frozen cells and immersed them in the tub of warm water (in the midst of all the sophisticated equipment and science that surrounds the transplant procedure, this step felt remarkably mundane). After a couple minutes the stem cells were thawed, John was hooked up via his Hickman catheter, and the infusion began.
John felt slightly flushed during the infusion but otherwise tolerated it well. After a couple more hours of IV hydration and monitoring, we were free to go home and begin the “wait and see” period. It’s the calm before the storm. If all goes well, the storm will cleanse the body and clear the air, making for a fresh start on the other side.