We took Adam into hospital late afternoon on Sunday in preparation for stem cell collection this week. During the evening he had pre-hydration in order to pump up those veins before vascath insertion the following day. His blood counts on admission were, quite simply, rubbish. Despite a full week of GCSF his white blood count was snubbing its nose at the nurses who had braved the awful weather conditions to get out to us and administer Adam's daily infusions. They were so poor in fact, that surgery was delayed on Monday pending a repeat set of blood results.
The first I heard of all this was a text from Alison on Monday morning saying 'blood results not good. Might not go ahead'. I suddenly thought to myself that we should've been prepared for this eventuality and we were not. We hadn't sat down and asked what happens now. Adam's white cell counts have always taken longer to recover than his platelets - which had themselves now begun to climb again after the chemotherapy. Why did we suppose that this time it would be any different? Had we seriously believed that Adam would simply respond to the priming in the manner required for it to be successful? How stupid were we?
I then got to wondering and worrying about what would happen next. The hospital had squeezed Adam into an already full transplant programme. The harvest had been delayed twice before; once because Adam hadn't yet recovered sufficiently from MIBG therapy, and the second time because the hospital were 'fully booked'. The machine used for the harvest itself belongs to, and is borrowed from, the adult unit. Were we going to hit problems and then find out that we'd missed our slot? How come I was asking these questions now when I should have asked them weeks ago. It wasn't that I was getting worked up about what the situation itself. Perhaps there was nothing to worry about. Perhaps this possibility had been factored in and the hospital could accommodate a delay of a day or two. I was annoyed with myself that I hadn't second guessed this would happen back when I could have tried to do something to ensure there was a Plan 'B'.
As I sat pondering what I would do if they told Alison it was no good and she'd have to take Adam home I received another text message. 'He's in. Going ahead today'. Huh? What? It transpired that overnight Adam's blood count had risen sufficiently (I think from zero point something to over six) for them to crack on with the original plan. I knew there was a reason I'd never bothered to think about what happened if things got delayed...
Not that I am a naturally suspicious person (I don't think so anyway) but it did fleetingly cross my mind that perhaps they were going ahead because they couldn't accommodate a wait-and-see approach, and therefore the only other option would've been to send Adam home. I know, I'm a crazy fool. I have to confess, my world does get a little paranoid at times.
By the time I arrived at the hospital Adam was awake from the general anaesthetic. Emotional. Angry. Moaning about the baby opposite who 'screamed all night long and didn't shut up and kept waking me up and I couldn't get back to sleep again.' On the plus side he didn't throw anything or try to punch anybody, specifically me. All-in-all not a bad result then I guess.
The harvest itself was uneventful and unremarkable. I had to make a quick dash for the commode at one point when Adam announced 'I need the toilet. It's a poo. BE QUICK, I NEED IT NOW.' There is no dignity in circumstances such as these. However, do spare a moment for the nurse who had to reset the machine next to Adam whilst he was in full flow. He was oblivious - too busy craning his head round so he could watch something on TV at the same time.
This morning we learnt that Monday's harvested yielded 1.1 million cells. The whole process was repeated today and yielded a further 0.9 million. Having achieved the objective of acquiring enough cells for two clear transplant procedures, Adam came home this evening. No point in doing a third day - diminishing returns and we've done what we set out to do. I said 3 x 2 was better than 2 x 2 didn't I? Having gone through an enormous amount to achieve the number of cells that we have, nothing would give me greater pleasure than to only ever have to use half of them ... the rest, as our consultant keeps putting it, 'will be for a rainy day'.