Cordon sanitaire

Once I start chemo next Monday, for a month or so I'll have basically no immune system. With an absolute neutrophil count of 0.6, I'm already on the borderline between "mild risk" (0.5-1) and "severe risk" (0-0.5) for infection. They used to give blood transfusions automatically when people hit the level I reached weeks ago.

Viruses like colds aren't the main problem. Instead, the main enemy is already within my body. Bacteria, like those that live in my gut and on my skin. Fungus, like athlete's foot. And dormant viruses like herpes zoster, the chickenpox virus, that can reactivate and cause shingles. (I had chickenpox as a child, so I guess this is not unlikely.) During this period, if I get a fever of 100.5° or more, I go straight to the emergency room and I'm automatically admitted to the hospital.

So Gabrielle has been building a cordon sanitaire around me. All this week I haven't gone out in public much. When I do, I avoid contact (handshaking, close-up conversation) with people I meet. I carry little bottles of Purell in all my outerwear, and I wash my hands a lot. The timing rule, by the way, is to sing "Happy Birthday" twice while you wash. (Got that from my mom.) I'm humming "Six Blade Knife" instead.

As for visitors, we haven't had any since last week, especially kids. Luka won't be having play dates here until this is all over. (Whatever that means, when you have cancer.) With tradespeople and our house cleaner, we ask them to use Purell before entering. Gabrielle put a scary sign on the front door: "Immune compromised patient at risk — please use sanitizer and face wipes immediately on entering the house."

A year ago, when the possibility of another flu pandemic was in the news a lot, I read that hospital-grade surgical masks (plus hand washing) would be your best bet to avoid infection. I also read about how difficult it might be to buy those masks if a pandemic did start and there was a run on them. So I laid in a big box of NIOSH-95 masks. Now that seems prescient. Anybody who visits while I'm in chemo, or in the following weeks, will need to wear one. Gabrielle sent some to my family, who'll be coming for Christmas, to wear on the trip here, since airplanes are basically bottles of germs. I'm doubtful they'll achieve 100 percent coverage, but anything is probably better than nothing. Overkill, maybe, but we're not taking any chances.

Sunday night, the last night before chemo starts, I'm going to a concert at the Ark. I'll wear a mask to the show. I'll get weird looks, I'm sure, but that's a small price to pay for avoiding infection right now.