SNAFU

In case you don't know the origin of that acronym, look here.

Chemo hookup day (yesterday) got pretty interesting, though not in a good way.

Hookup was supposed to happen at 10:30 AM, right after my visit with Dr. A. We sat down to wait in the Infusion Clinic. (That name makes me think of chamomile tea, but you don't want these infusions in your cup if you can help it.) I wore my NIOSH-95 surgical mask: great at keeping out viruses, but man is that thing a bear to wear. The metal nosepiece grinds into your cartilage, and breathing through it takes real effort. If you breathe too shallowly, you'll just recycle your own CO2 and then pass out. More bald kids in scrubs, one of them, about 4 years old, squealing in delight while Mom chased her into the infusion clinic. Happiness, even here.

At noon, a nurse finally appeared. She told us that the hospital's Home Med department handles the pump, the drug supply, and all the ancillary equipment. Until recently Home Med was a separate company, and its offices are on the other side of town, three miles from the hospital. Dr. A's office had failed to process the order for drugs and supplies earlier, so Home Med had just received it. Over the weekend we'd learned from the Visiting Nurses that Home Med was also supposed to have delivered chemo spill supplies, extra dressings, and heparin syringes to our house. They never got that order either. According to Home Med, this happens all the time. They even have a whole system — drivers, delivery people, a protocol — for working up "same day" prescriptions and delivering them fast.

So after teaching us how to use the chemo pump, the nurse sent us home to wait some more. We returned at 2:30, waited for another hour. A linebacker type wearing blue scrubs finally appeared with a Macy's-style two-handle shopping bag full of supplies. They got ready to plug me in.

Then one of the nurses eyeballed me, as I was rolling up my sleeve, and said (in a slightly disbelieving tone), so, you really weigh 185 lbs? No, I said, I was 168 in my clothes just a few hours earlier, right here in Hematology/Oncology. On my home scale I'm 165-166.

All three nurses began to scramble, furiously looking up records and making phone calls. One led me down the hall to weigh me again. 171 lbs. after a big lunch and a lot of water.

How much drug they give you depends on how much you weigh: so many milliliters of drug for each kilogram of body weight. If I weigh 185, I get one amount; if I weigh 168 I get less. They're allowed a 10% "fudge factor," they said. But the difference between 168 and 185 crossed over that line.

I think I know exactly what happened here. That morning, Hematology weighed me in at 168 lbs. Somewhere along the line, somebody converted pounds to kilos — and simply divided by 2 (instead of 2.2, the correct factor), recording my weight as 84 kg (should have been 76). Since the dose calculation uses kilos, 84 kg became the basis for the incorrect dose calculation. [Posted later: this turned out to be wrong.]

They were about to give me an overdose. If that nurse hadn't had such a good eye for body weight, I would have gone home with too much medicine dripping into my blood. If she hadn't known how to correctly convert kilos to pounds, she might not have spotted it at all, since her eye for kilos probably isn't as good.

Now they had to get the doctor to revise the prescription and send it in, then wait for their pharmacy to fill it. So they sent us home again, promising that Home Med would deliver the drug straight to our door, and Nurse M would come by to hook me up. This finally happened around 7:30 PM, eleven hours after we'd originally left for the hospital that morning.

Once again, nurses rule. They're the ones that track the supplies, check the doses, watch for errors, and even more important, know how to work around the problems.