Bronch

• Hemoglobin 8.1 (WHO normal 14.0-17.3)
• Absolute neutrophil count 0.79 (normal 1.4-7.5)
• White blood cell count 1.1 (normal 4-10)
• Red blood cell count 2.48 (normal 4.5-5.9)
• Platelet count 114 (normal 150-450)

NIH, day 5. Slept OK last night but woke up at 5:45 with a raging low-hemoglobin headache. In to the hospital at 8:30. Checked in at the day hospital, got an IV placed — big needle this time, so they could push sedatives for the bronch — and blood drawn for the daily CBC (complete blood count).

Thought we’d have to go check in to the pulmonary unit, but instead they came to us, right away. Pulmonary nurse took a history, went off to check me in. A few minutes later she came back with the pulmonologist, who went through the whole history again, probing for anything that might explain the lung infection. He was interested in my night sweats. (I’d chalked those up to HCL, but then remembered the first time I had them, during a case of pneumonia in the Netherlands in 2007.) Said he was sure it wasn’t cancer. Thought it was probably pneumonia but surprised that there were no symptoms. So maybe it’s something atypical.

Some of the bronch results will come back tomorrow, but the full results will take a month. Some of the possible critters take that long to reproduce. Anyway, we'll make a decision about antibiotics tomorrow, after the gram stain results come back.

Into the bronch room. The techs wired me up, fired up a nebulizer filled with lidocaine. I inhaled lidocaine mist for about 10 minutes. Stuff tastes unbelievably nasty, like a blend of aspirin and burning tires. Meanwhile, they got ready to snake the bronchoscope through my left nostril and into my lungs. I remember them injecting my IV with fentanyl. 7 seconds of bliss and happiness, then nothing but a blur of hands and instruments over my face. They told me later I’d coughed a lot — which can’t make scoping someone easier — so they loaded me up with extra fentanyl. Too bad I couldn’t enjoy it. Once it was over, they loaded me into a wheelchair and sent me back to the day hospital for my daily dose of cladribine.

Dr. Kreitman came by to check in. Proposed giving me a blood transfusion tomorrow, since my hemoglobin’s at 8.2 and I have to fly on Sunday. Good plan, I thought. I was going to try to power through it, but I remember the utter horror of sub-8 hemoglobin from last time. Wasn’t looking forward to that. Effects of the transfusion might last 3 weeks and keep me in a better range while the bone marrow recovers and starts to produce new blood.

Left the hospital around 3:45 PM and went to the hotel, where my mother and Luka were waiting for us, having arrived a couple of hours earlier. I took a nap until 7:15, then we all went to dinner at Redwood in downtown Bethesda — highly recommended. Eating in classy restaurants (on Thursday we tried Green Papaya, also very good) after chemo feels extremely weird. But we have to eat — so why not?