The Lonely Donor, Part 6: Donation Day

Me and my machine
Me and my machine. Yes, I have a bottom lip. Yes, I’m on narcotics.

He is alive, and so am I.

And never I have felt so alive: Lying in a hospital bed, the apheresis machine sucking stem cells from my veins for the better part of a workday. 6 hours, 10 minutes to be exact.

I reported for duty at Mayo Clinic Hospital at 7:15 AM in my favorite, long-sleeved dress-pajamas with my lucky New Orleans Saints Super Bowl Champions T-shirt underneath. They needed ready access to my veins, and I needed a good omen… or three.

But when luck is not enough, there’s always narcotics. Because the entire volume of my blood would be filtered FIVE TIMES, and because the staff had encouraged me to take one of my precious oxycodone pills to ease my transition onto the machine, I gleefully obliged.

My precious.

After my final two (of 10) filgrastim sticks that morning, Nurse Heather was the leader in the clubhouse on Stacy’s Blue Ribbon Needle-Sticker Championships (10 sticks = lots of opportunities for misery). Heather promptly relinquished her crown to first-runner up Nurse Charles just 10 minutes later, when she put the in-bound 18-gauge IV line in my right arm.

If you’re squeamish about needles or blood, you might be reading the wrong blog post.

More blood-testing ensued. We had an hour to wait before I was cleared for the machine, so Patrick and I popped downstairs (IN MY PAJAMAS!) to the Mayo Clinic Cafeteria for some (cheap) early-morning deliciousness.

Knowing I needed to stay on track with my magnesium-potassium-and-calcium-loading, I opted for frozen yogurt (206 mg Ca) with sprinkles (0 mg Mg) and a banana (422 mg K). I was just about to pull the tap on the Italian roast coffee when Pat said, “Are you sure you want to do that?”

Oh, yeah… that. It was my No. 1 question when I found out how this whole procedure was going down: What if I have to go to the bathroom?

Would I have a (gulp) foley catheter? Should I rock one of those adult diapers, like the astronauts?

“No,” Nurse Heather had said. “You’ll have a bedside commode or a bedpan. We will help you, if you have to go, but we have to keep your left arm immobilized. We don’t want to dislodge the line… So you want to be pre-hydrated to help with blood flow, but you don’t want to drink a lot the morning of the procedure.”

My No. 2 question wasn’t pertinent because of the aforementioned oxycodone.

We returned from breakfast to get down to business, and I took care of business one last time in a standard American Standard flush-toilet. I climbed into the bed. Pat set up my electronics. Nurse Heather slapped some science on us:

Everything you’ve heard about stem cells are true: They are the badass motherfuckers of the cellular universe. Some blood-cancer patients can even donate stem cells to themselves because stem cells can survive chemotherapy. My Type A- goodness would be sucked into the apheresis machine. The stem cells would be filtered from my blood via osmosis; bagged-tagged-and-relocated to the waiting recipient; and infused into him through a simple IV procedure.

“And they’re just like little homing pigeons,” Nurse Heather explained. “They know exactly where to go. They just return to the bones and start making marrow. It’s really remarkable.”

Your average stem cell donor will produce about 10 stem cells per drop of blood. I produce 134.4 stem cells per drop.

Now, I may struggle to finish in the top 95% of the Athena division of a sprint triathlon, and I know I have trouble completing sentences without offending a blast radius of bystanders, but I have one talent that can save lives: I produce stem cells like a champ.

134.4 stem cells per drop of me… but once my blood left my left arm, the stem cells therein belonged to him. Legally. My filtered blood would then be returned through that pesky 18-gauge line in my right arm to go about its business of being offered up to the highest bidder among a coterie of job applicants and competitive cyclists.

Nurse Heather inserted the other, outbound, 18-gauge stainless steel line in the pit of my left elbow. We adjusted the pillows in infinitesimal increments so I wouldn’t be nagged by the ache of sustained stillness. She strapped a blood pressure cuff to my left biceps to keep mild pressure on that arm … and strapped another one to my left calf to monitor my actual blood pressure (which was shockingly painful when it inflated.)

My blood volume is about 4.4 liters. The patient weighs about 8 kilos more than I. Based on the small difference between us (another reason to be an Athena!), they needed 5 million stem cells from me. And no, after I got off the machine, sans 5 million stem cells, I did not weigh any less. WHERE IS THE JUSTICE IN THAT?

Using some simple math, Nurse Heather determined I’d be on the machine about 5 hours.

EXCEPT THAT MY ARTERIAL INFRASTRUCTURE DOES NOT LIKE MATH.

Lines attached. All systems go. At 10:37 AM, she turned the nob on Old Betty the Apheresis Machine, and my veins started to spasm.

Saving lives is sexy business. Yeah, baby.
Saving lives is sexy business. Yeah, baby.

Since few of you have ever probably experienced a “vein spasm,” it was a lot like having the chills FROM THE INSIDE OF MY ARM. Fits of trembling, rocketing from my elbow up to my shoulder. Nurse Heather put hot compresses on to “warm up” my veins, but they were having none of it. They raged against that machine.

She turned down the extraction rate. The arteries assented. She did some more math.

“Get comfortable. We’re going to be here awhile. We’ll try to turn this up as your body gets used to it, but this is the rate your body will allow.”

It would be a long day.

Outbound... bye-bye, stem cells!
Outbound… bye-bye, stem cells! Yeah, that’s a big-assed line.

Fortunately Mayo Clinic allowed visitors – both in person and online. Coinciding with my filgrastim shots, Candice sent me a daily poem. Emily Dickinson, she is not, but her text verses put a smile on my face as I rode the elevator for each of my appointed shots. Her prayers – and those of so many others – carried me like a raft above a torrent of worry.

Pat texted my tribe to keep them in the arterial loop. He also went about documenting the adventure on film… err, pixel? Another friend Laurie, a Mayo employee, popped by with some delicious chocolate chip cookies. Troy, a cancer survivor himself, came by to visit and entertain his beloved “Troyfriend.” (That would be Pat, his BFF).

My constant companion, Heather monitored the rhythms of my body, gently advancing the march of the machine.

“Is there a hum in here?” I asked Troy and Pat. They looked at me like I was on heavy duty narcotics… and I was!

“What do you mean by a hum?” Heather asked.

“Like a vibration… like you pushed the bed next to the machine.”

“Where do you feel this vibration?” Heather asked, pulling a long syringe out from her tray of goodness.

“In the roof of my mouth.”

In addition to separating the peripheral blood stem cells from the rest of my A- awesomeness, the machine strips calcium from the bloodstream – hence my pre-donation diet. She moved the syringe to my inbound line.

Nurse Heather's tray of magic tricks. All this stuff is for me!
Nurse Heather’s tray of magic tricks. All this is for me!

“What you’re feeling is a lack of calcium, which we are going to fix right now… You may feel a warm sensation, like you’ve wet your pants,” she explained as she slowly depressed the plunger. “But I’m not going to let you wet your pants.”

“Oh my God, I feel like I just wet my pants!” I shrieked, peeking under my sheet. The blue polka-dotted pajamas remained unsoiled. Pat and Troy doubled over with laughter. The vibration disappeared. Heather, for the win!

Pat left to prepare the house for my triumphant return (We live only 10 minutes from Mayo Hospital). Reveling in the freedom of retirement, my friend Bob swung by for a visit. With no place to go – and no way to speed up my timeline on getting there – I enjoyed almost one full hour of his time.

When was the last time you visited with a friend without distractions, without deadlines, without the machinations of eating to disrupt the conversation? It is a lost luxury in this day of electronic tethers. Bob and I talked about travel and art and cooking, his grandkids, the machine, my donation, his encore career as an animal activist… and then he had to step into the hallway to make a call for his next appointment… and I had to go to the bathroom (since I had not previously wet my pants and I’d already been on the machine for two-and-a-half hours).

I looked at Nurse Heather.

“I think when Bob leaves, I might have to go to the bathroom,” I whispered.

“Really?” Her eyes bored into my soul. “Do you really have to go?”

“Well, uh, after Bob leaves… I mean, I wouldn’t want to make him uncomfortable… but after he leaves… in a half hour or so… then, yeah… maybe.”

She nodded almost imperceptibly.

Bob wrapped up his call. We talked more… about concerts and Arkansas and friends long departed. We bid our goodbyes. He slipped away. Heather had disappeared, and another nurse had relieved her.

I shrugged (right shoulder only) – I didn’t know how I felt about relieving myself with a new nurse, so I played Words With Friends on my iPhone: ZARF is a word, who knew? Narcotics for the triple-word win!

The Pantone strip shows the color they wanted to achieve as they spun out my stem cells. This is not a technical explanation... but it's cool.
The Pantone strip shows the color / concentration they wanted to achieve as they spun out my his stem cells. This is not a technical explanation… but it’s cool.

At the suggestion of my friend Mary, who had been undergoing radiation treatment for breast cancer, I tried the Deepak Chopra / Oprah meditation: Om-ing in time with the hum of my machine. I thought about my patient, somewhere in the United States in a similar hospital setting – the yin to my yang. When your every bodily function is being monitored and your own bloodflow is being guided by a machine, being present and mindful is a gift.

The narcotics helped, too.

Moments later, when Heather returned from her lunch break, I’d already meditated myself into a fitful state of airplane sleep.

“If I stare at her long enough, maybe she will wake up…”

It was Robin – the donor coordinator at Mayo! (And yes, if you do stare at me long enough, I will wake up. Just ask my dogs… or my husband). Robin had held my hand through a frustrating week of pre-donation testing, follow-up tests, an inordinate number of pregnancy tests, a last-minute postponement and quick-turnaround rescheduling. My heart jumped to see her – and the machine didn’t seem to mind.

“How are you feeling?”

“Good, good… Pretty comfortable. Can’t complain. I haven’t had to go to the bathroom yet… but I think I might have to in a little while.”

“Really?” Heather interjected. “Do you really have to go?”

“Well, not exactly right now… maybe when Robin leaves… but not right now.”

“Really?”

It was around 3PM. Almost 5 hours in, not only was Heather in control of my bloodflow, she’d also gone all Obi Wan on my bladder.

So I checked Twitter. I checked Facebook. I couldn’t post anything regarding my current state of affairs due to patient privacy rules via Be The Match. I started to watch the first season of Game of Thrones (Spoiler alert: Beheadings are never appropriate for a hospital setting!)

That familiar hum of calcium depletion returned with a vengeance. Heather pushed the plunger on salvation: I did not wet my pants. Those weren’t the droids I was looking for.

“We’ve been able to increase the rate… you might want to call your husband. You’re going to get to go home early.”

“Really?”

“We’re looking at around 4.”

I was so happy, I almost wet my pants!

“I know you’re excited,” she said, “but we’re going to take this slowly. We’ve got to get you unhooked. You’re going to be able to sit up. Then we’re going to wait for a while. If you jump right up, you’ll probably pass out, so we’ll take this easy.”

She drew blood for additional tests. She unhooked my left arm… the blood drained back in through my right. 4:37 PM. 6 hours, 10 minutes. Hanging up above my head, a red blood bag was pregnant with stem cells – his life blood.

5 million stem cells - not bad for a day's work.
5 million stem cells – not bad for a day’s work.

By now, Pat had broken several traffic laws to arrive at the gates in time for my early parole. I gingerly set one foot on the floor and then the other. Heather helped me up and walked me to the bathroom.

“There’s a catch-basin in the toilet that will measure your volume. Go like you normally would, but I need you to tell me how much is collected.”

“Got it.”

I felt like Coolidge on a morning after a long rain, lifting his leg on every shrub, tree and lamppost on the block. Aahh… aaaaaaaaahhhhhh… still going… ahhhhhhh.

I checked the basin. I had filled it exactly to the top line: 800 milliliters. (I did, in fact, take a photo, but I do not want that image to dissuade you from signing up for the registry).

I announced my achievement to the apheresis unit.

“Damn woman, you’ve got a bladder like a nurse!”

I high-fived Pat and wondered aloud why I could last 6 hours, 10 minutes in the apheresis unit, but sit me down in an actual movie theater and I will make a beeline for the potty at THE MOST DRAMATIC MOMENT OF THE FILM. I decided I would invite Heather to see the next Denzel Washington vehicle with me: Are you sure? Do you really have to go?

The transporter arrived to ferry my his stem cells to my intended recipient. I’d hoped that he would drive a hot Audi and look like Jason Statham. Instead, it was his first day on the job… though ultimately, I think there was a helicopter involved.

“Dude. Drive carefully. Obey the speed limit. Stop on yellow. We’re trying to save a life here.”

 

I wonder if the transporter got to drive in the HOV lane since he was carrying this box of goodness?
Did the transporter get to drive in the HOV lane since he was carrying this box of goodness?

I said goodbye and Godspeed to my his cells in their little ice chest. My work here was done… and now it was up to him, my recipient… my literal blood brother.

I was in bed and asleep by 8, exhausted from the quietest, most life-affirming adventure of my 42 years.

Over the next 30 days, as I worked my way back to fighting strength, I prayed fervently for his recovery: For engraftment – for my stem cells to find their way home in his bones without infection or rejection. At the 30-day mark, I got an email from Be The Match:

 

Good news.
Good news.

At the 100-day mark, I’ll get another update, and then perhaps, a year from now, I’ll have the chance to meet him. If he chooses to remain anonymous, it’ll be enough for me to know he’s alive. After reading that email, I sent him another card and signed it with the very best line in my first novel (which I finished writing a year before this ordeal began, and which, ironically, is about organ donation):

“Take care of the part of me that belongs to you.”

Be well, my friend.

They did let me take home my own biohazard bag as a delightful parting gift. This one has 5 million stem cells in it... but still.
They did let me take home my own biohazard bag as a delightful parting gift. This one has 5 million stem cells in it. Now go sign up for the registry, dammit!

The Lonely Donor, Part V: Preparation

 

Not sniffing my pits, just showing off all the bruises and spots from my subcutaneous chicken-wing filgrastim shots.
Not sniffing my pits, just showing off all the bruises and spots from my subcutaneous chicken-wing filgrastim shots.

 

Good morning, fourth metatarsal.

Hello, tibia. Hello, fibula. Right back atcha,’ femoral head.

Unfolding from my fetal position among the dogs and husband, today I can feel my thoracic spine, right there at T5. The metacarpal bones of my right hand spent the fretful night reminding me that I am, in fact, right-handed.

This is my life on filgrastim – the stem-cell stimulating drug. I got two shots of it per day for five days leading up to and including the donation – one shot in each chicken wing, among the ample, subcutaneous margins of my triceps.

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The Lonely Donor, Part IV: That’s Why They Call Me Fed-Ex

When it absolutely, positively has to get there overnight.
When it absolutely, positively has to get there overnight.

When you’re carrying a box labeled “HUMAN SPECIMEN,” people get out of your way. Sure, you may have to stand in line at the FedEx office, but I can assure you that no one will crowd your personal space.

I came to this discovery when I called Be The Match to alert my donation coordinator of some travel plans. Three weeks out from my postponed peripheral blood stem cell (PBSC) donation, I’d agreed to give them a heads-up on geographic changes to my whereabouts – a medical tether, if you will.

“Hi Chi, it’s Stacy. I’m headed to California on Thursday, back on Sunday. I know you said it could be five weeks or more before we rescheduled the donation. Any word on the patient?”

“We have not heard anything regarding the patient’s status. We do not contact them. I’ll let you know as soon as I hear anything. Just go and have a nice time on your trip.”

Don’t call them. They’ll call us: Welcome to my life in sales.

15 minutes later, Chi’s caller-ID popped up on my mobile. I rolled my eyes, assuming she probably forgot to check my pregnancy status again or see if I’d shared any unclean needles with the prison population.

“Hi Stacy, it’s Chi. You won’t believe this, but as soon as I hung up the phone with you, the patient’s coordinator called. Are you available on [ REDACTED ] for the peripheral blood stem-cell transplant?”

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The Lonely Donor, Part III: Postponed

Germ-free and living large.
Germ-free and living large.

You have been cleared to donate, but the patient is not ready to receive your gift at this time.

That time was to have been this week, or thereabouts, and now who knows when it’s going to happen. My donation has been deferred… again.

I would like to say that I had been training up for this moment, like so many triathlons before: Monitoring my food intake (high potassium, calcium and magnesium – low saturated fats); denying myself the pleasures of drink; ensuring proper hydration; getting plenty of sleep and avoiding any reckless shenanigans that might jeopardize my ability to give.

In truth, it’s not hard to register to donate bone marrow or peripheral blood stem cells (PBSC – the method I’m scheduled to undergo) or even to undergo the procedure. Can you sacrifice a little bit of time? Yes. Overcome a slight aversion to needles? Of course you can. Forgo running with scissors or jaywalking? Seriously?

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