Blood is thicker than...

I took an impromptu drive to New York Monday night. It's about 180 miles and it usually takes about 3 1/2 hours depending on traffic. When my bride and I make the trip, I usually drive the first two hours and after we stop for a short break at one of those mega-pissoirs on the New Jersey Turnpike, she does the rest. I love those places named for various storied figures of American history, and on occasion, we've driven from Clara Barton straight through to Vince Lombardi. They draw you in with a promise of free, unlimited urination in a setting of relative cleanliness, ease and comfort (although they do insist architecturally that you line up for public short arm inspection), and once you have been drawn into their web, they are licensed by the state to engage in highway robbery (couldn't be a better place for that, I suppose) by charging outrageous prices for all manner of brightly packaged junk food.

But I digress. Here's the back story: When my son was in college at Columbia, he registered for bone marrow donation. A number of months ago he received word from the registry that his tissue type matched someone who might need a transplant. He subsequently underwent more extensive examination and was recently notified that his stem cells could be used. In preparation for the harvest, he had to receive 5 days of injections of an agent to boost his marrow production of those hematopoietic stem cells that could then repopulate the marrow of the recipient who, several days before the transplant, would have his own malignant marrow wiped out by radiation and chemotherapy. The harvest of my son's healthy stem cells would occur on Tuesday in a hospital in Manhattan. He would undergo a procedure called apheresis where he is hooked up to a machine by several IV's and, as his blood flows through the apparatus, it is filtered and the "buffy coat" of white blood cells containing those stem cells is removed and subsequently transported and administered to the transplant recipient.

First off, I wasn't thrilled about his receiving injections of this stuff to boost his white cell count. Though I am a physician, I have always felt that unless you ABSOLUTELY need to take a medicine, you shouldn't. And then knowing he was going to have to be hooked up to a blood filtering machine also gave me pause to worry. I feel the same about "procedures" as I do about medicines. Since there is always a finite possibility that something can go wrong, best to not have things done that you don't really need to do. I also had some worries about tainted heparin which has been in the medical news lately, but was assured that he did not risk any heparin exposure with the apheresis. Also, generally speaking, being or being closely related to a physician or an attorney often guarantees a disaster of some sort. My son who is an attorney, therefore, had two strikes against him but was determined to go through with it.

While eating dinner at home Monday night, we realized he would be alone on Tuesday. His wife was in Israel for a family function. My bride had a big day in the office coming up, but I was free-so I decided to drive up to be with him. I didn't call him until I was passing Newark airport-about 1/2 hour from his place on the Upper West Side- since I knew he would not be thrilled (a euphemistic understatement, I know) that Dad had come to keep an eye on him. But too bad, ya' know? That's what parents do.

It turned out to be quite an experience. On Tuesday morning we took a cab to the hospital and were met by a young woman from the registry who treated us to breakfast in the cafeteria to help pass the time waiting the final hour after my son had received his last injection of the medication. We then entered the apheresis unit which was a large room with 4 or 5 of the machines along its walls and comfortable recliner chairs in between each unit-sort of like a dialysis unit for those familiar with that. There were patients already there undergoing the procedure, though all the others were cancer victims saving their own cells, my son being the only one there donating to another. After having IV's started in both arms, the device began doing its thing and we started the long wait.

It took about 5 1/2 hours. We played scrabble, watched TV, read books and chatted. I had to feed him, cover and uncover him with blankets and even help him with his runny nose. I had flashbacks to when he was a little boy. I don't think the irony of his temporary helplessness and the need to depend on me (he's a very independent guy) was lost on him.

We got a chance to meet some of the other patients and their families. Though my career was not spent dealing with cancer victims, virtually all of my patients had significant heart disease of one type or another and had to learn (as these folks have) how to deal with a long term problem that was likely to ultimately kill them. So, I have had a great deal of experience talking to patients with serious health issues, and once it was ascertained that I was a physician, several of them opened up to me sharing their hopes, frustrations, and fears. It's one of the two-edged swords of being a doctor. More than once I have had to listen to someone whom I've just casually met in a social setting describe in graphic detail their recent hemorrhoid operation and subsequent difficulties of a defecatory nature. On the other hand, as happened in the apheresis unit, when people sense a sympathetic ear, they do share many of their feelings and thoughts, and it often is (and was in this instance) an uplifting experience.

It was finally over and we took a cab back to his apartment, hugged and I began the journey through NYC rush hour traffic back to Baltimore. It wasn't too bad, actually. The next morning I tried calling him to find out how he was doing. I knew he had had some symptoms of hypocalcemia (not unexpected) during the procedure and they had given him some IV calcium. No answer. OK, I thought. I'll call back in 1/2 an hour. I called again in 15 minutes. Then I started calling every 10 minutes. I was sure his heart had stopped (God forbid!) sometime in the middle of the night due to the calcium imbalance. I knew I should have stayed over. I called his office and got voice mail. I sent him an email. I was ready to try and call his wife in Israel when, in desperation, I called him back one more time. "Hi, Dad. I was about to call you." "Nice to hear from you," I said. "I was sure you were dead in your sleep from hypocalcemia." "Well, he said, "It would have been peaceful." "Not for me," said I. Ah...The joys of parenthood.

But having said all that, I'm very proud of my son for unselfishly demonstrating the concept of Tikkun Olam (making the world a better place) and for being a mensch which is the most any parent could hope for.

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Best Martyrdom Ever

Sitting at a small birthday celebration with my mother-in-law, my bride, my daughter and son-in-law. We're all eating snacks and have drinks--except for my 84 year old mother-in-law. "Would you like me to get you a drink, Bubbie?" my daughter asks. "No" she says, pointing to the ice bucket "I'll just wait until some of that melts."
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Travelin' Man

We're back. It was quite a bori relaxing vacation. I'm not complaining. My bride works very hard, long hours (she's the executive director of the largest Orthodox synagogue in the US), and the slow pace was good for her. Since my job for the last 6 months has not been particularly demanding, I was already in relaxation mode. I did a lot of reading and turned on the in-cabin TV a few times. I don't watch much at home, but I think I'm going to send Royal Caribbean a note concerning their choice of programming. I mean really- the Hand Washing channel? the Ozzie and Harriet channel? Please! Can you imagine a TV channel that shows nothing but O&H reruns? I hadn't thought about the Nelsons (accompanied by that incessant, annoying 1950's laugh track) in decades. Of course between episodes we did get to spend quality time with hosts Gunnar and Matthew. What was it with Rick? Was he actually drugged out as a teenager or was it early Parkinson's disease? He sported masklike facies (hypomimia) with eyes half shut (dreamboat style, I guess) in those music videos we're treated to at the end of each show.

Besides watching TV, we did get to rub elbows with some 3000 shipmates and 1600 crew members. Too many people in close proximity for my taste. I don't think I need to describe what happens at the buffet table when they all decide to eat lunch, do I? I didn't think so. It's not a pretty sight.

Then came the excursions. We generally don't go on them unless there's something really special that we can't do by ourselves. Basically the islands are all the same. The only difference in the junk in the stores is which island's name has been stenciled on during its manufacture in China or Korea.

On Labadee we spoke to a fellow who took the "zip line" ride down a mountain. Way too expensive and revealing when he shared with us his discomfort on the way to the jumping off point where he saw teams of shotgun toting security men patrolling the borders around the stretch of beach where they allowed us to stay during the day. It's sort of like living in Chevron (Hebron) in the disputed territories in Israel. If it weren't for the army, there would be no settlers. Likewise, if not for the shotguns, I suspect there would be no tours of this little corner of paradise.

So now it's back to life. I'll tell you about my fingerprinting adventure the next time.

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Don't Rock the Boat

For the next 9 days my bride and I will be cruising in the Caribbean. I will do my best not to gain weight. I don't know if I will be able to contribute anything to this blog while I'm on the high seas, but I'll take notes to let you all know if anything interesting (or thought provoking) happens while I'm away. I never received the fingerprint kit in the mail so I was unable to complete the security clearance procedure for SSA. I suspect it will come while we are away-then another few weeks wait while they check me out. Today is my last day at the cardiac rehab program. They are moving to a hospital next week and will no longer need me there to "put out fires". Note to the schmendrick who contacted me about my commentary on Dr. Jarvik: Put it in the Comments section rather than emailing me. That's why it's there. Thank you.

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That's the signpost up ahead - your next stop.....

It finally happened! I got the contract from SSA. I received the document via email and sent back a signed copy. Called my friend in the disability office to find out when I could actually start and was told I needed to pass the security check before I could begin. They were supposed to send me some forms to fill out but forgot to include them. Also need to get fingerprinted and it says the contractor (that's me--an offerer no longer) will bear the cost of the procedure. It would be nice if I could get all of that done before my bride and I go away at the end of this week. Speaking of my bride, it was her birthday this past Monday so I went to a mall I never go to to look for her present. (BTW-I already returned it today-she's very easy to buy for; returns virtually everything.) Anyway, that little excursion was a foreshadowing of things to come in my life, I'm afraid. It took me at least 15 minutes to find (what I thought) was the correct exit to a parking lot that I'm very unfamiliar with. Once in the lot I couldn't find my car. I pressed the key fob and faintly heard a honk above all the din. Over the next 20 minutes I tried walking in every possible direction while listening to distant honks become more distant. It was a mash-up of a Seinfeld and a Twilight Zone. I finally realized I was on the wrong level. I'd probably still be there if not for that minor epiphany.

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