A stem cell transplant is all about the numbers. Everything – blood composition, fluid volume, body temperature and weight – is counted, measured, and recorded.
Even the days are numbered. The day of the transplant itself is known as “Day 0,” and the days leading up to it are counted down in negative numbers: Day -3, Day -2, Day -1, Happy Transplant! After that, they start counting back up again. By Day 30 after his transplant, Nick would hopefully be discharged and on the road to recovery. By Day 100, his immune system should be almost back to normal. But all that would depend on the stem cells he’d get on Day 0.
When I worked in pedes oncology, we told the kids that Day 0 was like their second birthday. From that point on, they’d have two birthdays to celebrate: the day they were born, and the day they got their transplant, which marked the start of the rest of their lives. We made a huge deal out of every patient’s “stem cell party,” so the whole thing would seem more exciting than scary. So on the day of Nick’s transplant, I showed up in his hospital room with birthday hats, cupcakes, and a huge bouquet of “Happy Birthday!” balloons. Of course, he looked at me like I was nuts, until I explained about the birthday thing.
“Besides, I thought these would help cheer this place up,” I added brightly, tying the balloon strings to his IV stand so that they floated over his bed. Flowers weren’t allowed in the transplant wing, but balloons were more fun anyway. “And the cupcakes aren’t from a bakery; I made them myself, so they should be okay for you to eat,” I added, showing him the rows of cupcakes I’d slaved over the day before. He was on a restricted diet as long as his blood counts were low, so I’d been extra careful to keep my germs out of the cupcakes. “They’re just white cake with peppermint frosting, not too rich.”
It had been hard trying to coax him into eating the last few days; he hadn’t had much of an appetite, and the little he did manage to get down usually came back up again, eventually. I hoped the cupcakes would tempt his taste buds without upsetting his stomach even more. “They look great,” he said, smiling up at me. “When the hell did you have time to make those?”
“Yesterday, when I left you with AJ.” We had worked out a schedule where at least one of the guys or his sister Angel came to visit for a couple of hours each day, which gave me a chance to run back to his condo to shower and change clothes. Yesterday, I’d baked cupcakes and bought party supplies. I set the Tupperware down on his bedside table and whipped out the package of birthday hats, the same pointy, cone-shaped kind you see at little kids’ parties.
“Are you serious?” Nick asked flatly, giving me a look, as I held one up.
“Absolutely!” I sang, and before he could stop me, I snatched the knit skullcap he was wearing off his newly-shaven head and swapped it for one of the hats.
“I look fuckin’ ridiculous,” he complained, but he let me slip the elastic under his chin to secure it. He did look pretty silly, like an overgrown baby with his bald head. It was still weird seeing him completely without hair. You’d think I’d be used to it, having spent my whole nursing career caring for cancer patients and elderly men, but there was a part of me that had felt like crying as I’d watched AJ shave off Nick’s beautiful, blonde hair.
“Aww, no way,” I lied and winked, knowing he couldn’t see me smile behind the mask I wore to wear to keep my cooties off him. “You’re adorable.” To make him feel better, I put a hat on, too, and he tweeted a picture of us looking ridiculous together. At least he hadn’t lost his sense of humor along with his hair.
While we waited for the transplant team to show up with his stem cells, he kept us both entertained with his iTunes playlist. We were singing, “It’s the final countdown…” when the nurse walked in to get started. She set up the equipment and explained the procedure and risks one more time, so Nick would be ready when his doctor arrived.
The word “transplant” makes most people think of a major operation, but really, after all the build-up, a stem cell transplant is pretty anticlimactic, not much different than getting chemo or a blood transfusion. Dr. Schnabeltier hooked up an IV line to Nick’s port, through which to infuse the stem cells, which, once they were thawed, looked basically just like donor blood.
“Hey there, stem cells,” Nick muttered, eyeing the IV bag. “Long time, no see. Glad to have you back.”
I smiled. “Tell them to make themselves at home. The sooner they set up shop and start cranking out blood cells again, the sooner you can get out of here.”
“Yeah… you hear that? What she said,” Nick added, and I laughed.
“How do you feel?” asked the nurse, who was in charge of checking his vitals and monitoring him for signs of a bad reaction.
“Okay…” Nick answered at first, but after a few minutes, he made a face, squirming uncomfortably in his bed. “Ugh… I’m sorta getting sick to my stomach,” he admitted. “I got this nasty taste in my mouth… like-”
“Garlic?” I supplied.
He looked at me in astonishment. “How’d you know?”
I was glad I had a mask on, so he couldn’t see me smile. “Didn’t I tell you I could read minds?” I teased. “No, it’s the preservative they use when they freeze the stem cells. It secretes through the tongue and causes that garlic taste. I can smell it on you.” And I could; he reeked like he’d spent all day working in the kitchen of an Italian restaurant. It wasn’t that bad, really, but I imagined the taste was a lot stronger than the smell.
He wrinkled his nose. “Really?” He exhaled through his mouth and then grimaced. “So I’m gonna have garlic breath all day?”
“Hey, at least you’ll keep the vampires away.”
That got a smile out of him, but he was starting to look pretty green around the gills. The nurse offered him a peppermint to suck on, to get rid of the bad taste, and that helped settle his stomach.
It only took about fifteen minutes for the stem cells to finish running in, and when the doctor disconnected the IV line, Nick said in surprise, “That’s it?”
“That’s it,” repeated Dr. Schnabeltier in his German accent, his blue eyes crinkling above his mask. “Now you just have to vait for them to start verking. It vill take a few days; you’ll feel verse before you feel better, as your blood counts continue to drop from the chemo. But if all goes vell, vee should have you out of here in a couple of veeks.”
And at first, all did go well. Nick, despite being so stubborn, was a good patient. He did everything the team asked of him, even when it annoyed or embarrassed him. He didn’t have the energy to refuse, or maybe he’d just accepted that it was in his best interest. He had always been so private about his condition before, but there was no such thing as privacy on the transplant floor. Nurses came in at all hours to check his vitals and draw his blood for testing. They forced him out of bed and onto a scale morning and night to weigh him, since rapid weight gain was a warning sign of certain complications. For the same reason, they kept track of everything he ate and drank and everything that came out of him, too.
“Can’t believe someone gets paid to measure my shit,” he grumbled on Day 2, pushing the nurse call button after a trip to the bathroom. “You know how sick that is?” He gave me a sidelong glance. “You should know; you went to school for it.”
Clearly, he thought I was insane. “That’s right, Nick; that’s exactly why I went into nursing, so I could learn how to measure people’s stool,” I said sarcastically, rolling my eyes at him. “It’s not like that’s her whole job, but yeah, it’s one part of it, and damn right she gets paid – and probably not enough.”
He shook his head. “You couldn’t pay me enough to do that.”
“Well, good thing not everyone feels the same way, or you’d have no one to take care of you.” That came out sounding snippier than I’d meant it to. The days of being cooped up in this hospital room together were starting to take their toll on both of us; tempers were running high, and patience was running low. I tolerated Nick’s moodiness, knowing it was just because he didn’t feel well, but sometimes it got the best of me, too.
He always knew how to charm me, though. “I’d have you,” he said, grinning up at me suddenly. “You’d take care of me, wouldn’t you?”
His smile was irresistible. My annoyance melted away, like butter in his hot little hands. “Yes,” I admitted, feeling myself soften as I smiled back. “I guess I’d have to, huh?”
He gave a nod. “I can always count on you, Cary,” he muttered, his words slurring together from fatigue. His blood counts had dropped so much that just the short walk to the bathroom and back completely sapped his strength, and he didn’t have the energy to do much else. The physical therapist had brought in an exercise bike for him to pedal when he felt up to it, but until his counts started climbing again, he was limited to the deep breathing and leg exercises she had shown him how to do in bed. We were all waiting for that day, the day when his bloodwork would show that the stem cells had engrafted in his bone marrow and started making new blood cells. Until then, he needed transfusions and shots of growth factor just to function.
The nurse finally showed up, and I pointed her to the bathroom. When I looked back at Nick, his eyes were closed, and I thought he’d fallen asleep. Then, without opening them, he said, “You don’t have to stick around, you know. You should go out… go shopping or something… go to the beach… get some fresh air and sun for me.”
“I’m fine,” I said quickly. “I wouldn’t have any fun at the beach by myself, and if I went shopping out here, I might never come back.”
He chuckled. “I don’t know why you do come back every day. If I were you, I’d make a break for it the first chance I got.”
I swallowed. The answer to that was easy in my head, but much harder to say out loud. It wasn’t the way I wanted to tell him I loved him, so instead I said, “Because I care about you, Nick.”
Eyes still closed, he smiled and stretched out his hand. I took it, lacing my fingers through his. As I looked down at our hands, I could plainly see what this was doing to both of us. Mine was thin and white as a ghost; I obviously hadn’t seen much of the sun lately. His was swollen and discolored, a reaction to the chemo that had poisoned his body. My nails, which I usually kept well-manicured, had been chewed down to nubs, and most of the red polish had chipped off. In the last week, his had grown out, almost past his fingertips, since nail clippers weren’t allowed, due to the risk of bleeding and infection. Maybe I’ll give us both manicures tomorrow, I thought, smiling to myself. I could file his nails for him and repaint my own. At least it would be something to do.
But I didn’t get the chance. Nick woke from his nap that afternoon complaining that he was cold, but when I brought over an extra blanket, I saw that he was sweating profusely. Even the sheets were damp. His whole body was shivering, but I even before I put my hand on his sweaty forehead, I could feel the heat radiating off his skin. My heart leaped into my throat, and I smacked the nurse call button.
“What’sa matter?” Nick croaked.
“You’re burning up!” I exclaimed.
“Heh… I’m burning up… and up,” he sang to himself. He tried to smile, but it looked more like a grimace with his teeth chattering.
“This is serious, Nick. How do you feel? Are you in any pain?” As I pelted him with questions, I kept looking at the door, anxious for the nurse to get there and annoyed with her for taking so long and angry at myself for not catching this sooner. Nick had his temperature taken every four hours, and the last time it had been checked, around noon, it had been normal. But I’d been sitting in the room with him for the last three hours, just reading my book while he slept, and hadn’t even bothered to feel his forehead. Even though I wasn’t on duty, wasn’t his nurse anymore, I felt terrible for dropping the ball.
“Just cold…” Nick mumbled, closing his eyes as he burrowed further down into his blankets. But he was practically panting, his breathing rapid and shallow, and when I dug his arm out from under the covers and took his pulse, it was too fast for someone who had just woken up from a deep sleep.
When the nurse came in, I was ready for her. “He’s spiked a fever,” I said, right off the bat. “Resps are twenty, heart rate’s ninety.”
She looked at me, looked at Nick, and got out the thermometer. Sure enough, his temperature measured in at 101.9. “I’ll call the doctor,” she said, and got right on the phone.
Things moved quickly after that. I stood out of the way and watched, as the room filled with people in white coats and scrubs, sterile masks and gloves. They swarmed around Nick’s bed, checking vital signs, hooking him up to various monitors and drips, collecting blood and urine samples to test for bacteria. In no time at all, they’d converted his hospital room into a private ICU.
“We won’t know anything definite until we get the cultures back from the lab,” the attending physician told me, and of course, I knew that. But like all of them, I sensed the seriousness of the situation. Fever meant infection, and infection, in someone whose immune system was almost nonexistent, could mean death. I knew Nick was in good hands, but if this medical team couldn’t get the infection under control, only the hands of God would be able to save him.
Sitting by his bed, as night fell around us, I bowed my head and said a prayer. For a minute or so, I was comforted. But when I looked up and caught sight of the monitors over Nick’s head, I felt an overwhelming sense of dread deep in the pit of my stomach.
The numbers didn’t lie: Nick was in bad shape.
***
