It was a typical day in November 2010. I was taking care of patients when a new admission arrived to the floor. The patient's admission diagnosis was pancytopenia. A bone marrow biopsy had already been performed. The patient and his family were eagerly awaiting the results. The oncologist notified the patient of the acute lymphocytic leukemia (ALL) diagnosis.
As I entered the room, the patient's wife was very upset, so I gave her a hug, and with tearful eyes, I asked both of them if there was anything I could do for them. As I gave them information on chemotherapy and leukemia, I answered their questions, started IV fluids, and administered the prep medications. We talked about our younger days in high school, and we exchanged stories about our children. I could feel the connection we had created.
After the induction chemotherapy, the patient received frequent transfusions of irradiated PRBCs and platelets. The patient coded during this period, requiring intubation and a prolonged stay in the ICU due to complications of acute renal failure, hepatic failure, respiratory failure, and cardiac failure.
During his stay in the ICU, the family was accommodated with a hospital room to stay in, so they could be close by. I would go to the ICU to visit with the patient while he was in the unit, and I would always go by the room to visit with the family. The patient returned to the floor when his symptoms had improved enough to be transferred out of the ICU.
He was readmitted into the hospital multiple times over the next months, receiving chemotherapy and blood transfusions. During his admissions, he was always so excited when he would be getting discharged in time to watch his youngest daughter play sports. There was one time she was going to be in a pageant, and his wife brought her to the hospital, so that he could see the dress on her. He called me to come to the room, so I could see her in the dress. They would always ask me how my family was doing, and they were so excited to tell me about seeing my oldest daughter at a baseball game they had attended.
In August 2011, he received a bone marrow transplant. During this time, the patient's wife and I would text each other to keep in touch, so I could stay up to date on how everything was going. He was started on Sprycel 100mg daily after some features on his bone marrow suggested that he may benefit from it.
In December 2011, he was admitted with a fever, chills, coughing, and pneumonitis. He received a 10-day course of Zosyn IV and transfusions of PRBCs and platelets every 3-4 days. A bone marrow biopsy had been obtained at the time of admission, and before being discharged home, he was told that the leukemia was back.
Just a few days later, he was readmitted into the hospital. I had this gut feeling that day -- a feeling I had never had before. I had gotten to know this family personally, and apparently the patient's wife had learned to read me without my ever speaking a word. In the hallway, she asked me, "Are you OK?"
I was as honest as I could be when I told her I was worried about her husband. She told me, "Don't worry, he will be fine." This is a man whom she had supported in his early 20s during testicular cancer, which was treated surgically. She was confident he'd get through it.
The day he started having respiratory distress and was transferred into the ICU, she continued to stay positive about him getting better. In the middle of January 2012, he was just not getting any better. He was actually steadily declining. The family stayed at the hospital, visiting him every time the ICU had visiting hours. The family was again accommodated with a hospital room when he was in the ICU. Knowing that his condition was not going to get any better, his wife and their two daughters made peace with taking him off life support, and they made the decision to do so. His wife and I stay in touch with each other, and they are doing fine.
How has walking out the journey from diagnosis to death with a patient changed you?