And so it goes, Day +8

There are many days I don't go outside. I take the third floor walkway from the hotel to the hospital parking garage, continue across the walkway over Euclid Avenue into the Center for Advanced Medicine (CAM), and finally end up in Barnes-Jewish Hospital North. Then I take the elevator to the 5th floor, Stem Cell Transplants and Leukemia. When I'm lucky I hear musicians serenading all of us from their first floor position at the bottom of the atrium in the CAM. One late night I caught two male hospital employees in blue scrubs playing piano. I cheered them on.

The temperatures in St. Louis have been at least ten degrees above normal most days with clear skies. But outside Bob's window is a tree that tells us fall is on its way. A couple of days ago I noticed a small patch of leaves had turned from green to red. Only a couple of other leaves have joined them, but perhaps we'll see more when it becomes cooler on Sunday.

If you picture a bell curve and then flip it upside down, Bob is right at the bottom. His absolute neutrophilic count is 0. (Neutrophils, a common type of white blood cell, are essential for fighting disease. Normal is over 1,000.) His white blood count is 0.1. (Normal is 5-10.) His platelets, which help clot blood, measure at 22,000. (Normal is 150,000-450,000.) His hemoglobin, which carries oxygen to the blood, is at 9.2 (instead of 12-16), and his hematocrit is 27.5 (instead of 36-45). The melphalan has done its job.

Bob has been receiving growth factor shots each day since Day +5, just like he did before the apheresis to stimulate stem cell development. Today he received his first transfusion ever, a bag of platelets. The bag looked like it held thick chicken noodle soup without the chicken or the noodles!

Only occasionally does Bob search for a word as he's speaking, a sign of chemo brain or chemo fog. It's extremely common. He also is having some difficulty maintaining his blood pressure when he stands up. It seems there is a very fine line between his intake and output of liquids so that his pressure is high enough but he doesn't have swelling in his legs and feet. He's being as careful as he can and has had no falls (although he is embarrassed by having to wear a yellow bracelet that says FALL RISK. He calls it his gomer bracelet.). Other than these specific things, he just has a general feeling of malaise and fatigue and continues to be bothered with the pain from the neuropathy.

I have nicknamed him Captain Courageous. (Yes, I know the real title of the book is Captains Courageous and the plot summary doesn't fit but the name sure does.) He has met all of this head on with an optimistic attitude and without whining. And, you won't be surprised by this, he has enamored himself with all of the staff and some of the patients. He teases and jokes and extracts their life stories, and soon they seem like friends. He's in his element and fighting for his life.