November 9, 2024
We headed over to Fayetteville this afternoon for the oncology labs and appointment. We were scheduled to see the NP today and not Dr. B. When the NP came in, she said David’s hemoglobin was 6.6 and even more alarming was that his WBC was (710) .7 which meant he was neutropenic. She went to speak with Dr. B.
A scheduler started calling around to see if there was a hospital location anywhere near us that could do a blood transfusion asap. While we waited on that, I asked about the serotonin syndrome. The NP considered it could be a thing. I also asked how we would know if the port line was infected and she was interested in why I asked. I explained because that is a thing of course, but also our primary mentioned it happens sometimes but rarely without some other symptoms. The discussion didn’t go too far because the scheduler called to say that since it was approaching closing time on a Friday afternoon, there either was no answer at the locations, or they couldn’t do it until sometime next week. The NP said Dr. B felt this could be cancer fever but fever spikes are a major concern with neutropenia so they told us we needed to go to the ER. Dr. B’s office does not have admitting privileges so this meant David would need to be admitted through the ER. We were given masks and told to stay far away from sick people. We debated coming home to URMC, but David was ready to get the ball rolling here not knowing what this may turn in to so we went downstairs to Piedmont Fayette’s ER with all the sick people. It was difficult to find a place to sit away from anyone but we did our best and they called him back in about 15 minutes. Like we found out last Saturday, ER’s tend to pay attention to people with feverish confusion and also people with very low white blood counts in need of a blood transfusion. After the assessment, they got David back to a little room in the ER and they told us they were initiating neutropenia protocol meaning healthcare personnel or visitors who have a communicable disease (including colds and other respiratory symptoms) should refrain from caring for or entering the room. Everyone else has to wear a mask. They got started with the IV lines, fluids and blood draws. They immediately started more cultures and got him going on broad spectrum antibiotics. Radiology came down for a portable chest Xray (his second in a week). They told us they were doing the same sepsis protocol we had at URMC last week. Cancer patients are susceptible to sepsis and it can happen very quickly. It is basically why I had him in the hospital or doctor’s office more than normal this week. I shared all info, labs, scans, etc. We saw the ER doctor and she said she would be admitting him and starting the cross match for the blood transfusion. Oddly enough, with the lab tests in the ER his WBC was 1400 (1.4) and his hemoglobin was 7. ER doc thought it odd as well. At any rate, they moved right along and around 8pm they were getting ready for the first unit of blood. We had been back and forth, since learning he would be admitted, trying to decide if I should take off home and pack a bag and finally decided I would go and then come back. He would most likely be moved to a room by the time I got back but the nurses said they would be sure I could get up to the room. Aggravating I had packed a bag when we went to URMC on Saturday and also when we went to see Dr. W on Wednesday just because we didn’t know what was coming. I did not pack a bag to go to our regular oncologist appointment, but I bet I do from now on. Before I left, I asked his nurse if he could have a snack or something since he had not eaten anything since before the doctor’s appointment. He got him a turkey sandwich, saltines, graham crackers and some juice. All of the ER nurses, lab techs, med techs and doctors were so nice and accommodating. When leaving through the ER waiting room, it was now standing room only and I thought about all the sick people having wait on their turn and how miserable that was for them. Noting a little gratitude that we didn’t have to wait that long nor were we that familiar with ER waiting rooms. I drove the hour home stopping on the way to grab food to eat on the way. David texted me as things were happening to let me know what was going on and what they were giving him. I got home and grabbed the bags SL had gone ahead and got packed up as best she could with things I told her I needed. I turned right around and headed back. Just my luck we were under a fog advisory for the evening, and it was hard to see 20 feet in front of the car in most places between home and Fayetteville. I got back to the hospital around 10:30. David had already texted to let me know they took him up to a room and a nurse would most likely need to escort me up as elevators are not supposed to be used 9pm-7am. At least in the area where he was. I had to go in through the emergency entrance since the main entrance was closed by now. The very nice lady at the first desk in the foyer looked David up and found he was moved to a floor but it did not yet say which room. I texted him and he gave us the room number and she wrote me name sticker and said she would put me on the elevator up there herself. She said if anyone stopped me to say I checked in with her and it should be fine. I went up without issue and got to the room as they were just starting to give him another unit of blood. When he got to the floor, his hemoglobin was 6.8 so yet another whacky reading but they were readying another unit of blood. There were a few IV lines with more antibiotics and fluids waiting to start after the blood. Blood infusion took around 2 hours and we both were too wired up to sleep but were very tired. Stupidly forgetting what hospitals were like, we thought well, we will get settled and eventually drift off. That was not the case. I melted down 2 or 3 times during the night because we could not close our eyes before lights were coming on and people were in there doing this or that and giving him this or that. I am not a patient person but for some reason in the hospital (when I am not the patient) I can roll with things because he is where is needs to be for treatment. This time, I did him zero favors by having 3 perimenopausal mood swings and becoming very home sick. His fever spiked several times during the night, and I kept cold wash cloths and paper towels on him until it cooled down. This was preferable to him having to get the dreaded underarm and behind the knee ice packs he got in February.
Notes: Dos and Donts of Neutropenia
