Sunday, July 02, 2006

Last chemo session is tomorrow

I know that my few regular readers noticed that my postings had dropped off significantly. In a way that's good news. It had all become routine without all that much to report. Tomorrow is my last chemo session. I'll go in for the last time tomorrow morning at 9 am. Hooray.

Before the session three weeks ago, Dr. O the oncologist, came in to report the results of a CT scan that I'd taken on the prior Thursday. "I have good news." She couldn't detect any clear signs of swollen nodes within the abdomen. Tomorrow's session is therefore just a kind of protective measure in case something didn't show up on the scan.

So, it's gone. No more lymphoma. It all seems from this vantage point that it was not a big deal. I'm still more tired than usual. I still have problems walking up hills. But at least I now know that those conditions are caused pretty much entirely by the chemo drugs and not by the cancer itself.

I've even started to get fuzz on my head that appears to be relatively widespread without too many obvious blotches.

But there are a couple of other reasons for the dropoff in postings. For one things, I've been busy for the past two months with tasks for a non-profit group at which I've volunteered for years. I manage their website and do print graphics for their big annual fundraising party. I switched the website over to a new host and prepared -- with much email deliberation -- the graphic "look" for the part before preparing the many posters, mailers, fliers, and related material.

So that's kept me busy. But a more significant change transpired when someone that all of us in the family was diagnosed with breast cancer. Because she wouldn't want to be identified any more clearly, I'll call her "M".

M didn't really want to tell anyone about the cancer. At one point when I asked her why she wasn't reading the brochures the doctors had given me, she said to me, "I don't want to become one with this cancer."

Fair enough. But many of us worried that she wasn't yet prepared to do what it would take to "kill bill" as she has named the critter.

While all that was happening, it seemed a bit self-indulgent of me to post these entries. So I stopped for a while.

But M is now in chemo, getting session every other week. She reports

All is well, the second Chemo was this last Tuesday, it's not so bad...compared to bull fighting. No really, it was not bad at all. It just kicks the crap out of you for a few days...like a bull would too. Otherwise, not bad. Food tastes funny...but I'll eat my peas with honey, I've done so all my life it makes the peas taste funny but it keeps them on my knife!!!

Yup. Comapared to bull fighting.

Tuesday, May 02, 2006

Finally getting the mid-point CHOP treatment

These are a few notes I recorded yesterday:

From a [Monday 1:35 pm] email to sister #4:
I'm sitting in the infusion room now about to start chemo... And now 2/3 of the way through it. The platelets came up just enough today to get it started. It was a busy day here today that's only now starting to settle down. Fortunately, I thought to head down to the cafeteria to get a sandwich while waiting for labs and the chemo go-ahead.

[Monday 1:45 pm] I'm been in the infusion room since 9:30 this morning, but the third of the three drugs that drip into my new chest-spigot is on its way into my system.

My platelet count was up just enough to risk the chemo.

It's been a busy day in here today with two people dropping in complaining of severe nausea after chemo sessions.

[Tuesday 3:20 am] good thing i heard those nausea explanations. i just threw up.

The infusion room was packed when I arrived at 9:30. The guy who usually checks us in from a desk on the east side of the room was off for the day. The three already-busy nurses on duty had to fill in for check-ins and to run blood samples down to the lab on the ground floor.

The infusion room is on the sixth floor of the original hospital building. It's wedged into what was intended to be a four-bed hospital ward and is one of the rooms that demonstrate how necessary it was to build the new buildings that are rising just across the street to the east of this ward.

Five large easy chairs are arranged along two walls on the west and north side of the ward. Three desks with computer monitors for the nurses, scheduler, and on-staff pharmacist are jammed along the south and part of the east wall of the old ward. A standing-height island with medical supplies is positioned in the center of the room with a wide supply cabinet just to the left of the door on the east wall.

One of the patient easy chairs is positioned so that a walkway for the nurses is blocked if the foot risers of the chair are extended into the full lounge position.

There is very little room for visitors, so if anyone brings along family members, the whole place becomes even more cozy for everyone.

It was so packed that my regular nurse had to install what I call the spigot into my port while I was sitting in the check-in chair so that she could draw a blood sample. To do that, she applies just enough lidocaine to deaden the area. I don't feel a thing when she inserts a large needle into the access port. Even though the skin that's stretched tight over that port is still somewhat sensitive, it seems to have be a worthwhile alternative to the regular search and poke to find a "good vein" that would otherwise still be necessary.

So when I say "packed", I mean it. After getting the spigot installed and getting the blood drawn, one of the chairs opened up. I grabbed it. And waited. And waited. It was becoming clear from some comments of nurses to each other that the lab was equally busy this morning.

One of those waiting uncomfortably was a young Hispanic man. He seemed eager to give up the easy chair he sat in, but the nurse told him each time, "No. Stay. We're working on getting a translator." He speaks no English and the hospital's translator service was being as inefficient as ever.

When a translator finally arrived, I listened even more closely than I usually would because I realized I didn't know how to use the nausea pills they'd given me after my first chemo session. Like the young guy in the chair next to me, I hadn't had trouble with nausea after my first two sessions. But my neighbor described through the translator significant problems after his third sessions. "I hate to call my boss and tell him that I can't get to work, but sometimes it's so bad, I just can't get there."

The nurse and translator explained that he should now take one of the pills (the one shaped like an American football) twice a day even if he wasn't feeling sick. He could take the small white pill up to eight times a day if he felt like he was even getting close to being sick.

With a good translator present, the guy poured out a number of other questions like, "Why am I always so tired." (Nurse: "I'm afraid there's nothing we can do about that. You'll just have to rest as much as you can when you're not working.") "Why do I have to wait so many days before getting another treatment?" ("This is complicated," the nurse said to the translator who conveyed something like that to the patient. The nurse explained the notion of "protocols" and "what works" and then the translator did what seemed to be a good job of conveying as much as possible of that to the patient.)

As the patient was leaving, the nurse said to him through the translator, "I admire you for trying to work every day through this. Come back here if you have any more problems. We'll get a translator next time even if we have to do it over the phone."

I've seen the guy a couple of other times in the infusion room, always before this without a translator. He always seemed confused and just a little frightened. As he left yesterday and for the first time that I've seen him here, he smiled as he left.

(And, it occurred to me that this ambitious young guy who is so worried about missing a shift at his restaurant job because of chemo treatments would be one of the first folks that Lou Dobbs and the politicians he speaks for would like to see run out of the country.)

While waiting for the labs and listening to the nausea-med instructions, I realized, incongruously, that I was getting very hungry. I'd forgotten to bring cash with me this morning so I checked my wallet to see if one of the cards might have enough cash available to get a sandwich and to get the co-pay fee for the drugs they'd give me after the chemo. I found one and headed down to the cafeteria with a stop at a bank machine. (Oh, my... In front of me was an ATM customer who tried out several cards in the machine until she finally, slowly, found one that worked. Sigh.)

With two sandwiches in hand, I headed back to the infusion room where I found my favorite chair open. I set up the laptop just in case even though I was feeling tired. By then the nurses had gotten permission from Dr. O to go ahead with the chemo even though my platelet count had made only a slight jump. There had also been a delay getting the chemo drugs -- I imagine that was partly due to the two delayed sessions from last week.

As I began to eat a sandwich and crunch on chips, the chair next to me was taken by another guy who complained of the same sort of nausea that its prior occupant had suffered. He had tried to take the pills as directed but was worried that he hadn't been able to keep them down. The nurses, after consulting with his oncologist, decided to give him a fluid drip with some anti-nausea meds added in. He had also gotten through his first couple of sessions without nausea.

"This isn't a good sign," I thought as I waited for my delayed third chemo session. I tried to munch my sandwich as quietly as possible as the fellow next to me explained his symptoms.

The nurse attached a fluid drip to my chest spigot as we waited for the actual meds which were finally delivered at about 1 pm.

The protocol used for my chemo treatments is called CHOP, which was, at one time, an acronym for the four different medications delivered during the tri-weekly chemo sessions. The four drugs are now more commonly called Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone.

Many lymphoma patients are now treated with a modified regimen called rCHOP or CHOPr [for those who prefer an Easy Rider style]. This regimen adds another medication called Rituxan to the mix. But Rituxan works only with the most common form of lymphoma -- diffuse large B-Cell lymphoma. It doesn't work at all with the form of lymphoma I have, so it was wisely left out of my regimen.

Only three of the drugs are administered during the infusion session. I take Prednisone in a nasty-tasting oral pill for five days in the morning after the chemo session. Two of the drugs are added to the drip tube by a nurse who slowly squeezes the liquids out of a large syringe type device. One of those is Vincristine, which is a red liquid that turns the pee a deep orange for a few hours after it's administered. Before the central line was attached, the nurse had to closely monitor the vein where the IV was attached to make sure the drug didn't leak into surrounding tissue. This is no longer an issue with the central line dangling into a major vein.

Another of the drugs is administered with the help of a drip-pump along with fluids into the vein.

I've found nothing painful or bothersome about any of the three chemo sessions I've experienced. I was tired yesterday during the chemo session and even fell asleep a few times in the easy chair. As I've been after each chemo session and transfusion, I was very tired when I returned home and slept for several hours before retiring for the night.

But until last night at about 3 am, I hadn't experienced the kind of nausea that can be so debilitating for some chemo patients. Even last night, I vomited a few times, took the indicated pill, and then slept through the rest of the night. No problem so far today, but I'll take another of those football-shaped pills in about an hour and another one tonight -- just in case.

Yesterday's chemo session should be about the half-way point in my treatment. When my sisters and I met with Dr. O last Tuesday, she said she's hopeful because of my quick and apparently permanent response to the first chemo session. She explained that after the fifth session, they'll run through the same set of tests that they ran after my initial diagnosis. That would mean a CT-scan and -- probably -- another of those bone-marrow biopsies. They'll be looking for remaining signs of the cancer and will stop at six treatments if they find nothing.

So all of this is mostly hopeful. But behind it all lurks the notes I've heard and read about the problems with predicting the course of the kind of T-Cell lymphoma that I have. Fewer than one percent of non-Hodgkins lymphoma cases involve things other than the B-Cells of the immune system. With so few cases, there is far less clinical history to predict things like long- or short-term complications of the disease and its treatment.

But, so far, it generally feels good. I'm starting to worry now about getting off this chair and getting a job in a month or two. It's time.

Sunday, April 30, 2006

Getting an IV port in my chest #2: The operation

Our portacath adventure which started here, continues...

As we waited for an empty car in a sixth-floor elevator lobby during lunchtime rush, the hospital transportation worker explained to my sisters and me that the short bed is called a stretcher and is made to fit into any of the hospital's elevators. And it did fit -- just barely -- into the central elevators which are rarely used for this kind of thing. We headed to the building's maze-like basement which connects all of the spread-out wings of the facility, even passing in a tunnel under a city street at one point.

We headed into an area that I think was on the south side of the hospital's original building. I don't recall the name and I wasn't able to find the door when I walked through the basement hallways yesterday. Maybe it was in a different area of the basement.

My sisters were directed to a waiting room. (They ended up doing a lot of waiting in various areas of the hospital during their visit. Fortunately, both of them had laptops and/or other devices to keep them connected with their jobs.)

I was wheeled into an area that's called something like "Special Procedures Unit". I was deposited in a short equipment-filled hallway just outside double doors that I recognized as typical OR entry ways. Two friendly nurses came over to check my plastic ID bracelet and start and IV drip. Shortly thereafter a young woman introduced herself and said she'd be "performing the procedure." She then explained what would happen in relatively elaborate detail. "We'll be giving you a local anesthetic. You'll feel some pulling and pushing on your skin, but you shouldn't feel any pain. If you do feel pain, tell us immediately, and we'll take care of it."

She warned me, however, that I would feel pain for several days in the area where the port would be placed. She assured me that ibuprofen is usually the best solution to deaden the pain. She then gave me several consent forms to sign before I was wheeled through the double doors into the procedure room.

This room wasn't nearly as bright as the OR I'd been in for the biopsy. But what it lacked in lights it made up for in equipment. My first thought was "Frankenstein!" as I surveyed the complex tracks on the ceiling with an x-ray camera hanging from one section along with the long narrow bed standing on a single high pedestal in the center of the room. I was asked to climb off the short stretcher onto the long thin bed. Even though the bed had been hydraulically lowered, it was still just barely low enough for me to get onto it. They raised the bed after I was situated.

Two nurses attached plastic troughs onto either side of the bed and placed my forearms into the troughs. The technician said, "We won't be strapping your arms down yet, but don't move them under any condition." It was clear to me that they would strap my arms into the trough if I ignored this injunction. "Tell us if you have any kind of itch, and we'll take care of it."

One of the nurses appeared with a razor and explained as he was doing it, "We're shaving your chest so that the bandages that we'll put on later won't pull on the hairs." It wasn't a choice -- not that I would have objected. It was just an explanation.

This was a friendly crew in the room. They joked easily with one another, but didn't come across as anything less that professional. I've found this sort of friendliness to be common in this hospital (as long as you're not trying to call someone on any number that goes through an operator).

"Your world is about to become very blue when we put a blue hood over your head," the technician said. "Tell me if you have any problem breathing." As she explained it and asked me to lean my head to the left, one of the nurses expertly positioned the blue hood over my head, leaving a wide space in the back for air circulation and a small porthole to my left through which I could see a small portion of the room.

I'd later recognize this and the heavy blanket that had been placed over my lower chest and groin as lead blankets to protect me from the x-rays to be taken of my chest during the procedure. That part of the procedure had not been explained, but I knew that this unit was part of the radiology department, so it wasn't all that surprising.

Now that the prep work was complete, I heard the technician say for the first of many times, "You'll feel a needle prick and a tingling sensation." She said it again and again as she deadened a widening circle on my upper left chest. Dozens of injections. By the end, I could barely feel the needle as it was inserted.

"Do you feel any pain?" she asked. I didn't. Perhaps a bit of pressure on my chest. But nothing even close to pain. She might have asked that as she made the incision. I'm not sure.

The technician had warned me out in the hallway that I'd feel some pushing and pulling as she separated tissues under the skin to make way for the port. "It will feel odd, but there shouldn't be any pain." Now, as her voice from above the blue hood said it was about to happen, it did, indeed feel odd. There might have even been a bit of sound involved, but I could be imagining that part of it. It was painless, but -- as she had predicted -- still an odd sensation.

At some point during this process she told me that I didn't have much fat to work with so the skin would be stretched pretty tight over the access port. As she sewed up the incision, she mentioned the lack of fat again. "You're pretty skinny, which doesn't give us much extra skin to work with." I thought of apologizing for my lack of body fat, but I didn't.

"I'm suturing the incision with a thread that will be dissolved in several days by your body, so you won't have to come in to have the stitches removed. I'm afraid this will leave a scar because there isn't much skin to overlap."

The hood over my head and heavy lead blanket on my torso were removed. I then saw the overhead track system in action as the camera and two large monitors were positioned into a place where I could see the monitors. "Show him the last image we took," the technician said to someone I couldn't see. And there it was: an x-ray image of my chest with the circular metal port showing clearly in the upper chest cavity and the long catheter tube angling upward and then dangling down inside a vein.

That part of the image surprised me. "So the whole tube just dangles in the vein?"
"Yes, we inserted it into the vein up here."
"There's no problem with clotting around the tube?"
"Not really. The nurses in the infusion room might sometimes give you something to prevent clotting inside the catheter, but I've never heard of problems in the vein itself"

I'd later find a tiny incision in my upper chest above the main incision for the port. That's apparently the hole they had used to thread the catheter into the vein.

During the procedure, by the way, I'd often felt the bed I was on swiveling on its pedestal. As they pushed the camera and its monitors out of the way, I realized that the swiveling bed had been used to position me under the x-ray at the ideal angle. The two sets of tracks on the ceiling allowed the camera to be moved from side to side and from front to back. The swivel on the bed added a third direction of movement.

I realized as I looked at this x-ray image on a monitor that the technician had been using these video x-ray images throughout the procedure to guide her through it.

A nurse removed several monitoring ports that had been attached to me at some point. He even took away the disposable blood pressure cuff that had been attached to my arm upstairs in the LSU. I was steadied by two nurses as I was directed back onto my short stretcher, and taken back into the hallway outside the room.

The technician who had performed the operation returned with a small glass of water and two pills. "The oncology nurses don't want me to give you ibuprofen because of your anemia. This is..." and she mentioned the brand name of the pain killer. "It's basically Tylenol and oxycodone." It should work OK to deaden the pain. But make sure to take it for the next few days as soon as you start to feel the pain." Since she was giving me only the two pills, I made a mental note to ask the nurses for more of whatever this was when I got back to the LSU. "My fingers were inside your tissues there" -- she pointed to the large bandage on my chest, "so you could feel considerable pain for a day or two until the tissue heals."

I was then handed off to a transport worker who rolled me toward the deeper north elevator bank this time around. These elevators may be slow and jerky, but they're made for this kind of transit.

I was worried about finding my sisters, but they were already back in the LSU room when my stretcher was wheeled into its position.

To be continued...

Saturday, April 29, 2006

Chemo delayed by poor lab results

[Friday, 9:30 am] This hospital doesn't have wi-fi for patients and visitors, but I decided to bring along my laptop today to store a few posts for later uploading to the blog.

[10:15] Platelets are low. Maybe too low for chemo. We're waiting for Dr. O to respond to a page for her decision on whether to go with it.

[10:25] Dr. O just called. I heard the nurse explain, "Labs look OK, but platelets are low." She ran through the numbers for Dr. O before coming over to explain to me, "We're concerned about your platelet count today. We don't usually like to give chemo when the counts are this low, so we'd like to reschedule for Monday. We'll check the blood work again to see if things have rebounded."

---
And so that was it for yesterday's attempt at semi-live blogging and for yesterday's attempt at the third chemo session.

This isn't good news -- that my blood components have become so erratic, even after Wednesday's transfusion. I'll try to schedule a clinic visit with Dr. O on Tuesday to see if there is anything more I should be doing with diet or anything else to help get things back on track. But it's really starting to sound that the reactions of my blood to all of this are a bit baffling even to the doctors.

Before leaving the infusion room, a nurse explained to me, "We really don't like delaying chemo for too long, but a week is usually OK. On the other hand, we don't want you to bleed out after we give you the chemo."

And somehow, that seemed funny (as I believe it was intended to be). "Yeah," I laughed, "that doesn't sound like a good alternative."

I packed up my laptop and headed down to the clinic to try to take care of some billing issues that have cropped up over the past month. I managed to meet with one of the two financial counselors that I'd hoped to see. I'll have to devote several more hours next week to getting the issues under some sort of control.

While doing that, I worried that I might be setting up a jumble of missed crossed paths with my sisters who had planned to come over to see me in the chemo room in the early afternoon.

After we'd lost one another due to a misunderstanding after walking last Saturday to a local outdoor outfitters store, Sister #3 had lent me one of her cell phones for the past several days so that it would be easier for us to keep in touch. I'd given it back to her Thursday night, thinking it wouldn't really be necessary while I was sitting in the infusion room all day Friday.

Of course, Friday turned out to be the second time that the mobile phone would have been most helpful. I hoped that we wouldn't cross paths as I waited in the clinic to sign papers and to pick up the replacement meds that might help alleviate my anemia. At about 11 am, I headed off toward their hotel, trying to keep an eye out on cross-streets to spot them if they were walking in the opposite direction.

But it all worked out. They were preparing to head off to the hospital when I knocked on their hotel room door.

Sister #4 was packed up and ready to head home. An airport shuttle was scheduled to pick her up at the hotel at 2:30.

That gave us just enough time to enjoy a nice brunch at a neighborhood cafe. We were back to the hotel and had rolled #4's luggage off the elevator just as the airport shuttle pulled into the driveway.

Thursday, April 27, 2006

Walking test: Transfusion worked

Judging from my stamina today, yesterday's blood transfusion did its magic in bringing my blood back to something close to its expected oxygen-carrying capacity. And we sure did test it today.

I figured I'd show my sisters (#3 and #4) a bit of west coastishness by taking them to dim sum in Chinatown. (That is -- for those unfamiliar with it -- a style of brunch common in some Chinese restaurants. One sits at a table and selects small samples of various foods offered on carts moving through the room. As any small platter of food is selected the waitress will mark off a number or symbol on the bill. It's a style of eating similar to "tapas" in a Spanish restaurant.)

Chinatown is downhill (way down) from the hotel where the sisters were staying, so I figured a walk would be OK. And it was -- at least for me -- although I'd started to realize that some of the walks I'd been leading them on had been a challenge for #3 who had some footwear issues during the week.

But we walked down the steep hills. At the appointed restaurant we met a friend (the same one who gave me rides after biopsy surgery) who is more familiar than I am with the various foods offered on the carts. Three of the four of us enjoyed the meal. Sister #3 didn't seem to be enjoying much of anything that the place (or the neighborhood, for that matter) had to offer.

But at least it was an experience. Right? (I hope so, anyway.)

After the dim sum brunch, I figured we'd head back to the hotel, but sister #3 wanted to do a bit of shopping for IPod accessories. And I figured I owed her that much after subjecting her to the dim sum that she clearly hadn't enjoyed I sensed she hadn't enjoyed. So we caught a bus to the U District where there's a dedicated Mac store.

And we did a fair amount of walking there among the stores that the two of them wanted to check out. And at some point in the process, I realized, "Hey, I'd never have tried this on my own, but I'm still feeling pretty good."

So --hurray for the transfusion. Tomorrow, I hope to pick up the new meds from the clinic pharmacy to see if those help to keep the CBC up to close to their current levels.

[Update, Saturday, 4/29] Before she left town, Sister #3 seemed a bit offended when I mentioned this blog post to her. She insisted that she really had enjoyed the visit to the restaurant for dim sum even though she didn't care to try out most of the food that was stacked onto our table. I'm still not sure that even what she did try agreed with her much. But now I know a class of restaurants to avoid if she visits again.

Wednesday, April 26, 2006

A transfusion instead of an infusion

Instead of today's regularly scheduled chemo infusion, I had a blood transfusion. My oncologist (we'll call her Dr. O) decided that it would be best to do that and move the chemo to Friday because my "crit" count was way done in the blood draw taken prior to the placement of the central line.

So that was today's five hour-tour in the infusion room.

There's nothing noteworthy about this. It's just a matter of sitting there and waiting while the blood is slowly pumped in through the new portacath. (The skin around that still hurts every bit as much as the technologist who put it in said it would. More on that when I get around to completing the report on its placement.)

I was worn out once again after this transfusion. After getting home, I dropped off to sleep for nearly three hours.

I was briefly interrupted by a phone call from my regular doctor (aka primary care physician or Dr. R for the purposes of references here). She and Dr. O had discussed the anemia after I visited each of them yesterday with my sisters. The docs decided that one of the non-cancer-related medications I've been taking might be contributing to the anemia. They've decided to switch me to a different medication to see if that helps with the anemia.

With my sisters in town, I haven't had much time to contribute to this blog's history, but it's better for them to get the info directly, after all. Things will get back to the usual wordiness after the weekend.

Tuesday, April 25, 2006

Getting an IV port in my chest

I now have a dedicated IV port sitting just below the skin on my right chest. It's an odd little thing with a round metal access device about 3/4 inch in diameter and about 1/4 inch thick (this PDF page is the best explanation and diagram that I can find). The metal device is filled with a viscous plastic material of some sort into which an IV needle can be inserted. A thin eight-inch plastic tube was threaded into a hole in a vein and then allowed to dangle inside the vein. That tube will deliver chemo drugs into the vein.

Because the access port is under the skin, there will still be a needle poke, but because the target is so much larger than a vein in the arm, it's a simpler procedure and less given to misses.

It was inserted using local anesthesia (mostly delivered via a large number of injections) yesterday starting at around noon yesterday.

Despite the local anesthesia, I was required to do the typical pre-op fast that I'd become familiar with from my two visits for the initial biopsy. The nurse who explained it to me over the phone said that the fast was required "so that we have the option to give you more elaborate anesthesia if you're feeling too much pain during the procedure."

OK, then. (That did add a bit to my nervousness about it all Sunday night.)

To prepare for the fast prior to the midnight start, my two sisters and I went out on Sunday evening for a passable Chinese meal at a nearby cafe -- it's not one of the places I'd recommend to visitors as a true taste of that cuisine here, but it's close and cheap and quick -- so why not.

They both came by my place Monday morning and we headed off to the hospital for the 11 am appointment at what's called the "Limited Stay Unit" or LSU. Even before the nurse explained, I realized that the gown, pants and terry-cloth booties lying on the bed were meant to replace all of my clothes which would be transferred into the big orange logo-bag.

That done, I climbed onto the bed. But a strange bed it was. It's only about 5 feet long and I'm 6 feet long, so my feet had to dangle over the bottom. As the three of us ("us" being siblings 3 through 5) laughed about this odd arrangement, a flurry of unrelated activity erupted in the otherwise unoccupied room. The nurse came in the wrap the arm I offered her -- "Left arm. Please." -- in warm blankets to encourage veins to reveal themselves. Then two guys who could have been sent by an unimaginative casting director for their roles showed up in the room. There was a tall, thin, nervous and apparently harried fellow who would have been scripted as 'IT guy #1' and a strong barrel chested fellow carrying a tool chest playing the role of 'Carpenter #1'. IT guy explained what had to be done and then scurried off. Carpenter used an electric screw gun to remove something from the wall. He said to my sisters or to no one in particular. "He'll change his mind by the time he gets back, so I think I'll wait."

The nurse came back; selected a likely vein; and skillfully inserted IV catheters. She did it well, but it's a procedure I've never been able to watch. I did watch her tape down the IV tubes to my arm and insert a blood sample vial. Just as the blood began to pour into the vial, we got a very odd sound effect: the loud whooosh of a power drill. "Jeez," I said. "I'm glad that sound effect didn't come 30 seconds sooner." Somehow, it wasn't a sound I wanted to hear as a plastic needle was being inserted into my arm.

The friendly carpenter, it turned out, was installing new wall-mounted computer CPU units for the IT guy who was also a friendly fellow when he stopped for a moment.

At about 12:30, a woman in scrubs showed up. "I'm from [hospital] Transport. I'll take you down to the procedure room." For some reason, she decided to use the newer central elevators even though they're smaller than the old east elevators that are made for the mobile beds. She said she wasn't sure if we would fit, but decided to try.

To be continued...