In order to generate the "cell therapy" that I hoped to receive as a participant in the TIL clinical trial, the researchers needed "tumor material". This meant another lung wedge surgery for me (they can use tumors in other locations for this trial, as long as they meet the size requirement and are relatively easy to remove). I had the same procedure in December on my right lung; this time a nodule in my left lung would be the target. (This nodule was known to Patrick and me as "Jorge"--the same one that escaped the interventionist radiologist's needle some five month's earlier: Part 1 of that ordeal and Part 2.)
Surgery was scheduled for "first of the day." I transferred to a gurney early in the morning of April 1, and was whisked through the halls of NIH to pre-op. Once there, an I.V. was placed in the back of my right hand (though I still had Vein Lady's access on the back of my left hand), and many, many questions were asked and answered. My hair was tucked up under a disposable bouffant cap. The surgeon stopped by to pen his initials onto my left upper chest, right over my port (ow!). I was asked for maybe the third time to describe the surgery that was about to happen. I'm sure that I must've bid Patrick good-bye, but I can't remember it.
What I do remember is waking up in my hospital room with a tube coming out of my left side. "You again," I thought to myself. The I.V. in my right hand was now clamped off, and the one in my left hand was connected to a hanging bag of...something. A nurse explained that I was receiving morphine, and that I could boost the dose with the push of button. I was free to move about as long as I brought the I.V. pole along with me. (There was no moving about.) All I did was sleep and push the button. In fact, they were concerned that something stronger than morphine would be warranted, since I was apparently pushing the button quite a lot. I admit that I was hoping to avoid the excruciating pain I remembered from last time.
Dilaudid replaced morphine and the hours inched by hazily. I ordered only a popsicle for dinner. As evening approached nausea set in. It was not pretty. An antiemetic was added to the I.V.—too late. Soon after that unsettling event, I asked to be taken off the narcotics, hoping that that would relieve the unrelenting nausea. I switched to Tylenol for pain control. Doctors and nurses came and went, checking the vacuum-chamber attached to the chest tube, listening to my breathing, taking my blood pressure...I slept off and on through the night.
In the late morning the surgeon's assistant arrived at the foot of my bed and explained that he would remove the tube "very soon." He first peeled away layers of tape and gauze from my left side, then pressed a stethoscope to my side to listen to my lungs. He asked me to cough, inspected the vacuum-box, and then told me that he was going to "pull the tube." "As I'm doing this," he explained, "I want you to hum loudly." He demonstrated this by humming loudly himself, which I then mimicked. I imagined that this was some sort of distraction ploy, but he maintained that the vibration would aid in the tube's removal. I thought that since I had undergone a tube extraction just a short while ago, I knew what to expect. I was wrong! This doc had a different technique entirely. Whereas the resident at the other hospital ever-so-slowly-and-gingerly eked the tube out one nauseating centimeter at a time, this new doc merely issued the commanded, "Hum!" and not one-second of "humming" later, he had yanked that tube out of me with such force that I barely grasped what was going on. I had no time to think about it--it was finished almost as soon as it started.
Me: Is it out?!
Doc: Yep. That's it.
Me [to Patrick]: Did you see that?! That was SO COOL!
I prattled on stupidly about how quick and very different this procedure had gone compared to what it had been like the previous time. I was elated! The nurses were amused. "Nobody ever says, 'That was cool'." She smiled as she high-fived those around her.
Later in the day Patrick and I tooled around the hospital--him pushing me in a wheelchair. We each would need security badges for our eventual return to the hospital, and (!) there were m&ms to be located.† I felt great and suffered no unexpected set-backs.
Toward late afternoon an assortment of doctors gathered at the foot of my bed. The attending physician explained that my tumors (unbeknownst to me they had taken two, Javier in addition to Jorge) were at that moment in the lab just a short distance from my room. Scientists had sliced them up, and would be trying to "grow TIL" from them. Whether the TIL would cooperate was to be determined.
The path to TIL treatment is strewn with one benchmark after another. If just one hurdle gets knocked down along the way, the patient may be dropped from the trial. Thankfully, when my thoracic surgeon came to check on me the next morning, he gave us the encouraging news that the TIL were already growing! He said that he had personally gone to the lab to find out, and had seen them for himself.
What great news!
I was released from the hospital on the second day past surgery, confident that the events in the lab were unfolding just as they were meant to. It would be several days before my contact at NIH, an immunotherapy fellow, would have any information for me. So began another period of waiting.
† m&ms can be purchased in the Concessions Shop located in the basement of the Clinical Center (Blg. 10). My new favorite, Milky Way Dark, are sold there too!