Thursday, June 11, 2015

More Screening

With apheresis and the MRI behind me, a new set of tests was scheduled for the next day.  I had a lung function test in the morning, which was not very exciting.  I merely had to inhale in one quick, deep breath, and then exhale while the tech kept saying, "Go…go…go!go!go!" to the point that I was sure I was exhaling nothing but dust particles from the very bottom of my lungs.  Expiration testing happened twice.  Next came a test which I think is called, "Hold Your Breath Until You See Stars."  That test was repeated once, but then I was done!  Easy peasy.  No fasting; no radiation.  My favorite.

Up next, a renogram.  This is a test that determines whether or not the kidneys are doing their job.  This one isn't standard for the TIL trial, but since I had had surgery on both kidneys shortly before I was diagnosed, the medical team wanted to make sure that my kidneys were going to be able to withstand the drugs required for the trial.

As I've mentioned in previous posts, no female under the age of 55 gets near the imaging equipment without a negative pregnancy test.  Once again, my admittance to the scanning area was postponed while we waited for the results of a "STAT" pregnancy test.  After almost an hour, I was escorted into a room that felt about as large as my dishwasher.  The scanner took up the majority of the space.  The poor technician had no room to maneuver at all.  He positioned me on the narrow table, face up.  The beam-generator was underneath me embedded into the table and aimed at my lower back.  When the tech needed to move to the opposite side of the table, the only option was for him to duck under the table!  There was no room to walk around.

The poor technician (tPT) lugged a locked, leaden case into the room and removed a vial of the radioactive element technetium.

Me:  What's in the box?

the Poor Technician:  Technetium.

Me:  That sounds like a made-up name.

Patrick:  What isotope?

Me [in my head]: Wait, what? That's a real thing?

the Poor Technician:  Ninety-nine.  It's one of the daughters of molybdenum.

Me, unspoken:  [One of the what?  These two are going to hit it off famously...]

My husband and tPT then yammered on and on about the Periodic Table of Elements, isotopes, and half-lifes (lives?) as tPT arranged the equipment. I only rolled my eyes and marveled at just how geeky my husband is. Twenty-five years of marriage had not--until now--revealed (to me, at any rate) the depth of his knowledge of chemistry. It was a little disturbing.

FYI, technetium is number 43 on the Periodic Table of Elements.  I won't hold it against you if you don't care.

tPT injected the radioactive technetium into my vein via the I.V. that remained in my left hand from the previous day's apheresis procedure.  (Thanks again, Vein Lady!)  He then ducked under the table and popped up on the other side to adjust the computer monitor so that we could watch as a grainy black and white image became visible there. "Those are your kidneys," he explained, pointing to the screen.  "Now lie still.  This will take forty minutes."

The images on the monitor brought to mind an hourglass with technetium playing the role of the timer's sand.  Instead of the typical hourglass upper chamber, this timer had two—two kidneys filling up with radioactive "sand", and slowly emptying into a lower chamber, the bladder.  tPT injected what I think was saline into the I.V. numerous times during the course of the test, ducking under the table each time.  He probably would have preferred it much better had the I.V. been placed in my right hand instead of the (far) left hand.  It would've meant a lot less exercise for him.

Minute after slowly-slogging minute passed as we watched grainy specks of light on the screen move from the kidneys into the the bladder.  At one point a man in a khaki uniform came in to check on our progress.  (I found out later that he was a member of the National Health Service.  Their uniforms are remarkably similar to those of the Navy.)  Finally, the forty minutes expired and I was released with the instruction, "Drink lots of fluids."  Later, my immunotherapy fellow would report that my kidneys were in good shape.  It was another hurdle cleared on the way to the clinical trial.

Next up was an interview with some anesthesiology people—first a nurse, then a doctor.  They pretty much repeated each of the many, many questions that other people had already asked.  Each one double-checked that the information stored in my electronic file matched my responses.  No one could accuse NIH of not being thorough enough.

The anesthesiologist shared this helpful bit of insider-intel:  the food service menus in the rooms are "merely suggestions".  She explained, "You can order anything you want.  Go, have a milkshake!  You have surgery coming up…but nothing after midnight.  Not even water!"  Though I was tempted to, I didn't order a milkshake that night.  I discovered later that this bit of intel was not entirely accurate.  Though in theory, I suppose I could "order anything I want", that didn't mean that it was available.  Oh well.  It doesn't get any easier than merely dialing "3"...

Not-so-pleasant was sharing a room with another patient.  My roommate on 3NW was a lovely woman who happened to snore like a chainsaw.  Surgery to remove a lung tumor for use in the clinical trial would happen the next day; "first of the morning".  Listening to the snoring, I reminded myself of what seems to be the over-arching principle concerning my ability to find rest in a hospital--any hospital:  "No sleep for you."  Though it was past 11:00 PM, I ventured out of the room in search of a place to read. 

Four hours later, I returned to the ward on the wrong side of a locked door...

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