I enter through the sliding doors, my flip-flops slapping the linoleum as I search for the information desk. “Can you point me towards the apheresis center?” I ask, noticing my voice rise a notch. I am clearly uncomfortable. My feet feel naked and exposed without my Dansko clogs, and I can’t remember the last time I wore jeans in a hospital. Two medical students scurry by, their stethoscopes bouncing around their necks. Late for morning rounds, I assume. Two wrong turns, three right ones, and an accidental tour of a hematology-oncology floor later, I arrive at the appropriate door. I am grateful to see a familiar face as Jan opens the door before I can even knock.
“Good, you’re here!” She hustles me through the doorway. About ten beds line the walls, each with its own apheresis machine, which in about 2 hours will be full of my own blood and working hard to pull out the excess stem cells. Jan hands me a gown. “You only need to take off your top,” she tells me and points to the restroom.
This experience actually began over two years ago when I signed up for a medical school blood drive. I donated my unit and also allowed them to swab my cheek, entering me into the marrow registry. About two years later, I received a call from Jan stating my bone marrow had been matched to a complete stranger with leukemia. Without hesitation, I quickly agreed to participate in the donation. As the paperwork came pouring in, I realized how extensive this process really was. Chest x-rays, EKGs, full physicals all to be completed in another city an hour away. Several blood tests requiring me to miss attending rounds on multiple occasions.
When I could feel frustration building, I reminded myself of my unknown recipient. She needed this, and I was potentially going to save her life. The whole process was temporarily halted when the recipient was hospitalized with infection. After she recovered, I repeated my barrage of tests and the donation was scheduled for May, about six months after that first phone call. It was going to be a peripheral stem cell collection. I was to receive filgrastim injections five days prior to the collection, sending my bone marrow into overdrive and resulting in increased white cell production. These young, immature cells would then be filtered from my blood.
I emerge from the restroom and trade in my flip-flops for padded socks. My already cold feet are thankful. Jan shows me to my bed and quickly gives me the schedule of the day, details we have discussed ad nauseam.
“First you will have the central line placed. Then you will come back up here for the collection. You can ask for anything you want. If you are anxious, we can give you meds. If you want to sleep, we can give you meds. Everything should take 6 to 8 hours. If we don’t get enough cells, you have to stay the night.” She pushes a bedside commode up next to me. “Just let us know if you need to go, and we’ll pull your curtain.” Between IV fluids and nerves, I know I’ll be going every 15 minutes. I begin to feel overwhelmed. The statistics of central line infections swirl through my head.
The bed arrives to take me for the line placement. I know this is a simple procedure, and I’ve watched many. However, my heart still beats quickly, up in my throat. I feel like a bug in a jar, on display, as my bed jolts over the ridges in the floor on our way to interventional radiology. I meet a resident, hoping to have a friendly conversation about medicine to distract myself from my rising anxiety, but he is curt and brief, showing no interest in my third-year status. I am wheeled into the procedure room, and the technicians talk to me using the same script they probably used on the last patient and the one before that. I feel a stinging coolness as medicines are pushed into my IV, and I try to focus my eyes on the heart monitor. My head feels heavy, and my eyes want to close. I work to keep them open as I attempt to read my heart rhythm. The doctor talks in the background.
“You’re all done,” I hear the radiologist say.
“It’s over already?” I ask. I must have drifted off in spite of my best efforts. My hand moves to the adhesive on my right neck. A catheter was threaded through my jugular vein. I could picture it sitting nicely close to my heart. I feel relief and frank happiness, almost like I could giggle. “Maybe the meds?” I think to myself. The nurse offers me ice chips, and I accept gratefully suddenly noticing the gritty dryness of my mouth.
Back upstairs the collection officially begins. Dr. K, the attending responsible for the apheresis unit, walks over with my chart. I feel almost foolish, in a hospital gown, confined to bed with a mobile toilet in arm’s reach. “I belong standing next to you,” I want to say. Out of this gown and in my white coat. The feeling of being watched over and cared for makes me uncomfortable. I need to be doing the watching and the caring. Dr. K knows of my medical training and rattles off my blood counts, stating something about my MCV, MCHC, and my monocyte count. I quickly rack my brain, searching for the meaning of her speedy sentences, but any previous knowledge of these values eludes me. I realize now, that maybe I would like to be talked to as a patient, not a medical colleague.
The remainder of the collection proceeds uneventfully. “Looks like we have enough cells,” Jan says triumphantly. “We’ll get your line out, and home you’ll go.” Again, the bed arrives, and I am wheeled away. Again, the radiology resident is curt and brief. I am tired now and abandon all attempts at small talk. The line is removed quickly, painlessly. Out of my gown and socks and back into street clothes. I’m taken to the lobby in a wheelchair, despite my protests that I can indeed walk on my own. Patients and visitors are milling about the entrance, and I wonder how their days were similar to mine. Maybe they felt nervous, uncomfortable, or even scared. Maybe they wished for a nicer, friendly resident or a physician who actually talked with them and not at them. My ride arrives, and I am eager to leave the wheelchair behind.
My life returns to normal after this. The next day, I am back at the pediatric outpatient clinic with only a small incision on my neck telling where I have been. I await a phone call from Jan with an update, although I’m told not to expect news for at least a month. Meanwhile, I meet with my primary care doctor for a follow-up appointment where she tells me that she, too, was a bone marrow donor. She became good friends with her recipient, and he even came to her medical school graduation. This excites me, and I imagine a chain of emails and letters connecting me to her. Certainly, I already feel a connection of sorts. After all, my immune system will now become hers.
About three weeks after the collection, my phone rings, and I recognize Jan’s number. “Hi,” I say cautiously, as I know a month has not passed.
“Hey there Ashley,” Jan says, in a somber voice. “I have some unfortunate news about your recipient. She passed away a few days ago. Systemic infection most likely. I don’t know all the details. I’m really sorry.”
I am silent for a moment. “Oh, OK,” I murmur. Jan says she’ll let me know if there is anyone I can contact with my condolences. We hang up. I sit on my couch, not really understanding the wave of sadness that has swept over me. This is someone whom I have never met. I don’t even know her name, where she lives, if she is married or has children. I realize, though, that I don’t need to know these things. Our relationship was different. It was brief, but unique in a way I might never experience again.
Being part of a bone marrow donation was an extraordinary and rare opportunity. It was not just another day at the hospital for me. It was a day where I exchanged my white coat for a gown, my stethoscope for an IV, and my role as doctor for a turn as the patient. This allowed me to experience some of the emotions felt by my patients, and I was able to see the hospital through their eyes. Also, I had the opportunity to give a woman a chance at beating leukemia. While she ultimately lost her battle, she taught me the power and significance of relationships. As a future physician, I believe this is what medicine is truly about — relationships.
Ashley Chambers is an internal medicine physician and can be reached on Twitter @chambers_ae.