It Is Time.

I had been working at Emory University Hospital in Atlanta for close to a year before my first, severe panic attack. Before that, I had done clinicals at a local hospital here in Augusta. They had all been on oncology/bone marrow transplant floors.

I have always had a passion for cancer patients. Cancer is an UGLY disease, and no one is immune. NO ONE.

I loved my patients...especially the Bone Marrow Transplant (BMT) patients. They would usually spend about 2-3 months in the hospital, receiving chemotherapy to knock out ALL of their cells (not only the cancer cells - because chemotherapy cannot identify a "good" cell versus a "bad" cell), receive their transplant (either an auto-from their own cells, or an allo -from sibling, or a MUD - an unrelated donor who had matched with them), and then the patient had to recover. Recovery was the most brutal part.

Think about it this way. You have absolutely no immune system left after the harsh chemotherapy. Many hosts of infection enter in your room each day, putting you at great risk, and you have absolutely no idea if the transplant is going to take, or if your body is going to reject it.

Rejection is the horrible part.

And for the faint of heart, you should probably stop reading here.

A patient who receives a MUD transplant is at the greatest risk of rejection. And they are all educated (somewhat) on what may or may not happen during the recovery phase. But what can really happen is something out of a horror story.

My very first patient that I saw reject a transplant stayed in the hospital for over 100 days. The first sign of his rejection was diarrhea - yellow, mushy and seedy. (I have to be truthful.) We collected stool, and measured it. That first day I measured 1/3 of a liter. Within a week, he would be losing 1 full liter per day of stool. He developed a rash that covered his body. The nausea and vomiting was unrelenting. The mouth sores prevented him from speaking to his own mother. And then the worst begins to happen. Mucositis (swelling and irritation of the mucous membrane) occurs from the mouth to the anus. His intestines began to slough away.

His intestines began to Slough. Away.

Can you imagine - going to the bathroom - with increasing abdominal pain, and turning around and seeing that there were intestines in your toilet? With blood spatters, everywhere?

This is not an exaggeration. On a separate patient, I remember having to call a GI specialist, and asking them to come and examine a piece of intestine that I had just put in a specimen cup, pulled from the toilet.

You think Ebola's bad? Try rejecting a bone marrow transplant.

His skin turned yellow as he developed GVHD (graft versus host disease - the technical name for rejecting a transplant) of the liver. He developed ascites, his abdomen looked like he was 9 months pregnant.

And he suffered. And suffered. And suffered. I watched this man suffer for 100 days. Until, finally, Jesus gave him relief.

And his mother developed the same disease later. And died of a fungal infection to her heart. Another terrible risk of having a MUD transplant. I took care of her, too.

I have seen a patient - my most humble, blessed patient - watch the blood pressure machine as his blood pressure dropped from 110/60 to 90/50 to 76/36 - all while he waited on his brother to reach his room to say his final goodbyes (and I could still bless out that healthcare worker that let him visualize his death on a dinamap.) His brother made it, in time to say his goodbyes and hold his brothers hand as he took his last breath. Yeah, I cleaned up his intestines, too.

I say this not for sympathy, but for understanding. Every nurse who works with a cancer patient does it because she/he has a calling. A calling to help those who suffer, and either see that patient live to celebrate, or die. And many of the nurses you encounter experience a certain degree of PTSD.

I always thought that Post Traumatic Stress Disorder was reserved for soldiers, people who had survived severe attacks, those that had witnessed a murder.

I had no idea I was at risk, too. But after witnessing the most horrible, painful deaths - and watched the families look on as their most beloved were taken from them, I know that I suffer from this. I am so afraid of dying a horrible death. I am so afraid of dying in way that NO ONE deserves - not even a murderer (yes, I've taken care of one of those, too.) Just like these people.

My anxiety has arisen from the care I have given to the sick and dying. And I would do it again in a heartbeat.

But you must take care when dealing with those that know what hell on earth looks like. When you encounter someone who works in healthcare - a doctor, nurse, respiratory therapist, whoever - encounter them with love and kindness. You never know if you're talking to a nurse who has held the hand of a grieving new mother, who has just lost her newborn baby to a heart defect. You don't know if you're talking to a doctor who just told a family that their loved one has weeks to live. You don't know if that respiratory therapist you are having a conversation with worked a code last night and placed a patient on a ventilator. You never know who's experiencing PTSD.

This is all written with a very heavy heart. A heart that has loved patients, and their loved ones with such great depths. A heart has been broken time after time.

And a heart that has been filled with joy. Joy in watching those fight, and survive this terrible disease.

Humbly his,
L.