Friends of Geraldine

Emily, Geraldine and Monica in the Apheresis Unit

Before she went into the transplant process that she is undergoing now, Geraldine wrote a post that she did not finish. I made the decision to publish what she had written. This is the followup post.

That first day of stem cell harvesting, which happened on “Black Friday”, came to her as a surprise.

She had been going to Richmond every day to get her blood counts measured, and expected this to be like any of the previous mornings that she had traveled to the hospital. Her routine consisted of having someone drive her the 1.5 hour trip to VCU Medical Center/MCV (the hospital where her transplant is occurring) so that she could be one of the first in line, and therefore avoid the crowds.  She was not allowed to eat, so most mornings she would show up around 8am and wait briefly to get her blood drawn.  Once that was done, she grabbed a light breakfast and began her 2 hour wait, just like every other morning. There wasn’t much of a crowd because it was the day after Thanksgiving, and many other people probably had plans to come after they had done their early Christmas shopping. In fact, Geraldine had considered going out later that day as well, but the hospital had other plans.

Olig, Monica and Geraldine in Apheresis

She was surprised when that day she was told that her counts were high enough to harvest the stem cells. She headed out for the apheresis unit in another building. In case you’re wondering, the process of apheresis involves drawing her blood out, running it through a centrifuge which separates it into red, white, and plasma, and then harvesting the stem cells that she will need for her autogolous bone marrow transplant.

The process takes several days. In the case of Geraldine, they needed 8 to 10 million cells for both transplants.

The staff that worked with her over the next few days was the best group of people that she could have asked for. Many thanks to Emily, Monica, and Olin for being awesome. Anyway, they really thought the harvesting would take 5 to 7 days, but Geraldine was able to really produce and harvest well over the goal in 3 days. This sped up her timeline for transplant quite a bit.

1st Transplant Delivered

And then, on Thursday, Geraldine was admitted for the long haul to MCV in Richmond, VA.  They had frozen the stem cells, and would administer the transplant on Friday. First, they had to kill off her existing bone marrow with a high dose of Melphalan. This chemotherapy regimen was delivered in all of 30 minutes on Thursday, which has further reduced her time in Richmond.  The original plan was to have 7 days of BEAM chemotherapy (BCNU, etoposide, ara-C, and melphalan), but that was changed to this one short dose of Melphalan.

So, about killing her bone marrow – one of the medical staff members used the analogy of a sink full of dirty water.  You pull the plug and the sink starts to slowly drain. That’s what this melphalan dose is doing to her old bone marrow. Now, pour in the stem cells that were harvested, fortified, etc., and that will eventually replace the bone marrow that is dying.

It will take about a week for her bone marrow to completely go away and about two weeks for the stem cells to grow the new bone marrow. So, during this process, her immune system will be completely weakened.

The next day after that chemo regimen, they performed the autogolous stem cell transplant.  They brought the four frozen packets of stem cells into the room in a metal container filled with dry ice. The guy who was handling it used large rubber gauntlets to remove the frozen bags, and placed them into another container with bags of warm water in it. Once the stem cells had turned slushy, they hooked them to an IV and they entered her body. She started shivering during this process, because of the cold contents of the bags. They warned her that a preservative, DMSO, had been added to the stem cells and may make her nauseous. Of course, it did.

An hour later, the stem cell transplant was complete!

Today marks about a week since her transplant. She has been and will continue to be in Richmond, in a hospital room on the 10th floor of MCV. She’s been tired and nauseous, mostly because she is at her lowest point – where the old bone marrow is gone and the new cells haven’t yet begun to grow. Her white blood cell counts should begin increasing at this point, so it is going to get better as each day passes. The good news is that a few days before Christmas, she may be released to an apartment that her parents have rented in Richmond about 5 minutes away from the hospital. So, she will be able to spend that holiday and the subsequent week after that with her family, albeit in a city about an hour and a half away from her home.  Most importantly, her daughter will be able to spend that time with her mom at Christmas.

Now, here are the rules if you want to visit her. Geraldine spends most of her time sleeping lately.

Tired

She is very weak and nauseous. She is also very susceptible to infections and viruses. No live plants, no flowers, no fruit, no fresh vegetables. She can have visitors, but they must have had a flu shot – no exceptions. And visitors can’t show the slightest sign of being sick.  No cough, runny nose, etc.

If you visit – and you should – you will have to wash your hands before entering the room and you might have to wear a mask (probably not unless they specifically tell you to.) Don’t let that stop you. Visiting Geraldine will mean a lot to her.

Malcom with mask

Also, Geraldine isn’t really answering the phone much unless it has to do with her daughter, so don’t be offended if she doesn’t respond to texts, emails, and phone calls until she gets back on her feet.

I’ll keep you posted as best as I am able over the next couple of weeks. Hopefully, it will be Geraldine writing the next post, but if that doesn’t happen, I’ll bring you up to speed next week.