D+36 -- What Could Possibly Go Wrong? (Part 1)

The two main risks for a stem cell transplant patient, after transplant, are infections and graft-vs-host disease (GVHD). The latter is when the new immune system (the graft) starts to attack one or more organs of the old body (the host). More on GVHD later, and I hope it's not from personal experience.

To minimize the chances of GVHD, I take a medication that suppresses the activity of my new immune system, which isn't yet fully functional anyway. My white blood cell counts are lower than normal, which is normal at this point. The combination of low counts and medication makes me exceptionally vulnerable to infection. A bacterium, fungal spore, or virus that a healthy person would typically dispatch without breaking a sweat — without even noticing — can now easily and quickly make me sweat. And spew. And squirt. (Feel free to take this as a warning to proceed at your own risk.)

A couple of weeks ago, I had a mild sore throat. Neither Jan nor Paul were sick. Based on the symptoms, my doctor felt it was likely a virus and, as long as I didn't develop a fever, it was safe to ride it out. It went away after a few days.

This past Wednesday, after a really good Tuesday, I wake up anticipating another really good day. It starts well enough. I get up, have a bowl of cereal (first breakfast), do a little work. My belly is slightly gurgly, and I am a little queasy.

As I am taking my morning medications, I choke on one of the pills. The choking leads to gagging, which leads to my first post-transplant upchuck. It feels more like a gag reflex than something more serious, but it's reason enough to call my doctor. (The rule for transplant patients is, everything is reason enough to call the doctor -- a splinter, a small cough, a tiny rash, a reddish eye, a mild earache...)

Is anyone else in the family sick? No? She tells me to keep hydrated and watch for fever. If I can't stay hydrated, or if I develop a fever, she wants me back up at the clinic, and possibly readmitted. I'm not really in the mood for eating, but I can drink, and I do. I tell Jan what's going on, and she asks for regular updates.

Meanwhile, my body is doing its best to dehydrate me. It is the Day of Diarrhea. I do not spend the whole day on the toilet, but there are quite a few increasingly fluid trips. Between trips, my intestines are occasionally at peace and sometimes amusingly noisy — gurgles, gloops, rumbles, blips. And sometimes it feels like miniature dolphins are playing tag inside Joe's Intestinal Fun House. And that's usually when it's time to make another trip to the bathroom. I also keep a bucket with me.

Lunch is a piece of toast. Then I take a nap, during which Jan can't reach me, so she comes home to work and keep an eye on me.

In the afternoon, I'm feeling that the worst is over. The diarrhea seems to have played itself out — could there be any more in there? My parents call, knowing that I was ill earlier in the day, wanting some peace of mind before they go out to a play. I reassure them, honestly.

As soon as I hang up, the dolphins start chasing each other again, but they're headed the other way. And my bucket's in the other room! Paul, home from school, runs into the living room (my "office") with the bucket and gets out as fast as he can.

This episode is more convincing than the morning's, which I could pass off as a gag reflex. This one is more productive, more gripping, longer lasting — everything a vomiting episode would want to be, really.

I'm feeling a little better, as one often does post-purge. I don't have a fever. Still, I'm clearly not well. Jan has some race commitments at the end of the day, and it turns out Paul has a movie to watch for school at roughly the same time. We put out a couple of calls for a "sitter," and quickly find a willing tandem: Robert, when he's done with soccer practice, and Cathy in case Robert is late.

After Robert arrives, I make some white rice. I have been drinking all day, but the only food I've had is cereal (temporarily) and toast (also temporarily). I sit down to some plain rice, while Robert gets a can of Guinness for dinner.

After two bites of rice, the dolphins are at play again. I'm off to the bathroom, with my bucket. Which is a good thing, because I'm already retching before I reach the bathroom. Then I'm on the toilet, forcefully emptying my digestive tract from both ends, simultaneously. (Why is that even possible? Wouldn't that create a vacuum in the middle?) All the drinking has its effect, so I'm peeing at the same time, and the retching is so powerful that my eyes are watering. I'm dehydrating through four types of orifice at once! I dub this accomplishment, The Quad. Rarely attempted, never enjoyed.

(Maybe if I had drunk more heavily in college, this experience would have been less novel. No regrets there.)

The Quad marks the high/low point of this infection. The rest of Robert's visit is uneventful, even pleasant. (Thanks, Robert!) During the night, I run a low fever but not above the call-the-doctor threshold. The next day, I'm still queasy but everything stays down. Friday is a good day, Saturday better.

Time to get back to boring.