DAY 24: Quicker than you can say Benadryl...

I'm here at Emory as an impatient, on day 2 of round 2, and things are going great so far. I'm sitting up in a chair, getting the lemon-lime flavor today (known to the smart people at Methotrexate). I checked in yesterday and they told me it would be the early afternoon before they tethered me up to the infusion pump, so like any good parolee, I bolted from the hospital and had 'one last lunch' at my favorite taco place in the world. The cheese dip never tasted so good.

After lunch, we had a follow-up with a cardiologist about my atrial fibrillation episode during round 1. We got another EKG, which was thankfully normal. Our best guess is that it was a stress-induced event and it may never happen again. One thing I learned was that young people often go into atrial-fib when they exercise too hard or get their heear rate up relatively high. This was comforting.

Also, while my red blood cell count is depressed, I get a little flow murmur whereby the heart is trying to work harder due to the amemia. The sensation is as if you can feel your heart beating in your extremities, and see it visibly in your abdominal area, pulsating with each beat.

Later, in our room, the RN was getting ready to access my port. This involves sticking in the plastic/needle apparatus into my port on my chest -- twice, one in each side. She seemed to know what she was doing, until she counted to three, pushed really hard for a few seconds and then said, "Huh, that's not it." Then she pulled it out. I was incredulous! How could you miss it! She tried again, but preceded it with "I'm not 100%, 100% positive, but I think I know where to go." I said, "I'm ok waiting until we get to 100%, cause that hurt!"

Next, we received a brief consult from a cadrdiologist PA who told us a little more about what to expect from the sugery to implant the Rickham resevoir in my head. She said that they make a crescent-shaped incision in the right frontal lobe, pull back the layers of skin, bore a dime-sized hole through the skull, and then insert a straw-like catheter 5cm into my brain (through the dura mater). When they hit the appropriate ventricle where the CSF (Cerebrospinal fluid) is housed, it will, as she put it, "spew CSF everywhere", at which point they will cap off the straw with a small dome-shaped device that will sit against the skull directly. Then, they fold back the layers of skin and staple me shut. Simple as that.

I have decided to give it a shot, and I go under the knife first thing Thursday morning. As a reminder, this resevoir will take the place of the lumbar punctures (Intrathecal chemo injections) that I am scheduled to get twice per inpatient visit. We'll just put the chemo directly into my brain, ok? Seems safe. Well I guess if I have any unintelligent moments in my future, I have a simple excuse to proffer.

Last night, they gave me Rituxan as my first chemo du jour, and preceded it with an anti-nausea IV and a bolus (IV push) of Benadryl. I was sitting in the chair next to my bed when all this happened... and really wish I had been lying down in the bed itself. Once they push 50mg of Benadryl directly into your heart, it takes literally three seconds for you to fall out. "Ben-a-dr-zzzzzz...." I was hit by the proverbial Mack truck in a flash. Getting from the chair to my bed was just plain sloppy. The evening from that point forward was a fragmented jumble. From 8pm to midnight, I was in and out of the present. Darn-- and I really wanted to watch American Idol, right?

At midnight, we finished the Rituxan and got another bolus of the next chemo drug, Methotrexate-- which has the appearance of lemon-lime Gatorade. We had Orange Gatorade last time. At 1am, we got hooked up for a 23.5hr IV, also of Methotrexate. We also got a steriod that should've kept me from sleeping... but did not. Lots of action; constantly a nurse in the room -- hooking, unhooking, making me swallow pills.

I also give blood and and get vital signs checked every few hours. They check the pH of my urine every time, to ensure it's >7. They don't like to give you this chemo unless your kidneys are operating in an alkaline state. We've been hovering around a pH of 8.0-- which is where we want to be. Not a whole lotta privacy going on.

At 7am, I got a knock at the door, saying it was time to get a CT of my brain as preparation for tomorrow's surgery. I was pulled out of bed and taken down to another floor via wheelchair where I got the CT -- a very quick and uneventful procedure. Back up to the room to rest in bed until breakfast arrived: off-brand Rice Krispies ('Rice Crunchies') and chocolate milk.

Today has been just great. I have walked ten laps, spent some time with a few friends catching up, and been spending some quiet time with Candace. An uneventful day is a great day, in these circumstances.

Tomorrow will be an adventure. Please pray that the surgeons' hands will be guided where they need to go and that tomorrow, too, will be as uneventful as possible.

I am quietly reminded about the goal of focusing on the here-and-now. In this singular moment, life is happening... unfolding... and the story is being written real-time. Not just for me, but for you as well.

This is where all the good stuff occurs: it's not about yearning for some other day, in some other place, under some other conditon. We need not ignore today with the presumptive anticipation of soaking it all in tomorrow. Tomorrow, as with any of the future, is not real...yet; and it may never become. But today is and it's where our focus should be.