So Much for the Afterglow...

Hi gang,

Chris here filling in for the suddenly downed Teresa.

So as one of my favorite bands Everclear once sang, "Guess the honeymoon is over/So much for the afterglow." On Day 12 of her chemotherapy, the side effects finally caught up with poor Teresa. If you had Day 12 in your official "When will Teresa finally get sick from chemotherapy?" office pool, congratulations! Go around and collect your winnings from your fellow co-workers. You deserve it, you predator on other's misery, you!

So as those of you who read her previous post, "The Lone Beagle and Chemo-sabe" have probably already noted, (and frankly, if you haven't read that post yet, shame on you. It's right below here and not very long. Go on, go read it. I'll wait for you to come back. It won't take you long. Go.) Teresa woke up this morning feeling a little hinky due to her nightsweats from last night (to which I can attest--when I reached over and touched her arm this morning as we were waking up, she was rather clammy, which is not her normal condition). But she seemed alright and was deep into her usual sedate morning routine when she suddenly got a very noticeable case of the chills. Like, can't-stop-shaking, teeth-chattering, crawl back into bed chills. Dutifully I took her temperature and noticed it had jumped to 100.8 degrees. Well then, back to bed with her! And more fluids and Tylenol (since Tylenol is a fever-breaker). The chemo instruction booklet we got from Wilshire Oncology (okay, not so much a booklet as much as a bunch of printed sheets stapled together) gave these same directions for dealing with fevers, so we were going to go with it. Rest, fluids, and Tylenol? We can do that. The chills will soon subside and Teresa can make it into the office. No big deal.

Exept the chills didn't subside;they got worse. To the point where they were making it difficult for her to sleep. We cranked up the heater in the house, and I made her some lunch since she was hungry (chicken salad on wheat toast and tortilla chips, for those keeping track). She polished off the sandwich no problem and wasn't feeling nauseous and was able to keep it down, but she just couldn't kick the chills. So I took her temperature again. This time: 102.6. Uh oh. Fever not going down. Instruction booklet/pages stapled together says to call if the fever jumps 101...

So that's exactly what I did. Call the Oncology Center. Okay, so how do you know when you have a less-than-stellar oncology center? Well, if you've been reading this blog you already have a good idea, but here's a few more reasons: when on the packet of stapled pages they give you that they call a chemotherapy instruction manual, they have to hand-write in the primary phone number of the office. Then, when listed below that are the hours when you can call, and it says that office hours are 8:30 am to 5 pm, except they are closed for lunch from 12pm to 2 pm. Closed for frelling lunch?!? Are you frelling kidding me? You're a frelling oncology center, for crying out loud? In Upland! Not Barcelona! Not Madrid! There is no siesta in the United States for Freaking America! You should be open from 8:30 am to 5 pm with absolutely no frelling break whatsoever! If the receptionist needs to take a lunch break, you should have someone there covering the phones for her. It's the American frelling way!!!

So suffice to say, when Chris called the Center at 12:30 pm to inform them about one of their patient's uncontrollable chills and spiking 102.6 degree fever, I wasn't the happiest of campers (whoops! Almost wrote "cancer" there...) when I got an automated message explaining to me that they were closed for lunch and that I could press 0 to be transferred to the exchange. Oh, you better believe I pressed 0. Like 57 times in a row until that woman came on. So even thought she tried to pass me off and just get me to take a message, I basically hammered on her explaining Teresa's situation and that I wasn't going to hang up until I spoke to either our doctor or a nurse. What's another way to tell you're at a terrible oncological center? When the exchange operator puts you on hold for ten minutes, then answers informing you that your doctor in out of town...IN FRELLING SWITZERLAND! Which Teresa was helpful enough to point out (yes, she remembered from our ONE and ONLY meeting with Dr. What's-Her-Name) mere seconds before the Exchange Operator informed me. Suffice to say, there's an operator somewhere in the United States today sitting a little more uncomfortably right now due to the fact that she now has a brand new poop shoot right next to the one Jesus gave her. But she was nice enough to finally connect me to one of the nurses at the center who could actually answer my questions and tell me what to do.

And the answer was fluids, rest, and Tylenol, of course. The fever and chills weren't a great sign, but the fact that she wasn't nauseous or vomiting and didn't have a persistent cough were all things working in our favor. The nurse also wanted me to take Teresa in to get her blood work done today (she was scheduled to do it tomorrow) and had me write "STAT" on the sheet (and let me tell you, I felt just like Noah Wylie doing it) so that they'd expedite the lab work and get them results today. They also wanted blood cultures from her too ("Damn it, Dr. Benton, I need a CBC and blood cultures stat!" tee hee!), but at this point, we were basically at a wait-and-see/fluids-rest-and-Tylenol approach until those labs came back. Oh, and did I mention that it was now 1:15 pm, and the nurse at the center told us that STAT labs usually take around 4 hours to get back? Yeah, suffice to say, we scrambled like the Alert-5 aircraft in "Top Gun" to get dressed and out the door over to the lab (and a posthumous apology to our neighbors for leaving Seamus home alone and howling so hastily...)

Yeah, I really wish that this picture was just an exaggeration for what the waiting room at Quest Diagnostics in the Raincross Medical Building in Riverside looked like (these folks are actually waiting for a train), but it's not. In fact, this is sparse compared to what the waiting room at Quest Diagnostic looked like. And once again, it was like we'd stepped into Mother Teresa's Calcutta Hospice for the Sick, Poor, and Diseased. You want archetypes? We've got archetypes! The morbidly obese woman? Check. Confused old man who rambles on aimlessly to his neighbor? Check. Young single mother who decided to bring all four of her children along with her? Check. The other young single mother who decided to bring all four of her children with her, including the two hopped up on something who just kept running around screaming? Check. Junita, the Hispanic Juno, with her high school babydaddy in tow who couldn't look less excited to be here if he tried? Si, check! It was a veritable smorgasbord of terrible medical office waiting room stereotypes. Oh, except for one: the patient that looks so sickly and frail that you fear they may either be near-death or contagious and infecting everyone in the room. Fortunately, that role was filled by Teresa (whose chills were only getting worse, despite having her swaddled in a blanket and the brief reprieve she got in the car ride over with the heater on full blast), so we had the complete set.

So we check in at 1:50 pm (important later) and are told to have a seat in the already overcrowded waiting room. Teresa wisely decided that instead of crowding ourselves into the last two seats in the room, we'd grab two chairs in the foyer right outside the open door of Quest Diagnostic. Which was a great idea until we realized it was about 250 decibels louder in the foyer, and the constantly opening and closing sliding doors brought in wave after wave of cold air which did nothing to alleviate her chills. So 90 seconds later, we slide back into the waiting room, only there are only single chairs left. None of them together. Teresa may be shaking like she's having an epileptic fit, but no one's moving, either out of indifference or out of fear. So I sit her down and say, "you sit here, and I'll sit over here," but before I can get the words, "and we'll just hope that this isn't contagious" out of my mouth, the rambling old man is nice enough to move over one seat so that Teresa and I can sit together. But he's not nice enough to not stare at her doubled-over, bundled-up, uncontrollably-shaking form. And neither is anyone else in the room. It got to the point where I had to say to the little 3 or 4 year old girl standing not three feet away from us and staring like that dog on "The Soup" that was fixated on cupcakes, "It's not polite to stare." Which may have been more effective had I known how to say it in Spanish, but I think my tone got the point across, considering she spent the rest of her time in the waiting room either hidden behind her mother's chair or with her back to us.

So, at some point as we were waiting, on advice of counsel, I approached the reception desk and let them know that our labs were supposed to be stat, and the 23-year -old former cheerleader/recent Bryman College graduate told me flatly that stat only matters when she enters the labs in but not when you're waiting, so have a seat. Bear in mind that Teresa looks like she's about to keep over any minute and that everyone in the room is staring at her--that doesn't get you through the door any faster. At one point, we heard the other woman at the reception desk (she must have been a University of Phoenix or 4-D College grad) say to someone hidden behind the window that they had 8 people on the walk-in waiting list and another 3 who had called and reserved an appointment. Suffice to say, I'm close to pulling a John Q and charging in there. Teresa's not doing well. There's less movement in this waiting room than in the Astro Orbiter line at Disneyland...and you wonder why Teresa and I leave Riverside for any medical procedure we need. I honestly could go on with this screed, but I'll stop here.

So finally, after 35 minutes of waiting, we get called in. And suspiciously, as we pass through the door, a Maric College graduate tells everyone of the three patients she just called, "second door on your left." Hmmm, so we proceed to the second door on the left, which leads into what looks like a leftover utility room in the office. Except there are three special blood-drawing chairs in there, one each against one of the walls. That's right, folks, three chairs, no waiting. It's like an old Italian East-Coast barber shop. Honestly, I've been in storage units nicer than this room. So two young Kaplan College graduates walk in and start drawing the blood from the three up. Which goes fine, no problem. Until the girl pulling Teresa's blood looks at the form and says, "Oh, it looks like they want blood cultures too. You're going to need to wait 15 minutes after this one before we can draw your blood again." Wonderful! And thanks for letting us know that ahead of time or at least expediting this first draw since we'd have to wait! We appreciate that, Riverside Medical-Industrial Complex. Bear in mind it's now 2:30. We'd waited 35 minutes, the first draw had taken less than 5, and now she's telling us to come back at 2:47 for the next draw. Thankfully, I don't own a gun.

So wisely I shuffle Teresa out of there and into my car, where we can sit in the sun and with the heater going and she can relax and sleep a spell until the next draw. Which we walk back to, and they let us walk right in and do it. No waiting this time. But to sum it all up, we were there for one hour, 50 minutes of which was waiting and less than 10 was the actual (two) blood draws. And who says medicine in Riverside isn't screwed up beyond all recognition. I've seen slums in Indonesia with better health care than Riverside has.

So I drive Teresa home, and the good news is, her chills have seemed to subside. I put her to bed and take her temperature as I lay her down. Beep. 104.8. Christ, that CAN'T be good! I take it again. 104.6! Crap crap crap crap crap. No wonder her chills are gone. Suffice to say, I quickly dial the Oncology Center. Amazingly, they are open now. No exchange this time. I guess siesta is over. So I speak to Mari, one of the nurses there (since Doctor I'vealreadyforgottenwhethershe'samanorwoman is presumably still in Switzerland and our Nurse Practitioner who works two days a week is nowhere to be found). She basically says that they'll wait for the blood tests to come back, but they'll probably put Teresa on a couple of antibiotics depending on the results but until we know for sure, it's fluids, rest, and Tylenol. Oh, and that she'll call me back soon. Bear in mind it's around 3:20 by now.

So I wait for her call. And I wait. And I wait. It gets too hot for Teresa upstairs so I move her downstairs, where she's basically passed out on the couch, moaning occasionally in some sort of fever dream. And I wait and I wait and I wait. I take her temperature again at 4:30. 105.1! Ratfarts! That's really not good. Sadly, I know the blood-alcohol levels that cause coma and death (that would be 0.45 and 0.5 respectively) but I have no idea what the fever temperatures that cause the same are, though I suspect 105.1 is got to be close. Christ, that's high for an FM radio station, let alone a human body temperature. So I get on the phone with the Oncology Center again. It's 4:45 pm.

FRELLING EXCHANGE! ARE YOU FELLING KIDDING ME??? THE SHEET SAID 5 FRICKING O'CLOCK! IT'S 4:45! ARE YOU KIDDING ME?!?!?!?!?!?

So suffice to say, I'm fuming, and I scream at the exchange operator. This woman tragically no longer has the ability to sit and is in dire need of a rare and difficult derriere transplant because of the way and scope in which I yell at her. She says she'll get the nurse, then puts me on hold and ten minutes later tells me the nurse is tied up at the moment and will give me a call back. I slam the phone down, hurl it through our french doors into the courtyard, then calmly walk outside and proceed to stomp the phone into a fine paste. Can you tell I wasn't happy?

So finally, an hour later, at 5:30, Mari finally calls me back, and she's gotten the results from the blood work (the STAT CBCs, not the blood cultures, which need a day to sit). See those bad boys to the left? Those are white blood cells. Teresa doesn't have any of those right now. That's basically the diagnosis. So Mari's first piece of advice is that Teresa needs to stay away from sick people. Well, duh! But the long story is that she's calling in two prescriptions for antibiotics (Cipro and what I later found out was amoxicillin--Laureen, couldn't you have picked us up some of that when you were down in Tijuana this past weekend?) and during her next and subsequent chemo treatments they'll give her an injection of Nulasta to boost the white blood cell count and make sure it stays high throughout the three weeks, and that she'll probably still have the fever until she takes the antibiotics, but that the basic course of treatment is...say it with me now...fluids, rest, and Tylenol. Ladies and gentlemen, the entire medical profession boiled down into 4 words. And you need 7 years of medical school for that.

So our good friend DULCE PENA (capitalized since Teresa tells me people love to Google search for their own names) was nice enough to drive down from Redlands and stay with Teresa while I stopped at Target to pick up the prescriptions. Then I basically gave Teresa her medication, gave her more fluids, took her temperature again (103.1 when I gave her the meds at 7:30 and then down to 102.6 around 10 when I moved her from the downstairs sofa upstairs to bed) and let her sleep it off. I will say, most of her fever dreams were comprised of unintelligible moans, but she did have one instance when I checked on her, put my hand to her forehead, and she said, "It's pink." I have no idea what that means, and she probably doesn't either, but I thought I'd put it down so she can be slightly embarrassed when she reads this tomorrow. Love you honey!

Oh, and we need to thank DUANE AND KELLY ROBERTS for sending us one of the nicest and easily the heaviest and largest flower arrangement we've received yet. Honestly, the flowers are beautiful and it was a lovely gesture and we really appreciate it, but since I know neither Duane nor Kelly are reading this, I can say that next time, in lieu of flowers, a half-case of Cakebread Chardonnay would be even more appreciated AND would last longer and be better remembered than the floral arrangement. But then again, that's just me. I'm not the one with the metallic taste in my mouth or the fevered dreams and no white blood cells.

So here I am now, writing all of this up with a stiff brandy in my hand (actually, I HAD a stiff brandy in my hand) and about to get up every couple of hours to make sure Teresa's still breathing and all of that. I guess maybe I am going to experience what first-time parents actually go through, although I have to say, it's not pushing me any further away from the anti-baby stance I've already adopted. And that awful little staring girl in the waiting room didn't do anything to help sway me either. Sorry, single fertile women out there. My sperm is staying completely dateless and unattached for the time being.

The irony behind all of this is that we got a call this morning (back when Teresa still thought she was going to make it into the office) that Seamus is due for his 6-month cancer check-up at Dr. Dutelle's tomorrow. Yeah, I think they'll be okay if I'm forced to cancel (hee hee! I almost wrote "cancer" again. Can't tell if it's the stress, the late hour, or the brandy that's making me do it.) that appointment because I'm taking care of my other cancer patient at home. And no, it's not lost on me that a dramatic drop in white blood cell count is the same and sole complication that affected Seamus's chemotherapy as well. I guess Teresa and that mutt really do have more in common that I first thought.

If you made it through all of that, congratulations. (And you thought Teresa was wordy...). No hair update tonight since I've gone long and late. Perhaps later this week. Or maybe even tomorrow night if Teresa's still not well enough to post a blog of her own. Which, after seeing what I've done tonight to destroy her blog and chase away every single one of her followers probably won't be the case.

Until next time (if there even is one...)

Ciao belissima!