Sunday, July 6, 2008

Easy come, easy go: The late night loss of a PICC line

Slip sliding away, slip sliding away You know the nearer your destination, the more you slip sliding away
Simon and Garfunkel

Not much of a story. And it's another medical one. I have thought of labeling my posts as medical or how's the old guy doing, or comic relief or some pressing existential issues hidden in a gauze dressing.  And though I favor the last three, I know some want the medical details and it is a good way for me to keep a record.  Plus the divisions are so arbitrary and the best moments I share have all the elements.  Not this one though. Just the fact, sir:

Tired and sleepy after staying up late to start a "transplant" Excel spread sheet of my lab results,  I reached to turn off the wall light. When I moved back to bed, the external "start" of my PICC line had slipped silently and painless and I might add, bloodlessly from my left biceps to my left wrist. 28 centimeters of tubing that used to run snug to my heart in its sterile vascular chambers was now lying on my not so sterile flexor surface of my forearm. Seems the locking device had failed. Oh, wouldn't it be nice to be simply able to slide that tube back to the heart of the matter, where it belongs, quietly and efficiently using its 2 lumen capacity to effortlessly keep me hydrated and at the same time keep separate the proper balance of poisons in a safe and measured way. But on it's few second journey from out of arm and to onto my arm, it may have pickup uninvited hitchhikers, normally innocuous skin bacteria that my suppressed immune system might welcome to a new home in my circulatory system, or worse yet in my heart taking up long term residency on its valves (subacute bacterial endocarditis or SBE). rather than rebuffing their inappropriate advances. Not a risk worth taking. So after a careful taping up twice of the evidence of the extruded tubing, and two tries, I got an old fashion butterfly IV above my left wrist doing the heavy lifting for now. My PICC was removed the rest of the way in the AM, also a non event, and sent to the lab to make it was bug free. When I get the new PICC line is antibody's guess. Today? Tomorrow? In the meantime it's old school blood draws from the veins in my arm. No fun at midnight. Ouch. And to add more fun to the mix, all my IVs are not compatible, so either I get a second peripheral line, or I run my antivirals and antifungals through at double time and shorten to 10 minutes for a quick shower my beloved unplugged time (read my romantic last post) while holding my anti-rejections drugs, but not for too long. If we time it like a NASA lift off, I can be running the tacrolimus, the continuous IV anti rejection drug for more than 22 hours instead of the usual of a bit less than 23. A gamble worth saving a vein or two. I might need those veins later.
And if this is my biggest issue in my transplant course, all I can say is that I am a lucky man. 
My counts are starting to rise, too soon for engraftment methinks, so it must be my old marrow, or maybe just a blip. 
Platelets are now 275, up from 160 July 3, Hg is rock stable at 11.5 almost the same over the last 5 days, and even my most sensitive white cells have climbed from yesterday's 1.2 to 1.5 today. Nadir is usually day 10-14. I am day 9, so I wait. Funny to be hoping to feel miserable and vulnerable. True, the immediate goal is to survive the transplant, but the reason for all this is to be cancer free.


Blogger Unknown said...

So the loss of the PICC now requires you to be poked? That just adds a little excitement to an otherwise humdrum transplant.

Maybe your donor was such a grand complement that your engraftment is occurring in record time. Keep your sprits up.

Your CLL Friend

Robert and Family.

July 6, 2008 at 3:52 PM  
Blogger Jeannette Brown said...

I know you are a doctor, but I wondered about your decision to have a pic line instead of a port. My port gives me hell because of the keloid on the incision but at least it is internal.
I hope you do well with your new line. I move around too much to have a line like that.
Jeannette Brown

July 6, 2008 at 4:32 PM  
Blogger Diane Anderson and Family said...

Okay, how does one "silently and painlessly" undo a PICC line? Granted, it's the outside part but still......
You have to be such an overachiever don't 'cha?
we're thinking of you.
Diane and Brad

July 6, 2008 at 8:40 PM  
Blogger carola and bruce said...

Dear Brian,
We find your writings inspiring, fascinating, informative, and funny as hell (amazing!) Perhaps after you've recovered you can consider a career doing stand-up. Wait a minute! You have done that, as well as a helluva lot of other things, haven't you? Well, you are an amazing guy, Brian Koffman, and we send you and your family warmest wishes and virtual hugs. We'll be by for a visit as soon as it's OK. Will call to find out when.
Carola and Bruce

July 6, 2008 at 8:42 PM  

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