When the doctors can’t explain something it can either be bad (“We don’t know why the tumor didn’t respond to treatments”) or it can be good (“We don’t know why his neutrophils jumped up so dramatically”). We have now heard both.
We learned early on that neutrophils are the type of white blood cell that fight infections. Neutrophils are the main ingredient in pus, for instance. Cancer cells are the intended target of chemotherapy, but the drugs affect all fast-growing cells, so chemo patients lose their hair. And another more important effect that you cannot see: chemo attacks another fast-growing cell, bone marrow, which stops producing new blood cells. So neutrophils, along with platelets (important for blood clotting), and hemoglobin (the red blood cells that carry oxygen) plummet after chemo. They can give transfusions of hemoglobin and platelets, and they often do for Peter, but for neutrophils we just have to wait for them to come up on their own.
After the five days in a row of chemo we expected to wait three weeks or so for his blood counts to come up. Then Peter would go home for a short break before a PET scan to check for tumor activity and then begin round two. The X-ray during the week gave a snapshot of a shrinking tumor (half a Hallelujah) and then on Friday we got another surprise.
A normal range of neutrophils is 1.5 – 8.5 x 109 per liter of blood. 109 means adding nine zeros, so 1.5-8.5 billion neutrophils per liter of blood. There are a lot of cells in a body! From Thursday to Friday Peter’s neutrophils had gone from zero to .42 billion. For some reason the doctors all refer to this as 420. I guess they put the decimal in a different place. Anyway, the attending doctor who visits Peter every morning on rounds was literally incredulous: he did not believe the results. He guessed it was a miscount. Although Peter had received a medication to increase the production of white blood cells, such skyrocketing numbers was a complete shock. If it was a miscount we would find out the next day, Saturday.
On Friday night one of the MD fellows spent the evening socializing with us and our four kids. Her family is from India and we happened to be eating Indian food prepared by my co-pastor and his wife that night. The doctor accepted a samosa, rice, dall, and vegetable curry and joined us for at least an hour and a half until her pager finally went off. Among other topics, she talked with Peter about his theory that it was the copious quantity of dried mango that he had eaten (a great way to get him to consume calories) that had spurred his body’s production of neutrophils. She had mentioned earlier that they had never seen a patient receive so much mail. Thanks everyone! It really means a lot to Peter to open up so many cards and hear how many people ae praying for him. The doctor said at the end of the night that her other dinner plans had fallen through, but she ended up with a very pleasant evening with our family. We felt the same. Peter’s hospital room has sometimes been a place of sober misery. That night it was a place of friendship and laughter.
Saturday’s numbers were even higher, .66 or 660. 500 is the magic number for being discharged, so they sent Peter home. Excitement rippled through the whole family. Going home for a break a full two weeks earlier than expected! Hallelujah (three-quarters this time)! At the same time the drag of disease, the hospital, and all the accompanying worries and complications was evident in our manner through the afternoon. I find myself more snappy than usual.
Because our older son was registered for a chess tournament in the Bay area for Sunday we stayed at the Family House for a night. (Thank God for the Family House. Paying for a hotel in San Francisco would be ridiculously expensive). A few weeks ago Rebecca ran into a woman we knew from our little church in Los Angeles. We had last seen her twelve years ago. One of her young daughters is being treated for cancer here too. She and Rebecca were both happy to find a friend to share their struggles with. And her older daughter and Peter quickly became friends. Peter was happy to see his friend again at the Family House. She came along when I took Peter and his younger siblings to a great little park in the neighborhood.
We have watched Peter’s body weaken through chemo and inactivity. Physical therapy and a Unicef Kid Power band (like a fitbit) have kept Peter motivated to stay active, but he remains extremely thin, weak, and unstable. He can’t walk like normal. Part of that is an effect of some of the chemo, which affects the longer nerves like those that run down the shins. He literally cannot stand on his heels and raise his toes off the ground. Peter’s physical condition was evident on the way out of the hospital. Rushing to get the younger kids from the playroom, Peter took a hard fall. Somehow his knee started bleeding.
Rather than avoid physical activity, it is important for him to maintain and build muscle and balance. That afternoon we walked (slowly) to the park, gladly holding hands for stability while his younger siblings and his friend ran on ahead. In the hospital they offer physical therapy, art therapy, music therapy, aroma therapy – I might be missing more. The music therapist and I joked that they should offer math therapy, but then more people would require therapy after math. “That’s funny, Peter,” Rebeca said to the stoic Peter, but he wasn’t in a mood to laugh those days. That hour at the park Peter did something far better than any kind of therapy a person could offer: he played.
This afternoon we will head home. We are glad for the break, but our hearts are still full of worry. (What does a visit from the palliative care doctors mean? How will all the complications of a bone marrow transplant affect Peter the rest of his life? How long will that life be?) When his platelets are up Peter will be back for the next round of chemo, probably on Wednesday or Friday. So for the next few days we will all engage in that life-giving, God-honoring activity – we will play.