how long would i live?

For the past two days on the day shift, I have had a new admission/new diagnosis leukemia patient. It's been a while since I've had a day shift new diagnosis. I had forgotten the intense anxiety and just fear that you face every time you walk in the room. For most people especially a leukemia diagnosis, they are just shocked and shocked. Leukemia presents for most people like the flu that lingers and lingers. They usually are misdiagnosed and told to wait it out, and that it'll pass. Then finally someone does a blood test, and they are told to go immediately to the hospital. It's usually healthy people who have never even spent the night in the hospital. The first few days are filled with bone marrow biopsies, lumbar punctures, blood transfusions, x-rays, echos, blood draws, central line placements, chemo, pills, and a gazillion and one people walking into your room with only the slightest of knocks.

It's hard. I had forgotten, being on the night shift, you kinda lose your sense of the experience of a newbie. Night shift is covered by one doc that usually doesn't specialize in hem/onc and definitely doesn't round. People sleep, and occasionally get sick. Lights are turned down, and for the most part you try hard not to wake them when you do your well-fare checks, vital signs and infusions. On the days, you have like 3-4 teams of doctors, nurses and pharmacist rounding on the patients. You have am meds, tests and procedures, visitors, meals, physical therapy, blood, phone calls, managers, and a bunch of other people that you never see during the night shift.

These last few days, I have been reminded. She was so scared that every time I walked in the room, any thing she said she fell into tears. It was hard being her nurse. She and her husband are intense. They want answers that I just didn't have, but at the same time they only wanted to talk to the doctor. They wanted to know what would happen. While all patients have a similar diagnosis, not all their experiences are equal. Some get sicker than others. Some have no problems and breeze through it all. Sometimes the treatment works, and sometimes people die. It's a call that no one can predict, and I definitely don't feel qualified to answer.

There were so many moments that I could write about with this one patient, but the one that sticks out post bone marrow biopsy. I had promised to be there during the procedure, but typical day shift craziness occurred and I was stuck with another patient. By the time I walked into the room, the procedure was over. She is laying on her stomach crying quiet tears and looking completely distressed. The doc is cleaning up. I walk over to her and asks if she would like some pain meds. She says no. She has refused all other pain meds since admission, so I'm not surprised. It does distress me that she wouldn't take anything. I ask if she wants anything, and she grabs me and tells me not to go. I stay but I don't feel like I'm helping. Finally I remember her husband is outside, so I grab him. The doc asks if she's ok. She asks him, "How long would I live if we didn't do anything?"

The room is quiet. The doc responds that she would probably have weeks to months if they did nothing. She says nothing and covers her eyes. The husband replies that they definitely want treatment. There's silence for a minute. And I finally asks what I've been wondering the entire time, and what I had hoped the doc or her husband would have asked after such a loaded question. "What are you thinking?" She replies that she doesn't want to continue if everything is going to be as hard as the bone marrow biopsy.

At this moment, I was kind of shocked. I guess I haven't been in the room when someone was so completely done in at such an early stage. We haven't even begun treatment, only the work-up. She's going to need to stay this admission for at least four weeks following chemo and return for several treatments for months. There are going to probably be worse moments than that biopsy. But this is her life and it is ultimately her decision on whether treatment is continued or not.

After some more talk, she does decide to continue. It's strange how this moment is going to have such a dramatic effect on her life. She decided to try for life, even though the road is going to be hard.