Of the 11,000 new cases of Acute Myelogenous Leukemia each year in the US, most are grandparents who will be missed by friends, siblings, children, and grandchildren within a couple years of diagnosis. Few will be missed by parents. Only about 100 are young adults like Hector, Eric, and Aaron. Eric, also in his 20’s, was issued his ticket to the 4th floor ICU a couple weeks ago by a lung infection. The invaders of Eric’s lungs are not bacteria. They are fungus who’s rent-free squatting in the air conditioning unit at his home might have gone unnoticed for years by legal residents with functional immune systems. But Eric’s defenses were demolished by the powerful poisons and radiation given to destroy his bone marrow and his ability to reject stem cells harvested from the blood of a stranger in Germany identified by an international computer database of potential donors. Fungus infections are hard to fight. That he yet lives is due to transfusions of white blood cells from his mother, which fight on behalf of his own decimated defenses.
Aaron’s white cell count has leveled off at about 30,000, the high end of a normal response to bad infection. While the search for infection continues, it is the clot in his right external iliac vein that is most immediately worrisome. On the theory that if there’s one, there may be more, and on the knowledge that, for reasons unknown, clots which can break loose and wreak havoc to the heart and lung usually come from the legs, it is deemed important to install a clot catcher in the inferior vena cava so that any clot detaching from either leg will be stopped on its way to the heart. Through a small incision above his left thigh, a tiny, wispy titanium daddy longlegs spider kind of kind creature is inserted and threaded up to the vena cava. There, it is opened like a miniature cocktail umbrella. It spidery feet brace against the walls of the vein. It will not allow any chunk of stuff big enough to cause damage to pass. While it is possible to remove the catcher, it is also possible that it may never be removed. Just another small uncertainty of the future.
With the clot catcher in place, it is now time to confirm or disprove the suspicions about the gall bladder. The gallbladder is a small, pear-shaped bladder whose purpose in life is to receive, concentrate, and store a few tablespoons of bile manufactured by the liver. An Inuit whose dietary habit consists primarily of gorging on whale blubber might find the gallbladder useful, since bile is needed to digest fat and the liver manufactures bile only so fast. But for most of us, it’s an optional feature with little market value.
Aaron is wheeled for his second field trip (it’s no big deal anymore) of the day down to the “A” level basement into the department with the ominous name “Nuclear Medicine”. A scintillation detector the size of a fat swamp buggy tire attached to a movable arm is positioned a few inches above Aaron, centered on his invisible liver. It is big enough to nearly touch his chin. A slender box that might be a gift box for an expensive necklace is brought into the room. Except this box is made of lead, and in it is a syringe containing radioactive metastable Technetium 99 (gamma emitter, half-life of 6 hours) which is injected into Aaron’s bloodstream. The Technetium finds its way to his liver, and Aaron’s radioactive liver now glows brightly on the monitor attached to the detector. Every minute or so, a new image is captured and saved to an ancient (pre-GS3) Mac (one of the few in this decidedly non-Mac environment). In a normal healthy person, part of the glowing liver will fade over the space of an hour as the radioactive Technetium moves with bile produced by the liver into and through the gallbladder.
Aaron’s whole liver stays bright for an hour and a half. Something is definitely wrong. The bile is going nowhere. Surgery to remove the gall bladder is scheduled for tomorrow morning. Perhaps this will put an end to the fever’s continuing daily dance and the growing pain on the right side of Aaron’s stomach; pain enough to part the opiate veil. Natalie wonders if the continuing periodic tremors are perhaps not withdrawal or panic, but pain.
Cousin Kandice, fresh out of fourth grade and into summer, visiting from Santa Barbara, asks her mom if God is married. (Mom’s know about these kinds of things.) Tami replies, deferring to orthodox theology, and Kandice observes wisely that she didn’t think so, as Mrs. God would never have allowed this to happen to Aaron.