26 Minutes to Deliver the Cells

It took 26 minutes to get this little teeny bag of invisible cells to drip into the line and into Jon's body. The fluid is clear, not like a stem cell transplant. The transplant nurse kept saying that when you walk past someone who is getting a regular transplant, you can tell right away what is happening because the bags of blood parts going in have color. With CAR-T you can't see anything. And there is a strict 30 minute limit to get it all in, otherwise they cut you off. The nurses stay right there and watch the entire bag until it is emptied, making sure that every drop comes down and is not leaking from any of the tubing.

The cells are delivered frozen, directly from the lab at a pre-ordained time (11 AM). They come in a big canister of liquid nitrogen that weighs about 50 pounds. Two medical professionals (a technician and a Nurse Practitioner) come with the cells and they stay to watch the whole procedure. 

But before all that, the electricity in the whole hospital went off at 10:21. Greg the nurse was careful to project pure calm, even though he said that had only happened once before in his entire long career. He said that the CAR-T would not be interrupted because they just had to get it up to the fifth floor and defrost it and then gravity would deliver it.  But there were no elevators for 20 minutes, among all the other things, and that did seem a little worrisome. Of course hospitals have huge back-up generators, and there is a whole set of red outlets that are the emergency power, but just imagine being a surgeon in the middle of a procedure and having all the lights go out.

The NP who came with the cells did not trust the elevator and she huffed her way all the way up the stairs. The technician took her chances with the 50 pound container and got on the elevator.

Anyway, the only uncomfortable part was the IV Benadryl. Jon hates Benadryl because it makes him so sleepy, and when it is delivered by IV it goes straight to his brain and makes him feel leaden -- and twitchy. So he didn't get to sleep for the two hours that he was in the bed waiting to be set free because he was too wired even though he couldn't open his eyes.  Meanwhile, I went outside where the sun was shining and it was another beautiful day.

The IPOP nurse said that we are waiting to see if there are any symptoms of cytokine release syndrome in the next week or so. He said they usually show up in 2 - 7 days.  Mostly we are watching for fever. He said if you get a fever you are likely to be admitted (there is a dedicated hospital wing for these IPOP people). As I say, we are ready for anything in the next few weeks.

I noticed the familiar smell of creamed corn almost immediately, coming off of Jon. It has something to do with the transplant process. The nurses say they can't smell it anymore, but it is certainly distinctive.

For lunch we got a pizza from a shop on the northern side of the same block we live on. By the time I walked in, it was going into the oven. This is truly a luxurious existence, in terms of access to food and medicine.

This afternoon, as a demonstration of our total vacation mode, we watched Kiss Me Kate on PBS because it was recommended to us by Chip. It was a good production and it seemed like they tried to soften what is usually an unpalatable ending. We can't remember the original story well but we do know that the ending, where they tame the shrew, is no good. This one was much more tempered, as a show within a show within a show. The performers were great.

This is our seventh night in Baltimore. Hopefully only two weeks to go.