From Jon on Day 2

This is Jon. I will tell you what happened today but Alissa may have a different perspective. She can comment if she wishes.

As Hana said yesterday, Alissa was here today so she had to endure the day, and me. We were at the clinic at 8:15 after the, by now, expected breakfast of scrambled eggs and oatmeal. It should have been a short day, just waiting the 45 minutes, or so, for the blood results to come back, then we would be on our way. But it took a while for them to see me to get my vitals and take my blood because, as the nurse said, there were only two of them. And then it took five times longer for her to fill the four vials because my PICC line was particularly balky. Since it was put in a week ago, it has been fine for pushing fluids in, but hard to pull the blood out and, seemingly, getting harder each day. But we were settled down to wait by about 9:00. Alissa got me something to drink and did most of the crossword puzzle (which Rebecca, with her crossword-puzzle-finding-the-one-wrong-letter superpower had the finish). The numbers came back fine but the dressing on my PICC line is supposed to be replaced after seven days so there was still that to be done. But when the nurse went to flush the lines (there are two separate lines on one small tube), this time she still could push the saline in fine, but could not get any blood return on either line. This was concerning. She worked it for a while, and then decided to escalate it by putting in exactly enough anti-coagulant to fill the lines (but not enough to push it into my artery) in case the problem was a clot. Then we had to wait two hours for it to take effect. I took a nap so I don't know what Alissa was doing. But it wasn't until Alissa got off the 12:00 Newcomb family zoom call that they got around to try to pull the anti-coagulant out of the lines. They didn't budge. So the concern was now a worry. The nurse said she thought they may have to do it the anti-coagulant infusion again. So she went to the attending oncologist on call. This began the combative part of the interaction. Alissa could hear the nurse briefing the doctor in the hallway and describing me as somewhat obstructionist, in which she was not wrong. So he came in saying they were going to do it all again. Given how the first time there was not the slightest indication there was any movement I said I didn't see there was any reason to think the result would be any different. He said this is the protocol. I wanted to know what the probability was that it would have a better outcome. He wouldn't answer that and said he was the doctor and if I wanted to go home, that was always the patient's prerogative.

I should mention at this point that I had, very quickly, started to confront him with the tone my family knows well. I don't think yelling is the correct term, but I was certainly loudly emphatic. I think it was his perfunctory attitude without trying to explain anything that set me off, but it is possible I was confrontational from the beginning. I should also say that before he came in Alissa had got me to agree that I would let her do the talking, but that, clearly, had not happened. He was talking directly to me so, I guess, it was impossible for me not to respond. He did not raise his voice back to me but, I would say, he did fall into that doctor's habit of just being aloof and dismissive. After we left Alissa again, for the nth time, explained to me that my tone and attitude was not only not helpful, but was quite counter productive but we can see how I have not turned over a new leaf, yet.

Anyway, I eventually said I would certainly do as he suggested but I really would like some reasoning. He said it just his way of exhausting all the options, which I don't think explains the cost/benefits at all. So Alissa went back to the hotel to eat something and exercise while I got ready for the hours to go. But after 15 minutes the nurse came back and said we would only wait an hour this time so I told Alissa and she came back in time to wake me from my second nap and see the nurse have no more luck this time and kick us out. We went back to the room, Alissa went and exercised then (and I didn't kack out when she was out of the room), and we went out for an early dinner, Hana came back with the car so Alissa could turn right around and go back to Vienna to see all her nieces -- and siblings, of course.

Tomorrow we will see. It is possible the nurse will be able get enough for the blood tests, but either way they way they are going to do an x-ray and/or and ultrasound to try to figure out what is wrong. It is not clear to me what they could possibly see that will change their approach to the solution. I would guess they will have to pull the line, then we will see what comes next. I think the port I already have should suffice, but the doctor pooh-poohed that idea.

I would mention one other thing. When I had my first port, maybe 14 years ago, that was being used to give me my treatment infusions, there came a day when the nurses couldn't get it to work. Very similar to the problem with my PICC. They ended up just using a vein and then sent me the interventional radiology to get it worked on. When I got there it worked fine and they sent me home. So maybe this PICC line will work fine tomorrow. We'll see.

P.S. from Hana -- meanwhile, I had a peaceful day with Mika and Liana and Thalia and their parents. It was raining all day and I never left the house. Not sure I would have had any more luck keeping Jon from arguing with the doctor, so I am glad it was Alissa's day.