9 days, 8 nights.

On the evening of January 6 (the day following my most recent blog entry) I found myself lying in a bed in the emergency room at a major LA hospital. The bed was located in a supply closet (I guess the manger was occupied), along with enough miscellaneous and sundry items to equip a new hospital if one were so inclined; I was not.

The day had started innocently enough. Cecily and I had traveled to LA for consult in preparation for enrollment in a clinical trial of the chemotherapy agent Trabectedin, the sea squirt derivative. The LA oncologist indicated that he needed signoff from a cardiologist that I was fit enough to begin treatment. So I was sent to an LA cardiologist’s office where an echocardiogram was performed. The imaging study reaffirmed a large volume of fluid in my chest cavity, both within the membrane (pericardium) surrounding the heart and between the pericardium and the lungs. These conditions (known as “pericardial effusion” and “pleural effusion”, respectively) are longstanding and have been progressively worsening. It was the LA cardiologist’s opinion that the effusions posed a serious risk to the proper functioning of my heart and therefore required immediate treatment (drainage), regardless of whether chemotherapy was under consideration or not. He sent me to an internist who had me admitted to the hospital.

(Incidentally, the SB cardiologist indicated that they would not recommend drainage of the effusions unless my blood pressure was extremely low and my heart rate very high due to risk/benefit issues. The LA cardiologist stated “why wait until we’re behind the eight ball?” I’ve come to the conclusion that the SB guys are reactive while the LA guys are proactive.)

As I lay there in that supply closet, suffering from the intense pressure on my heart, I determined that pain/sleep medication was in order but I had no interest in beginning the cycle of narcotics that was given to me during my previous hospitalization that resulted in four weeks of constipation. So I dosed myself with one-fifth gram of hashish in chocolate bar format. That was the last cannabis that I have consumed.

Later that night I was transferred to a proper room on the cardiology floor. The next morning I was wheeled into surgery whereupon two heart surgeons cut a “window” (read “hole”) in my pericardium and installed two drainage tubes in my chest, one within the pericardium and one between the pericardium and lungs. The tube in the pericardium was removed three days later.



Here’s a photo taken immediately prior to removal of the first tube by one of the surgeons. I had been given 4 mg of morphine to help manage the pain of the tube removal procedure (which amounts to a yanking out of the seven inches of tubing that extends into the chest cavity). The morphine was totally useless in mitigating the resulting pain, but fortunately it is a quick procedure and the intense pain does not linger.

The second tube was removed seven days after installation. While I do not have a precise count as to how much fluid was drained altogether, I believe it totaled approximately 4.5 liters (10 lbs.). I was discharged from the hospital on Wednesday, January 14.

The improvement in how I feel from having this pressure removed from my heart cannot be overstated. Yesterday I drove for the first time in three months. I am able to walk around again without debilitating discomfort (during the prior ten weeks it has been a struggle to get from my bed to the sofa and back again). And . . . I can now sit up for extended periods, hence this rather lengthy post.

But I have lost a lot of weight and my muscles have atrophied beyond belief. I weigh 148 lbs. and have the physique of a starving child in Biafra. I scare myself every time I catch a glimpse in the mirror. A couple of times I’ve been standing around, minding my own business, and upon shifting my weight ever so slightly my pants have dropped like a lead balloon down to my ankles. I swear, the only thing holding them up is the tumor protruding from my left hip. Hopefully, my increased level of activity will bring back some muscle tone and will allow me to add some mass to this ridiculous frame. Time will tell . . .

I am scheduled to submit to another surgical procedure on Monday – the installation of a “port-a-cath”, a device used to make the administration of chemotherapy easier and reduce the risk of certain chemotherapy-related complications. I’m really growing weary of all these procedures but you gotta do what you gotta do, right? And for those of you who are keeping score, I've added another four physicians to my quiver: an internist, another cardiologist, and two heart surgeons.

And if all goes according to schedule, I will have my first 24-hr infusion of Trabectedin on Thursday and Friday of next week. This is the gorilla in the basement, finally brought into the fray. Hold onto your helmets – we could end up miles from here.