Yesterday, we went in for what was supposed to be a routine blood-draw and simple out-patient chemo injection. I should have learned by now...
Things were moving slowly in the clinic, so Scarlett and I had time for a bottle, a few diaper changes, and some play before the nurse was ready to access her port and draw her bi-weekly labs. As soon as Scarlett had tired out and fell asleep, in came the nurse, ready to poke. Luckily, Scarlett is a champion port accesser, and hardly notices that we have to hold her down and poke a 3/4 inch needle into her chest (thanks to the numbing cream we always use first!). We finished quickly, and packed up as the nurse called in a prescription refill for us. Before we left, I asked (I asked!) if we needed to wait for the results before we left; she said no, we were clear to leave. Our regular nurse practitioner was on vacation, so we left some of our big questions for next week.
The pharmacy needed a little while to prepare our prescription, so we grabbed a drink and a snack in the cafeteria. We came back to the pharmacy just in time for the clinic nurse to come running in, saying, "Oh, thank goodness we found you!" Apparently, Scarlett's platelet count was below 10,000 (normal would be above 100,000) so they wanted to transfuse immediately. This was somewhat alarming, but not unexpected - that's the whole point of chemo, and we knew her counts were low; she had been easily bruising and had a few bloody noses, but we were just waiting for the call that it was time. As I went to re-apply the numbing cream to her port, I realized that the first puncture had not stopped bleeding; the band-aid on her chest was soaked through, and her shirt (white, of course!) was spotted with blood. Her port is directly under the car seat strap, so I hadn't noticed. I'm glad they stopped us, or we would have gotten all the way home and had to come back.
Platelets are cells that help the blood clot. When we are injured, platelets cause our blood to get sticky and coat the injury so that we don't lose too much blood. When platelet counts are low, blood does not clot, and bleeding can be difficult to stop. Scarlett had low hemoglobin (red cells) too, so losing much of anything was not good. They accessed her again and started a platelet transfusion, where platelets spun out of donated blood are given just like blood (interestingly, they don't have to match the blood type like blood, and are thick, sticky and yellow.)
When the platelets were done, she looked good, so we de-accessed her port again and held a piece of gauze on the puncture. And we held it. And we held it. For 20 minutes. Now she had two oozy punctures that would not stop bleeding, one from each needle access. Just as they were discussing putting ice on it, which I was arguing would make her so upset she she would bleed more, things got really exciting: she developed two hives, one on each temple. She has had allergic reactions to blood products in the past, but not to platelets. This caused the nurses to jump into hyper-drive, pulling in doctors and equipment to access her port for a THIRD time. They were in a hurry to get antihistamines and Benadryl into her system in case her breathing became affected, so they couldn't wait the 30 minutes for the numbing cream to take effect and had to poke without it. That was my cue to go out of the room and cry; I can't take it when they have to hurt her. I went back in when I could hear that things had calmed down, and they assured me she had taken it like a champ and had already relaxed.
The gave the reaction medications, and the hives went away, but the bleeding persisted. For some reason, it seemed that the platelets were taking longer than they should to be incorporated and stop the bleeding. So, since it was already 6pm and the clinic was near closing, they made the decision to admit her over night for observation. We were moved over to the short stay unit, which is for just that - short stays less than 24 hours for minor issues. It took almost two hours for the paperwork to go through, for a bed to be found and for everyone to be prepped on Scarlett's case...by which point, the bleeding had long since stopped.
I spent the night in a freezing room with too many windows, all of which face the fully-lit and always bustling main entrance of the hospital, sleeping in a reclined hospital chair. Thankfully, my mom had been nearby and brought me some clothes (because of course I picked yesterday to wear a skirt!) Scarlett got her blood transfusion, all her labs came back regular, and she was cleared to go home at 11am.
Thank goodness it is Friday. No hospital this weekend. We are going to the beach!