This morning, getting George’s lab results provided a nasty surprise. We knew that his red cells and platelets hadn’t come back the way that his oncologist was hoping. But being severely anemic again and essentially having no platelets circulating was not on the planned list of results.

The brief, short visit turned into hours as he received both platelets and packed, irradiated red blood cells.

And, if I haven’t said it before – my sincere thanks to all of you who are regular blood donors. It isn’t just the military, traffic accident victims and those caught in mass shootings who benefit from a healthy and robust blood supply. It is also those who are older, or under treatment for various malignancies who are kept alive during the course of treatment by the generosity of total strangers.

and we will have to be back tomorrow. Probably Saturday and Sunday as well.

Oh, joy.

The time was 0930 in the morning and we had left the house on the way to UCSF. The HOV lanes were still active so after making a kamikaze series of four lane changes to the left, we sailed along to the left sided flyover headed toward the Bay Bridge. There isn’t all that much traffic in the left lane, made even less by those single drivers smart enough to get out of the HOV lane before the cameras documents their law breaking activity. From there the flyover lane crosses to the right side and meets up with the HOV lane coming from the Oakland direction. Sailing through the toll plaza, we entered the main portion of the traffic just past the metering lights. To our left, and ahead of us was a small, reddish Fiat. There was no one around the Fiat by 10 meters or so in any direction. In a location where traffic was almost bumper to bumper, there was this bubble of “no drive” around the Fiat.

From there, all the way across the bridge, no matter the speed for the rest of the traffic, this Fiat seemed to travel at a slow and constant speed with everyone avoiding it. Traffic going 40? The Fiat is going 30 and everyone passes it. Traffic going 20? The Fiat continues to sail along with everyone avoiding it. Admittedly, I didn’t see much with it traveling faster than everyone around it. More like it turtling along with every single last car, truck and motorcycle avoiding getting anywhere near the Fiat.

When last seen, it was puttering south on the freeway, its bubble space still intact.

Arriving at UCSF early, George had his labs drawn and his follow up appointment. From there it didn’t run as smoothly as I would have liked. Because his feet hurt, someone hadn’t been drinking enough fluids. Not drinking fluids puts one’s kidneys at risk. Instead of heading home, we wound up spending almost an additional  four hours while someone (fill in the name yourself) received a significant amount of IV hydration.

The drive home was painful as the afternoon rush traffic had already started. My afternoon errands had been completely and totally taken over by hanging out at UCSF while someone’s IV went drip, drip, drip. Taking a deep breath here and releasing the last of the pent up anger, frustration and general disgust….

But the next time someone doesn’t drink enough on his own – he can Lyft or Uber home….

From where I am staying in outer Sunset, it is just a short hike across Golden Gate Park to the SFVA. Of course, I can just ignore the fact that the portion of the stroll from the park to the VA is straight up 42nd.

at the top of the map

you can see the location of the VA. and at the bottom you can see the small upside-down “V” where the cross-road park road connects to the streets on the north side of the park. Please count them, five blocks straight up hill, a definite challenge on a cool and foggy morning.

It was dental day for me. Like many others of our generation, I have a significant amount of dental work. Due to the care and diligence of Army (and Air Force) dentistry over the years, I still have all of my teeth (except for wisdom which exited when I was in med school thanks to the U of MN Oral Surgery Residency Program. $25, thank you very much). In fact, I have had one crown for a significant number of years, enough that I actually have worn through the crown. Today’s mission impossible for my poor dentist whom I have gotten to know rather well over the last two years, was to see if it could be patched with the alternative facing me of a new crown. Much as I really appreciate the SFVA dental staff, I don’t need to devote another several ½ days to the dental clinic. A successful patch later, I was about to go out the door. Only one dental issue left in my future – replacement of crown that will involve a visit to the periodontist. Since the previous dentist retired, there is only a part-timer on contract. His tech stopped in – would I be able to trade my August appointment for returning this afternoon?

Of course!

It was only a matter of taking the shuttle over to UCSF and hang out with George for about three hours and taking the shuttle back. Nice guy (family Ukraine -> Israel -> to California) which means, of course, his practice is in Menlo Park (altho he denies living in Sunnyvale). His tech’s family came from China when she was young. My dentist’s family came from India. The nurses and cleaning staff are equally reflective of who takes care of our veterans–it is the new immigrants and their children. The ones that feel that they are contributing to the U.S. by taking care of those who serve. And often, they are also first to volunteer should the country need them and at a much higher rate than those who are two generations or more in the U.S..

(off soap box).

After being told to expect pain, I breezed through the pharmacy and ran for the shuttle, getting back to UCSF by 1600. I spent the afternoon just hanging out with George, then we watched the first three quarters of the Warrior-Raptors game before I headed to the N-Judah. He still has squat for white cells or platelets; I figure another week in this place. He is bored, he is tired. If you want to email him directly – georgeDOTrehmATicloudDOTcom with substituting the appropriate punctuation  It would be a lot more appreciated by him than me playing momma monkey and plucking loose hair.

totally amazed this morning – I had to wait for the outbound N-Judah to clear before proceeding to the tram stop. The drive of the inbound waited for me! Perhaps I am just having great luck right now with transportation drivers. Yesterday I had an appointment at the SFVA. My choice was to take the N-Judah in to Powell, then catch the 38R out Geary spending almost 90 minutes under way or .. walk across Golden Gate Park. I chose the latter. 40th->41st. Across the park on pleasant paths which come out at 42nd. Stagger up the hill for a few blocks (about four?) and there I am at the VA. Distance well under 3k, time less than 30 minutes. Coffee my reward on arrival.

Last night seemed to be another of those “not getting enough sleep” for George so he slept most of the morning. I wound up going back to the Outer Sunset for a few hours of sleep myself. Met Alex at the ballpark to collect the “unicorn rainbow fanny pack” give away and watch the As lose another to Houston.

Headed to Berkeley for the night to do home laundry, repack some clothes and otherwise take a short break.

In general, transplants are messy, painful operations involving anesthesia, surgeons, recovery; did I mention pain for days afterwards.

But this is what a stem cell transplant looks like

transplant in a bag

Now add in vital signs, premedications (the usual to prevent a reaction), two nurses carefully double checking each and every bit of identifying data (just like a blood transfusion only more so), and in less than an hour it is done. Never have to leave the room; no rolling down the hall dressed in horrible hospital best with all these people who don’t know you staring as you are wheeled past. No opportunity to say stupid stuff in the recovery room that may come back to haunt you. Just the opportunity to read or sleep while the pump does its thing.

Meanwhile, now a few hours post transplant, George is watching the Warrior-Toronto game after supper. I spent time playing computer games.

Then, I decided to read more on ethnicity, HLA typing and other fun scientific inquiries. There is a really neat data base here which gives you background on HLA typing and has a database in which you can look up HLA alleles that have been correlated with different ethnic groups. Besides the obvious data from Europe, there is also significant data from Africa, Asia, Pacific Islands, New World Native,  and various combinations there of.

If you are interested – this link provides data on the relation between ethnicity, donor availability (unrelated donor match) and survival. This particular study is now ten years old, but the facts remain that being Caucasian improves your chances of a finding a match with an unrelated donor.  The closer your match, the fewer complications and the better your long term chances. Most of us do not have enough siblings to have one a perfect match. In fact, some of us, by retirement age, don’t have any sibs, or none that are healthy enough to donate. The US National Registry is here. The same exist in UK, OZ, all Western European countries. Primarily, they are looking for the under 30 crew (free to register) and males are preferred over females (and females who have not been pregnant over those that have). In case you are scratching your head – pregnancy exposes a woman to HLA antigens not her own. Unlike other organs, stem cells/bone marrow is self renewing.

George was still doing fine when I headed off for the night. We were told to “not expect problems” but to report anything that was a change. Anything at all. Discomfort, pain, itching, anything.