Wednesday, June 11, 2008

Kiss the ground





Getting here was actually the easy part. Once we were given the green light to come back to the States. I immediately booked us tickets home. Always a challenge especially with British Airways, we at least managed to get on the same flight, seats together were another story. I felt we needed to go sooner rather than later although there are always things to do and friends to see. I felt the time on the other end would be more beneficially for us.

We were also fighting the clock against a pregnant cat our in-laws had. One of the Lindsell's cats, became pregnant while we are there and as she grew so did our worry. New pets and especially baby animals are big bacteria no-nos for Rafiki and I am sure if we were around for the exciting moment of motherhood, Rafiki would want to join in with his cousins holding and petting each and ever kitty. We beat the kittens arrival by a week.

I booked tickets for us to come home June 11th. There was a lot to get done before leaving especially figuring out how we were going to get all the stuff we had accumulated home. Now that Rafiki is two and we basically pay full price for his seat, he had a baggage allowance thankfully. Rafiki had one huge duffle bag just of his toys and books; all the thoughtful presents friends and family had sent for his birthday and his hospital stay.

I am incapable of traveling light. My Dad always is surprised that I mange to fit 20 pounds of stuff into a 10 pound bag. Between the three of us we had-2 camera bags, 1 laptop bag, diaper bag, 2 carry-ons, purse, stroller and 4 giant duffle bags. We had so much stuff we had to do a trial run in the car to see if we could even make it to the airport with all our kit. Liz, our sister -in-law only had a small Land Rover.
http://www.analogstereo.com/images/om/land_rover_freelander.jp

It sounds big but was only big in the gas prices. A full tank of diesel in England cost us $120. So with painstaking precision Patrick got it all in leaving room for Liz to even see out the back window.

The 24 hour journey began with a 2 hour drive to the airport. At the airport we were told the prized bulk head seats I had tried so hard to get the few weeks before were already booked. This is after phone calls and emails to British Airways telling them we were traveling with a sick child. Everyone of the customer service people said they would make note of it but there was nothing they could do until the day of the flight.

Patrick and Rafiki had originally flown British Airways over to London in February and had a variety of unhappy incidents and Patrick was not thrilled at the idea of flying them back. We are still waiting to see if they will give us any kind of refund for the tickets we lost when Rafiki became ill in March. It really is amazing how corporate and unfeeling people and organizations have become. A society of fear that doesn't allow employees to think and care about their customers because it might break the rules and maybe they could lose their job. Often I do find it hard to believe that the person I am speaking to is actually a human.

The woman booking us in at the airport, did have a heart however and tried her hardest to find us seats at least near each other. She was successful with that and also gave us access to the Big Executive club but we didn't' have time to take advantage of it. Rafiki and I toured the amazing facility which included a theater, a couple bars, massages, kids area, buffet and a view of the tarmack.

When she called to get us access to it, she quietly whispered to the person on the other line that the couple she was inquiring about were traveling with a critically ill child. My heart dropped I had never thought of our situation like that and it hit me in the chest with a lot of power. Already a bit stressed about the flight, getting through security and arriving safely I started to get a bit emotional. It is moments like those when I actually have a few seconds to see outside myself, see what other people see and realize, wow.. this is really our lives.

The flight went well and Rafiki was a star for most of it. He slept at least half of it. We managed to get through customs and immigration faster than I have ever before and were greeted by our good friends Julie Quihuiz and Mia Giard. Mia was a surprise we weren't expecting. Luckily we managed to fit all the kit in my Honda CR-V.

Because of our concern for us to get settled in immediately with our medical care. We booked an appointment to see the Dr. Greffe on the 12th the day after we arrived. We wanted to be prepared. If Rafiki's temperature gets above 100 we automatically go into the hospital as that is the first sign there may be an infection. If that were to happen we wanted to make sure we would be taken care of in the way we had been before.

Hoping that our visit would blow Patrick away was just enough to set me up for a disappointing result.

Of course the hospital was as gorgeous as I remember it. We got there early so we could get a bite to eat and have a look around. We started to hit a few little bumps in the road as we began our appointment. All being tired and anxious added to the situation. We were brought into an exam room which was incredibly sterile. The sight of it, sent Rafiki into tears, knowing only to well what he was in for. This was one of the rooms I had not seen, not that it really would have made a difference in the big picture but I was a little surprised. There wasn't a poster on the wall, not even an informational one and there was one book to read that was for middle schoolers and was a medical book not to exciting for Rafiki.

The nurse struggled to get Rafiki's vitals. His least favorite; getting his blood pressure taken which they try to do on his leg but have a hard time getting an accurate reading as most of the time he is hysterical.

After that was done the nurse brought Rafiki a nice noisy truck and that quieted him down for a bit. Dr. Greffe came in and we discussed all our adventures in the medical field so far and showed him the meds we had brought back with us. Rafiki seemed to be very comfortable with him. Rafiki does seem to favor male doctors.

We started to fill in the pieces and then of course came to the dreaded blood taking. Rafiki has a central line with an exterior port called a Groshong.

Central line: A catheter (tube) that is passed through a vein to end up in the thoracic (chest) portion of the vena cava (the large vein returning blood to the heart) or in the right atrium of the heart.
http://www.medterms.com/script/main/art.asp?articlekey=14394

The Groshong is a very common type of catheter in England but no so here.
http://www.rad.washington.edu/clinical/patinfo/interventional-radiology-clinic/Interventional-Procedures/vascular-access

So needless to say there has been a bit of confusion. The first attempts at taking Rafiki's blood from the Phlebotomist greatly concerned as, as access was not smooth and there was a struggle to get the blood taken and the line flushed clean.
It was quite the change from the last visit we had from our community nurse Janet Meikel in Stalbridge, in which Rafiki didn't even flinch the entire time.

We tried to describe the tools,syringes, and methods that they use in the UK but neither the nurse or the Phlebotomist was familiar with the groshong and it really surprised us. This was not something we anticipated.

I had met a lovely young girl, Zoey who is in the maintenance part of her chemo here in Fort Collins before I left. When I met with her and her family Zoey generously let me see and feel her central line which was under the skin and requires an injection. At the time I just figured different kids had different port for different reasons, and I really had no reason to believe that the groshong would not be used here.

Rafiki a brave boy quickly recovered and was up for exploring the hospital. On the ride home I asked Patrick what he thought and in his typical style said he was going to reserve judgement.

Fair enough. For right now I was just glad to be back home and in our own space and together.

Friday, June 6, 2008

Decisions


patrickrafiki



patrickglasses


Patrick and I haven't had much of chance to talk but he knew I was pushing for us to return to the States. The weeks apart have been so hard for both of us, and as my good friend Mia has said we both have been fighting the same war but in different trenches. There is no way I can even begin to know what he has gone through caring for Rafiki alone and not letting him out of his sight for even a second. The first month was the hardest when Rafiki was on Dexamothazone, steroids.

Dexamethasone (also called Decadron¨) is a man-made steroid medicine. It works like a natural steroid that is made in your body. This medicine has several uses:
• to relieve inflammation (swelling, heat, redness, and pain)
• to treat certain types of cancer
• to treat severe allergies and asthma
• to treat nausea and vomiting


Rafiki was a hand full feeling all the side effect that the drug has to offer. Eating all the time, not sleeping, grumpy, moody, and also in a far bit of pain not able to walk. The nurses at the hospital call kids on the drug DEX babies.

The side effects seem endless but it is very effective with this treatment

Possible side effects
Early
• Stomach irritation (burning)

Late (usually more than a day after treatment starts)
• Headache
• Dizziness
• Changes in personality and mood
• Increased appetite
• Problems sleeping
• Acne
• Eye problems (cataracts, glaucoma)
• Weight gain, mainly in the face and abdomen
• Water retention that can increase the blood pressure
• Increased white blood count, but decreased numbers of infection-fighting cells
• Increased blood sugar levels
• Decreased potassium levels in the blood, especially if you are taking other medicines that also decrease potassium levels in the blood

After taking dexamethasone for a long time
• Decreased muscle mass and muscle weakness
• Impaired wound healing
• Decreased growth
• Thin fragile skin
• Weakened bones

In and out of the hospital Patrick is not one to ask for help in any capacity. He takes all the burden himself rather than burden someone else even though there is a long list of people would love for the opportunity to help.

We finally decided that we would return to the States sometime mid-May. Over the last 6 weeks of being separated I have thought and rethought about the decision to stay in England or move back to the States. I have come to realize that no matter which decision we make there will always be a price to pay whether that is financial or mental. We aren't going to get out of this situation without paying a price somewhere along the line. Of course this doesn't even take into consideration the price Rafiki pays as a sick child every day.

Since the beginning of this journey, the medical staff here in England have been incredible.

Southampton General Hospital
http://www.suht.nhs.uk/index.cfm?articleid=1694

Dorset Community Hospital
http://www.dch.org.uk/


Although both Patrick and I have been out of minds with worry for our son the doctors and nurses never gave us anything more to worry about. They have always been confident, clear and comforting dealing with us. They reassured us at ever step often easing our fears about the future and Rafiki's treatment. To be honest the hardest part of this journey was in the beginning, not knowing or understanding and carrying the hope that this was all a big mistake, the denial was overpowering. I think in some ways I am still in denial as I have missed such a horrendous part of the treatment and I see my lovely little 2 year-old old running around, playing and laughing and trying to keep up with his cousins.

When I thanked one of the many wonderful nurses, Leigh Shaw, she said it was just her job. Although that might be the case there aren't enough thanks that can go out to these wonderful people.
They are sure we will get the same treatment back in the States but again the unknown is the hardest part. My only regret I have is that I didn't get pictures of all these wonderful people to bring home with us.

I have begun to see Rafiki again in his new body He has lost a lot of the weight and puffiness he got while on the DEX. I have realized that the little boy who went to Zimbabwe in February of 2008, is gone, and he would have been gone regardless. He is growing and the cliches about it happening so fast are true. He is going to be growing while he has this disease, and when we reach the other side he will be a whole new person. He will be a whole new person in 3 years time even if he weren't' sick. I carry the image a friend of mine gave me imagining Rafiki walking through the doors into his first day of kindergarten a totally healthy little boy.

I have been anxious to return sooner than later as I feel we will need a lot of time on the other end to settle in. I have been pushing Patrick to make a decision and I haven't been as gently as I probably should have.

We decided that once Rafiki had his Minimal residual disease, MRD test( MRD stands for Minimal Residual Disease. It is a term that simply put means that they detect leukemia cells with a much greater sensitivity than they did in the early days of childhood leukemia treatment. Instead of looking at 100 cells and finding 1 leukemia cell, they can now look at 10,000 cells and find 1 leukemia cell. this is a great place to get a better understanding for the MRD http://atlasgeneticsoncology.org/Deep/MinResidDisID20007.html)

and we had a chance to talk to our consultant, Dr. Janice Kohler, who is an amazing woman and doctor. We would make plans to go. We won't receive the results for a few weeks but we do feel confident that we are still in remission.
As we waited for Rafiki to be called for his treatment at the hospital last week, we were able to talk to Dr. Kohler who first indicted to us that Rafiki is doing very well and right on track with where he should be. She was impressed with how he looked and was acting. I believe it had been about 3 to 4 weeks since she last saw him and he was quite the different little character both physically and mentally.


She knew I had been doing research in the States to find out about treatment there and what our options were. She asked what I had found out and that is when I told her we would be retuning to the States. It was a very difficult sentence to get out and I could see Patrick's eyes well up a bit with tears. It is amazing how you bond with people in tragedy and I think Patrick considered the staff at both Southampton General and Dorset county family if not even angles and saints.

We realize we are taking a risk by moving and I think we are both anxious about the trip and the future.
I have booked a ticket for us to return to the States on June 11th. I feel a bit nervous in that if Rafiki's health changes in the slightest we may have to cancel our flight.

Our lives are completely about one step one day at a time now.