Fever! (All Through the Night)

Yesterday morning was Michael’s final appointment at Princess Margaret Hospital before his case is transferred to the transplant team at Queen Mary Hospital, where he’ll be admitted on Monday. We popped into the Day Ward for one last visit to the staff we’ve come to know so well over the last six months. Michael had half his stitches removed from the placement of his Hickman Line and then it was quickly time to return home.

I teared up just a little as we waited for our taxi, and took a photo of our feet in front of the hospital, in our unintentionally matching trousers. While we are as ready as we’ll ever be to move on to the next phase of his treatment, it’s a little bittersweet to leave this once-strange bubble that has been a second home for so long, and jump into a new place that is bigger and further away, with all new rhythms and procedures and personalities.

The Hickman Line self-care is quite comprehensive and we’ve been following the instructions faithfully, including the direction to take a shower every single day. It’s a time consuming hassle, as we have to cover the incision sites and hanging lines with gauze, then surgical tape, then a full waterproof dressing before showering, then carefully remove it all and wipe everything down with no less than nine alcohol wipes, always moving in the same direction. But the lines hanging outside his body go straight to his heart, so the precautions are there to prevent small infections which could become quickly serious considering Michael’s immunocompromised state.

Last night as we were prepping Michael for his shower, I noticed heat radiating off him. It was a hot, muggy day with the lowest typhoon signal raised, and he’d gone for a walk outside to keep up his strength leading to the transplant. I asked him to take his temperature. It was 38C (100.4F), the threshold for Michael to go to the A&E (ER) as a blood cancer patient. We know the protocol from previous experience: if he goes to A&E, he will be admitted. We both groaned at the thought of returning to the place we’d just left for the last time (Ha!), potentially putting the whole transplant schedule at risk.

Michael popped a Panadol (acetaminophen/Tylenol) and took his shower (tepid, not hot) since he was already prepped for it. After, his temperature rose to 39C (102.2F), so he got a big glass of ice water and sat in our air conditioned bedroom while I took a quick shower as well. After two hours his temperature still had not come down. Using both oral and ear thermometers it was above the hospital protocol’s threshold, even with the medication and cool air blasting on him. So we grabbed his hospital go-bag, stepped out into the hot, muggy night, and grabbed a taxi back to Princess Margaret, just eight hours after we’d thought we’d seen the last of her for awhile.

Once there, things went fast. Michael’s pink “Neutropenia Patient Alert Card” jumped him to the front of the queue, and before the triage nurse had even finished taking his blood pressure, an orderly appeared next to us with a gurney and asked Michael to hop on and take a rest. He was immediately whisked away for a blood draw, EKG, and chest X-ray, and I sat in the waiting room, intending to wait until he was indeed admitted.

Our son Benjamin, who will be Michael’s donor, was passing by on his way home from rehearsal at 11:00 p.m., so he stopped to wait with me. Together we briefly saw Michael as they wheeled him out of the A&E down the sidewalk back to the familiar Hematology Ward for the night.

They’ve run multiple tests to see if there’s an infection brewing. So far his temperature has stayed below 38C the entire time he’s been admitted. Today the doctor said he’ll stop the antibiotics to see if the fever comes back overnight. If it doesn’t, he’ll likely be released tomorrow (Saturday) and everything will probably remain as scheduled with his admission to Queen Mary Hospital on Monday. If the fever does return, Michael will need to remain at Princess Margaret until they figure out what’s going on. Obviously this will impact all the careful planning surrounding the transplant.

This is frustrating and worrisome… for the last two weeks, every doctor, nurse, fellow patient, and even the wife of another patient has said whatever you do, do not get sick right now. With so much at risk, we know we made the right choice, the good choice, the brave choice, to take him in. But it was hard considering he has no other symptoms at all which means this could all be for nothing, putting the transplant schedule in jeopardy. Even so, these protocols for cancer patients are there for a reason, and we’d be foolish to disregard them, thinking we know better.

We will rejoice if there continues to be no sign of infection, and we’ll hope and pray this unexpected encore visit to Princess Margaret Hospital after our formal goodbye doesn’t put the finely choreographed transplant schedule in flux. It’s likely Michael was simply the victim of Hong Kong’s heat and humidity, but with the possibility of it being so many other serious things, it’s currently in all of our best interests to be exceedingly safe rather than devastatingly sorry.