But Not Carried Away

Friday 4 May around midday

I remember cautioning last year against undue optimism. People are inclined - out of the goodness of their hearts - to extrapolate an upward trend or a finer moment in a patient's history and conclude that things have started to change for the better. The reverse is not necessarily true either: if patients have a bad day for once, it doesn't mean they are inexorably headed for the end. Patients have ups and downs, and both provide a feeble base for making firm predictions.

Of course, everybody rejoices after reading my previous post, but let's not get carried away. The odds are still pretty stiff. Lara has low levels of platelets, decent but sinking levels of red blood cells and almost no leukocytes (WBC). Her defense immune system is essentially absent. She needs regular blood transfusions to keep her going, since the leukemic cells in het bone marrow drown out the production of home made bloodcells. Antiobiotics and supportive medication keep her at a bearable level. So do 20 mg of morphine and a tranquilizer (Tranxen). She has lost considerable weight and will lose more.

The question is rather if her present condition is a winnable one. Friends compare the present situation to the one when she was in the ICU last year. They might be wrong. There is a salient and dramatic difference.  Last year, even at the worst moments when she was about to die of pneumonia, Lara was in full remission and would essentially remain so until January this year. Today Lara is contending with rampant leukemia which is not going to lessen spontaneously and against which there is no medication. None. The last time doctors took a look, her bone marrow cells were 80% bad!

It pains me to have to dampen people's enthusiasm. Believe me, I would wish it to be different, too.