The doctors stopped by very late this morning, about 9:30 am. I guess they wanted to keep me in suspense. The good news is that the CT scan did not reveal any abscessing, so I won’t be needed any amputations just yet. The good news was tempered by the bad news that one of my blood cultures had tested positive for an infection; later another one tested positive too. What this means is that they have to keep me on a wide range of antibiotics for a while. Most likely, the infection is in one of the ports of my port-a-cath, that ingenious device that was implanted in my chest earlier, from which my twice-daily blood draws are taken, and through which I receive my daily infusions.

As I understand it, the port-a-cath serves as an expanded vein providing a reservoir of blood just below the skin. There are two external access ports to the port-a-cath that each consist of a needle that accesses the reservoir internally, and externally has a little box thingamajig about three centimeters long and 0.5 centimeters wide, resting on a pad of gauze, and standing out from the chest. The box thingamajig is connected to a length of plastic tubing about ten inches long and terminates in a blue plastic screw connector. There is a clamp on this tube allowing flow to be shut off. This connector is connected and disconnected several times daily. To draw blood, for example, you (the nurse) must disconnect the tube from the IV and draw off some blood (10 cc). This blood goes to waste because it is mixed with whatever you were just being infused with. Then the nurse gets the needed blood sample by connecting the tube to a color coded vial containing a vacuum. The blood is drawn into the vial by the vacuum. The vial is disconnected and the nurse injects saline into the line. Each time the tube is disconnected you have to wipe the connecter with an alcohol wipe. If the tube is to be disconnected for any length of time—for example when I am disconnected from the IV to take a shower— the tubes have to be flushed with Heparin, a substance that prevents clotting.

My blood cultures are being re-checked. As well as drawing blood from both ports, they also sent a phlebotomist who drew blood directly from the vein. It takes about a day to run the cultures, so I hope to get more info tomorrow. How this impacts the beginning of my next round of chemo is not yet clear. Dr. Jacobson is out of town and the residents have been emailing him. My guess is that Dr. J. will want to start the CODOX-M round as soon as possible. Whether this changes the math about whether CODOX-M is done in-patient or out-patient is also unclear. The antibiotics that I’m on have to be delivered IV and there is the possibility that this too can be done at home. I think Mo is none too thrilled about the prospect of having to manage IV at home! Hopefully the doctors will be able to agree on the plan tomorrow and let Mo and I know what’s going on. The uncertainty grates.