Bone Marrow Biopsy: 3rd Time's the Charm!

Rainy Monday

Today it rained.  We woke up to a sky filled with heavy clouds, threatening to unload their rain at any moment.  There was a chill in the air that cut through my thin teeshirt as I walked out to the car to get some clothes.  Our hospital room is tiny and filled to the limit with the hospital bed and my cot that we shoved in the corner.  I think I may be the only family member staying in the unit with the patient because every visiting family member I have met has been surprised when I tell them I have a cot in the room.
"I didn't know I was allowed to stay in the room!" One woman said after learning this.  Her husband has been here for months and she has been staying in a hotel down the road.  I'm not sure if I am allowed to stay in here or not because we never asked if it was ok.  We just told them I needed a cot and they made it happen!
There is a small bedside table that holds a few clothing items, but not enough for our extended stay.  Thus, I keep most of our clothes in the car and I make a trip out to stock up on clothes every so often.  On my trip back from the car it started to pour.  The nice thing about a rainy day is it makes it a lot easier to be stuck inside.  The rain also matched the quiet mood in our room.  We were informed last week that Willie would need another bone marrow biopsy and it was scheduled for today.  After the drama of his last biopsy, it is understandable that he would have a bit of anxiety about today.  It is not his favorite procedure by any means.
The team made their rounds and told us that he would be getting his biopsy at 2PM.  We had heard that there is a nurse practitioner named Carl who is "the best" at doing these biopsies so we asked for him by name.  The team had heard of his skill as well and assured us they would get him to do it. 
 Willie has had some really good days and his energy has been good.  Two sets of friends came to visit yesterday and we had company from noon until 7PM.  We spent the day laughing and reminiscing and it was exactly the lift that his spirits needed for today. 
We waited out the morning with a bit of angst. At 1PM the nurse came in with a shot of vicodin.  We were thinking this would be the IV administered type of shot, but instead it was a cough syrup/drink-it-down type of shot.  He drank it back and said it tasted like cough syrup.  I thought it was funny that vicodin came in such a form.
Carl showed up at 1:30 PM and introduced himself.  He is impossibly young looking with light sandy hair and baby smooth cheeks.  He has a sensitive quality about him and carries an empathetic energy that makes me think he owns several rescue cats and cries when he watches Hallmark commercials.  He was not the bulk and brawn that we thought we would see from someone who carries the title of being the best at drilling through hip bones.  He talked us through the procedure and as he did, he put us both at ease.
"I hate doing these procedures" he admitted "but I am the best at doing them so you have nothing to worry about."
This kind of self gratification may have been annoying in another setting, but that was exactly what we needed to hear.  We wanted the best and we got it!
He had Willie sign release papers then left to get his supplies promising to return on time for his 2PM appointment.
"I hate being late for my appointments." He said as he left, and we knew he would not make us wait as so many others have done.
He showed up at 2:05 PM and we were in place, ready to go.  Willie laid on the bed, sporting his superman shirt for added support.  His Mom gave him this shirt when we entered the hospital as a reminder that he is just as incredible as Superman and can do anything.  He had been saving the shirt to that very moment to prove just how super he is. 
Carl removed his lab coat revealing a carefully pressed checkered shirt and creased khaki pants. He was dressy, yet trendy and his casual Adidas sneakers gave away the secret of his youth.  He carefully laid out every item he would need for the biopsy then checked the clock.  It was 2:15 and the fun was about to begin.
From the moment he started to procedure, we could see he indeed was the best.  He numbed Willie with two tubes of local anesthetic where the previous MD's had only used half a tube to one one.  He had a third tube filled on back up as he carried on with the procedure.  This guy does not mess around.  He had barely numbed the skin when he was inserting the drilling device and getting down to business. 
Willie winced as he tried to enter the bone so he shot a bit more anesthetic into the area and continued on.  There was no problem that time so he got busy, applying pressure to push the instrument into the bone.  He leaned over Will's hip and leveraged his body weight against Will's thick, weigh lifter hip bone.  As he drilled, I noticed a soft scratching sound like a saw being pulled back and forth through a log.  I turned my head to the side, thinking it was coming from the TV in neighboring room.  I suddenly realized it was the sound of the metal rod boaring into Willie's hip and I shuddered. 
I looked to Willie to see if he was hearing anything, but he was doing great.  He has developed a deep breathing method that has worked him through the previous biopsies.  He takes a deep breath in then lets it out with a low hum noise that drowns out any other sound in the room.  It helps him keep himself distracted from the action in the room, but today it was also helpful to keep me from hearing the drilling sounds. 
Carl stopped drilling and removed the top of the instrument.  He attached a syringe and pulled up on the hollow core of the drilling device.  Red liquid shot up into the tube and Carl, me, and the lab tech in the room all cheered in unison.
Success!
It was 5 minutes into the procedure and Carl had just done what it took the past doctor 50 minutes to do!  He gave the blood to the lab tech who immediately started inspecting it and placing it on slides.
"This looks perfect!" she said, looking at Carl.  "Has he already had Chemo?" she looked a bit confused.
We assured that he had finished a round already and she looked relieved.  She explained that there are certain qualities in the blood that can be seen by the naked eye when cancer is present in the bone marrow.  She saw nothing in the blood today.  They refer to it as an "empty sample" in which there is no good or bad cells present in the marrow.  That is what is supposed to happen after someone receives chemotherapy.  If the chemo is effective, there is nothing good or bad to be seen because everything has been wiped out. This bone marrow biopsy was to confirm that the chemo has wiped out everything.  In a sort of ironic way, the point of this biopsy is to see nothing.
Nothing means everything to us today.
As Willie's body continues to heal and he completes all his treatments he will receive another biopsy to see if his good cells have returned and the cancer cells have not.  That is when they can declare remission.  Today they are just making sure everything is gone: good and bad. 
Carl removed the first instrument and traded if for a larger, far more intimidating version.  Will's platelet count was 14 today which means he is lacking in the ability to clot blood.  Because of this he was bleeding a lot more than he has in the past.  This didn't slow down Carl at all.  He quickly mopped up the blood, then continued to drill as drops of blood fell from his gloves, a remnant of his quick clean up job. He drilled the larger piece back in the same hole and began applying pressure again.  This was a bit more difficult and he broke out into a sweat. 
"I can see why Quan had such a hard time!" he said, referring to the tiny Asian woman who was unable to do Willie's last biopsy.
We all laughed at that.  Carl gave the piece one more twist then rocked it back and forth in order to chip out a section of bone.  I imagine it looks likes trying to pull a metal fence post out of a block of cement.  If you push it back and forth long enough, the concrete will eventually crack and let it go.  Apparently Will's hips are just one step away from concrete, but Carl was able to slowly rock the piece until it chipped away and he pulled out a perfect sample of bone.
"Are you a weight lifter?" he said as he inspected the piece of bone he had removed.
Will told him about his weight lifting records and he nodded, clearly impressed. 
"Yep," he said "I could tell you lift weights by the density of your bones.  I've only seen bones like that on one other guy who was a weight lifter and I wasn't able to finish the biopsy on him."
We asked if that guys hips were just too thick to get through, but he said it was that the guy simply had too much anxiety and made him stop the procedure.  They ended up sending him to the operating room to have him knocked out to perform the biopsy.  Carl congratulated Willie on being able to handle the biopsy with hip bones as thick as his are.  We congratulated Carl for being able to drill through them!
It was 2:25PM and he was done with the procedure.  We were in awe.  He cleaned up so quickly that it was hard to believe there was ever any mess.  He had Willie bandaged up and was back in his lab coat before Willie even finished letting out his final humming breaths.
Will actually looked shocked when he informed him it was over and asked him to turn on his back to apply pressure to the site.  He turned over, then thanked Carl, declaring him the best ever.
Carl nodded and modestly accepted our praise, then left.
Silence filled the air as we processed the tornado of activity that had just whipped through our room. 

Relaxing after the biopsy and playing baseball

"Carl really is the best!" Willie said, breaking the silence.
We talked about the way he did it and what things we liked then agreed that we will gladly drive 3 hours to have him do the biopsy again if that is the case.  When you've found the best, you can't settle for anything less.
As if on cue with our lifted moods, the skies cleared and the rain stopped coming down.  Sunlight poured in our window and we relaxed in the afternoon glow.  The Ellen DeGeneres show came on and we watched a married couple perform a dance routine while wearing roller skates.
"Why don't we learn to do something amazing like that together?" I asked Willie
"We're beating cancer together baby," he said "that's pretty amazing."
He's the one that's amazing. 
I am lucky to call him mine!