9 Jan 08

About the Blood Stem-Cell Transplant Center Known as 11 Long

(An Assessment through the Experience of Michael Rossman)

        It was not until late in my stay, just before my release, that a gestalt impression condensed from the individual droplets of my experience. In effect, I have been a test particle as well as a creature, passing through a massive functional machinery, subjected to its complex processing.

        From the moment my daily tests recorded the first credible rise in my neutrophil counts, a phase-change radiated through the machine’s functioning, like a glad spasm through an organic being. A small legion of functional specialists surrounded me to attend to the many factors of my discharge, preparing my transition to post-hospital recuperation. Some were familiars from my ongoing treatment, shifting gears abruptly to prep me for this next phase. Others were new for new purposes, like the pharmacist tutoring me in the rigorous schedule of my eight initial medications, and coordinating the contract between my HMO and my chosen pharmacy. One functioned with pinpoint precision, simply to arrange my teaching-appointment with the home-care supply company that would deliver my intravenous electrolyte replacement, packaged in a way the hospital was not prepared to teach me to use.

        This abrupt sense of a comprehensive, coordinated machinery shifting gears catalyzed the latent impression of my whole experience as having been through such a mechanism. This of course was obvious, I could have described it so from the first, or predicted it – but I did not actually feel it consciously until this moment of transition, and then the feeling radiated backwards to illuminate the whole of my experience. By then, I had been tended directly by nearly one-third of the sixty-five nurses staffing this floor, three of the six hematologists rotating in charge, two nurse-practitioners, a clinical nurse specialist (aka staff sergeant), three food-servicers, two room-cleaners, a leftist Buddhist chaplain and a laundryman, all indigenous to this floor; by a physical therapist, a social worker, a pharmacist, a nutritionist, a chaplain minstrel team, and two volunteers delivering my daily paper and offering beaucoup services, all serving broader domains; and behind the scenes by a battery of routine and specialized laboratory workers, pharmacists, billing-agents and administrators, and doubtless other specialists unknown to me.

        All this was necessary to conduct me through a month-long process of being preemptively killed and then brought back to life – involving, foremost among other agencies, twenty-six drugs – myeloablative, immunosuppressant, anti-emetic, anti-hypertensive, anti-histaminic, antibiotic, anti-fungal, anti-viral, sedative, muco-protective, antacid, granulocyte-colony-stimulative, laxative, stool-softening, membrane-tightening – and three species of cellular transfusions, administered by precise protocols and empirical responses to my changing conditions, monitored by rigorous panoplies of continual testing, observation, and inquisition, and supported by everything necessary to maintain my tangible body otherwise in adequate nutrition and relative safety and comfort – not to mention conducting my intangible socioeconomic body safely through the bureaucratic and fiscal maze of modern non-socialized medicine.

        The complexity of this process required not simply a complex machinery of inanimate and human agencies, but one in which nearly every component was itself complexly prepared and functional -- from the machines delivering my intravenous medications with so much more reliability and sophistication than those infusing my son’s chemotherapy a quarter-century before, to the nurses, doctors, and other specialists trained to attend my condition with knowledge and competences at the forefront of current practice – and in which, moreover, these human components were prepared and practiced to relate functionally with each other in accomplishing the machinery’s overall function of saving my life.

        All in all, what awed me was not only the complexity of this machinery, but how well it worked in practice. So much was encompassed in saying, “My, they certainly have their act together here!”Of course, my experience was a favorable display for the system’s virtues, since my pessimistic case presented so simply and resolved so straightforwardly and successfully. But in view of how it worked with me, I have no doubt that the nature and quality of its operation would have been as complexly admirable in any case beset with more complications, whether the patient lived or died. It’s no surprise, in retrospect, that my preliminary online research revealed the success record of the UCSF stem-cell transplant center to be nearly equal to that of the Hutchinson center in Seattle, the best in the nation. Nor does this stand in isolation, but as one of many factors contributing to UCSF’s claim to be among the nation’s ten top hospitals overall.

        Yet however precise and evocative this description of the transplant center as a functional machinery may be, it is inadequate, for it neglects a human dimension that is not merely decorative but essential to the machinery’s workings. During my stay here, with no conscious purpose I began in effect to interview -- my son says, “interrogate” -- the staff attending me, informally but systematically. I wish I had kept notes, for the picture that emerged was as fascinating in individual detail as it was coherent in the whole. In summarizing it, I must scant the colorful personal details of a multiethnic, multicultural congress drawn to work here from many motivations, places, and careers. Yet their collective persona is as vivid and distinctive as any individual’s.

        In short, what they told me – the nurses particularly -- was this: Cancer care is distinct among the many medical sectors, in ways that invite particular kinds of compassionate involvement. Within this sector, hematological treatment and care is distinct from solid-tumor work, in ways that further this invitation and support specialized focus. Nearly everyone was specific about their reasons for beginning in or migrating to this very specialized field, which offers prolonged encounter with patients poised between death and life, and the opportunity to become truly skillful in their ministry. And nearly every one shared their feeling or opinion that the transplant center here is a very special place.

        Some said simply that the feeling on the 11th floor of Long is markedly different than anywhere else in this world-class hospital complex. Others with wider perspectives testified to the working environment here as being uniquely collaborative and supportive. No-one offered a clue as to what occasioned the magic that bound them together, as if it simply proceeded naturally from the needs of their special patients. But I expect that other vital factors are involved. Likely one is leadership. I recall the quiet pride with which my first attending hematologist, Dr. Charles Linker, who has been in charge here since 1988, referred to the entire floor in introducing himself: “This is my baby.” Surely the transplant unit is an organic entity that has been well-guided as well as well-staffed and well-tended in its growth. I imagine that others have also contributed vitally to this.

        Encountered individually, the great majority of my attending nurses and specialists impressed me as being sharply competent and positive, and those in key positions seemed exceptionally qualified and capable. Overall, there were just enough mediocre nurses and outlying consultants to reassure me that my assessments of all were critical, rather than simply grateful. Taken collectively, then, they amount to an outstanding group of workers in their varied fields. Yet this description neglects the dimension of esprit de corps, the moral concert that binds them into organic unity as a working ensemble.

        This is hard to describe, for it resides nowhere in particular, is rarely visible more sharply than as a general haze of good feeling for each other in their work, an efficiency of cooperation, a lack of petty aggressiveness in meetings. Yet this collective spirit is a substance as tangible in its way as the chemical poisons that coursed in my veins. I can characterize it as the key lubricant that enables this complex machinery to operate so smoothly, efficiently, and effectively; and be well-pleased with this metaphor. But perhaps there is more depth than this, perhaps this collective well of good feeling is itself a healing agency, abetting all the agencies of healing that can be better described and measured. To discount such a notion is arrogant; it is better to be humble in the face of mystery, even with armament as obviously powerful as the machinery that has cared for and saved me.

        In consequence of this collective spirit embracing all individual generosities, as a patient I found myself treated not only efficiently but humanely, bathed in active concern for my welfare in all regards, and attended with respect as an individual, with distinctive peculiarities and needs which routine institutional treatment would surely have frustrated. In my desires for abundant and specialized information, for reasons and rationales, for a role in processes of routine and specialized decision; in my import and uses of computer equipment; in my wanting opportunity and privacy for intimate relations with loved ones – in all such varied ways, I found myself testing the limits of this system. With each, I encountered no simple acceptance or rejection, but instead a dynamic process of response, first involving caution and resistance; then negotiation regarding the system’s needs and priorities for my care and for its own operation, often enlightening my ignorance; and finally a genuinely bilateral accommodation, satisfying me in a practical sense. Such dynamics and qualities contributed greatly to my sense of being embraced and tended by a warm organic entity.

        This descriptive summary of a multitude of personal interactions is abstract and stilted, but precise. I was an unusual patient, as distinctive and demanding in various social ways as in my unusual physical case (AML-M7), and hardly everyone’s cup of tea. Most came to find me interesting and well worth the extra trouble I occasioned; but many did not do so instantly or automatically, and I think some never did. Regardless, the individual peculiarities of my case serve mainly to point up a general conclusion regarding this mechanism’s flexibility, its ability to accommodate a variety of individualities in the process of dealing with their commonalities of purpose and need. In such regards, I have been a trial particle, identifying and testing the properties of the system’s operation in social dimensions as well as in its overt, central mission of physical healing. I can hardly express how grateful I am to have found it so competent in both regards.

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