November 19, 2019 – As I walked into the Autologous Transplant Day Hospital on the 14th Floor of the Princess Margaret Cancer Centre, I was overcome with emotion as I saw many familiar faces from over six years ago when I had my first stem cell transplant.
I saw Aileen who was very pregnant when she oversaw my first stem cell infusion. Joanne reminded me that she had helped shave my head while I was in hospital six years ago. I saw Ana who gave me a big hug and said, “welcome back Premji”. And then there was Tasha, one of my all-time favourite nurses. Tasha is representative of the incredible nurses that work in the Autologous Transplant unit – experienced, competent and caring. She then proceeded to give me warm and personalized care throughout the day and answered all of Nagib’s questions about the countless medications I have to take over the next month. I continue to be amazed with the grace with which Tasha and her colleagues look after their patients.
Then we met LeePing, the nurse practitioner assigned to me, who was overall in charge of my care. LeePing is unapologetically herself. She is a cross between Boss Lady, regally in command, and Mother Hen, highly protective of her patients. She is smart, confident in her approach, funny and collaborative in decision-making.
The first step of the stem cell process is where I was given Melphalan, a very high-dose chemotherapy, to get rid of the residual cancer in my body. This chemo is so strong that it destroys the bone marrow, which is where blood cells are made. To ensure that the chemo does not affect my mouth and cause mouth sores, I had to stuff my mouth with ice chips for 15 minutes prior to the chemo, during the chemo and 15 minutes after the chemo.
In the midst of the chemotherapy, Nagib gets a text and says to me, “I have such good news. I don’t even know how to tell you.” With my mouth full of ice, I signal to him to share this good news. The text was from Shayne saying that he was coming to Toronto the next day, for 10 days, to support us through the stem cell process. Against all odds, I was at the airport the next day to pick my son up!
After one day of rest, I was back at the hospital for the stem cell transplant. Since you cannot live without blood cells, it is critical that the high-dose chemo be followed by a stem cell transplant within a day or so to allow the bone marrow to grow back and start making blood cells again.
Millie, the Supervisor of the Cell Processing Lab, brought my stem cells that had been collected and frozen more than six years ago. We watched as she thawed six bags of stem cells and then handed them, one by one, to Tasha to infuse into my body. They worked efficiently as thawed stem cells need to be infused into the body within 10 minutes or they are rendered useless. With the magic of technology, Sabrina and Afzal watched the whole stem cell transplant process from Kuwait via video chat.
The following three weeks were the most difficult days I faced in my life. I felt like I was hit by a bus. All my counts went down to zero from the chemotherapy, and the stem cell needed time to take root and multiply. I required multiple blood and platelets transfusions and operated on very low blood pressure. Unfortunately, I also ended up with two infections in the bloodstream that required strong antibiotics. There were days when I was not sure if I would make it through. At one point, I needed to be hospitalized for four days so that the infections could be dealt with aggressively with antibiotics infused by IV. During this time, Shayne had to leave to attend a Directors course in Singapore. It was a tearful goodbye on a stormy Sunday afternoon.
The next day, while still in the hospital, Nagib announced, “I have a special visitor for you.” I cringed as I was not in the mood to see any visitors. The next thing I know, Sabrina storms through the door with a big smile, surprising us with an earlier than expected visit. I was operating on empty and welcomed Sabrina with open and tired arms, so grateful for her presence.
I was subsequently discharged from the hospital but had to continue receiving antibiotics through the IV, administered daily at home by a nurse from LHIN (Local Health Integration Network, formerly known as CCAC).
Christmas was a wonderful time with family – Sabrina, Afzal, Shayne and Cherrelle were home, and we cooked and played games and watched movies, and cuddled and caught up on the goings-on in their busy and active lives. And then they left, and the house became empty again. Throughout this time, I had to make hospital visits to get my Hickman line removed and get bloodwork done. My platelets have been taking their sweet time to get back up to acceptable levels, and my white cells, although above critical levels, have been lower than normal as well. As a result, my recovery has been much slower than last time.
It’s been two weeks since I was formally released from Day Hospital, and 50 days since my stem cell transplant and I am now finally on the road to recovery, feeling like I have joined the land of the living. My 100-day post-transplant follow-up will be in the third week of February when we know for sure if I have achieved a Complete Response (i.e. the cancer cells in my bone marrow are reduced to 5% or less).
In the meantime, I’m trying to get comfortable with the new me – Munira Version 3.0. I really liked the original Munira, which was my life pre-cancer when life was simpler and everything seemed possible. In February 2013, I had to learn to adapt to Munira Version 2.0 until I embraced her – she was a kinder, more loving and caring version of me. I am curious as to what Munira Version 3.0 will turn out to be and look forward to exploring her with all her vulnerabilities and idiosyncrasies as she slowly comes into her own.