365

The bone marrow biopsy begins, like all good audits, with your pants down.  You: prone on the "bed" or what we like to call the workbench.  Your practitioner's hands will no doubt be cold and she will palpate the low back searching for just the points on the posterior iliac crest where bone is nearest the surface or what we like to call skin.  Recall that areas of thin skin or with proximal bone bleed easily (near the eyes, e.g.), are fairly sensitive comparatively (back of the arm, say) and prompt hard-wire reflexive protection, (your groin).  Once she finds a spot, the drill master will hold it with a finger like you do for someone tying a bow on a present.  This marking is so she can deliver the "pinch and burn" of a local numbing medicine.  If it's your first time you may even get a target drawn on you.  "Pinch" is really a euphemism for stabbed with a needle, and burn is burn except the flames are on the inside.  While you wait for the numbing to numb, don't be surprised by small chit chat like you might have with a bank teller or your barber even.  No one really likes BMB's and rather than go to pieces, you act like the transaction is far more quotidian and commercial than it really is.  There are no instructions about this.  You just go along to get along.  Once numbed, there is more numbing medicine, this time applied to the bone.  This burns too, but only for a moment.  The bone per se can't really be numbed, but the surface and it's coatings can be and every little bit of numbing is helpful.  You're numbed up, not when numb, exactly, but when you feel things the way you'd feel them if you were made of wood.  From a tree.  That hasn't been cut down yet.  Your healthcare professional will ask you if you feel anything.  The desired answer here is "No."   But it won't really be true.  Say it anyway if your pain or sensation is at or below the level you'd feel if you smashed your thumb with a hammer twenty minutes ago.  At or below this level is just about the best you're going to do.  Above this level, well, you're probably not going to do much better than this either, but everyone will be more earnest in acting like they're doing everything they reasonably can.  It's a bmb, after all, did you expect it to be soothing?  When the drilling starts--think of wine bottle and a corkscrew-- very often you'll hear grunts and clenches of the driller as if your cork broke inside the neck of the bottle.  Cork=your bone  Bottle=you.  You'll feel what people who DO bmb's call "pressure" and what people who GET bmb's call pain.  The pain can range from strange discomforting weight on the posterior iliac crest: "Oh, that's my bone" to a white-hot searing from within. "Jesus, that's MY BONE."  You hope for the low end of the scale and take what you get.  At a certain point in the drilling the driller will decide that she is deep enough into the bone to harvest the needed samples.  There are two sorts:  the aspirate and the marrow proper.  Aspirate is the liquid that seeps or is sucked violently from  punctured bone.  Violent sucking is the preferred method of collection.  When the plunger is pulled back there is a feeling quite like being electrocuted so deep in your person that it must be where the soul resides.  Soul electrocution.  But it only takes three of these per biopsy.  Unless you-know-who did not really drill down/in far enough.  Then there are four or five, a RE-drilling, and a couple more electrocutions of the soul.  Tensions run very high in these cases.  People will think and say things they might not in other circumstances mean.  The cost of science or of simply seeing the end of the procedure will seem quite high.  Hope that proper bone depth is achieved on the first try.  A simple technique for mitigating the electrocution sensation is to breathe out forcefully at the exact time that the plunger is sucking up it's (your) juices.  This works very very well.  It's probably the only thing that lets one lie down on the workbench a second or third or dozenth time without sedation.  If you forget if to blow out or breathe in--you're anxious, the stakes are high--don't worry you will only forget this one time.  You'll never ever ever forget again.  You blow out.  Breathing in upon extraction is likely only topped in desolate, pitiless pain by being fed into a wood chipper feet first, but only if it stalls at the waist.  After the aspirate is collected the marrow proper is sorta scooped out like osso buco only minus the risotto and good Chianti.  The marrow sample is far less demanding of the donor.  After a shark bite, the dog that nips you isn't all that big a deal.   Here too, though, you are likely to feel a good bit of "pressure" but your practitioner will soon announce that you (she) is almost done.  Sample volume is critical.  If not enough is collected, she'll have to harvest more.  If the instruments are still in your back, well that just means more "pressure"  If they have been removed they will be reinserted quickly before the numbing medicine wears off, or that's the theory anyway.  In practice, she just screws them back in with apologies.  Or she may pick a brand new spot altogether, re-numb, drill, and scoop and in this way you get valuable practice for your next, next biopsy, since this is now technically your next one.  Neosporin, big ass band-aid and BP check (it might be high) and you're all set.  Now all that remains is to wait a week or so for news about how your life might turn out.


Did one of these last Monday.  KME, sadly, not there to pass out and add to the general hilarity.  Call from practitioner (who really is a lovely person, quite warm and affable):  Disease free.  Not a trace.  Zero is the best score they give and I got a zero.  Audit passed.  One year ago today (well, the 15th actually) I received a stem cell transplant.  Today I dead lifted 305.  Sumo style.  On an axel bar.  I thought I might try to pass along some of what I've learned though my ordeal thus far, or drill down on one aspect or another of what these 300-odd days have been like, in retrospect.  I always have a thought or two and I never seem to lack a point of view.  But those will have to wait.  What I think is in order, indeed, what I feel most compelled to do is to offer my simple but profound gratitude.  Thank you.  To my wife.  To my parents and brother.  To my dear family.  To my friends.  To the folks at Angel Flights. To my nurses and doctors. You fended for me when I couldn't fend for myself.  I'm honored by that and humbled too.  I wish I had the means or capacity or the know-how to communicate how grateful I am for your love and support, your help.  Instead I'll just tell you that I'm trying to live out my days as the best version of myself--Curious, loyal, skeptical, trenchant (hopefully), stubborn and die-hard--for you.  And for me too.  I intend to do this as an expression of my love and affection and because quite honestly it is all and everything I have to give.  Happy my new birthday to you.