Round Three Phinished, Home Again

What's up, Phin phans! Dustin here with an update. Here we go!

Phin leaves the hospital, still feeling a little 

weird from that morning's anesthesia.

Phin is home for a few days while his counts recover after his third round of chemotherapy. This round lasted 29 days. 

To be clear, he wasn't receiving chemotherapy that entire time. Like always, he got blasted with chemo every twelve hours for a sequence of days at the beginning (five, this time), and then he stayed in the Children's Hospital for 24 more days while the effects of that played out in his bone marrow and blood. He's scheduled to return for his fourth round on July 12.

The big unanswered questions from Neesha's update last week are, what happened with the girls and Covid, and did everybody get it? By some miracle, both of the girls only ever had mild symptoms. Neesha confined them both to a bedroom, cared for them until last Friday when they both produced a negative test, and somehow managed not to become infected herself. She had the harder job, for sure. I was holed up far away, binge-watching Ted Lasso in an N95 across the room from Neesha's brother, Kiran, who, like me, had been exposed to Covid from the girls, but not for as long. Both Kiran and I tested negative for enough consecutive days that Phin's doctor eventually allowed me to return and tag out our hero, Aunt Seale. 

All of this probably seems like a lot of trouble, and it is. It's a lot of risk assessment, a lot of cleaning, disinfecting, mask-wearing, and shuffling people around. A lot of sad austerity measures and restrictions that take the form of canceled kiddo sleepovers and turned-down invitations. After Phin's second round, we were hiding from influenza. This time, it was Covid. Those two viruses are just the famous ones, though. We recognize them like we would when the camera zooms in on a celebrity couple at a sporting event. We see these famous faces in the stands, but when it zooms out they're instantly lost among the teeming masses. 

As far as microscopic pathogens go, viruses get a lot of attention--so much so that in English we make a linguistic association to them with anything that can be quickly reproduced and distributed. "Going viral" does have a better ring to it than "going fungal," or "going bacterial," or "going protozoal," but fungi, bacteria, and protozoa all occupy the microscopic world alongside viruses. There are untold trillions of these pathogens, and each will readily exploit any opportunity to colonize new territory.  

The middle of the 19th century brought a shift in the way we think about Nature, as the Transcendentalists helped to reposition the wild outdoors as a source of serenity, balance, and sublime beauty instead of a place of physical and spiritual danger, the dominion of beasts, evil spirits, and demons. Many of those ideas are still with us, and rightfully so. Nature can indeed be sublimely beautiful and restorative, which makes it easy to forget that it's also a war zone. 

Sign at Oatland Island Wildlife Center that

explains types of forest succession.

Often what we call balance is an illusion created by a host of competing organisms locked in a desperate struggle for space and resources. There is a section of Phin's favorite place, Oatland Island Wildlife Center, that illustrates this. It's called the Tornado Trail because several years ago a tornado tore through part of the forest located on the grounds, ripping apart established trees and leaving a swath of destruction that was eventually cleared and designated as a new walking path for visitors. Signs near this trail describe the natural process of forest succession, where plants take advantage of disruption and establish themselves in newly available spaces. 

Something like this process also happens in the wilderness of cells. For most of us, an army of white blood cells stands at the gates. When we dive into a freshwater lake or river and our organs aren't subsequently devoured by amoebas, or when we scrape our knees on the pavement and we don't get sepsis, we have these tiny heroes to thank. They dutifully fend off endless assaults from legions of mindless invaders. But should they fall, into the breach these enemies would pour, driven on by a principle of nature that applies to every creature from the tiniest sporazoa to the tallest redwood. 

Phin, who spends a month at a time in a hospital room trying to rebuild his white blood cell fortifications, will tell anyone who asks about his eagerness to get back into nature and to be around creatures. The thing is, he never left nature--none of us have--and there are always billions of creatures nearby, too small to see, but doing exactly what creatures do.  

Phin's new CVC

Medical Updates
At the end of his most punishing and intensive round of chemo yet, Phin's weight, energy levels, appetite, and moods all seem normal. Finally. It took longer for him to bounce back this time than it did for his previous rounds, and weirder stuff happened along the way. For most of the first half of June, his back was a topographic map of scabs and bruises, the result of a reaction he had in the first few days that made his skin erupt in itchy hives all over his body. He also managed to crack his CVC somehow, so that had to be replaced with a new CVC on the opposite side of his chest. There were stretches of days when he only wanted to stay in his room, either because of the chemo's lingering effects, the sweltering daytime heat at the playground, or the tendency of outdoor humidity and/or his own sweat to make his bandages peel off. When the dressings peel to within an inch of the site where the catheter enters his chest, the whole patch has to come off and get changed. Phin hates it when that happens. He reports the peeling bandages diligently and bears the dressing changes with true courage, but hates them nonetheless.      

The latest report on Phin's bloodwork is from July 5, and it indicated that his white blood cell, platelet, and neutrophil counts were all creeping back up toward normal levels. Who knows what they're doing now, though. Phin's physicians had suggested he might be stable enough to be discharged the previous week, but then his numbers suddenly dipped. Then they crawled back up a little. Then they dipped again. And so on. Up and down like that until finally they achieved a threshold that allowed him to leave. But they could be plummeting at this moment, as his body continues to respond to the poison it received a month ago. It is entirely possible that his scheduled return to the hospital for more chemo next week will have to be delayed in order to allow his system to further recover.     

Phin On the Daily
There was only one thing on Phin's to-do list this time: bats.

He wasn't specific about what that meant. Probably it was something like that scene from Batman Begins. 

In any case, we've already checked the box. 

The night he came home, we took a walk near our house on a path that runs between a small clearing and a grove of trees that separates our little subdivision from the next one. A pinkish purple summer dusk was quickly fading into indigo night and a soft warm breeze blew against the rising and falling of the grasshoppers and cicadas' REEEerrrREEEerrrrREEEEE in the trees. Phin, still a little wobbly off the anesthetic from his CVC replacement and bone marrow aspiration procedures earlier that day, rode in his old stroller. Early stars poked out in the empty sky. We were about head for home when out of the grove of trees a single bat appeared. It swooped, dove, and circled above us, then flapped away for the trees again. 

"Wow!" Phin said. 

We watched the tiny bat disappear into the darkness. Phin was overjoyed. He said he couldn't wait to tell mama. 

"We saw it!" he said. "I can't believe we saw it!"

I turned the stroller back up the path and started pushing it back toward the house. 

"So, what do you want to do next, now that you've seen a bat?" I asked. 

"Anything!" he said.