TRANSPLANT

Simon was notably less comfortable upon waking this morning. His face is puffy, his eyes are dry and itchy and a bit bloodshot, he noticed his first mouth sore (ouch!), and his voice "isn't working" (presumably because the mucositis in his mouth/throat/gastrointestinal system is beginning to set in). Mucositis is the condition that chemo patients can get when the rapidly dividing cells of the mouth, etc. are killed off by the chemo. Unfortunately, chemo agents are too unsophisticated to know if they're disrupting the division of a nasty cancer cell or a healthy mouth-lining cell. So, the body desperately needs to heal. This healing process is complicated by the fact that the patient feels little inclination to nourish himself because it hurts too much to swallow.

Simon's first mini-dose of morphine came around 9:00 am. By mid-afternoon, the Pain Service had sent up a pump to administer the morphine. It is set up to give him a tiny dose on command by pushing the button. When/if his pain gets worse, the pump will be set to provide a steady dose of morphine, with the option of additional "pushes" of the button as needed. We hate to think of Simon needing so much medicine for pain, but we are taking the advice to stay ahead of the pain, rather than try to bring it under control later.

In a day or two, the doctors will put Simon on TPN, which is intravenous nutrition. We would dearly love to get him back on Ambrotose because it is thought to provide the building blocks his body needs to heal itself, and Simon's doctors are supportive. Unfortunately, Simon's nausea (currently controlled with overlapping doses of Ativan and Zofran), his disinclination, and his sore mouth have made it impossible to get the stuff into him yet today.

He's been napping heavily this afternoon. When he woke once to pee, he managed a chipper, whispered comment about how his urination was somehow like the functioning of the wheels of a locomotive, like a piston. He seemed pleased by the thought, and I (Mary) was delighted to see his momentary animation. Then he snuggled back to sleep.

GLOSSARY