However you look at it, yesterday was not a normal day for Robert and me. We had already cast our ballots, thanks to the early voting offered by D.C. I did an early run to the park with Chewey, and we were off to Johns Hopkins at about 8 a.m. to get the first of four doses of the GVAX melanoma vaccine that will be administered for the clinical trial Robert is enrolled in. It was the start of another one of those days that didn’t go quite as planned.
We checked in at the phlebotomy lab in the Weinberg building at about 9:30, our appointed time. After some initial confusion about who was going to take the blood, we went into the lab with Robert Gray, the nurse who draws samples for our trial. Just as he was finishing the last of his tubes – one of two that seemed particularly big to me – his patient checked out. As in, passed out!
This wasn’t just a case of Robert nodding off in his chair, although he was snoring pretty loudly! I’ll spare you all the details, but suffice it to say it was a frightening time for me with all the flurry of activity that surrounds a “code” in a hospital. Afterwards, Robert’s doctor carefully reviewed all that happened, including his recovery and responsiveness after he regained consciousness, and came to the conclusion that he had a vasovagal response – to what, we are not sure. Essentially, as Dr. Lipson explained, his body was pumping adrenaline, and that started a “calm-down” reaction. Once all the adrenaline was gone, all that was left was the calm-down reaction, and Robert passed out.
Essentially, in a vasovagal response the patient’s blood pressure drops suddenly, causing him/her to faint. These reactions are typically seen in response to anxiety, stress, standing too suddenly, dehydration, or a drop in blood sugar. We ruled those causes out – Robert was not anxious or stressed by the prospect of getting the vaccine, and he has never been squeamish at the sight of blood or having blood drawn. His one previous, similar incident happened when he was being treated for a giant tear in his retina and the ophthalmologist injected avastin into his eye. (I wasn’t there – and am glad, in retrospect, that I wasn’t! It was frightening enough to have it happen in a very fine medical institution, where all the systems and personnel seemed to work very well.)
After my initial, fearful reaction to watching Robert lose consciousness and come back to some semblance of himself, I was concerned that they might not give him the vaccine. Robert regained his wisecracking sense of humor pretty quickly, and Dr. Lipson was quick to rule out a seizure or other condition that could have caused him to lose consciousness. So, after we rested for a while, we all agreed to go forward.
The procedure itself was as we expected. Susan, the study nurse, applied lidocaine on Robert’s thighs in patches about three inches apart, three per leg, and covered each one with a bandage. About ½ hour later she returned, and another nurse arrived from the lab with the GVAX syringes. Each injection took about a minute. After she finished each thigh, she applied band-aids to each injection site. A little after three we were done.
After Robert dressed and we sat a little while longer, Susan came back to check us out. We were home by about 4:30.
Not the day we were expecting. But neither of us is complaining, either. We got what we went for – a chance that, if there are melanoma cells floating around in Robert’s body somewhere, his immune system will react to this vaccine and kill them off. Perhaps we will never know whether it works, but we are ready to complete the study procedures on the chance that these researchers are right.
Tomorrow – a punch biopsy. We plan for Robert to be lying down when they take the blood this time, and I won’t be surprised if the “other” Robert, Nurse Gray, draws the samples more slowly next time.
I’ll post again if there’s anything else to say. Feel free to call if you have questions.