Infection or Graft-Versus-Host-Disease?

The risk for complications from a transplant is highest during the first 100 days after receiving the donor cells. Today is Day 24. We thought there was a good chance Jim would be discharged tomorrow but he spiked a fever last night. It was 103. It is not uncommon to return to the hospital within those 100 days. There are two major concerns with fevers. One is an infection. The other is graft-versus-host-disease (GvHD). This is when the white blood cells in the donated tissue (the graft) recognize the recipient (the host) as "foreign." The transplanted immune cells then attack the host's body cells.

After meeting with the team this morning they don't think Jim has GvHD. Instead they are looking at an infection in his system. They drew blood cultures last night and it will take a minimum of 48 hours before they get the results. Jimmy was a little dehydrated so they gave him more fluids through his veins. He is drinking plenty of water but it must be all the medications he is taking that contributes to the dehydration. 

Later in the morning we took some laps around the floor. Then we went to the Resource Room which is a place patients and visitors can go. They have a pool table, lots of games, an area for children to play and visit their parents if in the hospital. There also is an outside patio with tables and chairs. Jim and I walked out there to get a little sunshine and New York air. Today the sun came out.

At 2:00 I met Debra and Lloyd for coffee, my two new friends who are also caretakers. It is refreshing to talk to others who are going through similar experiences. Both of their husbands recently had transplants and were on the 8th floor the same time as Jim. Lloyd and her husband are at the Hope Lodge. Debra and her husband live 5 minutes from the hospital. 

After coffee I went to get a few things at the grocery store including a frozen ravioli dinner for Jim. He is tired of the hospital menu. I picked up Chipotle on my way back to the hospital and ate it in Jim's room. I am supposed to wear a mask and gloves to protect him from germs but I cheat once in awhile like when I eat. After all, he is exposed to my germs when we are in the Hope Lodge together. I am fastidious about cleaning too.

I am waiting for the PM nurse to come in before I take a cab back to the Hope Lodge. It is 9:30 and we haven't seen a soul since the 7 PM shift started. Jim was supposed to have his nightly meds by now. His anti-rejection medication in particular. We have been having issues with certain nurses on this floor. This morning we voiced our concern to the transplant team when they did rounds. Some of the nurses are not as proficient when it comes to transplant patients as others. We asked to be moved to the 14th floor if beds are available. That is the overflow floor for transplant. We will see what tomorrow has in store.