Who you gonna call?
Ghostbusters was an absolute smash hit when it came out in 1984. I was just barely into my twenties and the over-the-top (for the time) special effects and campy comedy delivered by some of the brightest creative minds of the day were mesmerizing.
It even had a very catchy theme song that reached #1 on the music charts in the US and Canada and stayed there for three weeks. And it is that song as well as a whole cascade of positive memories and emotions related to it that have been bouncing around my cranium the past few weeks.
Let me start out by saying that I don't define myself by what I do at work. I much prefer to define myself by the relationships I have with others - my children, my wife, my family, my friends. That said, as a clinical pharmacist words and phrases like thrombolytic and fibrin sheath are as much a part of my vocabulary as slime or ectoplasm were to the writers of Ghostbusters. I use them all the time with other medical professionals because we share an efficient language that allows us to communicate complicated aspects of treatment or diagnosis quickly and clearly. When we are talking to what we often describe as laypeople though, myself and every other medical professional I know translates this efficient language into a simpler, more accessible form. If you've ever gotten a prescription dispensed at a pharmacy and have looked at the brief sentence that the doctor scribbled and compare that to the clear, plain English (or whatever language is common in your locale) sentences on the pill bottle you will understand how this translation works.
But see, here's the thing... I don't look like a clinical pharmacist right now. I look like a patient undergoing chemotherapy. And as such, the medical professionals I engage with in my care tend not so use the medical vocabulary that they might if they saw me as a colleague.
How can you look like a clinical pharmacist? Okay, that may not be the question that was foremost on your mind, but just go with me on this one. Let's pretend that was the only question on your minds and that you're not replaying the Ghostbusters theme in your head or seeing a 100 foot tall Stay-Puft Marshmallow Man climbing a gothic apartment block. So... back to me being a patient rather than a clinical pharmacist and why I chose the words thrombolytic and fibrin sheath as examples of medical terminology and not, say, radius and ulna or great saphenous vein.
One of the things that makes me look like a patient undergoing chemotherapy is the PICC in my right upper arm. I've had this device in situ (there's another example of medical terminology that I frequently use) for eleven weeks now, a direct line between my superior vena cava (big vein that empties oxygen-depleted blood into the right side of the heart) and the outside world. This PICC allows my medical team to administer the chemotherapy agents that I am receiving into the largest volume of blood possible each cycle. But why is that necessary?
Oxaliplatin is classified as a vesicant, which means that it can cause blisters and tissue damage (including total destruction) if extravasation (leaking or inadvertent administration outside the bloodstream) occurs. Fluorouracil is not a vesicant but it is classified as an irritant hazard if extravasation occurs. It makes good sense then that both of these agents be given through something like a PICC to avoid the risk of them going insterstitial (the space around cells of the body) and thereby causing damage or destruction of otherwise healthy cells. Because my chemotherapy involved eight cycles of these irritant drugs over sixteen weeks, my PICC definitely adds to my quality of life.
Except that, a few weeks ago, it stopped working.
To be fair, my PICC still worked to administer medications. Unfortunately though it no longer worked to draw blood back from the vena cava. Drawing blood from my PICC would be helpful for my biweekly bloodwork if I were needle-phobic or it was difficult for the phlebotomists (trained professionals who draw blood) in the lab to get blood from my peripheral veins. I do not meet either of those criteria though so drawing blood from my PICC isn't necessary, strictly speaking. It is a requirement for continued use of my PICC under treatment guidelines though, and when my chemotherapy nurse could not establish blood return on cycle 4 we both knew there was a problem.
"Try this," he told me, pantomiming a movement where I lifted my right arm over my head and turned my head to the left. That didn't work, so over the next thirty minutes I felt like a dancer in a Bob Fosse production as we tried different positions and movements to establish bloodflow so he could use my PICC to give my chemo.
"It might be positional," he explained, meaning that the tip of my PICC might be up against the wall of the vena cava and that was what was blocking blood return. By moving in different ways, the hope was that he could get the blood return he needed to start my chemo. And it worked - barely.
"It's super sluggish. We may need to use a clotbuster next time."
Cue the music.
Clotbuster is a common translation that medical professionals use instead of the term thrombolytic. Most people have heard of clotbusters in the context of people having a stroke or heart attack. This class of drugs dissolve the mesh that forms with a blood clot, returning the trapped cells to the bloodstream and removing the blockage from the affected blood vessel. When I started working as a pharmacist, the common clotbusters were derived from bacteria that just happened to make these chemicals as part of their ecosystem, but now the most common clotbuster is alteplase, a commercially-produced version of our body's own natural clotbuster tissue plasminogen activator or TPA. While larger doses are given in the case of heart attacks or strokes, smaller doses of TPA have been shown to be very effective in dissolving the fibrin sheaths that can form around the tip of indwelling central venous catheters like my PICC.
These fibrin sheaths act like a sort of check valve, allowing fluid to flow past them in one direction (from the inside of the catheter into the bloodstream) but then closing over the end of the catheter to prevent blood return. This is not a good thing from a medical perspective and that's why on my last cycle, after 45 minutes of the dance of a thousand movements, my nurse (a different one from cycle 4) called my doctor for an order for TPA for my catheter.
And it worked like a charm!
My nurse was easily able to instill (infuse the drug into) the TPA into my PICC, and an hour later another nurse drew back and easily got the 5 mL (about a teaspoon) of blood they were required to get in order to use my PICC. The clotbuster had done its job and whatever fibrin sheath had been around the tip of my PICC was probably gone. Given that I am past the midway point, there is a very good chance that they won't have to use the clotbuster again before my PICC is removed after cycle 8 about six weeks from now.
That is all very clinical and easy to follow, but you may be asking yourself why I drew such a strong connection between the theme song from a 35 year old comedy classic and a common English term for a drug that reestablished bloodflow in my PICC. Humour me here - you've read this far, so let's just carry the meandering herd of cats that are my thoughts through to its not-so-logical conclusion.
So... why is the theme song from Ghostbusters stuck in my brain? The answer to that lies a little over a decade after Ghostbusters was released.
It was a bright, cold February morning on the prairies and my wife and I were both off work. Our son was about three and a half and our daughter was about eighteen months old at the time. She was sitting in a high chair eating, which at the time mostly meant she was pushing her food from one side of her tray to the other and playing with the one toy that she was fascinated by at the time - a small, cheap, red plastic phone. She lifted the phone to her ear and looked at our son whose face brightened immediately - he still loves his sister more than he will admit to anybody - as he asked her a very simple, logical question.
"Who you gonna call?"
I immediately responded. "Ghostbusters!!"
My son and I practically fell to the floor laughing, but both my wife and our daughter looked at me with a mixture of mild amusement and intense disappointment. That image - the look in my daughter's beautiful hazel eyes - is burned into my memory and is one of the happiest moments of my life. At eighteen months old, she was already more mature than myself or my son would ever be, and that look told me that she had just realized that the task of being mature was now a shared responsibility between her and my wife - it was obvious that the males of the family were going to be no use in that regard.
My PICC will be gone in a matter of weeks. I will be done my chemotherapy and radiation and surgery. I will re-establish my life - perhaps with some modifications due to everything I've been through - and will return to my job as a clinical pharmacist. All of that will be, as I have said before, part of my medical history. None of that will define who I am or what really matters in my life.
But the look in my daughter's eyes will.
Yeah, she still looks at me with that longsuffering gaze every so often and I hug her every time she does. She has grown from a formidable and remarkable little girl into a truly amazing and independent woman. My son - so very like me in so many ways yet totally his own person - has grown as well and is one of the most loving and capable men I know. The times I spent with them when they were little - when Ghostbusters was still a relatively recent release to home video, let's say - fill my memories far more than the dance of a thousand movements or an offhand remark from a nurse who is remarkable in his own way but who probably had no idea that his plain English translation of thrombolytic would trigger this flood of emotions and memories.
So what will you do when your proverbial PICC is blocked? What will you do when life just sucks? Because believe me, getting chemo sucks and unfortuantely your life will too - at times. Will you focus on the immediate, letting that define your life? Or will you look at the joy that is all around you - your children, your pets, your friends, your passions - and let that define you?
Who you gonna call?
It even had a very catchy theme song that reached #1 on the music charts in the US and Canada and stayed there for three weeks. And it is that song as well as a whole cascade of positive memories and emotions related to it that have been bouncing around my cranium the past few weeks.
Let me start out by saying that I don't define myself by what I do at work. I much prefer to define myself by the relationships I have with others - my children, my wife, my family, my friends. That said, as a clinical pharmacist words and phrases like thrombolytic and fibrin sheath are as much a part of my vocabulary as slime or ectoplasm were to the writers of Ghostbusters. I use them all the time with other medical professionals because we share an efficient language that allows us to communicate complicated aspects of treatment or diagnosis quickly and clearly. When we are talking to what we often describe as laypeople though, myself and every other medical professional I know translates this efficient language into a simpler, more accessible form. If you've ever gotten a prescription dispensed at a pharmacy and have looked at the brief sentence that the doctor scribbled and compare that to the clear, plain English (or whatever language is common in your locale) sentences on the pill bottle you will understand how this translation works.
But see, here's the thing... I don't look like a clinical pharmacist right now. I look like a patient undergoing chemotherapy. And as such, the medical professionals I engage with in my care tend not so use the medical vocabulary that they might if they saw me as a colleague.
How can you look like a clinical pharmacist? Okay, that may not be the question that was foremost on your mind, but just go with me on this one. Let's pretend that was the only question on your minds and that you're not replaying the Ghostbusters theme in your head or seeing a 100 foot tall Stay-Puft Marshmallow Man climbing a gothic apartment block. So... back to me being a patient rather than a clinical pharmacist and why I chose the words thrombolytic and fibrin sheath as examples of medical terminology and not, say, radius and ulna or great saphenous vein.
One of the things that makes me look like a patient undergoing chemotherapy is the PICC in my right upper arm. I've had this device in situ (there's another example of medical terminology that I frequently use) for eleven weeks now, a direct line between my superior vena cava (big vein that empties oxygen-depleted blood into the right side of the heart) and the outside world. This PICC allows my medical team to administer the chemotherapy agents that I am receiving into the largest volume of blood possible each cycle. But why is that necessary?
Oxaliplatin is classified as a vesicant, which means that it can cause blisters and tissue damage (including total destruction) if extravasation (leaking or inadvertent administration outside the bloodstream) occurs. Fluorouracil is not a vesicant but it is classified as an irritant hazard if extravasation occurs. It makes good sense then that both of these agents be given through something like a PICC to avoid the risk of them going insterstitial (the space around cells of the body) and thereby causing damage or destruction of otherwise healthy cells. Because my chemotherapy involved eight cycles of these irritant drugs over sixteen weeks, my PICC definitely adds to my quality of life.
Except that, a few weeks ago, it stopped working.
To be fair, my PICC still worked to administer medications. Unfortunately though it no longer worked to draw blood back from the vena cava. Drawing blood from my PICC would be helpful for my biweekly bloodwork if I were needle-phobic or it was difficult for the phlebotomists (trained professionals who draw blood) in the lab to get blood from my peripheral veins. I do not meet either of those criteria though so drawing blood from my PICC isn't necessary, strictly speaking. It is a requirement for continued use of my PICC under treatment guidelines though, and when my chemotherapy nurse could not establish blood return on cycle 4 we both knew there was a problem.
"Try this," he told me, pantomiming a movement where I lifted my right arm over my head and turned my head to the left. That didn't work, so over the next thirty minutes I felt like a dancer in a Bob Fosse production as we tried different positions and movements to establish bloodflow so he could use my PICC to give my chemo.
"It might be positional," he explained, meaning that the tip of my PICC might be up against the wall of the vena cava and that was what was blocking blood return. By moving in different ways, the hope was that he could get the blood return he needed to start my chemo. And it worked - barely.
"It's super sluggish. We may need to use a clotbuster next time."
Cue the music.
Clotbuster is a common translation that medical professionals use instead of the term thrombolytic. Most people have heard of clotbusters in the context of people having a stroke or heart attack. This class of drugs dissolve the mesh that forms with a blood clot, returning the trapped cells to the bloodstream and removing the blockage from the affected blood vessel. When I started working as a pharmacist, the common clotbusters were derived from bacteria that just happened to make these chemicals as part of their ecosystem, but now the most common clotbuster is alteplase, a commercially-produced version of our body's own natural clotbuster tissue plasminogen activator or TPA. While larger doses are given in the case of heart attacks or strokes, smaller doses of TPA have been shown to be very effective in dissolving the fibrin sheaths that can form around the tip of indwelling central venous catheters like my PICC.
These fibrin sheaths act like a sort of check valve, allowing fluid to flow past them in one direction (from the inside of the catheter into the bloodstream) but then closing over the end of the catheter to prevent blood return. This is not a good thing from a medical perspective and that's why on my last cycle, after 45 minutes of the dance of a thousand movements, my nurse (a different one from cycle 4) called my doctor for an order for TPA for my catheter.
And it worked like a charm!
My nurse was easily able to instill (infuse the drug into) the TPA into my PICC, and an hour later another nurse drew back and easily got the 5 mL (about a teaspoon) of blood they were required to get in order to use my PICC. The clotbuster had done its job and whatever fibrin sheath had been around the tip of my PICC was probably gone. Given that I am past the midway point, there is a very good chance that they won't have to use the clotbuster again before my PICC is removed after cycle 8 about six weeks from now.
That is all very clinical and easy to follow, but you may be asking yourself why I drew such a strong connection between the theme song from a 35 year old comedy classic and a common English term for a drug that reestablished bloodflow in my PICC. Humour me here - you've read this far, so let's just carry the meandering herd of cats that are my thoughts through to its not-so-logical conclusion.
So... why is the theme song from Ghostbusters stuck in my brain? The answer to that lies a little over a decade after Ghostbusters was released.
It was a bright, cold February morning on the prairies and my wife and I were both off work. Our son was about three and a half and our daughter was about eighteen months old at the time. She was sitting in a high chair eating, which at the time mostly meant she was pushing her food from one side of her tray to the other and playing with the one toy that she was fascinated by at the time - a small, cheap, red plastic phone. She lifted the phone to her ear and looked at our son whose face brightened immediately - he still loves his sister more than he will admit to anybody - as he asked her a very simple, logical question.
"Who you gonna call?"
I immediately responded. "Ghostbusters!!"
My son and I practically fell to the floor laughing, but both my wife and our daughter looked at me with a mixture of mild amusement and intense disappointment. That image - the look in my daughter's beautiful hazel eyes - is burned into my memory and is one of the happiest moments of my life. At eighteen months old, she was already more mature than myself or my son would ever be, and that look told me that she had just realized that the task of being mature was now a shared responsibility between her and my wife - it was obvious that the males of the family were going to be no use in that regard.
My PICC will be gone in a matter of weeks. I will be done my chemotherapy and radiation and surgery. I will re-establish my life - perhaps with some modifications due to everything I've been through - and will return to my job as a clinical pharmacist. All of that will be, as I have said before, part of my medical history. None of that will define who I am or what really matters in my life.
But the look in my daughter's eyes will.
Yeah, she still looks at me with that longsuffering gaze every so often and I hug her every time she does. She has grown from a formidable and remarkable little girl into a truly amazing and independent woman. My son - so very like me in so many ways yet totally his own person - has grown as well and is one of the most loving and capable men I know. The times I spent with them when they were little - when Ghostbusters was still a relatively recent release to home video, let's say - fill my memories far more than the dance of a thousand movements or an offhand remark from a nurse who is remarkable in his own way but who probably had no idea that his plain English translation of thrombolytic would trigger this flood of emotions and memories.
So what will you do when your proverbial PICC is blocked? What will you do when life just sucks? Because believe me, getting chemo sucks and unfortuantely your life will too - at times. Will you focus on the immediate, letting that define your life? Or will you look at the joy that is all around you - your children, your pets, your friends, your passions - and let that define you?
Who you gonna call?
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