Yesterday I had an appointment with the microbiologist, to see how my abscess is going, and decide whether or not to continue the IV antibiotics, particularly when faced with another dose of Bendamustine next week.
The underlying problem is that the antibiotics can only do so much to deal with the bacteria in the abscess, but it takes actual neutrophils (of which I have approximately zero) to completely clean it out. That, or surgery to cut it out, which is contra-indicated, considering I have no platelets (for clotting).
The literature about Bendamustine strongly suggests that the patient has a neutrophil count in excess of 1.6 before receiving the drug. However, this is a catch 22, because in order to get a neutrophil count of >1.6, I need a bone marrow transplant, and for that I need Bendamustine.
The options are: (a) abort the Bendamustine treatment until I have more neutrophils to fight the infection, or (b) risk the Bendamustine and the inevitable infections that will occur, including have the abscess flare up again.
Option (a) has no chance of survival, option (b) gives me a chance of survival, although not 100%. I choose (b). This means that a reservoir of infection will persist in the abscess. It can’t be fixed or killed, only controlled and managed. If the Bendamustine does what it is supposed to do, we will have to revisit the infection question before the bone marrow transplant, but we will cross that bridge when we come to it.
I have had several weeks to think about this, since the abscess flared after the previous Bendamustine dose. It isn’t a choice between a few dishes on the smorgasboard, it is finding the least-worst course of action. At this stage, all branches of the decission tree have non-zero probabilities of death. I feel calm about next week, and I feel confident all will go well.
I accept this gift.