July 25, 2007 - Again, with the Bone-Marrow Biopsy

Yeah, today it’s time to go through this lovely ritual again (see my December 15, 2005 entry for my first experience with this test). I arrive at Dr. Lerner’s office about 2:00 p.m., feeling a good bit more composed about this than I did last time. I’m a veteran, now, I say to myself. I even have the presence of mind to dress in drawstring gym shorts and a t-shirt, knowing this will make things go a little more smoothly.

They take me back to the phlebotomy room for a blood draw (absolutely routine for me, now, as many times as I’ve had this done), then into the little room they use for bone-marrow biopsies. It’s the first time I’ve been in here since my last one. There’s an examining-table in the center of the room. Laid out on a counter, off to one side, are some glass microscope slides, ready to receive the red goo the doctor will soon suck out of my pelvic bone. They don’t have the actual instruments laid out yet, though. That’s probably a good thing.

After taking my blood pressure and temperature, the nurse instructs me to pull my pants halfway down my buttocks, and lay on my left side on the examining-table, looking away from the counter with the slides laid out on it. (Forget about dignity with this procedure.) She covers me with some surgical paper coverings. Dr. Lerner, who had stuck his head in to greet me a few minutes earlier, comes in now, and says it’s time to get started.

The first order of business is to numb the area up, with some injections of novocaine (or something similar). These injections are the most acutely painful part of the experience (ironic that the pain-killer causes so much pain – but, then, I wouldn’t want to imagine what this would feel like without the local anesthetic). It’s a sharp, burning pain, repeated each time he sticks me with the needle. Waiting a few moments, he does it again – though I don’t feel much this time, because the first dose has started to take effect.

From my last experience, I remember what I felt during the actual harvesting of the marrow could better be described as pressure than actual pain. This time, it’s not quite so benign. When he’s ready to go in, Dr. Lerner suggests I may want to take some deep breaths: in through my nose, out through my mouth. (Let me tell you, whenever a doctor tells you to breathe like this, what’s coming your way is not good.)

I fix my eyes on a nearby, random object – the adjustment knob on the back of a desk chair – and try my best to zone out, going someplace far away. I do feel actual pain, this time – a sharp sort of pain that seems to be coming from my tailbone, rather than from the hip (where the doctor is actually working). This happens as Dr. Lerner inserts a syringe into my bone, to “draw out some fluid.”

Next, it’s time for the actual biopsy. Thanks to the local anesthetic, I don’t feel anything when the instrument goes through the skin, but I do feel him twisting something rapidly behind me – rather like the motion you’d use to turn a corkscrew – and then I feel a sort of pop. This, I’d imagine, is the biopsy instrument punching its small hole in the pelvic bone. Next, Dr. Lerner says I may feel a sort of pulling, as he removes the sample. I don’t actually experience that, though I do feel the same sharp pain in my tailbone I felt when he stuck the needle in.

Moments later, it's all over. “We got a nice, big piece,” he informs me, with a tone of satisfaction. (“We didn’t get it, you did,” I think to myself, “but thanks, anyway, for including me as a partner in the project.”) While he works on setting up the microscope sides, the nurse cleans me up and puts a dressing on the wound. She then instructs me to turn over and lay on my back.

This I remember from the last time. I have a few minutes, looking up at the ceiling while Dr. Lerner is filling out some paperwork, to bring him up to speed on the latest appointments – the delay of my PET/CT scan till tomorrow, and the fact that I’m now scheduled to visit Dr. Portlock at Memorial Sloan-Kettering on August 7. He suggests I make my next appointment with him for August 8, the very next day, so we can discuss treatment options.

Dr. Lerner says goodbye, then, and turns to leave the room. “Thank you for everything you’re doing to help me,” I blurt out, before he goes (it just occurred to me that maybe I haven’t said “thank you” often enough). That may sound like a strange thing to say to someone who’s just poked a hole in your bone, but I really mean it. As uncomfortable as the procedure was, it certainly wasn’t terrible. I’ve heard enough stories from fellow cancer patients about absolutely agonizing bone-marrow biopsies – and enough good things, from the nurses, about Dr. Lerner’s skill at the procedure – to know he’s kept my pain to a minimum.

A few more minutes of looking up at the ceiling, and the nurse tells me I can sit up and dangle my legs off the table. She brings me a small can of orange juice (rather like being a blood donor, I think to myself). Then, after asking me a couple times if I feel dizzy (I don’t – well, not much, anyway), she says I can go home.

I take it easy the rest of the day – sitting on the couch and reading the new Harry Potter book. Every time I get up, I feel a dull pain in my right hip, like a pulled muscle. This, too, shall pass.

Dr. Lerner told me the lab-test results will be available around the middle of next week. If I don’t hear from someone in his office by Friday, he suggested, I should give them a call.