Flunking out of blood school

by Brian on July 21, 2019

in Cancer

I flunked out of blood school last week. I wasn’t expelled exactly, but my scores dropped significantly enough that I was put on probation and sent for an emergency remedial course.

Blood school is not the kind of place you go on a whim. You first have to receive several “letters of recommendation.” Once you’re in, attendance is mandatory and, like a certain hotel in California, you can never really leave. Even if you go on vacation for a while, you’re required to show up for annual reunions, where the staff checks how well you’re doing and decides if re-enrollment is necessary. 

Back when I was in regular school, I was the kid who always got straight A’s. I was several teachers’ pet. I brought that same sensibility with me to blood school. I peppered the instructors (who for some reason insist we call them “doctors” and “nurses”) with questions showing how much I had prepared and how well I was going to do at my new school.

So, when I received the equivalent of a “D” from blood school, it was a blow to my ego as much as to my body. I had expected to sail through blood school with nary a hiccup.

It’s not like you can cheat in blood school. We all follow the teachers’ assignments assiduously. If you get a poor score, it’s entirely a matter of inner constitution, something you’re born with.

Blood school, of course, is what I like to call the time I’ve been spending at the hematology daycare ward since I was diagnosed with follicular lymphoma last year. The occasion of my recent failure was a sudden drop in my white blood cell count – in particular, a type of cell known as a neutrophil – 10 days after my fifth session of immunotherapy maintenance treatment. 

Nothing like that had happened over the previous four treatments nor during the months of chemotherapy that preceded this phase. That’s why it came as such a shock. 

I was a star pupil, I told anyone who asked. Instead, it turns out, I’m quite ordinary. 

If your blood test scores drop too low, it means your immune system can’t fight off the bacteria all around us, putting you at a higher risk of infection and hospitalization, two situations I desperately want to avoid. There is also the risk that your immune system could remain permanently depressed. 

The protocol in cases like mine is to get a shot of a medication called Neupogen, which prompts your bone marrow to rapidly produce extra white blood cells that can mature into more neutrophils. 

The shot itself didn’t hurt but, afterward, every single bone in my body seemed to ache while the marrow inside was working overtime. It felt like I’d come down with an especially nasty flu. 

Susan, my favorite nurse, cautioned me to avoid crowds for the next few days. That knocked out a dinner we had planned with some friends who were in town, but at that point, I wasn’t in a social mood anyway.

A follow-up blood test showed that the shot worked: my initial scores were out of the danger zone, although it’s too soon to celebrate – it will take another month or two to see if they stay up. 

The whole experience dispelled my illogical belief that my time in blood school would, unlike my peers, somehow be limited in duration.

It’s not all bad. Blood school can even be fun. Only a few courses are compulsory. 

Everyone has to take basic math (“if you need 12 treatments over two years and you’ve done five already, how many more do you have to go?”) and sport (regular exercise can keep you from calling in sick too often). I particularly like the literature class – we read lots of cancer memoirs and books on managing chronic pain. I chose to do my science elective on medical cannabis. 

The social scene at blood school is a lot like any other school. You’re thrown into a room with a group of strangers. At first, you stay quiet and avoid eye contact. When you do connect with someone, the bond forged in blood school is like no other. But there’s competition, too, where you wind up comparing yourself to others and determining who’s the more promising student. Sometimes you get to take an experimental advanced placement class. 

There are blood schools in every major city these days and demand is steadily increasing. My school is a bit run down. Some of the equipment hasn’t been updated since the 1950s and there are never enough pillows. But the staff is uniformly great; they really care about their students, which is what’s most important, after all.

I’m not due for my first furlough from blood school for another year, after which I can look forward to the annual homecoming dance, although it’s not with the other students or even my favorite teachers but with the maintenance team that manages the PET CT machine that looks for tumors. If you’re clear, you’re free to go about your business normally until the next reunion. 

Every so often, you hear about a student who defied the odds and graduated, no longer needing to come back, not even for continuing education courses. 

That’s my hope and the hope of every student in blood school: to receive an actual diploma from a school that’s steadfastly stingy about granting them.

I first wrote about blood school in The Jerusalem Post.

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