Back In Avondale

I was formally discharged by the Johns Hopkins IPOP clinic on Thursday. The whole thing could not have been more anticlimactic. Since I no longer had my catheter, there was no attempt to draw blood for testing; only my vitals were taken, after which I and perhaps seven or eight of my fellow patients and our caregivers were herded into a conference room for our final debriefing. This consisted mostly of a review of the "life after the transplant" materials that I described in the previous post. The content of these materials varies with the precise nature of the procedure one has undergone; the allogeneic transplant patients for example received stuff about Graft Versus Host Disease (GVHD) that was entirely absent from my package. After this session, there was nothing left to do but to just go home; we arrived here in the early afternoon.

I have a couple of additional observations about the transplant procedure that I'd like to record here, that I'd prefer not to forget.

The entire transplant procedure was carried out with minimal involvement by MDs. I encountered MDs in the initial consultation; at the consent signing; at the catheter installation; and daily (but very briefly), when I was an inpatient. On Christmas night, I was converted into a inpatient by the after-hours on-call IPOP MD. But otherwise, all the work was carried out by RNs, nursing assistants, and various medical technicians. Although the RNs had all received special training in oncology, there is no specific certification around this, as there is for example around anesthesia (an RN must be a CRNA to carry out anesthetic procedures). The daily outpatient show in the IPOP clinic was run by a Certified Registered Nurse Practitioner (CRNP). I have to confess that I haven't really figured out CRNPs yet; the legalisms around them seem to be changing as I write this. But one significant power they do possess is to write prescriptions. Nearly all the medications I received in the course of my transplant were prescribed by the CRNP.

I was rarely seen by the same RN from day to day. Each day, upon arriving in the IPOP clinic, I would sign in, and then consult a whiteboard carrying the day's patient-RN assignments. Furthermore, the RNs often worked long shifts, in which case they wouldn't be present on consecutive days. And they were also rotated between the outpatient clinic and the inpatient ward. However, they apparently had their patient status recording system down cold, as I saw few if any problems relating to the loss of information, or the introduction of misinformation, about my case occurring because of the endless hand-offs. In the end, though, there were very few RNs we felt we knew well enough (or could find) to say "goodbye" to before we left the IPOP clinic for the last time. As we departed, the IPOP machine continued to click along, seemingly oblivious to our existence.