As far as I remember, my very first bone marrow biopsy took place on the evening of 31st October 2005, an ambush manoeuvre not long after I arrived at St George’s for the first time. It’s not the most comfortable procedure, and it quickly went to the top of my list of least favourite medical events.
The next time I had the option of sedation; perhaps wanting to retain some semblance of being tough, I asked the registrar whether he would go for the ‘easy option’ or not. Given the choice between feeling the pain and not feeling the pain, he suggested, he would be inclined towards the latter. I went for it, particularly as when you’re stuck in hospital, you don’t really mind if you’re a bit conked out for a couple of hours afterwards.
I always dreaded bone marrow biopsies – although knowing I would be sedated always helped – until one day I was again ambushed with the procedure; by the time I knew it was happening, it was too late to organise sedation, and the doctor enthused about it not being necessary. We went ahead; the registrar was very efficient and managed to keep the pain to the minimum. I was surprised and delighted that it wasn’t nearly as bad as I had expected.
No doubt this was in part due to the skill of the doctor – apparently he had experience back in India of doing the procedure at least dozens of times a day – and the power of the local anaesthetic (which is always used). But perhaps, too, the fact that I had had no time to worry about how much it was going to hurt made a big difference. After that, I was no longer a slave to sedation – although when it wasn’t going to be difficult to arrange, I still sometimes made the most of it.
When I came in more recently for the bone marrow biopsy that confirmed my relapse, I was happy to go without sedation, reasoning that it would just keep me stuck in hospital for longer. But Mariacristina was keen for me to be in as little pain as possible, so for her sake as much as mine I ended up asking for sedation, which put me at the end of queue for biopsies that day.
When it came to it, however, the registrar was discouraging the sedation, not least because Fenella wanted to see me after the biopsy, and I wouldn’t have been in a state to remember anything if she’d talked to me in the couple of hours afterwards. So, with the acceptance – if not approval – of Mariacristina, I agreed to give up the sedation.
Perhaps this was the best approach: by expecting the sedation, I had no reason to worry about how much pain I might be from the procedure. But by cancelling it at the last minute, I was able to make sure I was awake and alert immediately afterwards. And by letting my wife ‘persuade’ me initially, of course, I could still pretend I’m as tough as nails, me.
It was probably my experience of bone marrow biopsies that made me realise how much of the difficulty of pain comes from the anticipation. The easiest medical events have always been those I wasn’t expecting; the toughest come when I have days to lie around thinking about how painful they may or may not be. Often the moments of pain are fleeting, and you know they’re going to be over soon. Also, of course, when the pain’s there there’s nothing to do about it – you just have to accept it. Thinking about it beforehand lets your imagination run riot…
The bone marrow biopsy – as just one example – is undoubtedly unpleasant, but once you’ve got through the jab and sting of the local anaesthetic – which are brief – it’s more of a strange feeling you get, rather than any great pain. Building it up in your mind beforehand, however, it seems a monster of a procedure, designed to leave you in agony.
The pain of anticipation is another reason to take things day by day and focus on what is immediately in front of me. I’ll have another bone marrow biopsy when my counts are up, to see how much residual leukaemia there is, but I’m not thinking about it much, as for now I just need to get through the days and avoid infections while I wait for my neutrophils to rise.
I know, too, that the bone marrow transplant (BMT), when it comes, will be tough. But that’s something I will deal with when it happens, day by day and procedure by procedure. It’s not something to worry about now, as it is not happening now.
Oh – and I doubt I’ll have sedation for my next biopsy; just so you know how tough I really am…