Lily, Part III

And so, Lily came back to us septic. In fact, she went almost straight to the ICU. I think she lasted a few days on our unit before she ended up there with low blood pressures, being kept alive by medicine drips while the antibiotics worked on killing all the bacteria in her blood.

I still remember the song that was on repeat in my head the morning I came into work, sat down at my desk, and saw that Lily's name and room number had changed to an ICU bed.

Rise! And shine! And give God, the glory glory!
Rise, and shine, and give God, the glory glory!
Rise! And shine! And! Give God, the glory glory, children of the Lord.

A sort of sick feeling entered the pit of my stomach. Not this girl. This was our sweetest girl, one I loved more than a lot of the others I didn't see as often. I didn't really believe Lily was going to die in the ICU, but you never know for sure, until they survive.

To make a long story short: Lily survived. She fought off the infection and came back to our floor, weakened but alive. At this point, it was still such a joy to see her every day; sick to her stomach from her second round of chemotherapy, she still managed to conjure up a smile for us on rounds each morning. Pictures and Bible verses went up all over her walls and outside her room in the bone marrow transplant unit. She survived her second course... and we all began to think she would be ready for her transplant soon.

Until one day, Lily started coughing. It was a harmless cough at first, but then the fevers started; the antibiotics restarted; and within a few days, after imaging her chest, we found out more bad news: Lily was so immune suppressed that big balls of fungus were growing in her lungs. Lots of them.

Ordinarily, no one goes through chemotherapy without getting low white blood cell counts. This is to be expected. However, we also give patients antifungal medicines when we know they will have no white cells to fight infection for an extended period of time. So, when Lily began growing fungus balls while on antifungals~ we started saying serious silent prayers. I did, anyway.

Here's the point: you can get a bone marrow transplant and have a 50% survival if you are in great condition. But start knocking out major organs, like your lungs, and your survival from that kind of transplant starts to approach zero. Fungus just before transplant, like secondary AML, is a real killer.

We gave Lily antifungals... and more antifungals. And then increased the dose of her antifungals. The girl might as well have been taking baths in voriconazole, chugging kegs of ambisome; caspofungin was approaching high enough concentrations to start spouting out of her eyeballs. But despite all this- Lily didn't clear the fungus. She didn't come anywhere close, in fact; upon repeat CT scan, the fungus balls were still there. Smaller, but just barely. There was just too much lung fungus for her weakened immune system to clear prior to transplant, even with the help of drugs.

It was at this point that Dr. Rooms, Lily's bone marrow transplant doctor, had a big decision to make.

Do I offer hospice to Lily's family, and let her go home to die?

Or do we send her to the surgeons to cut her chest open, spread her ribs, and dissect out the fungus balls, one by one?