The Two Kinds of Decay

Vitamin K

After twenty-odd apheresis sessions, the veins in my arms had grown too scarred to access, and my body had grown too frail to tolerate having thick temporary catheters implanted in my chest and pulled after one week. I’d already had three of those.

And so it was time for a permanent central line.

But that would require a long surgery, with general anesthesia, which I wasn’t in any shape for, so I couldn’t get the permanent line right away.

I’d been taking azathioprine for two weeks, a cytotoxic chemotherapy drug often used as an immunosuppressive. It had killed a lot of my red blood cells and a lot of my white blood cells. I was anemic and susceptible to infections. That was the cellular problem.

Then there was the plasma problem. Throwing away my plasma got rid of the devil antibodies, but my plasma also contained other cells and proteins that the blood needs. If they’re missing, you get trouble.

My fibrinogens had disappeared almost completely. The hospital was doing a good job of removing my plasma and tossing out the fibrinogens with the bathwater.

Fibrinogens help knit the plasma together into a clot. When there aren’t enough of them, you will bleed.

The evening before my surgery, my fibrinogen level was low. We’d been waiting for my fibrinogens to regenerate. But in order for that to happen, we had to take time off from replacing my plasma. So while the fibrinogens were coming back, the antibodies were coming back, too. So I was filling my blood with poison again, at the same time it was filling with the molecules I needed to tolerate the surgery.

My fibrinogen levels were checked all night, but by morning I still didn’t have enough.

Two hours before I was to go in to surgery, an Irish doctor appeared. His brogue was beautiful and thick. He had been called to give me a shot of vitamin K, which would help my blood clot during the surgery.

He shot it into my right triceps. God, was he handsome.

The injection site stayed sore for five years, but not once during those years did I mind remembering the Irishman who had shot me full of K.