I continue to let the days go by. That’s been harder than it sounds. Not that I have any big complaints about my physical condition. I really couldn’t have asked for things to go any better. If you have to go through this, I don’t imagine it could be much easier than I’ve had it so far. I’ve been out the hospital nearly two months now, and I have not had a single incidence of fever, vomiting, or prolonged diarrhea—the kinds of things that send you back to the emergency room. I still suffer from food aversions and a weak appetite. I’ve lost about 10 pounds, but nobody seems worried about that. I am not particularly weak although I am weaker, of course, than when I went in the hospital. Still the last three weeks I’ve managed to workout—cardio and weights—three days a week and go to yoga once a week. Ice cream and pie have kept the calories coming in. If you know me from Facebook, you know that of late I have been specializing in fresh blueberry pies. They are a crowd pleaser. In January about 6 weeks before the transplant I injured my left knee running. X-rays revealed nothing. I did not have time to get an MRI before the transplant, but the pain persisted. I had to give up running and switched to a spin bike at home and a stationary bike in the hospital. When I got out of the hospital The Dog I went for walks in the woods and I used the spin bike again, but this past week the knee felt good enough for a couple of short and slow runs in the woods. That lifted the spirits of the canine and human both.
No I have no reason to complain about my physical condition. I know people who have had it much rougher afterwards. People for whom the new immune system decided that the old bodily organs were a threat. Graft versus host disease can be a serious problem. The graft, the new immune system, can go after any organ in the body, the host, that it registers as foreign. That’s why I am on immune suppressants, which increase my risk of infection. When you talk about this, you’ll notice, it’s really hard not to ascribe agency and intelligence to the immune system: It “decides;” it “goes after;” it “registers.” All of this, as if the immune system is a homunculus taking in its environment and deciding to act according to its purposes. As philosophers of mind will stress, this is really no explanation at all since your left explaining how a bodily system works by positing some little dwarf inside acting, but then there must be an even smaller dwarf in him, and so on. Although it seems so natural to ascribe intelligence and agency to systems within in us, in fact it obscures a difficult and fascinating problem. How does this all work anyway? What is the causal explanation for why the immune system might “recognize” an organ as a threat and “direct” an attack against it? And how can it be explained without an infinite army of ever smaller homunculi?
I remember talking to my hematologist before the transplant about blood production. She was explaining that as the bone marrow becomes more scarred and produces less blood, the spleen and liver slowly, but increasingly, take over more and more of the blood production. That is surprising enough since it’s not their function to produce blood, but somehow they have the capacity to do so. But I found another question even more fascinating: How do they “know” to start to produce blood and then to produce more? She smiled and said, “That’s still a mystery.” That doctors can carry off a stem cell transplant and save a person’s life is evidence that medical science understands a lot, but that they don’t know what causes the liver and spleen to begin producing blood and how that cause is related to the bone marrow producing less blood shows how much more there is to learn. It’s crazy.
Anyway, I am physically well, considering it all. I was warned that my recovery would take at least 6 months, and possibly as long as 12 months. Still, I am frustrated and impatient. I am well enough to feel pretty damn good much of the time although I still proceed more ploddingly than normal, and BF assures me that I am sometimes a bit confused—although I can’t say that I have noticed it! But it’s like those little dogs I see in the woods that are on very long retractable leads. The leashes are so long that they run along, tail wagging, thinking they are free. That is until the owner pulls the trigger and the leads pulls them back in. Once and while after I have been running along with my tail wagging, I get yanked back and find myself plopped in the Ikea chair or lying on the couch with little will or energy to do much of anything else the entire day. But that, I am told, is part of the process.
I am in a kind of purgatory. There is every reason to be hopeful that I will just continue to get better. Slowly. But for the meantime, despite often feeling pretty good, I move more slowly, accomplish things less quickly, spend my life mostly in the house, and I must reckon with unannounced and unwelcome fatigue. It’s been that way for several weeks now and will probably remain so for some time still to come.