trovia (trovia) wrote in little_details,

multiple myeloma, bone marrow transplants, hospital procedure, and an insurance question

Setting: Massachusetts, within the last five years.

I'm working on a fic about a doctor who befriends a cancer patient. Since I'm neither a doctor, nor do I have any experience with cancer (and I don't live in America), I'd really appreciate some help to get my facts straight. Cutting for length:

1. My doctor is an attending at the palliative care unit; she's also a geriatrician affiliated with the hospice for eldery people that belongs to the hospital. Basically I want her to usually work with older dying people. The hospital is a small one, it's understaffed because it's Christmas. Her friend the oncologist wants to go home and be with his family, so as a favor, she agrees to take charge of his cancer patients. Is there anything in there so far that doesn't make sense? Can she just take patients from other departments like that although it's outside her specialty? Would I have to mention that she could always call in the oncologist in case of emergencies, or is she fully qualify to get the job done herself? I figure she'd get enough contact with cancer patients in the PACU to make this reasonable?

2. The patient is an eighteen-year-old female with multiple myeloma - extremely rare in people that young, I know, terrible tragedy. She's waiting for a bone marrow transplant, which she needs to survive. I need her to be sick enough to be in the hospital, but stable enough for her doctors to have decided that she can wait for the transplant until after Christmas. So the donor can enjoy the holidays first - and the doctors involved can take the vacation they planned, obviously. So I figured I say she's gotten several rounds of chemotherapy and radiation treatment before, but no avail. She's immunocompromised by now and she's in an isolation room. What other issues would she have? I can find lists of symptoms such as kidney failure, but I can't find out which she would have at this particular point. I also can't find out the severity of the issues. Could her kidneys be failing, yet the doctors are still confident that they can wait these couple of days, and her kidneys would recover if the transplant takes?

3. Would she still be allowed to receive visits by her fiancee while in the isolation room? I know it depends on the hospital, but let's assume they're lax because hey, it's Christmas. Is it okay to let the fiancee stay after visiting hours from a medical view point?

4. Would the isolation room necessarily have to be in the ICU?

5. The first time my doctor skims her chart, what's a thing she might take notice of / check out specifically? (something like, "Her XXX was way down, but at least her YY count remained steady.")

6. When my doctor checks up on the patient, what monitors would she check? What kind of tests might she order? What would she write down on the chart? Assuming the patient remains stable.

7. I need the patient's anonymous donor to match with her just well enough for the doctors to decide that they should do the transplant, although the risks of graft-versus-host disease are very high. Research indicates that a 4/10 match should do the trick. Does that work? I understand it also depends on what matches exactly? I want this to be just on the brink of "We should try this. / The chances that this will work out are too low."

8. My patient had no health insurance when she was diagnosed with cancer. Am I right in assuming that she would not have been able to find an insurance company who'd take her on after that diagnosis? Because I have the rich dad of the fiancee paying her bills.

Google foo: all the variations of bone marrow transplants, multiple myeloma and its symptoms, isolation rooms, hospital procedure, hospital protocol. There's plenty of medical information, but none of it easily individualized. I found some awesome things on hospital procedures, and a couple of entries here on the comm on what medication she'd receive, what's it like in an ICU, what's the atmosphere. I'm all set on isolation room procedure, too.

I'd be grateful for anything you can help me with. Every additional realistic detail will make this a much better fic.
Tags: usa: health care and hospitals, ~medicine: illnesses: cancers, ~medicine: transplants/transfusions

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