Lymphoblastic Lymphoma/Leukemia (1) Emergency Admission and Diagnosis (part 1)

I leave it to the readers to judge whether this is fact or fiction.

~Continuation of Episode 1~

In response to my friend's question,

"Actually, I'm struggling... it doesn't seem like a monitor malfunction..." I said, my voice weaker than my usual calm self.

As the oxygen saturation (SpO2) on the monitor drifted between the high 80s and low 90s, that slow, heavy sentence made everyone in the room realize that the situation was indeed grave.

~~~

What everyone had been hoping was just a mistake was now mutually recognized by all as an undeniable fact.

Difficulty with blood clotting, facial pallor, low oxygen (SpO2) and its progression...

This raised the possibility that the situation was even more serious than the bad scenario everyone had somewhat anticipated.

Upon hearing those words, my friend immediately walked quickly to find a doctor and brought them to my room.

My friend (a resident) explained my condition to the doctor, and I was immediately admitted to the ICU.

Various monitors were attached, and the oxygen that had been started in the outpatient clinic was quickly switched to the oxygen outlet on the ICU wall.

Staff were bustling in and out of the room.

Shortly after being admitted to the ICU, I had to have a chest X-ray taken due to a drop in my oxygen saturation (SpO2). (In this country, where tuberculosis is not widespread, a chest X-ray upon admission is not routine. It is a test performed only on patients who show clinically necessary symptoms.)

After seeing the images taken immediately with a portable X-ray, a CT scan was scheduled for the same day. (Even in non-emergency situations, waiting times for imaging tests are at least three months, and even in emergencies, waiting for several hours is considered normal. In an environment where imaging tests are not easily accessible unless heavily utilized, being admitted around sunset and getting a scan on the same day is considered lucky. Sometimes you are admitted in the evening and your turn for the test doesn't come until the middle of the night.)

Since a CT scan was performed on the same day, I, as the patient who had not yet seen the images, was convinced that the abnormality on the X-ray was obvious and that the findings were likely of a somewhat high urgency.

In a foreign land, I had gone from being perfectly healthy (subjectively) to being suddenly admitted to the ICU. The hospital made arrangements for my friend and my supervisor to stay with me.

Therefore, even after being admitted to the ICU, I remained quite cheerful and kept smiling.

My friend also continued to cheer me up with fun topics as usual.

While I was talking with my friend, I felt (or so I thought) relatively healthy despite being in the ICU for an emergency admission. At the very least, my spirits were as high as they were in normal times (or so I thought).

The monitor was beeping frequently.

However, as evening approached, both my friend and my supervisor had to leave the ICU.

For a while, I watched the sunset from my ICU bed by the window, and I was comforted by the beautiful scenery.

However, when I suddenly looked around, I saw my monitor sitting there prominently on a large screen, positioned at an angle easily visible from the room entrance, up to the upper right (by the window).

Although there is a threshold, I can tell just by the sound that my neighbor is on a ventilator.

I am also connected to an IV drip.
I am also connected to a monitor.

Yes, I am not a doctor on vacation or in surgical training; I am lying in an ICU bed as a patient.

Until then, even though it was an emergency admission, it felt like observing fish in an aquarium from behind glass. Even the symptoms occurring in my own body felt somewhat detached, as if I were viewing the situation as a third party.

However, at some point, it was as if I suddenly realized that I myself was admitted to the ICU. And I simply understood that my medical condition was serious enough to require ICU admission.

~~~My state of mind at that time 1~~~

Ah, I've been admitted to the ICU again...

I really thought it would never happen again...

I don't want to be intubated (put on a ventilator)💦

Absolutely impossible!

My parents aren't here, and💦
my friends are at work, too💦

I can't bear that alone.

I have to tell the doctor that I refuse intubation!
(Even though I want to live)

• Because I want to live, I want them to treat me well and help me recover so that I don't have to be put on a ventilator...

• I want to get through this without being on a ventilator

• That is the one thing I want to avoid...

• But I strongly wish to live...

However, if by any chance I end up in a situation where I would die without a ventilator, even then, I cannot be put on one...

That is the one thing I absolutely cannot do...

Even so, I truly believe that there must be a way that does not require a ventilator.

And I truly believe that I can 100% survive and recover.

This was my honest state of mind on the day I was admitted to the ICU.

~~~End of State of Mind on ICU Admission Day 1~~~

Next, my own thoughts regarding my medical condition

~~~My thoughts on my medical condition upon ICU admission~~~

Wait, what? Lymphoma...⁉️

Huh, so it really was lymphoma after all...

My fever isn't that high.
And I don't really have much of a cough, do I?
Come to think of it, I'm always coughing because of the surgery, so maybe I just didn't notice?
No, but I don't have a pneumonia-like cough or purulent sputum, right?
As I thought, it's unlikely that a pneumonia-like infection is strongly suspected.

Come to think of it, today it's in the high 37s... no, but I've always had a high body temperature, right?
Tumor fever? No, no, no, no, if that were the case, wouldn't it be higher? But then again, a low-grade fever for a while is a common pattern...



Then, is the drop in oxygen (SpO2) due to airway compression? Wait, is it Bulky Disease (a condition where the lesion in the chest is large)?... At least one poor prognostic factor is present... (If it's Bulky Disease, wouldn't there be chest radiation therapy?... No, nowadays if it disappears with anticancer drugs, sometimes there's no radiation... In pediatric Hodgkin's... but I'm not a child! But, AYA generation... anticancer drugs... if it's Hodgkin's, wouldn't it be the same? Maybe BEACOPP? No, ABVD for a slightly longer duration? If it's non-Hodgkin's, R-CHOP?... But, speaking of a large thymic mass, that's Hodgkin's, right? In terms of age, it's a period where it's somewhat common, right?) ((By the way, if Hodgkin's lymphoma achieves complete remission at the initial onset and does not recur, it is a type of lymphoma with a fairly good prognosis.))

Pleural effusion? (Stage IV) In terms of age, if it's early stage, depending on the type, the complete remission rate (almost a cure) is in the 90% range...
The words '20 or 30 percent' cross my mind, but I'll have them pass by quickly.
The good thing about lymphoma is that it can be cured even at Stage IV.

((I can hear my own breathing sounds.
I have sensation in my body.
Although various things are falling into place like a puzzle, if that's inconvenient, I'm telling myself that it's just my misunderstanding...))

If it's loss of consciousness and a tendency to bleed, it's probably pancytopenia...


I haven't noticed any petechiae (subcutaneous bleeding) as far as I can tell, have I?
Did I look at my body properly?... I didn't...
But if there were any, wouldn't someone have noticed when we were all swimming in the lake in our swimsuits a little while ago?


Hmm? Could it be a pattern where it's in the oral cavity or pharynx?
No, no, no, no, I don't think so...
Did I bruise easily? Since surgery is like doing sports every day... isn't it just that I think bruising is normal because the operation is hard?

Hey, wait!
No, surely not...
I don't think it's lymphoma.
I mean, normally... isn't it a rare disease?
I don't feel like I have lymphoma.

I'm on immunosuppressants...

Carcinogenesis is a side effect...

But, it might be lymphoma after all.

I suppose there must be pancytopenia...

In terms of symptoms...

~~~My thoughts for now (Analysis of the medical condition)~~~

Not long after the dramatic turn of events where I was told 'It's lymphoma' during an X-ray meant to prove I was healthy, only to be told 'Actually, it's not lymphoma,' I realized that it would become 'Actually, it is lymphoma' after all.

However, the situation was far worse than I had anticipated.

Immature white blood cells called blasts were being spotted in my blood.

At this moment, I made up my mind. 'Ah, it's leukemia...'

On the same day, I was to receive a blood transfusion, and the explanations and signing of consent forms proceeded in a dizzying blur.

A bone marrow examination (bone marrow aspiration) was also rushed forward.
(As well as a bone marrow biopsy)

And a lumbar puncture (spinal tap) as well...

While telling my attending physician how much I wanted to avoid a ventilator, I also repeatedly emphasized that I 'wanted to live.'
(Making sure this 'I want to live' is properly understood is extremely important for survival, so even though I was exhausted, I desperately pleaded that I 'wanted to live' while struggling for breath, but also explained how I wanted to avoid a respirator...)

Somehow, I wanted them to help me live while avoiding a ventilator.
(What an incredible request...)

But I think I also said that if it were something like pneumonia or reversible airway compression, where improvement was expected in a short period and I could be cured... then maybe?
(😅)

After the doctor told me they would do everything in their power to treat me, they confirmed over and over again whether I understood what it would mean if I did not go on a respirator should my respiratory condition worsen. Once we were both satisfied with that understanding, they told me they would work hard on the treatment to ensure I wouldn't need to be put on a respirator.Aiming for recovery with the best possible system, rather than assuming I would go on a respirator, they said things to that effect. (Although my memory of the exact phrasing and the words themselves is hazy, I clearly remember the impression that I had successfully communicated with my attending physician at the time. I remember that she understood my wishes, that she stood by me, that even without making impossible promises, she had an attitude of aiming for the best outcome with the best possible response, and that our conversation was positive and based on the premise of recovery... these things I remember.)

And just outside my two-person ICU room, I could hear fragmented words: "Wait, this is the ICU?", "Refusing intubation? (I couldn't hear the rest)", and "Even though they're so young."

Shortly after this, I was quickly moved to a private ICU room, where the diagnosis and treatment proceeded.

Stay tuned for the next part!

Let's cherish living in the present!