Dear Friends and Family,
“What’s a bone marrow transplant procedure like?”
It’s a frequent question.
So here’s my attempt to describe it to you.
The two lab technicians were all grins when they knocked on our door and entered Nancy’s hospital room. Cedric and Erin introduced themselves. They were from the hematology lab, the one that handles bone marrow transplants. Cedric was carefully carrying a small IV bag in his arms like it was a newborn baby. Erin had a black, large briefcase-sized shoulder bag containing equipment. Cedric immediately stepped up to Nancy’s bedside so that she could see what he was cradling with his left hand while protecting it with his right arm.
The contents of the bag were bright, glow-in-the-dark red, like the AraC chemotherapy medicine. Since Cedric was holding the bag close to his body, its intense scarlet brilliance made quite a contrast with the long, white lab coat he was wearing. Jayna, Nancy’s sister, Linda, and I had anxiously been waiting since early in the day. Erin quickly read the inquisitive look on our faces and explained, “We didn’t receive the donor specimen until 6:30 p.m. tonight. I’m sorry it took us so long to get here.”
I looked at the clock. It was well past midnight. Jaret was already back in his dorm asleep because he had two classes in the morning. October 27, rather than the originally expected October 26, would now be the “date of record” for Nancy’s new beginning because of the lateness of the hour.
“Is that all I get?” Nancy inquired, sitting forward in her bed and leaning to her left for a closer look at the small bag in Cedric’s comforting embrace.
“Yep,” Cedric replied, shuffling his feet. “But let me explain what’s happened so far. When the specimen reached us, there was over a liter and a half of fresh bone marrow material. It was collected early this morning and flown here from somewhere in the United States, probably back east, but we’re not sure. We’ve been processing the bone marrow ever since it arrived at the lab. First, we drained off the fat and bone products. Then we put it in our spinner. Next, we siphoned off the stem cells that form at the top and ran tests for infections like hepatitis. Finally, we separated as many red blood cells from the stem cells as possible. We are left with mostly the stem cells that are right here.”
Cedric’s face beamed as he looked proudly at the bag he held close to his chest. He rubbed it gently, as if it was a baby’s head.
“Well, just how much is in that little bag? It’s pretty tiny compared to any of the IVs I’ve been given the last nine days.”
Before Cedric could answer, Erin chimed in, “Almost two ounces. Fifty-three ccs to be exact.”
Less than two ounces?
In my hand was a standard Pepsi can, twelve ounces. That’s six times more fluid than the IV bag that was in Cedric’s hands. I couldn’t help but think how could such a tiny amount of fluid be worth the ordeal of the last five months?
“Are there enough stem cells to help Nancy?” I blurted without thinking.
“Absolutely,” Erin announced, highlighting each syllable loudly. “Each cc in this bag contains about 340 million stem cells. Nancy will get more than enough to give her a fresh start.”
When Erin paused, Cedric added, “Approximately 8 cc of the 53 cc are red cells we weren’t able to separate away without damaging the stem cells. They cause the very bright-red color. And those red cells will probably cause a minor reaction because Nancy’s red blood cell type is different from the donor’s. But 8 cc is an acceptable amount, so Nancy’s discomfort shouldn’t be too great. All she should feel are a few aches and chills.”
Erin finished her paperwork and double-checked the numbers on Nancy’s ID bracelet. She handed the transplant bag to our nurse, Chris, using both hands so there was no chance the bag could be dropped inadvertently. Chris willingly accepted the offering with two hands, added the IV tubing she had prefilled with normal saline solution, and hooked the tubing into Nancy’s central line, the special IV that enters her right upper chest and drains directly into a large vein below her clavicle.
“Well, Nancy, are you ready?” Chris asked as she looked at the wall clock (now almost four hours ago) and recorded the time, 12:37 a.m., on the form that had been placed on Nancy’s night table. Chris had a smile from ear to ear—just like Cedric and Erin.
A bone marrow transplant, while not a major surgical operation like a kidney or heart transplant, is still dramatic. The science behind this potentially life-altering moment spans literally decades. And the logistics in our case of finding an unmatched donor and getting the “little red bag” to Room 507 at the University of Utah Hospital in Salt Lake City had been formidable.
Everyone in the room heard Nancy’s audible gulp.
What could she be thinking? I thought silently. I squeezed her slightly sweaty hand between both of mine. Her resolute blue eyes looked squarely into my eyes. She didn’t even have to ask.
Yes, I was ready even though my hands were now moist like Nancy’s. My mind raced almost out of control and I silently thought to myself:
What if our donor had been hit by a truck on the way to the hospital?
What if the plane carrying his sample had crashed unexpectedly?
What if, of all days, an earthquake struck the Wasatch Fault today?
A multitude of unpleasant and usually catastrophic possibilities dominated every moment I wasn’t engaged in direct conversation with Nancy or the others in the room. Each thought gave me pause. And through them all, I attempted to appear normal.
Once again, I thought silently—Is this what schizophrenic voices were like?
Erin finally broke the silence, “Did you know that to get your one and a half liters of bone marrow, your donor endured more than 150 sticks?” She pointed to her left hip. “Right here.”
Despite all my research, I hadn’t uncovered that particular detail. I would have been even more frantic had I known what the donor endured for my Nancy. Such worries, though, were now officially over. The red miracle fluid was being hung on its own IV pole as Erin spoke. The tiny life-giving cells were alive in our plastic bag. A crash to the floor couldn’t jeopardize Nancy’s chance for a cure.
Chris turned the dial to begin the flow of bone marrow after handing the tubing to Linda, Jayna, and me so it would pass through each of our hands before going into Nancy’s chest. The 53 cc of mostly stem cells slowly dripped from the IV bag. The red stem cell fluid mixed with the clear liquid in the tubing and trickled down toward Nancy, lying in bed with her head elevated on three comfortable down pillows. I said a silent thank you to our “angel” donor as I watched the stem cells pass through first Jayna’s, then Linda’s, and finally my hands. In seconds, the leading red edge of the fluid entered Nancy’s body. The entire tubing was now red, stem cells marching dutifully through her central line.
“Please find a suitable home,” I prayed silently.
“Do you feel anything, Mom?” Jayna asked softly.
Nancy looked at Erin and Cedric and then each of us. “Relief,” she answered, imparting the cheerfulness we all needed.
Jayna and Linda had moist eyes. Though my contacts did their job, Nancy wasn’t wearing her lens. A tear ran down her left cheek.
“Mommer, don’t cry. You’re getting a brand new immune system. I know you’ll make it.”
“What makes you think that?” Nancy inquired, getting her own tissue. None of the rest of us dared remove our hands from the tubing.
“Because you’re so strong. Look how you’ve made it through chemotherapy.” Linda definitely agreed. Her shoulders appeared ten pounds lighter.
“And so nice,” our nurse Chris added. “I’ve never had a patient thank me when I give her a shot.”
Nancy frowned slightly so that her eyebrows pointed downward and her forehead wrinkled: “But I’m soooo old. Even though today is my new birthday.” We all laughed. (According to bone marrow tradition, from this day forward, Nancy will consider today her “other” birthday, the day her new bone marrow was born.) No longer frowning, her face was glowing and without tears.
Emily Post doesn’t have a chapter on how to act at a bone marrow transplant party. We sang “Happy Birthday Baby, Baby” several times and small parts of any other song that more than two of us knew. Jayna even made a video of our second rendition of the transplant shuffle, though Nancy danced with her arms only from her bed, the rest of her body beginning to ache. We made toasts (with water), and everyone but Nancy ate the chocolate “birthday” cake that I brought for the occasion, as well as the candy and cookies Jayna had picked up at the store.
By the time our neighbor’s nurse stuck his head in our room and good-naturedly threatened, “I’ve already given my patient two ‘sleepers.’ Can you tone it down just a bit?” we were all emotionally spent and ready to settle down. Chris returned to other duties, and Linda and Jayna kissed Nancy good night and departed to our Sugar House (Salt Lake City) apartment.
When our room was empty and it was just Nancy and me, we did something we had not done since May 29, the day of Nancy’s diagnosis. We discussed the future. We talked about what we will do once Nancy is well. We talked about trips that we’ll take together. We talked about restaurants we’ll visit. And most importantly, all the people we’ll thank from the bottom our hearts—each and every one of you.
Summary: Last night, just after midnight, Nancy received her new bone marrow. We had a very special party to celebrate her transplant “birthday.” If all goes well, we look forward to many, many more.
All our love,
Winnie