The Lenten period is when Christians are encouraged to reflect on their own limitations. In the midst of the hustle and bustle of life, the pain and inconvenience caused by giving up a pleasure or a minor indulgence brings the attention of the faithful back to their own finitude, embodiment, and mortality.
I don’t think that I will have any trouble reflecting on my mortality; I’m giving up my immune system.
This coming Thursday—the day after Ash Wednesday—I check into the hospital, at which point I surrender myself to modern medical knowledge, the competence of my doctors and nurses, and the vagaries of complex biochemical processes. Surrender is just another part of being a patient.
Here’s the plan. The treatment protocol assigns the days numerals that revolve around the transplant day. The days before the transplant have negative numerals, the days after have positive ones. I arrive on day -7, and I am given an anticonvulsant. The chemo, it seems, can cause convulsions. I am also fitted with a port through which the chemo and stem cells will flow, the first to destroy and the second to rebuild. On days -6 through -3, I continue to receive the anticonvulsant supplemented by two different forms of chemotherapy, busulvan and fludarabine. These attack the immune system and immature blood cells. Three days of the regimen is sometimes used, but for the strong a fourth day is preferred. The additional day better serves the purpose of killing the marrow, making the likelihood of a successful transplant greater.
According to the Wikipedia entry on fludarabine, “Common side effects include nausea, diarrhea, fever, rash, shortness of breath, numbness, vision changes, and feeling tired. Severe side effects include brain dysfunction, low blood cell counts, and lung inflammation.” The doctors have assigned me a fourth day of chemo. I’m glad; I guess. But I don’t expect to have the leisure of ignoring my embodiment.
The point of the whole drill is to destroy my body’s erstwhile best friend, my immune system. The mutinous forces of my bone marrow must be crushed and replaced with more benevolent ones.
Day -2 looks to be something of a respite. I receive only the anticonvulsant. On day -1 I receive an immunosuppressant called Tacrolimus, which targets T cells in my muscles. Produced by soil bacterium, Tacrolimus helps to reduce the incidence of organ rejection.
Meanwhile my anonymous donor will be receiving daily injections of filgrastim, which causes the bone marrow to make and then release a whole bunch of stem cells into the blood. After several days of injections, the stem cells are harvested by a process called apheresis. Blood is removed and run through a machine; the stem cells separated out; and the remaining blood is returned, all over the course of 2 to 4 hours. It could take a day or two to harvest enough stem cells from the donor. The result is the greatest gift that I could be given at this point in my life. I am filled with gratitude beyond measure for the generosity of that donor.
Day 0 is the transplant day. Almost anti-climatically the stem cells are introduced into my body by means of an IV. By a mechanism of biochemical causation that I can’t really fathom, the cells are propelled to my bones—I want to say that they seek my bones—where they squat in the residence that used to house my marrow. During days +1-+6 I receive an additional immunosuppressant called Mycophenolate to prevent rejection of the new bone marrow.
The first week or two after the transplant is critical. I will be in a condition known as aplasia. Absent any well-functioning bone marrow, my immune system will be in shambles. I will be dependent on blood transfusions. My job is simply to wait. The doctors look for signs that the stem cells are grafting and starting to make new bone marrow—this occurs 90 percent of the time. And I hope to avoid serious infection. My blood counts are continually monitored. When the new bone marrow produces enough blood for me to be safely released, I go home.
From start to finish I can expect a five to six week stay at the transplant unit. I start on the day after Ash Wednesday, and I hope to be on my feet after Good Friday.