It was only when my friend and colleague, Keith, had a stem cell transplant with his own stem cells (autologous), and when that failed, a second transplant with his brother's stem cells (allogeneic), that I gained an appreciation of the complexity of the process. [Keith is doing great, by the way, two years post transplant.] But I still didn't really get it. Not only didn't I get how dangerous, precarious and slow the recovery process would be, but I also didn't get the science of it all. I knew that the stem cells from my 33 year old male donor would cause my type A blood to convert to his type O. It makes sense that if the bone marrow factory that makes all my blood is making type O, then the type A blood "still on the shelves," as Dr. Goldberg put it, will eventually be replaced. It's still pretty weird, but it makes sense.
I recently learned that, in addition to my bone marrow being 100% converted to a male donor, the actual DNA is male. Wait, what? My bone marrow DNA is now male but the DNA for the rest of me is female? Yes, indeed. How does that work again? Seriously. This goes beyond science fiction: Too much science, not enough fiction. I know it's real because I keep staring at the test results. Yet I still can't wrap my head around it. I could leave my blood on a crime scene, and when the cops show up to swab the inside of my cheek, I'm innocent! I'm sure CSI has done at least one episode with this twist.
It really is amazing how far the science of medicine has come. I find myself cursing all the medications I have to take because of all the side effects that keep me from feeling well. But they are literally keeping me alive, after this incredibly violent and bizarre transformation at the core of my physical being.
Imagine this screenplay: Under medical guidance based on decades of research, a person's bone marrow is destroyed completely, leaving the patient on the brink of death. In swoops a bag of magic stem cells from God knows where, and somehow the patient doesn't die. The stem cells take hold, make new bone marrow, which produces new blood, and an internal war breaks out. As the stem cells fight both cancer and the patient (host), immunosuppressants, antibiotics, anti-virals, and a bunch of other preventative medications work to anticipate the next battle. In the meantime, the patient's DNA for part of the body may switch genders, but this storyline trails off because it doesn't make sense. If the patient makes it through the first year, chances are the new stem cells will stop fighting the host but keep fighting the cancer and everyone will live together in harmony. Fade to black.
Honestly, if you read a screenplay like this, how likely are you to invest in this script? Not me. It's too unrealistic.
With all these thoughts swirling around in my head, I started thinking again about my donor. I wrote him a second letter last week, hoping he will write me back. My letters are screened by the National Marrow Donor Program, as his identity is confidential unless he agrees to disclose it after a year. Until then, we can correspond in general terms, without giving away personal information about ourselves. Here is part of the letter I wrote to him.
I wish there was more publicity, knowledge, encouragement, incentives to donate stem cells and bone marrow in this country. Several of my friends and family members registered to be donors after learning of my illness. But most people don't know about the registry or its importance. I know I didn't. The vast majority of people of color who need transplants will not find a donor because matches are based on race and ethnicity, and there are not enough people of color in the registry. This is nothing short of tragic. The fight is hard enough, even when a perfect match is found, as in my case. My donor is as much a mystery to me as the science of this journey. To answer my original question, I don't know how this works. I'm just glad it does.When I think of you, I’m reminded of a story I’d like to share. I was getting blood work done last October, before the transplant, as you probably were too. There was a man in a chair across from me who was donating his stem cells. I could tell from the questions he asked his nurse that he was donating to a stranger. When I finished my tests, I walked up to him and said, “I’d like to thank you for what you are doing.” He looked at me like I was totally crazy, and asked, “Why?” I said, “Because you are saving someone’s life.” He then said, “But this is easy,” gesturing to the IV in each arm. Then I told him, “You may see it as easy, but it means everything to the person you are helping. It literally means the world to them. And someone like you somewhere will be doing that for me in about two weeks.” I think it was at that moment he realized, as he looked at me standing in front of him, the importance of his donation.
It made me feel good to thank that man, because I couldn’t thank you. You are that man for me, and I hope you know that you have saved my life.
CANcer + HEALth = CAN HEAL