The Big Day

In previous posts, I have anguished over the fact that I would soon need to make a huge, potentially life altering decision: to wit, will I proceed with a bone marrow transplant (BMT) or not? This decision is not like deciding whether I will wear a plain shirt or a striped shirt; it is not even like deciding whether I will pay my taxes or not. In my mind this decision is on the order of Russian roulette, you know the "game" where you put one cartridge in the cylinder of a revolver, spin the cylinder, and without looking, put the revolver to your temple and pull the trigger. 

In the strictly theoretical sense, Russian roulette gives you a one in six chance of blowing your brains out.  (This, of course, is why I always use my NINE shot .22 caliber pistol when I play Russian roulette!) Even if you factor in the weight of that one bullet in the cylinder, which might make it more likely that the spinning cylinder will stop with the bullet laden chamber at the bottom, away from the barrel of the gun (but more importantly, away from the hammer which causes the cartridge to fire) the odds are not the kind I like. 

BMT, with it's potential to increase the odds of a cure for leukemia carries with it a significant risk (~15%) of catastrophic side effects from "graft versus host disease." By catastrophic, I mean severe, debilitating effects that could mean a prolonged length of life with a severely diminished quality of life. So, think about it for a moment. One in six (Russian roulette) amounts to 16.7%. That's not significantly different in my mind from 15%. Would I play Russian roulette? Are you CRAZY? Perhaps, you can see why I have dreaded this decision. 

In my case, I have no family members who qualify as donors. My living blood relatives include my 79 year old brother, my 79 year old first cousin, and her 75 year old brother, obviously also a first cousin. Because none of them can be considered as donors due to their age, I would need to find an unrelated donor whose DNA was a close enough match to make the odds of  a successful BMT good enough to risk the procedure. 

There is a worldwide registry for people with big hearts, who have volunteered to donate stem cells from their bodies to be transplanted to leukemia patients in an effort to save their lives. I thank God for people like that. When I was last at Club Sunnyside, a sample of my blood was taken in order to look for a well-matched donor from this database. Then I was sent home to recover from my fourth and final round of HiDAC chemotherapy. 

So, while I was home, dealing with a loss of blood platelets that makes me more vulnerable to some kind of bleeding episode (read stroke) and low red blood cell counts that result in my brain being starved for oxygen, making me dizzy and lethargic, and a lack of neutrophils, the white blood cells that stand between me and significant infections, I was also dealing with the looming decision about BMT. Perhaps, you can see why I was dreading the day I would have to make that decision. 

I am grateful that we have a God who loves His children and will intervene in circumstances, if asked. During the time of my physical recovery from the effects of chemotherapy, I spent a good deal of time talking with God about this decision. He told us in the book of Matthew: 

⁷ “Ask, and it will be given to you; seek, and you will find; knock, and it will be opened to you. ⁸ For everyone who asks receives, and the one who seeks finds, and to the one who knocks it will be opened. ⁹ Or which one of you, if his son asks him for bread, will give him a stone? ¹⁰ Or if he asks for a fish, will give him a serpent? ¹¹ If you then, who are evil, know how to give good gifts to your children, how much more will your Father who is in heaven give good things to those who ask him! (Matthew 7:7-11, emphasis added)

Now, in spite of these promises from God, I continued to nurse some anxiety about what was on the horizon. I even prayed, as our Lord Jesus did on the night he was betrayed, arrested and tried in a kangaroo court, found guilty and sentenced to death on a Roman cross, 

“Father, if you are willing, remove this cup from me. Nevertheless, not my will, but yours, be done.”  (Luke 22:42)

Yesterday came the day of reckoning. The day began with a blood draw at Kaiser in Salem. My blood counts are rising, and I have been feeling good the last couple of days. That was good news indeed. We went home and prepared what my beautiful bride calls a "car picnic." Our consultation appointment at Oregon Health and Science University (OHSU) was scheduled for noon, followed by a laboratory procedure at 2:00pm. It wasn't looking good for getting fed! 

The drive to Portland was not pleasant. There was a driving (you should pardon the pun) rain storm, and poor Jill had to navigate that while looking for an address that we had never visited before. At the critical moment, Apple maps gave us a bogus direction causing us to miss the proper exit. Fortunately, Apple Annie was able to find a secondary route promptly and we pulled into the parking structure at OHSU with half an hour to spare. Nevertheless, our stress levels were high. 

We sat in the car and had our picnic, and then we began searching for the place we needed to be. Fortunately, we discovered that we had parked directly under the proper building. A young man at the front desk checked us in and directed us to the proper floor, where we were to see Dr. Rachel Cook, Hematologist/Oncologist, specializing in BMT. 

To our surprise, we were ushered into a treatment room, where my vital signs were taken, and a medical assistant reviewed my records, noting what medications I am currently taking and updating my medical history. We had both, independently imagined that we would be seen in Dr. Cooks office...you know with a desk and a lot of large books of medical knowledge on a bookcase; that kind of thing. Wrong!

In a few minutes, a tiny woman came in and introduced herself. After some pleasantries, she proceeded to the business at hand. I think she was a little nervous as she began explaining the importance of a good genetic match in choosing a donor for BMT. At last she came to the point I had been anticipating with dread; decision time. 

Well, it turns out that, out of that worldwide registry of anonymous donors, no donor had been found who was closely enough matched to my DNA to make a transplant advisable.  Dr. Cook explained again about the catastrophic results of proceeding with BMT, if the donor's genetic markers are not a near perfect match with mine. Ten of ten markers is a perfect match. A BMT might be considered in the event of a nine of ten match, but the closest match they found for me was on the order of seven of ten. 

Dr. Cook, I believe, felt that this news would be devastating to us. She went on to say that a great deal of research, including clinical trials, is underway in the area of post transplant medical treatments that would mitigate the effects of a less perfectly matched BMT, but she was quick to add that she would not recommend that I be involved in such clinical trials. She also talked about oral chemotherapeutic agents that can be used to reduce the likelihood of relapse of the leukemia, and other chemotherapies that are available, in the event of relapse.

One of the interesting things that she mentioned is that the chemotherapy I received would typically be given to a patient in his thirties. So, the fact that I not only was able to receive such treatment, but that I fared so well during that treatment is a very positive sign, and there is the possibility that it has cured the leukemia. She plans to relay her findings to Dr. Waugh and consult with her on potential treatments going forward. 

Now my outlook on all of this is as follows: my Heavenly Father, the Great Physician, brought me through the chemotherapy with virtually no complications. I never even had what the oncology staff calls "neutropenic fever." That is a fever that occurs after the chemotherapy has killed off the neutrophils, the white blood cells that provide much of the body's immune capabilities.  

Furthermore, the Creator of the entire universe surely could have provided one stem cell donor, if He had so desired. He has brought me through a very difficult course of treatment unscathed, why would He abandon me now? He wouldn't, of course. 

The steadfast love of the Lord never ceases;
    his mercies never come to an end;
²³ they are new every morning;
    great is your faithfulness.
²⁴ “The Lord is my portion,” says my soul,
    “therefore I will hope in him.” (Lamentations 3:22-24, emphasis added)

He promises, “I will never leave you nor forsake you.” (Hebrews 13:5) So, the decision I was dreading was taken out of my hands. He made it for me! He "remove[d] this cup from me." That is so like Him. He apparently knows I am not as strong as my Lord Jesus Christ, from whom He did not remove His cup. 

On the drive home yesterday, Jill said that her level of anxiety and stress seemed to be greatly diminished. At the hospital, after our meeting with Dr. Cook, Jill asked me how I was feeling about the outcome and was it what I was expecting. I told her that, honestly, I had had a feeling that it would turn out so, and that I am frankly relieved. The decision was taken off my plate. I am not facing more hospital time, and my faith in my Savior tells me that whatever He has for me in the future will be a blessing. 

And we know that for those who love God all things work together for good, for those who are called according to his purpose. (Romans 8:28)