
XVI: Into the Fire
Like all the steps that came before it, stem cell mobilization and collection proceeded smoothly. After four days of daily subcutaneous shots and some mild bone aches, I went in for apheresis on Monday. After only two and a half hours hooked to the machine — which is very similar to a dialysis machine — nearly twice the goal number of stem cells had already been collected.
Completing cell collection in one session meant that I didn’t have to come back Monday evening for more shots or Tuesday morning for more apheresis. It also meant there were no more steps left before being admitted for stem cell transplant itself. Fortunately my admit date was able to be bumped up a few days. I’ll be admitted to the stem cell transplant unit this Monday. Then Tuesday it finally starts.
Conditioning chemotherapy consists of 6 straight days of intravenous chemo involving total of four different drugs. Once those six days are over I get a day of rest, then the stem cells that were collected this past Monday are re-infused intravenously. The re-infusion process is apparently uneventful, except for that the preservative agent mixed in with the stem cells make you smell like garlic.
Much like a space shuttle launch, the day I get my cells back is considered day 0, and thus the chemo days are numbered -7, -6, -5, etc. While my prior chemotherapy experiences would lead me to believe those chemo days would be the toughest, the consensus appears to be that days 5–10 (plus or minus a couple days on either end) are the worst.
During that time my blood counts will nadir, rendering me potentially dependent on transfusions and uniquely vulnerable to infection. My temperature will be regularly monitored and I’ll get broad spectrum antibiotics if I develop a fever. Also apparently that’s the time that mouth sores and gastrointestinal issues are at their peak. To be blunt it sounds like it’s gonna suck.
The good news is the vast majority of patients make it through that stretch with counts recovering somewhere between days 10 and 14. Supposedly when counts recover, at lot of the other issues clear up. And being that I’m in good health, young, and pretty much recovered from salvage chemotherapy there’s every reason to expect that I sail through the process as smoothly as possible.
Yet, the fact remains that this process will be me sailing closer to the sun (or perhaps black hole) than anything that has come before. While I’ve avoided any major reaction or side effect of both ABVD and B/Br, the chemotherapy is more intense than any I’ve dealt with and thus has more potential for more serious adverse effects. Similarly my youth and general good health have meant that I’ve only been mildly immunocompromised with prior chemo, but there’s no way around the severe vulnerability that comes with stem cell transplant.
All told the risk of death is still very small. This isn’t some wild last ditch prayer — it’s a very well established process that has been optimized over the past twenty years both in terms of dosing and infection prevention. But even the small risk is significantly higher than what I’ve faced to this point.
Everyone gets uncomfortable when I bring up death. I guess they get concerned about me feeling down or fatalistic. In reality the opposite is true. I’m feeling much more optimistic than I felt this past June when I was staring at the enlarged nodes in my mediastinum at 1:00 AM in the IU North emergency room. The finish line is in sight. Suddenly I’m weeks not months away to the start of recovery (and hopefully long term remission).
However, I’ve also been around medicine long enough to have respect for death. Death is the one certainty of human existence. We all aspire to live to a ripe old age and die peacefully in our sleep, but the reality is most people don’t. My aunt died of sepsis. My maternal grandmother died of kidney failure. My maternal grandfather died of a massive heart attack. My paternal grandfather did die at home, in bed, but his passing occurred over several days.
Fortunately, most of us aren’t remembered by the moment of our passing, but rather by all the life we live before it. I have faith and expectation that my departure from this world with be years, nay decades in the future. But regardless of when it happens I’ve been blessed with opportunities, friends and experiences far beyond what most people in this world experience.
I‘ve lived a very good life thus far. I don’t have any major regrets. Thing is I just happen to have a whole lot more life left to live.
Onto stem cell transplant.
“There is only one god, and his name is death. And there is only one thing we say to death…
Not today”
— Syrio Forel, Game of Thrones

