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Prior to the exam, the morning offered an opportunity to visit with an old friend over a substantial breakfast at a classic NY-style diner.  We hadn’t seen one another in years and  mutually agreed during the course of conversation that it felt more like weeks.

Again, dialogue about this donation process gave rise to good questions.  I wrote them down to make sure they weren’t lost.  We went for a walk on the upper east side (with a short excursion to Bloomingdale’s), she accompanied me to the exam location, and kept me company until the initial paperwork was completed and my name was called by the donor coordinator. Her presence took the edge off of being alone and dispelled the surreal quality of the experience.

The purpose of the exam was two-fold, as follows: to ensure that my health would not be adversely impacted by the donation process; and to confirm that I am indeed a healthy specimen whose blood stem cells will help to re-generate the obliterated immune system of the recipient in a few weeks (a.k.a. not introduce any communicable diseases).  The surreal part is being a healthy person in an environment based on pathology and intervention, and to remember that I am not sick.  Just because there was a sheet of paper that had approximately 30 stickers on it all bearing my name, donor number, and bar code did not mean that one of the tests I was about to receive was going to turn up a health concern of my own.

The exam started with the blood work and the donor coordinator did the draw.  She was exceptional.  She encouraged me to go to my ‘happy place,’ and then asked, ‘well, was I going to tell her about my destination of choice?’  Fortunately, I chose the G-rated environs of an old growth redwood forest I had recently visited while in Del Norte County, CA for work.  Those mighty trees can stabilize me like nothing else.  Their big dinosaur ankles planted in the moist carpet of the forest floor oozing in a circumference 20+ feet wide and stretching in height beyond the reach of my gaze help to remind me of my place in the order of things.  Before I knew it, she was undoing the band around my arm and we were on to the next part of the exam.

Questions about my health history, the health history of my parents and their parents came next.  Every time I sit through one of those sessions and have the great fortune of checking ‘no’ next to five sheets of paper filled with potential health concerns, I am filled with gratitude.  I would like to say that I never take my good health for granted.  But, to be truthful, it is easy enough to get pulled from my center and swept away by the frustrations spawned by the obstacle(s) of the day, lose perspective, and go on a tear.  Last night over dinner my aunt said if you have your health, you have everything.   It’s true.

The second person on the team of professionals, a nurse practitioner, asked me if I had any questions.  I did, as follows.

1. May I have an anti-anxiety drug?  I get a little wiggy with the blood-draw thing.
   (Answer: Not a problem at all)
2. Can I see the room where the apheresis process will take place?
   (Answer: Yes, you’ll see that next)
3. Are there any diet or exercise recommendations before or after the procedure?
   (Answer: No ibuprofen the week you’re getting Neopogen shots and no interactive sports.  I want you to take Calcium the week leading up to the procedure because we put an additive in your blood to keep it from clotting during the apheresis process and unless you’ve got sufficient Calcium in your body, you may experience tingling around your mouth.)  Glad she told me this, that would have been freaky.
4. What makes me a match, and how hard is it to find a match?
   (Answer: we tend to inherit bone marrow along ethnic lines, the recipient of your bone marrow is most likely Caucasian and of European descent.  We try to have as diverse a pool as possible in the registry, but not all ethnicities are represented and some people never find a match)

Then she explained the process to me, a few times, in a few different ways.  I understood it each time and appreciated that what was really happening was a layering and a sinking in.  She was allowing me time to make sure the information was penetrating.  This was a quality endemic to every single person I dealt with that was part of the hematology-oncology department at Cornell University.  I was treated with the utmost respect and given the sense that every member of that team had all the time in the world for whatever question I may have had.

A few physical assessments were taken and all proved normal.  My blood counts came back, better than normal.  I was told I have good veins and a central line would not be necessary, which was a big relief to me.   Then the electrocardiogram which was totally different than I expected – they just hooked a bunch of electrodes up to my ankles and chest and did a reading while I was at rest.

Then I got to see the apheresis room with the reclining chairs where I will sit for 5 hours while the apheresis process takes place.  To break it down, as mentioned in Post Number 1, the Neupogen shots will increase my neutrophils, the most common type of white blood cell in the body and the first immune cell to show up at any site of infection in a healthy immune system.  All blood cells are  produced by bone marrow in the long bones of the body.  By the third day of the Neopogen shots I will start to feel achy because there is limited space in those long bones, and they’ll be bursting at the seams with the over-production stimulated by the Neupogen.  On the 5th and final day of the shots, I’ll be back in NY where they’ll take my blood out of one arm, run it through a machine that will extract my stem cells, and put my blood minus the stem cells with the additive to keep the blood from clotting into my other arm.  That cycle has to run its course six times which will take approximately 5 hours.

That day or the following day, the recipient will receive my harvested stem cells.  The cells will know where to travel in her body and, hopefully, within a week and a half they will help to regenerate a healthy immune system in her body (called ingrafting).  After a month, she’ll be released from the hospital.  Getting past the first 100 days will be a big milestone for her, and getting past the first year will be an even bigger milestone.  At 5 years, she’ll be considered cured.  Because she will have my immune system, she’ll inherit any allergies I have.  Wild, huh?

Neupogen is FDA approved, but only for its use in cancer patients because it helps to regenerate their immune systems when aggressive treatments kill everything.  It has only been used in ‘healthy’ donors for about 15 years.  Eventually a study will be published noting the drug’s use in the peripheral blood stem cell donation process, and multi-center data collection is feeding into this study.  I will receive follow-up calls to be part of this long term study as well.

The Spring 2011 issue of Parabola is on the subject of suffering.  The first essay is written by a Zen Buddhist priest from NYC who traveled to Zimbabwe where Africa’s first hospice program, Island Hospice is located.  They don’t have anything remotely like the kind of medicine and science noted above.  The essay focuses on one man, a pastor, who is dying of stomach cancer and the best they can do for pain medication is rationed out Tylenol.  The essay begins with this Zen Buddhist chant:

Let me respectfully remind you
Life and death are of supreme importance
Time swiftly passes by and opportunity is lost
Each of us should strive to awaken
Awaken, take heed do not squander your life.

On that note, I need to rest this body for another lucky day on the planet tomorrow.

Post number one.

Live from the 10th floor of the Helmsley Medical Tower on the upper east side of Manhattan.  These are my accommodations as set up by the Gift of Life Bone Marrow Foundation.

Tomorrow at 2 pm I am scheduled to participate in a 3 hour medical exam at Cornell.  This is the final precursor to ensure we can proceed to the next level of the peripheral blood stem cell donation scheduled for May 9, 2011.  Tomorrow’s exam will include a chest x-ray, electrocardiogram, pregnancy test, full blood panel, and (oh joy) a vein assessment.  I am drinking water as if I have been in the hot sun for days so that my veins pop out like I am some sort of super hero.  When logistics were finalized the other day, my work-up coordinator advised me to abstain from alcohol and drink lots of water.  No need to tell me twice.

Ten years ago when I was playing au pair to my two young sisters during the summer of 2001 while our dad was in the hospital following surgery on his brain stem, our routine included trips to the JCC for their swim lessons.  One day, the Gift of Life organization had a table set up and asked if I’d be interested in signing up as a donor.  Not knowing what all was involved, and thinking it was as simple as a blood donation, I joined the global registry, and forgot about it.  Until last August when I got a call informing me that there was a 44-year old woman for whom I may be a match. Was I still interested in pursuing the next steps?  There began the questions, the symmetries, soul-searching, and ultimately, the resolution to go through with the process.  The next step, by the way, was a simple cheek swab.

I can’t claim blind altruism and have had many questions during this unfolding.  On top of the specific questions that have come up in relation to this process, there’s the fact that faith and trust have never been my strong suits.  Religion, government, authority, institutions, and anything organized, in general, makes me raise an eyebrow.

As part of this process I will receive subcutaneous shots of Neupogen(R) for the week leading up to the donation.  The Neupogen will increase the production of neutrophils in my system.  The excess neutrophils will be harvested through an apheresis process on May 9 and promptly given to the recipient who will have gone through intensive chemotherapy and radiation to kill her cancerous cells in preparation for my healthy cells.  Smack in the middle of the medical institution, albeit pretty miraculous, there are unknowns and risks and I have trepidation.  Then again, it is a risk every time you step outside your door.  Sometimes you don’t even have to step outside your door, the risk comes to you.  I am stepping outside my door in a very active way, asking questions, and choosing to trust that it is all going to work out better than fine.  Nothing less than an adventure – donor and recipient, two protagonists on shared but separate journeys, facing obstacles and being changed by the process.

My familial conditioning to be the responsible one has instilled in me a strong desire to mend lives.  And this opportunity, as I’ve come to perceive it, hit me ‘where I live’ as the saying goes.  The juxtaposition of the words ‘jaded’ and ‘shaman’ have been used to describe me.  In the spirit of the jaded shaman, I have stepped gingerly, one foot in front of the other, to walk through the doors of Cornell tomorrow.