Chapter 14: Harvest

Harvest is such a nice word. It brings about images of golden wheat in vast fields under a blue sky. The heat of summer yielding to the first crisp nip of fall. Stem cell harvesting is nothing like that. It is you in a small curtained room hooked up to a massive centrifuge with tubes of blood going everywhere. More Children of the Corn than Field of Dreams.

Remember all my bitching about Neulasta and bone pain? Well Neulasta has a little short-acting cousin named Neupogen. Where Neulasta is meant to increase white blood counts over a week or two, Neupogen is meant to do all that work in a day or two. Why does this matter? Because, as mentioned before, when all of these white blood cells are pumped out of your bones they take a few stem cells with them. So by getting two shots of Neupogen a day, I would be getting ready for the harvest the following week.

So, how to describe harvest?

It is done in a smallish room with two hospital beds separated by a curtain. Blood runs from one tube of my TriFusion catheter into an apheresis machine. There the blood moves around a maze of gears and wheels, and ultimately disappears into a dark cabinet where a centrifuge is housed. Two tubes come out of the housing. One to a bag suspended above the machine, and the other back to me.

You show up at the hospital at 8 in the morning and check in. Once in the apheresis room you get a set of blood tests and the once over from a physician. Assuming your levels are good, your blood starts the circuit of catheter to machine to catheter. And, as the nurses make abundantly clear, they don’t stop for 5 hours. Have to pee? Here’s a plastic jug. Have to defecate? Good news, here’s a dry toilet we can bring bedside.

About halfway through your collection a lab technician comes up and takes a sample of the stem cells being collected. At the end of the day, the whole bag is sent down to the lab (more on that in a minute) where they determine how many stem cells they’ve collected.

My goal was 4-5 million. Day one, about 2 million, see you tomorrow. Day two, another 1.3 million (so close), see you tomorrow. Day 3? Total of 4.8 million. Congratulations, see you next week for the actual transplant.

Mundane Miracles

For three days I laid in a bed as my blood flowed from my chest into that machine and then back into my chest. The stem cells were pumped throughout the day into a collection bag. That bag was literally my life as the following week I would go into a hospital and voluntarily take a lethal dose of chemicals. Chemicals that would kill off any remaining cancer (hopefully). Chemicals so potent that they would wipe out my bone marrow. Chemicals so toxic they would also rip away at my entire digestive track leaving blisters and sores in their wake. Without that bag of stem cells to regrow my bone marrow I would die. No way to heal, no way to stop bleeding, no way to feed my body the oxygen it needed to live.

I was marveling at this sci-fi like procedure when I saw that bag of stem cells (i.e., my life) put into a Ziploc bag and transported to a lab in an Igloo cooler. That’s right, the inventory of crucial pieces of equipment to keep me alive included the same equipment used to safeguard cheese sandwiches and transport six-packs of beer to the beach.

Now I’ve been trying to write up some inspiring sermon-esque section on this transplant process. I’ve tried to figure out soaring rhetoric on faith, medicine, science, and such. After all, this is a big deal. An organ transplant…poisons…epic drama kind of stuff. But then I keep coming back to the Igloo cooler and the Ziploc bag. When you think about it, this whole thing is pretty absurd.

I mean I had to sign a consent form that said:

I can pull out of this procedure at any time, and
If I pull out of this procedure I will face “certain death.”

I actually signed a document that had the phrase “certain death” in it. I mean, seriously?! Who sits through a lethal dose of chemo and says, “You know what? I’m good.”

“But sir, if you leave now you will face CERTAIN DEATH!”

“Yeah, I’m OK with that, I got Tylenol at home.”

And seriously, an Igloo cooler? Who will be the first lab tech to mistake that for their lunch? “Ah, man? Stem cells again?”

When I got a PET scan they give me a shot from a syringe encased in friken titanium. When I got a chest X-Ray, they wheeled an armature with a full color display into my room – an X-Ray that can only take black and white images mind you. I’ve had my brain scanned with magnetic beams, and my gut outlined with protons and gamma rays…but the fluid that will save me from CERTAIN DEATH? Igloo and Ziploc.

How insane is this? I’m sitting all day as my blood is processed by a set piece from the original Star Trek series, watching the Olympics where the curling team uses high tech granite pucks with embedded hand sensors. Meanwhile, my stem cells will be injected into an IV line over the course of about 45 minutes…that’s the transplant. No lasers. No high-tech imaging device. Just a doctor and the same medical instrument that Sherlock Holmes used to shoot up over a century ago. How do they prepare the stem cells for transplant? They thaw them out in a warm water bath. Water! I hoped they would at least play some dramatic music on a Zune (yes I went there Microsoft – and no they didn’t do that).

It gets more absurd still. A year after I have this transplant, I will have to go back to the hospital to get my childhood vaccinations. In a year I will have to stare down the Jenny McCarthys of the world on the risks of diphtheria and MMR vaccination. After this miracle-of-science transplant my biggest fear is polio…POLIO!! The way this is going I’ll probably end up sitting in the “well kid” waiting room at my kid’s pediatrician’s office working on a puzzle out of a 1973 issue of Highlights magazine.

So, was there some lesson in this, some larger take away? I suppose it was this: when the extraordinary becomes the mundane, it is no less important. Those who deliver the essential, but expected, are doing something important. When my doctor delivers my stem cells in a routine infusion from an Igloo cooler, he will still be saving my life. When an optometrist fits you with optical technology (glasses) that has been around for centuries, you still can see. The world around us is so filled with the extraordinary that we have become used to it so as to make it seem mundane…but it is spectacular.

I pray you don’t have to fight cancer to see the extraordinary. Sure, we see it in toys and gadgets every day. We have become enamored with iPhones and smart watches and marvel at how fast/small/stylish they are. But try and recognize how incredible the everyday is. Next time you wash your hands, remember that indoor plumbing has saved more lives than any miracle drug.

See the spectacular every day in the love of friends and family. When you wish your son would just be quiet, remember the wonder and thrill of his first word. Make the next peck on your wife’s cheek rekindle the passion of your first kiss. And laugh – every day – laugh. The world we live in is a wondrous mundane miracle. Rejoice in it.