Passage

Two days before we set sail, a light rain fell on the dusty valley floor. Almost all of the fields had been transplanted, the few remaining would have to dry out before planting. But the rain was a good thing. Even those of us afraid of the ocean - the great watery deeps heaving our small boat about - thought the unusual rain spoke of travel to distant lands, unknown to us, teaming with life. How strange once the clouds lifted their grey mantle, to see the great ship awaiting those brave enough to walk aboard.

Have you ever thought what a hematapoetic stem cell looks like? Rooted, red, hidden in the small fissures of your large bones, one out of 100,000 cells. Not all are immortal in your bone marrow, but some are.

And yet, and yet - tsuyu noyo nagara - they can re-create the constituents of our red and white blood cell systems.

Does eternity nest in my bones?

 Aphresis with Betsy and the Oibius, the finger oxygen god.

 Richard, the bone marrow transplant nurse, par-excellence. Some might call him cerebeus but that would mis-represent what this process is all about.

 Ahh a cupa after surgical implant (npo after midnight) of aphresis line.

 Dr. T! and I. When I told him my hair is growing back and my legs are getting stronger he responded "like mine?"

Yoooo-whoooooooo, where are you hiding? O stem cells, where are youuuu- a? While laying about yesterday getting totally fagged out what with the tubing and the blood going a-out and then coming a-in with a little extra anti-coagulant and citrate and sodium mixed in and did I forget to mention the industrious Betsy? running all around me doing the nasty "P" work. (I thought that was what I did with the curtain pulled, palease-a). Did I also forget to mention my father? Well, he was there by my side mixing the biology all up but dead-on with what the people do/where are we going/why is education not a priority and yes! half - cups of coffee. No scones though as there were eaten in route from coffee stand to hospital room. 

I suppose I should start at the beginning. Saturday, while slowly twirling my finger in my gin and tonic and admiring my lovely wife's legs, skirted of course, in the back yard drawing, palease-a, I thought it might be too early since Tx to have a drink. Halfway through, I became convinced. By dinner, I began to whinny like a horse as waves of pressure rode through my illiac crest. Nightfall, brought fits of insane-like laughter as the damn horse kept kicking my back. Pain-killers let me sleep half the night. Then the dark horse rode me through morning into day. The pain lasted through late afternoon and then left abruptly. 

When we checked in for apheresis, Betsy said doctors receive pain descriptions like mine with ALRIGHT! meaning the mobilization is working and your bone-marrow is spitting cells out into the blood as fast as it can make them. Where they float around on the red blood cell couches waiting for their next todo.  Little did they know that Betsy was waiting impatiently for them ( and us to show up). 

After checking blood counts and getting the green light, even though platelets were below 100, Betsy hooked me, manual style, to my new blood brother COBE. Manual style means the apheresis nurse gets to "read" the color of your blood sample as it is pulled from your body. Did you know white blood cells are red? (The beginning of where we lost my father). Again Betsy " you know how a little bit of food coloring goes a long way? Well, it's just like that with blood. Even in the white blood cell faction there are a very few red cells, coloring the whole bag". 

The apheresis machine pulls the blood from your body and then centrifuges to separate. Centrifugation pulls the red cells to the bottom of the tube. Floating between the red cells and the yellowish plasma (B Vitamins!) is the buffy coat. We want the buffy coat.  In the buffy coat are the lymphocytes and stem cells. How many stem cells is determined later in the lab where the collection is sent for cryopreservation and characterisation. After centrifuging the cells, COBE decants the buffy coat to a collection bag and then returns the red cells and plasma to my body. Around 5 hours into it Betsy could see that we were getting close to our target collection amount.

"Everyone is different. We won't know how many stem cells until they count in the lab. Dr. Fernando will call to confirm the collected amounts".

I left feeling (and looking) rather green. At least four of my blood volumes had passed through COBE, and he kept one cup of it. We visited floor 8 where Brittaney was working. Looked into the closed doors of the bone marrow transplant unit. 8 beds. 8 patients each spending an average of ~30 days in those rooms. ? 72 patients a year?

Made our way home. Dad, Zoe, Kai and I went for walk. The greeness began to leave me.

As promised at dinner, Dr. Fernando called. "Mr. Jacobs, you are more than okay. You are very good. We have 6.6 million cells/kilogram. You will not be able to see Betsy tomorrow. And, no more neupogen".

Gearing Up

It's happening. We're getting ready in many ways to begin this transplant adventure. The hospital stay last weekend was smooth. Joseph had his port put in and A 12 hour chemo drip. Released on Saturday and feeling well. I've been giving him two shots every day for the past week so that his stem cells mass produce. The shots are supposed to cause bone pain, as that's where the cells are created and concentrated. Luckily, until last night, there has been very little discomfort. Neil, Joseph's dad, will come tonight in order to take him to the hospital for an all-day stem cell harvesting session. Joseph will be hooked up to a machine via his port, that takes his blood out of his body, filters and collects his stem cells, and puts the "naked" blood back in him. This should leave him feeling tired. Tuesday, I will take him for collection and Wednesday his sister, Caroline, will take him. Hopefully by then they will have collected enough cells to do the transplant, but if not, he goes back Thursday and Friday. On the chalkboard in the kitchen we've started a "comfort list" of things that Joseph would like in the hospital. My mom is altering some personal shirts that can Velcro open on one side, in order to fit over his IV pole. He hates wearing that stupid hospital gown. So those will be uplifting. And taking his own blanket, poetry, music, sketch pad, his favorite face scrub, and lip balm are all up there. We'll get through this. He's tough and grounded. I think it'll in some ways be harder on the people watching him go through it.

glow-in-the-dark mama

Today was my three year scan. It always feels a little creepy being injected with radioactive fluoride. I tried to kill time afterward, to stay away from Zoe and Kai. Took myself out to lunch on Broadway at a Buddhist Vietnamese restaurant. Watched the crazy Sacramento folk while eating tofu and rice. It was lovely to be alone. Then went shopping at the Plaza, and grocery shopping at Trader Joe's. Finally, I went home and the kids ran away screaming, "Mom's radioactive! AAaaahhhh!!!!" Very funny.

All of this to say that while reading them a story, Dr. Tuscano called Joseph with the news that my scan results are clear. And that because it's been three years, I'm as good as cured.

I'm giddy with relief.

Now to get Joseph some of that.

Beautiful children

everywhere bring

songs of the great opening

(snot-nosed/irritated/ing/loud)

they sing the breath

blowing life

blowing love

blowing heart

back into this tired human world.