Day Zero-Transplant

            I wish they called it ‘day one’. I have to force myself not to think of ‘ground zero’.

            Spoiler: David is tolerating the transplant well so far. The Benadryl has put him to sleep.

            Sam and I drive to MGH early this morning. After dropping Sam off and parking, I go directly to David’s room: Lunder 1034. David’s asleep, so I settle in to read and work on my laptop. The MGH guest internet works with my computer!

            The plan is for David to stay overnight and go home tomorrow around noon. I hope I’m not jinxing the plan by announcing it. Since David’s ‘conditioning’ chemotherapy, starting on Day Minus Six, was less intense than the typical regimen, his white blood cell counts are higher than typical and he can return home a week or three earlier than expected.

            The reason David received the lower intensity conditioning therapy is that his echocardiogram showed heart ‘dysfunction’. With imaging, doctors can measure the ‘ejection fraction’: the percentage of blood that is ejected from the heart chambers at each contraction. 55% or higher is expected for a healthy adult. David’s EF is 32%. David has no symptoms: shortness of breath or chest pains, but he is taking carvedilol and lisinopril.

            Sam spends 4 hours donating his hematopoetic stem cells (the cells that develop into blood cells). Based on David’s weight, he only needs half the amount they collect from Sam, but all of the stem cells are infused into David’s central port, very satisfying to the donor.

            Around 2 p.m., Benadryl, Tylenol, and hydrocortisone are given preemptively to avoid an inflammatory reaction.

            At 3:18 p.m., Sam emails the photo of himself with his bag of stem cells. It’s the color of raspberry sherbet.

             At 3:45 p.m. the transplant begins. Meredith, the transplant nurse practitioner, Ashley and Lisa, David’s oncology nurses today, and Stephanie, an oncology nurse in training, stand near the foot of his hospital bed, suited up in thin, yellow cloth gowns and disposable, blue nitrile gloves. A small plastic bag with the pinkish-red fluid hangs on David’s IV rack and gravity feeds it into his central port, which goes into the superior venal cava, in his chest. A blood pressure machine squeezes his left upper arm every five minutes, and his blood oxygen absorption and pulse are monitored closely.

            By 4:08 p.m. the bag is empty and Meredith starts a saline drip to flush the line.

            Ashley asks, “Can I get you anything?”

            “A cheese pizza.”

            At 4:40 p.m., Dr. Chen arrives. “Did I miss all the excitement?” He reports that Sam’s cells looked great. “You did good, man!”

            Jim, Sam, and David settle down to watch the Nigeria-Iran game while I polish my post.

            Here’s a surprise: although Sam’s stem cells are a 10 out of 10 match, his blood type is O positive; David’s has always been A positive. This isn’t likely to be a problem, since O positive is compatible with A positive, but over the next few weeks, Sam’s blood cells will take over and David will be transformed into an O positive guy.