The word “transplant” sounds complex and possibly a little gory, like a surgery. But the procedure last night wasn’t at all. It was as dull as it is possible for a medical procedure to be, and that is a very good thing. In case anyone is interested in what actually happened during it, I thought I’d write up the details.
Brad was given Ativan, Benadryl, and some other meds about an hour in advance, so by the time I got to the hospital at 5:45 he was pretty sleepy. The transplant was scheduled for 6:00pm, after James’s stem cells had been conditioned and counted by the lab and sent to Brad’s hospital room. They arrived just a little later than that; the good news was that they collected nearly three times as many cells as they needed. So Brad got more than the minimum dose and they were able to cryopreserve some in case he needs more at some point. They use a preservative when they freeze the cells, so apparently transplants with preserved cells have a strong garlicky odor from the preservative, but with fresh stem cells there is none.
When the nurse brought the bag of stem cells into the room she asked both of us if we wanted to hold it. Brad said no but I said yes. I figured, when would I have another chance? The bag in my hand was heavy for its size and squishy, just a little bigger than my outstretched hand. The liquid inside looked and somehow felt, through the sturdy plastic, thick. Thicker than water. Thicker than blood, but a lighter color of red, really a bricklike dark pink like the preppy men’s pants they call Nantucket reds. (That color reminded me of a family vacation we took to a seaside resort in Maine a few years ago.)
The nurse gently took the bag back from me from me and hung it on the IV tower along with the bag of fluids that was already there. (They bumped Brad’s fluid drip back up for the transplant itself.) For her this was all routine, another day on shift. It was, in fact, the end of her shift, about 6:30 by this point. We were just waiting for the doctor to come in so the transplant could begin.
Once the transplant doctor arrived, the nurse attached bag to the drip where it mingled with IV fluid, and deftly and almost imperceptibly hooked it up to the lumen of the Hickman catheter that burrows under Brad’s chest and into his vein and from there leads directly to the heart. The heart was already being constantly monitored, its steady pumping recorded and able to push that viscous dark pink stuff to every corner of Brad’s body, where they will circulate until all his old bone marrow is dead and gone. And then, the cells—more than 600 million stem cells, 8 million for every kilogram of his body weight—will settle into his bones and grow him new marrow.
The drip was started, and that was about all the medical drama the evening provided. The doctor and the nurses talked about show dogs and dog breeds, about football, about former colleagues. Brad dozed off. The drip continued. After twenty minutes or so the transplant doctor said that if a reaction were going to happen, it would have happened by now, so he left. The reaction that they were concerned about was an immediate rejection; that is apparently more likely with donors whose blood type is different from the recipient. Brad and James do have the same blood type (which does mean that Brad’s blood type won’t change, a weird-but-true thing that happens in transplants). Later reactions of varying degrees of severity, called graft-versus-host disease, are likely but will happen after the new immune system engrafts.
The nurses’ shift changed and the night nurse came on. She stayed in the room for the remaining hour or so of the slow, steady drip, monitoring things. I sat in a corner in my yellow robe and disposable face mask. I took a few pictures of the pink fluid coursing through Brad’s lines, because I liked the pattern it made.
After a while James arrived to say goodbye to Brad; James left early this morning to fly home. The drip finished about eight, slowly turning a paler and paler pink as the end of the bag was more and more diluted with the IV fluids, and that was it: a stem cell transplant.
It was a big relief to me to get past the actual transplant. For much of the past year, we’ve been leading up to that event, and getting to it felt like a real milestone even if the actual transplant was about as exciting as watching paint, well, drip. Frankly, I am not really interested in any further medical drama. Today, Brad is doing well overall, as he said in his post, but more tired today, and his white counts are steadily dropping, as expected in the wake of the intense radiation and chemo of the prep week. But he’s still eating, sitting up, using the exercise bike, and writing. Next up: more waiting.