Day Zero/Transplant Day

"Look, Tom. I'm a little drip."

"No. You're more like a big drip."

With a bag of blood perched on a silver pole, its contents slowly slowly funneling through a series of lines and tubes, Tom and I bantered and chatted and told bad Big Brother/Little Sister jokes as if oblivious to the miracle unfolding between us.
My stem cells -- all nine million of them -- were beginning the journey to their new home just after 4 p.m. on Tuesday May 27, 2008. But before they seeped into my oldest brother's body, a cake, birthday cards and boxing gloves were in order.

Day Zero, A New Birthday, Rejuvenation Day, Transplantation Day -- all names given the day that cancer patients (or others with blood disorders) receive a new lease on life via Peripheral Blood Stem Cells. Like blood-building-blocks, these stem cells multiply and grow into platelets, white cells or red cells and fill damaged bone marrow with a new cancer-free immune system.
My brother turned 63 on May 2.
Tuesday, he celebrated another birth-day with a tiny wind-up toy birthday cake presented by our mother, birthday cards and a pair of old symbolic boxing gloves given by our oldest sister, Anne. Carrying in the pint bag of stem cells, the nurse sang "Happy Birthday."
Soon, Tom's central Hickman chest catheter flowed with bright red liquid collected from me the previous day.
The official count of stem cells in the first bag?
3.74 million.
Don't ask me, I have no idea what that means or how cells that can't be seen can be counted. Only that it was enough to start Tom's transplant, which is similar to a transfusion of blood.
Just an hour earlier, a second bag of stem cells had been collected from me in the Apheresis Unit. Like the day before, the process lasted just short of four hours.

An apheresis unit nurse rushed the second bag up to the laboratory for processing. I knew at least five million stem cells were needed for my brother, based on his weight. But I had no idea how many cells this little sister's veins popped out Tuesday. Twenty minutes after my brother's transplant began, a nurse stopped me in the hall to give me the news: "Five million more stem cells today! Great job! That's a total of almost nine million. Way to go."

Even my big brother was impressed.
We all gathered around his bed, taking photos, pulling up chairs, taking calls on cell phones from well-wishers, including a brother in Kansas. Our 89-year-old mother stood steadfastly by watching her oldest child endure a risky cancer treatment.
The day was poignant in another way for our family, especially for our mother.
May 27 is the birthday of our second oldest brother, John, who unexpectedly died of a heart attack 13 years ago. Now, it's a birthday of her oldest child whose immune system is being reborn with the blood of her youngest child.

All seem to be going well until Tom developed severe chills, chills that wouldn't stop no matter how many blankets were piled atop him. Benadryl, then Demerol finally helped. Such a reaction is fairly common with any blood transfusion, we had been warned ahead of time but it scared everyone in the room. The nurse reassured the family that Tom could stay and receive fluids until he felt better, which turned out to be about 9:30 p.m. -- 13 hours after he'd arrive that morning, including enduring a full hour of full-body radiation.

I had already left for home when he suffered the reaction. So I felt bad I hadn't stayed. My Mom felt bad because she couldn't do anything to help. Of course, his wife and daughter also felt scared and helpless.

It's, unfortunately, the beginning of a lot of unknowns that lie ahead. Tom's immune system is essentially non-existent so avoiding people, germs and infection is of utmost importance. Four months is how long he and his wife have lived in downtown Seattle while going through countless medical appointments, blood tests, pre-transplant protocol screenings and doctors' conferences at Seattle Cancer Care Alliance.

Now the countdown begins from Day Zero to Day 100.
That's how long patients generally need for their immune system to strengthen and for their bodies to start recovering.
It means three more months away for my brother and his wife from their sprawling rural log home in the mountain town of Leavenworth. Three more months biding time reading, watching Mariners baseball game on TV, piecing together puzzles in a one-bedroom apartment at Fred Hutchinson Cancer Research Center's Pete Gross House for out-of-town cancer patients. Three more months making countless daily trips down to the clinic for one more blood draw.

But Day Zero is finally behind us.
And Day One is done.