Happy (Third) Birthday, Pavel!

Today, we celebrate the third anniversary of my husband’s stem-cell transplant–also known as his new birthday, January 20, 2015. Clearly, this day was a significant milestone in Pavel’s life and in our relationship. I believe, however, that telling the story might also be of benefit to others. Some might find the procedure itself as fascinating as I do–the details of a medical miracle unfolding day by day. Others–those diagnosed with a life-threatening illness and the ones who care for them–might gain strength or hope from learning of one man’s multi-decade battle with cancer. Mostly, though, I would like to share with everyone the dailyness of the experience. A diagnosis of cancer need not shape one’s life. Rather, it can be just another of the many challenges one must meet with grace, face with dignity, and learn from with humility. It can even be a source of inspiration and gratitude. These are the lessons I have learned from two husbands with cancer and from all the courageous men and women who shared the same experience and often turned it into a blessing in the lives of others.

Amazingly, this story starts in the early summer of 1989 in Toronto, Ontario, when the 29-year-old Pavel Derka, an avid runner and cyclist, was preparing to marry the beautiful and exotic Rosaline Tseu. After an evening of drinking with his future mother-in-law–his first taste of alcohol–he felt a swelling in his abdomen and was shortly thereafter diagnosed with a fast-growing and aggressive cancer, diffuse large B-cell lymphoma. Even in Canada, where the wait for medical treatment could be weeks or even months, he was moved to the head of the line and began chemotherapy. The wedding had to be postponed for the treatment, and his hair had fallen out by the time he and Rosi said their vows on November 7.

Despite some lasting side effects, the combination of chemotherapy and radiation was successful, and Pavel remained cancer free for more than two decades. Then, on a trip to visit his mother in Mississippi in the summer of 2010, he felt a growth under his chin, and a biopsy revealed follicular lymphoma, an indolent (slow-growing) cancer with a recommended treatment plan of wait and see. The waiting stage lasted more than three years, but in late 2013, Pavel sensed a change in his disease as tumors grew in his abdomen.

In January 2014, he began a kinder, gentler form of chemotherapy than the CHOP regimen he underwent in 1989. The tumors immediately reduced in size, and the overall treatment went well, with no nausea and not even any hair loss. However, by June, although the follicular lymphoma had been treated successfully, the remaining cancer cells had transformed into the aggressive type of lymphoma he had in 1989.

He began another round of treatments–this time as an inpatient, several days at a time throughout the summer. This was the grueling kind of chemotherapy (RICE), with hair loss and nausea and overall debilitation. In the midst of it all, we got married on September 5, 2014, and he had to return to the hospital for another round of chemotherapy on September 7.

Having undergone this successful treatment of his lymphoma, Pavel was simply waiting to be accepted as a candidate for stem-cell transplant. Once he had his initial appointment at the UNC Bone Marrow Transplant Clinic, the preparations began.

For much of the time before and after the transplant, we were privileged to stay at the Family House sponsored by the State Employees’ Credit Union. This place of compassion and love offers rooms or suites, depending on the length of the stay, for people who must be near the hospital for frequent visits. Volunteers provide lavish meals each evening, and local music groups provide frequent concerts and other entertainment. The times spent there were truly periods of healing among other patients and caregivers grateful for a look or a word of understanding.

The first step for an autologous transplant patient is called mobilization. Two days of high-dose chemotherapy both destroy any remaining lymphoma and lower the blood counts to make room for the rapid proliferation of stem cells needed for the transplant. After receiving the chemotherapy, the patient receives injections of the growth factor Neupogen to increase the production of stem cells. During this period, the immune system has basically been destroyed, so the danger of infection is extremely high. Seven to ten days after the chemotherapy, the counts should be sufficient to begin harvesting the stem calls. When sufficient cells have been collected, they are frozen–a process which not only preserves them, but also kills any cancer cells that might remain.

After the successful harvest, another period of waiting began. We bough a new car, and then we went to the beach for Christmas with our two favorite people, Bianca and Claudius. Although the Outer Banks was practically closed for the holidays, we managed to find some pretty good food.

Day minus 6 was January 14, 2015. Pavel was admitted to the UNC Bone Marrow Transplant Unit and began the countdown to his transplant. The unit is a community unto itself–albeit it a very clean one. All visitors must go sterilize themselves themselves thoroughly–two hand washings while singing “Happy Birthday” and then the mandatory hand sanitizer. I had my own bed in Pavel’s room, and we had all the comforts of home (more, actually). Patients are encouraged to keep active and can even win prizes for completing a marathon around the halls of the unit. People brought homemade knit caps and blankets for the patients, a recreational therapist led some of us in singing, and the nurses always had time to share personal stories. An even higher dose of chemotherapy began on the first day of admission. This treatment is designed to wipe out the bone marrow and enable the body to better accept the stem cells. Of course, the possibility of infection is high, so constant monitoring of vital signs and blood counts is essential.

Day 0 finally arrived: January 20, 2015. A team of professional, efficient, and personable nurses began arriving in the room at 11:00 in the morning. They brought the frozen stem cells in a refrigerated compartment and quickly began checking name and birth date on all each bag. They provided mints to counteract the taste of the preservative DMSO; they also told me to expect that he would smell like garlic or creamed corn for several days. Bringing one bag out of the freezer at a time, they warmed them and then began infusing the life-giving cells through a large syringe inserted into the aphaeresis catheter. Pavel took their pictures with his phone, and we talked and laughed throughout the procedure. It was over by 11:45. And by 3:00, he was recreating his completion of the BMT marathon, complete with finish line and medal.

And so we come to the end of Pavel’s new birthday. Tomorrow I will continue with the days, months, and years post-transplant–times of fatigue and despair followed by hope and joy and the promise of a bright future.