58: 100 Days in Omaha
Chimerism is a rare phenomena in nature and a fairly common one in a transplant hospital. I mentioned in an earlier post that I am partly me and partly my brother Donald. This is not a figurative statement — my bone marrow and blood system has two different DNAs. I’m fortunate that Donald’s alleles — and for that matter, my brother David’s as well — are almost the same as mine. This isn’t assured or even common among siblings and its even less common when you’re an only child. Good work Bob and Joyce.
Donald and David, the image of nonchalance and confidence.
The question now is how much? It’s not easy to answer, at least I assume it’s difficult because it takes a couple of weeks. Doctor Cathy was especially eager to recognize my excellent levels for platelets, white cells, red cells, hemoglobin, iron and magnesium, etc., so I knew something was up. She flipped the stapled pages and her tone changed. “The chimerism count is concerning.”
On my first chimerism count, the assault campaign was looking promising. The good guys had established a beach-head and were softening up the bad guys’ defenses with light shell fire. The tacrolimus and mycophenalate were providing air cover over the mountains and it looked like a matter of weeks before the bad guys would abandon their posts, leading to a rout. But news from the front travels slowly. What we know today represents the facts on the ground two weeks ago. The latest reports show a disappointing reversal. The good guys are down to only five per cent.
I try not to consider the obvious: that fifteen to five per cent represents a downward trend and that, if it was five per cent two weeks ago, it could be zero now. I consider, instead my overall feeling of well being, my increasing level of energy, my stable appetite, and my life-long record of plain dumb luck. I also take into consideration the matter-of-fact expression on Doctor Julie’s face after Doctor Cathy had delivered the report. Doctor Julie chose a new, lower level of mycophenalate and said, “We’re looking for a little host versus graft.”
You might take the view that the air-cover is being called off so that the bad guys venture down the slopes. This provides an opportunity for the good guys to engage in battle, make an advance and call in a new battalion. I try to keep in mind that the stem cells transplanted from Donald are still there. I didn’t count, but there where several thousand of them and apparently, at least in theory, you could generate a whole new system from only one. It’s like having an unlimited supply of patriotic youth. Ultimately, one of us has to prevail, however, and it may not be the good guys.
But my general health is so good that Doctor Julie has confidently released us from Omaha except for a weekly morning of tests and appointments. Yes, we are packing our bags and heading home to Des Moines.