Lessons From Living, Dying and Living Again

Chapter 6 (preceding chapters are posted below)

Elevator Bldg., Park Vu

In October 1958, at the Boris Kidrich Institute in Vinca, Yugoslavia, there was an accident involving a nuclear reactor. The reactor, in use for research purposes, malfunctioned and released radiation into the lab’s interior spaces. Six workers received potentially lethal doses. All developed severe radiation sickness and one of them died right away. The other five unwittingly took part in a medical marvel. They received experimental allogeneic bone marrow transplants, the first ever in humans. The transplants eventually were rejected by all the patients, so little was known about blood and cell compatibility. But it was thought that before rejection the infusion of donor marrow probably contributed to the men’s initial survival.

         Rushing to the scene to conduct the transplants had been a French oncologist named Georges Mathe. He and others had been working on transplants, usually with mice, for some time, with promising results. But they’d been reluctant to try it on human beings. Now, with Mathe’s relentless pushing, they’d just gone ahead and done it. In certain, major ways the work had been successful, but it still seemed like an experiment. It had a back-to-the-drawing board feel to it. Doctor Mathe did go back to work, almost obsessively, and in 1963 he shocked the medical establishment again by announcing he’d cured a patient of leukemia via a bone marrow transplant. Again, the patient didn’t survive for long, but it wasn’t the leukemia that killed him, it again was complications from the procedure. After that, work on thousands of refinements started up around the world, but Dr. Mathe had set the bar. “It was quite a leap of scientific genius,” said Dr. Joseph H. Antin, chief of stem-cell transplantation at Boston’s Dana-Farber Cancer Institute. “He’s one of the original innovators. Much of what we’ve accomplished can be linked back in a fairly direct way to the work he did in the 1950s and ‘60s.”

         At around the time of Dr. Mathe’s leukemia announcement, a couple of Canadian researchers, Drs. James Till and Ernest McCulloch, stumbled upon a discovery that would soon make all the difference in the transplant world. While delving into the many mysteries of bone marrow they’d turned up a cache of something they hadn’t noticed before: self-renewing cells – stem cells, as they’d eventually be called. Further, they discovered that these cells had the ability not only to grow, but to take on the characteristics of whatever type of blood cells the body needed – white (help the body fight infection), red (carry oxygen through the body) or platelets (help blood clot and prevent bleeding). Researchers realized that if they could inject the cells into a failing vessel, they might propagate and bring new life and strength, and not just for cancer patients but possibly for other illnesses as well. Now other labs around the world joined in the effort. One major finding came early on. It became clear that, once they were injected, the new stem cells often went fatally to war with whatever host cells they encountered. Researchers realized that in order for the new cells to have a chance do their job, the old cells would first have to be removed. The good news was that advances in chemotherapy and radiation were making that increasingly possible. In my case, several days of intense chemo would wipe out both my cancerous and noncancerous cells (kill me) and then an injection of Matt’s healthy, younger cells would bring me back to life.

         As to Matt’s role, other advances over the years had made the donor’s job reasonably simple and painless. Instead of undergoing the arduous physical removal of marrow from his hip bone, he’d lie on a hospital bed as a catheter in one arm removed blood, sent it to a machine that extracted the stem cells (I always picture a coffee filter doing the separating), and then returned it via a feed to his other arm. It would take four or five hours to collect enough stem cells. They’d be bagged, tagged and, in a day or two, injected into my own bloodstream, where they’d migrate to my marrow and replace the cells that had been burned away by chemo. At least that was the plan. Lots of problems might pop up, especially among the millions of adjustments following the procedure, but the road into Mount Sinai’s operating theater had become clear, straight and well-lit. No turning back. June 27 was the day.

         Following Connecticut’s long winters and stubborn springs, June can sometimes seem like it will never arrive. But in 2023 it arrived way too soon for my taste. It came in at a gallop. I by now had little to do but wait as the days tumbled forward. My continuing neutropenic state kept me from any “Connecticut Icons” speaking engagements. I’d withdrawn from my golf league, leaving my partner with the task of finding a new mate. I couldn’t summon the focus or the creative energy to work on any writing projects. My calendar showed nothing other than doctor appointments and a few birthdays and anniversaries. Doctor Keyzner had not seemed terribly fazed by my stay in St. Mary’s. There’d been no lingering effects or notable weakening in my systems. Just to be sure, she put me through all the preliminaries: EKG, echocardiogram, CT scan, liver and kidney exams, a pulmonary function test, an assessment of my veins, and blood draws of every stripe. All was “go,” as they used to say leading up to NASA space launches. I was ready to get locked into the capsule.

         We didn’t have any kind of send-off. We didn’t really have too much of an idea of how long I’d be gone. I’d always been in charge of paying the bills and minding our family financials, but by now most of the major bills were taken care of with auto-pay and our financials were in the capable hands of Marcia’s brother, Dave, a longtime broker and financial advisor. Even so, I went over everything with Marcia and John, warned them we’d soon be getting our property tax bill in the mail, and asked that my car be taken out for a run every now and then. There was also the question of our July beach rental in Rhode Island. As I indicated earlier, Quonnie had for years been a place of peace and relaxation for all, but especially for our children. They’d enjoyed its sea breezes, sandy bike paths, crabbing expeditions and weekend morning softball games for as long as they could remember. Even now, they liked to entertain each other with tales from Quonnie’s timeless summer story and their own indelible places in it. We months earlier had reserved our place for four weeks, beginning the last Saturday in June. Soon after, I realized I wouldn’t be able to do it and then I learned that no one else in the family wanted to, either, if I was going to be in a hospital room somewhere. At first we thought the last two weeks of July might be a possibility but then decided the last two weeks of September could work. Luckily, we’d rented the same place for several summers in a row and had built a relationship of sorts with the owners. They hung with us through all our changes, as did the rental agent, and for that we will always be grateful. My own take was that if I could get to the beach, by medivac if necessary, even for a single day, I’d be delighted. But delight would not be on the menu that summer.

         Marcia and I went down to Manhattan a day early and stayed overnight in our friends’ unoccupied apartment just off Madison Avenue on East 67th Street. We strolled over to an Italian restaurant on Lex, where we dined in one of those ubiquitous sidewalk enclosures. Dining at the table next to ours was a person in a full Spiderman costume who, as far as I could tell, never went out of character. We tried not to be solemn about the occasion, but the “last meal” or at least “last good meal” aspect was hard to avoid. The plan was to go up to Mount Sinai the next day for admission and a battery of meetings with the admitting nurse, the social worker, the physical therapy worker, the drug person, and so forth, all of which we did. At some point, Marcia left for home and I changed into my hospital gown. Also at some point, when I was out of my room, someone entered and lifted my pair of AirPods, brand new and never worn, a “going away” gift from a dear friend that I was stupid enough to leave on the bedside table. Not a great start to my visit, although it taught a valuable lesson about pocketable valuables in a place where many different people entered and exited many times a day. I think we did manage to trace them to New Brunswick, N.J., but that’s where the trail went cold.

         I don’t know if I ever learned what floor I was on, but it was another Neutropenia Suite for one, with bathroom, TV, comfortable chair and even a view of a sliver of Central Park, shockingly green and inviting against the neutral colors of the hospital exteriors. It was even possible to see the softball diamonds where Matt played some of his city games. The building was the Guggenheim Pavilion, designed by I.M. Pei and opened in 1992. The New York Times had greeted the new building with lavish praise (I did notice the name of Times publisher A. O. Sulzberger on the hospital’s roster of board members). “I.M. Pei continues his quest for a clean, well-lighted place,” the Times’ report began. “This time, the search has turned up a couple of beauties: a pair of lofty atriums, luminous with natural light. Rising 6 and 11 stories, respectively, these radiant, three-sided rooms offer Mount Sinai’s patients one of the world’s oldest holistic therapies: architecture.” But wait, there’s more: “Mr. Pei has created a modern building that looks nothing like a hospital, even though it is one. It resembles, rather, a health spa, a tranquil oasis where trees grow and space soars amid urban bustle and big-city hospital commotion. [It’s] a building of uncommon clarity in more than one sense: lucid in organization, lustrous in space.” Well then. Would it be churlish of me to say that the brilliance of the triangles never occurred to me, nor did I ever say to myself, “Hey, wait a minute, am I in a hospital or a health spa?” I saw it instead as a handsomely designed hospital, on the new side, well equipped, with public spaces I was unfortunately never able to visit. I guess the gulf between a patient’s view and that of a newspaper’s architecture critic can be wide.  

         One thing I did notice and come to greatly appreciate during my long term at Mount Sinai was the roster of names displayed on the walls of the hospital’s many buildings and halls – Guggenheim, Hess, Icahn, Klingerstein, Kravis, Rubin, Annenberg and all the rest. Were they robber barons and thieves? I don’t know, maybe, but they’d been big givers in a world where big giving was needed. Of course there’d been thousands of little givers, too, and all could be rightfully proud of what they’d helped create. But the big guys, the pharaohs, kept Mount Sinai at the head of the class when that meant raising $500 million for a building project. The longer I stayed, the more I was thankful for their largesse.

         As that first night fell, I had no choice but to contemplate what lay ahead. All else, all those months and years, had been mere prologue. The moment had finally arrived. I would undergo three days of powerful chemo infusions, have a day of rest, and then receive my new stem cells. At some point during this period, Matt would be in a bed in another part of the hospital having his cells extracted. I’d had a chance to speak with him a few days earlier. He of course feared that his cells would not be enough to do the job and somehow would lead to my demise. He wondered if he was really the right one for the job. I begged him not to worry, and that if anything went wrong it was the fault of the patient (me) and not him. “If the procedure is a success, you’re a hero,” I said to him. “And if it’s not a success, you’re still a hero.” I thought of that conversation as I drifted off in my narrow hospital bed that night of June 22, the first of 100 straight nights of sleeping flat on my back.