They gave him a choice: He could have both chemotherapy and radiation, or just chemotherapy.
Steve Preblud decided on the chemo alone. He knew it would be like taking poison, but it was the only way to kill the other poison, the cancer that had spread through his bone marrow. Of course, it would kill the rest of his bone marrow cells, as well. The hope was that a transplant would cure him.His illness was called chronic myelogenous leukemia. He was jogging last summer when he felt the first sign of it, a great fatigue. He was 39 at the time, an epidemiologist with the Centers for Disease Control in Atlanta. Now he'd journeyed to the Seattle VA Medical Center for a bone marrow transplant. He'd come there with Barry. Barry, his brother. Barry, his donor.
Growing up, it had just been the two of them, two boys. Steve was the family achiever - valedictorian at high school, Brown University, then medical school. And Barry? Barry was different. Barry was special, dependent on his mother and older brother. Even when Barry was in his teens, he sometimes would need help getting dressed, help cutting his food, help being included in play outdoors. Steve would give him that help. That was his role.
There in Seattle, Steve began his chemotherapy. The first drug he had to take was Busulfan. The regimen was a harsh one. He had to swallow 37 pills in a sitting, four times a day. The nausea would start soon after, and then the sickness. It got to a point where he couldn't even keep water down. Then they started him in on Cytoxan, the second round.
The chemo began to go to work. It was toxic to the follicles on his head. Steve's thick, curly hair began to fall out. It was also toxic to his bone marrow, not just the cancerous cells, but the normal ones, too. His bone marrow began to die.
Many patients who are diagnosed with chronic myelogenous leukemia are left with few treatment alternatives. The chances of finding a donor with the right genetic makeup is only one in 20,000. Siblings, however, have a one in four chance of being the right match. Steve's one sibling, Barry, was such a match.
Barry didn't understand all of what was involved with the transplant. He knew only that his brother Steve was sick, and he had the power to help.
Barry checked into a room on the same corridor as Steve. At 6 a.m., Feb. 16, the morning the transplant was scheduled, Barry was taken down for the procedure. He lay on his stomach while the anesthesiologist prepared to put him under. Then it was time to get the bone marrow. While he was asleep, another needle was inserted deep into Barry's pelvis. A full quart of his bone marrow was suctioned out.
At 10 a.m. the marrow was brought up in a bag into Steve's room. The bag was hung on an IV pole. A tube from the bag was inserted into a special needle that had been anchored into Steve's chest, directly into a chamber of his heart. Then, drip by drip, the transplant from his brother began.
It was a long process, due to last six hours. At one point, Steve walked down the corridor, guiding the IV pole, to see Barry, who was just coming out of the anesthesia.
"Hey, buddy boy," said Steve, "how you doing?"
Barry said he was sleepy. Steve stood there for a few moments. For so many years, he'd been Barry's caregiver. Because of Barry's limitations, Steve had presumed he'd always be the one to do the helping. Now it was Barry's turn. That is, if the transplant worked.
Steve knew it would take 14 to 21 days to see if the transplant would kick in. A key measure of the process was Steve's count of polymorphonuclear leukocytes - a form of white cell that fights infection. When Steve first came into the hospital, his poly count was 12,000. Slowly the chemo was killing those off. By Feb. 22, day six after the transplant, his poly count was down to 440. Steve's mouth began to get sore. It was so hard for him to swallow he needed morphine to sleep. By Feb. 28, Steve's poly count was at 30, leaving him with no ability to fight infection. He guessed he would probably linger like this for up to two more weeks.
Meanwhile, he and Barry would play out a ritual. Each day patients are encouraged to walk 22 times around the hospital corridor - a mile. Barry would come with Steve. They were lap partners.
"You're the guy," Steve would say as they walked. "You're my hero. You've done it, Barry."
It wasn't Barry's style to talk a lot. He would simply say, "That's right, Steve," and give him a thumbs-up.
Then came March 1, 13 days after the transplant. At 8 a.m., a nurse came into Steve's room with his poly count. It was 70 - a jump upward. A full 24 hours before the 14-day minimum turnaround point, Barry's marrow had begun to kick in. The next day, Steve's polys were up to 120, then over 500 and rising steadily into the thousands. The transplant was working.
If further tests prove Steve Preblud free of cancer, as is expected, he'll have a 70-80 percent chance for a five-year cure, with every reason for hope after that.
All because of Barry; whom he spent so many years helping _ never realizing what he would be given in return.
Distributed by Scripps Howard News Service