In articulo mortis

Barring unusual complications (e.g, renal failure, resistant virus), most of the aSCT process is routine. There is, though, one moment in which the risk is high, and that is when the frozen stem cells collected earlier are thawed and reinfused.

The day before, they hook you up to an infuser and pump in the Melphalan. No big deal, even though it destroys the bone marrow. The next day, though, an odd thing happens. Before the infusion of the stored cells, the room starts filling up with doctors and nurses. They mill around as if at a cocktail party, chatting with each other about nothing much, almost looking for the canapés. A few minutes after the infusion starts they all melt away, going about their usual business.

So why were they there in the first place?

Believe it or not, the cells, when frozen in liquid nitrogen, are preserved with DMSO. That's right, horse liniment. Apparently, adding DMSO makes it less likely for cells to rupture as they are frozen. Definitely an idea from an out-of-the-box thinker, but it would have been better to find something else.

The problem is some people react to the DMSO with anaphylactic shock. This is not a good thing for a couple of reasons. First, it can kill you right then and there. Secondly, you need the cells to be infused to survive—what happens if you can't use them?

Which is why there are so many doctors and nurses milling around, just in case. If one is going to respond badly, one will do so at once. So after a few minutes, everybody goes back to work.

I should ask my doc about these things.

But I can tell you one more story. The mother of my former housekeeper had to have such a transplant a few years ago. She had the kind of horrible reaction I'm describing. Eventually, it killed her. I believe that when it came time for me to have my first aSCT in 2005, the memories of the death of her mother caused her to emotionally pull away from me. I lost her as a result.