Day Zero

Susannah received a bone marrow transplant today, around one PM. The donor was anonymous, and will remain so for at least a year, maybe forever. We know he was male, and in his fifties, and probably from North America. (An internationally shipped bag of stem cells would have been packed in a preservative that would cause Susannah to smell like "rotting garlic," which she does not.) The process, like so much of medicine, involves hanging a plastic bag of liquid upside down and letting it drip (no pump in this case) into her bloodstream. Rather un-momentous in appearance, but truly incredible in impact.

The stem cells meander into Susannah's now-ablated bone marrow, and take up residence. They will (slowly) take over the functionality of her old bone marrow, which means producing her blood. (Susannah's blood type, for instance, will change to match her donor's; she will also lose almost all of her old immune system's “knowledge” of diseases, and need to be re-vaccinated.) Typically there is a long period of squabbling as the new set of cells come into harmony with her body. Susannah finds a new guest-metaphor in this, Shams as the guest of Rumi. (Shams was also, of course, an epically disruptive house-guest. But a beloved one.)

From now on, Susannah is a chimera, an individual with cells that are genetically distinct from one other. (The tree at the top is a botanical graft-chimera, once a popular novelty in English gardens. (The photo is by Simon Garbutt.)) At the moment, since Susannah still has the Hickman catheters, she is chimera-cyborg. Which goes to show you.

This miraculous process is made possible by the generosity of someone we may never meet, to someone they may never meet: a nearly pure example of free-sharing. It is, by itself, an awesome thing to experience. It is also made possible, for us, by a series of particular good fortunes, both biological and socio-economic, which we are very much aware of. Last but not least, it is made possible by six decades of research into stem cell techniques.

Stem cells remain one of the most promising frontiers of medical research, one of the most controversial, and one of the least understood in the popular imagination. It is my impression that the “stem cell controversy” has served as kind of a proxy campaign for the pro-life movement, a fallback line to hold after they lost Roe v. Wade. In all events, the bulk of this controversy only really relates to embryonic stem cells, a point that often seems to get obscured in popular science articles, or even in congress. (A similar and related lack of clarity surrounds cloning technologies.)

That the maintenance and reproduction of our bodies is a task fraught with ethical issues is nothing new. Nor is it new for the up-and-coming technologies to be seen as scary in a fundamental way. This whole realm of technology, we have been told in generalities since at least Humanae Vitae, is a violation of the “sanctity of human life.” But what we saw today does not feel that way at all: it feels like a gift of life, from a stranger to someone who was a stranger to them: an expression of pure love. That experience, too, should have some voice in this unavoidable debate.

For Susannah, today is Day Zero, the beginning of a count upwards as her (new) white blood cell count begins to climb, and the delayed aftermath of the radiation and chemotherapy announce themselves and ultimately abate. This recovery process is often quoted as lasting for a hundred days, but her immune system will take a year or more to recover some kind of normalcy. But now we are counting up, rather than down.