Remission, Relapse, Rejoice

My family is safe and sound following several harrowing trips through the Columbia River Gorge. We’ve lived in the Hood River Valley for 30 years. Nothing confers “sourdough” status upon visitors more quickly than driving The Gorge in a winter storm. It doesn’t matter whether you are a passenger or behind the wheel. If you’ve negotiated black ice along the mighty Columbia while dodging the snow baths of 18-wheelers, then you’re deserving of some props.

Likewise, stem cell transplants are dicey endeavors worthy of respect. In particular, an allotransplant poses significant threats to the recipient because the donor cells come from another person. These patients must earn their stripes over and over on their journey to remission.

The word remission carries major mojo for cancer patients. To the layperson it connotes cure. In Seattle, at the Cancer Care Alliance, doctors and nurses parsed their assessment of therapies with the word response. This semantic nuance blunts the danger of assuming too much, too soon. Instead of a remission the patient has a complete response or near complete response. Sometimes, unfortunately, the patient does not respond. In such instances, their disease is refractory and relapsed.

This week I learned that a second acquaintance from my summer in Seattle has died. Both received an allotransplant. Leslie was 28 years old. She possessed the caring soul of the kindergarten teacher she was before blood cancer interrupted her nurturing of children. My wife and I met her at a Mariner’s game on the 4th of July. We had the good fortune to spend an afternoon with this bright spirit.

Leslie had been at the SCCA for several months, whereas I was on the brink of my first chemo. She patiently reassured me about the treatments ahead. When I was in the hospital, she returned to her home in New Jersey.

Leslie Smith RIP
Leslie Smith RIP

From there she continued to encourage me with messages on this site just as if I were one of her students learning to finger paint. Now I find she succumbed to her aggressive leukemia, stemmed in part by a transplant that ultimately proved inadequate.

My autologous transplant caused few complications. The cells were my own. I didn’t have to worry about my body rejecting them. I can testify to the simplicity of the procedure. I don’t discount the difficulty of what I went through; it wasn’t a picnic. Seattle roughed me up pretty good. Yet many cancer patients undergo ordeals of invasive surgeries that are much more trying. Some endure extensive radiation that leaves permanent burns. Others, such as my friend, bravely dare the dreaded allotransplant. I got off easy by comparison. My auto transplant is like driving The Gorge with chains on; it’s slow going but you usually make it ok. The allotransplant patient, however, travels the same road with bald tires.

The erratic nature of graft versus host disease, GVHD, endangers the recipient. Like black ice, you cannot see the peril until you are spinning out of control. Patients do not choose allos on a whim. Usually, their disease resisted other options or advanced beyond the scope of safer measures. Occasionally, an allotransplant actually cures the cancer. But the ratio of risk vs. reward is high.

My friends with myeloma have unique takes on how to proceed with their own journeys to remission. Conventional maintenance therapies, alternative supplements, strict dietary regimens; these all offer possibilities for remission. The important thing is to be proactive about your cancer. One can confront it without being obsessive. For me, directing my mind to find the blessing in each common artifact of life seems important. Emotional pain, disability, even death have redeeming qualities, yet they try my equanimity.


Leslie, shortly before her death
Leslie, shortly before her death

I grieve for my friend. There are no cute linguistic tricks to compensate for the loss of such a kind soul. I glimpsed a shining light harshly snuffed out too soon. All will miss her. Her life was brief but well lived with grace and courage. In that, I can rejoice.

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