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.Just before Bart boarded the flight, Steve Wolff called back with worrisome news.David s white blood-cell count was 177,000 and the normal white blood-cell countfor a young man is between 4,000 and 7,000. He s got about thirty times toomany white blood cells, and that indicates a lot of disease, Dr.Wolff said. It svery aggressive. The immediate danger, he said, was leukostasis, a life-threatening thickening ofthe blood. He s at a critical juncture, Wolff said.He recommended that David bemoved, and quickly, to a specialized facility equipped to deal with aggressiveleukemias; otherwise he could deteriorate quickly. He needs to make someimmediate progress against the disease, he told us.Bart got on his plane, worried sick.He and Och flew to the States with Bart sittingbolt upright.Finally they touched down inChicago, and as he changed planesforAustin, Bart talked again to Steve Wolff.David was going to be moved byambulance to the M.D.Anderson cancer facility inHouston, where a specialist waswaiting to admit him.Bart landed inAustin, got in a car, picked up his mother, and began drivingtoHouston.He was so tired that his mom had to sing songs to keep him awake ashe drove.They reached M.D.Anderson at aboutfourA.M., and David s new cancerdoctors, Archie Bleyer and William Wierda, met them there.What happened nextwas a testament to the power of science.BysevenA.M.they had performed a bone biopsy on David and typed the cancer.Next, they performed a procedure to lower his dangerously high white blood-cell count.They gradually removed the blood from his body, pulling it from his innerthigh, in order to remove some of the white cells.They centrifuged the blood andput it back into his body.Bynoon, the procedure was complete and his whiteblood-cell count had fallen below 100,000.The last time Bart had laid eyes on David, his younger brother was a robustlyhealthy man with an easy way about him, one of the many smart, athletic youngAustinites who d found a good life in the city, who tapped at a computer by day andplayed pickup basketball by night, and who was so sure and secure in his futurethat he was starting a family.Now Bart stood by David sbedside.In 24 hours, David had acquired small bluebruises all over his body.They were the marks from the capillaries that werebursting and bleeding inside him because he had no platelets.His breathing waslabored and shallow, because there was a mass in his chest.Once David was stabilized, he embarked on a course of clinical-trialchemotherapy, a regimen only available at specialized cancer centers.By August1, he was undergoing the rigors and toxins of chemo, and he had a fighting chanceto survive.I talked to Bart every day, and I sent David handwritten notes regularly. I believein you, I wrote. I know that what you re doing is even harder than what I did.Isee how hard it is on your brother.But I know you re strong, and he s strong.I mjust another guy who s had cancer, and who knows that you can do this. David did well until November, when his health went sideways.He lost the use ofhis hands and feet, the result of nerve damage.He could move one finger.Thatwas it.The doctors began talking about a bone-marrow transplant and looking for adonor, testing the members of his family for a match.David s wife, Rhiannon, spent most of her pregnancy sleeping on a Murphy bedin his room at M.D.Anderson.One evening, as David slept, she went into labor.Rather than wake him, she rushed with her mother to the Texas Women sHospital.Later, as she fought through her contractions, she reached David byphone.She lay there in the delivery room, while David talked to her soothingly.David listened on the other end of the receiver as his first child came into the world.Isabella Knaggs was born onNovember 24, 2002.At Christmas, they found a perfect sibling match for David s bone-marrowtransplant: Bart.On the day after Christmas, my 36-year-old best friend went toHoustonto beginthe process for harvesting his bone marrow, so it could be transplanted into his brother.After a series of EKGs and MRIs, to make sure he was perfectly healthy,the doctors put Bart on Neupogen, the blood-boosting drug that I d been givenduring my own chemo.They also gave him a series of shots in order to build up hisstem cells.Twice a day for five straight days, Bart had to get shots in his stomachfrom a long hypodermic needle.The shots and the drugs gave him terrible bone aches.He complained of horrible,dull, incessant pains.I knew exactly what he was talking about: they re called boneflares, and chemo patients get them all the time.One minute you re lying in bed,feeling okay, and the next minute a deep pain flares through the center of yourbones, deep down below your muscles, where it seems no painkiller could everreach.I teased Bart, trying to keep things light, but it hurt me to know that my best friendfinally, fully understood the cancer experience. Oh-ho, I said. Now you ve joinedthe bone-pain fraternity. On New Year s Eve, they siphoned Bart s blood out of him, and centrifuged it,taking it from his left arm and putting it back into his right arm.They separated outthe plasma.It was difficult to grasp that what was left, a small yellow drip bag withsome fluid in it, contained stem cells from Bart s bones and was his brother s bestchance to live.The transplant was done: some of Bart s life passed into David.It took 100 days before we knew whether the transplant was successful.Eachday went by, and Bart hoped, and I watched from afar, sending messages from myvarious travels. The strength is inyou , I wrote to David. You ve just got tobelieve it. One day in early May, Bart called me.His voice trembled as he said, David iswell, and he s coming home. OnMay 6, 2003, David came home toAustin.He was temporarily leukemia-free,and his platelet count was normal.He was still on medications for nerve pain, andhe was 50 pounds lighter cancer takes the mass out of you.He d lost his job, andthe body he knew, and he had a lot of rehab ahead, with an uncertain outcome.Buthe was home.I wasn t there when he came home, because I was inEurope, but I sent him apresent.It was a bike, a black Trek mountain bike, and a fine-looking thing.Bartmounted it on rollers and plugged it into a windtrainer in David s living room.Davidrode it every day, as part of his rehab.He sat and watched Cubs games and rodehis bike.We hoped his strength would return, but it didn t
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