At Life's Excruciating Edge

I will say this for the New York Blood Center: they know what they are doing. The day after I received the call, a package arrived in the mail with a videotape, a binder labelled "now that you are a match" (in subtle, lower case letters), a folder from the National Marrow Donor Program (among the contents a Newsweek article on marrow donation with the less-than-subtle title "The Right Thing To Do"), and a personalized letter (dated on my birthday) that made it seem like they had been planning this behind my back for months.

I had a quick flash of what might have happened at the Blood Center after I hung up the phone the previous morning: the nurse setting down the receiver with one hand and slapping a giant red button with the other; flashing amber lights and sirens exploding all over the building as men and women in white lab coats scurried to and fro, the occasional "one in a million" and "we've got a live one" overheard among the din; schedules rewritten; tennis games cancelled; oompa-loompas laboring over complicated marrow-collection devices.

They were, of course, simply well-prepared, since marrow transplants are time-sensitive procedures. Included among the paperwork was a 10-point schedule for the next month with the unappetizing title (in all caps) "EVENTS LEADING TO MARROW HARVEST." I never became accustomed to the word "harvest" with regard to my own body; I associated it with post-mortem eyeball transplants or waking up in a bathtub full of ice with my kidneys missing.

The information washed over me like a dull, grey tide. I became lost in the sentimental video tape (two Hallmark-style dramas entitled "The Living Gift" and "The Challenge of a Lifetime"); the reams of practical information (pre-transplant diet limitations, physical exams I would undergo, an unnecessary pregnancy test); and even the professional qualifications of the staff (among the "MD"s and "RN"s that followed names on the letter was the bizarre concoction "MT(ASCP)SBB" after the director of Special Donor Services).

I would have been happier if they had just slipped into my apartment in the middle of the night, chloroformed me, and drained my marrow as I dozed. But it was not that easy -- removing marrow for transplant is a long, complicated procedure. They had already set the date for early December -- just five weeks away -- and over the course of November I would be poked, prodded, and bled for test after test to make sure my marrow was healthy enough for transplant. The removal process is risky and would drain a good deal of my blood, so I had to give several pints in advance to be pumped back into me during the procedure. Slowly, by the drop and the needle, I felt my momentum stall. By late November I was so sapped of strength that I had to withdraw from two of my classes, and I found myself sleeping past noon every day.

So when the next call came, this time late in the morning, it was as surreal as the first. I was told the transplant would be delayed because the patient had an unbalanced white blood cell count and required further testing. This made little sense to me; an unbalanced white blood cell count is the very definition of leukemia -- why was this considered a new development? It took a few long seconds to realize the nurse was not talking about the marrow recipient, she was talking about the donor -- apparently my blood had secrets of its own. I needed to see a specialist. Immediately.

Over the previous weeks I had made numerous visits to the Blood Center to fill out forms, donate precious fluids to my future self, and submit my various components to endless needles and machines. The visits were unremarkable -- sterile floors, polite doctors, a mélange of white cotton, green walls and cold steel. But one person, a mid-40s check-in clerk named Reymond, always stuck in my memory. Reymond, frankly, creeped me out. He was the first person I had to talk to at each visit, and it was never enough for him to check me in. He looked at me the way a 10-year-old girl would look at an injured bird, wanting to cover me with a blanket and feed me hot soup until I felt better. He always insisted on making small talk, but as sincerely as possible, and always with an awkward religious comment before he ushered me into the clinic -- "I'll pray for you" or "God is with you." I appreciated his empathy, but he only reminded me how much my world was suddenly beyond my control.

For 18 months I had been rewriting my future, pressing every atom of courage into a second chance, only to have my own body attack from within. I sat in silence after hanging up the receiver. All I could think about was Reymond -- who must have been taking the news of my illness at least as hard as I was -- kneeling in an Upper East Side hospital chapel during his lunch break, quietly praying for my life.

Regrets

I learned early on that I was the last person I could trust. My own impulses have scared me -- and scarred me -- more than any fight or car wreck I've ever been in. I call them my "little sins," those moments of misguided spontaneity that followed since I was first caught stealing from my parents, occasions so utterly humiliating that I would again be transported beyond my senses to view myself from an outsider's perspective. At several points in my life I had thought about studying law and moving into the political sphere, but considering my lack of restraint (and its accompanying penchant for brutal candor), I belong in front of a podium like a road flare belongs on top of a Christmas tree. I don't drink alcohol, for obvious reasons. And like most people, but with probably a little more gratitude, I thank God for the advent of email.

These moments seemed harmless at the time, the smallest off-the-cuff comment or playful flick of the ear, normally innocuous, except when the comment was during a job interview and the ear belonged to a relative stranger. Memorable among these regrets was the day a fellow soldier, Private Herron, confessed during boot camp that he and his wife had recently lost their child, leading to an awkward silence I tried to fill with the brilliant zinger, "Did you find it?" This was the second time this had happened to me.

When I was in grade school, I wanted to be funny. More accurately, I wanted to be liked, and since I was poor and runty, funny was the only weapon within reach. I used to memorize Red Buttons routines -- ancient monologues about his wife that I barely understood but my mom seemed to laugh at -- and insert them into fourth-grade playground banter as if they were coming to me deus ex machina. They never laughed, and I rarely cared, regarding humiliation as, more or less, a permanent state of being.

But when I think of Julie, a girl I knew for one day in my early 20s, the twinge in my stomach returns -- the sudden, painful knot I get when I lean too far back in my chair and lose control -- the pang that accompanies memories of my endless stupidity. Julie was a beautiful young college student with whom a friend had fixed me up on a double date. It was her voice that attracted me, like warm honey, sweet and viscous. She had made us a spaghetti dinner at her apartment, and I felt as if I were on a quiz show, as if everything I said or did had to be intelligent and entertaining.

I remember how she laughed when she hit the floor, or rather, gasped in surprise as I watched my hands pull her chair out from under her, how fingers shot past hips to absorb the impact, how she looked up at my hands on the back of her chair, then at my face, at my stupid face, which must have been frozen in guilt, which must have begged for pity with one solid, pathetic expression. I was trying to be funny, and immediately realized that I wasn't. But she laughed, stood up, and pulled her chair to the table, keeping both eyes on me, her smile fading.

I had wanted so badly to impress her. Her laugh was fake, but generous, a kind gesture, a towering statue of pity with my name inscribed on the base commemorating the event, and the inscription: "Slapstick is not funny, especially on the first date." The prank was forgotten in minutes, washed out to sea by waves of idle dinner chat, but I couldn't get it out of my mind, not through dinner, not the next day, not in the dozen years since.

Their eyes always reveal different messages, each a unique, subjective judgment of my intent, my moral disposition, my state of mind. The fourth-graders looked at me with simple confusion, and today I look back at them with amusement at my childhood awkwardness. Private Herron's eyes burn deeper -- the wordless stare of a would-be father manufacturing memories of a would-be son. When I try to soften the memory, I feel only quicksand rising in my chest. There are dozens more, gazes angry, quizzical, and pitying, but Julie's seems to melt them all. She understood, I felt, judged kindly, saw something of herself in me, a memory of a prank gone wrong or an odd comment she meant with the best of intentions. In my memory, all of these faces appear jaundiced, a tint of motel-sign yellow, telling me I would never be as good as them. But in Julie's eyes, in those kind eyes wrinkled by that kind laugh in that warm, honeyed voice, I felt that I could be better.

Warrior

Without a doubt, the most physically challenging period of my life was a summer month my battalion spent learning how to perform cliff assaults in the high altitudes of California's Sierra mountains. Early every morning, when the moon was still the brightest object in the sky, we would don rifle, helmet, flak jacket, and approximately 40 pounds of gear, and hike in the snow from 3,000 feet to 5,000 feet just to reach the training area. Some days we would continue climbing to as high as 13,000 feet, and some nights would perform mock raids in lieu of sleep.

But the most demanding task -- a ritualistic passage towards the end of training -- was a high-altitude river crossing. Think of reaching into a trough of ice water to retrieve a beer or soda. Imagine the drink you want is hidden somewhere on the bottom, and you have to dig down, past your elbow, and feel around for a few seconds, grimacing as the heat is instantly drawn from your arm and an excruciating iciness sets in. Now imagine that you are standing in the water up to your chest, that it is a rushing current, and that you have to walk from one side to another -- approximately the width of a football field -- wearing all of your gear, with only a limp rope strung across the river keeping you from being swept to what seems like certain death. By the time I put my second foot in, I had forgotten where my first foot was.

Once the water hit my waist, I immediately sank to my chest as my legs crumbled beneath me, and only by glancing downward into the rushing water could I tell they were still there at all, limp and helpless against the freezing current. As the panic set in I looked downstream for the rescue divers, the boat, the dock, the dam, the safety net that would collect me and carry my frozen body to some sort of warm chemical bath or resuscitation unit. I saw only men, dressed like me, standing on the banks, waiting for me to cross or die -- it didn't seem to matter which -- so the next soldier could take his turn.

As the current pressed my flaccid body against the line, I was propelled to the middle of the river, so retreating to the shore would have been as difficult as going forward. And there I sat -- or rather, dangled -- as had the men before me and those who would follow, the freshly melted snow carving arctic chasms through my bones. It was a numbness more profound than any actual sensation I had ever felt, not just a numbness of body, but of mind, of spirit, a black hole that sucked everything light and dark from my being, draining the unnecessary and reducing me to the simplest binary equations: yes or no, one or zero, live or die.

By tucking the rope under my armpit, I managed to keep my head above the current, and though I could no longer feel my arms and hands, I could still move them if I could see where they wanted to go. I watched them grip the rope and pull, a few inches at a time, my face hovering just above the surface of the water, until I felt my body rising above the current, saw two pairs of boots beside me, and realized that there were four hands on my backpack, lifting me onto the opposite shore. I remember them smiling, then guiding me over a berm, where a dozen Marines lay stripped and exhausted in the sun, their wet clothes in piles beside them, some chuckling, some crying, many doing both, all with closed eyes and expressions of intense serenity. With my legs still unable to support my full weight, I had to strip lying down, and as if triggered by the sun's rays, I felt a growing combustion on a molecular level, a searing forest fire spreading from cell to cell. I closed my eyes and lay naked in the snow, consumed by a profound heat I didn't know my body was capable of. I was the opposite of numb.

I would revisit the pain of that day -- but sadly, not the pleasure -- five years later as I lay on a cold table in the office of a blood specialist on Manhattan's Central Park West. For a doctor, her office was sparse, just a small reception area and an even smaller examining room with the table, a few instruments, and cabinets lined with an assortment of glass tubes and vials.

Until the news of my own possible illness, the most difficult part of the impending transplant was deciding whether to go under the gas (a general anesthetic) or to be numbed from the chest down with a local. To retrieve my marrow, doctors planned to insert three needles into my iliac crest (the back of the pelvic bone). Since marrow grows in tiny honeycombs, the needles must be repeatedly withdrawn and re-inserted -- several hundred times -- to collect enough marrow (enough being, roughly, a coffee pot full, or 10 per cent of my entire supply). My marrow is apparently very clever -- it would simply be injected into the recipient and find its way to her bones. My own body would replenish the loss within a few weeks.

Which anesthetic to choose became a moot point. The blood specialist needed to withdraw marrow from my pelvic bone for testing (using the same procedure as they later would for the harvest), and she only had the local variety available. I don't know how painful it would have been to use no anesthetic at all -- excruciating, I'm sure -- but it is hard to imagine it being more painful than the anesthetic itself, which is injected directly into the spine and deadens the lower half of the body.

The anesthetic, once introduced, took less than 10 seconds to completely paralyze me, during which time it seemed as if my nerves were trying to relay in advance all the pain I would be missing over the next half hour. I lay face down on the table as a concentrated dose of agony coursed down my spine and into my legs. I was back in the river, this time the icy water attacking from the inside out, every large and tiny nerve below my waist flash-frozen in a moment of pure electric pain.

But there was no rope to guide me to safety. I had waived all agency -- I didn't even have the luxury of giving up. It was as if I had never made it to the shore, my body pulled down into the cold darkness, washed, unmissed, into the ocean with the other insignificant detritus. I thought of the woman, lying in a hospital bed somewhere, counting on me for her future when I couldn't even salvage my own. My attempt at redemption was a sham. I was the author of nothing. My last memory before a sudden, comprehensive coldness, was of every muscle in my legs contracting in an all-encompassing charlie horse, my toes curling tight against a cold steel rail.

Tomorrow: When you take a life, a part of you goes with it. The conclusion to the memoir Little Sins.