God’s promise was never that life would be fair. God’s promise was that when we had to confront the unfairness of life, we would not have to do so alone because He would be with us.– The twenty-third psalm
Whoever saves one life saves the world entire.– The Talmud
Today is October 15th, 2020. One year ago today I received a stem cell transplant. Soon after I sat down to write a letter to the stranger who had donated her stem cells and saved my life.
I knew nothing about her other than she lived in Germany and was thirty-seven (one year older than me) and she had beautiful cursive handwriting, much better than mine. The letter she had sent me (the one I was responding to) was written on colorful stationary and in perfect English, although if she had someone translate the words for her, I don’t know.
She called me friend and said she was sending love and best wishes for my recovery. She sent me lip balm and hand cream and cinnamon candies and a hat she had knitted herself.
I had no stationary, so I ripped out a few pages from my notebook and clipped the edges with scissors to make them as clean as possible. I had terrible handwriting, even worse than usual; I was taking so many medications I could barely keep track of them, and I didn’t know which one was causing the tremor in my hands, the slight vibration that made it almost impossible to write.
I sat in stasis, pen in hand, hovered over the page. What was holding me back wasn’t my tremulous hands, or my penmanship, or my lack of stationary. It was that I didn’t know how to thank a stranger who had just saved my life.
Here I was, thirty-six but withered away because of what had happened to me, skin brown and mottled from the radiation, eyes sunken and hollow. How could anything I ever did going forward be as significant as the act that saved me? What could I say when I simultaneously felt I had been saved, but also felt like everything had been taken away?
I wasn’t sure what to write her, so I wrote her the truth.
God’s promise was never that life would be fair. When I found out my cancer had relapsed, I hoped I would die quickly. It’s because I had learned there is something worse than death, and it is fear.
That night, my oncologist, Dr. Eradat, came to see me in the hospital. He sat next to me on the hospital bed and and told me the prognosis wasn’t as good this time. He wouldn’t give me a number (he never wanted to take away hope), so I did the research myself. The most recent paper on the subject showed a 5-year survival rate for someone like me as 18%.
Dr. Eradat told me a stem cell transplant was my only hope. Without it I would die. I needed a genetically matched donor. Did I have any siblings?
As I listened to him I felt the blood drain out of my face, and I tried to control the trembling of my hands but I couldn’t.
“I have a brother,” I said. “But he’s not biologically related to me. I’m adopted.”
He frowned. “We’ll have to find a match on the bone marrow registry, then.”
I think family is the order in which you call people when you find out you’re going to die. First I called my parents. My mom picked up the phone, and when I told her she said “Oh…fuck,” and then I don’t remember what was said after.
She was with me the first time it happened—through the diagnosis and three years of chemotherapy, and she stayed home from work to take care of me, and she blended my food into a little paste when the sores in my mouth made it too painful to eat, and she wrapped herself around me when I flung myself into her arms crying that I was sure the pain would kill me—so I’m not sure much more needed to be said.
Next I called my brother, Zach. Whatever shock he felt on the phone he concealed well, but his wife told me later that after we hung up he frantically Google searched “relapsed T cell acute lymphoblastic lymphoma stem cell transplant prognosis” and then locked himself in the bathroom for the rest of the afternoon and sobbed.
I told him he couldn’t be a donor match for me because we weren’t biologically related, but he signed up to be a donor on the Be The Match website and mailed in his DNA kit anyway.
God’s promise was never that life would be fair. There are over twenty million people on the registry, but because so many genes need to be matched, many people cannot find a single matched donor. The match rate is the lowest—perhaps under 50%—for people who are of mixed ethnicity (I am half Caucasian and half North African).
I always thought my ethnic background was so interesting. Now I wished I were just plain-ol’ lily white.
When I got out of the hospital I continued to work and see patients (because what else was I going to do?). When my hair started falling out from the chemotherapy I bought hats and scarfs to cover my head, and when I shat my pants in front of a patient because I no longer had any control over my body I ran into the bathroom and hid until someone came in I could ask for help. I lost my favorite pair of pants that day.
In between patients I would check my phone and email obsessively, waiting to hear if the doctors had found a match for me.
At night there was no escape from the fear. I would lie in bed—hearing only the hollow echo of emptiness vibrating back to me, observing myself as if I were hovering outside of my body—and think about what it would feel like to die.
Most likely the tumor in my chest would continue to rapidly grow unchecked, and it would become so large it would surround and squeeze my lungs and heart, and I would either go into heart failure or suffocate to death.
To expect anything else felt futile; to have hope felt too sad and too crushing.
One day I was at my office, sitting at my desk and clicking through work emails. I had sent a mass announcement to my patients letting them knowing I was closing my practice, and making sure they had referrals. I received many beautiful emails in response from my patients telling me how sorry they were and how they wished me well. There is one message I will never forget.
It was from a shy, reserved young man with treatment-resistant depression. Something about his age (too young to be suffering so much) and his demeanor (charmingly awkward) endeared him to me, and I so desired to take his pain away. Nothing I did, though, seemed to work. I had felt like a failure for letting him down.
His message to me told a different story. It might have contained more words than he had spoken cumulatively since we first started working together six months earlier. He wrote:
“I’ll be forever grateful for what your guidance has done for me. Until you started treating me, I never trusted the therapists I had seen and I didn’t believe what I had was really something that could be helped. I thought I’d just have to deal with it.
I want you to know that there are very few people that have made as positive an impact on my life as you, and your help truly changed my life. It may have even saved it.”
Something shifted in me when I read it. Had I really saved his life? Could it be true my life was worth this much to others, that sometimes we help the world in ways we don’t realize? Could I hope for my life not just for myself, but for those I might one day help?
I started to cry, and then I started to beg. It felt futile to hope, but I did it anyway. Please God, I don’t want to die. I don’t want to die.
At least one life had been saved, even if it wasn’t mine.
It was shortly after that we found her—the one in twenty million who shared enough of my genes that she could save my life. All they would tell me was she lived in Germany and was thirty-seven years old. I asked, Was this confirmed? Did she promise? Could we wrap her in bubble wrap until it happened (you know, just to be safe)?
My transplant was scheduled. I was admitted to the hospital and received my conditioning treatment (chemotherapy and radiation). She donated her cells in Germany, and they were couriered overnight to Los Angeles. I couldn’t let myself believe it was really happening until it did—until I saw the pale pink bag of cells hanging off of my IV pole, infusing into my arm.
It worked. The next month was hard, but her cells successfully engrafted into my bone marrow. Over this past year I’ve been slowly recovering. My DNA is gone; my blood cells are no longer mine, but hers.
Now it was not just one life that had been saved, but two.
Then… something really amazing happened.
Two months ago, my brother received a call.
It was from Be the Match, and they were calling about that DNA kit he had mailed in the year before, the one he did in symbolic solidarity with me. He was a perfect DNA match for someone who needed a stem cell transplant, a sixty-seven year old man—the one in twenty million who shared enough of his genes he could save his life. A stem cell transplant was the only cure for this man’s disease. He had no family who could donate. Without it he would die.
My brother submitted a second kit for confirmation, and then did the pre-donation physicals and labs. The week before, he received injections of Neupogen, a medication that stimulates your bone marrow to make extra stem cells. Then he drove from his home in Fort Lauderdale to Miami where he was hooked up to a machine that filtered the extra stem cells out of his blood. It took eight hours.
When he was done the cells were whisked away and couriered overnight to wherever they had to go the save the person who needed them.
Maybe this man, too, had asked if my brother could be wrapped in bubble wrap, asked if he had promised, prayed he would follow through. Maybe he couldn’t let himself believe it was really happening until it did—until he saw the pale pink bag of cells hanging off of his IV pole, infusing into his arm.
It was not two lives that had been saved, but three.
When I was in Hebrew school I learned about the part of the Talmud that says, “Whoever saves one life saves the world entire.” I didn’t understand it then, but I understand it now.
God’s promise was never that life would be fair. But God promised that when we had to confront the unfairness of life, we would not have to do so alone because we are unavoidably interconnected.
I’m not sure I believe in God—in the sense that God is a conscious being who dictates the events of the universe. I believe the universe is random, chaotic, and without imposed order. But isn’t this idea even more beautiful? It’s not up to God to take chaos and create connection—it’s up to us.
God never promised fairness, but he promised a choice. Was my life saved, or was it taken away? Perhaps I can hold those two thoughts simultaneously in my mind. Perhaps I can choose which one I want to focus on.
I choose to take my chaos and construct meaning from it, to create coherence, to become whole through telling a story.
I’ve decided my story is this:
Every action I’ve ever taken, and ever will take, and every action that has been taken for me, creates an energy that expands out into the entire universe. And energy can never be destroyed, but only transformed, so even after I die, the energy of every good thing I’ve done and every good thing done for me will continue to ripple out forever, into eternity. There it will exist for everyone, always.