VN News (May 26, 1997---2)

[Vu Thanh Ca <vuca@envi.env.civil.saitama-u.ac.jp>]

Sunday - May 25, 1997


The Fight To Survive A Transpalnt -- Vietnamese Race To America In Attempt  
To Save Brother With Bone-Marrow Operation

By HUNTLY COLLINS <br>
The Seattle Times <p>

PHILADELPHIA - Cu Nguyen felt a rush of cold air as his gurney was
wheeled into the cavernous operating room at Thomas Jefferson
University Hospital shortly after dawn on April 9.

<P>A blur of white lights, stainless-steel tables and beeping
monitors, the room frightened the 27-year-old man as he stared at
long needles neatly lined up on a tray near the operating table.

<p>
Cu did not speak English and did not fully understand what was
about to happen to him. What he did know was that if he didn't
undergo this medical procedure, his brother Huong Nguyen would die.

<P>Huong, one year older than Cu, was in the advanced stages of
acute leukemia and had only weeks to live. His last hope was a
bone-marrow transplant from a genetically similar donor. Cu and
another brother had just been rushed from  Vietnam with the hope of
saving his life.

<P>A doctor placed the anesthesia mask over Cu's face, and he
breathed in deeply.

<P>Within seconds, he was out, his mind drifting back to the small
fishing village in  Vietnam where he had lived all his life. He was
walking along a familiar pathway. And he was singing.

<P>
Where the journey began

<P>It was there, in an isolated hamlet north of Danang, that Cu and
another brother, Bon Nguyen, 39, had begun their journey to America
three weeks earlier, responding to the plea from their brother so
far away.

<P>Both fishermen, Cu and Bon never had traveled much beyond their
village of 80 families. They spoke no English and were illiterate in 
Vietnamese.

<P>When they got on the plane to the United States, they had $20
between them and carried all their belongings in a small gym bag.
Their airfare had been paid by an anonymous donor.

<P>In less than 24 hours, they entered the world of high-tech
medicine where doctors in surgical masks talked of HLA types, stem
cells and myeloblastic leukemia.

<P>Tests showed that both brothers were close genetic matches.
Doctors decided to take the marrow from Cu because he was younger
and healthier.

<P>If the bone marrow took and there were no complications, Huong
would have a 20 percent chance of surviving at least two to five
more years. Without the transplant, he had no chance at all.

<P>
The first harvesting needle

<P>After the anesthesia took effect, Cu was rolled on his belly and
covered with sheets that revealed only his lower back.

<P>Neal Flomenberg, who headed the transplant team, plunged the
first harvesting needle into Cu's left pelvis. His associate, Frank
Beardell, worked on the right pelvis.

<P>As soft jazz played in the background, the doctors drew up
syringe after syringe of marrow and handed it to Janet Brunner, a
physician assistant, who emptied them into a stainless-steel beaker.

<P>In 90 minutes, they made dozens of needle sticks. The dark red
liquid taken from Cu filled four bags.

<P>A laboratory report indicated the marrow was rich in stem
cells, the mother cells that would give rise to a new blood supply
for Huong.

<P>By 10 a.m., Cu was sitting up in the recovery room.

<P>"Everything went great," Beardell told Cu, speaking through a
translator, a  Vietnamese man who worked in the hospital pharmacy.

<P>Cu heaved a sigh of relief and settled back in bed.

<P>
Purging the white blood cells

<P>For the next 10 hours, Cu's marrow was spun in centrifuges,
washed with chemicals and hit by lasers to remove the mature white
blood cells known as T cells.

<P>These cells, which are the body's main defense against
infection, must be removed to prevent them from attacking the host's
cells as though they were foreign invaders.

<P>As the machines whirred, Huong waited anxiously in the
bone-marrow-transplant unit.

<P>As a child working in the rice fields, he had survived the worst
ravages of the  Vietnam War. After  Vietnam fell to the Communists,
Huong escaped and spent three years in refugee camps in the
Philippines.

<P>He made it to America in 1989, completed a training program and
got a job as an auto mechanic in South Philadelphia.

<P>He found a girlfriend and the two planned to marry and raise a
family.

<P>Now, all of that was in danger of slipping away.

<P>His leukemia, which was diagnosed in August, and for a while
successfully treated, had returned.

<P>So far all experimental treatments had failed to bring the
disease back into remission.

<P>
Without an immune system

<P>Shortly after 11 p.m., the doctors began gathering at Huong's
bedside in Room 1406.

<P>Like the other bone-marrow patients on the floor, Huong had a
private room. People who entered had to put on two surgical gowns,
latex gloves and a surgical mask to protect Huong from infection.

<P>Huong had practically no immune system and was completely
vulnerable to the slightest infection. Doctors had spent the last
eight days destroying his immunity with radiation and chemotherapy.

<P>The process - known as lethal conditioning because without the
new marrow it would kill him - was necessary to destroy all the
leukemia cells and eliminate enough of his own immune system to
prevent it from rejecting his brother's transplanted marrow.

<P>A bone-marrow transplant is a risky procedure. There is a 15 to
20 percent chance that patients will develop fatal complications.

<P>Terror was in Huong's eyes as he lay in his bed, machines all
around him, waiting for the new marrow. His gaze softened when he
looked at his girlfriend, Kim Young, 29, and his brothers.

<P>Cu was at the foot of Huong's bed, attached to a portable IV
line to help his recovery from the bone-marrow harvest earlier in
the day.

<P>Except for the beeping of monitors, the room was silent as Fred
Garbrecht, who ran the laboratory for the transplant team, picked up
the plastic bag labeled 109180

<P>A nurse attached a line from the bag to the Hickman catheter
that was delivering antibiotics and other medicines into Huong's
body.

<P>"Are you ready?" said Flomenberg. "I'm going to start it."

<P>Huong nodded.

<P>The doctor turned and put his hand first on Cu and then on Huong.

<P>"Mang from him to you," he said, using one of the  Vietnamese
words he had learned during the months he had been treating Huong.
It meant "strength."

<P>Slowly, the bone marrow - a beige-colored liquid - dripped into
Huong's veins. It would go first to his lungs and then, in about a
day, find its way to the cavities in his bones.

<P>The procedure, which took just 15 minutes, didn't look much
different from a blood transfusion.

<P>But everyone in the room - three doctors, two nurses, a
laboratory technician, the brothers and Kim - knew what was at
stake. They stood in silence, surrounding Huong's bed, watching as
the bag of marrow emptied.

<P>Huong began to shake, a common reaction to the introduction of
new bone marrow.

<P>Cu left the room. His brother's distress was too much for him.

<P>The doctors gave Demerol and other sedatives to Huong. He
stopped shaking, shut his eyes, and drifted off to sleep.

<P>"Good night, Huong," said Flomenberg.

<P>Kim lingered, holding the hand of the man she loved.

<P>
Highly vulnerable

<P>The next two weeks were difficult for Huong.

<P>With practically no immune system and few platelets to clot his
blood, Huong was particularly vulnerable to infection and bleeding.

<P>For that reason, he had to remain in his isolated room in the
transplant unit, a high-containment area protected from germs by
doors within doors. And he was infused with platelets.

<P>Kim and his two brothers visited every day. At night, they went
home to sleep in Kim's cramped second-floor apartment.
Kim had given up her job as a seamstress to take care of Huong after
he fell sick.

<P>Now, she not only had Huong to tend to, but his two brothers as
well. Without her, they could not navigate the bewildering world
they had been thrust into.

<P>A few days after the transplant, Huong developed a fever and
painful sores in his mouth and gut, problems that are typical in
transplant patients. The doctors were not alarmed.

<P>But on April 15, six days after the infusion, Huong became short
of breath and began coughing up blood. He was put on a ventilator.

<P>Doctors didn't know why this was happening.

<P>X-rays showed no evidence of a lung infection. Perhaps it was a
side effect of the radiation and chemotherapy.

<P>Repeated treatments can weaken the blood vessels in the lungs,
making them vulnerable to hemorrhage.

<P>And with few platelets, Huong's blood was having trouble
clotting.

<P>But then Huong's white blood count started to rise, indicating
that the marrow was engrafting. Huong became more alert and
communicative. He asked for a hug from Flomenberg.

<P>For the first time in weeks, doctors let people enter Huong's
room without surgical masks.

<P>Huong motioned to Kim. He wanted a kiss.

<P>Doctors were ready to wean Huong off the ventilator.

<P>But on April 25, Huong threw up. Some of the vomit got into his
lungs, setting off more respiratory distress. The ventilator had to
be turned up full throttle.

<P>As Kim and the two brothers looked on, the doctors and nurses
worked frantically to help Huong breathe.

<P>Unable to speak  Vietnamese, the staff couldn't explain what was
happening, but it was clear to the  Vietnamese that something was
desperately wrong.

<P>It was now a Catch-22 situation. If doctors turned down the
ventilator, Huong didn't get enough oxygen.

<P>But if they left it on full strength, the oxygen pressure
threatened further damage to his lungs.

<P>
A web of tubes

<P>On May 5, Huong lay in his bed, unconscious from high doses of
morphine and other sedatives, his chest rising and falling with the
rhythm of the ventilator.

<P>Numerous tubes ran from his body to the machines that filled
the room. They carried nutrients, antibiotics, amnesiacs for sleep,
and a paralytic agent to keep him from fighting the ventilator.

<P>Kim sat in the hallway outside Huong's room, crying. Bon stood
stoicly by his brother's bed. Cu was too upset to come to the
hospital.

<P>At dawn the next day, Huong's heart began beating irregularly.
His blood pressure dropped. An electrocardiogram showed that Huong
had suffered a heart attack.

<P>During the next few hours, Huong had a series of similar
episodes.

<P>Each time, the arrhythmias lasted a little longer.

<P>Late in the morning, Beardell pulled Kim aside and told her she
should plan to stay at Huong's side through the day.

<P>He also urged her to make sure Cu and Bon were there.

<P>Then he left the bone-marrow-transplant unit to do rounds
elsewhere in the hospital.

<P>Ten minutes later, Beardell was paged. Huong's heart had
stopped. He had been pronounced dead at 12:02 p.m.

<P>
An offering to the dead

<P>More than 50 friends, most of them  Vietnamese, gathered for
Huong's funeral Mass at St. Thomas Aquinas Church in South
Philadelphia on May 10.

<P>Kim and Huong's brothers accompanied the casket as it was
carried into the great domed sanctuary.

<P>Cu and Bon wore white headbands, the custom at  Vietnamese
funerals. Bon carried a plate of fruit as an offering to the dead.

<P>A priest said Mass in  Vietnamese. The ritual was unfamiliar to
the brothers, who were Buddhist.

<P>Bon and Cu, who came to Philadelphia March 18 on three-month
medical visas, plan to return to their village soon.

<P>They will be carrying Huong's ashes.

<br>
<br>
on: 1) VICKI VALERIO / PHILADELPHIA INQUIRER: HUONG NGUYEN
GAVE UP HIS JOB AS A MECHANIC AFTER BECOMING ILL WITH LEUKEMIA. A
MARROW TRANSPLANT DID NOT SAVE HIM.

2) PHILADELPHIA INQUIRER: CU AND BON NYUGEN ATTEND THEIR BROTHER'S
FUNERAL.

3) VICKI VALERIO / PHILADELPHIA INQUIRER: DOCTORS DRAW BONE MARROW
FROM CU NYUGEN'S HIP BONE FOR CU'S BROTHER.