The procedure involves the patient receiving high doses of chemotherapy and total body irradiation which decimates the bone marrow (the body's blood producing factory). The idea is to give more intensive therapy to effectively wipe out the cancer and also to clear the way for an infusion of healthy donor bone marrow to engraft in a new home. This process takes several weeks or more. Meanwhile, the patient waits at death's doorstep wondering if it will work. For some it doesn't.

Such are my thoughts on November 28, 1998, as my wife and I escort Doris, 12, to the BMT unit for admission. While not dwelling on the misfortune of Doris' diagnosis of acute lymphoblastic leukemia in May 1998, or its recurrence five months later, we're silently thankful for the matching donor found in her 11-year-old sister, Rose.

Our focus at this point is goal-oriented. Once we're buzzed through the security entrance of the BMT unit, a weary Doris turns to her mother and me and says, "Let's get this thing over by Christmas."

While our passage into the BMT unit for Doris' admission opened a new chapter in our fast paced story, it closed yet another quick chapter. The 30 days before her admission had been intense. Once Doris achieved a second remission, we quickly packed our bags and dashed off to Orlando, Florida, courtesy of Make-A-Wish Foundation. The day following Doris' wish trip found us right back to the grind of running daily between our Fredericksburg home and MCV in Richmond for numerous pre-BMT tests; surgery to install an indwelling catheter; and, six consecutive days of cranial radiation.

Doris and mom before leaving for the hospital.

Once admitted, the count down starts with Day -5 and -4 consisting of chemotherapy. Total body irradiation is administered twice a day on Days -3, -2, and -1. This is done to destroy the bone marrow--to "prepare" it to accept the infusion (on Day 0) of the new marrow harvested from Rose.

Although the procedure is easy for me to describe, it's impossible to convey my feelings, for example, watching--safely, by monitor--as Doris stands perfectly still for 20 long minutes to absorb the invisible beams cranked out by a droning radiation machine.

Doris receiving an infusion of Rosey's marrow.

The days following the transplant are positive numbers (e.g., Days +1, +2, +3, etc.). It's a waiting game for marrow engraftment, return of blood counts, and the resumption of Doris' ability to drink or eat.

We also had to adjust to a new ward and staff. Unlike in the pediatric unit there are mostly adult patients in the BMT unit. I write down my impressions.

It seems so serious and quiet. No kids escaping their rooms and sprinting down the hall making motor sounds. No kids sitting in little chairs, wearing party hats, and eating treats under the watchful eye of a fairy Godmother--a common activity at the pediatric clinic. Jackie, the fairy Godmother, visits Doris regularly. Dr. Yanovich would have a fit if he knew about the presence of fairy dust in this sterile environment!

In the room, the telephone rings. Only Doris can answer because of the risk of spreading germs with the handset. The caller asks for someone who apparently had been a patient in this room. What happened to the previous patient? We don't know and certainly are afraid to find out. Careful boundaries at the edge of an abyss.

Several days into the countdown, Doris' emotions surface. "I'm scared." We hug, which may not seem like a big deal but this was different. It was a long, desperate, clinging, holding on sort of hug that we would repeat often.

My wife and I work in shifts staying with Doris. On one of the nights, after she has begun to sleep following several intense hours of vomiting and diarrhea, I lie down on the spare cot in her room and reflect on an earlier consultation:

The doctor says, "Doris, we will give you chemotherapy and radiation and this will cause you to feel weak and nauseated. It will cause hair loss but since you currently have no hair, this is not a concern. The drugs we will give you following the transplant, however, will cause you to grow hair."

"Hey, that's great!" I say with a smile that freezes when I see no reciprocation of excitement.

The doctor adds, "These drugs may also cause you to grow some hair in other places. Like on your face."

Try as I might I cannot visualize Doris with hair. Excessive hair is the least of our worries at this point.

The doctor continues: "But this is only a temporary situation. Everything will return to normal eventually."

My reflection ends. I turn over on the narrow cot in the darkened room and listen to the periodic gurgle of the IV pump. I say to myself, "Yes, eventually life will return to normal as before. The only thing Doris and the rest of us will have to worry about is her leukemia returning."

We'd been told that the fastest any kid has been released from the BMT unit was three weeks. With her mother and me as culpable participants, Doris implements her 3-part strategy to reach her discharge goal.

The first part is exercise. Ten days (Day plus 10) post-transplant, I return from lunch to find Doris with her face mask on, pacing up and down the hallway with an IV pole that has six or seven plastic bags swinging from its top. I notice that all of the patients at some point do this--the hall walk. It's inspiring to see people who haven't been able to eat or drink for several weeks following chemo and radiation, pace up and down the hallway. Their eyes reveal a focused intensity that Olympic athletes would envy. I notice that Doris has the same look.

The second part of the strategy is psychological--influence the gatekeepers. When we hear the doctors making their rounds, Doris hops onto the stationary bicycle in the room. I open her room door so the doctors will notice what she's doing, should they walk by.

The third strategic component of obtaining freedom from the isolation of the BMT unit is eating and drinking again. The therapy disrupts the mucous membranes of GI tract. Regaining the ability to eat is a slow and gradual process. On two occasions, an over eager Doris overeats and is placed back on intravenous nutrition. Despite the setbacks, she keeps pushing hard to reach her goal.

On Day plus 23, Doris wins her discharge and returns home, just in time for our family to be together for Christmas.

According to the Leukemia Society of America, acute leukemia is the principal disease killer of children in the United States. Over the last two decades, the incidence of childhood cancer has increased 20 percent. Its cause remains a mystery. Improved treatments for childhood cancer, including bone marrow transplantation, have resulted in higher survival rates.