🌀Mood: Courage, Uncertainty, Preparation, Resolve

Yesterday I met a different version of myself in the mirror.

Today I began the treatment that will rebuild my body from the inside out.

Today was melphalan day.

Melphalan is the chemotherapy given before a stem cell transplant. Its job is simple, but powerful: wipe out the blood-forming stem cells living inside my bone marrow so new, healthy ones can grow in their place.

The infusion itself is surprisingly short — about twenty minutes.

But don’t let the timing fool you.

Melphalan is mighty.

It’s strong enough to destroy the stem cells that have been producing my blood cells my entire life. It will take my hair. It will wipe out my immune system. And it will create the conditions needed for the transplant to work.

In transplant language, this step is often called “clearing the site.”

Act I: Clearing the Site

Before doctors can return my stem cells during transplant, they first have to clear out the environment in the bone marrow where those cells will grow.

One way to think about bone marrow is like a garden that has been overtaken by weeds. In my case, those weeds are multiple myeloma cells.

Melphalan is the weed killer.

Scientifically, melphalan is what’s called an alkylating agent. It works by attaching itself to the DNA of rapidly dividing cells — like cancer cells — preventing them from reproducing and eventually causing them to die.

But it doesn’t just target the weeds.

It clears the entire garden.

This process, called ablation, wipes out the blood-forming stem cells in the marrow to make space for the transplant that will come on Day 0.

The goal is simple:

Create space for new, healthy stem cells to move in and begin growing.

The Day Itself

Even though the melphalan infusion itself only takes about twenty minutes, the day surrounding it is much longer.

First came the pre-medications — anti-nausea drugs and other medications designed to prevent reactions and help my body tolerate the chemotherapy.

Then the nurses brought in the melphalan.

What struck me immediately was the size of the bag.

It was small. Very small.

Compared to many of the IV bags I’ve received since my diagnosis, it was almost surprising to see something so compact hanging on the IV pole next to me.

I remember looking at it and thinking two things at the same time.

That tiny bag is about to wreck my body.

How can something so small do something so big?

And yet that tiny bag held a drug powerful enough to wipe out the blood-forming system I’ve lived with my entire life.

Twenty minutes.

That’s all it takes.

But the part of the day that required the most effort from me had nothing to do with the IV.

It had to do with ice.

To help prevent severe mouth sores — one of the most painful side effects of melphalan — I had to keep my mouth constantly cold. The cold reduces blood flow to the tissues in the mouth, limiting how much chemotherapy reaches them.

So the routine looked like this:

Start icing 30 minutes before the chemo begins and continue for 4–6 hours total.

Ice chips. Popsicles. Anything cold.

Constantly.

My husband helped prepare a cooler full of everything I might need, and once the process started it became a bit of a marathon: ice in, ice out, repeat.

It sounds simple, but after a few hours you realize how even the small parts of transplant require focus and endurance.

And then, just when everything seemed to be going smoothly, something unexpected happened.

About ten minutes into the melphalan infusion I suddenly felt a little dizzy — almost like a head rush.

The nurses immediately paused the drip to figure out what was happening. Within moments more nurses came into the room, and my physician assistant came in as well to check on me.

My reaction wasn’t typical, so they wanted to make sure everything was okay before continuing.

After talking through the symptoms, their best guess was the alcohol used in the melphalan solution.

Apparently the drug is mixed with alcohol to help keep it stable.

So yes… it turns out it’s possible to get a small “buzz” from chemotherapy.

Not exactly something I expected to experience today.

After the infusion finished, the work wasn’t over. I still had three and a half hours of hydration running through my Hickman line to help flush the medication through my system and protect my kidneys.

By the time everything was done, it had been a long day.

But an important one.

Today the garden was cleared.

Now the waiting begins.

As I left Fred Hutch and headed home, one thought kept circling in my mind:

What exactly is this going to do to me… and how soon?

Because with chemotherapy like this, you know the side effects are coming.

You just don’t know when they’ll arrive.

Tonight I’m grateful. The day went as well as it could have. Thank you, Jesus, for being in my corner!