Three times Reed Salmons ignored the phone calls. Final exams were approaching, so was winter break and Salmons' senior season of college lacrosse. Who had time for a telemarketer? A follow-up email, however, snared his attention.
"Please in God's name," Reed recounts reading, "give us a call back."
Salmons slipped out of the biology research lab at Dickinson College, a small school with an undergraduate enrollment of 2,370 students tucked in the rolling hills of Central Pennsylvania, returned to his house and pressed the phone against his ear. Somewhere, he was told, a middle-aged man was dying from an aggressive blood and bone marrow cancer, acute myeloid leukemia. The patient's only hope for survival was a blood stem cell transplant, and suitable donors are rare. To avoid tissue rejection, at least 6 of 10 specific genetic protein markers must match, and most patients don't have a viable donor in their family.
Instead, they must seek salvation from a stranger.
Months earlier, Salmons and his teammates were encouraged by lacrosse coach Dave Webster to participate in an on-campus bone marrow drive. Many did, rubbing cotton swabs against their cheeks and submitting the DNA samples to the national Be The Match Registry, part of a worldwide database of more than 22.5 million potential adult stem cell donors.
Only a tiny fraction of registry members are ever called for additional testing, and far fewer go on to donate. But after a handful of months and the barrage of missed calls, Salmons learned he and a patient shared 10 of 10 protein markers. Their cells were an ideal match. A man hit the genetic jackpot if Salmons agreed to donate.
The patient's identity would remain secret for at least a year, and perhaps forever, unless he waived his right to confidentiality. He wasn't guaranteed to survive a transplant, but without one was certain to die.
Salmons faced few known long-term risks, all remote, but timing was critical and the procedure jeopardized his senior season, his last chance to play the sport he loved since seventh grade.
Would he follow through? Would you?
Mark Tose and his wife Patty were recent college graduates in 1981 when they stored their possessions, bought two motorcycles, a bunch of camping gear and just rode. They traveled from San Diego to Prince Rupert in British Columbia, and on the return trip stopped to visit friends near Seattle. The Pacific Northwest suited Tose well, feeding his deep appreciation for music and love of flying. The young couple decided to stay. Tose started a family, founded a rock band, and developed an affinity for the Seahawks. He also built a long career with aerospace giant Boeing.
By the morning of May 14, 2013, Tose had been with the company for 25 years and was flying every day. His daughter Amanda had graduated from the University of Washington with a degree in neurobiology and was traveling the globe. His son Alex, a couple of years younger and on the autism spectrum, was living at home and doing well. Patty had recently retired from her management job with the Community Transit bus agency.
"Everything was going great in my life," Tose recalls.
He headed to a routine physical to renew his pilot license. They drew blood. The next day, his doctor called. Something was terribly wrong.
"You've got to see a hematologist," he was told. "Your white count is point-six."
"Well that's obviously a mistake," Tose said, "because I feel fine. You need to re-run that test."
"We already did," the doctor said. "You've got to go."
Within a week, Tose began chemotherapy. Patty started an online journal at CaringBridge.org to keep friends and family updated on Mark's condition. He remained at Providence Regional Medical Center in Everett, Wash., for four weeks. Tose, a gregarious giant at 6' 7", quickly settled into a routine and began making friends and setting goals, each day walking 40 to 60 laps around Floor 7A. The family of another patient did the wave as he passed. Patty and Alex brought a computer monitor and joystick to install Mark's flight simulator in his hospital room, where he offered to teach some of the nurses to fly. His doctor was surprised and pleased to find him cruising over her hometown of Qingdao, China, in a 1950s-era People's Liberation Army two-seat fighter plane.
By the end of the month, the chemo began to take its toll. Tose was down to 10 laps around the floor, which he began calling the "cell block." Soon, he struggled with five.
Tose stared out the window at a sprawling view of Port Gardner Bay. It was a beautiful summer afternoon, the kind of day he'd like to spend riding his motorcycle along the Snohomish River. He settled for the computer monitor and a virtual cruise past Mount Rainier.
A nurse's aide taught Tose how to say his longtime mantra, "It's all good," in Ukrainian. The next day, a friend brought 15 colorful signs, each with the phrase written in a different language. Tose was ecstatic. They decorated his room. His strength fluctuated, but his blog posts remained upbeat. He began using versions of the saying to close each entry.
June 4: Another biopsy. Mabuti Ang Lahat.
June 7: The chemo's working. Todo esta muy bien.
Tose's hair began to fall out, so he cut it all off.
June 12: Vse Dobre.
June 17: Tất cả đều tốt.
June 18: Hersey Yolunda.
June 19: It's All Good!
Tose spent more than 120 days in the hospital before the end of the year. He developed a severe rash, and had a mishap with the catheter in his chest. He withstood waves of fever and avoided skin contact to evade germs. The days blended into months. Eventually, he stopped counting.
"I really want to beat this," Tose wrote, "and get back to my life."
In August, his brother Greg was tested as a possible blood stem cell donor. He didn't match. In September, a biopsy confirmed an enduring anomaly, an IDH1 gene mutation. It's a problem. In October, he learned that chemotherapy wasn't enough.
"The transplant procedure is still evolving," Tose wrote, "and the risk of complications is not small, both during and following the procedure. I'll leave it at that."
It was his only hope to survive.
Tose headed back to Providence for the fifth round of chemo, the last one, at least as originally planned. In November, he received a phone call from the Seattle Cancer Care Alliance. They had found a suitable match, a willing donor, a complete stranger.
All Tose knew was the man was 22 years old.
Courtesy of Mark Tose
Months later, Salmons missed the start of spring semester as he rose before dawn at his childhood home in Wilmington, Del. He was anxious, but determined to fulfill a promise to a man he had never met, never spoken with and whose name he didn't know.
"How would I feel if there was someone out there who had the opportunity to save my dad and didn't do it?" Salmons says.
Salmons clambered into the passenger seat of his mother's car and traveled a short distance to Christiana Hospital in nearby Newark. A nurse prepared three identical syringes of Filgrastim and pushed the drug under Salmons' skin. The injections increase production of blood stem cells—which mature into white blood cells to fight infections, red blood cells to carry oxygen, or platelets to help blood clot—and caused them to seep from his bone marrow into his bloodstream for collection.
At first, Salmons expected his blood to flow from a vein in his arm, through a tube and into a machine that separates and collects his stem cells, and the filtered blood warmed and returned to his body through a tube in his other arm. But there was a rare problem. His veins were too narrow.
Salmons agreed to have a catheter threaded into the much larger femoral vein in his right leg, near his groin. It was uncomfortable, but he's an optimist. "I had my arms free," he says later, "as opposed to someone who had their arms attached to the machine."
In a quiet room, collection began. Tubes snaked from under Salmons' gown and across the face of the bedside apheresis machine, about the size of a mini fridge. Several fluid bags hung overhead.
Dials spun. Screens flashed. An internal centrifuge hummed to life.
Nearly 15,000 Americans are diagnosed with acute myeloid leukemia each year. Even before he and the stranger were deemed a genetic match, Salmons was studying this very disease in a lab at Dickinson, where leukemia cells are grown in plastic Petri dishes inside an incubator.
Science has a basic understanding of the various chromosome mutations that turn healthy bone marrow cells cancerous, and how the information provided by long strands of DNA can become corrupted. The cells short-circuit the immune system and alter the genes that regulate cell behavior, inciting continuous division and growth, simultaneously and insidiously stomping the gas and cutting the brakes so the disease consumes the body.
But why do these occur? Can they be prevented? Repaired? Modern medicine's best weapon is chemotherapy, which targets and destroys fast-growing leukemia cells. But since healthy bone marrow cells also divide quickly, they're wiped out as well.
For some patients, a transplant is the only hope to beat the disease. Their bone marrow, cancer and accompanying immune system are eradicated by chemo, and with even minor maladies lethal, they're infused with healthy stem cells. Standard practice is to use fresh cells within 24 hours after donation.
Salmons' donation took seven hours. Finally, enough stem cells were siphoned and combined with his plasma to maintain viability during transport. The garnet elixir was sealed in a bag, placed inside a small rigid cooler and whisked from the room by a professional courier, who raced out of the building and into a snowstorm.
The transplant was scheduled for the same day at University of Washington Medical Center in Seattle, and Tose had been there for some time, having returned to the hospital earlier than expected with a painful and contagious case of shingles. He spent Christmas in isolation. In mid-January he began chemo, a sixth and final round to eradicate his bone marrow and cancer. That lasted a week. In his room, each day, Tose's nurses tracked the countdown on a dry erase board.
His blood levels and well-being crashed, as expected, but on Monday, Jan. 20, the transplant was rescheduled, delayed by a day.
A number "1" lingered on the whiteboard. Would the stem cells arrive in time?
"All I know is they told me there was a storm and there might be some issues with the flight," Tose recalls. "And I just thought, 'please, please let that flight arrive safely.'"
Courtesy of Reed Salmons
Salmons returned to school within two days of the donation and headed straight for the weight room, rejoining his teammates for the first week of practice. With the season opener less than a month away, there was no time to waste. Salmons expected even more playing time this year, but now his body ached and his legs weren't cooperating with his mind's instructions. The drugs were still in his system. The effects dissipated after a few days, but remained a hindrance for weeks. Soon, another problem was apparent—the catheter wound in the crease of his right inner thigh. It limited his movement. Salmons injured his left hip flexor hobbling around campus, overcompensating because of the hole in his leg.
Webster knew Salmons donated stem cells, but the senior wasn't interested in acknowledging his physical limitations. It was his final season. He wanted to play.
"I never did make excuses ... I didn't want to make one because I didn't want to be injured," he says later. "I wanted this whole stem cell thing to be really low-key and not to have affected anything."
Salmons began the season starting on the wing during faceoffs, tasked with running to collect ground balls. But he was slowed by the burning sensation in his leg, and it wasn't long, only a few games, before he and his coach shared an unspoken acknowledgement. This wasn't working out.
Across the country, a day after the donation, a nurse drew a "0" on the dry erase board in Tose's room, along with "Happy birthday!" and several balloons in black marker.
"[At the time I thought it was] a little bit macabre," Tose says. "But also kind of funny, because they're such unbelievably wonderful people and they made a tough situation bearable for us. A situation that's so difficult, they turned it into a celebration."
Once the pouch of stem cells arrived in the room, moments before being connected to the catheter in his chest, Tose flashed a thumbs up, posing for a photo with a nurse holding the bag. The transplant procedure resembled a blood transfusion. Tose was already hooked up to several tubes. The nurse just added another. The stem cells flowed from the bag into his heart.
"And I just watched them. I watched them," he says. "The line that they came through was clear, and I could watch them coming."
For a couple of weeks, the bone marrow built. Tose developed another severe rash, painful bleeding mouth sores and an inflamed digestive tract, making it difficult to swallow. His crusting shingles blisters remained tender. His face and throat swelled. Soon, he struggled to breathe.
On Sunday, Feb. 2, Tose was sedated and intubated. The breathing tube remained down his throat for eight days. Greg and Patty took 12-hour turns by his side, around the clock.
"My family says it was the worst time," Tose says. "But I don't remember any of that. I only remember waking up."
Tears welled in the eyes of the faces crowding the room, various medical personnel, his brother and his wife, as Tose squeezed a question past his raw vocal cords.
"Who won the Super Bowl?"
His Seahawks, in a blowout.
Salmons played only in man-down scenarios for the rest of his senior season. Dickinson reached the conference semifinals, where the Red Devils lost to Franklin & Marshall and finished with a 9–7 record, two victories short of a fifth straight NCAA tournament appearance.
A representative from Be The Match remained in touch to document Salmons' recovery process. He pleaded for information about the stranger, to no avail. Suddenly, he was the one waiting, hoping for someone to call him.
"But no regrets," he says.
Salmons graduated and accepted an internship at The Children's Hospital of Philadelphia, the same medical complex where former Bengals defensive tackle Devon Still's young daughter had her chemotherapy and stem cell transplant. Soon after, Salmons received his first update on the stranger's condition.
"It's basically summed up doctor jargon," he says.
But the news was positive. Another dispatch arrived in August 2014. "The only negative thing in the whole process was that it messed up my lacrosse game for the season," Salmons said, "but it was totally, 100% worth doing that, because I get updates that he's still alive, he's doing well"
Salmons had done his part, physically and mentally, an admirable and selfless act for a man he had never met, and federal privacy law ensured the status quo for at least several more months. But Salmons ached to learn more. He wrote an anonymous letter to the stranger, mailing it through his rep at Be The Match.
"There are plenty of cases where people don't ever meet each other," Salmons says. "But I would love to meet him, just to shake his hand and tell him I'm rooting for him. That'd be really cool."
In February 2015, nearly two years after his mouth swab, 15 months since learning he and a dying man were a genetic match, a little more than a year after donating his stem cells, Salmons agreed to waive his own patient confidentiality, disclosing his name, address, email, phone number, everything.
A week later, Salmons was riding the train to work when his phone buzzed with an email. The subject line: "How Do You Thank Someone For Saving Your Life?"
Hours later, his phone rings. This time he answers right away. Through the speaker, a voice trembles.
There's a long, awkward pause. They are strangers no more.
Courtesy of Bloodworks Northwest
Tose's recovery remains slow. He'd lost 50 pounds since the day of his flight physical in 2013, and for months everything tasted like spoonsful of ground pepper. But another biopsy showed the leukemia and IDH1 marker were gone. He returned home with Patty on Valentine's Day.
It took a week to muster the strength to make it to his bedroom upstairs. He still tires easily. Before the transplant, Tose performed in an amateur rock band, The Toasters. Through three sets, he'd jump around. Now, he's more or less hung that up. His only flying is on the simulator. He has yet to return work.
"But there are so many things in life that I do enjoy," Tose says.
He recorded a new album. "I couldn't be with a large group of people because my immune system was so screwed up, but one-on-one in a studio or something like that, for a half hour, hour at a time, I could do that," he says.
Several musicians around town were eager to help. It was good to mentally reconnect. Other friends and family, including his children, joined in with handclaps so he could credit them in the liner notes. He called it "The Toast of Society," printed 50 copies and gave them to loved ones in December 2014, in time for his 60th birthday.
On July 26, he and Patty celebrated their 40th wedding anniversary.
"Comparatively speaking, he's got a lot more life that he's lived," Salmons says, "so I felt pretty lame compared to his résumé."
Salmons told Tose he was from Delaware, played lacrosse at Dickinson, was a biology major and wanted to go to med school. He said he was researching the same disease Tose was diagnosed with, and donated stem cells to help him fight.
"So that was kind of cool. But other than that," Salmons says, "I didn't have much to offer him."
Several months later, Salmons packed a suitcase along with his parents, Emily and Hal, to fly from Philadelphia to Seattle. Tose was throwing a party and invited friends and family from all over. His brother and 81-year-old mother traveled from California.
"I'm still immunocompromised," Tose says, "so I'm taking a little chance here, but it's too special to not do this. I'm not going to live in a plastic bubble."
As a side effect of the transplant, Tose's blood type has changed to match his donor's. Salmons cracks a wry smile, joking in the days before his visit that the stranger whose life he saved now has to "bleed green." He brings an Eagles sweatshirt along as a gift. But after Salmons is swallowed in Tose's bear hug, he learns the man already has a new favorite team.
Tose pulls a red shirt with white lettering over his head. On the front it reads, "RED DEVILS LACROSSE," on the back, "SALMONS," number 46.
INTERESTED IN DONATING?
A patient's likelihood of finding a suitable blood stem cell donor through the Be The Match registry ranges from 66% to 97%, depending on race and ethnicity. Patients are most likely to match someone from their own ancestry, and adding donors from diverse racial and ethnic backgrounds remains an important focus of the organization. The more potential donors, the better the odds of finding a match. Adults between the ages of 18 and 60 are eligible to join. See complete guidelines at bethematch.org.