Charles Asmar sat at the kitchen table of his new home inFrederick County, showing slides of Lebanon on his laptop. Around himwere signs of the American dream he has lived for two decades -- thehigh-speed computer, the spacious white kitchen, the grassy vista outthe window. As he clicked through images from his homeland, he pausedat the smiling faces of his brother, Ziad, and sister, Marcelle. Atear dripped onto his bathrobe.
"I'm very lucky to have such a close family," he said.
Without his brother and sister, he might not be alive.
Asmar, 44, a busy Internet consultant with a wife and three youngchildren, had just placed a down payment on his house in Urbana lastMay when he fell ill with what he thought was the flu. It turned outto be leukemia. Within weeks, he was hospitalized, and by late lastyear, after a period of remission, his time was running short.
Then two weeks ago, his sister stepped off a jet at DullesInternational Airport, carrying a small, Styrofoam cooler fromBeirut.
"She was holding my life," Asmar said.
In the cooler was a fluid-filled pouch containing stem cellsextracted from 42-year-old Ziad Asmar -- cells that Charles Asmardesperately needed to fight his disease and for which no suitabledonor but his brother could be found.
Normally, the stem cell transplant -- and the several days of pre-transplant medical preparation that each man had to endure -- wouldhave been done with the brothers in the same hospital.
But despite months of pleading by the Asmars and the University ofMaryland Medical Center in Baltimore, where Charles Asmar wastreated, the State Department would not expedite Ziad Asmar's requestfor a visa so he could travel to his brother's side. Ziad Asmar, aLebanese Christian who runs a printing business in Beirut, said he isnot a threat to U.S. security. But an official of the embassy wherehe applied said the process is slow, given the nation's heightenedsecurity.
With his brother barred from the country, only extraordinarycoordination between doctors in Maryland and Lebanon prolongedCharles Asmar's life.
After the brothers were simultaneously prepped for the transplantat hospitals nearly 6,000 miles apart, Beirut physicians harvestedthe cells from Ziad Asmar, getting technical advice by fax andtelephone from their colleagues in Baltimore. Marcelle Asmar, who hasheld a 10-year U.S. visa for some time, quickly departed Beirut withthe cells, which would remain viable outside a human body only fortwo days. With the clock ticking, she traveled for 20 hours --through airports where security personnel had been alerted not to X-ray the cooler or open the pouch -- until she reached the Washingtonarea.
"It was very much a family effort, and a tremendous amount ofcredit goes to [Charles] Asmar himself," said his physician,hematologist-oncologist Aaron P. Rapoport, director of gene medicineand lymphoma at the medical center's Greenebaum Cancer Center. "Hesaw this as the only potential option, and he never, ever gave up."
Before the transplant, Asmar had a few weeks to live, Rapoportsaid. Now, as his brother's stem cells help Asmar's body develop ahealthy blood system, he has a good chance of making a full recovery,the doctor said.
"We couldn't believe the whole thing worked," his brother said byphone from Beirut. "Now we really have the same blood."
Charles Asmar arrived in the United States from war-ravagedLebanon in 1984, at age 26, and received an engineering degree fromthe University of Toledo, where he met his wife, Suad Omer. He earneda master's degree in business, became a U.S. citizen and set up shopas a consultant to Web-based companies in 1993.
All along, he stayed in close touch with his family in Lebanon.His parents and his sister Marcelle, 34, visited often. And Asmarreturned to Lebanon frequently, giving him a chance to see hisbrother, who has never been to the United States.
Ziad Asmar first applied for a visa in 1990. He said U.S.officials did not respond to his application, and he did not pursueit. He said he suspects that that application, and one he submittedlast year, were set aside for detailed review because the StateDepartment has concerns about the theft of his Lebanese passport in1986.
Because the U.S. Embassy in Beirut was not handling new visarequests, Ziad Asmar filed his second application at the embassy inneighboring Syria. In a letter last month, the embassy's vice consul,Joseph J. Bedessem, said that despite his brother's illness, ZiadAsmar would have to wait. "Visa applications are now subject to agreater degree of scrutiny than in the past," Bedessem wrote.
Last May, after Charles Asmar fell ill, the diagnosis was grim:acute myelogenous leukemia, cancer of the blood. Chemotherapy led toremission, and in November, Asmar visited Lebanon and his siblings.In photos from the trip, Asmar looks robust. But a month after hereturned, his cancer recurred, this time resisting treatment.
"The worst feeling," Asmar said, "is when a doctor tells you, 'Idon't know what to do next.' "
He was referred to Rapoport, who told him that his only hope was atransplant of healthy stem cells, the building blocks of blood.Finding a suitable stem cell donor is difficult. If a match can befound, often it is a relative -- but there is no guarantee. InAsmar's case, his sister's stem cells are not right. But hisbrother's are an ideal match.
A donor must undergo several days of tests and injections toincrease the supply of stem cells. Meanwhile, the patient mustundergo intensive chemotherapy and radiation to kill cancerous cellsand prepare the body for the transplant. Those aggressive treatmentsput the patient at high risk for potentially deadly infection andbleeding, a danger that remains until the transplant is complete. Sothe donor and patient need to be prepared for the transplant at thesame time.
Soon after his brother's cancer was diagnosed, Ziad Asmar appliedfor a visa. For months, as Charles Asmar's condition deteriorated,the family waited for a decision. The Asmars, their friends andofficials at the medical center repeatedly contacted the embassy.
They were told that the process takes a long time -- "one thing wedidn't have," said Kathy Ruehle, the medical center's senior stemcell transplant coordinator.
Last month, Rapoport sought help from Sen. Barbara A. Mikulski (D-Md.). "We must proceed . . . urgently or Mr. Asmar will surely die,"the doctor wrote her. "While I certainly understand the travelconstraints placed on individuals from Middle Eastern countries inthe wake of the Homeland Security Act, on humanitarian grounds Iappeal to you."
Mikulski contacted the embassy in Syria. In a Feb. 25 letter ofreply, vice consul Bedessem referred to Ziad Asmar, telling thesenator: "We . . . trust he understands that this waiting period isnecessary as we strive to make every effort to ensure the safety andsecurity of the United States for all. . . . We recognize that Mr.Asmar's case appears to have been in process for an unusually longtime. . . . We are unable to predict, however, when he may receive aresponse."
Charles Asmar's eldest child, 12-year-old Karina, sent an e-mailto the president. "Ziad Asmar is the only donor who can help myfather. So could you please grant him an entry visa to the UnitedStates?" The girl did not receive a response, according to herfather.
Meanwhile, Ziad Asmar contacted Al Makassed Hospital in Beirut,where two physicians, Ahmed Ibrahim and Tamim El Jisr, had experiencewith stem cell transplants. And a last-ditch plan was hatched.
In a flurry of faxes and phone calls, Ruehle relayed the Baltimorehospital's procedures for harvesting, packing and transporting freshstem cells. The Lebanese doctors contacted airports in Beirut and inParis, a transfer point, with instructions. The cells were nothazardous, the doctors told security officials. The fluid-filledpouch should not be opened, they said, and the Styrofoam coolerholding it should not be X-rayed. Most important, they said, thecourier, Marcelle Asmar, should not be delayed.
For most of her journey, she said, she cradled a green backpack,containing the cooler, in her lap, afraid to sleep. "I was prayingthat everything would be fine," she recalled by phone last week.Marcelle Asmar arrived at the hospital "in a flurry," Ruehle said. "Igave her a great big hug. Then I went to the lab and broke down."
When she saw her brother Charles, Marcelle Asmar said passed alonga message from Ziad: "You're going to make it."
After the transplant, which took less than an hour, the siblingscalled their brother, and the three wept together.
Charles Asmar, who went home from the hospital Tuesday, wishes hecould thank his brother in person for "fighting as if this were hisown disease, and his own life."
And then, "I'd like to go out to a few places, and have some fun."
Комментариев нет:
Отправить комментарий