Stem Cell Transplant Offers Hope of a Miracle

SEATTLE, WA (July 5, 2005) - Lying in a hospital bed undergoing chemotherapy isn't exactly the way Nora Nagaruk hoped to spend her wedding anniversary. But since she was diagnosed with acute myelocytic leukemia (ALM) last summer, Nora says she's used to things not going her way.

"I had my whole life planned out," says Nora, who was in the last year of a medical family practice residency when she got sick. "Now I don't know what's going to happen next week."

Nora, who grew up in the Evangelical Covenant Church in Unalakleet, has dreamed of being a doctor from the time she was four years old. After 11 years of training - four years at the University of Oklahoma, another four at the University of Washington medical school, a year of internship and two years of residency - her dream was almost a reality.

Then she got what she thought was a cold last summer. When her nagging sore throat and fatigue wouldn't go away, she wondered if it was something worse. Perhaps strep throat, or maybe a case of mononucleosis, brought on by the demands of her residency. She'd often have to spend the night at the hospital during her rounds, where she was lucky to catch "an hour or two" of sleep.

But the strep test came back negative, and while she waited for results from the mono test, Nora kept feeling worse and worse. "I had never been that sick before," Nora says. "It felt like the life was being taken out of me."

Blood tests revealed that Nora had an abnormally high blood count, a sign of leukemia. On July 9, 2004, four days after their wedding anniversary, Nora and her husband Nathan, arrived in Seattle to begin her cancer treatments. There Nora learned she had ALM, the same disease that killed her father, Glenn Ivanoff, in 1979, and her nephew in 2000.

The Nagaruks spent several months in Seattle while she was undergoing treatment, then returned home to Anchorage to continue chemotherapy. Her cancer has put her training on hold, as Nora has been too sick return to her residency.

Sometimes she gets angry at God for letting her get so close to becoming a doctor, then putting her life on hold. "I was so close to finishing - in my last year of this 12-year journey," Nora says. "Why couldn't I have gotten sick at the end of my residency?"

Still, she adds, "you can't stop living" in the face of cancer. "You have to keep going - but how do you find normal?" she asks. "You've got to find something that feels normal."

Doctors believe that for her, long-term health would be a stem cell transplant. After taking several months off from chemotherapy to build up Nora's strength, the Nagaruks returned to Seattle to prepare for a transplant. Nora's younger brother, Wil, is the donor - which Nora sees as a kind of miracle.

When her father was diagnosed with ALM in the 1970s, doctors told him that because of the cancer treatments, he'd likely never have any more children. But he went into remission for a short time before his death in 1979, and during that time Wil was conceived.

"Wil came along and he is a perfect match," says Nora. "He's giving me his stem cells - he'll be saving my life in a few days."

Nora wonders sometimes if she will ever realize her dream of becoming a doctor. The transplant may leave her with chronic side effects that would make the demands of a doctor's life impossible. She's planning to return to her residency program in July 2006, following a year of recovery ordered by her doctors. "But that's penciled in," she says. "Our motto is day by day - I can't make my decision until the transplant is over."

Despite the toll that chemotherapy is taking on her - doctors will basically kill off all her bone marrow cells before starting the transplant - Nora still retains her enthusiasm and curiosity about medicine. During a telephone interview from her hospital room, while she was receiving a chemotherapy treatment, she launches into an energetic explanation of the transplant process.

"The donor gets medication that makes them make more stem cells," she says, "and those cells leak out into their blood stream. Then the donor is hooked up to a machine that filters the blood and harvests the stem cells.

"It's pretty cool," she adds. "The stem cells end up in a little plastic bag, and it takes about 30 minutes for those cells to be transplanted through an IV (intravenous) line. The cells know where to go. They'll go into the bone marrow and set up their little blood cell-making factory." Doctors will know within about three weeks if the transplant, scheduled for Thursday, is successful.

Throughout her illness, Nora says she has been surrounded by the love and care of family and friends. A website called thestatus.com allows the Nagaruks to post updates of Nora's condition and the progress of her treatment. One of her friends, Phil Hofstetter, was inspired to raise funds for leukemia by rowing a sea kayak from Nome to Barrow, Alaska.

Hofstetter's trip coincided with the stem cell transplant, and Nora has been tracking his progress from her hospital room. Hofstetter started a 34-mile row across the Kotzebue Sound about the same time Nora started her pre-transplant chemotherapy.

"Once you've started (to row across that sound) you can't turn back," she says. "And that's exactly where I am once I start chemo. There is no turning back once you start the chemo process . . . I can't give up or he'd be rowing for nothing."

Through it all, Nathan has been by Nora's side. He says his job is mostly to support Nora and make sure she takes her medication. He also cooks and does laundry, and keeps house and home together. An active outdoorsman, he'd rather be out hunting and fishing than cramped in a hospital room. "Poor Nathan," Nora says. "He didn't know what he was in for when he married me."

If any good comes out of her illness, Nora says, it will be that she better understands what it's like to be a patient. "It's different being on this side," she says. "Nausea, for example, has a whole new meaning."

The illness has also changed the ways she views God.

"I feel like he is taking care of me physically, it's been made more tangible," she says. "You know things about God's character - that he is loving and caring - but when you are lying in a hospital bed and you can feel people praying for you, it's like God has come to me down to my bedside."

(Editor's note: An updated story on Nora Nagaruk will appear in the September issue of The Covenant Companion.

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