Chapter 6 — Medical Appointments

_August 13, 1983, Chicago, Illinois_

{psc} "How are you feeling?" I asked Keiko when she came downstairs after her nap.

"Better. I'm still a bit tired. Doctor Morrison said if I'm too easily tired, we could do another transfusion. I'm going to call him on Monday morning. You don't need to take off work for that, especially given you're going to miss work if we do go to Mayo Clinic."

"So long as you're sure."

"I am."

"What did you want to do for the rest of the day?"

"It's our wedding night tonight!" Keiko said with a smile. "We have to make love at least once!"

"So long as you're up for it."

"I think you're the one who has to be 'up' for it!" she teased.

"Fortunately, that's never been a problem!" I chuckled. "How does it feel to be married?"

"It happened so fast!" she smirked.

I chuckled, "Again, that's never been a problem! But in all seriousness, I understand your point. And I could answer my own question in various ways, but the one I think that best describes how I feel is that the piece of paper and the judge's words simply confirmed something that was already true, once we'd decided to marry."

"That does fit your thinking," Keiko observed. "When you decide to do something, it's a _fait accompli_, at least in your mind, which is, of course, what matters to you."

"It is, but I'm also looking forward to the ceremony on October 8th. And if your treatments interfere with that, we'll reschedule. I know it's important to you to follow tradition, if only to please your parents and grandparents."

"My parents weren't happy we didn't invite them, but my grandfather understood, especially once I explained what you had done to arrange it at basically the last moment. They're happy we're still planning the full ceremony."

"Which is sufficient reason to do it in my mind, even if we have to adjust the timing."

"How do I change my driver's license?"

"Once we receive the marriage certificate, you simply take it, and your current license, to the Secretary of State's office and they'll make the change and issue you a new license. Once you have that, we'll go to the bank and add you to the checking and savings accounts. You'll need to do the same with Loyola and with Doctor Morrison and the hospital. The one thing I'm not sure about is the car title and registration. I can add you to the insurance right away, and I'll do that on Monday, but I'll have to check with the Secretary of State on that. I also want to add you to the deed for the house."

"Are you sure you should do that now…"

"Positive. As I said before, I won't change my behavior based on your illness unless and until I'm forced to do so by circumstances. I absolutely want to maintain a positive outlook, and Doctor Morrison said that was an important factor in the success of your treatment. And it's not feigned — I really do believe you can be cured."

"But the odds…"

"Is this where I quote Han Solo? _'Never tell me the odds!'_"

Keiko smiled, "But isn't that how you make decisions at work?"

"In a sense, but the odds are far fuzzier than any offered in a casino because there are too many unknowns. Similar to a casino, longer odds result in bigger gains. Generally, the more risk you can tolerate, the larger your potential gains, but the more likely you are to lose. But, and this is important, in my mind, I took zero risk in marrying you. I love you, Keiko, period. What's going to happen is going to happen, married or not, and I'd much rather be married to you than not."

"It's hard to be positive when the news is always bad," Keiko sighed.

"Except that's not true! It was neutral, not bad, until this last report. And your blast count is low enough that it's not crowding out the good cells. That's something, even if you need a marrow transplant. If I understand correctly from what I've read, you have much more time than someone who has a higher blast count."

"You always seem to find the positive in things."

"Perhaps because of the way I was raised," I replied. "When every day was a struggle, even the smallest positive development was important. I could have focused on how poor we were, and how little I had, and that we had to manage carefully to have enough to eat, and blamed the universe or 'the man' or whomever, and let that hold me back or get me down. I didn't do that then, and I won't do that now.

"That said, I'm not blind to the possibility, and I know it frightens you, but I promise you that no matter what happens, I will be there for you and with you, and do everything in my power to care for you and help you. Nothing is going to interfere with that, Keiko. Nothing. And it's my fervent hope we have sixty or seventy years together. And it's on that hope that I base my actions."

Keiko smiled. "It makes it easier for me to know you have that determination."

"And you have the same determination," I replied. "We'll beat this thing together. On a more mundane note, what do you want to do about dinner?"

"Are there any newlyweds here?" Jack called out.

"In the Japanese room," I called back.

Jack and Kristy came in carrying a cake, which to my surprise had Keiko's and my names on it, as well as bride and groom figurines.

"We ordered Italian," Jack said. "Kristy will go pick it up. Kristy is fully aware of Keiko's diet and there will be things she can eat. Bianca and Juliette will be here shortly; they went to get ice cream."

"Thanks," I said. "I had just asked Keiko about dinner, so perfect timing."

"The food will be ready in about forty minutes," Kristy said. "We'll put the cake in the fridge and leave you two alone until dinner."

"Thanks, Kristy," Keiko said. "We really appreciate it!"

"I wonder how they had the cake made so fast on a Saturday afternoon," I said once Jack and Kristy had left the room.

"Asks the man who arranged a marriage license and a marriage ceremony on a Friday night after 5:00pm, and had us married before 10:00am the next morning!"

"You might have a point," I chuckled.

"I want to ask a philosophical question — does it bother you that you were able to do something that most people could never do?"

"I think my answer has to be 'no', so long as I don't misuse it to hurt others. Using what happened last night as an example, the clerk made several hundred dollars and so did the judge. As for Mr. Spurgeon, he did it because he wants to keep me happy and earning money for him. A counter example would be those judges, lawyers, and police who took bribes and payoffs to fix murder trials. Or corrupt politicians who enrich themselves and their friends at public expense. Do you have a problem living a life of privilege?"

"No, I was just curious given what you've said about growing up."

"I never resented anyone who had more than I did, and I don't now."

"What do you think about giving to charity?"

"It's a good thing, and it's something I intend to look into once I receive my annual bonus. Do you have a specific charity in mind?"

"No, but I think it's important for people who are well off to be charitable and philanthropic."

"I agree. I'll do some research, and speak with Jeri — her mom supports all manner of charities from the Foundation."

"When's your next dinner with your friends?"

"On the 31st. It was originally set for the 23rd, but we changed it because you have chemo that week, and it's Wednesday because I have class on Tuesdays and Thursdays."

"You know, I haven't asked, but how is your client development going?"

"Slow, but that's normal for someone who is just starting out and doesn't have an industry-wide reputation and a track record of market-beating gains. Part of my plans for the coming week are to make follow-up calls for the letters and prospectuses that I sent out.

"Remember, my timeframe is longer because I'm still an analyst, which means I don't have any specific business development goals to earn my bonus. I do that by finding opportunities for Mr. Matheson and other traders to make money. Granted, bringing in new business helps, but it's not my primary job."

We had a very nice Italian meal with Jack, Kristy, Bianca, and Juliette, followed by cake and ice cream. After dinner, the six of us watched _Blazing Saddles_, which Bianca had rented at the video store. After the movie, Keiko and I went up to our room and made love for the first time as husband and wife.

_August 14, 1983, Chicago, Illinois_

"I can't believe you got married yesterday!" Violet exclaimed when I arrived at her house for our usual Sunday visit.

"Did my mom tell you why we did that before she left this morning?"

"No."

"On Friday, Keiko received her test results, and her oncologist says she needs a bone marrow transplant. We don't know when that will happen, so we might not be able to have our Shinto ceremony on October 8th. Because of the uncertainty related to finding a donor and scheduling the procedure, I arranged to have a marriage certificate issued Friday night, and to have a judge marry us yesterday morning."

"It's bad, isn't it?"

"It's not good," I replied. "I'm going to take Keiko to Mayo Clinic for an evaluation and investigate any new drug trials to give her the best possible chance to beat the leukemia."

"I'm sorry," Violet said. "I should have said 'congratulations, not said what I did."

"It's OK," I replied. "You were surprised by the news, just as our families were yesterday. Keiko's cousin had the same reaction you had."

"You're not taking a honeymoon, are you?"

"No. We’ll travel once Keiko recovers from her transplant."

"You say that as if it's a sure thing."

"I'd rather focus on the positive than the negative. I do want to apologize again for missing the game yesterday."

"It's totally OK. Are we still going to be able to meet after classes on Tuesdays and Thursdays, starting in two weeks?"

"Yes. I want to, and Keiko would insist."

"Will you help with dinner?"

"Yes, of course!"

_August 15, 1983, Chicago, Illinois_

On Monday morning, I completed my usual tasks, and at 9:00am, went to see Mrs. Peterson in Personnel. I described what had happened, and after an expression of concern and surprise, she explained what I would need to do.

"First, you may want to fill out a new W-4, changing your status to married, and possibly adjusting your deductions. Do you have an accountant?"

"Yes."

"Then verify with him what you should show, because what you don't want to do is under-withhold. I can't provide you with specific advice, as I don't know the totality of your financial situation. You can fill out the form at any time, but sooner is usually better."

"OK. I'll call Robert Black as soon as I return to my desk."

"Good. Next, you should change your beneficiaries on your life insurance forms. Illinois law requires you to list your spouse unless she signs a waiver."

"OK. My intent was to name her as beneficiary."

"Last, there's the question of insurance. Our policy does not have any pre-existing condition exclusions. but there is a ninety-day waiting period when you add someone to your policy, except in the case of a baby. I take it Keiko has insurance?"

"Through her parents, as a full-time student."

"They should keep her on their policy until the end of November, when your policy here will begin covering her. Depending on how the policy works, they may need to keep her on it until the end of December, but it would become secondary after the ninety-day waiting period. That means it might, within the policy limits, cover anything not covered by our policy, but our policy is basically the gold standard."

"OK. I'll make sure her father is aware. Anything else?"

"No, that's it for now. You'll obviously need to take care of any personal financial accounts, and so on, and your CPA or attorney can advise you. If you don't have a will, I suggest creating one, but again, speak to your attorney about that."

"Thanks, Mrs. Peterson."

"You're welcome. I hope things turn out well for your wife."

"Me, too."

I left her office and returned to my desk, then placed a call to Robert Black. Once again I explained the situation and, after expressing concern for Keiko, he asked several questions, then advised me to modify my withholding. I thanked him, ended the call, then placed a call to Nelson. After congratulations and expressing concern for Keiko, he and I discussed creating simple wills. I also asked for advice on changing the deed for the house and the title for my car.

"Not to be insensitive, but I'd advise you not to do that, as it could complicate things if the worst happens."

"Maybe so, but the symbolism is important to me," I replied. "What's the downside?"

"Probate, mostly. There are other considerations for high net worth individuals, but I know you'll reject protecting yourself in the case of divorce out of hand."

"You're right. And I'm not exactly 'high net worth'."

"Not yet, but you will be, and you do have significant assets. It's too late for this now, but you probably should have had a pre-nuptial agreement that limited your wife's ability to force liquidation of positions in your fund ."

"That would be insulting and show a complete lack of trust," I protested.

"I understand your feelings on the matter, but my job is to advise you about worst-case scenarios. In any event, it's water under the bridge given your spur-of-the-moment marriage. What about October 8th?"

"We're still hoping to have the Shinto ceremony that day, but a lot depends on Keiko's treatment."

"Keep me posted. I'll draw up the simple wills and send them to you. I assume you simply want to leave everything to Keiko, and vice versa?"

"Almost. I want to set aside $25,000 for my mom. I'll increase that in the future, but for now, that's the number."

"Ok. I'll take care of it."

"There's one other thing," I said. "And this has to be completely confidential."

"Everything you say to me as your attorney, except for expressing intent to commit a crime, is confidential."

"Bianca is pregnant. We'll need to draw up some kind of document."

"I know you well enough that had to be intentional."

"It was. Bianca wanted to have a child with me and odds are Keiko cannot have biological children, so she agreed to Bianca and me having one together. Keiko and I will adopt when the time comes."

"That complicates things a bit," Nelson said. "Let me review this with a partner in family law and get back to you, but the basic rules in Illinois are that your unborn child does have some claim on your estate."

"Just let me know, please. See you next week at Jeri's."

I ended the call, then called Cheryl, Mr. Spurgeon's secretary, to relay my request for the contact at Mayo Clinic. Cheryl gave me the name and number of an oncologist that Mr. Spurgeon's contact had provided, and who was expecting my call. She also let me know Mr. Spurgeon had made the corporate Gulfstream III available, as he'd offered on Friday night. I thanked her, ended the call, then called Keiko to relay the oncologist's name and number.

All of that out of the way, I returned to my analyst duties, including working with Bianca on the volatility model. She and I ate lunch together, then went to the gym to work out. When I returned to the office, I found a message slip noting that Thad Baker, a partner at Allen & Baker, had called about the prospectus I'd sent. I returned the call, and his secretary put me through to him.

"Thanks for returning my call, Mr. Kane."

"Jonathan, please," I replied. "You called about the proposal and prospectus I sent you?"

"Yes. Do you have some time to meet with me to discuss it?"

"Of course. What's convenient for you?"

"How about Thursday at 1:00pm?" he offered.

"I'll be at your offices at 1:00pm on Thursday," I replied.

"Thanks, Jonathan; see you then."

We ended the call, I made a note in on my desk calendar, then went to Mr. Matheson's office to let him know about the meeting.

"It sounds preliminary," he observed.

"I agree. I'll gather information and answer his questions. I suspect he'll have to take it to the other partners for approval, similar to Hart-Lincoln."

"I'd say that's a sure thing. Just let me know how it goes. On another topic, Noel let me know about your weekend activity. Are you sharing that?"

"Our families and closest friends know, and I saw Mrs. Peterson this morning to discuss changing my taxes, insurance, and beneficiary. Did Mr. Spurgeon let you know about me taking Keiko to Mayo Clinic?"

"Yes. He said he'd authorized as much time off as you need. I know you well enough that you won't neglect your job while taking care of your wife."

"I'll do my best."

"Keep me posted."

"Will do!"

I returned to my desk and continued my usual afternoon research and analysis. Just after 3:00pm, Keiko called to say she'd spoken to Doctor Weiss at Mayo.

"He can see me at 2:00pm on Friday afternoon," Keiko said. "Will that work?"

"I just need to let Mr. Spurgeon's secretary know we need the jet and let Mr. Matheson know I'll miss Friday. Did you speak to Doctor Morrison?"

"Doctor Weiss promised to call him to get my records and discuss treatment while we wait for a bone marrow donor."

"OK. Let me make the arrangements. I love you, Keiko!"

"I love you, Jonathan!"

We ended the call, and I dialed Cheryl's number and asked her to make arrangements for Keiko and me to fly to Rochester on Friday. She promised to do that and call me back with the details. She called back about an hour later.

"The plane will be waiting for you at Meigs on Friday at 10:30am. It will fly you to Rochester, wait for you, and bring you back to Meigs that evening."

That schedule would allow me to work for a few hours on Friday morning, assuming Kristy could bring Keiko to Meigs. I was sure she could, but if not, I'd work out another plan. Being able to create my daily analyst report was very important, and Mr. Matheson had made a point of how he’d missed it during my two-week leave.

"Perfect," I said to Cheryl. "Thanks."

"You're welcome."

I ended the call, then let Mr. Matheson know I'd be in early on Friday and leave about 10:00am to head to Meigs.

_August 18, 1983, Chicago, Illinois_

"Jonathan Kane to see Thad Baker," I said to the receptionist when I walked into the offices of Allen & Baker.

"Please have a seat and someone will come to get you."

"Thanks."

I sat down and she made a call, and about two minutes later, a young woman came to the door and invited me to follow her to Thad Baker's office.

"Good afternoon," Jonathan he said. "Please, have a seat. Can Sue get you anything to drink?"

"A Coke would be nice, thanks."

"A Coke for Jonathan and coffee of me, please," he said to his secretary.

"Right away!" she exclaimed.

She left and returned a minute later with coffee and a Coke.

"I have to ask," Mr. Baker said, "how long have you been doing this?"

"I'm relatively new. Spurgeon has been in business for about ten years, and I joined two years ago. I have my Series 3 and Series 7 securities licenses, and currently have about $50 million under management personally, and Spurgeon has about $3 billion under management. I'm one of the fund managers, and I'm also a foreign exchange analyst."

"And the returns in your proposal and prospectus are legitimate?"

"All the statements in the prospectus are audited, except for my new fund, which was just established this year. And to answer a question I've been asked before - Spurgeon Capital has never once been found to have violated securities laws."

"How is it that you can consistently beat market returns?"

"To use a cliché, knowledge is power. I, and other analysts, do the legwork to know which financial instruments will generate the best returns, and to take positions before the general public. As I said, it's all legal, and requires always being at the top of our game. As Mr. Spurgeon says, nobody makes billions pitching underhand."

"What kind of risk would we be taking on?"

"Actually, less than if you were invested in an S&P or Dow index fund. That said, I won't pull any punches — as with any investment, it is possible that you could lose all your principal and any gains."

"That's not exactly a strong sales pitch!"

"Perhaps not, but if you read through the prospectus, as I'm sure you have, it says that, couched in legalese and financial jargon. While I cannot guarantee returns, Spurgeon has historically made money in both up _and_ down markets. And remember, the first 8% profits belong solely to the investor. That gives us the incentive to beat that by as much as possible, within our risk parameters."

"I compared your returns with the returns we’re currently earning on our investments and they're significantly better, even allowing for the higher fees. What's the process?"

"You fill out an application, our Legal and Compliance teams will review the application, then our New Accounts team will arrange to transfer your investments from your current broker. The entire process takes less than two weeks. What's needed on your end?"

"I simply need to confirm with Joe Allen, the other name partner. I'm the managing partner, so, in the end, it's my decision, but I always run things by him."

"I brought the application form with me," I said, taking it from my satchel and handing it to Thad Baker.

"Joe is in court today and tomorrow, so I won't speak to him until Monday."

"OK. I'll look to hear from you next week. If you have questions, please call. I will be out most of tomorrow, but I'll be in the office all day Monday. What is the value of your current holdings?"

"A million and a half."

"Thanks for taking the time to meet with me.

"Thanks for coming in."

We stood up, he walked me to reception, and we shook hands. I got into the elevator, nodded to him, and when the elevator reached the ground floor, I walked out of the building and headed back to the Hancock Center.

When I arrived in the office, I let Mr. Matheson know what had transpired.

"How much?" he asked.

"A million and a half," I replied.

"Great job, Kane!"

"Thanks."

I went back to my desk and placed a call to Bill Wyatt.

"What can I do for you?" he asked. "You can't be ready to upgrade!"

I chucked, "Not yet. I'd like you to look for a two-flat for investment and income."

"I'll pull a list from the MLS, view them myself, and let you know. Give me a week."

"Perfect. Thanks, Bill."

_August 19, 1983, Mayo Clinic, Rochester, Minnesota_

"This is crazy!" Keiko said once the Gulfstream had taken off from Meigs Field for our flight to Rochester.

"It sure beats flying commercial! Don't get too used to it, though! I'd need to be richer than Matheson to afford something like this.

"How much is that? I mean, not Mr. Matheson, but how much would you need to own a plane?"

"Given all the costs associated with it, at least two hundred million. And I don't mean assets under management, I mean personal net wealth. This plane, new, costs something like $15,000,000, and would cost around $300,000 a year to operate, plus fuel and airport fees."

"What's your goal?"

"The same as it always was — to have a comfortable life, marry, have kids, and enjoy myself. I've actually achieved all of those things; well, the baby is on the way."

"I just wish I could have a baby with you."

"We will," I replied. "What do you think about trying to find a Japanese child?"

"I can't imagine that would be easy," Keiko replied. "I hear it's hard to adopt an infant as it is, and there are very few Japanese people in the US."

"It doesn't hurt to ask," I observed. "But I'll be happy with any baby we adopt."

"We have to get through the bone marrow transplant first, assuming they can find a donor."

"Please stay positive, Keiko-chan. Loyola started their marrow drive, and as students come back for class, I'm sure more and more will be tested. And more people are being added every day to the National Marrow Donor Registry, which was started in Minneapolis."

"It's difficult," Keiko sighed.

"I know, but Doctor Morrison said staying positive will improve the chances of success. As strange as that sounds, he did say that the statistics back that up. Being depressed makes an opportunistic infection more likely and makes outcomes worse."

"With your help, I can do it."

"I love you very much, Keiko-chan."

"I love you, too, Jonathan!"

The flight was quick, and a car was waiting at the airport to take us to Mayo Clinic, where a medical student met us in the lobby.

"Keiko Suzuki?" she asked.

"Yes," Keiko replied.

"Hi. I'm Kalinda Sharma, a Sub-Intern in oncology. Would you come with me, please?"

We followed her to the Oncology Department, and she introduced us to Doctor Martin Weiss.

"How are you feeling today, Keiko?" Doctor Weiss asked after he had greeted us.

"Tired," she replied.

"Understandable. Our plan for today is a complete physical, blood tests, and then a meeting with our bone marrow transplant specialist. He's been in touch with the Registry in Minneapolis and will be notified the moment a suitable match is found. Do either of you have any questions before we begin?"

"No, I don't," Keiko said, and I shook my head.

"Then, please go with Kalinda."

Keiko and I followed the medical student to an exam room. She asked Keiko to change into a gown, then stepped out of the room. I helped Keiko change, and four minutes later, Kalinda came back into the room with a nurse. Kalinda checked Keiko's vital signs and wrote the information on a chart, then the nurse, Michelle, drew blood and had Keiko provide a urine sample. Once that was complete, Doctor Weiss came in and performed a complete physical exam and asked Keiko about her medical history.

"I'd like to ask a question, if I might," I said.

"Sure Jonathan," Doctor Weiss replied.

"All of that information is in Keiko's records. Why ask her about it again?"

He smiled, "Every physician repeats the same questions upon a first visit because things change, patients remember things, and, while I don't believe it's the case with Keiko, patients lie or change their stories. By asking, we find things that were forgotten, missed, or purposefully admitted."

"Thanks for answering the question."

"Don't ever hesitate to ask your physicians questions, even if you think it might be silly. It's always appropriate to ask those questions."

"I'll remember that."

"Keiko, you're in excellent condition, all things considered. Having reviewed your records, I believe you're an excellent candidate for a marrow transplant. With regard to treatment, my recommendation is to have the next round of chemo and then re-evaluate. I don't believe either of the experimental trials is appropriate at this time."

"Why is that?" Keiko asked.

"The chemo is keeping your leukemia under control and you haven't had so much as a sniffle, and as I said, you're an excellent candidate for a transplant. The experimental treatments have more severe side effects, and could leave you in worse shape with regard to having the transplant."

"OK," Keiko replied.

"I'll evaluate the results of the next round of chemo with Doctor Morrison, and we'll decide on the best course of action following that. I'll make sure he has the results of today's blood test results no later than Monday morning. Do you have any questions?"

"When you say 'under control', what does that mean?"

"So long as your blast count is significantly reduced by each round, and doesn't increase by more than 5% between each round, we consider your leukemia under control. Any other questions?"

"No," Keiko answered.

"Then let's get you to Doctor Gualtieri, the marrow transplant specialist. Kalinda will escort you. If you have any questions before you leave, let Kalinda know, and she'll bring you back to see me. Otherwise, I'll see you when we find a donor."

"Thank you, Doctor Weiss," Keiko said.

We shook hands, he left, and Kalinda led us to Doctor Gualtieri’s office. He didn't perform an exam, but instead conducted an in-depth review of Keiko's diet, daily routine, and just about every other aspect of her life, including what he termed 'intimate relations'. I was surprised at the level of detail he requested.

"Why is that important?" I asked.

"It's part of the evaluation of overall risk. Close, intimate contact is a transmission vector for infections. The bigger concern is the number of people in the household, though that's mitigated by the air cleaning systems you have. The reason this is a concern is that any kind of infection would delay the transplant."

"Sorry, I wasn’t objecting to the question, simply wondering why the details mattered."

"There are some activities which are riskier than others, but you haven't reported doing any of those, and given you're married, you're exclusive with each other."

Which wasn't true just a month ago, but there was no point in raising that with Doctor Gualtieri.

"How big a risk is it?" Keiko asked.

"It's simply part of the overall risk profile," Doctor Gualtieri replied. "There are no specific objective criteria, only subjective analysis. When the time comes, we'll discuss how you can reduce your risk of infection and a diet to boost your recovery. On that topic, how quickly are you able to come here?"

"Jonathan?" Keiko prompted.

"We have access to a corporate jet," I said. "We can, in many cases, be here within a few hours. If the plane is elsewhere, we'd take a commercial flight, which might mean six to eight hours, or possibly overnight. I thought this wasn't a time-critical as an organ transplant."

"It's not, but time is of the essence because of the necessary preliminary procedures, which involves both chemo and radiation prep. The goal of that process is to destroy cancer cells. suppress your immune system. and ablate your diseased bone marrow. The side effects can be pretty severe. They include, among other possibilities — nausea and vomiting; diarrhea; hair loss; mouth sores or ulcers; infection; bleeding; infertility or sterility;; anemia; fatigue; cataracts; and in rare instances, organ complications, such as heart, liver or lung failure.

"The procedure itself is simple — a transfusion of donated marrow cells via your existing catheter. We'll keep you for a short time following the transplant, then turn you over to Doctor Morrison in Chicago as soon as you feel up to travel, and having access to a private jet makes that much easier. Of course, we'll stay in close touch with Doctor Morrison and coordinate care. There are possible complications from the bone marrow transplant — graft-versus-host disease, which is akin to rejection of an organ transplant; stem cell graft failure; organ damage; infections; cataracts; infertility; new cancers; and, in rare cases, death.

"I know that sounds terrible, but the alternative is that your leukemia progresses to a point where chemotherapy is no longer effective, and eventually your immune system will be unable to fight off even a mild cold, which would likely lead to pneumonia and even high-dose antibiotics won't resolve it. There are many other possible infections as well, and while there is risk if you have the marrow transplant, that at least gives you a fighting change.

"After the marrow transfusion, you'll be closely monitored, as I said, and will likely receive blood transfusions while your body is unable to generate enough healthy blood cells. We'll likely prescribe immunosuppressants, as well as antibiotics, to preemptively fight infections. I know that might sound contradictory, but we want to prevent graft-versus-host disease.

"Finally, you'll meet with a nutritionist before you leave us. He or she will develop a diet for you, but the general guidelines are to eat a wide variety of healthy foods, including vegetables; fruits; whole grains; lean meats, poultry and fish; legumes; and healthy fats, such as olive oil. You should limit salt intake, severely limit alcohol, not eat grapefruit or drink grapefruit juice, and absolutely not use any tobacco products. You'll also want to engage in regular physical activity. Any questions?"

"Do you have all of this in writing?" Keiko asked.

"Yes. You'll need to sign consent forms that include all of that, and I'll give you copies before you leave today, along with a brochure that describes the procedure. You can read those at your leisure, because you won't need to sign anything until you return for the procedure."

"Is there any way of predicting which symptoms or complications Keiko will have?" I asked.

"No," Doctor Gualtieri replied. "Let me reassure you about one thing, and it's the thing that most people need reassurance about — death from graft-versus-host disease is far less likely than death from refractory AML. Any other questions for me?"

"Not at the moment," Keiko replied.

"Call me any time with any questions. And, of course, I'll call you as soon as we locate a donor. Do you have any questions for Doctor Weiss?"

"No," Keiko replied.

"Then let me give you the paperwork and call Kalinda to walk you out."

"I need to call for a car," I said.

"Use my phone, please," Doctor Gualtieri offered.

I placed the call while he gave Keiko the paperwork, and then he called Kalinda to walk us out. Twenty minutes later, we were boarding the Gulfstream for the return flight to Meigs Field.

_August 20, 1983, Chicago, Illinois_

On Saturday morning, Bianca and I drove to Loyola Medical Center for her appointment with Doctor Janice Wisniewski.

"How are you doing?" Bianca asked.

"I'm doing OK," I replied. "In the end, it all comes down to finding a marrow donor. The doctors at Mayo said that the chemo is effectively controlling Keiko's leukemia, which gives us time to find a donor."

"What does 'controlling' mean?"

"I asked that question and per Doctor Weiss, it means her blast count is significantly reduced by each round of chemo and doesn't increase by more than 5% between each round. That can't continue forever, but the longer it does, the more time we have to find a donor,"

"That sounds like better news than you had."

"I think it's about the same, really. Both Doctor Morrison and Doctor Weiss said that chemo won't save her, and that eventually it will become ineffective or she'll develop some kind of infection. We just have to hope for a match. Anyway, what does this doctor visit involve?"

"A physical exam, blood tests to check for anemia or elevated blood sugar. The main problem they look for with the physical exam is high blood pressure. They'll also do a breast exam and a gynecological exam."

"And you're OK with me being in the exam room for that?"

"First of all, you've seen everything! And you've done your own close exams and probed deeply!"

"All kidding aside, I have no clue what that means."

"A breast exam is basically checking for lumps; a gynecological exam uses a device called a speculum to allow the doctor to do a Pap smear, which is collecting cells from my cervix to check for abnormalities. That's basically a cancer check. At future appointments, they'll do an ultrasound and we'll get a picture."

'"Cool!"

"At some point we'll go to Lamaze classes to learn about childbirth so you can coach me."

"Hey, I have experience! I was with Bev when she delivered!"

"But you'll go to classes with me, right?"

"Of course I will."