Nothing Was the Same by Kay Redfield Jamison

was a good thing; it carried the possibility of life. My Hopkins colleagues made an appointment for us to see an oncologist at Hopkins the next day. I will go to my death, as Richard did his, more than willing to walk on broken glass for him.
    Richard Ambinder, the director of hematologic malignancies at Hopkins, took one look at Richard and said, “So. You look sick.” This, in itself, would not have been enough to secure our trust; it was not a penetrating observation. The lucidity and rigor with which he laid out the diagnostic and treatment possibilities, however, and the insistent concern with which he regarded Richard’s rapidly deteriorating condition, did catch our attention. Richard’s MRI scans showed clearly malignant disease, he said, and it was progressing rapidly. If Richard did not get immediate and aggressive treatment, he would die. We had entered the blunt and exquisitely competent world of Ambinder and were relieved to have done so.
    Ambinder said he would consult a Hopkins pathologist and one of his colleagues at the National Institutes of Health (NIH); if it turned out to be a solid tumor malignancy, he did not hold out much hope. If it was Burkitt’s lymphoma, as he thought likely, Richard had a chance. Ambinder grasped Richard’s shoulder and told him that he and the Hopkins staff would take good care of him. He then turned to me and assured me of the same. He took Richard up to the ward himself, talking with him all the while about their research interests and common experiences as medical students at Hopkins. I saw, for the first time in weeks, a trace of animation in Richard’s eyes. I also saw him tap deeply into the trinitarian roots of his true faith: Medicine, Science, and Hopkins.
    Ambinder told us that the pathologist would talk to me later that evening about his diagnostic impressions and suggestions for treatment. Things would get moving; everyone would do what could be done. No grass grew under Ambinder’s feet.
    The pathologist called that night. Richard almost certainly had Burkitt’s lymphoma, he said, and he concurred with Ambinder that if Richard did not start chemotherapy straightaway he would die. His directness, together with his careful description of Richard’s disease and its prognosis, made our decision relatively easy. He and Ambinder did not present an array of complex and competing options. There were no meaningful options besides chemotherapy, and there was no point in wasting time.
    Ambinder had said that if Richard responded to the chemotherapy, he was likely to show a quick and dramatic improvement in his symptoms. This was true. I went to sleep in a chair next to Richard’s bed that night and woke up in the morning to find him smiling at me, revived as from the dead. Not among the quick, perhaps, but a bracing distance from the dead. “I think I like this doctor,” he said. “I think I like him very much.”
    A few weeks after Richard’s dramatic response to chemotherapy, Ambinder recommended that he undergo a peripheral stem cell transplant. Stem cells would be recruited from his bone marrow into his bloodstream, removed, and stored. In order to destroy any remaining cancer cells, he would undergo eight days of very high-dose chemotherapy His previously harvested stem cells would then be transplanted into him through his veins and stimulated to proliferate. In painstaking detail, Am-binder made it clear to us that Richard was a high-risk patient undergoing a high-risk procedure. Death was a distinct possibility. Death was becoming part of what we had to think about.
    Richard was sick for a long time. He lost his hair, retched and vomited in places too many to mention, and became transiently psychotic from steroids. One day, as he put it, he shed his gut like a snake sheds its skin. Anticancer drugs were injected directly into his cerebrospinal fluid. He endured so many uncomfortable and harrowing procedures that what he went through was only partially