Living Out Loud

by Craig Sager

  I was hopeful when Dad and Stacy went to MD Anderson, because I knew it was the best hospital in the world.

  I was at the Atlanta Falcons’ headquarters on May 26 to wrap up my final day of covering their spring practice. I went home that night to start packing for a trip to visit my sister in Tampa the next morning. As I was packing, my cell phone rang.

  “Junior,” said Stacy, “your father needs you.”

  Stacy explained to me the direness of the situation for Dad and the immediate need to do a second bone marrow transplant. Though the first attempt using my marrow had failed, doctors wanted to try a second time but with a different procedure. Before our conversation ended, there was an 8:00 a.m. flight to Houston already booked and an itinerary waiting in my inbox from MD Anderson, laying out the first three days of the donation process, as this time around things would be much different.

  I arrived in Houston less than twelve hours later. Dad’s condition was deteriorating, and the odds were stacked against us more than at any time before, but knowing I had another chance made me feel alive again.

  I had forty minutes before my first appointment, not even enough time to check in at my hotel and drop off my luggage. I rushed through the terminal until I was stopped in my tracks by a massive wall-to-wall MD Anderson advertisement overhead: ONE GOAL: CANCER. I let that simple message resonate as I took a deep breath. I felt a surge of focus and began the long walk.

  I was fascinated by the hospital’s efficiency and organization. With my donor checklist in hand, I migrated with hundreds of other patients from floor to floor and building to building. There was a process at MD Anderson, not the waiting lines I was accustomed to. To get my blood work done, I’d scan my wristband at the front desk and get handed an index-card-size form with printed labels ready to be peeled off and slapped on whatever number of vials my card called for that day. I was funneled into a room with several nurses who were perched at their stations and ready to go. Eye contact and an empty chair were the inherent language. Like a pit crew, they had us in and out before I could even suggest how relieved I was to be done with my blood work—at least for the first day.

  Instead of harvesting the transplant directly from my bone marrow, like the first time around, this transplant process consisted of daily shots that would generate enough white blood cells to escape into my bloodstream. This allowed them to avoid having to drill through my bone to reach the stem cells.

  The daily labs were done in the mornings, followed by meetings with the doctors who would be performing the stem cell harvest. I received Neupogen shots in my abdomen each day, which were used to boost my stem cell and white blood cell counts. I Googled Neupogen and learned that a donor can administer the shots himself; the doctors actually asked if I wanted to jam a needle into my own stomach each time. Most of the time, I just laughed uncomfortably at the question. Each day, I could feel my legs getting fuller with blood, my body feeling heavier, and my chest feeling tighter. The discomfort meant that it was working.

  I spent the time between my appointments in my dad’s hospital room until he couldn’t take it anymore and demanded that I “go have fun instead.” I played golf in Houston, toured the city’s sports venues, strolled Rice University’s campus, and even squeezed in an Astros game and a trip to the Museum of Natural Science. During my visit to the museum, a Texas flash flood came out of nowhere and left me locked in the exhibits for hours after closing. My dad watched the weather reports from his room and laughed with me over the phone as I staved off my hunger with the only source of food I could find—rock candy from the museum gift shop.

  Every day, Dad would go for a walk at around the same time, and I made it a point to be there during his only time out of his room. The walks were therapeutic for both of us. With his gown and mask much more loosely fitted than any doctor would advise, he led the way. He wheeled a tower of tubes, cords, chemo, and monitors through the longest and most scenic path he could devise. There was no way that this was what the doctors had in mind when they told him he could go for a walk, but it was exactly what I expected. We hit every corner of the hospital, including a secret workout room where he rode the bike each day. We always ended the walks outside in the hospital garden, where Dad had found a bench he liked. Once we were situated, he worked, made phone calls, and enjoyed the groomed landscape surrounding the hospital until the doctors urged him to return or he had his next treatment or checkin. The humidity and scorching heat were smothering, but since he didn’t mind, I didn’t either.

  Every previous trip I’d gone on with my dad had been either a party or work; that was all we knew. Golf trips, barhopping, trips to the Bahamas, playoff basketball—that was the only pace of life we’d known before this. Now the two of us were sharing a moment of our lives where the future was too unpredictable and overwhelming to even exist and there was nothing else in the world to be doing. The only thing we did know was that speaking about leukemia or the hospital or anything to do with the indoors would have interrupted the moment. During our walks, our conversations bounced around from mapping out his favorite places in Houston to admiring the pigeons that were stalking us for food.

  The pigeons reminded us of the Olympics in 1996, when the City of Atlanta brutally purged the pigeon population. We also reminisced about a round of golf in Malibu where Dad’s fuchsia flower-printed shorts had drawn aerial attacks from hungry hummingbirds the entire round. When we finished our conversation or when it was time to leave, we would make the walk back up to his room. I’d change back into a gown and mask and Dad would return to a rotating wardrobe of warm-ups and team T-shirts, ready to check off another day.

  With enough Neupogen in my body to saturate my bloodstream plus another two shots for assurance, doctors moved me on to the harvesting process, or apheresis, on the morning of June 2. “Apheresis” is a word that still triggers a Pavlovian urge to roll down my sleeves and cringe, but in the medical world, it is a technology that separates the blood of the donor to collect a particular substance (stem cells in our case) and returns the remaining blood to the donor.

  The first thing I noticed during the apheresis procedure was that the needles looked more like ballpoint pens. Nurses forced them deep into each arm as I clenched my teeth and realized how much more painful this would be than the first transplant. I watched my entire bloodstream filter through the noisy dialysis machine next to me for hours as the blood ran out one arm, filtered through the machine’s network of tubes, and then reentered my body through my other arm. If the blood started to drizzle out of my arm more slowly than was required, the machine would sound an alarm and I would have to squeeze more quickly the stress balls that I was rhythmically pumping the entire time. I thought I had overcome my fear of needles, but I was pushing streams of blood out of my own body and I couldn’t ignore it. I tried to stay as still as possible, but my body became more uncomfortably tense the longer I tried not to move.

  When it was over for the day, the nurses pulled the needles out and sent the collected cells to the lab to see if they had extracted enough of them for the transplant. Confident in my relative youth as a donor, my own immune system, and my swollen stomach from a week of shots, I believed the process was done.

  When I returned the next morning, however, I was greeted with two more Neupogen shots and a new room number—they were not even halfway to the threshold they were aiming to collect. At least by now the nurses knew better than to ask me if I wanted to give myself the shots that day. My bruised veins ached as I lay down and the nurses repeated the same process. More needles, more blood, more squeezing balls. I was haunted by the thought of having to schedule another flight and go through this yet another time if they didn’t get enough.

  On June 4, I got the news I was waiting for. Doctors had collected the targeted six million stem cells and then some. With a flight to catch later that day, I rushed up to Dad’s room to relay the good news and to say goodbye. Before I could enjoy my relief, however, a team of doctors entered
the room behind me and blindsided us all with the most unexpected and difficult news I had heard since Dad’s original diagnosis.

  The chemotherapy drugs that he had been on since arriving at MD Anderson a few weeks earlier weren’t working, and his leukemia blasts had skyrocketed to a lethal 74 percent. Doctors won’t even consider a transplant unless the blasts are below 8 percent, so the transplant was on hold. The issue now was whether doctors could save my dad’s life. As Dad and the doctors discussed options, I sat quietly off to the side, stunned. I wanted to stay, but Dad insisted that I had done enough and should go catch my flight.

  Seeing that he wanted—maybe even needed—me to leave, I respected his wishes, but I left the hospital armed only with the knowledge that my efforts and stem cell donation would be useless without some sort of miracle. My dad was dying.

  21

  RELENTLESS

  When Dr. Pemmaraju told me that my blasts were up to 74 percent, it was a left hook; despite my fight gene, I knew the harsh reality of the situation. My leukemia was aggressive and was finding new ways to fight me. I had spontaneous bleeding from my mouth and nose, and I was dangerously low on platelets. The chemo had weakened my immune system, and I had little strength left to fight.

  “If untreated, this relapse of AML, after a transplant, can take your life in just weeks to a month,” Dr. Pemmaraju told me, “unless we find a way to extend your life.”

  Weeks to a month. Yeah, right, just like Dr. Holland had given me three weeks in March. What’s with doctors putting a stopwatch on my life?

  “But I have a plan,” said Dr. P, and my eyes lit up. “We will get you into a new, aggressive clinical trial, and we will get this fixed together.”

  I believed him—that not only did he know what he was doing but that he was doing it with us, not just for us. He went to work and identified the right trial for me to start right away, and the nurse began the hefty paperwork.

  “This is your best chance for remission,” he reminded me as I griped through the bureaucratic process.

  Six hours later, Dr. Pemmaraju returned with devastating news. The trial he wanted me in, with a drug that was my last hope for survival, did not accept AML patients who had already had a stem cell transplant.

  “No way!” Stacy jumped in. “They are taking away Craig’s only chance. I suggest we figure this out. I know that with a little more paperwork and phone calls we can get this done … and we have thirty minutes to make it happen and we won’t take no for an answer.”

  There was a second of silence as Dr. Pemmaraju’s eyes darted quickly from Stacy to me.

  “Great, let’s go for it!” he said. “Let’s do it!”

  With that, Dr. Pemmaraju disappeared and we waited. Stacy and I held hands, and she kept telling me that we would get into the trial and it would work and I would be fine. Her confidence and reassurances meant the world to me. Dr. P returned to the room a few minutes later with an update. The biotech company whose drug was used in the clinical trial was based in Japan, and it would not make an exception to include me in the trial unless its full board gave their blessing. Dr. Qazilbash, said no to Dr. Pemmaraju’s wanting to try to get a board vote. He told him I couldn’t be part of the trial.

  “I don’t care,” said Stacy. “Make it happen.”

  So, again, Dr. Pemmaraju went to work. A few hours later, he told us the board would consider my case but that they would not meet until Monday, as we were entering the weekend.

  Will I make it till Monday? I asked myself. But then I thought, Of course I will.

  *

  “Relentless” is a kind adjective that some folks use in describing me. I guess it’s much more of a compliment than “pest” or “pain in the ass,” which I have also heard throughout my career. My dogged pursuit of the story—of information—dates way back to my first job as a radio update anchor in Sarasota, where I would call the city’s mayor at 5:00 a.m. to confirm something I had heard the night before.

  When two-sport star Deion Sanders was traded from the Cincinnati Reds to the San Francisco Giants in August 1995, I wanted to be the first to hear from “Prime Time,” who declined to speak to the media. A few decades earlier, I had broadcast ten-year-old Deion’s Pee Wee football games in Fort Myers, getting $25 a game from sponsor Pepsi to do so. And yes, Deion was amazing even as a ten-year-old. I used that connection to track down his mother, Ms. Connie Knight, living in Florida, to help me secure an interview with Deion.

  In March 1997, Shaquille O’Neal was a member of the Los Angeles Lakers, having signed as a free agent the previous summer, ending his time with the Orlando Magic. The Lakers were on the road to face Shaq’s old team, but an injured Shaq wasn’t talking to the media, choosing instead to seclude himself at his Isleworth mansion, outside Orlando. I knew the security guards at the gate would never let me and my television crew in, so I had to get creative.

  We drove around the lake until we found a boat launch spot, where I noticed a man struggling to get his motorboat into the water. I offered assistance, with a catch—he had to pilot me to Shaq’s house. So with assistance from the crew, we launched the boat and drove around the waters of Isleworth until we spotted Shaq’s boat, docked out back of his house. Shaq was outside shooting hoops, but despite my most convincing pleas, he still refused to talk. I pleaded with the big guy that my crew and I had gone through so much effort just to get there—could he please talk with me?

  “Next time I am going to send my alligators on you,” he told me.

  But I got the interview.

  I guess if any athlete really thought I was a pain in the ass, it was Mr. October, the great New York Yankee Reggie Jackson. As a cub reporter in Fort Myers, I would cover the Yankees when they came to town, and Reggie was always unavailable. He would drive up to the ball field right before the start of the game in a Rolls-Royce and brush right past the young, adoring fans asking for autographs. As a reporter, I wanted the interview, so I followed the Yankees from Fort Myers to Sarasota to Fort Lauderdale, always trying to talk to him on his way in or out.

  At this point in my career, I was still a one-man band, lugging around a big old wooden tripod and a rudimentary video camera that weighed a ton. Everywhere I went, so, too, went my equipment. During a Yankees game in Fort Myers, I decided that today would be it. I knew that Reggie had a habit of changing clothes and leaving the park early, well before his teammates. So I set up my tripod and camera a few feet behind his Rolls-Royce, clearly blocking his exit.

  “Reggie, I am all set up,” I pleaded with a smile.

  He shrugged, scowled, and insisted he didn’t have time.

  “Please. Just a few questions?”

  And in the parking lot in Fort Myers I got my interview. Sometimes you need to create your own luck. Ever since then, whenever Reggie has spotted me at a game or a press conference, he’s smiled and said, “One-man gang.”

  Relentless.

  As it turns out, Stacy was relentless, too. And that drive had at least given us hope for the weekend.

  22

  DANIEL AND BRANDON

  The wait over the weekend was excruciating. I was dying, and my only hope rested with a group of Japanese businessmen whom I had never met, in a land far, far away. They didn’t know me, didn’t know how much my bride and kids needed me, and surely didn’t know or care that I was a sports broadcaster. The odds were against us, but haven’t they been for a long time?

  Late Monday, a miracle happened when we received the news: we were a go.

  Dr. Pemmaraju, Stacy, the nurses, and everyone else on our team was thrilled, but Dr. P laid out all the risks.

  “We will do fourteen straight days of chemotherapy, twenty-four hours a day,” he said. “There is a risk that the chemo may shut down your organs and kill you—but you will have a chance.”

  Never before, anywhere in the world, Dr. Pemmaraju explained, had this intensity of chemo been tried on an AML patient in my condition. Either the chemo would kill me or the leuke
mia would, or maybe, just maybe, I could be a miracle.

  So on June 9, I started fourteen days of around-the-clock chemo. Because I had declined to be on the isolation floor and was staying on the “leukemia floor,” I had a bit more freedom. So much freedom, in fact, that while doctors and nurses told me I couldn’t leave the hospital, Stacy and I would grab a few minutes every day and walk around outside in the courtyard, gowned, gloved, and masked, with my ongoing chemo rig in tow. Just feeling the fresh air and watching the clouds move against a crystal blue sky was all I needed. As for the chemo, I felt remarkably well and my body was holding up, except for the loss of hair.

  On June 23, fourteen days later, the doctors stopped the chemo. I was still alive, which was great news, but we wouldn’t know if the chemo had worked until a biopsy. (As I write this book, the number of aspirations and biopsies has reached twenty-three and counting, and I have become quite an authority on this barbaric procedure.)

  Two days later, I had a bone marrow biopsy, and I actually looked forward to it, because I knew it was the only way to know if my blasts had gone down. The results came back: my blasts were down to zero percent. That’s right. In two weeks, I went from near-death 74 percent blasts to absolutely zero. The miraculous chemo trial had worked. Stacy’s pushing, Dr. Pemmaraju’s advocacy, and a Japanese drug had saved my life.

  Now that I was back in remission, the doctors worked toward a second stem cell transplant around July 4, ten days away, having already harvested the necessary stem cells from Junior. Since I was in remission, Dr. Pemmaraju allowed me to continue my treatment on an outpatient basis, so at least Stacy and I found some normalcy at the Marriott Medical Center. But on July 3, the night before the scheduled transplant procedure, I woke up in the middle of the night at the hotel with a fever, chills, and vomiting. Stacy got me right to the emergency room, and within hours, doctors had confirmed that I had come down with an infection—pseudomonas, a deadly type of bacterial infection for immune-compromised patients like me—and this would postpone the transplant. I was devastated. I had persevered through the ups and downs, through the fourteen days of chemo, and I was looking forward to another rebirth with a second transplant. I pouted for about one minute and then became re-determined to rid my body of the infection. You’re supposed to be dead, remember? The power of positive thinking (and medicine) worked, the infection soon went away, and the transplant was back on.