‘Yes, I can,’ she said. ‘We already know the supportive therapy isn’t going to cure you. It’s helping—but clearly it’s not helping enough, because you’re still tired. My best friend Tamsin is a GP—a medico di famiglia, like Orlando—and she has a friend who works in haematology.’ For Bartolomeo’s benefit she added, ‘Disorders of the blood, like thalassaemia and aplastic anaemia. They talked last night and Tamsin called me this morning. She says that definitive therapy—in other words, a bone-marrow transplant—will restore healthy, working bone marrow. And then you won’t need the blood transfusions any more.’
Orlando held up a hand in protest. ‘Hang on—you’re rushing things. There’s Bartolomeo’s age to consider, and transplants are usually done from a brother or sister or a matched unrelated donor.’
Eleanor’s mouth tightened. ‘Bartolomeo’s sisters are not a match. He has no brothers. And you know as well as I do, the risks of rejection are much lower in an allogenic transplant from a blood relative than they are in a transplant from an unrelated donor. Which means me.’
Bartolomeo frowned. ‘I’m not happy about this. What about the risks to you?’
‘They’re low,’ Eleanor reassured him. ‘I’m thirty years old, I’m perfectly healthy, and I’ll recover quickly.’
‘How quickly?’ Bartolomeo asked.
‘That depends on how the marrow is harvested,’ she admitted. She didn’t want to lie to him. But she didn’t want him worrying either. ‘You know how a transplant works?’
He wrinkled his nose. ‘Vaguely.’
Which meant he didn’t. Probably nobody had explained it to him because nobody had thought it was an option. Until now. ‘There are three parts to your blood—red blood cells that carry oxygen round your body, white cells that fight infection, and platelets that help stop you bleeding. The blood is made with stem cells in your bone marrow—that’s the spongy stuff in the middle of your bones. If your bone marrow isn’t working properly, your body can’t produce blood. So right now you need a transplant of bone marrow to help your body make the blood cells.’
‘How it would work,’ Orlando chipped in, ‘is that we test the donor’s blood to see if the tissue type matches yours. If it does, then we would give the donor a full medical examination and counselling.’
Eleanor rolled her eyes. ‘There’s no “if” about it. I’m Bartolomeo’s daughter. You can even see the family resemblance, for goodness’ sake! As his daughter, I’ve inherited three out of my six antigens from him. So our tissue types will match.’
‘You would still have to undergo counselling,’ Orlando said.
‘I don’t need counselling over this.’ Didn’t he realise? Wasn’t he listening? ‘Bartolomeo is my father.’ Her only living blood relative. Who was dying. And it was in her power to save him. ‘I want to do this. And, yes, of course I need to undergo a medical examination, but I can tell you now the results will be fine.’
‘You need counselling,’ Orlando repeated stubbornly.
‘Then help me fast-track it. Because I’m not going to change my mind,’ Eleanor informed him coolly.
Orlando glared at her, then turned to Bartolomeo. ‘For a week or so before the bone marrow is taken from the donor, we give him or her injections of growth factor to produce lots of stem cells in the bone marrow.’
‘So it hurts?’ Bartolomeo asked.
‘No,’ Eleanor reassured him. ‘The injections are done in the arm or the leg.’ And sometimes in the abdomen, but she thought it politic not to mention that. She grinned. ‘Hey, I’m a doctor and I work in the emergency department, so I see needles all the time. I’m not scared of needles.’
‘I loathe needles,’ Bartolomeo muttered. ‘So then they take out the bone marrow? How? Does it hurt?’
‘The donor has a general anaesthetic,’ Orlando said. ‘The operation lasts for an hour, maybe two, and the surgeon collects the marrow cells from the pelvis with a needle and syringe.’
‘There’s no cutting or stitching involved, and I’d be able to leave hospital the next day,’ Eleanor said. ‘Then the bone marrow would be given to you in the same kind of way as you have a blood transfusion—there’s a thin plastic tube called a Hickman line that the surgeon would put in your neck or your groin, and the healthy marrow travels through your body and settles in the spaces in the middle of your large bones. Then hopefully in the next fortnight to a month your body will accept the new bone marrow and start producing new healthy blood cells.’
Bartolomeo looked impressed. ‘I thought you said you were an emergency doctor? I didn’t think you did that sort of operation in the emergency department.’
‘I am, and we don’t,’ Eleanor said. ‘But I’ve been researching the procedures since you told me about the aplastic anaemia, and my best friend’s haematology colleague filled in the gaps for me.’ She smiled at him. ‘It’s pretty straightforward. Though before the operation you’ll need radiotherapy or chemotherapy to destroy your remaining bone marrow cells, so there’s less risk of your body rejecting the donated cells.’
Orlando frowned. ‘That’s not suitable for all patients, Eleanor. And it might be too stressful for Bartolomeo’s body.’
Given his age, she knew that was true. ‘There are other ways,’ Eleanor countered. ‘Such as a non-myeloablative stem cell transplant, with smaller doses of drugs and chemo to lower his immune system enough to accept the donor cells.’
Bartolomeo waved both hands. ‘Hello, I am still here! Don’t talk over me—I’m not following half of what you’re saying now. Non-mye—what?’
‘Non-myeloablative,’ Eleanor said. ‘Sorry. I didn’t mean to talk over you. Or talk jargon.’ She’d just wanted Orlando to realise that she knew exactly what she was getting into. She needed him on her side. Needed him to help her convince the consultant to give her father the life-saving treatment he so desperately required. ‘Non-myeloablative just means treatment that won’t destroy your bone marrow. Normally if a cell goes into your body that your body doesn’t recognise as its own, your immune system will kick in to destroy the invader—so if we don’t lower your immune system before the transplant, you’ll be at risk from something called “graft versus host disease”.’ She smiled at him. ‘If we lower your immune system, it won’t attack the bone marrow cells from my system when we transplant them to your body. For a while, our cells will be mixed, and eventually mine will replace yours.’
‘After the transplant, you’ll need medication to stimulate the production of blood cells, and you’ll have blood tests to check the new bone marrow is working,’ Orlando said.
‘More needles,’ Bartolomeo said wryly.
‘Though I should warn you that while you recover, you’re likely to pick up infections because your immune system will be so low,’ Eleanor continued. ‘You need to avoid anyone coming near you who has a cold.’
‘We can try to minimise it by giving you antibiotics, so the infections don’t get a chance to take hold,’ Orlando said. ‘But as well as the medication, you’ll still need blood transfusions to maintain the right level of blood cells in your body until the new bone marrow is working. It’s demanding, Bartolomeo—very demanding, physically and emotionally. And it can take a long time to recover.’
‘How long?’ Bartolomeo asked.
Orlando took a deep breath. ‘I have to be honest with you. It could take as much as a year.’
Eleanor glanced at her father. A year’s recovery was a much better prospect than having no time at all, in her eyes. Did he feel the same? Oh, please. He had to. She couldn’t bear the idea of losing him so soon after she’d found him. ‘Often it’s less than that,’ she said.
‘And you, Eleanor?’ Bartolomeo asked. ‘What side effects will it have on you?’
‘Hardly anything,’ Eleanor said swiftly.
Bartolomeo scoffed. ‘Orlando, you took the Hippocratic oath, yes? So tell me the truth. Tell me what Eleanor is trying not to tell me.’
She tried kicking Orlando’
s ankle under the table, but he ignored her. ‘A donor might have bruising and soreness in the lower back and in the place where the bone marrow was taken. It’ll last for a few weeks. And while the bone marrow renews itself the donor will feel tired and should avoid strenuous exertion. It may take a week or so to recover.’
‘That’s if we go for a traditional bone-marrow harvest under a general anaesthetic,’ Eleanor argued. ‘There’s a newer procedure called PBSC, which stands for peripheral blood stem cell donation. What that means is that I’d have daily injections of a growth factor to increase the number of stem cells and make them move out of my bone marrow and into my general circulation. Then the surgeons simply hook me up to a special machine that separates out the stem calls from the rest of my blood cells. The procedure’s called leukapheresis. Basically the blood goes out of one arm, gets filtered, and goes back into the other arm. The doctors collect the cells in two separate sessions, each lasting about four or five hours, so I won’t need to stay in hospital overnight. I won’t need any anaesthetic either—definitely not a general and not even a spinal block, so you can take out a huge chunk of risks there.’
Bartolomeo folded his arms. ‘And the side effects?’
Eleanor smiled. ‘I might feel a bit fluey, but a donor can go back to their normal job within twenty-four hours of a PBSC.’
‘The success rate is good?’ Bartolomeo asked.
‘Between forty per cent and seventy per cent,’ Orlando said.
‘And it’s getting better,’ Eleanor added.
Bartolomeo looked thoughtful. ‘So how new is this process?’
‘It’s becoming more and more common,’ Eleanor said. ‘And it’s much better for the donor and the person receiving the stem cells. On the donor’s side, it’s not an invasive procedure, doesn’t involve a general anaesthetic and has a shorter recovery period. On your side, it means you’ll spend a shorter time in hospital, and your white blood and platelet counts return to normal more quickly so there’s less of a chance of complications.’
‘It still doesn’t mean you can definitely do it,’ Orlando warned. ‘You inherited one set of haplotypes from Bartolomeo and one from your mother—if your mother’s haplotypes are a bad mismatch for Bartolomeo’s …’
Eleanor’s jaw set. ‘Only one way to find out. I want that blood test. First thing tomorrow morning.’
Orlando shook his head. ‘Tomorrow’s Sunday. You’re not going to get a test on Sunday.’
‘Then we’ll do it Monday. I’ll pay for a private test if it’s quicker.’
Bartolomeo put his hand over hers and squeezed it. ‘I can’t ask you to do this for me.’
‘You’re not asking,’ Eleanor pointed out. ‘I’m offering. We’ve been through this, Bartolomeo. You’re my only blood family, I’ve just found you, and I’m not prepared to stand by and lose you before I get the chance to know you properly. If donating a few of my stem cells will keep you around a bit longer, I want to do it. And do it now.’
Bartolomeo stared helplessly at her. ‘I don’t know how to thank you.’
‘You don’t have to. You’re my family.’
CHAPTER TEN
THEY managed small talk for another half an hour, then Eleanor, noticing how tired her father looked, called a halt. ‘You need a rest,’ she said gently. ‘I’ll leave you.’ ‘I’ll see you back to the hotel,’ Orlando said. ‘No, it’s fine. I’m sure you have things to do.’ ‘I said,’ he repeated, ‘I’ll see you back safely to the hotel.’ It was fairly obvious he wanted to talk to her about something—something he didn’t want to say in front of Bartolomeo. Well, if he wanted a fight, he’d get it. She was still furious with him for spelling out the bleakest side of the bone-marrow donation and worrying her father. ‘Grazie,’ she said quietly, hugged Bartolomeo goodbye and followed Orlando outside.
As soon as they were seated on the metro, Orlando shot her a sidelong look. ‘You really sprang that one on me.’
She folded her arms. ‘Don’t be ridiculous. I told you I needed your help talking to my father’s consultant about the aplastic anaemia. And that I’d been researching it.’
‘But you didn’t warn me you were going to offer to be a donor.’ She rolled her eyes. ‘Oh, come off it. Isn’t it the obvious solution?’
Orlando mirrored her stance, arms folded. ‘May I point out that you only met the man a few days ago? And you’re proposing to undergo a very painful operation for someone you barely know.’
She glared at him in outrage. ‘How can you say that? He’s my father!’
‘You told me yourself you didn’t even know he existed until a couple of weeks ago.’
She shook her head in disbelief. ‘I know you’ve got a problem with families, Orlando, but don’t dump your insecurities on me.’
He gave a mirthless laugh. ‘I don’t have any insecurities.’
‘No?’ They’d shared the ultimate closeness the previous night, and the way he’d walked out on her so easily this morning still rankled. ‘The way I see it, Orlando, you can’t understand why anyone might want to show some commitment to another human being, because you can’t do it yourself.’
He rolled his eyes. ‘Don’t tell me you think this is about last night.’
‘Isn’t it?’
‘No,’ Orlando snapped. ‘This is about you. About the fact you’re rushing in to something without thinking it through properly. You said yourself, a bone marrow donation is complicated—that’s why it’s hard to get donors. It isn’t an easy option, Eleanor. It’s not like giving blood.’
She lifted her chin. ‘A PBSC is. Virtually.’
‘It’s more complicated than that, and you know it. It takes a lot longer, your blood is filtered, you have to take drugs beforehand, and you can’t just get up and carry on as normal after a cup of tea and a biscuit. And you’re proposing to do this,’ he repeated, ‘for someone you barely know.’
He really, really didn’t get this, did he? She frowned. ‘If I were donating blood marrow to someone on the transplant list, it’d be to someone I didn’t know. What’s the difference?’
‘The difference is you’re vulnerable right now and you’re setting yourself up for heartbreak because there’s no guarantee it’s going to work. If you were an unrelated donor, there wouldn’t be the emotional involvement: you’d be sad if it didn’t work, yes, but it wouldn’t really affect you. In this case, if it doesn’t work, you’ll be devastated. You’re pinning all your hopes on something that isn’t one hundred per cent guaranteed—on something that basically has a fifty-fifty chance of working, if you look at it objectively.’ He raked a hand through his hair. ‘And before you bring it up, I’m not proud of the way I took advantage of you last night. I’ve already apologised for that.’
He didn’t say it, but she could see the question in his eyes. What else do you want from me?
He’d told her the truth, right from the start. He didn’t do commitment, didn’t believe in love. What was the point in asking him for something he couldn’t give?
She swallowed the lump in her throat. ‘I’m sorry. I’m just …’
‘I know.’ He reached out and stroked her cheek. ‘I’m sorry, too. But you need to think about what you’re doing here, Eleanor. Don’t rush in blindly.’
She knew he was right, and it made the comment sting even more. And the gentleness of his touch … It hurt. Because she knew he couldn’t give her more, and she was ashamed of herself for wanting more. She pulled away from him. ‘So what am I supposed to do? Bartolomeo is my only living blood relative. Am I supposed to just stand by and watch him die slowly?’
‘No, of course not.’
‘His sisters aren’t a match, there isn’t a matched unrelated donor available, and the chances are that my bone marrow will be a match for his. Yes, you’re right in that I haven’t known him long. But I want time to get to know him. The only way I’ll get that time is if he has a bone-marrow donation. From me. What other way is there?’
He
was silent, and her rage died as quickly as it had blown up. ‘I’m sorry. I’m upset about the situation and I shouldn’t take it out on you. But you need to understand where I’m coming from, Orlando.’
‘I do.’
‘Really?’ She didn’t think so. ‘I’m completely alone in the world. I have good friends, and I’m grateful for that, but it’s not the same as having someone to belong to. It’s not the same as being part of a family.’
‘And that’s what you want?’
‘Doesn’t everyone? Don’t you?’
He shrugged. ‘I don’t need that. I’m happy as I am.’
‘Are you? I mean, really? Don’t you look at your friends—at Serafina and Alessandro, at your friends in London with your godson—and wonder what that special something is they have?’
‘No.’
She stared at him. ‘You’re unbelievable. Are you seriously telling me you think they’re going to split up?’
‘No. Just that confetti doesn’t last for ever. Honeymoons end. After that, you just have to make the best of it.’
‘You’re horribly cynical.’
‘I’m a realist, tesoro.’
‘So last night.’
He flinched. ‘How many times are you going to make me apologise for that, Eleanor?’
She shook her head. ‘That’s not what I was going to say. Last night there was a connection between us.’ She felt the colour seep into her face. ‘Apart from the physical, I mean. Are you telling me it wasn’t the same for you?’
There was a long, long, pause. ‘I don’t know,’ he admitted finally.
‘Then why did you agree to help me?’
‘Because I’m a nice guy?’ he suggested.
She shook her head. ‘You could’ve pleaded pressure of work. Or maybe put me in contact with a specialist you know. But you haven’t. You came with me to meet Bartolomeo yourself. You’re giving me support.’
‘As I would any colleague.’
She reached over to run her thumb over his lower lip. ‘If you were the kind of man you’re trying to make me believe you are, this wouldn’t affect you. But your pupils just dilated.’
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