Saying the Last Good-Bye to an Inspiring Friend I Never Met

Candles - Peace for Joyce. (Dr. Noorali Bharwani)
Candles - Peace for Joyce. (Dr. Noorali Bharwani)

I have been writing articles on a random basis since my school days. But my serious writing started in Medicine Hat. I also started taking a writing course inspired by a friend I never met, Joyce. Joyce is a successful writer.

Due to various reasons, I never finished the writing course but Joyce received my columns on a regular basis. From time to time she would write to me encouraging and inspiring letters. She lived in British Columbia. Once I was there on a holiday with my family. I arranged to meet with Joyce. The meeting was cancelled at the last minute, as I was running late in my other commitment. Now I feel so bad that I never got to meet Joyce.

In the last few months, Joyce has been sharing with me her health issues, which are not very good. I think about her and pray for her health and comfort. You wonder sometimes why such good people have to suffer so much at the end of the their wonderful and satisfying life. I saw my mother suffer from the consequences of cancer in her dying days. As a physician I know what Joyce is going through.

Her last email to me arrived few weeks ago. I will share that with the readers of my column because many will empathise with what Joyce has to say. Her email reads as follows:

Hello Doctor,

I’m shutting down my computer in a few days, so I wanted to bring you up-to-date.  I think I told you I have lymphoma.  They radiated the tumour and I went into remission.

About three months ago, I came up with a tumour in the colon, unrelated to the lymphoma. Last week they sent me for a scope and couldn’t even get it in the colon.  As far as they can tell, my large colon is almost solid with cancer.  It is fast growing and metastasizing. I’ve decided not to do anything.

I’m almost 80, have had 39 surgeries, 2 heart attacks, been hit by lightning twice, Don is gone and I’ve had over 40 years of pain. It all started when I got that heart virus.  To be honest, I’m tired and can’t fight anymore.  My kidney function is approaching dialysis so it’s unlikely I’d survive removing my entire large bowel.

The oncologist said I’m not going to feel much worse until the bowel completely closes and perforates.  From then it’s right to hospice and it will go quickly.  He said they’d likely put me in a coma the first day or two. Until then, it’s life, as we know it.

I’ve done everything I’ve wanted to, have made all my amends and have left a legacy of which I’m proud.  It’s been difficult for my family and some of my friends, but everyone is starting to settle down.  I have no fear and am actually anxious to start the next adventure.

I’m very proud of you and what you’ve done with your talent.  It’s been fun for me to watch you grow and to read your columns.  Thanks for taking the time to send them to me.  I wish you all the luck as you go forward with your writing.  The blessing is, it is something you can do no matter where life takes you.  You’ve been an inspiration in my life.  Thank you!


Well, what can I say Joyce. You have inspired me and many of your students. So good-bye Joyce, may you find peace and comfort where ever you go in the world beyond this planet. May your soul rest in eternal peace… Amen.

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What Do You Know About Bone Marrow Transplant?

Bone marrow is the spongy tissue inside some of your bones, such as your hip and thigh bones. When bone marrow transplant occurs, this spongy healthy tissue is used to replace unhealthy blood-forming cells.

The important thing to remember about bone marrow is that it contains stem cells, which are immature cells. These immature cells can develop into the red blood cells that carry oxygen through your body, the white blood cells that fight infections, and the platelets help with blood clotting.

Bone marrow transplant is required if there is a problem with the bone marrow, if it is diseased with cancers like leukemia or lymphoma. You might need a transplant if a strong cancer treatment kills your healthy blood cells.

Bone marrow is usually collected from the hip bone (or pelvic bone) or less commonly from the breast bone (or sternum). The procedure is done under anaesthesia. Needles are inserted into the bone and marrow is withdrawn. The procedure takes about an hour. This process is called ‘harvesting’.

To prepare for the transplant, you may be given strong chemotherapy and/or radiation therapy. This treatment kills your unhealthy cells. Then healthy blood-forming cells are given to you in your vein. This is like a blood transfusion. The transplanted cells begin to grow and make the red blood cells, white blood cells and platelets your body needs. It typically takes three to four weeks for the cells to mature.

The cells used in transplants can come from three sources: bone marrow (as described earlier), peripheral (circulating) blood or blood collected from an umbilical cord after a baby is born. Umbilical cord blood is rich in blood-forming cells. The donated cord blood is tested, frozen and stored at a cord blood bank for future use. Your transplant doctor will choose the source of cells that is best for you.

You can use your own blood-forming cells or cells collected from someone else. This choice depends on your disease and other health factors. Your transplant doctor decides what kind of donor to use. In autologous transplant your own cells are used. The cells are collected from your bloodstream (or, less often, from your marrow) and stored for your transplant.

A transplant using cells from a family member, unrelated donor or cord blood unit is called an allogeneic transplant. A transplant using cells from an identical twin is called a syngeneic transplant. If your transplant donor is other than yourself then the tissue type has to match. So your best chance of finding a match is with a brother or sister. However, 70 per cent of patients do not have a suitable donor in their family.

If there is no donor in the family then you need to find a donor who can match your tissue type. For this your doctor goes to Be The Match Registry , operated by the National Marrow Donor Program (NMDP), which provides access to more than 12 million volunteer donors on the global donor listing. This includes more than 7 million volunteer donors and nearly 90,000 cord blood units.

Unfortunately, not everyone finds a suitable match. In that case your doctor will look at other treatment options. These options might include using a partly matched family member (haploidentical donor).

The procedure is associated some risk of complications like infection, bleeding, pain and others. How well you do after transplant depends on many factors such as: what type of bone marrow transplant you had, how well your donor’s cells match yours, your age and overall health and many other factors. If the transplant works, you can go back to most of your normal activities.

If you want to be a donor then visit National Marrow Donor Program (

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!