Andrew and Michael (Andrew-23, Michael-23)
My husband and I were blessed to have fraternal twin boys in December of 1998. That’s when our lives changed. Michael was the first to greet us. Jim and I were so excited and we were asking the Doctor is it a boy or a girl? She didn’t answer us so we asked again. The Doctor then replied, “I don’t know?” Jim and I were stunned. That’s where Michael and Andrew’s story with Diamond Blackfan Anemia began but we had no idea what was yet to come. Our fraternal twin boys were born with many health issues which in turn took us to many Doctors and Hospital’s from day one of them being born. We saw a different Doc almost every day of their lives for almost the first year. We eventually ended up down at A. I. DuPont Hospital For Children - Nemours in Wilmington, DE. where we met the twins Hematologist.
I had our fraternal twins at the Geneticist one day when the Doc told me Michael looked very pale. She told me to take him to his Pediatrician and get his hemoglobin checked immediately. I did and his hemoglobin was down to 2.3. A normal hemoglobin is anywhere from 12-14. Michael was dangerously low. The Pediatrician sent us to Bryn Mawr Hospital’s E.R. where they contacted A. I. DuPont Hospital For Children and they sent an ambulance up for Michael and took him down to DuPont where his Hematologist entered the picture. They ended up admitting him. They did a lot of testing and Michael received his first transfusion. To this date Michael and Andrew have had over 300 transfusions each. After all testing was complete the Hematologist diagnosed Michael with Diamond Blackfan Anemia. Andrew was diagnosed months later.
Michael and Andrew have many health issues. Our Andrew even had open heart surgery at 18 months of age. Both Michael and Andrew have had over 50-60 surgeries in their short lifetime. They have a long list of Doctors they see. They are followed by NIH, Hematology/Oncology, Cardiology, Nephrology, Endocrinology, Pulmonology, Gastroenterology, Opthamology, Urology and Orthopedics. Our boys were also born Developmentally Delayed. They have brains of an 8 year old. That just makes them extra precious to us.
Around 13 years ago Michael’s bone marrow biopsy showed a presence of some funky cells. Since then our fraternal twins have had bone marrow biopsies twice a year to be on the look out for MDS - Pre-Acute Myeloid Leukemia. In June of 2019 Michael’s bone marrow biopsy showed the presence of MDS. It was time. Michael would have to have a bone marrow transplant. His HEMONC Doc at DuPont wanted him to be placed inpatient in December of 2019 but was worried about the flu so she waited. Michael ended up being placed inpatient at DuPont - Nemours in Wilmington, DE on April 16th of 2020. Right at the height of COVID-19. Can’t make this stuff up. Michael had a very tough time with his bone marrow transplant. His Mucositis was absolutely horrible. Doc couldn’t get over it but Michael has been truly blessed. He has continued his bone marrow transplant journey now at home. We are truly grateful he is still with us.
Move ahead to June of 2021 where Andrew’s bone marrow biopsy showed MDS. Andrew was to be placed inpatient at DuPont - Nemours down in Wilmington, DE now too. Doc wanted him to be placed inpatient in November of 2021 but Michael had had major surgery and I could not be in two places at one time. Michael had a lengthy recovery so we pushed Drew to May 19, 2022. The difference between Michael and Andrew’s bone marrow transplant is that Michael was treated prophylactically for VOD - Veno - Occlusive Disease. Andrew was not. They do not do that now. They treat you when you show signs of VOD. Hence the nightmare Andrew is living today. As I am writing this Andrew and I have been in Nemours for almost 3 months. He’s been in the PICU for almost 2 months. He made it back to the Bone Marrow Transplant Unit for a day and a half but ended up right back in the PICU. Andrew has suffered from Acute Respiratory Failure, Pneumonia, Right lung collapse, Acute Renal Failure, Dialysis, Distributive Shock, Liver Failure, VOD, Bone Marrow Transplant acquired Type 1 Diabetes and more. He was on a vent for over 2 weeks initially and then has been put back on it intermittently due to surgeries and lung issues. He is currently on a vent and has been for days. God bless him he is wide awake - on the vent! Freaks me out but he has handled it gracefully. Andrew has almost died on many occasions but has continued to fight. He is such a fighter. It breaks my heart to see all the suffering he continues to go through yet he continues to worry and care about everyone else around him. Such a sweet, caring, loving, compassionate, old soul our Andrew is and has always been. God bless him. He continues to have times where he bleeds and it's to the point of him almost bleeding out so then they have to call another Massive Transfusion Protocol where they push red cells, platelets, FFP etc. When he was bleeding on one occasion he ended up having to go to surgery and the Doctor ended up taking a foot of his small intestine out. This was after another surgeon had already operated on that section of his bowel to try and stop the bleeds. They continue to try and figure out why his insides are so friable and why he continues to bleed but have not come up with anything yet. It just comes out of left field. It is so truly frustrating and so heartbreaking for Andrew. He has also not eaten anything in three months and he is just so hungry and it really gets him down. Andrew continued to go through dialysis, being on a vent due to Acute Respiratory Failure, Pneumonia, Distributive shock, Liver Failure, Bone Marrow Transplant acquired Type 1 Diabetes and more for another month.
Andrew was inpatient down at Nemours in Wilmington, DE for four months total. One month in the Bone Marrow Transplant Unit and the last three in Nemours PICU. On Saturday, September 10, 2022, Sarah - Dr. Perry came to tell me that my sweet boys organs were shutting down. I could not believe it. I had kept my faith all this time. Actually close to twenty four years because the twins have been through over fifty surgeries each and I always knew the good Lord had them. Never did I ever think we would be here. Andrew himself told me he was in God's hands before we left home and we were placed inpatient. I responded back to him, "I know Sweetie I just hope He brings you back home?” God had other plans for Andrew. On September 13th we had Andrew removed from his vent and the Doc's thought he would leave us within a couple hours. Andrew had his own agenda. The Pastor even said, "Well obviously Andrew is on his own timeline so I will be back later to see him!" Andrew awoke from the meds on the vent and spent the next three days present with us. Watching T.V. and his favorite Star Wars movies. He even got to eat a few spoonfulls of a blue rasberry slushy:) He was so happy about that. His big brother Jimmy stayed with Andrew and I his last week and his father and Michael would come down and spend the days with us. On September 16th Andrew slipped into a coma and never awoke again. From September 16th on Jim, Jimmy, Michael and I stayed by Andrew's side. It was Brutal! He stayed with us until September 18th, 2022 till 4:45 p.m. Andrew has blessed our lives in so ways. We will miss his selfless, happy, caring, giving, loving and spiritual guidance.
Andrew's exit from this plane was a beautiful one and many shared in it. When the Doctor said, "Time of Death 4:45 p.m." Andrew's PICU door handle jiggled and the door slammed. Everyone's eyes opened wide. There was no one there. I said, "That was Andrew's exit!" A little later when I went out into the hall the Head Respiratory Therapist and the Head Nurse came running. They were like, "Donna, Donna come here!" Three months in the PICU we were all like family. The Nurses desk was right outside of Andrew's PICU room so they knew when Andrew passed. They were telling me that when Andrew transitioned they were watching Michael - Andrew's fraternal twin. He was on the other side of Andrew's room wall. It was too difficult for Michael to see Andrew in this state so Michael pretty much stayed in the Pocket Park looking at his phone and writing things down. This is what Michael does. So they continued to say that as they were watching Michael doing his thing on his phone after Andrew had transitioned, Michael's head all of a sudden shot straight up at the ceiling and he just continued to stare at it. That did not surprise me. I believe once Andrew passed he continued out of his PICU room - slamming the door to let us all know he was leaving and then went around the corner to his sweet twin Michael - touched him to let him know that he would be ok and then let Michael know that he would be okay without him. I cannot think of a more beautiful, selfless goodbye. Our sweet Drew. Once again in the end thinking of someone else and no one more special then his twin. God bless him. I am also so very grateful for Andrew showing us that there is life after death. He continues to send Michael and I many a sign and we are so truly grateful for each and every one. Thank you so much Sweetie:) Andrew and I have spoken about this on many occasions. Drew is a very spiritual little dude and how I miss our spiritual chats:( He is guiding me from the other side now. Thank you again Sweetie:) Andrew was selfless in another way in the end. We let Nemours do a selective autopsy on Andrew. We allowed them to take Andrew's lungs so they could bank them and allow Doctor's now and future researchers to look at them. They had no idea what was wrong with Andrew's lungs. If we can help them further medical education and also figure out what went wrong with Andrew's lungs and this in turn helps other kids in the future then that will make us all - including Andrew very happy.
I received a little info on Andrew's autopsy findings on his lungs. It's looking like it could have been the TMA - Thrombotic Microangiopathies - that took him from us. TMA is a well - described, potentially lethal complication seen in patients undergoing Bone Marrow Transplant. Post Bone Marrow Transplant TMA is characterized by microangiopathic hemolytic anemia, thrombocytopenia and mutli - organ failure. The term TMA defines a lesion of thickening of arteriole and capillary walls with prominent endothelial damage, subendothelial accumulation of proteins and cell debris, and obstruction of vessel lumina by fibrin and platelet - rich thrombi. The association of post Bone Marrow Transplant and TMA ranges between 0.5 and 63.6%. I had no idea it was this high. It seems that Michael was spared because he had gone through a very toxic chemo regime. That chemo seemed to keep the TMA at bay. Andrew was given a less toxic chemo regime due to his heart issues which looks like in the end gave the TMA a chance to cause all this damage and shut down his organs. I cannot believe we are here 🙁 He is so heartbreakingly missed. Rest in Peace my sweet Angel.
Michael continues to live on for he and Andrew. He takes it one day at a time. Who knows what DBA will throw at him next. What cancer might come along next. There sure is plenty of them - Leukemia - MDS again, Osteosarcoma, Colorectal, Brain Tumors or any other kind of cancer now since he has had a Bone Marrow Transplant. That's okay. We live for today. We stay in Gratitude. Our boys are truly formidable. Andrew still is in Heaven. Michael will continue to be. Whatever comes his way he will continue to handle with grace. God bless our boys. God bless you Michael. God bless you Andrew. God bless you Jimmy. God bless all with DBA.