Charles Asmar sat at the kitchen table of his new home in Frederick County, showing slides of Lebanon on his laptop. Around him were signs of the American dream he has lived for two decades -- the high-speed computer, the spacious white kitchen, the grassy vista out the window. As he clicked through images from his homeland, he paused at the smiling faces of his brother, Ziad, and sister, Marcelle. A tear dripped onto his bathrobe.
"I'm very lucky to have such a close family," he said.
Without his brother and sister, he might not be alive.
Asmar, 44, an Internet consultant with a wife and three young children, had just placed a down payment on his house in Urbana in May when he fell ill with what he thought was the flu. It turned out to be leukemia. Within weeks, he was hospitalized, and by late last year, after a period of remission, his time was running short.
Then two weeks ago, his sister stepped off a jet at Dulles International Airport, carrying a Styrofoam cooler from Beirut.
"She was holding my life," Asmar said.
In the cooler was a fluid-filled pouch containing stem cells extracted from 42-year-old Ziad Asmar -- cells that Charles Asmar desperately needed to fight his disease and for which no suitable donor but his brother could be found.
Normally, the stem cell transplant -- and the several days of pre-transplant medical preparation that each man had to endure -- would have been done with the brothers in the same hospital.
But despite months of pleading by the Asmars and the University of Maryland Medical Center in Baltimore, where Charles Asmar was treated, the State Department would not expedite Ziad Asmar's request for a visa so he could travel to his brother's side. Ziad Asmar, who runs a printing business in Beirut, said he is not a threat to U.S. security. But an official of the embassy where he applied said the process is slow, given the nation's heightened security.
With his brother barred from the country, only extraordinary coordination between doctors in Maryland and Lebanon prolonged Charles Asmar's life.
After the brothers were simultaneously prepped for the transplant at hospitals nearly 6,000 miles apart, Beirut physicians harvested the cells from Ziad Asmar, getting advice by fax and telephone from their colleagues in Baltimore. Marcelle Asmar, who has held a 10-year U.S. visa, quickly departed Beirut with the cells, which would remain viable outside a human body only for two days. With the clock ticking, she traveled for 20 hours -- through airports where security personnel had been alerted not to X-ray the cooler or open the pouch -- until she reached the Washington area.
"It was very much a family effort, and a tremendous amount of credit goes to [Charles] Asmar himself," said his physician, hematologist-oncologist Aaron P. Rapoport, director of gene medicine and lymphoma at the medical center's Greenebaum Cancer Center. "He saw this as the only potential option, and he never, ever gave up."
Before the transplant, Asmar had a few weeks to live. Now, his brother's stem cells are helping Asmar's body develop a healthy blood system. After a year, 25 percent of patients such as Asmar remain cancer-free, Rapoport said.
"We couldn't believe the whole thing worked," his brother said by phone from Beirut. "Now we really have the same blood."
Charles Asmar arrived in the United States from war-ravaged Lebanon in 1984, at age 26, and received an engineering degree from the University of Toledo, where he met his wife, Suad Omer. He earned a master's degree in business, became a U.S. citizen and set up shop as a consultant to Web-based companies in 1993.
All along, he stayed in close touch with his family in Lebanon. His parents and sister Marcelle, 34, a layout designer at a women's fashion magazine, visited often. And Asmar returned to Lebanon frequently, giving him a chance to see his brother, who has never been to America.
Ziad Asmar first applied for a visa in 1990. He said he received no response from U.S. officials, and he did not pursue it. He said he suspects that that application, and one he submitted last year, were set aside for detailed review because the State Department has concerns about the theft of his Lebanese passport in 1986.
Because the U.S. Embassy in Beirut was not handling new visa requests, Ziad Asmar filed his second application at the embassy in neighboring Syria. In a letter last month, the embassy's vice consul, Joseph J. Bedessem, said that despite his brother's illness, Ziad Asmar would have to wait. "Visa applications are now subject to a greater degree of scrutiny than in the past," Bedessem wrote.
"The time needed for adjudication of individual cases continues to be difficult to predict."
In May, after Charles Asmar fell ill, the diagnosis was grim: acute myelogenous leukemia, cancer of the blood-forming tissues. Chemotherapy led to remission, and in November, Asmar visited Lebanon and his siblings. In photos from the trip, Asmar looks robust. But a month after he returned to Maryland, his cancer recurred, this time resisting treatment.
"The worst feeling," Asmar said, "is when a doctor tells you, 'I don't know what to do next.' "
He was referred to Rapoport, who told him that his only hope was a transplant of healthy stem cells, the building blocks of blood. Finding a suitable stem cell donor is difficult. If a match can be found, often it is a relative -- but there is no guarantee. In Asmar's case, his sister's stem cells weren't a match. But his brother's were ideal.
A donor must undergo several days of tests and injections to increase the supply of stem cells. Meanwhile, the patient must undergo intensive chemotherapy and radiation to kill cancerous cells and prepare the body for the transplant. Those aggressive treatments put the patient at high risk for potentially deadly infection and bleeding, a danger that remains until the transplant is complete. So the donor and patient need to be prepared for the transplant at the same time.
"Our first choice, and ideal, is for the donor to come to the center where the transplant is being done," Rapoport said.
Soon after his brother's cancer was diagnosed, Ziad Asmar applied for a visa. For months, as Charles Asmar's condition deteriorated, the family waited for a decision. The Asmars, their friends and officials at the medical center repeatedly contacted the embassy.
They were told that the process takes a long time -- "one thing we didn't have," said Kathy Ruehle, the medical center's senior stem cell transplant coordinator.
Last month, Rapoport sought help from Sen. Barbara A. Mikulski (D-Md.). "We must proceed . . . urgently or Mr. Asmar will surely die," the doctor wrote her. "While I certainly understand the travel constraints placed on individuals from Middle Eastern countries in the wake of the Homeland Security Act, on humanitarian grounds I appeal to you."
Mikulski contacted the embassy in Syria. In a Feb. 25 letter of reply, vice consul Bedessem referred to Ziad Asmar, telling the senator: "We . . . trust he understands that this waiting period is necessary as we strive to make every effort to ensure the safety and security of the United States for all. . . . We recognize that Mr. Asmar's case appears to have been in process for an unusually long time. . . . We are unable to predict, however, when he may receive a response."
Charles Asmar's eldest child, 12-year-old Karina, sent an e-mail to the president. "Ziad Asmar is the only donor who can help my father. So could you please grant him an entry visa to the United States?" The girl did not receive a response, according to her father.
Meanwhile, Ziad Asmar contacted Al Makassed Hospital in Beirut, where two physicians, Ahmed Ibrahim and Tamim El Jisr, had experience with stem cell transplants. And a last-ditch plan was hatched.
In a flurry of faxes and phone calls, Ruehle relayed the Baltimore hospital's procedures for harvesting, packing and transporting stem cells.
The Lebanese doctors contacted airports in Beirut and in Paris, a transfer point. The cells were not hazardous, the doctors told security officials. The fluid-filled pouch should not be opened, they said, and the Styrofoam cooler holding it should not be X-rayed.
Most important, they said, the courier, Marcelle Asmar, should not be delayed.
For most of her journey, she said, she cradled a green backpack, containing the cooler, in her lap, afraid to sleep.
"I was praying that everything would be fine," she recalled by phone last week. Marcelle Asmar arrived at the hospital "in a flurry," Ruehle said. "I gave her a great big hug. Then I went to the lab and broke down."
When she saw her brother Charles, Marcelle Asmar passed along a message from Ziad: "You're going to make it."
After the transplant, which took less than an hour, the siblings called their brother, and the three wept together.
Charles Asmar, who left the hospital Tuesday, wishes he could thank his brother in person for "fighting as if this were his own disease, and his own life."
And then, "I'd like to go out to a few places, and have some fun."