Just over a year ago, Joseph Coates faced a harrowing decision: would he prefer to die at home or in the hospital? At that time, Coates was 37 and residing in Renton, Wash. , barely conscious after months of struggling with POEMS syndrome, a rare blood disorder. This illness had resulted in numbness in his hands and feet, an enlarged heart, and kidney failure. Regularly, doctors had to drain liters of fluid from his abdomen. His condition had deteriorated to the point where he was no longer eligible for a stem cell transplant, one of the few treatments that could have potentially brought him into remission. “I had given up, ” he shared.

“I believed the end was unavoidable. ” However, Coates’s girlfriend, Tara Theobald, was determined not to let him give up. She reached out via email, pleading for assistance from a doctor in Philadelphia named David Fajgenbaum, whom they had met at a rare disease summit the previous year. By the following morning, Dr. Fajgenbaum responded with a proposal: a novel combination of chemotherapy, immunotherapy, and steroids, which had not been tested before as a treatment for Coates’s condition.