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Helen dug her printout of the
directions to the Oncology wing out of her purse and grabbed her father’s arm.
They had to go to the basement level for the biopsy. From her review of the map
of Westwood, the basement was home to Radiology, the surgical wing, and the cafeteria,
but when they got out of the elevator they had to go around carts loaded with
trash bags, laundry, and oxygen tanks. Just before they made their last turn,
they passed an orderly pushing a gurney covered in a sheet. Her father stopped
walking and backed up against the wall, sliding down towards the floor and
clutching his knees to his chest.
“Shit,”
Helen muttered to herself before kneeling down. “What’s going on?”
“So
this is where she went after she died,” he said. “The same place they take the
trash.”
Helen
knew exactly who he meant by that: her mother. Watching her friends, she had
formed a rich picture of what having a mother might have been like for her. An
older woman who might have told her what it felt like to have her period, so
that the first time she saw blood and clots flowing from her legs she wouldn’t
have thought she was dying. An alternative adult in the house to ask for help
with her homework, or a boy problem. It might have been nice just to have
someone to balance her father’s irrational worry that going to a co-ed party
meant she would get drunk, have unprotected sex, and then try to drive home
intoxicated (and – perhaps worse - impregnated). But she accepted that she had
her father, their neighbor Adelheid, and Pete. And though her father was not a
reliable source for period problems, shopping advice, or emotional support
during any medical issue more advanced than a fever, he didn’t isolate himself
in the TV room or avoid talking about “girl stuff” the way Lydia’s dad did. For
her, that was enough.
She
appreciated her mother for carrying her into the world, but after that, her father
was the one who raised her. As she grew older, she thought more and more of her
mother as her father’s wife than as her mother. But knowing how much her father
loved her mother, she would not admit this to anyone but herself. She tried to
bring him back to the present, so he could get the biopsy, go home, and spend
the rest of the day watching The Food Network.
“Dad,
lots of people die in hospitals. That person was probably really, really old
and really sick.” She hooked her arms around his back and tried to pull him up,
making up for her relative lack of upper body strength by pushing herself up
with her legs. But she couldn’t force him up. “We have to go.”
A
tall, lean man in a white coat with a large coffee thermos approached them and
offered Reuben his hand. His tortoiseshell glasses and dirty blonde hair
reminded Helen who he was – Dr. Kutzner.
“Reuben
Fiennes,” Kutzner said softly, “I’m Dr. Kutzner. I saw you in the ED yesterday.
Do you remember me?”
“You
talked to Leni about the biopsy.”
“That’s
right. It’ll tell us more about what’s going on with your blood cells.”
Reuben
cringed. “Okay.”
Kutzner
handed his coffee to Helen and helped Reuben back up. “We’re going to the second
office on the left. Just check in with Kathy at the desk and I’ll get
everything ready in the procedure room.”
Helen
was let into the procedure room after her father was helped onto on the exam
table. He lied down on his stomach, with a small pillow under his head. He had
a johnny on, but was covered with blue sterile drapes from his neck to his
thighs, except for a fist-sized square in the middle of his lower back. While
Dr. Kutzner washed his hands, put on his gloves, and started to prepare a
syringe, her father dug his fingers into the pillow. She sat down a few feet
from his head, putting her hand on his shoulder.
“Reuben,
I need you to lie as still as possible. I’m going to give you something to numb
your skin. There will be a little pinch.”
Reuben
groaned. “That really hurts,” he
whispered to Helen.
“Tell
Dr. Kutzner that,” she told him. She then raised her voice. “He says it really
hurts.”
“I
can give you a little more of the numbing medicine.”
“Okay…
Ow.”
“I’m
going to give that some time to work.” Kutzner waited about a minute, dabbed a
gauze pad over the skin to absorb some of the medicine that leaked, and
prepared a second syringe. He slid it down a tiny bit and then slowly eased the
needle down, tapping gently. “This is going to numb the bone. Try to hold still
and relax.”
“Hold
still and relax?” Reuben repeated, confused.
“Keep
your body still. Relax your mind. Focus on your daughter.”
After
pulling out the syringe, Kutzner made a slight incision on the skin and picked
up something that had a large plastic grip on top and a wide needle.
“This
is the aspirate needle,” he said nonchalantly.
Helen,
who had a reputation among her friends for being able to sit through the
goriest horror movies without screaming, started to tense up watching Kutzner
pushing this giant needle into her father’s back. Then he started rotating it,
like a corkscrew. Eventually, he stopped, grasped the needle with one hand and
pulled the plastic grip up with the other. The grip was attached to a thin
stylet, leaving the aspirate needle hollow on the inside.
Reuben
didn’t feel the stabbing pain one would expect from having a needle inserted
into a bone, but there was a gnawing pressure in his hip as Kutzner advanced
the needle further down. It was a lot like having a cavity drilled. There was
something there, pushing past the hard outer layer of bone, but he couldn’t
tell how far in the needle was.
“Okay.
I’m going to get a bone marrow aspiration now. This part does hurt.”
“But…”
Reuben frowned.
If
he got numbing medicine in the bone, how was the bone marrow collection going
to hurt? Before he finished his line of thought, he felt a sharp pain in his
hip that shot up and up that made him want to jump off the table. But he knew
better than to move when there was a giant needle in his back. So he cried. A
month ago, his daughter had broken her tailbone, assaulted someone, gotten suspended,
and befriended a drug dealer (well, a fraudulent drug dealer, but still). It
felt like she had started to descend into teenage delinquency. But if he did
have leukemia, and it was advanced, it could truly ruin her life. Though he was
disappointed in her recent decisions, she at least had some choices in how she
handled the aftermath of her fight with Jess. She couldn’t chose if he was
healthy or sick, and they had a very small support net. He wondered if they
would have enough money to get by if he had to take time off from work. For the
past ten years, he’d been putting most of his savings in a college fund for
Helen. By comparison, their rainy day money was negligible.
“I
like to do this in small increments. I’m going to do two more of these and see
if I have a big enough sample for pathology.”
Not knowing what else to do, Helen held
her father’s hand. At first he just let it rest limp in her hand, but when
Kutzner started to pull back on the syringe plunger, Helen felt her father’s
nails dig into her palm.
“OUCH!”
the two of them said in unison.
Helen
pulled her hand away. There was a set of white crescents on her palm that
slowly turned pink, and a drop of blood rose out of one of them. She curled and
uncurled her fingers, trying to ease the soreness.
“Maybe
you should hold the pillow,” she grumbled. “It won’t bleed.”
Later,
Reuben felt a deep pressure in his back, but it came without the biting,
sucking pain of the aspirations. Helen
told him that this was the biopsy needle.
When it was all over, Helen looked at the area one
last time. All that was left was a tiny hole; there wasn’t even any blood or
bruising. Dr. Kutzner folded a gauze pad up until it was the size of a postage
stamp, held it down over the hole, and covered it with a dry bandage.
“Reuben,
I need you to keep that bandage totally dry. No swimming or showers for 24
hours. That area will probably feel sore for several days. If it bothers you,
take some Tylenol or ibuprofen. I’ll have the results tomorrow, so call me
anytime then between eight and five.”
***
Helen
brought her absence note to Principal Klein the next morning. Her father had
only written that she was absent due to an illness in the family, but he used
the first piece of scrap paper he found in the kitchen, which happened to be
the directions she had printed out to the Westwood Outpatient Bone Marrow
Screening Suite, complete with Dr. Kutzner’s name and work number.
“I’ll
have the secretary put this in as an excused absence,” Klein said. Her voice
was raspy that day and started to fade out. “Now, I know these family things
are complicated, but with your… suspension… your attendance is off to a bad
start. I wouldn’t want your grades to suffer too much because of that. Your
junior year is very important.”
Her
grades? Helen’s mouth dropped, but she felt
paralyzed. The note was written on directions to the oncology wing. She waited
for Klein to ask her if her family was okay, but her she merely opened her desk
drawer, pulled out a pack of cigarettes and a lighter, and walked out the front
entrance in silence.
The
rest of the day, Helen scribbled a bit in her notebooks, ate the apple in her
lunch, and warmed several chairs, but she couldn’t follow what was going on
around her. The bell would ring, and she wouldn’t get out of her seat until
half the class had strode out the door. No one said anything to her, but she
wondered if it was worthwhile to talk to anyone after her encounter with Ms.
Klein. What would she have said, anyway? My dad might have leukemia? She didn’t
think her father had told Pete about the biopsy, he just called in sick.
In
fifth period, Honors French, her prof
tapped a pen on her desk to catch her attention and told her that she had been
called down to the principal’s office over the loudspeaker.
“Hélène!”
Her
father and Principal Klein stood in front of the main office, their hands
folded primly. Helen caught a whiff of fresh cigarette smoke and wondered how
many smoking breaks the woman took. She didn’t understand how she got away with
it.
“Your
father says you need an early dismissal for another family issue.” She then
turned to Reuben. “You know there’s a limit of excused absences that students
can take each semester before they have to get incomplete marks on their report cards.”
“We
know,” Helen snapped.
Once
they were outside, Reuben confided to his daughter, “Dr. Kutzner told me to
come to his office at Westwood to talk about the results. The only time he had
was 2:30. I didn’t want to pull you out of class, but it sounded bad.”
“Well,
we don’t know if it’s bad news.” She attempted to sound reassuring, but her
voice fell flat. It seemed that she had also come to the conclusion that if he
wanted to speak in person, it would be bad. If he didn’t have anything,
wouldn’t Dr. Kutzner just say that over the phone?
This
time around, they went up to the second floor of the oncology wing. Dr.
Kutzner’s office was surprisingly soothing. He had pictures of coral reefs on
the walls and a collection of turtle paperweights on his desk. They reminded
Helen of her mother’s wide-eyed owls. She noticed her father glancing from side
to side, then looking blankly out the window as Dr. Kutzner started talking
about the biopsy results.
“Based
on the blood work you had in the ED and bone marrow results, you have leukemia.
The type you have is called Chronic Lymphocytic Leukemia, or CLL. It’s usually
very slow-growing, and rarely causes any serious problems. Most people don’t
know they have it until they get blood work for another illness. What happens
is that some of your white cells, B cells, have mutations that make them unable
to produce antibodies, and these mutated cells multiply.”
“But
I don’t feel sick,” Reuben insisted.
“That’s
very typical with chronic leukemia. Most people I see with CLL just need
regular bloodwork to monitor their white blood cell counts. But in your case,
the mutated B cells have multiplied so much that they’re starting to crowd out
your bone marrow and red blood cells.”
“Shit,”
Helen said aloud.
“Leni,”
Reuben hissed.
“I’ve
heard worse things,” Dr. Kutzner remarked. “And I don’t blame Leni for feeling
angry about this.”
“How
bad is it?” Reuben asked.
“Because
your total white cell count is so high and your red cell count is low, I would
put it at Stage III.”
“Stage
IV is the worst, right?” Helen clarified.
“That’s
right. I want to emphasize that Stage III is treatable, especially in someone
your father’s age. Most adult cancer patients are much older, and have other
conditions. But other than being overweight, your father doesn’t have any other
problems.”
“Uh
huh.”
“Do
you two want some time alone to process this before we talk about treatment?”
“No,”
Helen said. Her father shook his head in agreement.
“Okay.
Now, the thing about leukemia is that unless it starts affecting your spleen or
lymph nodes, the main form of treatment is chemotherapy. For a long time, we
had to hospitalize people to do this, but there are more and more drugs that
you can take at home, as pills.”
“So
I could still work?” Reuben asked. For the first time during the appointment,
he seemed optimistic about the future. He straightened up in his chair, and the
soreness in his hip no longer bothered him.
“I
can’t promise you that. These drugs still have serious side effects. A lot of
people experience nausea and fatigue, some worse than others. You might have to
take days off or cut back on your hours.”
“What
kind of drugs are we talking about?” Helen asked.
“I
want to start with fludarabine and cyclophosamide. These work by slowing down
and hopefully stopping the growth of the cancer cells. I’m going to write up a
plan for the first round. If you go through with this, Reuben, you’re going to
have to come back for blood work periodically to see how the chemo’s working.”
“Okay.”
Reuben signed the consent forms to start treatment right after Dr. Kutzner
handed them to him. The fear of leaving Helen without a family, even more than
the thought of dying young, made the decision easy.
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