by Amy Reed
Moskowitz gives me my pills and watches me swallow them before she’ll leave the room. In the stillness before Dr. Jacobs starts talking, I gather myself up, close my eyes, take a deep breath, and then I’m gone. It is one of the things I do best. Jenica’s good at school; I used to be good at cheerleading, and now I’m good at this. I zone out. I go away. I fly out of my body and up to the ceiling to watch the scene unfold. It is just information now. It is just facts. There is nothing for me to feel.
Metastasis.
I hear the word in Dr. Jacob’s voice. I am vaguely aware of my mother crying. My father groans. Jenica whimpers. But I am above it all. I am keeping a clear head. Someone in this family has to.
Metastasis.
The dirty word. The forbidden word. The word that separates the merely sick from the almost-dead. The word “terminal” has gone out of style, but that’s basically what it means. Metastasis means “spreading.” It means the cancer is everywhere. It’s what I expected. I know it’s what we all expected, though no one had the guts to say it out loud.
A year ago, when I was first diagnosed, the cancer was just a tidy little tumor on my left hip bone. Ewing’s sarcoma, a rare form of cancer that is almost exclusively reserved for teenagers, found its way into my body, got comfortable, and made a little home. But then it became ambitious. That’s the nature of cancer; it’s the overachiever of the disease world. It gets angry when you try to remove it. Sometimes the microscopic remnants left over after excision vow revenge and come back even stronger.
Of course, this is not how Dr. Jacobs describes it. His version of cancer doesn’t have a personality. He’s all monotone medical jargon behind the safety of his clipboard. “It’s in your bone marrow now,” he says with his practiced kindness. “We haven’t been able to contain it.” He continues explaining over my mother’s breathy sobs, describing how the cancer had spread down my side and into my femur, then jumped ship into my marrow, weakening the bone enough to make it useless, which is why I ended up breaking my leg two weeks ago while just walking. All this despite surgery, radiation, and a week of all-day chemo every month for the past year. All this despite everything in my life coming to a halt.
The cancer had been there for a while, hiding, dancing its invisible dance that tests missed until it was too late. The disease had been twirling itself into a frenzy during the months after my original diagnosis and the surgery to remove the tumor. I got into a rhythm during those months of outpatient treatment, during those three short weeks between rounds of chemo. My hair would start growing back, my body remembered how to eat and make a little muscle, and I could walk for more than a minute without getting exhausted. I started going to school again. I gave myself permission to get used to the feeling of my own bed. Will and I would resume our standing Friday-night date as if nothing happened, and I could fall back into his arms where I belonged and pretend I could stay there forever. I would start feeling good again just as it became time to do it all over.
No one ever told me I was cured. No one even said “remission.” But it’s like we all collectively agreed to pretend there was a chance the tumor was gone. It was only natural that I become the ringleader—I was a cheerleader, after all. I saw those heartbroken eyes looking at me—my parents, Kasey, Will, everyone at school who was used to me being so fun and positive and full of life—all of them wanting me to assure them everything was okay, and I knew it was my responsibility to keep their hope alive. Every time I got home from another round of chemo, I forced a smile and said I felt great. I learned how to puke quietly. We all believed in miracles then. We had to.
My hip was always a little sore after the surgery that removed the tumor, but I knew deep down this new pain was different. I knew the dull soreness of healing had turned into something sharper. Two months ago, when they discovered it had spread from my hip to my femur, I was not surprised. Even after radiation, while they were still waiting to do the tests that would tell them if the treatment worked, I knew it had gone even farther, deeper, and my whole body had started to betray me. Before their tests could confirm anything, I knew that everything inside me had somehow been infected. I knew all of this two weeks ago, walking with Will around Lake Merritt. I knew this new pain was never going to go away. But I wanted to give Will a good day, and even though it hurt, I knew it was my job to keep smiling. So that’s what I did. I kept smiling until I couldn’t.
It was one of those magical Bay Area winter days—the sun was out, the sky clear and blue, the temperature in the low sixties. Even the resident killer geese were on their best behavior. Moms were pushing strollers, pretty girls were jogging, handsome men were walking dogs, and Will was holding my hand in that perfect way he does—not so strong that he crushes me, but just firm enough that I know he’s not letting go. He was telling me about how someone saw a stingray in the lake the other day, and I wanted so badly to talk about this small thing with him. I wanted to be in that moment in that place and have it be the only thing that mattered, but the pain in my leg was unbearable. In the midst of all that beauty, I could feel my grip on it slipping away. I tried to keep walking, even after the pain got so bad I couldn’t see. I thought if I kept walking, if I kept pretending nothing was wrong, then I could be that almost-normal girl forever—a girl who just happened to be skinny and pale with a very short haircut, walking with a limp while leaning on a cane, holding the hand of her sweet and adorable boyfriend, taking a walk the way normal couples do.
But then I fell. I cannot describe the feeling of my leg breaking, the sound of the brittle bone cracking into shards inside me. I blacked out from the pain, but for some reason I clearly remember the squawking of the geese, as if they were angry with me for ruining their nice sunny day. I remember the jumble of spectators’ voices, all those other people’s dates made suddenly awkward. I remember Will’s touch, his fingertips cool and gentle on my skin, and it was the only thing that felt right on my body; it was the only thing in the world that was solid and unmoving. As I listened to Will explaining my medical history to the paramedics, I remember thinking there is no good reason a seventeen-year-old kid should know anything close to what he knows about cancer. His voice was calm and low, in control like always, but the words were gibberish, just sounds, more like music than meaningful things.
My left femur broke into five pieces. They should have just left the cruel puzzle and never bothered to put it back together. But here I am with a titanium rod and five screws in my leg. I have a brand-new bionic leg that will most likely never even know what it feels like to walk. What am I going to do with all that fancy metal when I’m in the ground? The pieces will just be there, buried and unused, while the rest of me disintegrates and crumbles back into the earth.
Will would tell me to keep hoping. I don’t have the heart to tell him that sometimes hope can be frivolous. It can be a big waste of time and love, not to mention money. People don’t say that kind of thing out loud in a place like this, but it’s true. What if I don’t get stronger? What if I’m too tired to keep hoping, to keep pretending everything’s going to be okay?
“Evie,” Dad says. “Are you listening?”
I come back down from my faraway place, back to this strange world where the land of the living meets the land of the dead.
“So we should start talking about next steps,” Dr. Jacobs says.
“Yes,” says Mom.
“Yes,” says Dad.
Just keep moving forward. Just keep doing something. As long as something’s happening, we can hold on to the illusion that something’s being fixed.
“As soon as Evie recovers from the surgery on her leg, we can start her on an even more aggressive series of chemo and radiation. She’ll need a bone marrow transplant, of course. Stem cell therapy. Blood transfusions.”
“Oh my,” Mom gasps. She puts her hand over her trembling lips, as if hiding her fear will make this any less real.
“There’s a clinical trial we may want to talk about. It’s still in th
e early stages, so there aren’t really any statistics available yet.”
“What’s the survival rate?” I say. “If I do all these treatments?”
Dr. Jacobs blinks, and for a split second, I see a crack in his armor of confidence.
“Four to seven percent,” he says, with the kind of straight face only very good doctors and very good actors are capable of. “And that’s just a five-year prognosis. As you know, this particular cancer has a reputation for recurring.”
Mom cries even harder. Dad sighs and puts his face in his hands. Tears are running down Jenica’s face. The doctor and I are the only ones with dry eyes.
“When can we start?” Mom says.
“Well, there’s the question of Evie’s leg, of course. And her white blood cell counts aren’t great yet. And—”
“No,” I say.
“What?” says Dad.
“No. I don’t want to do it.”
“The clinical trial?” Mom says. “We haven’t even heard the details yet.”
“Not just the clinical trial. I mean all of it.”
“Evie, you’re not feeling well,” Dad says. “You can’t be expected to make a decision right now.”
“Dad, I’m never feeling well. He said I have a four percent chance. I don’t want to go through all that again for four percent. It’s not worth it.”
“Of course it’s worth it,” he growls. When feelings get too much, his sadness turns to anger.
“Four to seven percent,” Mom pleads. “It could be seven.” Her sadness turns to desperation. Her sadness turns to the absurd.
“Oh my god,” Jenica says from the corner. Her whole body shakes. Somebody please go comfort her. Mom, Dad, she needs you too.
“Dr. Jacobs,” Dad says, his face getting red, his jaw getting tight. “Will you please talk some sense into her?”
Dr. Jacobs looks at them both, then at me. He holds my gaze for a while, and I know he is on my side. “As a doctor, I’m almost always for trying anything possible. But that’s not always the right decision for a family. You have to weigh your options very carefully. Treatment is really, really hard. Physically and emotionally. Evie knows that better than any of us.”
Mom’s mouth is open in disbelief. I think Dad may actually hit him.
After an excruciatingly long pause, Dr. Jacobs finally says, “I think you should listen to your daughter.”
Yes. Finally. Somebody cares what I think. Feelings flood my body, but they leave so quickly I can’t name any of them. What if I don’t know what I think?
“I want a second opinion,” Dad says immediately.
“That’s absolutely your right,” Dr. Jacobs says. “But I should remind you that I am the head of oncology, and diagnoses and prognoses are made by an entire team of doctors. Everybody’s been a part of Evie’s treatment. I’m afraid there isn’t a doctor here who will tell you anything different.”
“We’ll go to a different hospital, then.”
“Dad, no,” I say. “You can’t make me. I can’t do this anymore. I can’t make you do this anymore.”
“Don’t worry about us, Evie. We’ll do whatever it takes.”
“I know. That’s the problem. Sometimes you have to know when to stop.”
Silence. Too much silence. It’s heavy. Crushing. It will flatten us all.
Then Jenica’s phone rings and wipes the air clean.
“Dammit, Jenica!” Dad shouts. “Will you turn that damn thing off?”
“Sorry.” She fumbles for her phone, hands shaking. I silently thank whoever called her.
“Can you give us some time alone, Doctor?” Mom says softly. “This is a lot to process.”
“Of course. Let one of the nurses know if you want me paged, okay?” He puts his hand on my shoulder. “You too, kiddo. If you have any questions. You have me and Dan and the nurses and counselors all here to help you.”
“I know,” I say. “Okay.”
“I’m going to work on putting together a palliative care team for Evie. It’ll be me, Dan, a social worker and counselor, a chaplain if you want, and a nurse, probably Nurse Moskowitz.”
“Ugh,” I say.
Dr. Jacobs chuckles, and the sound of it is shocking. “Whatever you decide to do, we’re going to do this together, and we’re going to make you as comfortable as possible.”
“Thank you, Dr. Jacobs,” Mom says. Dad shakes his hand reluctantly, then the doctor walks out the door and we’re left to fend for ourselves.
I speak before anyone has a chance to say anything: “I don’t want to talk about this any more tonight.”
“But Evie—”
“Please, Dad. I have a migraine. I’m really tired.”
“Let’s let her rest,” Mom says, though I know it pains her. I know that what she really want is to be by my side all day and all night, holding my hand, keeping me talking. Especially now that she knows for sure that her time with me is almost over. I think this is what I should want too, but what I want more than anything right now is to be alone.
“You might as well go home,” I say. “All I’m going to do is sleep.”
“Are you sure?” Mom says. “I could stay with you. Are you sure you don’t want to talk? This is a lot to deal with. It doesn’t feel right to just leave you here all alone.”
“Mom,” Jenica says. “She said she wants us to leave. We should respect her wishes.” Thank you, Jenica.
They take turns kissing me good-bye, and it strikes me how my family has become so efficient with our love. It takes all my strength to hold on to my neutral face as they file out the door. As soon as it closes behind them, my lips can finally rest in their usual grimace. I press the button to call the nurse so I can ask for a sleeping pill.
I lie in bed, alone, in darkness, waiting for yet another pill to soften the pain, hoping it’ll happen before the feelings I’ve managed to avoid catch up with me. If there’s one consolation of dying, it’s that it won’t be too long until I can stop pretending I’m not.
And so I guess this means it is time to die. It’s time to let everyone off the hook, let Mom and Dad get on with their lives and stop wasting all their energy on the wrong daughter. Kasey shouldn’t have to spend her precious free time at my bedside. And Will—my sweet, loyal, perfect Will—it’s time to let him have something besides this dead-end love, let him find someone he can actually have a future with, let him become someone besides the guy with the dying girlfriend. It’s time to let them all go. It’s time to stop dragging them down with me.
The thing they don’t understand is, this is not life. This is a vague, cruel shadow of life. I am ready even if they aren’t. I’m ready to say good-bye.
three.
THERE’S NOTHING MORE DEPRESSING THAN VALENTINE’S Day in a children’s hospital. Nothing.
I’ll give them credit, though—they’re valiant in their efforts to make it not suck. All the nurses are wearing pink scrubs, with various heart-shaped and glittery accessories. There are a million art supplies in the kids’ playroom to make valentines. We woke up this morning to pink bags hanging off of everyone’s door, filled with candy and fancy pencils and other random little toys. Someone’s mom arrived with several Tupperware containers full of fresh-baked cookies, enough for every Cancer Kid to have at least two.
The little kids are falling for it, and I’m glad. It’s good to see them smiling and busy, doing something besides sitting in bed watching TV with their exhausted families. I wish I could join them like I used to, but every attempt at re-creating normal life in here, every special event or activity, just makes me sad. I should have been down there with them like Caleb, nostalgic for his days as an assistant Sunday school teacher, distributing scissors and glitter and helping them laugh. But instead, I’m in the empty teen lounge, watching Stella deface the new issue of Seventeen magazine. This destruction seems more in line with what I’m feeling. I can’t deal with sick kids right now.
My parents have finally accepted my decision. I g
et to go home in a couple of days. It took Dr. Jacobs and Dan describing in great detail how much pain and suffering I would experience if we went ahead with treatment. Did my parents really want to trade the slight possibility of my living a few extra months if the time I had left was going to be so miserable? Did they really think I was going to make it, or were they afraid of accepting the inevitable fact that they were going to have to let me go? Dan held my mom while she sobbed, and she looked so small in his long arms.
When she finally came up for air, she could not look at me. “Okay,” she finally said. I looked out the window. My mother had just given permission for me to die.
We’ve found a new peace since then. Mom still breaks down in tears sometimes and I still float away, but mostly we’re keeping our shit together as a family. Telling Stella and Caleb wasn’t as hard as I thought it’d be, maybe because we already sort of accepted that a condition of our friendship is that one of us could die at any second. We hugged and shed a few tears, then we vowed not to talk about it anymore.
Telling Kasey was the hardest because, unlike Stella and Caleb, she did not have the courtesy to save her strong feelings for later, so I had to comfort her through her meltdown. I was the one telling her everything is going to be okay, that life will go on just fine without me. That’s a strange position to be in, comforting someone else about your own death.
But none of this comes close to what will be the most terrible part of all. I don’t know how I’m going to tell Will that I’m giving up on the promise we made that we’d get through this together, that I’m leaving him to get through this alone, without me.
“Can you believe this shit?” Stella says, showing me a page featuring a scantily clad teen holding a math textbook with a confused look on her face. She has written in a thought bubble above the model’s head: Keep me stupid so I don’t ask questions. “I can’t believe this is legal. It’s like child porn.”
