by Steve Gannon
Working with her nurse, Dr. Kratovil draped the area with surgical towels, cleaned the skin over Catheryn’s left hip with Betadine, and administered a local anesthetic. Explaining the procedure as she worked, the doctor then made a tiny incision with a scalpel and inserted a large-bore needle with a cutting stylette on the end, using digital twisting to cut through cortical bone on a portion of Catheryn’s pelvis called the posterior iliac crest. Until then everything had been relatively painless, but when Dr. Kratovil attached a syringe to the needle and used it to draw a sample of bone-marrow aspirate, Catheryn experienced a painful sensation of pressure. The nurse held her hand, telling her it would soon be over.
Giving Catheryn a break, Dr. Kratovil removed her gloves and spent several minutes away from the examining table. Some of the marrow aspirate she injected into a petri dish, stained, and pipetted onto microscopic slides; the remainder she saved in a test tube. Next, after using a microscope to examine the slides, she regloved and completed the biopsy by reinserting the needle and coring out a plug of marrow that was subsequently pushed through the extraction needle with a small wire and expelled onto a sterile gauze pad. As the doctor placed the biopsy plug into formalin fixative, she explained that it would be sent, along with the slides and the test tube aspirate, to the pathology department at St. John’s Health Center, a nearby Santa Monica hospital.
“Pathology department?” said Catheryn uncertainly.
“Standard procedure,” replied Dr. Kratovil. Then, covering the puncture site on Catheryn’s hip with gauze and an elastic bandage, she added, “Keep this dry for twenty-four hours.”
Though the hematologist had been reassuring throughout the biopsy, toward the end Catheryn had detected what seemed to be an overriding tension in the physician’s manner, especially when she had been squinting through the microscope. Now, as Catheryn was about to hear the results of her tests, she began to suspect that Dr. Kratovil had requested Kane’s presence for reasons that went far beyond providing transportation.
Catheryn glanced around Dr. Kratovil’s private office as she entered. The small space was modest but well appointed. Perched on one corner of an oak desk were several framed photos of a smiling teenager. “Your son?” asked Catheryn, glancing at the pictures.
Dr. Kratovil nodded. “Jared turned eighteen this summer. He’ll be enrolling at Stanford in the fall.”
“I have a son and daughter in college myself,” said Catheryn, struggling to keep her voice even. Then, turning to Kane, “This is my husband. Dan, Dr. Kratovil.”
“Pleased to meet you,” said Kane, reaching across the desk to swallow the doctor’s outstretched hand in his. “What’s this all about?”
“Why don’t you both take a seat?” Dr. Kratovil suggested.
“Is something wrong?” asked Kane.
“Please,” the physician said, motioning toward a couch facing the desk.
Kane followed Catheryn to the couch. As they sat, her hand once more found his.
“What’s going on with Kate, Doc?” Kane asked again.
Dr. Kratovil looked at Kane, then at Catheryn. “I want you both to prepare yourselves for difficult news,” she said, her face like stone. “I’m going to have to tell you things I would rather not say, things you may not completely understand at first, but I need to get this over so we can move on. You have a blood disease, Catheryn. It’s a cancer of the white blood cells in your bone marrow called leukemia. This is a grave diagnosis, a life-threatening medical emergency comparable to a major heart attack. Left untreated, it will be fatal. Nonetheless, we have excellent nonsurgical treat—”
“Hold on,” Kane broke in. “You’re saying Kate has cancer? That’s not possible.”
“I’m afraid it is.”
Stunned, Catheryn shook her head. “But I’ve been fine. Tired, perhaps, that’s all. I recently went on a trip …”
“You’re sure about this?” asked Kane. “Is there any chance you’ve made a mistake?”
“None,” said the physician. “There’s no doubt about the diagnosis. Catheryn has a malignancy known as acute meyloblastic leukemia, or AML, type M-2. Fortunately, it’s one of the leukemic subtypes that is more amenable to therapy than others. Nevertheless, treatment will have to begin as soon as possible.”
“I have rehearsals starting this week,” Catheryn said numbly. “I can’t—”
Dr. Kratovil cut her off. “You have no choice. Curing your cancer is paramount. All other details of your life—your job, social engagements, family duties—are now secondary. It would be best to initiate treatment within the next day or two, and it will require your complete time, cooperation, and commitment over the coming weeks and months. If you want to get a second opinion, it will have to be done immediately.”
“No, I … I trust your judgment,” Catheryn stammered. “I just can’t believe this is happening.”
“I know,” Dr. Kratovil said sympathetically. “That’s a common reaction, but you have to accept that you have a disease so we can do something about it.”
“You’re sure?” Kane asked again. “There’s no chance you’re wrong?”
“No.”
“Then we want the best possible treatment. Pull out all the stops. Money is not a consideration.”
Dr. Kratovil nodded. “Treatment will necessitate long stays at the hospital and will be costly. I mention this only because I want you to be prepared.”
“Kate’s got health insurance with the Philharmonic,” said Kane. “She’s covered under my policy at work, too. We’ll come up with anything else we need, don’t worry. No matter how much it is.”
“Is leukemia hereditary?” asked Catheryn. “I mean, will my children …”
“The official answer is that leukemia isn’t a familial disease,” Dr. Kratovil replied. “We may learn more as time goes on, but in your case, given the circumstances, your family history, and the presentation of your illness, I can say with confidence that your children are not at increased risk.”
“Good,” said Catheryn.
“We’ll beat this thing, Kate,” said Kane, his voice hardening with rock-solid conviction. Then, to the doctor, “Tell us about the treatment.”
Dr. Kratovil leaned forward in her chair. “As I indicated, we have excellent nonsurgical treatments for leukemia, and the five-year survival rate for Catheryn’s type of AML is good.”
“Nonsurgical. You’re talking about chemotherapy,” said Catheryn.
“Yes. Depending upon how your disease responds, chemotherapy will probably run several courses, each lasting around four weeks. During the first course, or remission-induction phase, you’ll be given a combination of antileukemic drugs that will destroy most of the cancerous cells in your body. Unfortunately, the drugs will also destroy normal white blood cells, and there will be difficult side effects. You’ll lose your hair starting around day fourteen, and you’ll eventually suffer an almost complete lack of appetite, requiring that you be fed intravenously. With the new anti-emetic drugs available, nausea and vomiting probably won’t be a major problem, but you’ll lose weight and may become feverish. On the up side, your type of AML rarely affects the central nervous system, so drug administration into the spinal fluid probably won’t be required.”
Catheryn ran her fingers through her hair, glad to be concentrating on the mechanics of her treatment rather than the reality of her disease. “That’s something, I suppose.”
“I know all this sounds terrible, but I don’t want to minimize the discomfort you’ll have to undergo,” Dr. Kratovil went on.
“You’re doing a pretty fair job of not minimizing anything so far,” Kane noted with a frown, placing an arm around Catheryn.
Ignoring the interruption, Dr. Kratovil looked at Catheryn and continued. “As the cancerous cells are killed, your natural immune system will also be incapacitated, and opportunistic infections will have to be fought with antibiotics. Because of clotting problems you’ll be covered with bruises, and you’ll regularly
need blood and platelet transfusions. After the four-week induction phase, assuming everything goes well, you’ll be in remission. You’ll feel as though you’re on the mend, and you can go home for a week or so to regain your strength. Unfortunately, if we stopped treatment at that point, the malignancy would recur.
“So what happens next?” asked Catheryn. “More chemo?”
“Correct. You’ll return to the hospital for a second round of treatment. This continuation or consolidation phase will be similar to the first: five days of drug administration followed by three weeks of recovery while your bone marrow regenerates. That time will be a bit easier on you, with fewer blood and platelet transfusions, and afterward you can go home again. Following that, and depending on your postremission recovery, there are various treatment options open.”
“Let me get this straight,” said Kane. “Kate goes through two months of chemo, and then there’s more?”
“Yes, although one course of action would be to do nothing unless she experiences a relapse,” Dr. Kratovil explained. “Another plan would be to proceed with a further consolidation phase, continuing the chemotherapy until we’re confident the cancer is completely gone.”
“Are there other alternatives?”
Dr. Kratovil hesitated. “One last option would be to have a final session of combined chemotherapy and total-body irradiation, completely eradicating all white blood cells in Catheryn’s body.”
“Ensuring the cancer wouldn’t recur?” asked Catheryn.
“That’s the idea. On the downside, the latter course would irreversibly destroy your own natural immune system, requiring a bone-marrow graft. The graft tissue would have to come either from cells harvested from you during remission and subsequently purified, or from a closely matched donor. Which reminds me. Do you have any living siblings?”
“No.”
“Are your parents alive?”
“Just my mother.”
“You mentioned children.”
“We have three. Travis, Allison, and Nate.”
“We’ll want to test them for compatibility.” Dr. Kratovil jotted something on a pad of paper. “Your mother, too. But we’re getting ahead of ourselves. At the moment, the main thing to understand is that after the induction and consolidation phases, we’ll have to make a decision regarding future treatment. Now, I know I’ve thrown a lot at you, and I’ll be more than happy to answer any questions you might have.”
When Kane didn’t respond, Catheryn spoke. “I only have one. I’ve heard that people with leukemia often undergo months of treatment, only to die soon afterward. I realize there are no guarantees, but if that’s going to be the case, I want to know right now.”
“Jesus, Kate,” said Kane. “Don’t talk like that.”
“No, I want an answer.”
“Kate, she said the five-year cure rate was—”
“I know what she said. Now I’m asking about me.” Catheryn turned, her eyes finding the doctor’s. “Despite all this treatment you’ve discussed, am I going to die anyway?”
Dr. Kratovil met Catheryn’s gaze. “Not if I can help it,” she said quietly. “I promise you that.”
12
After dinner at the beach house on Wednesday, Mom called a family meeting. A leaden feeling in the pit of my stomach, I trailed my siblings into the living room, wondering what the topic of discussion would be. Because Travis and I were now away at school most of the time, family meetings had become an infrequent event in the Kane household, and when they did occur, they were typically held at my father’s behest. Though in principle any family member could call a meeting, for my mother to have convened one was unusual, and I sensed it had not been called lightly. Does she already know that I’ve dropped out of summer session? I wondered. I shook my head, deciding that couldn’t be it. There was no way Mom could have found out. Not yet, anyway.
What, then?
The evening meal had been unusually subdued, monolithic lulls in the conversation more the rule than the exception. Throughout dinner I had detected what seemed an undercurrent of strain between my parents, but not as if they were fighting—a rare occurrence these days. It was more like they were hiding something. As I slumped down on the living room couch between Travis and Nate, another thought occurred. Oh, no … I’ll bet someone from UCLA telephoned after I withdrew from my lit class, checking on my housing arrangements.
Mom crossed the room and sat in an armchair facing the couch. Dad stood behind her, a hand resting on her shoulder.
“You two look about as cheery as a pair of funeral directors,” I observed nervously. “What’s up?”
When neither of my parents answered, I raised my chin defiantly, deciding to take the initiative. “Okay, Mom, let’s lay our cards on the table,” I said guiltily. I had intended to inform her of my decision to accept the CBS job offer; I just wished I could have been the one to break the news about withdrawing from school. Well, too late for that. “I know what this meeting’s about. Look, I was going to tell you. Last night I said I had some news, remember?”
“What are you yammering about?” asked Dad.
“I remember, Ali,” said Mom, silencing Dad with a glance. “What is it?”
“You mean you don’t know?”
“Know what?”
“That I, uh, that I was offered a summer position at CBS. I thought somebody from UCLA student housing had called.”
“Working part-time would be fine, but what does that have to do with student housing? You’re not thinking of dropping out of summer session?”
“I can’t do both, and this is a great opportunity. It’ll give me a chance to see whether—”
Mom cut me off. “Out of the question. You need the credits from your literature course to transfer to USC. Your education is more important than any summer job. Besides, how would you get to work?”
“I’m only lacking four units, and I’ve already contacted the USC admissions office,” I said. “They told me I could make up my missing credits during my first quarter at SC. As for getting to work, Trav lent me his Bronco for the rest of the summer.”
Mom turned to Travis. “Oh? I wondered where you car was.”
“I wouldn’t have been driving it much, anyway,” explained Travis, clearly regretting being caught in the middle. “I’ll be gone most of July and August with my recitals.”
Mom frowned, returning her gaze to me. “Why this sudden interest in working at a TV station? When you changed your major to journalism, I thought it was to find an outlet for your writing.”
“TV news needs writers, too,” I reasoned. “It may not be print journalism, but working at CBS would be a great start.”
“You have this all figured out, don’t you, young lady? Let me guess. If you drop out of summer session, I don’t suppose you plan on living at home, do you?”
“No. I would like to keep my room at UCLA to be closer to work. Don’t worry, I’ll be getting paid, so I can handle the rent.”
“We’ll talk about this later,” said Mom. “Unless it’s too late to discuss. You haven’t already dropped your literature course, have you?”
I shifted uncomfortably. “This was the last week I could withdraw. Plus I had to give them an answer at CBS.”
“You can’t simply—”
“It’s done,” I broke in, my voice filling with rebellion.
“If your mother says to, you’ll undo it,” my father warned.
“Dad, be reasonable. I’m old enough to make my own decision on this. I’m not a kid anymore. I’m about to turn twenty.”
Dad scowled. “That depends on what comes out of your mouth next. Are you going to do what your mother says?”
“No.”
“I beg your pardon? To the untrained ear, it sounded like you just said no.”
“I can’t reregister at UCLA. It’s too late. Besides, you’re not being fair. There’s no reason I shouldn’t do this.”
“Damn it, Ali.” Dad shook his head in exasperat
ion. “How’d you get to be so hardheaded?”
“I’m the way you taught me to be,” I shot back. “You’ve always said that if I thought I was right, to challenge authority.”
“When I told you that, I didn’t mean me.”
“You also said to decide what I wanted, and then to do whatever it took to get it. Remember?”
“I remember. And you’d better remember who you’re talking to. You’re skating on thin ice here, cupcake. You and I need to have a little conference after this meeting is over.”
I ducked my head, sensing from the set of my father’s jaw that I had gone too far.
Nate, who had long ago learned to lie low when older family members clashed, finally spoke up. “What is this meeting about, anyway?”
Mom sat straighter in her chair. She glanced at Dad, then took a deep breath. “At the doctor’s office today, I received some bad news,” she said. “They did a biopsy of my bone marrow. It seems I have a disease in which my white blood cells are growing out of control.”
“Leukemia?” whispered Travis, his eyes widening.
Mom nodded. “But the kind I have has a good cure rate, and I have a fine physician,” she added. “Her name is Dr. Kratovil. She said she would be glad to talk with all of you kids and answer any questions you have concerning my treatment.”
“Is leukemia malig—what’s the word?—malignant?” asked Nate.
“Yes, honey. It is. But that doesn’t mean I won’t get better.”
“And you said everything was all right,” I said. “Just a slight case of cancer.”
“Ali, shut the hell up!” snapped Travis. “This isn’t the time for wisecracks.”
“I’m sorry, Mom,” I said quickly, feeling ashamed. “I didn’t mean that. I say stupid things when I’m upset.”
