by Charles Bock
“Mmm. Oliver—my husband—gives them to me.”
“Cancer in your family history?”
Alice’s hands joined and webbed; she flexed them in her lap, pursed her lips. “My father died from pancreatic cancer when I was eleven.” Be calm. Release. “And his mother as well—she was older by then, and two packs a day her whole life, a fiend. So I’m not sure how that affects the family tree, if you include…”
Closing her eyes, keeping them shut, she did a short breathing thing, unlocking her hands, putting them back on her knees, feeling the pointed jags beneath the denim. “Doctor, this whole day, being back in this…it’s already—I feel very…”
“Take your time.”
She held off her emotions. “I’m sorry. I’ll do better. Keep going.”
“There’s no solid reason why people get leukemia. I wish I had something more definitive to tell you.”
“What about heredity?” She jerked forward. “It’s not genetic?”
“Very few cases of acute myeloid leukemia are passed down,” Eisenstatt said. “If I had to guess—and it would only be a guess—I’d say chances are rare.”
Alice grimaced, snorted, gasped for air, “She’s safe?” Her chin crumpled. “My baby’s going to be all right? She can’t get this?”
The nurse-practitioner was at her side with tissues. Alice blew her nose, became aware of a disturbance. Her daughter’s eyes, huge white saucers; Doe’s little face uncertain, turning flush, light orange, now a deep crimson. Infant features scrunched around the meeting point of her nose; her mouth widened. That juncture, intimately familiar to a parent, right before the screaming starts. Horrible as your child’s misery might be, when you’d been through it enough, the building process toward eruption could actually be endearing. Through her tears Alice made eye contact with an equally entertained Oliver. She motioned for him to bring over Doe.
The baby was inches from her mother’s bosom when the inevitable finally took place, those tonsorial sirens blaring, their noise resonant, inclusive, the royal and imperial we: We are all going to plummet to the depths of my unhappiness.
Alice bounced Doe, made placating noises, grimaced.
Next to her, Dr. Eisenstatt pinched the bridge of his nose with his right hand. Bereft of a wedding band, an adult single childless male doctor, with how many patients waiting for him, he looked as if he’d gotten a wedgie in his ears.
“It runs in the family,” Alice said. “We’re criers.”
She smiled at her girl, made more cuddly sounds. The nurse-practitioner came over and added a soft “It’s all right.”
Once Doe calmed, Alice began. “It’s why we started early. One of the reasons anyway. I knew the disease was part of my family history. When you’re a child, that absence defines you. You form around it, you know? Then, you get older, you don’t know how long you have. Every friend—everyone we know, is busy trying to establish themselves, get their professional life going. I have ambition, too, I’m not Miss Merry Homemaker.” She sniffed, motioned with her hand, an absent gesture. “I wanted to make sure I had the chance. To—to be a mommy. I wanted kids while I’m young and can care for them and chase them. I get colds, all the time, but nothing of consequence, my entire life I’ve been healthy. So I thought, Okay, honeysuckle—”
Her voice cracked. “And now, this.”
She stared at the rack next to the door, cardboard boxes of light blue plastic gloves, surgical masks, hand sanitizer. Reaching around, so her child was still wrapped in her arms, Alice used the sleeve of her thermal, wiped at her eyes. Oliver was poised, ready with a slender stick of cheese wrapped in plastic.
“As I said, we really don’t know why leukemia appears in most patients.” Eisenstatt’s face was pink with health and closely shaven, but also had a shadow, stubble coming in. “This says you don’t have any brothers and sisters?”
“Correct.” She lightly rocked Doe. “I’m an only child.”
A pager in the room was vibrating on someone’s belt loop. Someone was laughing and walking down the hall outside the door.
A doctorish thought formed across the doctor’s face. Eisenstatt digested whatever he was thinking. When he said, “Okay,” his tone was more authoritative, the okay acting as a switch. Oliver withdrew a spiral school notebook from their bag. The doctor blinked and swallowed, tics that Alice would come to recognize as indicators he was preparing to speak at length.
“You’re on top of your treatments, that’s impressive. It’ll be helpful down the road. If you have any questions, make sure to ask. If I’m telling you things you know, I apologize, but I’d rather we’re all on the same page.”
Medical personnel, doctors and nurses alike, talked in this clipped manner: short sentences, quick back-and-forth exchanges. It was the same way in the design world, or dealing with magazine people, anyone who seemed to straddle the lines between corporate and creative worlds. Time was at a premium. Unless someone was above you on the hierarchical ladder, you didn’t have a moment to spare, merely enough time to explain what you needed, or wanted, or had to get across—then you waited for the person to catch up, nod that they understood, or stare at you looking glazed. Once the supervisor left, it was up to whomever to sink or swim. In the medical realm, at least, in Alice’s experiences there—all of which encompassed her pregnancy and these six weeks of insanity—doctors pretended it mattered if the patient understood, before continuing to the next thing.
“You have acute myeloid leukemia, or AML,” began Eisenstatt. “What this means: inside your bones there is marrow, a spongy red tissue responsible for producing your blood cells. AML is a mutation, or disruption, inside that marrow. Instead of producing a normal blood cell, your marrow produces purplish cells called myeloblasts.”
He checked to make sure she was with him, saw an eager student.
“Your red blood cell counts, your whites, your platelets—myeloblasts are what is produced instead, and when they replace your healthy blood cells, this causes a major disruption. Among what’s disrupted is the production of neutrophils—the part of the immune system that helps fight infections. We think this is what happened with your pneumonia. It’s why it was key for you to get diagnosed as quickly as you did.”
The sounds of Oliver scribbling. The conspicuous scratch of Bhakti’s nail file, now pausing. Alice gave Doe her forefinger. The baby’s cheeks imploded, her brow furrowed, her sucking rhythmic, fervent.
“With you, Doctor,” she said.
“Based on the genetic makeup of myeloblasts, AML has three possible courses of treatment. First: simple. The genetic makeup of the AML cells is, for lack of a better term, the most straightforward. Treatment: straight systematic chemotherapy. With simple AML we have a good—”
“You can spare us,” Oliver said. “We know we have the complicated kind.”
Eisenstatt nodded. “So you already know we’re looking at a stem cell transplant. And you know this is a serious procedure. We have to find a bone marrow donor with a genetic match of your DNA. There are ten categories that have to match. The more we can line up, the better we are.” He waited a count. “Since siblings have DNA from both parents, they often give us a chance at the best match. You’re an only child, so—”
“That option is not available,” Alice finished.
“We’ll look to the National Donor Registry. If and when we do match you with a donor, the next step would be an aggressive regime, followed by a transplant. You’ll be in the hospital for six to eight weeks, under a high-level quarantine.”
“The rooms on the transplant floor are very nice,” Dr. Bhakti said. She’d reemerged from whatever hole, her nail file no longer apparent.
Eisenstatt put down the clipboard next to him, picked it back up, tapped it against his upper thigh. “Transplants are a fairly recent development. And as far as the success rate—”
Alice cut him off. “Let me be as clear as I can make myself,” she said. “Any numbers or information that might upset
me, I don’t want to know. I’m young. I’ve been healthy my whole life. I’m not another one of the seventy-year-olds in your waiting room, health and blessings to them all.”
She felt the bones inside her fingers vibrating, felt herself powerless to stop them, felt herself pulsing with strength, ready to vomit. “Please, just let me know what I have to do each day. Just put it in front of me. Do that, I promise, I will work hard. Because I am going to watch my child grow.”
Dr. Bhakti was looking at Alice in a manner that suggested, for the first time, she considered the possibility Alice might have legitimate thoughts and feelings. Dr. Eisenstatt was squinting lightly, his eyes considerate.
“I think your attitude is admirable,” he said. “I’ll only provide statistics if you ask.”
“Blinders on,” Oliver said. “That’s how we’ve been getting through this.”
“You should know,” the doctor said, “right now things are going extremely well. The work in New Hampshire was first rate. And getting you to this point was a big step. My job is to shepherd you to the transplant. I take this responsibility seriously. My modus operandi, I always operate on a worst-case-scenario basis. I’m going to assume the worst, give you the most conservative and oppressive possibilities. Consider me your new Jewish grandmother.” He met her eyes, gave a bit of a smile. “That’s my job. Get you to transplant. Once we find a donor, a transplant doctor will take over. You’ll go forward from there and be happy to be rid of me.”
Doe squirmed, kicking at Mommy’s chest.
“As I said, BMT is a fairly recent procedure,” Eisenstatt continued. “We’ve been doing it at Whitman for about five years. And while it’s no walk in the park, it can work: genetic matches do happen, people do find donors. People have this procedure and they get better. From what we’ve seen, new marrow acts as a cure.”
His words were punctuated by the redolent smack of hands against knees, Oliver rocking in place. Alice watched him flexing his feet, pressing forward from the balls of his toes; she was aware of her own stillness, the fussing child against the front of her right shoulder, her hand weak on the back of the baby’s head, supporting her. The child was sweating, her little fuzz of hair damp.
“I’m also legally obligated to tell you,” said Eisenstatt, “for medical purposes, we define cure as the disease being in remission for at least five years.”
An unhappy squeal, little hands pushing away from Alice’s neck.
Oliver was respectful, if uncertain: “You said you’ve only been doing them for five years?”
“Exactly,” piped Bhakti.
“Classifying remission as five years doesn’t mean your leukemia will return in five years,” Eisenstatt answered. “As you said, you’re young. You have a history of being healthy, a daughter and a husband—you have every reason to live.”
—
Early in the afternoon, on day forty-seven since Alice’s diagnosis in New Hampshire, Oliver was standing in the back of the exam room, listening to a chunky-watch-wearing catalogue-looking motherfucker talking about some sort of irregularities with Alice’s blood work. Alice’s numbers weren’t bad, the doctor was saying. But he was still concerned with the makeup of Alice’s cells. In fact, Oliver was watching the guy push to do some procedure that Oliver had vaguely heard references to before. “I’d like to do it as soon as possible,” he was saying to Alice, “if that’s okay with you.”
This procedure, this aspirate—this bone marrow aspirate—would allow Dr. Eisenstatt to find out what was going on with the closest person to Oliver on this stupid planet, Oliver was hearing. And usually, when Oliver heard something scary, his means of dealing with, or addressing his fears was to share them, only he couldn’t, not now, because these worst-case scenarios all involved the person he wanted to share them with. So, the sharing option wasn’t on the table. And this lovely woman, she was bereft, her body racked, tremorous. She was gulping through tears: “I’m never going to get better.”
Some sort of levee inside Oliver was breached, and now tears stung, left hot trails down his cheeks. “You’re not allowed to say that,” he said, fighting to breathe, embracing his wife. His voice went sharp: “That can’t be true.”
—
Alice had a deep-rooted conviction that, as a means of expression, tears were just as valid as speaking, just as necessary as laughter. Anywhere, any time, no matter how uncomfortable it may have made people around her, Alice was fine with a good cry. If Oliver mocked her, if he derived pleasure from needling her, that didn’t matter much, in the end—for after all his little quips went silent, he still put up with her waterworks. Meanwhile, Alice could count on one hand the number of times she’d seen him cry. Number one was easy: when he’d cut the umbilical cord on his baby girl and taken Doe in his arms for the first time. Two, also easy: their wedding, staring into Alice’s eyes, slowly rocking to and fro while the Ramones blared around them and friends watched in silent joy, their first dance together as man and wife. Three: the call from his mother with news that Magoo, his beloved childhood dog, had finally been put down. Then when that power forward on the Knicks—who Oliver rooted for and insisted was underrated—had choked on consecutive point-blank layups during a key sequence of a deciding play-off game against Jordan and the Bulls. (The image fresh even now to her: the final buzzer sounding; Oliver walking numbly away from the television, shutting their bedroom door behind him; minutes later Alice entering to see him sitting on the edge of the bed, face in his hands.)
Six years together and she could count these four times—three legit, one ridiculous and endearing. Now number five.
In less time than it took her to blink the tears away, not two seconds after they’d begun, Alice decided that if one ramification of her tears was going to be the loss of her husband’s equilibrium, if seeing her crying was going to get him crying, if he was going to worry that she wasn’t going to be able to deal with what lay ahead, and this worry was going to mean he wouldn’t be able to deal—then, she wouldn’t be the one who let them down.
She disengaged from Oliver’s arms, dabbed at her eyes.
Doe, still cradled in her arms, was looking up at her, the largest, most concerned eyes ever put on a baby.
“Just a tug,” she said, “or the full regime?”
“Full aspirate,” answered Eisenstatt.
Alice could tell the doctor was being careful, wanted to keep their conversation grounded. “You should know,” he continued, “there are a lot of bone marrow biopsies.”
“My third,” Alice sniffed.
“It’s a stretch to say you’ll get used to having these procedures, but they should stop being foreign. Before we start a round of chemotherapy, we always confirm with an aspirate and biopsy. That’s what this is for.”
“Excuse me?” Alice asked, bouncing the child. “Another round?”
“We know more chemo is part of the regimen,” Oliver said. “But you don’t mean another round, now?”
“What kind of time frame are we dealing with, Doctor?”
“There’s really no point in getting excited by hypotheticals,” Eisenstatt said. “Let’s just see what the aspirate tells us.”
Alice managed to nod, while Oliver stared with murderous intent at the series of plugs and holes against the back wall. Alice was peripherally aware of a knock at the door; a nurse entering, sharing something with the nurse-practitioner. She was aware of Dr. Bhakti, watching her, projecting a concerned, or at least involved vibe, while at the same time running a hand through that luxurious and well-conditioned hair. If Alice looked at the visiting cancer fellow right now, she’d scratch out that bitch’s eyes.
This was when the baby decided she’d been on best behavior long enough. Rubbing her eyes would no longer suffice. Rubbing her ears had become old hat. Even rediscovering how good her toes tasted didn’t placate. Doe let everyone within the tristate area know her nappy time was long overdue. It was an affront that people were paying attention to everything but h
er. Knee bounces and a fresh pacifier weren’t going to solve jack. And when it seemed like her cries couldn’t become louder, they became louder. Alice focused on a spot directly across the room. Her world became that small spot. After two counts, the spot widened to include her fussing child.
“Is there a bottle?” she asked.
“I also have something in my notes about the insurance,” said Howard Eisenstatt, MD.
“Actually, that’s what I’m here about,” Requita said. “Business office called. On your way out, you need to go see them. I know you already did. They have something more.”
“Give her,” Oliver said. “Give her to me.”
Taking the baby, he said, “You’re a good girl, okay, there, there,” and started away from Alice, away from Eisenstatt, along the empty side of the exam room. “I’ve been dealing with Unified.” His voice was resigned, more than a little defensive. “It’s not a big deal, a bunch of red tape, mostly. But trying to get people to read the facts that are right in front of them, don’t ask me why—it’s really not worth getting into here.”
Eisenstatt had the expression of a judge who may have sympathized with the defendant but had been through the courtroom sob story more times than he could count. “By necessity there’s a wall between medical and billing.” His arms folded over his clipboard and held to the middle of his chest. “I hate insurance companies. Hate them. We’ll do what we can.” He asked the nurse-practitioner to put Oliver and Alice in touch with the hospital’s social services liaison. She could act as a mediator and help with financial aid forms, if it came to that. “Make no mistake,” said Eisenstatt. “You have to get this settled. Getting you to a transplant is the only option here.”
Whitman Memorial, 1220 York Ave., 4th floor, Hematology/Oncology (interview), N.
They’d been friends a long time now, living down the hall from one another for upwards of twenty years. This friend of hers, a single mom. She used to drop the boy off whenever, then she lucked out and got herself remarried. She scooted out of the city and up to the burbs, Rye: her and the new hubby and her son. Kid was a bright boy. Salutatorian of his high school, even earned a free ride to someplace down south, one of those states with traditions of Confederate flags and really good barbecue. When that child got down there, something happened—his heart got smashed, or being away freshman year was too much, maybe he just straight bugged. It wasn’t uncommon—a kid is alone, the year goes on and the pressure mounts, he burrows deep inside his own head. This young man became withdrawn, wouldn’t come out of his dorm room. Got so bad he had to leave school and head north. His mom kept wanting to know what was wrong. All he said: I had to get out of there.
