In Danger

by Josepha Dietrich

  Mieke was with me, likely girding her loins against the emotion of walking into the hub of cancer care, with all its reminders of life’s frailty. So used by then to repeat visits to accident and emergency with Celso, B and I clicked into automatons. B phoning with the news that there wasn’t another admission decelerated the carer-train thoughts of What next, what next, what next? Despite those sticky memories of Celso’s distress, I could focus on what lay ahead.

  The hospital and medical research complex in Herston was so vast it had its own postal code. B’s engineering company had one report that estimated the air-conditioning units there alone used enough energy to fan 30,000 homes.

  The walk to the RBWH took 15 minutes. We’d crossed the road from my house and walked up the steep street; either side was lined with Australian ivory curl trees, their young leaves split and splayed like storks’ feet. On my left were two houses dedicated to the families of children going through intensive cancer treatments. Often a parent stood outside smoking and staring at the ground. I turned right and away from these houses and walked up a steeper road to the back entrance of the hospital complex. This was the business end, with delivery docks and energy towers piping out mist. One dock near my turn-off to the day unit had the ominous title ‘neonatal collection’; the doors were always shut and smoke billowed out of a furnace. I saw the smoke as ashes of dead babies, even when I tried not to.

  While we waited inside, my concern for my son’s health still took my mind off my own. I kept my mobile in my hand in case B phoned with a scary change.

  Will you wear a wig? Mieke and I chatted about whatever came into our minds as we sat on the crammed waiting-room chairs. After decades of making Australia her naturalised home, she maintained a Dutch stress on words and said I sink instead of I think – a charming pronunciation.

  I nodded. I’ll buy one before I go bald.

  I think it’ll suit you. Mieke smiled with her entire face, her bright blue eyes twinkly.

  A chubby nurse with badges on her shirt called us both down the hall to the oncology rooms. The chemotherapy preparation room had a DVD player, pamphlets on every subject to do with cancer and its treatments, and two floral print couches.

  Everyone starting chemo watches this video, she said.

  Okay! I got across to the nurse that I didn’t want to talk any further, so she left Mieke and me alone.

  I turned to Mieke. I’ll be fine in here. Would you mind going home to help B?

  Are you sure? Ngaire’s with B. Mieke held my gaze and saw that I really was okay with her leaving. She hugged me and I closed the door behind her. In fact I wanted to be alone. Inside I was about to crack.

  It was my habit to retreat inside myself at times of intense stress or emotion, and I preferred to do it without an audience. It was as if I needed to shut the noise off – of conversations or communicating with someone else – to inhabit my inner world. I looked up at the ceiling to try and stop tears falling out of my eyes. I planted my hands on my hips while I slowly paced around the room, thinking, I’ll survive this, I’ll survive this. Out of the corner of my eye, I watched the video about other people’s stories of chemotherapy and how they’d coped with it. The footage of patients reflecting on their cancer treatment was a way of stepping through a door from one reality into another.

  Before this first day, I’d searched hungrily through The Emperor of All Maladies: A Biography of Cancer for Barbara Bradfield’s name. Dr Siddhartha Mukherjee told the story of how a fast-tracked trial of the drug Trastuzumab (Herceptin) saved her life, then later many lives when it came onto the market in the 1990s. It was about to save mine.

  After Barbara’s first lot of unsuccessful treatments, her pregnant daughter was killed in a car accident. Then her aggressive cancer flared up again. However, after receiving Trastuzumab, she survived the tolling bells of ‘terminal’ cancer and extraordinary grief. She remains alive today.

  Cancer genes come from within us; the unique chromosomal make-up in our cells was written with the potential to develop cancer. We’re loaded with cancer genes – oncogenes – but they need to be activated for cancer to develop, for instance by an infection or a mutation in another gene.

  When I was diagnosed my family paid for the BRCA1/BRCA2 genetic test to see if I’d inherited either of the known breast cancer genes. I received the result within a fortnight and it was negative. The truth was that even though my mother was diagnosed with breast cancer at 45 and I was diagnosed at 35, no one knew why. I stood in the room with two pieces of good news: I didn’t have a known faulty gene and the cancer was gone from my breast and armpit, which bolstered me against my fears.

  But the procedures required to test for mutant genes or remove flesh that held the result of bad genes were nothing in the face of what I was about to experience. I was taken out of the introductory room to a windowless space where nurses accessed portacaths and took bloods. It was as if I’d walked around the butcher’s counter to the super bright, cold refrigerator out back. I expected the room to go black and icy when a nurse closed the door. I would come to learn that nurses never closed that door because of feelings of claustrophobia.

  Take a deep breath, said the nurse. I later befriended her when she became my regular nurse. She told me a difficult story of her first baby, who had died soon after birth, and how she’d come to call Australia home. She’d moved countries to escape her mother tongue: it embodied the memory of her lost child. She held the puncture kit of round, white plastic with its metal proboscis and IV line attached over my recently inserted portacath.

  One, two and three. She pushed it through the septum of the port beneath my skin. Plunk.

  No pain. I didn’t feel it. Thank you.

  Good. She smiled and winked.

  I smiled back.

  Over several hours I was plugged and unplugged into my chemo cocktail. My face went hot, and then I went cold. My heart beat faster for a while, but I was also nervous.

  Brenda Walker’s Reading by Moonlight explored how books saved her while she went through treatments for breast cancer. She realised her third novel, Poe’s Cat, was an echo chamber of the ideas she’d worked on throughout her writing life, and that the writers so familiar to her, such as Edgar Allan Poe and Samuel Beckett, wrote similarly about their emotions not wholly stabilising after terrible experiences. I wondered if this was going to be my story too. I took a sip of tea and ignored my own enquiry. It wasn’t too bad.

  At first.

  Mieke and Ngaire had to return to Canberra in the afternoon, so I opted to walk home after chemotherapy, as B couldn’t bring our sick son into the oncology ward. I looked over at the parents smoking outside the childhood cancer houses with greater empathy this time.

  Happy birthday to you, happy birthday to you, happy birthday dear Celso, happy birthday to you.

  It was the fourth of July and our son was surrounded for his first birthday party by his family: his paternal grandmother, who had jumped out of retirement into heading an International Baccalaureate college; his maternal grandfather (my dad) and aunt (my youngest half-sister), both arrived from the south of England; his great-aunt and great-uncle from B’s side, who lived in Brisbane; and three of Celso’s first cousins once removed. I helped him blow out the candle.

  I cut the Mediterranean orange cake I’d made that day. It was for the adults as my son didn’t eat, but it was still incredibly important to me that I bake his first birthday cake. I’d commenced chemotherapy the week before and didn’t want to fail as his mother on the day he turned one in the world.

  My brain was strung out and my stomach was raked by hunger; the chemotherapy had begun its stripping-down effect, where your higher thoughts and feelings turn basic. At the time of Celso’s birthday I still had the mental capacity to think about what might come if I didn’t survive. However, over the horizon was a time where simple survival instincts were all I had left
– I could hardly factor him into my daily cancer routine, let alone parent effectively again.

  I bit into the cake. Oh, not good! Does it taste bland to you or is it my chemo mouth?

  Everyone politely said that it was a little savoury but okay.

  It was tasteless. I realised I’d put in too little sugar – or none at all.

  The following morning I couldn’t get warm.

  Are you all right? My father was in and out of the spare-room-slash-study getting me a breakfast of porridge with prunes, and a cup of tea.

  No, I don’t feel great actually. Could you get another duvet? I’m cold. I huddled under the pile of bedding, trying to sleep.

  B had gone to work and my father was minding Celso. In between I supervised his nasogastric feeds.

  My father and my sister Alex were staying in a nearby hotel because our house was too small for multiple guests. It was a two-bedroom post–World War II Queenslander with ornate ceilings and solid glass-panelled doors, the size of an apartment but on a proper-sized house block.

  When Alex arrived at our home near midday and took to reading a Spot book to Celso, I had flushed cheeks and my throat was raw. I took my temperature and drew a reading of 39. I better go to A & E, I told my father.

  If you’re an oncology patient having chemotherapy, you get an emergency card. You flash it at the triage nurse to be admitted without waiting, as fevers and chemo are a bad combination.

  My father and I were ushered into the emergency room. An experienced nurse walked up to us, held my father’s hand and exchanged some English–Australian banter about England winning the Ashes, then pointed to a seated area near the green cubicles. She simultaneously showed authority and calmed my father and me down. If Mum hadn’t briefly married an Australian man, Green Card style, we might never have stayed here. The reality of this sliding-doors moment came back to me; my father might have looked after me in situ instead of having to travel half a world to reach me.

  I was ushered into a curtained cubicle and my history was recorded by an experienced though young nurse with streaky dyed-blonde hair. An elderly woman was outside in the white corridor on a trolley, with a male nurse asking her questions: Do you know where you are? Who do you live with? She was disoriented and couldn’t answer him.

  I lay back on the trolley and stared up at the fluorescent-lit ceiling. My father was allowed to enter and pushed the drapes aside like he was swatting a fly. He sat in the one corner without heart monitors or the mobile observations trolley with its blood pressure cuff, oxygen saturation probes and long proboscis thermometer.

  Are your eyes normally this puffy? the nurse asked me.

  No. I’m also not normally this flushed.

  The nurse nodded. We’ll get something for your fever once we know what’s going on.

  She wore one of the old-fashioned nurse’s watches with only the face pinned to the left breast pocket so you could glance down to read the time.

  I might have picked up my mother-in-law’s cold. She arrived a few days ago, I said.

  You’re not supposed to see people with any infection once you’ve commenced chemotherapy, she said in a telling-off manner.

  I didn’t know at the time. Fuck’s sake, Josie. You were too blasé about contact with people. I wanted to reverse time and pay more attention to that chemo introductory room.

  Where did she arrive from? asked the nurse as she scribbled comments in my medical chart.

  Hong Kong.

  The nurse’s head jerked up. Does she normally live in Hong Kong?

  Yes.

  My father’s back straightened on the chair.

  The nurse asked a lot of questions about my mother-in-law’s presentation and whether she’d been tested for swine flu. No, she hadn’t been tested, but, despite it being considered an epidemic at the time, I figured the chances of her having swine flu were remote as she was in charge of a school where health standards were high. The nurse went off to inform the doctor and get a quarantine card to attach to the now-closed curtain over my cubicle. Anyone who entered had to wear a mask and gloves. It wasn’t quite code red, but definitely code pink, and after a throat swab that made me gag, and getting my nose poked, I was regarded as having swine flu until proven otherwise.

  My doctor arrived, a newly minted registrar of oncology, and shepherded me through the situation and medical requirements. He was one of those rare men who matched a keen intelligence with kindness – eyes that reflected inwards as well as looking out – and he also had the endearing quality of speaking aloud his thoughts. He questioned me about my breast cancer in relation to my mother. I guessed where this was going, so said:

  I’m not BRCA1 or 2 positive. There’s likely an inherited unspecified cluster that’s made me susceptible to breast cancer.

  Oh, highly intelligent.

  Alas no – just regurgitating what a highly intelligent geneticist with a name like Dr Gattaca said.

  I did well in biology at school because I had a good memory for rote-learning details and finding sequences that linked information together in pictures. After studying I’d close my eyes and read off the image in my mind to answer test questions. This ability would evaporate after chemotherapy and induced menopause.

  My fever remained constant at 38.5, and with no known source of infection the registrar had to get my blood tested. My white cell reading came back as 0.00. When a bacterial infection has no white cell soldiers to attack it, it attacks the organs directly. The registrar placed me on continuous antibiotics straight away, even though the full blood cultures were still not back from pathology.

  I’m treating this as serious; you’ll need to be admitted onto the oncology ward and likely stay up to five days, he said.

  I searched for my father’s eyes. They were fixed on mine. We couldn’t believe it. The day before I’d attended my son’s birthday party relatively well, and now I was febrile, with no white cells and possibly an unknown bacterial infection attacking my organs.

  After a few hours in the accident and emergency cubicle I was wheeled up to the oncology ward and into a large isolation room because of the swine flu possibility. The oncology ward had rooms that ran off a central, carpeted corridor. There were only four single rooms as the rest had multiple beds of four or two in a room. I later found out the single rooms were for people leaving us.

  I climbed onto my trolley-bed and looked through the open blinds out to a courtyard where a couple of medicos were smoking. A nurse wheeled a machine in to take my blood pressure and pulse. Its rubber wheels squeaked on the linoleum flooring. I looked up from my bed to the TV on its high mount. You had to pay extra to operate it, which I thought fair. The public system is burdened already, without footing patients’ pay-TV habits.

  After the nurse took my observations I grabbed the IV pole delivering my antibiotics and wheeled straight ahead into an industrial en suite with easy spray-down walls. I wanted to see all the corners of my isolation room.

  The nurse assigned to me for that night came in and introduced herself, and handed me a mask. Anyone who enters will be gowned up, she said, pointing to her own yellow smock, mask and blue rubber gloves.

  People’s eyes were all I would see for three days. I was a princess in my keep. Until day four when my cultures returned, proving I did not have swine flu.

  A friend working as an investment banker in Paris sent me an email. Contracting swine flu would’ve been just greedy, he wrote. His and my friendship was cemented trekking in the Rockies together when we were 26. He had befriended my mother first on a self-analysis course he attended after a very painful divorce. Mum had said, He walked into the meeting room and had the same energy as you. I thought you’d make great friends. And we did.

  I need to be travelling with someone like that, he’d apparently said after seeing a climbing photograph of me in the back of a Mountain Designs catalogue.
Our friendship had started in email letters before we met in London for the first time.

  Even though I had a casual boyfriend then, I secretly held out hope that this email friend might be the ‘one’. That didn’t turn out, but this dear, soulful banker taught me what decency in a man looked like. It was a quality I would later find in B.

  After many blood tests the speak-aloud oncologist came in with the results. Your bacterial infection is treatable. These types of infections can be life-threatening for immune-compromised people like you. He was holding the results sheet with both hands.

  Thank you, universe, I thought, and uncrossed my fingers. What did I have then?

  The primary source of infection was bacterial, streptococcus from your stripped throat.

  I put my hand up to my throat and swallowed: my oesophagus was a ribbed walnut.

  The viral infection was a cold – a secondary concern for us really.

  Okay.

  Because I wasn’t infectious I moved into a two-bed medical suite with an elderly man who had some type of severe rash and made strange rubbing sounds at night. In the morning a nurse with a short, straight-cut fringe came into my new room. You’re young for breast cancer, she said after enquiring why I was there.

  I know. I am. I was the youngest on the ward.

  As my white cell count was too low I was classed as ‘neutropenic’. My oncologist, who was in the early stages of pregnancy at the time, arranged for me to receive a G-CSF injection for free. G-CSF or granulocyte-colony stimulating factor is a haematopoietic (to make blood) growth factor. For people who become neutropenic, the Pharmaceutical Benefits Scheme provides a G-CSF injection. This medicine slow-releases over three weeks to stimulate the bone marrow to produce white cells to cope with the onslaught of chemotherapy. In three days my 0.00 neutrophil status was boosted to 23. Result. My white cell soldiers had returned: so too a functioning immune system. This was my first brush with the danger caused by the treatments to cure me and not by the cancer itself.