by Barbara Ebel
Over the weekend, the results of her bone scan showed areas of bone where too much tracer, or radioactive substance, had been absorbed. Annabel took a sip of coffee. Radiology had then placed her flat, to lie motionless, and be high jacked as slow as a snail through the MRI machine.
Annabel thumbed through the results and found the radiologist’s reading of the MRI. Later with the team, she knew they’d all look at the images themselves, but right now the report would arm her with the needed knowledge for rounds. She moved the paper cup into the corner and stared at the words. May Oliver had “two significant lesions in her brain.” To her, this was a game changer. The invasive cells had targeted the rest of her body and the heart of her nervous system. She squeezed her eyes shut. And she thought that she had problems!
She wondered if surgery was an option for May’s brain tumors and thought of her father – one of the best neurosurgeon anywhere. She frowned because she could not really refer someone outside of her teaching hospital or sphere of physicians. But if she could …
She drank down the last bit of coffee and put the paperwork where it belonged. After taking a deep breath, it was time to see May before the team gathered together. As a student, she needed to avoid any specific questions from May regarding the findings of their work-up. Someday when she was a resident that would be part of her job … a skill that must be cultivated and carried out with compassion.
May’s door was closed and, after Annabel knocked, she yelled for her to enter even though she was getting dressed. She hooked a bra up in the front and placed her pajama top on the bottom of the bed. “Hi,” she said, going to the closet and slipping a plaid blouse off a hanger. “I understand you had some time off. I bet you went out partying.”
“I wish,” Annabel said. “Life sometimes has its own plan; one you can’t foresee; one there is nothing you can do to change.”
“I have my own thoughts about the topic,” May said. “Social workers and psychologists are always advising people to plan ahead and sculpt their own destiny. That is only possible in limited circumstances.”
Annabel ran her fingers through her hair. “So true,” she said.
“Dr. Schott and Dr. Burg told me over the weekend that the bone scan was suspicious, so they sent me for an MRI. I can’t figure out which was less fun – having the MRI or watching my boyfriend Jeff’s reaction. I told him I was having a nuclear medicine test and they were going to inject a radioactive substance into my vein. He wobbled on his feet; I thought he’d pass out. These tests sound horrendously scary, like I’m being tested for cancer from my toes to the top of my head. I don’t think he wants any part of it, so he’s coming to see me less and less.”
“Hospitals scare off a lot of people. He’ll come around, May.”
“I don’t know. As it is, I weep over my dog every night I’m imprisoned here.”
“I understand. My family and I lost our beloved family dog two days ago. I don’t think I’ll ever get over it.”
May finished buttoning her blouse and sat on the edge of the bed. “I’m so sorry. That was God’s plan for your weekend. I didn’t know.” She took Annabel’s hand and squeezed.
Annabel forced a small smile. “Thank you. And yet we face each new day despite what happened the day before.”
“I have more time available to grieve than you do,” she said, letting go of Annabel. “You make sure you shed those tears when you’re able to or they’ll build up like water behind a damn.”
Annabel nodded, yet wondered. Her patient might not have the time she thought she had to grieve. Not since her lung cancer was moving around her body like sand in a dust storm.
“I better start moving for morning rounds,” Annabel said, checking the time. “Are you having any new symptoms this morning?”
May shook her head and Annabel listened to her heart and lungs before leaving.
-----
Annabel grabbed a spot on the couch next to Jordan, whose fingers bounced around his iPhone keyboard in haste. He texted more by 9 in the morning than she did all day. Bob came in and sat on the desk next to her.
“You doing all right this morning?” Bob asked.
“I’m hanging in there. Thanks again for this weekend.”
Jordan paused his fingers and tilted his head at both of them. Stuart put his index cards on his lap and glanced over.
“What?” Bob asked. “I drove Annabel to Nashville because she needed to go home at short notice.”
“Unfortunately,” Annabel said, “I took Bob away from studying. I hope his grade doesn’t suffer because of me.”
“Nah,” Bob said. “Maybe Stuart can give us both a crash study session before our midterm test.”
“If you want me to,” Stuart said, “I will.”
“A study evening could help all of us,” Annabel said as Dr. Schott and Dr. Mejia peered into the room.
“Come on, let’s round,” Dr. Schott said.
The four of them and the two residents tumbled out the doorway and followed. Annabel dug out chocolate-covered blueberries from her pocket and shared with Bob. They walked in silence with smiles on their faces, but the enthusiasm for rounds lessened when Dr. Schott mentioned that one of Bob’s patients had deteriorated and was transferred to the ICU.
Clenching her index cards, Annabel presented May Oliver last. “Mrs. Oliver’s vital signs are normal, although I noticed that since she’s been here, she dropped another pound. Her hemoptysis had an acute flare-up last night which worried staff and the doc on-call made several visits to her bedside. She stabilized overnight and this morning, she had no complaints. All of the results from the work up we ordered are in. The bone scan indicates cancer and the MRI shows lesions in her brain.”
“You can stop there,” Dr. Mejia said. “I’ll clear up the semantics of metastatic disease to the students right now because sometimes this point is overlooked. Cancer may form a tumor in a new location in a patient’s body, but it is still named after the part of the body where it started. In Mrs. Oliver’s case, any lung cancer that spread to her brain or bones is called metastatic lung cancer … not brain or bone cancer.” He placed his hands on his tie and made sure it was dead center on his shirt and continued.
“Also, another term you may hear is ‘recurrent lung cancer.’ That is not a metastatic disease. If Mrs. Oliver’s cancer in her lung is removed and there are no more signs of it there, but later it reappears, that is recurrent lung cancer.”
“This terminology,” Dr. Schott said, “is important. Doctors need to be on the same wavelength. We must understand when one of us is talking about a container of blueberries and not a container of chocolate-covered blueberries.”
“Annabel will share,” Bob countered immediately with a smile.
Donn put his hand out and Annabel quickly dropped two into his hand.
“Let’s hear from Dr. Burg,” Dr. Mejia said, now straightening the top of his tie. “What are our principles of treatment for lung cancer and what are the options for the metastases?”
Melody shifted her weight from one high-heel shoe to the other. Dr. Mejia and Melody took pride in their fashion statements, Annabel thought, but it was far easier for Dr. Mejia as a specialized cardiologist with a bulging salary.
“There are several options for the primary lung cancer,” she said. “Surgical resection, chemotherapy, and/or radiation therapy. They can be used in different combinations depending on several factors, but the intent must be clear – whether we’re trying to cure the tumor or be palliative. And, along with what Dr. Mejia just said, we would treat the metastatic cancers based on the treatment we use on the original cancer. That makes sense because the cancer cells have not changed but simply are living in a new place.”
“Perfect,” Dr. Mejia said.
“New medical advancements may be used in her case,” Dr. Schott said, “but the results are much more variable. Targeted therapy against mutations.”
“Mutations?” Annabel asked.
“Due to the glory of modern medicine, because of laboratory scientists serving their eight-hour days with flasks and pipettes, some mutations are known to be prevalent in adenocarcinoma subtypes.”
Annabel nodded.
“Time to explain the diagnosis and treatment to Mrs. Oliver,” Dr. Mejia said. He carefully scrolled their faces. “I try, and am not always successful, to not overwhelm a patient with data. They have enough to process with the diagnosis itself.”
-----
“I figured you were going to tell me that,” May said after Dr. Mejia broke the lung cancer news to her. “I kept telling myself it wasn’t going to be me. Each person always thinks that something bad is going to happen to the other guy, not them.”
“It’s sad that we have to sometimes be the ‘other guy,’” Dr. Mejia said.
May fidgeted with her hands and didn’t look up.
“It appears that some of the cancer cells have already travelled to other areas of your body,” Dr. Mejia added. “Let’s consider your options right now for treating your lung, such as surgery, chemotherapy, or radiation, as well as more lab work to identify mutations in those cells. I would suggest surgery first. Then we can discuss where to go from there. Whatever treatment we use can then be used for two areas in your brain and your bones … other places your cancer has seeded to.”
“Oh my god, you’re kidding. My brain? No way am I going to see my boyfriend again when he hears that.”
Everyone stayed silent. Annabel worried she was correct and May was going to need a support system.
May stared wide-eyed at Annabel. “What would you do?”
“It’s difficult to say,” Annabel answered, “but perhaps I would feel better knowing the primary tumor was rooted out. So I would have surgery and then discuss how to treat the other areas with my doctors.”
May nodded slowly and leaned forward in the chair. “I think so too.”
“Lung surgery is complicated,” Dr. Schott said. “I always want my patients to know that. But if you agree, we will send a thoracic surgeon to come talk to you.”
“It couldn’t hurt,” May said.
“We’ll set up the consult,” Dr. Schott said. “In the meantime, you have much to digest and questions to think about.”
The team walked away and Annabel lingered. “I’m sorry we had bad news,” she said.
“I know you are. These are dark days. I’ll say a prayer for your dog and can you say a prayer for me?”
“Consider it done,” Annabel said and left with a big sigh and a heavy heart.
-----
Gloria folded laundry on the kitchen counter and separated her mother’s day clothes from her night wear and stacked towels and wash cloths one on top of the other. From a second load, she shook out Darlene’s mattress pad, which had needed washing and fitted it on the bed, making sure the rubbery area to collect body fluids was squarely in the middle. She then untangled the sheets and snagged the elastic corners of the bottom sheet around the edges of the mattress. By the time she made up the top sheet and pillow case, the lavender fragrance from the fabric softener made the area smell a lot better than before the wash loads.
Darlene was propped into her chair with the TV in front of her, which aimlessly streamed cartoons. SpongeBob ran across the screen, his skinny legs in hot pursuit of a starfish, and laughing with his mouth fully open. With mouth agape as much as the yellow character, the elderly woman stared with an empty expression and a busy tremor in her hand.
“I hope you don’t mind, Mama,” Gloria said, stepping away from the bed, “I’m going to stop buying those heavy-duty nutritional drinks. From now on, it’ll be a tasty, sweetened shake for lunch. Enough calories for a meal too, so don’t worry about that.” She rolled her eyes why she bothered talking to her, but she knew it was the right thing to do. Her principles were steadfast.
She placed the towel pile into the linen closet and came back to the kitchen. From the refrigerator, she took out a twelve-ounce vanilla shake bottle and unscrewed the cap. She poured a third of it into a cup and gulped it down. Not bad, she thought. Before continuing, she practiced her germophobic habit and spilled hand sanitizer on her hand. She rubbed it in, leaned forward below the sink, and took out a container. After opening it, she used some of the liquid to top off the rest of the contents of the shake that she had sampled.
In front of Darlene, Gloria positioned the rolling table, secured a bib around the woman’s neck, and patted it down on the front of her shirt. “Here you go,” she said, putting the shake she’d formulated to her mother’s lips. Every time she tried to give her mother a drink, she wondered if it would be in vain. Darlene could clamp down her mouth as efficiently as a snapping turtle and not open back up.
Gloria managed to get a few droplets past Darlene’s lips and the woman darted her tongue as if figuring out the new flavor. Gloria tilted the bottle gently and her mother let the liquid slip in, slowly and over ten minutes, which seemed like ten hours.
“Hallelujah,” Gloria said. “As sweet as the apple pie you used to bake, isn’t it, Mama?”
At the end of the woman’s liquid lunch, Gloria shoved down a quick sandwich for herself, the first thing she’d eaten all day. She began the preparation to tuck Darlene into bed for an afternoon nap.
“This time tomorrow will be my first day of work at your old hospital, Mama,” Gloria said. “You’d be proud. Not to worry, though; someone will be here looking after you like always.”
Darlene decided her mother’s diaper could last longer and she supported the woman into bed. When she was finished, she redid her hands and turned off the TV. Her next task involved cooking homemade soup for dinner.
CHAPTER 17
While everyone emptied out of the office at the end of the day, Annabel’s phone dinged with a text message. She hung her jacket back up and leaned against the desk.
Hi, sweetheart. Just checking on you. Are you doing okay?
Carrying on, Dad, she texted back, because there’s no other way. Sad weekend. It amazed her that she heard from him now; most likely, he was still at the office or in the hospital. She typed again. ‘You all must feel Dakota’s loss there more than me. I’m thinking about that. Love and hugs.’
I’ll pass on your hugs. And say hi to your friend, Bob.
I will. Thanks, Dad.
She stayed where she was; a rare silence filled the room as patients in their rooms ate dinner and nurses did chart work. She wished she had made more trips home since starting medical school and spent more time with Dakota but, instead, the last two and a half years, she was too far away and too engrossed to make the journeys. It would be different if the relationships weren’t close, but she was blessed with every one of her family members. With serious reflection, a pensive mood came over her.
Another consideration she needed to tackle, she realized, was Robby Burk. Why wait to contact him since she had broken their weekend plan?
She decided to take the chance and text him.
Robby, sorry again about the other night. How about I take you out?
She smiled at her message and pressed ‘send.’ At least it would start a discussion going about when and where they could see each other. She checked her watch, not expecting a quick response, but a reply came back.
Gracious thought. I’m going home soon. What’s your plan tonight…let’s give it a shot. No formality!
She skipped a breath, and texted him back.
I’m leaving the hospital now. That would work.
I live over the bridge. Never mind….I’ll call.
Her cell rang in a moment. “Hi,” she said.
“Hello as well. How about we meet now? A simple bite to eat. Somewhere near your hospital or before the Ohio? I believe you said you live south of the hospital, too.”
“I do. I’m on this side of the bridge. How about a dependable, relaxed place with fine coffee and a sandwich and salad menu in my neighborhood?”
“That may be too casual but, under t
he circumstances, we’ll make it easier for you. And it will be my treat.”
Annabel clutched her cell with a firm grip. Finally, she thought, and gave him the name of the place and directions.
“I’m leaving in five minutes,” he said. “See you there.”
“I’m headed out, too.”
-----
Annabel drove off the interstate exit and veered east towards her neighborhood. This was it. This was finally the time and the place. No mix up over what restaurant to show up at and no family crises. She breathed deeply with a see-saw of emotions. On one end, the anticipation dissipated over wondering when they would meet again but, on the other hand, her adrenaline kicked into gear and her heart raced. Soon she would be sitting across from those gorgeous eyes.
Her nervousness only ramped up as she circled the street looking for a spot anywhere between her apartment and the corner café. Had she known about their meeting, she would be dressed much more stylishly. Her white coat was thrown on the passenger seat; underneath her jacket, she wore nondescript brown pants; at least they were form-fitting, more attractive for her figure. On top, she wore a tan turtleneck sweater; not exactly first date material.
Darn, she thought, she couldn’t make her debut more boring than this. She had been in such a hurry in the morning, she had not even slipped on a pair of earrings. She eyed a vehicle pulling out of a parking space.
“Come on,” she mumbled. The car jockeyed back and forth several times and then squeaked out with little room to spare. She glanced at her watch. He must be here by now, she thought. It was taking her forever to show up. She rolled her eyes at the cautious driver and parallel parked with little adjustment. Her heart beat like a metronome on speed as she removed her keys and grabbed her pocketbook from the passenger floor. She slipped out her change purse and let go of the big bag. After wiggling the change purse into her pocket, she opened the door to face the cold air and wondered what he would look like after not seeing him for several months. She took a few steps away from the car and realized she needed to beep the door locked, but she heard the automatic sound of the door locking.