PERFECTLY UNPREDICTABLE
Perfectly Series Book 4
LINDA O’CONNOR
Table of Contents
PERFECTLY UNPREDICTABLE
Acknowledgements
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7
Chapter 8
Chapter 9
Chapter 10
Chapter 11
Chapter 12
Chapter 13
Chapter 14
Chapter 15
Chapter 16
Chapter 17
Chapter 18
Chapter 19
Chapter 20
Chapter 21
Chapter 22
Chapter 23
Chapter 24
Chapter 25
Chapter 26
Chapter 27
About the Author
The Perfectly Series
PERFECTLY UNPREDICTABLE
Copyright©2016
LINDA O’CONNOR
This book is a work of fiction. The names, characters, places, and incidents are the products of the author’s imagination or are used fictitiously. Any resemblance to actual events, business establishments, locales, or persons, living or dead, is entirely coincidental.
All rights reserved. Thank you for buying an authorized edition of this book and for complying with copyright laws by not reproducing, distributing, or transmitting it in any form or by any means without the prior written permission of the publisher. The only exception is brief quotations in printed reviews.
Cover Design by Rae Monet, Inc.
Published in Canada by Interlock Publishing
[email protected]
Library and Archives Canada Cataloguing in Publication
O’Connor, Linda (Linda A.), author
Perfectly unpredictable / Linda O’Connor.
(Perfectly series ; book 4)
Issued in print and electronic formats.
ISBN 978-0-9949173-3-1 (paperback).—ISBN 978-0-9949173-2-4 (pdf)
I. Title. II. Series: O’Connor, Linda (Linda A.). Perfectly series
; bk 4.
PS8629.C652P48 2016 C813’.6 C2016-904028-3
C2016-904029-1
With love to Mom,
and to Dad, my guardian angel
Other Books in the Perfectly Series:
Perfectly Honest
Perfectly Reasonable
Perfectly Planned
Acknowledgements
Wow – book 4! This has been a thrilling journey, and I couldn’t have done it without the support of my family and friends.
Special thanks to Jenny Govier, editor extraordinaire, and to Rae Monet and Karen Duvall for the beautiful cover design.
Thank you from my heart to:
Brad, Tom, and Mark, who laugh with me;
my Mom, for all of her wise advice;
Karen Marcotte, artist of beautiful cards and my most avid supporter;
Susan Pettit, Lesley Rooke, and Anne Richards, for their positive voice and unwavering support;
and to everyone who read the Perfectly Series books and are perfectly supportive!
Here you have it – Perfectly Unpredictable – who’d have thought?
Chapter 1
Kalia Beck sat at her computer with a cup of coffee, enjoying the wave of alertness that accompanied the first few sips. Still in her pajamas, loose pale blue cotton pants and a matching teddy, with her long, wavy brown hair carelessly pulled up in a twist, she tucked a leg up under her and opened her emails.
She scanned the dozen or so new ones and deleted three that looked like junk. The one from her mother contained happy news about Blaine, Kalia’s brother, and another thank you for the ereader Kalia had given her for Christmas. Her mom had figured out how to put newspapers from around the world on it and happily read the Parisienne news, even when settled in their country home, nearby, in Emerson, Ontario.
She fired off an email to her mom in perfect French. Kalia came upon her love of languages honestly. Her mom, fluent in French and English, had spoken both interchangeably to her and Blaine from the time they were little. Her dad had grown up in Germany and added German, English, and a smattering of Russian into the mix. With her dad’s position at the German embassy in Canada, they were often host to international guests and had lively dinner discussions in a mix of accents and dialects.
By the time Kalia graduated high school, she could easily converse in English, French, and German and knew a smattering of Spanish and Russian. After studying languages at university, she added fluency in all five languages and picked up Mandarin along the way. Now, she was as busy as she wanted to be working as a freelance translator and interpreter. The freedom, the traveling, the variety of jobs – she loved it all. And to the delight of her parents, she regularly sharpened her skills with them.
The next few emails were responses to enquiries she had made about potential or completed projects. It was the sixth email that sparked her interest. She paused and reread it carefully.
Dear Ms. Beck,
We are very excited to be hosting the International Forum of Neuroscience this fall from October 15-24 in Nice, France.
This conference is held every three years for scientists and medical doctors to share the very latest in research and developments in the field of neuroscience. We anticipate over 800 registrants from all over the world. The main lectures will be presented in multiple languages, but we are hoping to offer their translation to English.
Your work as an interpreter comes highly recommended by members of our planning committee who have worked with you in Canada, and we are wondering if you would be available to do this.
If you are interested, please respond by February 22nd and we will provide you with further details. We look forward to hearing from you.
Sincerely,
Maurice Bastille
Planning Committee, International Forum of Neuroscience
Now that sounded intriguing. Challenging, no doubt. How much would her work at the hospital help with a neurosciences conference? She usually interpreted for patients in the emergency department. Not much neuroscience there. But the work she’d done at the art exhibit last year had been neuroscience-ish. “Mental Health Revealed” had stretched her medical translation skills, but the international judges had seemed pretty happy with what she’d done.
She sat up straighter. Working with all those languages had been a lot of fun. It was so different from the work available to her in a city of a hundred thousand here in Rivermede. And it involved traveling. How could she turn that down?
She scanned the letter again. She came “highly recommended.” Wasn’t that sweet? She owed someone a big hug. And Nice in the fall sounded heavenly, especially compared to the freezing temperatures and snow piling up outside of her condominium this time of year. She flipped to her calendar to see if she had any commitments in October. All clear.
She was definitely interested.
Dear M. Bastille,
Thank you very much for your email. I am very interested in this type of work, and I would love to discuss it further.
I am available to speak on the phone or through a video conference, whichever is most convenient for you.
Thanks again.
Kalia Beck
It would be late afternoon in France, and she wasn’t likely to hear back until tomorrow. A thrill ran through her. Can’t wait.
In the meantime, she needed to start her day and get to work on the manuscript she was translating. It was a fairly big project, and she had set aside three weeks to finish it. So far, it was on track. And sinc
e the full effect of the caffeine was kicking in, it was time to get to work.
Chapter 2
Dr. Alexandre Sinclair lay back in the hospital bed in Paris and stared at the ceiling. It had been only two days, but he was ready to write the discharge orders himself. He had a new appreciation for how patients felt. It sucked. It was much easier to be on the other end of things. A few more tests, they kept telling him. One more thing. What were they looking for? What had they found?
These were his colleagues. He’d sat at teaching rounds with them, shared cases, gone golfing, and had dinner with them. They had an easy camaraderie. Usually.
But mon Dieu.
Now he couldn’t get them to sit and talk with him for five minutes. What was it that they were so afraid of telling him? His gut clenched. It didn’t look good when the doctors started avoiding the patient. When they looked away and evaded the conversation he needed to have.
Frustration didn’t even begin to explain how he was feeling.
Disappointment. Sadness. Isolation.
Fear.
He sighed. Now fear. It was sneaking its way in. Like a snake slithering into his gut, his heart, his mind, his soul. He had managed to push that away. Focus on the positive. There was always hope, he had told himself, just as he had told his own patients countless times. But with each grim-faced visitor, each one deflecting his questions, hope became harder to hold onto.
He studied the hospital bracelet on his wrist. It had been surreal when they’d slapped it on and was worse now. Alexandre Sinclair. 76852-00. Just a name and a number. It didn’t really tell the whole story.
He had been born in France to French parents, both of whom were doctors. He was an only child but was never lonely. His parents loved to entertain and socialize and had made him and the family unit a priority. There were two other families with kids about the same age who were close friends and shared in Saturday dinners, Sunday brunches, trips to the beach, and holidays abroad. Weekdays were quiet family affairs, but weekends were always lively and entertaining. He had gone to local schools until university, where he’d studied science with a major in neuroscience. He had enjoyed the basic science and research but found that research grants favored those with a medical degree. That became a goal, so he’d continued and specialized in neurology. He’d settled in Paris at the prestigious Neuroscientific Research Institute and was able to balance clinical work with his research in addiction. He was only thirty years old and already a world-renowned expert. Or so his bio read from his most recent speaking engagement.
He supposed it was his enthusiasm for his topic. He liked to make his presentations entertaining and used humor as an icebreaker. His next engagement, two weeks away, was the keynote address at the International Forum of Neuroscience in Nice. He was looking forward to the ten-day conference. It would bring together brilliant scientific and medical minds from all over the world and focus on current trends and research. The cutting-edge stuff. He was looking forward to the seminars and presentations and the collegiality of the forum because he enjoyed talking with his colleagues. Normally.
A young internal medicine resident came into the room with a syringe and a tourniquet. She had purple-streaked hair pulled back in two ponytails, a bright pink shirt tucked into baggy red capris, and high-top sneakers with laces in two different colors.
“Good afternoon, Dr. Sinclair.” She greeted him with a smile.
Alexandre sighed. Yet another blood test? He ran a hand through his hair, brushing it off his forehead. “Bonjour.”
“I’m Clarice Van den Engel. I’m one of the Internal Medicine residents under Dr. José.”
Alexandre smirked. So now they were sending in junior residents.
Clarice gestured at the syringe in her hand. “We’d like to repeat your blood test, if that’s okay with you.”
“Why?”
“Your uric acid levels were a bit high on the last test, and we wanted to check them again.”
Alexandre frowned. “Why?”
“Ah … what do you understand about your illness?” Clarice asked slowly.
“I have no understanding. I haven’t been told anything.” He tried to dampen the bitter tone.
“Nothing?” she repeated with her eyebrows raised.
Alexandre shook his head. “Nothing.”
“Would you like me to go over the test results with you?” she offered.
“I would. More than I can tell you.”
“Un moment. Let me grab your chart.”
A few minutes later, Clarice returned with the chart in her hands and sat down in a chair next to the bed. “I’ll explain this as best as I can. If you don’t understand something, please ask. If I can’t answer it, I’ll speak to Dr. José and get back to you.”
“Merci. I appreciate it.”
Clarice scanned the note. “You presented to your doctor with an enlarged lymph node in your neck. Blood work and a biopsy were done shortly after and then you were admitted to hospital for more tests. Is this correct?”
He nodded curtly. “Yes.”
“Did your doctor discuss the possible diagnoses?”
“No. No, he didn’t. I’d had a cold and sore throat when this started, so I assumed the lymphadenopathy was due to that. But the enlarged lymph node persisted, and because I was concerned about some weight loss, I went to see my doctor,” he explained.
Clarice nodded. “Your hemoglobin, white cell, and platelet counts were all low. Not dangerously low, but still lower than usual. Your liver and kidney function tests were normal. And you had a bone marrow aspirate and biopsy?” She flipped to another page.
Alexandre nodded.
“Ah, oui. This showed that the bone marrow was involved, and although they saw large cells in the lymph node biopsy, there were small cleaved cells in the bone marrow.” She paused.
“What does that mean?” Alexandre asked, trying to curb his frustration.
Clarice looked him in the eye. “The diagnosis is lymphoma. A diffuse large B-cell lymphoma. I’m sorry, Dr. Sinclair,” she added in a gentle voice.
“Lymphoma?” he repeated slowly. “That’s what they were afraid to tell me. Are they sure?”
She nodded silently and checked the chart again. “Yes, the differential diagnosis before the biopsy included a lymphoma or a leukemia of some type, and the bone marrow biopsy confirmed a diffuse large B-cell lymphoma.”
“Can you tell me anything about it? What’s the prognosis? Treatment?” he asked, trying to recall what he’d learned about lymphoma in school.
“Well, the prognosis for all types of lymphomas is improving all the time. Newer chemotherapy drugs have really made a difference. Your age and the fact that you’re up and about and continuing to work make the prognosis better. You had a blood test for lactate dehydrogenase, which is an indicator for tumor lysis. Your level was high and that, along with the enlarged lymph nodes in your neck and groin, and the bone marrow involvement, indicates a more aggressive or faster growing tumor.”
Not what he wanted to hear.
Clarice looked at him hesitantly. “More sites involved can be trickier to treat. But it doesn’t really change the treatment.”
“So the survival rate is …?”
“The five-year survival rate is about thirty to forty percent,” Clarice said softly.
Alexandre jerked back. “Thirty to forty percent?”
“Oui.” Clarice nodded and then glanced at the notes. “Dr. José ordered a CT scan of your chest, abdomen, and pelvis and that should be done tomorrow. Once we see the extent of the tumor, we’ll be able to give you more information. The treatment is chemotherapy. The oncologists will have the final say on that, but it’s usually done as an outpatient.”
“Can I continue to work? There’s a conference in two weeks …”
“Yes, you can carry on with normal daily activities. You may find you tire more easily, especially if you try to do too much, but it’s not harmful. It’s not infectious, and your white bloo
d count is still low-normal, so there’s no need to be overly concerned about contact with others. Just be diligent about hand washing.
“One other thing for you to consider is whether you’d want to have your sperm banked. Once the oncologists decide on the chemotherapy, if there’s a risk to your testes, they may discuss that with you. Especially given the fact that you’re young.”
Alexandre barely listened. Cancer. Chemo. Sterility. Pressure built in his chest. He had a sudden aching need to be alone. “Thank you for–” he swallowed “–sitting down and explaining this. The uncertainty and silence …” He paused and looked off in the distance before looking back. “I needed to hear this, and I know it wasn’t easy because the house staff who are my colleagues and friends haven’t been able to tell me. So thank you.” He looked at her through watery eyes.
She rested a hand briefly on his arm. “No thanks is necessary. I’m sure you’ll have more questions once you’ve had a chance to think about this. Is there anyone you’d like me to speak to or call for you?”
His parents. He’d have to tell them, but he’d wait. Maybe there’d be good news after the CT scan. “No, but thank you for offering.”
Clarice nodded. “Your uric acid level was high yesterday, and it’s something that needs attention before we start chemotherapy. So we just wanted to re-check it today …”
“Yes, of course.”
Alexandre sat quietly as she drew the blood and then left the room.
Lymphoma. B-cell. What did she say? Diffuse, that can’t be good. Lymphoma. At age thirty.
Didn’t seem fair. He exercised, ate well, never smoked, watched his weight, hell, he even flossed every day. And all that time and energy spent on school and medicine and specialty training. He closed his eyes as emotion washed over him.
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