Night Reflections

by Robert Thomas Winn

  The ER doctor took one look at Nancy, drew some blood, and immediately called a hematologist in to consult. Nancy’s blood count was completely out of whack. Her white blood cell count, at 89,000, was more than ten times the normal count because immature cancer cells or “blasts” had been released “early” into her peripheral blood stream from her bone marrow. The white blood-making cells in the bone marrow where the cancer resides have squeezed out the parent cells that normally make platelets. Since platelets are integral in preventing bleeding, her lack of the platelets explains her nosebleeds and bruises. The same cancerous white cells in the bone marrow also impinge on her ability to produce red cells, leading to her anemia. Additionally, Nancy “presented,” or arrived, with a high fever, raising the specter of a systemic infection.

  Much to my astonishment and the surprise of the doctors, Nancy had absolutely no symptoms until the three days when she was on her overnight trip. Though I was shocked at how sick she appeared when I first saw her, I was completely taken aback when her hematologist, Dr. Morton, told me not only that he suspected that blood cancer leukemia was Nancy’s diagnosis but also that her disease was at an advanced stage.

  “How could she get so sick so quickly?”

  “It happens,” he replied simply.

  Dr. Morton has indicated that we were extremely lucky to get her to the hospital before she developed a significant bleeding problem or contracted a serious infection in her brain or another vital organ. With her blood count so far off and her immunity so compromised, either of these events could have caused Nancy’s immediate demise. But so far, so good. After exhaustive testing, Nancy has no signs of major bleeding and no evidence of serious infection.

  In contrast to the good news about life-threatening infections and bleeding, Dr. Morton has expressed pessimism going forward. He has told me her very high blood count numbers and the rapidity of the illness reveal an aggressive disease. He says that fighting blood cancer is much more of a challenge for someone at fifty-seven, like Nancy, than it would be for someone who was twenty-seven. When he presented his summary to me, I nearly collapsed to the floor. He isn’t certain he can get ahead of her disease. He isn’t sure Nancy will survive a full week.

  I don’t know if it is possible for me to describe how his prognosis makes me feel. However, your many kind replies have buoyed my spirits more than I can yet express.

  Summary: When Nancy arrived at the hospital three days ago, the doctor thought her death was imminent.

  So much love,

  Winnie

  The Exorcising of Demons

  June 1, 11:52 p.m.

  Dear Family and Friends,

  As the night advances, I’ve been reflecting on last evening. As you might imagine, it was a bad night. A really, really bad night. Demons have been everywhere in my head. I have desperately searched the Internet for answers to my many questions. “I’m a doctor after all,” I tell myself. “Surely I can make sense of this situation. Surely I can find something to help Nancy out of this mess.”

  In reality, I don’t want answers. I suspect anything I find will be unfavorable. Reading between my tears, I don’t find anything to change my mood. Every article I discover confirms Dr. Morton’s assessment of how progressive the illness is and what that potentially means.

  Still I vow not give up hope. Or, at the very least, I will support Nancy during each step of whatever her journey will come to be. Earlier, after a normally inconsequential bump into the hospital bed gave her a nasty new bruise, I convinced Nancy to allow me to assist on bathroom trips. With IVs constantly running, those trips are frequent.

  “I don’t want to awaken you if you are sleeping,” she initially told me. I pointed to the fresh bruise on her left thigh and gave her a look I hadn’t used since the kids were teens. “All right,” she replied to my unstated words and added, “You always seem to be awake anyway.” Nancy now allows me to rub her sore back and fetch her chocolate ice cream. By the end of last night, she understood. “You’re not going anywhere, are you?” “No, I’m not,” I replied as tears yet once again filled my eyes.

  Our new temporary home has one small window, approximately two feet square. From Nancy’s bed and the chair where I sit and sleep, the east-facing view provides a mostly unobstructed look at the Wasatch Mountains. The entire evening last night, I looked forward to seeing the snow-covered horizon if only to be comforted by knowing that our real home is somewhere amid the foothills. When the dark of night transitioned to the light of dawn, slate-gray clouds initially obscured the distant peaks. It was just another disappointment to add to a growing list.

  However, right before the doctors arrived on their morning rounds today, the clouds disappeared. Our window was filled with mountaintops jutting into a sky bright with sunshine. When the doctors arrived, they brought even brighter news.

  Nancy’s diagnosis has been confirmed. She is fighting acute myeloid leukemia, or AML for short. This particular leukemia has six subgroups, and Dr. Morton explained that Nancy has the rare one called M3. Of the six, M3 has the best prognosis. Statistically, M3 AML has an approximately 70% cure rate. Several of the other subgroups have cure rates of less than 2%, which is what I had read about before I forced myself to another task. And as I held my breath, Dr. Morton grabbed my hand and looked me straight in the eyes: “Winnie, this changes everything. We should be able to get Nancy into remission even though her blood count is so seriously altered.” We shook hands vigorously.

  So in less than forty-eight hours, Nancy has a solid diagnosis. And after a single five-minute conversation, my spirits jumped to above the mountains outside our tiny window. Even the sterile and stale hospital room air suddenly smelled fresher. The light in the room seemed brighter. I took a bite of Nancy’s unfinished hospital “everything” bagel, and it actually tasted like a gourmet bagel that exploded my taste buds with a multitude of flavors.

  I savored the moment and let Dr. Morton’s words pervade and wash over my being.

  Nancy should make it through this week!

  It is miraculous how quickly our fate has changed.

  When Nancy was first admitted, it was Memorial Day weekend. Initially, I worried nothing would happen until Tuesday and that I might have to take a nurse hostage to get a hematologist to come see her. I even fantasized picketing the hospital cafeteria to get her initial blood tests done.

  But now, instead of being frustrated and angry, I am celebrating this holiday weekend. As I write, our medical team not only has secured the diagnosis but is now hanging the IV fluid containing Nancy’s first chemotherapy treatment.

  Our journey has begun.

  We are now ready to tackle the day-to-day tasks. We have to think about nutrition, exercise, and the routine tests that Nancy will have pretty much every day. She does not need the painful procedure called a bone marrow extraction, since her AML diagnosis was so obvious. We are happy with that news since it means one less needle. Nancy faces many, many prods and sticks in the coming days and weeks. Presently, she has three separate IVs going into her body. When the chemotherapy side effects kick in, she may not be able to eat, which might mean more procedures and tubes. Still, Nancy’s smile is fully back. And mine is slowly beginning to emerge again.

  OK. You are current on Nancy’s status. If my explanation doesn’t make sense, it might be because I am on the last of my adrenaline having been up continuously over the last several days. Even toothpicks can’t keep my eyes open, and I am probably rambling with nonsense.

  Feel free to send questions so I can address them.

  We’re in this for the long haul, and both of us really appreciate your support. I have no doubt that if anyone can beat this thing, it is my Nancy.

  P.S. Nancy is not allowed to receive flowers due to the fragility of her immune system and the resulting worry about infection. Originally, my plan was to fill her room with the largest array of colors and varieties in Utah. I was going to set aside time for a mountain bike ride in quest of bu
ckets of spring wild flowers, which I planned to supplement with the best blossoms and plants the local florist had on hand. I also assumed Nancy might receive a few flowers from some of you. But, unfortunately, no flowers for now.

  However, if you’d like to send a card, Nancy’s address for at least the next several weeks is: LDS Hospital, Room 842 East, 8th and C Street, Salt Lake City, Utah 84143.

  Summary: Nancy is a different person than I wrote about yesterday. Her spirits are high. She is feeling stronger and ready to fight the good fight. Most importantly, her prognosis has changed. She still has a serious, life-threatening illness. But now there is hope.

  Love to you all,

  Winnie

  A Sack Full of Stones

  June 2, 8:24 p.m.

  Dear Family and Friends,

  I am overwhelmed with the outpouring of love that you’ve sent Nancy and our family. I don’t know if I could have survived these past few days without such unconditional support. Many of you have asked about our two children, Jaret and Jayna. Where are they? How are they coping? I will save Jaret for a future note, but tonight is a suitable occasion to address Jayna.

  Two weeks ago today, Jayna called from Cusco, Peru, where she has just completed her Junior Year Abroad coursework toward a Latin American Studies degree from Vassar College. Her voice was full of excitement.

  “I’m finished, Dadder. I learned so much.”

  I can forever visualize my daughter’s always expressive face. Twinkling blue eyes above a warm, tooth-filled, disarming smile. A childlike excitement in the way her eyebrows lift as she speaks. A flip of her head to position her darkish-blonde bangs back across her forehead. She’s inherited so much from Nancy.

  “What would you think of me staying awhile? I kind of met a guy I like . . .”

  I hoped Jayna couldn’t hear what to me was a very loud swallow. I wanted to scream, “No way, Jayna! You are my little girl, and I don’t want you to be with any guy. South America is too far away from Utah. We were only able to visit you once last year, and it nearly killed your mother and me.”

  Though those thoughts rattled in my head while I weighed an answer, I couldn’t ignore the fact that Jayna is, put simply, a fine young woman. She was valedictorian in high school. She is idealistic and wants to save the world. She is genuinely kind, warm, and loving.

  To be fair, at times she was a challenge as a kid, but she was mischievous rather than troublesome. And yes, she loves to argue with me and point out when I am wrong or inconsistent—or both. But Jayna is so vibrant and full of life that she can melt me on the spot with a grab of my hand, a kiss on my cheek, or the “look” that reinforces what she often verbalizes.

  “I do remember what you’ve taught me, Dadder. Friends and family are the most important things in life. And yes, Dadder. You are family.”

  “Well, I guess staying a little longer would be OK,” I responded trying to mask my reluctance. “Do you need anything?”

  “No, Dadder, I’ve already got a job. I’ll be home in a month.”

  Did I mention that Jayna is independent and adventuresome?

  “I do miss you both a lot. Thank goodness for mobile phones and the Internet.”

  It was therefore with a considerable weight on my shoulder that felt like a full sack of stones that I finally picked up the phone this morning to inform Jayna about her mother’s illness.

  Nancy, of course, urged me not to call.

  “I really don’t want to ruin Jayna’s special time in a faraway country. She is too young to have to deal with something like this.”

  Jayna and Nancy are as close as any mother and daughter. And I knew that Jayna would want to hear from me as strongly as Nancy didn’t want her to hear at all.

  Over the years, due to caring for visiting tourists as part of my day job, I’ve gained experience in making difficult calls to faraway family members. But experience doesn’t help when calling your own faraway daughter. As I dialed the long international number, I had to concentrate on not spilling over with emotion.

  “Jayna, it’s Dad.”

  “Dadder, is something wrong?”

  So much for my charade. Nancy often teases me about being transparent.

  After trying to disguise my audible deep breath by momentarily putting my hand over the phone, I answered, “Yes, Jayna, there is . . . Mom is sick.”

  Now it was Jayna’s voice that sounded distressed. She pleaded, “Sick? How sick, Dad?”

  “Real sick. She has the blood cancer called acute myeloid leukemia.”

  There was an uncomfortable delay not due to the connection. “Cancer? Mom has cancer? Do I need to come home?”

  “Yes.” I had hoped to elaborate but could not find any words.

  Jayna replied softly, “Dadder, I’ll make arrangements. I’ll call you back in a little while with details.”

  “Thanks, Jayna.”

  “Dadder? Tell Mom I love her. And that I’ll be there soon.”

  Jayna called me back within the hour. She had already packed her things, said good-bye to her friends, and made a reservation to be on the next plane to Utah that had space, leaving the next night and arriving (with connections and such) the following day.

  She ended our call with, “We can do this, Dadder. I’m ready.” There had been no second thoughts about coming and no doubts about her role.

  How many twenty-two-year-olds are willing to put their lives on hold instantaneously? (I know at least one.)

  When Jayna called initially, Nancy had been asleep. When she awakened about an hour later, I told her the news. She scrunched her eyebrows toward her nose, thrust her lower lip forward, and waved her index finger at me. The feigned anger morphed into the largest smile I have ever seen on my bride’s face. Shortly thereafter, tears were streaming down Nancy’s cheeks. It was the first time she had cried (unlike me).

  “Tomorrow?” she asked, not needing an answer. I hugged Nancy tightly. Surprisingly, though Nancy has been weakened by her ordeal, her return hug rivaled mine in strength.

  Lastly, tonight before I tucked Nancy between the starchy white hospital sheets and under the lime-green hospital blanket, she looked at me with those big sky-blue eyes of hers, and with a new bounce in her voice, she directed, “Can you add . . .” and gave me three new names to put on my update list.

  I guess I’ll have a lot of catch-up reading to do so that Nancy will know how thoughtful all of you have been.

  We’ve come a long, long way.

  On the other hand, Nancy is still adjusting to hospital life.

  Most of you can probably imagine her telling the nurse or aide that he or she doesn’t need to “make an extra trip” and me interrupting with, “Thank you. If you would bring that cold washcloth for Nancy’s forehead it would be wonderful!”

  I have such an incredible soul mate. Between naps this afternoon, she even helped Jaret with the final paper for his spring semester at Westminster College.

  Summary: Jayna will arrive home from Peru the day after tomorrow to be with her mom and support her dad. None too soon.

  Much love,

  Winnie

  The Hospital Roller Coaster

  June 3, 1:37 p.m.

  Dear Friends and Family,

  How can a single day have such extremes?

  Leukemia—the name on the side of our new personal roller coaster.

  Let me explain.

  This morning, I awakened feeling positive and upbeat. Jayna is set to board a plane this evening. Nancy has been cleared to begin a new drug specific to her AML subtype, M3. Our nurse even brought me my very own breakfast tray from a patient who had gone for surgery, thereby saving a trip to the cafeteria. Bright and cheery, Nancy commanded me to concentrate on my “other” patients. “Go to work,” she declared, pointing to the large, round clock on the wall opposite her bed, “It’s time . . .” I swallowed the last bite of French toast and raced to the parking lot.

  As I drove up the mountain to Park City from Salt Lake
City where I spent the night in my now familiar chair, it almost felt like a normal day. Within a half hour, I had treated one of my favorite patients, seven-year-old Johnny Hernandez, for strep throat and followed that with putting stitches into the arm of one of Jayna’s classmates, Amanda Lester. Unlike when sitting in Nancy’s hospital room, I felt the power of providing care rather than witnessing it. I walked taller than I have in days.

  In an instant, however, everything has changed.

  As prearranged, Nancy’s nurse called my mobile phone with the morning progress report just as I had requested. Her voice was flat. “Things are not so good here, Winnie. You better come right away.” I didn’t ask for nor want details.

  My partners have already made their support clear. After the emergency meeting they held the day I told them about Nancy’s illness, I received a unanimous message relayed by Joe Ferriter, our CEO: “Work as much or as little as is best for your family, Winnie. We will cover you.”

  As a result, with no hesitation, I told my medical assistant, Mindy, I was leaving, threw my stethoscope in my desk drawer, and sprinted for the exit seconds after I hung up with Nancy’s nurse. I was lucky there were no patrol officers on the highway to Salt Lake City. Not a single car passed me while speeding down the mountain on Interstate 80.

  Twenty-five minutes after exiting the clinic, I was back in my now accustomed chair next to Nancy’s bed, hanging on every word uttered by her oncologist, Dr. Elizabeth Prystas.