Time’s Up

“The results of your bone marrow biopsy came back and they confirmed our fear that the leukemia is back.  I’m sorry bud.”

This was a huge blow to the three people present and an oppressive hush fell upon them.  Finally, a barely audible voice broke the silence, “Um, how long?”

“A few weeks, maybe a month; I’ve had a few guys make it a couple of months with a mild, oral chemotherapy we’ll put you on.”

He didn’t scream, burst into hysterics, or even sob.  He just sat on the exam table and stared at his feet dangling in his brown and grey Vans.  Without looking up he asked, “There’s nothing more?  What about infusing the last of the donor’s lymphocyte cells?”

“Unfortunately, it’s much more aggressive this time and the infusion won’t even make a dent in its progression.  There are no more options for a cure.  We can look into experimental treatments being researched in Europe.  It could give you a few more months…but you’d be in the hospital indefinitely.”

“He sniffled once and raised his head to meet the doctor’s gaze.  Calmly, and with an ever-so-slight grin on his face he replied, “Well, you guys did everything you could to help me beat this thing and I thank you for that.  I guess this just wasn’t my game.”

A little while later, after deciding quality of life won out over quantity, he sat across the hall in a private infusion room, cracking jokes with the staff as he signed his DNR order and discussed hospice care.  Once all the necessary paperwork was signed, a nurse accessed his Porta-cath for a series of transfusions.  He really didn’t want to waste any more time in the clinic, but he knew spending a few hours hooked up to the IV would buy him a few days of energized respite from agonizing fatigue.

He sat back in the familiar plastic recliner while plastic tubing pumped fluids into him for what would be the last time.  It seemed like everyone in the clinic stopped by to say hi (or goodbye), and he entertained them with his natural wit and charm.  The only evidence of his sadness was a text to his best friend Batman:

Dude, I got some bad news today…I’m in the clinic at the moment hence the text.  Don’t wanna talk on the phone with all these people around but I gotta tell someone other than Izzy. My AML came back with a vengeance.  My time is short…weeks to months.  Sorry to unload via text but I don’t wanna crack in front of strangers.

Within a few short hours of getting the heartbreaking news, his mother-in-law met the couple at the hospital, and they decided he would ride home with her to make plans for dinner while his wife took care of his meds.  While she embarked upon the great pharmacy-hunt to fill his numerous prescriptions of sizeable dosages, dinner plans proved to be much less complicated.  He quickly decided on pizza, figuring he’d take a risk and eat a greasy pie from the dive down the street he’d been craving for months.  As he called to place the carry-out order for a large extra pepperoni and cheese pizza, he embraced the reality that germs had now been replaced as his greatest mortal enemy.  Gone was the fear of the myriad dangerous pathogens that may or may not invade his system with potentially deadly results.  He knew his fate.  His calm demeanor and happiness over his upcoming meal indicated that he was either at peace with his new reality or in complete denial.

As they drove to pick up dinner, his mother-in-law was determined to focus on a positive but realistic approach with him over his imminent mortality.  Knowing he had spent the entire afternoon at the hospital discussing it, signing paperwork about it, etc., she didn’t dwell but knew she had to acknowledge the “white elephant in the room” somehow.  If there was any question about his state of acceptance (or lack thereof) about his terminal diagnosis, he definitely cleared it up when she asked how he was coping with his new reality.  With a calm repose, he replied simply, “All I have to do now is focus on making a few more awesome memories for Izzy with the time I have left.”

Hot Sperm Dr.

When you live with cancer, the range of issues you have to deal with far surpasses most other life circumstances, and you find yourself stuck in conversations that span from scary to absurdly uncomfortable. The night before my husband was to start his first round of induction chemotherapy to treat his recently diagnosed leukemia, we found ourselves in the midst of one of the latter. Of course they had to find the hottest doctor in all of MCV to discuss our future reproductive options with Chris and I!

It all started when a clinician came in to go through all the final paperwork with us before his chemo could begin. She asked us to sign a document acknowledging that we understood the risks of conceiving while undergoing cancer treatment. She explained that chemotherapy and radiation cause mutations within the sex cells, leading to disruptions in fetal development and a whole host of birth defects. This wasn’t necessarily a permanent issue, but while he was undergoing treatment and for a period of time after, we had to put any plans of conceiving on the back burner. What she didn’t know was that this was a non-issue for us.

Chris politely declined to sign the document, trying to tactfully explain that pregnancy was not in our future, immediate or otherwise, without coming right out and saying, “My wife’s infertile.” He acknowledged the fact that chemo and/or radiation plus unprotected sex equaled a C.H.U.D. baby, but there was absolutely no risk of that happening to us. No matter how many times he repeated this, it didn’t seem to sink in. She was sure we were no different from any of the other couples who had said the same thing in the past, but then got pregnant regardless.

I’ve known about my infertility condition since I was 15 and had this exact conversation several times before. As considerate as he was being of handling this without divulging my medical history, this was a first for him and he was getting increasingly frustrated. After several minutes of going back and forth between her insisting he sign the document and he insisting that there was no need, I finally interjected. I was oh-so-eloquent and briefly explained, “This isn’t a problem. I had a hysterectomy over a decade ago.”

The clinician finally broke the awkward silence, “Oh, I see.” She then began a barrage of questions about any future plans we had regading having kids. We had two options: surrogacy (after all, I still had my ovaries), or adoption. Since surrogacy was on the table the clinician insisted we consult with a physician ASAP to discuss cryo-preservation of Chris’s sperm, just in case. We weren’t all that concerned with the future of our reproductive options…we were more concerned with the future of his mortality.

I think out of mere desperation to get this woman to shut up already, we agreed to talk with the attending physician about this issue. An hour later, a doctor in his early to mid-thirties came into our room whose looks rivaled those of Dr. McDreamy off of Grey’s Anatomy. All I could think was, “Sweet Buddha, don’t let him be the sperm doctor!” Sure enough, he was.

What followed was the most awkward conversation I have ever had in my life. Hot Sperm Doc proceeded to tell us that there were no consistent statistics on the effects of chemotherapy on male fertility. Some men experience a complete loss of fertility; others experience difficulty and need medical intervention, while some experience absolutely no problems conceiving naturally. He couldn’t give us any indication as to which category Chris would fall into. Then he proceeded to tell us that the hospital has arrangements with fertility clinics in the Richmond area, and we could easily have Chris’s sperm collected and cryo-preserved at any one of these facilities…for a monthly storage fee averaging about $225. He stressed how important it was that we decide as soon as possible so that the sample could be collected and his chemotherapy schedule readjusted. It was at this point that he excused himself to give us some time alone to discuss our options.

It took us all of 15 minutes to decide that we wanted to take our chances and move ahead with the chemotherapy as soon as possible. The ultimate decision ended up in my lap because Chris just couldn’t bring himself to make the call given my fertility issues. As chivalrous as that was, the last thing I was worried about was my own infertility and how his cancer was going to impact our chances of having future children. At that point, my only concern was just having a future with him period…end of conversation!

April Fools!

April 1, 2010 – I was sitting in an exam room at Virginia Commonwealth University’s bone marrow transplant clinic with my best friend and life partner, Chris, waiting for the doctor to tell him what I had known about for two excruciatingly long days. Three days before, he had gone in for a weekly checkup and his blood-work results indicated the need for a bone marrow biopsy. When I called the next day, the nurse gave me the comparison of both sets of blood-work drawn four hours apart the day before. If his initial results gave cause for worry, the second draw showed an exponential change in just four hours, making that worry turn to dread. The only way to say with 100% certainty that the leukemia had returned was to do a bone marrow biopsy…but the blood-work showed all-but conclusive evidence to support a relapse.

As a teacher, hearing this over the phone during my planning period at work was possibly the worst time and place to hear news like this. What made it intolerable was realizing that Chris didn’t know and I did and there was no way I was going to be the one to break the news. I didn’t have the answers I knew he’d need to hear and we had an appointment for the biopsy and a doctor’s visit in two days; that was the time to tell him. I had to hold my shit together until then. I had to keep the biggest secret of our relationship from him AND hold myself together for 48 long hours.

Two days later, relief washed over me when the doctor came in and explained the suspicion that yet another transplant had failed to keep his leukemia at bay. I was terrified of the potential diagnosis, but at least it was out in the open. Since we wouldn’t know anything for sure until the biopsy results came back in about a week, it was the doctor’s opinion that we enjoy our time spent in limbo. I was starting Spring Break the following day and he told us to go on vacation, eat whatever and wherever, throw a kegger, etc. For months, we had lived in this paranoid, germ-a-phobic bubble with all kinds of precautions to avoid infection, and then all at once the doctor lifted all the restrictions with such nonchalance. We left the room in good spirits and I felt like I was living in some parallel universe. While the three of us knew the underlying meaning of the conversation we all took the path of least resistance – optimistic denial.

That night we walked down to the courtyard of our building. The temperature was in the 70s and it was the first time we had the opportunity to just sit outside and hang out. I sat against the front wall with my legs stretched out in front of me. He laid perpendicular on the stone yard with his head in my lap. He looked up at my face asked me what I thought the doctor really meant and I didn’t know how to say the obvious. I tried to be tactful, “Something might be wrong, but we can’t sit around worrying until we know for sure. Why? What did you get out of it?”

“Shit’s about to hit the fan so we might as well have fun while we can.” I had to appreciate his blunt response; it was the one I wanted to say, but couldn’t bring myself to.

For all that was said that day, the two words I really wanted to hear were “April Fools!” and not one person uttered that obnoxious phrase. Was that too much to ask for on April Fools’ Day?

Worst Case Scenario

As a member of Generation X, I am one of many who were raised by a single mother.  Our mothers were the product of the 1970s feminist movement, bearing witness to the passing of the Equal Rights Amendment in 1972.  While this was an empowering step for American women, it happened to coincide with the rise of single parenthood in this country.  Single parents have to juggle raising their kids with “bringing home the bacon”, so many of us raised by single mothers seem to have an ingrained sense of self-reliance. Growing up, I can’t count the number of times I heard phrases like “Whatever you do in life, make sure you can take care of yourself,” and “You don’t need a man to be successful.” Now I can’t thank my mother enough for drilling these ideals into my head; they have served me well over the course of my life. Even after I got married, I was hell-bent on making sure to guarantee my future security.

A couple of months before Chris and I decided to get married, I was involved with a close friend’s upcoming nuptials. While she had dreams of being a princess bride, a phenomenon I was unfamiliar with, everything that could go wrong with her wedding almost did. I won’t go into any specific details, but this was the stuff of wedding-planning comic-lore. During months following the wedding she seemed very distant and didn’t want to do anything that didn’t involve her husband. By the time this reality sunk in I was already engaged, planning my own wedding, and terrified of losing my own identity. The combination of my observations of her newlywed life and my own fears led me to confront her about my concerns. It wasn’t the smartest decision and in hindsight, I know now that I was seeing my own doomed future. I remember pleading with her about the importance of being self-sufficient in case something was to happen to her marriage or, worse yet, her husband. Little did I know at the time was that I was talking to myself.

It was that conversation that led to a severe bout of depression as I worked through my first semester as a Humanities grad student. At the end of the term, I decided to switch from Humanities to Special Education because I knew I could get a job. I was marrying my best friend, who just so happened to be a fun, laid-back nice guy with the unfortunate side-effects of irresponsibility and a lack of motivation. I knew one of us was going to need a “real job,” which led to me shifting my graduate work in a direction that was more practical, and thus began my career in teaching. It was a good move and one that would serve not only me, but us as a couple well in our then-unknown tumultuous future.  Just as my mother taught me, I made sure I could take care of myself.