“Stem cells?” the word pricked my ears. That phrase was very controversial and political back at home in the states.
“Cells from bone marrow— either from a matching relative or from Mr. Elwood himself, if we can get close to remission— can be transplanted after high dose chemotherapy to kill off the remaining cells. A bit like demolishing the building and creating new cells from the ground up.”
“Isn’t that dangerous?” I looked from Neil’s grim expression to the doctor’s.
“There are different risks for both procedures. With donor cells there can be a potentially fatal reaction known as Graft-Versus-Host Disease. If we aim for the autologous transplant and your condition worsens during chemotherapy, the chances of a desirable outcome become more slim.” He paused. “I understand that you don’t wish to start treatment until after the first of the year. That will give you some time to consider your options, and time for me to review your case with my colleagues to see what course they recommend.”
The rest of the appointment kind of rushed past me in a blur of medical terms and growing dread. Dr. Grant warned us that patients who didn’t respond well to chemotherapy, who experienced “blast crisis,” had a very low survival rate. I didn’t know what blast crisis was. I didn’t know what level of cancer Neil had. All the numbers and figures confused me, and they all sounded like worst-case scenarios. Neil grabbed my hand and squeezed it, and I didn’t know if he was bolstering my courage or his.
Shit. This was real. All of it. Neil could die. Obviously, I’d thought of it before, but it had seemed such an outlandish possibility. “Neil could die” had been framed in an abstract way in my mind; anyone could die, theoretically. But the way Dr. Grant spoke, stern and without humor, made Neil’s mortality more immediate. I didn’t like it, and yet I appreciated it so much more than I would ever express to him. The cold, impersonal way he talked of Neil’s chances made them easier to confront.
Neil didn’t ask many questions. I had a feeling that, control freak that he was, he’d already pored over every website and medical journal available. But that wouldn’t make him feel any better. Neil wouldn’t be happy unless there was some magical switch to turn off his cancer, and then only if he got to flip it himself.
Near the end of the appointment, he said, his mouth audibly dry, “You’ve certainly given me much to consider.”
Dr. Grant looked briefly over at me. “I need to be clear about this type of treatment. The high dose chemotherapy is very likely to destroy your fertility. If the two of you were thinking of starting a family, you’ll want to explore some alternative options.”
Neil’s eyebrows rose. “Alternative options?”
“Some patients choose to bank their sperm, for example,” Dr. Grant said. “If that’s of interest to the two of you—”
“I’m not sure we can answer that today,” Neil said, glancing uncomfortably at me.
Yes, we can, I thought, looking him straight in the eye, so he would know what I was thinking.
He cleared his throat. “Thank you, doctor. My daughter Emma will remain in touch regarding arrangements at the house, if you’re still comfortable with me receiving the bulk of my treatment there?”
“Whatever we can do in the home, I’d like to. Patients seem to respond better than in a hospital environment, but hospitalization can’t be avoided entirely.”
“I understand.” Neil looked a great deal more anxious than he had when we’d first arrived for the appointment. Dr. Grant stood to show us to an exam room, where a nurse drew Neil’s blood. Dr. Grant would call us with the results.
We didn’t talk on the way out. Neil was super tense, and he kept swallowing and alternately clearing his throat.
And it wasn’t until we were in the car that I realized what was going on.
“Neil... are you crying?” I asked as we pulled away from the curb.
He was resting his elbow on the car door, and resting his mouth against his fist. His knuckles were white. “No.”
Okay, he was totally crying. “It’s okay if you are. You just got some pretty fucked up news.”
“It isn’t news. I always knew that eventually, this would happen. I would stop responding to the drugs, or...” he shook his head. There was a tear track on his cheek, but his voice didn’t betray any sign of emotion. He could have been ordering dinner. “I’m just not looking forward to this.”
“No one looks forward to chemotherapy.” I reached over and put my hand on his knee. He didn’t take it.
For a long moment, he didn’t say anything. When he did, his voice wavered. “Right now, all I’m seeing is a very long, very painful tunnel, and there’s no light at the other side.”