I felt better when I woke up the next morning. My headache was gone, and my back was less sore. For a few minutes, it was almost possible to pretend I’d dreamed everything - except that didn’t explain why I was still lying in a hospital bed and why it still hurt when I tried to sit up. I sat up anyway, rubbing my tender lower back, where the bone marrow had been taken out, and thought about everything that had happened in the last week.
I couldn’t believe it had only been a week since I’d gotten home from the tour. I had been dreading my appointment with Dr. Polakoff the next day, still convinced my heart condition had gotten worse. Now I knew it was cancer. I wondered how that was going to affect the rest of the tour. We were supposed to start up again at the end of May and tour the U.S. and Canada over the summer. Even before that, we were booked for a couple of small gigs - intimate, exclusive “fan events,” we were calling them - in Napa and New York, one in April and one in May. The Napa Valley show was less than three weeks away. I wondered if I’d be out of the hospital by then. Dr. Submarine had said it would only be a few days, but that was before she had diagnosed me with cancer.
I was glad to see her when she came in that afternoon to go over the results of my latest tests. Now that the initial shock had worn off, I wanted more information. She had plenty of it.
“I’ve gone through all of your test results from this week,” she began, patting a large envelope that was thick with paperwork, “and it appears that your lymphoma is in Stage IVb.”
“How bad is that?” I asked quickly.
“It’s not good,” she admitted, “but it’s common for this disease to be in an advanced stage when it’s diagnosed. Lymphoblastic lymphoma is an aggressive cancer; it starts and spreads very quickly. The results of your bone marrow biopsy show ten percent blasts - that means it has spread to your bone marrow, but not completely taken over yet. If the number were higher than twenty-five percent, it would be considered leukemia instead. The good news is that your abdominal and pelvic CT scans and your spinal fluid looked clear - that means the cancer hasn’t spread to other organs or your central nervous system.”
She paused then, and I nodded like I understood, even though my mind was racing with too much information to process. I wasn’t sure how to react yet.
“I’d like to discuss treatment options with you,” she said next, and I sat up straighter in my bed. This was the part I was most anxious to learn about.
“Am I gonna have to do chemo?” I asked, picturing again the bald, sickly-looking Make a Wish kids.
Dr. Submarine nodded, and my heart sank. “Chemotherapy yields the best results with this type of lymphoma. There are several different regimens used with adults, depending on the progression of the disease. Some are regimens designed for other types of Non-Hodgkin’s Lymphoma, and others are used with leukemia patients as well, since this disease is similar. For you, I would recommend the HyperCVAD regimen. It’s used to treat some forms of both leukemia and Non-Hodgkin’s Lymphoma, and it’s proven successful in advanced cases of your type of lymphoma.”
“Okay...” I said slowly, my brain still trying to catch up. “So what would that be like, exactly? Would I have to stay in the hospital, or are there just, like, pills I can take?”
“This chemotherapy treatment is given in up to eight three-week cycles. Most of the medications are given intravenously, so you would be hospitalized for a few days the first week of the cycle, a day or so the second week, and then off chemo for a week to recover,” she explained. “With HyperCVAD, there are two different courses that alternate with each cycle - the one I described is the first course. The second course only requires a three-day hospitalization at the start of the first week, then two-and-a-half weeks off to recover.”
I tried to keep track as she talked, doing the math in my head. “So basically, you’re saying I’d have to be in the hospital three times in six weeks?”
Her eyes flickered toward the ceiling as she considered it that way. “Yes, that’s right.”
“But that’s like once every couple of weeks! I can’t do that; I’m going on tour in two months. I’ll be traveling all over the country.”
“I don’t think you’ll be up to traveling,” said Dr. Submarine, looking at me with sympathy. “The chemotherapy will make you tired and lower your blood counts to the point where you might be anemic and more susceptible to infections. It’s not a good idea to be out and about around large groups of people.”
I snorted. That was exactly what I did for a living. “Great. So you’re telling me I can’t work while I’m on this? Then that ain’t gonna work for me. What are my other options?”
She pursed her lips, looking less sympathetic. I’m sure she was starting to get the male diva vibe off me, but right then, I didn’t care. I didn’t know what the guys and our management would say when they found out I was sick, but I didn’t like this doctor telling me that I couldn’t keep working if I wanted to.
“There are two other regimens to consider, but they’re both similar to HyperCVAD, in that most of the chemicals require IV access and need to be administered in a hospital, at least on an outpatient basis. There are chemo pumps you can be sent home with that will dispense the medication through a central line in your chest, but even those require a medical professional to set up for you. You would still need to visit the hospital regularly as an outpatient.”
I stiffened, squaring my jaw. “What if I don’t want to do that?”
She looked at me coolly, clinically, unfazed by my stubbornness. “Chemotherapy is the only way to put your disease in remission. Radiation won’t do it alone, and surgery isn’t an option. I told you that this type of lymphoma is very aggressive and spreads quickly. If you choose not to undergo chemo, you’ll be dead in a matter of weeks. As the tumor in your thymus gets bigger, it will continue to crowd your lungs and heart. The pleural effusion will worsen, and you’ll have difficulty breathing. You’ll likely develop a complication called superior vena cava syndrome, which happens when the tumor compresses the vena cava, the large vein that carries blood to your heart. Without treatment, it will kill you within a month.”
I held her gaze, determined not to blink or look away. Inside, I was terrified; I could feel my body temperature rising, my heart was pounding, and I was sweating. But I knew that was what she wanted, to scare me, and I didn’t want to give her the satisfaction of showing that I was.
“I know this is a lot to take in,” she added, after a long pause, her voice and features softening somewhat. “It’s normal to feel angry, depressed, even in denial. In a way, you’re grieving. You’re grieving the loss of your health. Just like any grief process, you’ll need support to help you get through this. Have you told your family about your diagnosis? Or friends?”
She was probably wondering why I’d had no visitors, why there was no one there with me to listen to the information she was giving me and ask the questions I hadn’t thought of yet. I shook my head. “Not yet,” I muttered. “I was waiting to get all the details first.”
She nodded. “Of course. Well, if you’d like, I brought some literature on the different chemo protocols that are available. Maybe you’d rather read about them on your own before making a decision. You don’t need to decide now, though I would suggest starting treatment as soon as possible.”
She offered me a handful of pamphlets, but I shook my head. “Nah, I don’t wanna read all that. Just tell me - which one’s gonna work the best?”
“Okay... well, as I said, I would recommend the HyperCVAD.”
“The one where I have to be in the hospital every two weeks, right,” I muttered. I still hated that part of it, but since it seemed like there was no way around it, I was willing to go with it... for now.
“Yes. To make it more convenient for you, I’ll also recommend a minor surgical procedure to implant you with a catheter. That will allow you to receive chemo without us having to stick you and start a new IV every time. There are different options for the catheter; you could have a PICC line in your arm or a central line or portacath in your chest. They really make things a lot easier, and when you’re done with treatment, they can be removed.”
I stared at her like she’d grown a second head. She couldn’t possibly imagine I’d say yes to having a tube sticking out of my body all the time, not just when I was getting chemo.
At the look on my face, she actually laughed, a light sort of chuckle. “It isn’t as bad as it sounds, I promise. If you’re concerned about the cosmetic aspect, a portacath would be your best option. The port is implanted completely under your skin, so it’s not as likely to show. You might have a little bump visible, but that is all. I have a brochure on that, as well, if you’d like to see a picture.”
She pushed one of her pamphlets into my hand. I set it aside without even looking at it. She sighed, then set the rest of the pamphlets on top of it. “Do some reading and some thinking on your own,” she told me firmly. “I have other patients to see, but I’ll drop in before I leave the hospital to discuss your decision. There’s just one other thing I want you to consider before I leave you, because you’ll need to pursue it soon.”
My head was already swimming with information; I didn’t want to hear any more. But she went on talking, anyway.
“No matter which regimen you choose, chemotherapy is very toxic. It has a number of possible side effects, many of which I’m sure you’ve heard of. You can read about them in the literature I’ve left you. One effect that you need to consider before starting treatment is sterility. Often, chemo affects your fertility - sometimes only temporary, but sometimes permanently. I don’t know if you’re in a serious relationship or not, Nick, but if you want to preserve your ability to father children someday, you might want to consider the services of a sperm bank. The hospital can help you arrange that, if you choose to freeze your sperm for future use.”
I felt my face redden, and I shook my head, wishing she’d go away. “I really don’t wanna talk about this right now...”
“I know you don’t, but you need to talk about it. You need to think hard about your options and make some decisions. Please, take a look at the material. If you have no questions for me now, I’ll go and come back later.”
I nodded, silently dismissing her, and she left. As soon as she was gone, I knocked all of the pamphlets off my mattress with one big sweep of my arm. They fanned across the floor, glossy booklets in every color combination, covering every subject she had mentioned. I didn’t want to read any of them.
I knew I was acting like a total asshole, but can you blame me? My life, as I’d known it, lived it, and loved it, was over. This new life my oncologist spoke of, a life of cancer and chemo and catheters in my chest, was completely foreign to me and even more terrifying. I just wasn’t ready to surrender to it yet.
***
My denial didn’t last all day. At some point, I got out of bed and forced myself to pick up every last one of the pamphlets I’d thrown on the floor. The fact that it killed my back to bend over made me regret the way I’d acted, like a spoiled little kid throwing a tantrum. I wondered what Dr. Submarine must have thought of me.
I decided that when she came back, I would have some answers for her, so I spent the rest of the day skimming through the pamphlets. I read about chemotherapy side effects and portacaths and how to cope when you’ve just been diagnosed with cancer. I didn’t think I was doing a very good job of it.
When my head started to hurt from reading and thinking about all of that, I put the pamphlets aside again and set up my laptop. I started looking through pictures I’d taken and saved over the years, pictures as recent as the Asian tour and as old as when Kevin was still in the group. I looked at the faces of my family and friends and the guys with their own families, and I knew I wasn’t ready to go down without a fight. I didn’t want to die. I wanted to live, even if it meant subjecting myself to the treatment my doctor had described. If that was the only way to extend my life for more than a month, then I’d do it.
I apologized to Dr. Submarine when she came back in the evening. “Sorry for acting like such an ass earlier,” I mumbled, feeling awkward, my face burning with shame.
To my relief, Dr. Submarine just smiled - actually freaking smiled! “No need to apologize,” she replied quickly. “Everyone reacts differently to bad news. Now that you’ve come around, I hope you’ve had a chance to think about your treatment options?”
I nodded and took a deep breath. “Yeah. I thought about it, and I’ll do whatever you think is best. I’ll do anything. Just... don’t let this thing kill me.”
She reached out and put her hand on mine, her dark brown skin contrasting with my fading tan. Looking me in the eye, she said, “I promise you, Nick... I will do my very best to keep you alive.”
***
