I was still picking at my breakfast the next morning when Dr. Submarine came to see me.
Maybe it was because I was still half-asleep or something, but at first, I was surprised to see her. As far as I knew, she hadn’t set foot inside the hospital since I’d checked in, and if she had, she hadn’t come to my room. I had only dealt with the radiologist who had done my biopsy and the nurses and residents on call on my floor - and they changed each shift. So at first it was kind of nice to see a familiar face, even if I still couldn’t pronounce the name that went with it. But then, noticing the stack of papers in her hand, I realized why she was there.
She had a diagnosis.
I looked questioningly at her as she walked into the room. “Good morning, Nickolas,” she said, but she didn’t smile. She hadn’t struck me as a particularly friendly woman at my first appointment with her in the clinic, but still, that’s when I knew it wasn’t good news.
My heart started to hammer, probably right up against the so-called “mass” that was in there with it. “Nick,” I said, my name sounding more like a croak. I cleared my throat. “Call me Nick.” I don’t know why it was so important to me right then, only that I would feel more comfortable if she wasn’t so damn formal. God, I wished she would smile...
“Nick,” she corrected herself with a nod. She still didn’t smile, and so it didn’t really help. “Your lab results are in from the procedures you had done yesterday, and I have a preliminary diagnosis for you.”
She paused then, like she was Ryan fucking Seacrest, waiting to see if I had anything to say before she continued. Of course, I didn’t; I just wanted to hear what it was, already. No - not wanted. I needed to hear.
I just stared at her, and finally, she cleared her throat, looked right into my face, and said, “I’m afraid it’s not good news. The CT scan showed a tumor in your thymus, which is a small organ in the center of your chest, above your heart. It produces special white blood cells called T-cells that help your immune system. The biopsy and analysis of the fluid samples from your lungs confirmed that the tumor is malignant. The official name for your disease is Precursor T-Cell Lymphoblastic Lymphoma - it’s a rare form of Non-Hodgkin’s Lymphoma.”
Half of what she said had gone over my head, but I’d picked out the words “malignant” and “lymphoma.” I could put them together to figure out what that meant, but I had to double check. “It’s... it’s cancer, then?”
“Yes,” she said with a nod. “I’m sorry to have to give you bad news.”
She was sorry? Of course she was sorry; no one wanted the job of telling someone he had cancer. But I was the one with the cancer! I was the one who should be feeling sorry - for myself. But my reaction wasn’t what I’d have expected it to be. I wasn’t shocked. I think the shock had come back in Dr. Polakoff’s office, when he’d first suggested it might be cancer. Now that I’d dealt with the possibility in my head for almost a week, it just seemed like she was telling me something I’d known all along. The only difference was that now I couldn’t hope for it to be something else.
I struggled to figure out what to say next. My doctor was still looking at me, waiting for my reaction, waiting for my questions. Later, I would have all kinds of questions, but in that moment, I couldn’t think of what to ask. Finally, I just said, “So how bad is this, exactly?”
“I can’t tell you exactly, until we know what stage it’s in. The stage will depend on whether or not it has spread. We know it’s in your thymus and the lymph nodes in your chest, and your blood work showed over thirty percent lymphoblasts, the immature cells that form the cancer,” Dr. Submarine explained. “This disease often spreads to the bone marrow, the central nervous system, or other organs, so it’s necessary that you undergo more testing to check for cancer in those locations. I’m going to order another set of CT scans of your abdomen and pelvis, a bone marrow biopsy, and a lumbar puncture to check your spinal fluid. Once we have those results, we’ll be able to stage you and discuss treatment options.”
I was sorry I’d asked.
She wanted to know if I had any other questions, but I was already overwhelmed with too much information, so I just shook my head. “I’ll leave you alone to digest this news, then,” she said gently, touching my upper arm with feather-light fingertips. “I know it’s a lot to take in. Please call me if you think of any questions. If not, I’ll be back to discuss this with you again once we know more.”
For the first time, I felt some warmth from her, but then she was gone, and I was suddenly very cold. Sitting up in bed, I drew my knees to my chest and pulled the blankets up around my shoulders, hugging myself into a ball beneath them. I stared across the room without seeing a thing, my eyes out of focus, trying to wrap my head around what I’d just been told.
Cancer. It didn’t make any sense, didn’t feel real to me just yet, like these last few days of doctor visits and medical testing had all been part of a bad nightmare that was going to end any second now. Despite how crappy I’d been feeling, despite being worried enough to go to the doctor in the first place, I just couldn’t believe that it was cancer. I had been so convinced it was my heart, I’d never even considered something like lymphoma, whatever the hell that even meant. I didn’t know, and right then, I wasn’t sure I wanted to know.
I’m not sure how long I stayed like that, huddled under my covers like a little kid afraid of the dark, but I only snapped out of it when an orderly showed up with a wheelchair to take me for my next round of tests, so it had to have been a pretty long time. As I reluctantly pushed the blankets off myself and slid my legs over the side of the bed, I had a sudden memory of being about seven years old and terrified that there were little gremlins living under my bed who would bite my toes if I let them hang off the side. I guess that’s what I got for staying up late to watch Gremlins.
It seemed funny to me now, to think that I’d once been that young and genuinely scared of something that silly. But things weren’t so different now. I was older, but still afraid of monsters. Only now I knew the monsters weren’t lurking under my bed. They were inside me.
***
“Hi, my name’s Bo; I’m gonna be assisting with the bone marrow biopsy today. Did your doctor explain this procedure to you?”
I looked up at the big guy who greeted me at the door of the small room I’d been dropped off at. I figured he was a nurse, since he wasn’t wearing a white coat over his scrubs. He looked more like a linebacker. I’m pretty tall, but looking up at him from a wheelchair made me feel tiny - the way Howie and Brian must feel whenever they stand by me. “Not really,” I said, to answer his question.
“No problem; I’ll talk you through it. First thing I’m gonna have you do is lie on the table, on your stomach. You can keep your gown on, but you’re gonna need to take off your boxers if you’re wearing them so the doc can access the area.”
If I’m wearing them... Right, like I’d go around the hospital in a backless hospital gown with no shorts on? I’ve been known to go commando from time to time, but only when there’s something else to cover my ass. The way I see it, if I’m wearing pants, what’s the point? But no pants? That’s a different story.
Then it occurred to me what else he’d said. So the doc can access the “area”? Uh... what??
The look on my face must have given away my thoughts, because Bo the Male Nurse laughed and said, “Okay, so I guess your doc really didn’t explain anything. Well, the point of this procedure is to remove a sample of your bone marrow - the stuff on the inside of your bones that makes blood cells - to test in the lab. For a biopsy, the marrow’s always removed from your hip bone. So we’ll have you lie on your stomach, and we’ll cover the area with a drape so you’re not totally exposed while the doc’s extracting the marrow.”
“Okay...” I couldn’t believe I was agreeing. God, I didn’t want to do this, but it didn’t seem like I had much of a choice. Everyone was just expecting me to go with the flow, like this was normal or something. I grudgingly got out of the wheelchair, dropped my drawers, and looked at the padded table. How was I supposed to get on there and lie facedown without flashing my whole ass in this male nurse’s face? Did it have to be a guy? A guy my age and twice my size? Then again, I supposed it wouldn’t have been any better if it were a hot girl my age, a girl who might be a fan. At least I didn’t think I had to worry about this dude getting on the Backstreet Boys fan club at home and blabbing about what my bare ass looked like in person.
Bo was cool enough to turn away while I got situated, and then, as promised, he covered my lower half with a sheet. A thin sheet, probably thinner than the skimpy hospital gown, but at least it was something. “The doctor who’s doing the procedure should be in any minute,” he told me. “What she’s going to do is numb you up, then insert a special needle into your pelvic bone to get the marrow. You’ll feel some pressure, but not pain. It should only take about ten minutes.”
I was glad he couldn’t see the look on my face this time. He sounded so casual when he talked about a needle going into my bone, I wanted to ask, Dude, have you been through this? But I didn’t. I guess I was too freaked out to be a smartass.
The doctor breezed in a moment later and came around to the head of the bed, so that I could see her. “Hi, Nick, I’m Dr. McDaniel, and I’ll be doing your bone marrow aspiration and biopsy,” she introduced herself. I was disappointed to see that she was both young, probably early thirties, and hot, in a fresh-faced, girl-next-door kind of way. So now I had the linebacker and the cheerleader staring at my ass. Awesome. I hoped she was too busy being a doctor to visit Backstreet Boys message boards. “Has someone talked to you about what to expect?”
“Yeah,” I grunted, “Bo filled me in.”
“Great. Do you have any questions before we get started?”
“No.”
“Okay then. Gimme a minute to wash my hands and get set up here.” I turned my head and watched her move around the room, washing her hands thoroughly at the sink in the corner, snapping on a pair of surgical gloves, and assembling instruments on a tray that she blocked from my sight with her body. I wondered if that was intentional. Did she not want me to see the needle she was going to use? I wondered how big and thick it must be, to be able to penetrate bone... I started picturing a drill bit, rather than a needle, and getting sort of queasy. “You doing okay, Nick?” Dr. McDaniel asked.
“Fine,” I murmured, though I was anything but.
“Alright, then I’m going to begin. I’m just going to use some Betadine to disinfect your skin first; this will feel a little cold.” I couldn’t see anything, but I winced as something cold and wet was rubbed over my lower back, right above my ass crack. I kept waiting for her finger to slide in there accidentally. “Now you’ll feel a little prick, like a bee sting; this is an injection of a local anesthetic to numb the area.” I gritted my teeth and hissed in a sharp breath as I felt the needle pierce my skin. It burned at first, but in a few seconds, the pain was gone, and I could feel the numbness start to set in.
This isn’t going to be so bad, I thought at first, thinking the worst was over, that I wouldn’t feel anything else. Boy, was I wrong.
Dr. McDaniel waited until my tailbone was numb, and then she said, “Now I’m starting with the aspiration. You’re going to need to lie very still. You’ll feel some pressure as the needle’s going in and possibly a sucking feeling as I’m extracting the marrow, but you shouldn’t feel any pain.”
It didn’t sound pleasant, but since she was the second one in the room to have told me it wouldn’t be painful, I still wasn’t too concerned about that part. That all changed the moment the needle went in. I say “needle,” but although I never saw it, it really did feel big enough to be a drill bit. I felt the force she had to use to punch it through my skin and then more crushing pressure as it twisted into my bone. I could hear the bone crunching against the metal of the needle as it drilled through, and I wanted to scream. Instead, I clutched the pillow wedged under my chest and clenched my jaw. They could have at least given me a fucking bullet to bite down on, like the army doctors did when they were sawing soldiers’ limbs off back in Civil War times.
Once the needle was apparently all the way in, the pain changed. “Take a deep breath,” Dr. McDaniel said. I did, and instead of the downward pressure, I felt the opposite - a sucking sensation so powerful, it felt like she was trying to vacuum up my whole skeleton through a tiny straw. It took my breath away, and the lungful of air I’d been holding came whooshing out in a gasp of intense pain.
It was the most uncomfortable thing I’d ever experienced, and it didn’t stop there - it repeated once, twice more, as she took more samples, three in all. That, I learned, was just the aspiration part - sucking out just the bone marrow fluid. Then came the biopsy, when the big needle went in a second time to get a sample of solid bone marrow. By the time it was all over, I felt sick to my stomach and didn’t even care that there was a guy holding gauze over a hole just above my right butt cheek.
After lying still for a few minutes, I felt better, but I knew as soon as the anesthetic wore off, I was going to be sore. Turns out, I didn’t know the half of it.
***
I was brought back to my room to rest, but just when I was finally starting to relax enough to take a nap, another orderly showed up to take me for my next test.
The dream team of Dr. McDaniel and Nurse Bo were back, this time to do the lumbar puncture. I didn’t have a clue what that meant, until Bo said, “You might have heard it called a spinal tap.” At first I pictured the movie, This Is Spinal Tap, which I’d watched with the guys on the tour bus I don’t know how many times. Then I started really thinking about it, how the “lumbar” part of “lumbar puncture” didn’t sound bad, and neither did the “tap” in “spinal tap,” but when you combined the other two words - “spinal puncture” - it sounded horrific. It must have been, because if it wasn’t, why wouldn’t they call it a “lumbar tap” instead? A lumbar tap sounded like some kind of massage technique. A spinal puncture sounded like some form of medieval torture. I knew it was going to hurt.
They had me lie on my side, curled up into the fetal position. They opened the back of my gown again, but at least I got to keep my boxers on this time. At first, it was similar to the bone marrow biopsy, which didn’t make me feel any less uneasy. Dr. McDaniel painted my back with Betadine, then injected me with a shot of anesthetic. I wasn’t sure why she even bothered because even though my skin was numb, it hurt like hell when she stuck the needle into my spine. There was no crushing pressure or sucking feeling this time, just pain, pain that seemed to go on forever while I waited for her to finish getting the samples of spinal fluid that she needed.
Just when I thought I couldn’t take it anymore, the pain let up, and Dr. McDaniel said, “All done. You did great, Nick. Bo’s going to get you cleaned up and have you lie flat for awhile before you go back to your room. You’ll want to lie on your back in bed for a few hours this afternoon, so you don’t get a bad headache.”
The thought of lying on my back, which now had two puncture wounds from her torture methods, was not an appealing one, but I did it. I did it, and I still got the headache she’d warned me about. When Reyna came in to take my vitals that night, I was lying flat on my bed in the dark, my eyes squeezed shut, trying to block out the pain. It was so bad, it was making me nauseous, but the thought of sitting up to vomit was equally painful.
“You poor thing. I wish there was something else I could do,” Reyna sympathized, as she tightened the blood pressure cuff around my arm. “The pain meds still aren’t helping?”
“No,” I whispered, without opening my eyes.
“Sometimes migraine medications work on post spinal headaches. I’ll check with the on-call resident when I’m done here to see if he can prescribe something else for you.”
“Thanks.”
“Sure, hon. I can tell you’re in pain; your BP is high.” She patted my shoulder as she removed the cuff. “Maybe you need something to distract you. When you’re lying here in the dark, all you’re thinking about is how much it hurts. It’s after nine; American Idol’s on again, you know. Want me to turn it on for you?”
I didn’t give a flying fuck about American Idol right then, but maybe she was right about distracting myself. “Sure,” I muttered. I heard her fumbling around for the remote, and then I saw a flash of light through my closed eyelids as the TV came on.
“Ooh, lucky us, just in time for Miley,” remarked Reyna, and as the sound came up, I heard Miley Cyrus warbling some ballad.
“Yeah, when my... world... is falling apart, when there’s no... light... to break up the dark, that’s when I... I... I look at you...”
“She sings like a sheep,” I grumbled, and Reyna laughed.
“Yeah, I’m partial to ‘Party in the USA’ myself. So I put my hands up, they’re playin’ my song, the butterflies fly away...” She started singing as she moved around my bedside, putting the thermometer in my ear. “I’m noddin’ my head like, ‘Yeah!’ Movin’ my hips like, ‘Yeah!’”
For the first time all day, I cracked a smile, and a weak chuckle escaped my lips.
Reyna giggled. “Sorry, I know - really bad, right? There’s a reason I’ll never audition for this show.”
“Nah, you’re fine,” I mumbled, wishing I felt up to flirting with her. “Thanks for keepin’ me entertained.”
“Anytime,” she laughed, as the thermometer beeped. “Hundred-and-one on the dot. I’m starting to wonder if you just run hot.”
Okay, that was all the incentive I needed. “You kidding? Look at me... of course I run hot.” I opened one eye just a slit to peek up at her. She was grinning down at me.
“Oh, what was I thinking? Of course you do, hot stuff.” She laughed again and patted my arm, but just before she turned away, I saw her smile fade, her upturned lips falling down. “I’ll ask about the migraine meds,” she promised before she left my room. It seemed like she was suddenly in a hurry.
I got it. She felt sorry for me. She’d had to have seen my diagnosis on my chart. It wasn’t so fun, flirting with a cancer patient. The thought made me cringe, picturing girls I’d met for Make a Wish, girls who were bald and puffy-faced from chemo treatments. Was that going to be me? I couldn’t picture myself bald and sick-looking, like those girls. Just thinking it made me feel even more nauseous. What was I going to do?
All I could do right then was try to distract myself, as Reyna had suggested, so I forced my eyes open and made myself concentrate on the rest of American Idol, as if I really cared about the results. The bottom two turned out to be the girl Reyna was rooting for, Cary, and the weird, smiling kid who had done the Queen song. That kid’s gettin’ the boot for sure, I thought, so I was surprised when it turned out to be the girl instead. Apparently, I didn’t understand how American Idol worked, because she wasn’t out just like that. She had the chance to sing a song - any song, it seemed - to convince the judges to save her and keep her in another week.
Her performance was exactly the opposite of the one I’d seen the night before. Alone on the stage, without a band or piano player or back-up singers, she started strumming a ukulele, and though the chords sounded familiar, it wasn’t until she started singing that I recognized the song as our own.
“Lookin’ at your picture, from when we first met... you gave me a smile that I could never forget... and nothin’ I could do could protect me from you, that ni-i-ight...”
It was “Just Want You to Know,” the song Reyna had told me she’d performed on the show before. It was a lot different, though; she wasn’t trying to sound like us, like me, at all. It was a cool cover, very subdued and simplified. I could picture her singing it on the tiny stage of a coffee house or under the blue lights of an intimate bar. It just didn’t work as well in a huge studio. When the judges told her she was going home, I actually felt kind of disappointed for her. It was clear that she was talented and had something special. I watched her cry on stage as they showed a montage of clips of her on the big screen behind her and thought, Guess I’m not the only one who got bad news today. Mine trumps yours, though, sweetheart.
Then I realized it was the first time I’d thought of my cancer diagnosis in at least ten minutes. Impressive, considering I’d been dwelling on it constantly all day. I’d even forgotten about my headache.
Reyna was right. All I needed was a distraction. I just didn’t yet know the important role that very distraction would come to play in my life.
***
