Those were the words Nick had dreaded hearing basically ever since he had gone into remission back in August. And now, it had finally happened. Not quite a full year after his initial diagnosis, he had already relapsed. He was out of remission; the cancer was back.
Devastation quickly set in.
Questions spun out of control in his brain, and he finally found his voice to speak. “C-can you treat it?” he asked, looking at Dr. Kingsbury with desperation in his eyes.
“Yes,” she said firmly. “I want you started on a six-week course of radiation therapy.”
“Radiation therapy?” Nick repeated. He did not like the sound of that at all.
“Yes. Radiotherapy is the use of high-energy rays that destroy cancer cells. If it works, it will shrink the tumor in your leg.”
“If it works?” Nick questioned, his voice rising shrilly.
Dr. Kingsbury smiled patiently and patted his knee. “Most Ewing’s Sarcoma tumors are sensitive to radiation. There’s a good chance the treatment will help.”
“Well, what if it doesn’t?”
“Then we’ll cross that bridge when we come it,” she replied, giving him her standard answer.
He nodded and hoped they would never have to cross that bridge. “So,” he said, “what’s radiation like? Is it... is it worse than chemo?” He bit his lip, not sure he wanted to hear the answer. The thought of being so sick and losing all his hair again was almost too much to bear.
“Oh no, much better actually,” smiled Dr. Kingsbury. “Radiation’s very simple. You’ll need to come to the radiology department here at the hospital five days a week for treatments...” His mouth dropped open in horror, and she continued quickly, “... but the treatments don’t take long at all. Just a few minutes, really. And they’re painless. No worse than an x-ray.”
He let out a sigh of relief. Although coming to the hospital once a day for this shit would suck, it had to be better than being hooked up to a chemo pump for a whole week. “So what about side effects?” he asked. “Like will it make me sick? Will my hair fall out again?”
“No,” she replied, and he let out a sigh of relief. “There are a few minor side effects, but nothing as bad as chemo. The biggest one is fatigue – the treatments will make you tired. Since you’ll be receiving the radiation on your shin, the hair there will either fall out or have to be shaved off, but that’s it. Also, you might have some redness or itching or burning on your shin, but other than that, it doesn’t cause much discomfort. Most patients I’ve had prefer radiation to chemo.”
He nodded. That didn’t sound so bad. “So when will I start this?”
“As soon as possible,” answered Dr. Kingsbury, looking at him seriously. “This week, if you can.”
“Okay,” he said. “I guess I should start this week then. The sooner I get started, the sooner it’s over, right?” He pasted a smile on his face.
“Right,” Dr. Kingsbury smiled back. “Okay then... on Monday, you’ll need to come in for a planning session. You won’t actually start the treatment that day, but you’ll meet your radiation oncologist, who will take you through the procedure and show you how everything works and get you ready to go for the next day, when you’ll receive your first treatment.”
“Radiation oncologist? So you won’t be my doctor?” asked Nick nervously. He liked Dr. Kingsbury and had grown comfortable around her; he didn’t want to be handed off to another specialist.
“Oh, I’ll still be your doctor,” Dr. Kingsbury assured him. “But you’ll go to a colleague of mine, Dr. Marvin, for your radiation treatments. I’ve already showed him your scans, which is why I took longer than usual to come talk to you, and he thinks you should start with a six-week course of treatment. He can talk to you more about it when you meet him on Monday. And I’m sure you’ll like him, Nick. Vin’s an excellent doctor, star of the radiology department, and he’s a very nice man as well. A little eccentric, but very sweet. Anyway, I’ll be in close contact with him to check on your progress, and at the end of the six weeks, you’ll have a follow-up visit with me so we can see how things look.”
Nick nodded.
“So... do you have any questions?”
Did he have any questions? It seemed he should, but he was so overwhelmed with this sudden news, he didn’t have the slightest clue what to ask. Slowly, he shook his head. “No, I guess not.”
“Okay. Well, if you think of anything over the weekend, don’t hesitate to call my office, and I’ll answer what I can. And Nick,” she said, causing him to look up, “this isn’t the end of the world. It’s a setback, sure, but things are still looking positive. Your chest x-ray looked fine, and your bone marrow should be clean. The tumor’s growing again, but as long as it stays in your leg, your chances of recovery are high.”
“H-how high, exactly?” Nick asked, licking his dry lips.
“For people with Ewing’s that hasn’t metastasized... spread, that is... the five-year survival rate is fifty-five to seventy percent.”
Nick blinked, his stomach lurching. Fifty-five to seventy percent? Then that meant that thirty to forty-five percent died within five years. He didn’t think that was very high chance of recovery at all; those were terrible odds! Okay, so it could be worse... but fifty-five/forty-five? That was almost fifty/fifty! Nothing more than the flip of a coin. Heads or tails.
“Concentrate on the seventy percent,” Dr. Kingsbury said, reading his mind (or maybe the expression on his face). “You can beat this, Nick.”
He nodded numbly, wishing he could feel as confident as she sounded. “So... so can I go now?” he murmured, not quite sure his legs would even support him when he slid off the table.
“Yes. But first let me call radiology and set up Monday’s appointment. Any specific time of day you’d prefer to come? If it were me, I’d do it early, get it over with. Then you still have the rest of the day. But it’s up to you.”
“Okay... yeah, make it in the morning, I guess.”
She nodded. “All right. I’ll call right now and get it set up for you.” She stood up, crossed the room, and picked up a phone that was mounted on one of the walls. She punched in a few numbers and waited a moment, then said, “Hi, this is Barb Kingsbury from Oncology. I’d like to schedule an appointment with Dr. Marvin for Monday morning for one of my patients. I’ve already spoken to him. Yes... Nickolas Carter. N-I-C-K-O-L-A-S. Yes. Nine o’clock? Okay, thank you.” She hung up and turned to Nick. “Nine o’clock on Monday morning, Nick. Don’t come here; go to the radiology department, where you go for your x-rays and CT scans. Got it?”
“Yup,” he replied dully.
“Good. Then go ahead and get dressed, and you can go. Good luck with your appointment on Monday, and feel free to call me if you need anything.” She rested her hand on his shoulder, like she had done so many times before, and gave it a reassuring squeeze. “I’ll see you in six weeks, if not before.”
“Thanks, Dr. K.”
She left, and he got up slowly. His legs felt like rubber, and his left shin throbbed as soon as he put weight on it. Now he knew why. It had been the tumor all along, and he’d been either too stupid to realize it or too much in denial to accept it. But there was no denying it now.
His cancer was back.
***
In a way, Sunday night came far too soon, but in another way, it couldn’t come soon enough. Nick was dreading radiation the following morning, but the weekend had been pure hell. He had been unable to escape the recurring nightmare that was his cancer, unable to forget about his relapse. The rest of Saturday and all day Sunday was spent just plain freaking out, worrying about the upcoming radiation treatments and whether or not they would work.
He had briefly considered calling Brian on Saturday to tell him the bad news, then decided against it. Dr. Kingsbury had said the radiation treatments would only last six weeks. What would come after that, he did not know, but he decided to wait until the treatments were done and see. If the tumor had cleared up by then, there would be no need to call the guys. Why worry them for no reason?
So he worried all by himself instead.
One thing he could not forget was the odds... seventy/thirty at best, fifty-five/forty-five at worst. They were not completely horrible... yet they didn’t do much for his confidence. Now eighty or ninety percent... that would have been a lot better. But fifty-five?
At one point, he recalled a conversation he’d had with Claire before her bone marrow transplant.
“Well... it’s too big a risk, I guess. That’s why they try chemo and everything first. This treatment is just sort of a last ditch effort...” She went quiet, her voice trailing off into nothing, and he felt a tremor of fear ripple down his spine.
“What kind of a risk?” he asked. “I mean... how dangerous is this thing?”
Her eyes locked with his, no trace of the usual twinkle of amusement alighting them. Instead, all he saw when he gazed into their light blue depths was fear. And he realized the truth... as hard as she was trying to hide it, as upbeat as she was trying to be, this was totally freaking her out.
She was scared to death.
“Claire?” he asked softly, not tearing his eyes from hers.
“Fifty-fifty,” she whispered, looking away.
His stomach lurched. Fifty-fifty. It was a coin toss. Heads, she won. Tails, she lost. And this was not just any game, but a battle of life and death. If she lost, she’d be losing her life...
Things had looked pretty grim for awhile for Claire. But she had made it through with worse odds than him. He felt a bit better. If Claire could do it, so could he.
He only wished she could be there with him. He remembered all the times she had sat with him in the waiting room and how she’d held his hand during his bone marrow aspiration that time. And all the conversations they’d had, some deep, others just silly. He would have given anything to tell her the bad news. She would understand, and up until recently, she would have been there for him in a heartbeat, he was sure of it.
Only now he was not so sure. He had pissed her the night before, and though he was still not sure exactly where he had gone wrong, he wasn’t about to call her now. His pride was too great. He had come crawling back to her, and look where it had gotten him. He wasn’t going to do it again. It was her turn; she could come crawling to him this time.
As he lay in bed, his stomach clenched with anxiety as he thought of the frightening new journey he would set out on all alone the following morning, he just hoped she would.
***
Promptly at nine a.m. the next day, Nick sat in the waiting room of the radiology department. It was the first time he’d had to wait there; although he’d been to radiology many times for his x-rays and bone scans, he’d always been shuttled in and out rather quickly. He hated having to sit there and wait because his nervousness only increased with every passing minute.
“Mr. Carter, there’s juice there on the table; help yourself,” called the receptionist from her desk, pointing to a large bowl filled with ice and juice boxes that sat atop the coffee table in the middle of the room.
Nick nodded in acknowledgement, but didn’t take one of the juice boxes, feeling as if anything he ate or drank would just come right back up again. He was about ready to throw up as it was, his nerves wreaking havoc on his stomach.
Luckily, he didn’t have to wait long before his name was called. Standing up on wobbly legs, he crossed the room to the nurse that stood waiting for him in the doorway. She smiled cheerfully, said hello, and led him down a hall and around a corner, stopping in front of a closed door. The door had a frosted glass window on which the name S. Vincent Marvin, M.D. was printed. The nurse knocked once, and a man from within called, “Come on in!”
The nurse opened the door and poked her head in. “Mr. Carter’s here, Dr. Marvin.” To Nick, she said, “Go on in, hon.” She stepped back so that he could enter and then left. He found himself in a small office. In the center, there was a large desk behind which a man in a white coat sat, arms crossed on the wooden surface in front of him, looking up expectantly at Nick.
“Good morning, Mr. Carter,” he greeted Nick pleasantly and stretched his hand out across the desk. “I’m Dr. Vin Marvin; good to meet you.”
“You too,” replied Nick, perching himself in one of the two chairs positioned in front of the doctor’s desk and shaking hands.
The Hispanic doctor looked younger than Nick had expected; he was possibly in his early thirties, no older. He had a casual air to him, and his office matched this. It was rather untidy, cluttered with several cardboard boxes containing God-knows-what. Amid university and medical school diplomas, random pictures hung on the walls, from a painting of a grassy green pasture in which several goats grazed, to an old poster from the Broadway play “The Miracle Worker.” The bookshelves in one corner were filled with thick medical volumes, framed pictures, and all sorts of peculiar odds and ends... a figurine of a chicken, a small taxi cab, a model train, things like that. His desk was cluttered with papers and more pictures and... a bat?
The doctor noticed Nick looking at the small, beady-eyed plastic bat lying upside down on one corner of the desk and laughed. “Look at this, isn’t this cool?” he exclaimed, picking up the bat. When he flipped a tiny switch on the bat’s underside, the toy sprang to life, its eyes flickering bright red, while an obnoxious, high-pitched humming noise sounded. Dr. Marvin laughed again, slapping his desk with the palm of his hand. “Ahh, that’s great, isn’t it?” he remarked mostly to himself, turning the bat off and setting it down again. “Perfect for Halloween, eh?”
Nick wanted to ask why he had Halloween stuff out in the middle of February, but kept his mouth closed, just nodding and smiling weakly. He now knew what Dr. Kingsbury had meant when she called her colleague “eccentric.” The guy was a freaking weirdo! Nick just hoped he was as good a doctor as Dr. Kingsbury had said. He didn’t want some quack shooting radioactive waves into his body.
“Well...” The doctor clapped his hands together and said, his voice sobering, “Shall we get started?”
“Yeah, sure,” replied Nick, desperately wishing Dr. Kingsbury could be in charge of the radiation instead of this lunatic.
But as they got started, Dr. Marvin quickly turned more professional and not so freaky. “First, let me just tell you what’s going to happen today. I’ll take you down to one of the radiation rooms, where you’ll be getting the treatment done every day. There, some of my technicians will take some measurements and do some calculations and then mark you up for treatment. What they’ll do is give you “tattoos,” as we call them – tiny dots on your skin that will show us how to line up the machine each time you come. That way, we know for sure that the radiation will hit the tumor and not another part of your body.”
“’Tattoos’?” Nick repeated. “Those dots... they come off, don’t they?”
“No, I’m afraid the dots are permanent, but they will fade over time, and they’ll be so small that no one will notice them. Once the dots are there, the technicians will sort of play Connect The Dots with a pen and draw lines on your skin. These lines are for the same purpose – to help us line up the machines – but, of course, they wash off. You’ll have to try to avoid using soap on that area when you shower, but the technicians will redraw those lines as they fade.”
Nick nodded. Well, so much for wearing shorts out in public. He’d look like freak with lines and dots all over the bottom half of his leg. And yay, he’d have the dots forever as a nice little souvenir of this pleasant experience. If he’d known he was going to have to get another tattoo, he would have picked something a bit more interesting than a bunch of lame dots.
“So is that it?” Nick asked.
“Pretty much. It should take around an hour, and if all goes well, you can start the actual treatments tomorrow. They only take a few minutes, so once you’re done today, the worst is over.” He grinned, and Nick managed a slight smile back. “So,” said Dr. Marvin, standing up, “why don’t you come with me? I’ll take you down to one of the rooms.”
Nick nodded and followed him out of his office, back up the hall and around the corner. They stopped at a heavy door, which Dr. Marvin yanked open and held for Nick to pass through. He found himself in large room with a bedlike table in the center. Positioned over the table was a gigantic machine with a cone-shaped device that pointed down.
“This is the machine we’ll be using,” said Dr. Marvin, running his hand over the smooth metal of the contraption. “You’ll lie here on the bed, and the technicians will position this over your leg so that it shoots the waves right at your tumor.”
Nick blanched. Dr. Marvin talked about it so casually, as if they were just playing a game of “Asteroids”. Only the cute little two-dimensional blipping spaceship was this very real, very intimidating piece of machinery. And instead of being threatened by asteroids, he had to fight off an even worse foe – cancer. And the idea of a tumor deep in his shin bone was a lot scarier than a few little white outlines hurting across a black screen (although, as a child, bouncing around like a spaz in front of the Atari Asteroids console at the local Pizza Hut with his tongue sticking out in concentration and a handful of quarters jangling in his pocket, he might have disagreed).
“So,” said Dr. Marvin, bringing Nick out of the black and white reaches of space and back to the radiation room, “if you’re ready, we can go ahead and get started with the calculation and marking.”
Nick felt he’d never quite be ready, but, like a puppet, his head bobbed up and down once in a nod, and he heard himself reply, “I’m ready.”
***
As Dr. Marvin had predicted, it took almost an hour for the technicians to do their calculations and “mark him up,” as they called it. When he left the hospital, his left shin was covered in a pattern of blue lines, intermixed with tiny dots – the “tattoos” Dr. Marvin had described. They were tiny indeed, only about the size of a freckle, but they were still noticeable, at least in Nick’s eyes. Seriously, who has bright blue freckles? He only hoped they really would fade the way the doctor had told him they would.
Bright and early Tuesday morning, he was on his way back to the hospital for his first actual radiation treatment. And he was nervous as hell. Dr. Kingsbury and Dr. Marvin had both told him the treatment was both short and painless, but he couldn’t help but feel uneasy.
When he was called from the waiting room, a nurse took him to a small room and gave him a hospital gown to change into. Grudgingly, he did, and when he was finished, he was escorted into one of the radiation rooms, not the same one he had been in the day before, but identical to it. He was positioned carefully on the table, his left leg immobilized so that he could not move it during the treatment. A technician then moved the large radiation machine, adjusting it so that the cone-shaped end was aimed at the markings on his left leg.
“Okay, Mr. Carter,” he said finally, “we’re going to start the treatment now. You’ll be alone here in the room, but I’ll be in the ‘control panel’ right through that window.” He pointed to a large window in one of the walls. Beyond the window, Nick could see a small room with all sorts of equipment and computers inside. “I’ll be able to see you from there, and there’s an intercom, so if you need anything, just holler, and I’ll be able to hear you too. Okay?”
Nick nodded.
“You’ll hear a whirring sound when I turn on the machine, but you won’t feel a thing. It will only take a few minutes, and then I’ll come back to readjust the machine so we can shoot from a different angle.”
He suddenly sounded like a photographer at a photo shoot. And though he normally despised photo shoots, Nick would have given anything to be at one of them now instead of here. No such luck though. The technician left the room, and as promised, there was a buzzing sound. It lasted just over a minute, and when it was over, the technician returned and set to repositioning the radiation machine. Some of Nick’s nerves left him; everyone had been right in saying that the treatment would be painless. He hadn’t felt anything. When the technician left again, the buzzing started back up, as another dose of radiation was shot into Nick’s leg from the second angle.
“That’s it. You’re done,” the technician announced cheerfully when he returned, helping Nick up from the table. “Same time tomorrow?”
“Yup,” Nick said, slightly shaky, but overall relieved at how truly easy the radiation had been.
“You look a little pale,” commented the technician, studying Nick’s face. “Probably just nerves, right?” Nick nodded, smiling a little. “That’s okay. Well, why don’t you grab a thing of juice on the way out, get your blood sugar up a bit before you drive home.”
“Okay.” The technician led Nick back out to the waiting room, where he grabbed a juice box from the bowl on the table, downing it in just two swallows. Flattening the small cardboard container, he tossed it in the trash.
“See you tomorrow,” he called to the receptionist and then left, thinking of how annoying it was going to be to have to come here five mornings out of the week for the next six weeks.
Still, if it got rid of his tumor, it was worth it. Anything was worth that.
***
