Bones (7b/10)
Continued from here. The medical jargon comes almost word for word from here.
The next few weeks are a blur of treatment and sickness and fighting with Mark over his continuing to work on Facebook and then feeling guilty for fighting with Mark because he is so weak, worn completely out by the chemotherapy. He finishes his final treatment a fortnight before going in for a consultation with Dr Lewis; it takes him longer and longer to get over it. The last week of chemo was the worst. Eduardo wasn’t sure Mark was going to make it through. Several times he woke up to the sound of Mark sobbing in agony into his pillow and he would get up from his place on the sofa and go to him, put his arms around him and reassure him that the pain was a good thing, it meant the chemotherapy was doing something, because that was what hurt. Late one evening, with Mark’s dad asleep in the chair by the bed, his head lolling back and his mouth hanging open, Eduardo sat by Mark with a bowl of water and helped him wash his face and brush his teeth because he was too weak to stand up to go to the bathroom. He then got a comb out and Mark closed his eyes, sighing softly as Eduardo brushed his hair. He only opened his eyes when Eduardo stopped, and they both stared at the thick clumps of hair in Eduardo’s hand, then at one another. He’d been lucky so far, not losing his hair, but things are getting far, far worse.
Eduardo and Mark sit side by side in Dr Lewis’ plush office on the top floor of the hospital in Palo Alto. He hadn’t told his parents that he was coming in today to find out whether the treatment had been successful, because he hadn’t wanted to worry them until it’s necessary, he said. Eduardo was long past arguing with him.
The doctor comes in quietly; they don’t hear him until the door clicks closed behind him. Nobody says anything and the air feels ominously heavy. When Dr Lewis has settled into his seat, he places both of his hands on top of Mark’s hospital notes, the bulging folder of letters and blood pressure readings and test results. Eduardo knows immediately, just from the carefully composed lack of expression on the doctor’s face, that the news is not going to be good.
“Gentlemen,” Dr Lewis says, and instinctively Eduardo reaches out and grabs Mark’s hand that is resting on his knee. “I’m afraid things haven’t gone quite as we had hoped.”
He had seen it coming, but still Eduardo’s stomach drops, and for a few seconds it feels as though his heart stops beating. He squeezes Mark’s hand tightly, grounding himself, holding fast.
“What do you mean?” Eduardo asks when Mark doesn’t speak. He has gone alarmingly pale, even paler than usual. He is staring helplessly at Dr Lewis, his ocean eyes blank and hopeless.
“In your case, Mark, the stem cells in the bone marrow malfunctioned, producing an excessive number of defective or immature blood cells. These blood cells interfere with the production of normal cells and accumulate in the bloodstream. That is the leukaemia. Now, as you know, chemotherapy acts by killing the cancerous cells. These cells divide rapidly, and the first stage of your treatment was to stop that, to stop the cell division. The second stage, which you have just completed, is to destroy the abnormal cells altogether -“
“Look,” Eduardo interrupts, frustrated. He knows all of this. “Can we get to the part where things haven’t gone as you had hoped?”
“I’m getting there,” Dr Lewis says, not unkindly. Eduardo grits his teeth and squeezes Mark’s hand again. Mark doesn’t respond.
“As I was saying, the second stage of chemotherapy destroys the abnormal cells. The therapy, however, not only kills abnormal cells, but can also damage the healthy cells found in the bone marrow. Which, Mark, is what has happened in your case.”
Eduardo gapes dumbly at the doctor, and then turns to Mark, who is still staring blankly forward, his eyes unfocused. He doesn’t look as if the words have quite reached him.
“Mark,” Eduardo says softly. Mark’s head turns slowly. He looks at Eduardo as if he doesn’t recognise him. “Mark. Do you - Were you - Are you okay?”
Mark nods. He turns back to Dr Lewis and asks, “Is that it, then?”
And everything that they talked about weeks ago, about Mark feeling as though he knew he were going to die...it hits Eduardo all over again. They really needed some good news today. Mark’s hope is as delicate and fragile as a soap bubble in Eduardo’s hands, and Eduardo had thought, until Dr Lewis had spoken, his words as sharp as needles, that he could hold on, keep it safe.
“No,” Eduardo says emphatically, twisting in his chair and putting a hand out, cupping Mark’s face. He can see the defeat written there, it’s in his eyes, and there is nothing, he realises, nothing that he would not do to save this man. “No. There’s something. Some way. There’s always something. Right?” He asks, turning back to the doctor.
Dr Lewis nods. “The next thing I suggest we try is a bone marrow transplant.”
The words stir something in Eduardo and he remembers reading about this forever ago, back when he first found out that Mark was sick. He frowns. The statistics, he remembers, were not good.
“Bone marrow transplantation is, in the scheme of things, a relatively new medical procedure. The transplant replaces the damaged and diseased bone marrow with healthy bone marrow.”
“But?” Mark asks, and his voice is a croak, a whisper, but it cuts through the air.
“But bone marrow transplants do not provide 100 percent insurance that the disease will not recur. And as you are already in a relatively weakened state from the treatment you have already received, it will be quite…taxing. The procedure, treatment and recovery period is long and painful. I realise that this isn’t what you want or need to hear, but that is how it is. It takes months, literally, to complete the full treatment and recovery phase. And of course there is the question of finding a bone marrow donor.”
“I’ll do it,” Eduardo says instantly, and Mark turns sharply to look at him, his eyes wide.
“No,” he murmurs.
“But I can help,” Eduardo tells him.
“I don’t want…There are other things I need you for, Wardo. I don’t want you to be hurt.”
Quietly, Dr Lewis coughs, and they both turn back to look at him. Eduardo tries to swallow down the lump that has formed in his throat. Mark really, really cares. It’s a strange time to discover this.
“With all due respect, Eduardo, it is highly unlikely that you could be the donor. The bone marrow needs to be a near-perfect genetic match.”
Eduardo looks down at their hands locked together, his own tan fingers linked with Mark’s pale ones. They are too different. It needs to be family, someone close, or -
“I can do it,” Mark says. “Right? I’ve read about this. Just take it from somewhere else in my body.”
“That is the other option,” Dr Lewis nods.
“I would rather do that,” Mark says. “I can’t ask my family for this.”
Eduardo opens his mouth to speak, to say they would kill to be able to do something for you, but he remembers that this is Mark, and of course he won’t ask for help, and of course he wouldn’t want to put any of them through that. If there’s a way that he can do something independently, he will always choose that route.
“I will explain to you now, Mark, what the treatment will entail, before you decide. Firstly, we have to assess whether you are strong enough to undergo the rigors of the transplant procedure. Prior to a bone marrow transplant, the patient undergoes a battery of tests. We assess the heart, lungs, kidneys - all the vital organs so that post-transplant, we can determine if any body functions have been impaired. We can get the ball rolling with this straight away. As this is a specialised private hospital for cancer care, we have both the facilities and expert staff who can quickly recognise problems and side effects during the treatment. If you were planning to undergo this treatment through a state hospital, they would send you here.”
Mark nods. Eduardo thinks, the world’s youngest billionaire and this is what he has to spend his money on. Saving his own life.
“If we decide that you are physically capable of undergoing the treatment, we then collect the healthy bone marrow. This is done with you under general anaesthetic. A needle is inserted into the cavity of the rear hip bone - where a large quantity of bone marrow is located - and the bone marrow is extracted with the needle and syringe. Several skin punctures on each hip are usually required to extract the requisite amount of bone marrow. We usually extract one to two quarts of marrow and blood. This may sound like a lot, but it really only represents about 2% of a person’s bone marrow, which the body replaces within four weeks.”
Eduardo nods this time. Mark looks even paler. The hand that isn’t clenched around Eduardo’s rests on his knee and is visibly shaking.
“For autologous transplants - meaning if you act as your own donor - the bone marrow will be frozen until we use it. It may first be purged - we remove any residual cancerous cells. Prior to the transplant you will first undergo several days of chemotherapy-“ at that Mark winces, “-which destroys bone marrow and cancerous cells to make room for the new, healthy bone marrow. This is the conditioning phase. Now, the dosage of chemotherapy given to you during conditioning is much stronger than dosages that you have already been administered.”
Dr Lewis stops when Mark closes his eyes and sighs audibly.
“Mark?” he asks.
“So it will be worse than what I’ve already gone through?” Mark asks.
“Exponentially,” he replies, and Mark takes a deep, shuddery breath, but nods.
“Okay. As long as I know.”
“Do you want me to go on?” Dr Lewis asks. He looks uncertain.
“Yeah. I just…wanted to know.”
“Of course. Now, the transplant is not technically what it sounds like. It isn’t a surgical operation. A day or two following the chemotherapy treatment, the transplant will occur. The bone marrow is infused into you intravenously, through your catheter, much in the same way that chemotherapy treatment is given. The effect on your body will be similar, only increased. I must warn you, it is a debilitating experience. Nausea, vomiting, fever, diarrhea and extreme weakness, such as you have already experienced, but lasting not for several days, but for several weeks following the transplant.”
“Oh, God,” Mark murmurs.
“Yes,” Dr Lewis agrees.
“What -“ Eduardo tries to say, but his mouth has dried up and he has to swallow before he can try again. “What could go wrong?”
“Complications such as infection - because your immune system will be so low - bleeding and mouth sores that make eating and drinking uncomfortable, as well as the risk of liver disease from the treatment or even the new marrow being rejected by your body. Psychologically, it is evidently a very trying period. Often the patients become confused and it can be quite frightening if they do not understand that it is only temporary. Patients are already traumatised by the news that they have a life-threatening disease. Helplessness is also a common feeling among bone marrow transplant patients. For many - and I have certainly recognised this within you, Mark - it is unnerving to be entirely dependent on a relative stranger for survival.”
There is a long pause. The air weighs heavy in the room. Eduardo is struggling to breathe evenly, to hold himself together. Only Mark’s hand in his, and the knowledge that Mark actually does need him right now, keeps him there.
Finally, Mark asks, “Is it worth it?”
Dr Lewis sits forward in his chair and links his hands together. He sighs quietly before speaking.
“Mark,” he says. “You are one of the most remarkable people I have ever treated. You have had a strength and honesty about you during your treatment so far that astonishes me, and as your doctor, I feel that I must at least attempt to carry myself the same way. I understand what you have already gone through. I was late to start my medical training, nearly in my forties. But I was young when I married, and when I had my daughter, Imogen. She was diagnosed with leukaemia when she was 13 years old. That is why I do what I do today - to help people the way that modern medicine helped her.”
“What happened to her?” Mark asks softly.
Dr Lewis smiles. “Six months ago she and her husband had their second child. A son.”
He turns around a framed photograph on his desk to show them a tired-looking but lovely young woman holding a bright red, sleeping newborn in her arms. Mark reaches out a hand, as if he wants to touch it, the photograph, to have some connection with this woman who survived. But he lets his hand drop.
“Throughout her treatment, Imogen wanted to know everything, every painful, gritty detail, and so we were honest with her, her mother and I. And I am going to be honest with you now, Mark, brutally so: without this treatment, you will almost certainly die.”
The words hit Eduardo hard, and he gasps inwards, sharply. It is Mark, this time, that squeezes his hand. He turns and Mark is staring at him, eyes bright now, head cocked slightly to one side as though he is figuring something out, deciding something.
“I don’t want to die,” he says finally, and Eduardo has never been so relieved to hear anything in his entire life. He is surprised at how calm Mark sounds. His hands have stopped shaking.
“The next few months are going to be tough, Mark. And as a doctor I am not encouraged to give out hope that could be seen as false, but I believe that you can do it.” Dr Lewis turns the photograph of his daughter back around to face him. He smiles slightly at the picture, and then at Mark and Eduardo. “I think that this can save you.”
To be continued
The next few weeks are a blur of treatment and sickness and fighting with Mark over his continuing to work on Facebook and then feeling guilty for fighting with Mark because he is so weak, worn completely out by the chemotherapy. He finishes his final treatment a fortnight before going in for a consultation with Dr Lewis; it takes him longer and longer to get over it. The last week of chemo was the worst. Eduardo wasn’t sure Mark was going to make it through. Several times he woke up to the sound of Mark sobbing in agony into his pillow and he would get up from his place on the sofa and go to him, put his arms around him and reassure him that the pain was a good thing, it meant the chemotherapy was doing something, because that was what hurt. Late one evening, with Mark’s dad asleep in the chair by the bed, his head lolling back and his mouth hanging open, Eduardo sat by Mark with a bowl of water and helped him wash his face and brush his teeth because he was too weak to stand up to go to the bathroom. He then got a comb out and Mark closed his eyes, sighing softly as Eduardo brushed his hair. He only opened his eyes when Eduardo stopped, and they both stared at the thick clumps of hair in Eduardo’s hand, then at one another. He’d been lucky so far, not losing his hair, but things are getting far, far worse.
Eduardo and Mark sit side by side in Dr Lewis’ plush office on the top floor of the hospital in Palo Alto. He hadn’t told his parents that he was coming in today to find out whether the treatment had been successful, because he hadn’t wanted to worry them until it’s necessary, he said. Eduardo was long past arguing with him.
The doctor comes in quietly; they don’t hear him until the door clicks closed behind him. Nobody says anything and the air feels ominously heavy. When Dr Lewis has settled into his seat, he places both of his hands on top of Mark’s hospital notes, the bulging folder of letters and blood pressure readings and test results. Eduardo knows immediately, just from the carefully composed lack of expression on the doctor’s face, that the news is not going to be good.
“Gentlemen,” Dr Lewis says, and instinctively Eduardo reaches out and grabs Mark’s hand that is resting on his knee. “I’m afraid things haven’t gone quite as we had hoped.”
He had seen it coming, but still Eduardo’s stomach drops, and for a few seconds it feels as though his heart stops beating. He squeezes Mark’s hand tightly, grounding himself, holding fast.
“What do you mean?” Eduardo asks when Mark doesn’t speak. He has gone alarmingly pale, even paler than usual. He is staring helplessly at Dr Lewis, his ocean eyes blank and hopeless.
“In your case, Mark, the stem cells in the bone marrow malfunctioned, producing an excessive number of defective or immature blood cells. These blood cells interfere with the production of normal cells and accumulate in the bloodstream. That is the leukaemia. Now, as you know, chemotherapy acts by killing the cancerous cells. These cells divide rapidly, and the first stage of your treatment was to stop that, to stop the cell division. The second stage, which you have just completed, is to destroy the abnormal cells altogether -“
“Look,” Eduardo interrupts, frustrated. He knows all of this. “Can we get to the part where things haven’t gone as you had hoped?”
“I’m getting there,” Dr Lewis says, not unkindly. Eduardo grits his teeth and squeezes Mark’s hand again. Mark doesn’t respond.
“As I was saying, the second stage of chemotherapy destroys the abnormal cells. The therapy, however, not only kills abnormal cells, but can also damage the healthy cells found in the bone marrow. Which, Mark, is what has happened in your case.”
Eduardo gapes dumbly at the doctor, and then turns to Mark, who is still staring blankly forward, his eyes unfocused. He doesn’t look as if the words have quite reached him.
“Mark,” Eduardo says softly. Mark’s head turns slowly. He looks at Eduardo as if he doesn’t recognise him. “Mark. Do you - Were you - Are you okay?”
Mark nods. He turns back to Dr Lewis and asks, “Is that it, then?”
And everything that they talked about weeks ago, about Mark feeling as though he knew he were going to die...it hits Eduardo all over again. They really needed some good news today. Mark’s hope is as delicate and fragile as a soap bubble in Eduardo’s hands, and Eduardo had thought, until Dr Lewis had spoken, his words as sharp as needles, that he could hold on, keep it safe.
“No,” Eduardo says emphatically, twisting in his chair and putting a hand out, cupping Mark’s face. He can see the defeat written there, it’s in his eyes, and there is nothing, he realises, nothing that he would not do to save this man. “No. There’s something. Some way. There’s always something. Right?” He asks, turning back to the doctor.
Dr Lewis nods. “The next thing I suggest we try is a bone marrow transplant.”
The words stir something in Eduardo and he remembers reading about this forever ago, back when he first found out that Mark was sick. He frowns. The statistics, he remembers, were not good.
“Bone marrow transplantation is, in the scheme of things, a relatively new medical procedure. The transplant replaces the damaged and diseased bone marrow with healthy bone marrow.”
“But?” Mark asks, and his voice is a croak, a whisper, but it cuts through the air.
“But bone marrow transplants do not provide 100 percent insurance that the disease will not recur. And as you are already in a relatively weakened state from the treatment you have already received, it will be quite…taxing. The procedure, treatment and recovery period is long and painful. I realise that this isn’t what you want or need to hear, but that is how it is. It takes months, literally, to complete the full treatment and recovery phase. And of course there is the question of finding a bone marrow donor.”
“I’ll do it,” Eduardo says instantly, and Mark turns sharply to look at him, his eyes wide.
“No,” he murmurs.
“But I can help,” Eduardo tells him.
“I don’t want…There are other things I need you for, Wardo. I don’t want you to be hurt.”
Quietly, Dr Lewis coughs, and they both turn back to look at him. Eduardo tries to swallow down the lump that has formed in his throat. Mark really, really cares. It’s a strange time to discover this.
“With all due respect, Eduardo, it is highly unlikely that you could be the donor. The bone marrow needs to be a near-perfect genetic match.”
Eduardo looks down at their hands locked together, his own tan fingers linked with Mark’s pale ones. They are too different. It needs to be family, someone close, or -
“I can do it,” Mark says. “Right? I’ve read about this. Just take it from somewhere else in my body.”
“That is the other option,” Dr Lewis nods.
“I would rather do that,” Mark says. “I can’t ask my family for this.”
Eduardo opens his mouth to speak, to say they would kill to be able to do something for you, but he remembers that this is Mark, and of course he won’t ask for help, and of course he wouldn’t want to put any of them through that. If there’s a way that he can do something independently, he will always choose that route.
“I will explain to you now, Mark, what the treatment will entail, before you decide. Firstly, we have to assess whether you are strong enough to undergo the rigors of the transplant procedure. Prior to a bone marrow transplant, the patient undergoes a battery of tests. We assess the heart, lungs, kidneys - all the vital organs so that post-transplant, we can determine if any body functions have been impaired. We can get the ball rolling with this straight away. As this is a specialised private hospital for cancer care, we have both the facilities and expert staff who can quickly recognise problems and side effects during the treatment. If you were planning to undergo this treatment through a state hospital, they would send you here.”
Mark nods. Eduardo thinks, the world’s youngest billionaire and this is what he has to spend his money on. Saving his own life.
“If we decide that you are physically capable of undergoing the treatment, we then collect the healthy bone marrow. This is done with you under general anaesthetic. A needle is inserted into the cavity of the rear hip bone - where a large quantity of bone marrow is located - and the bone marrow is extracted with the needle and syringe. Several skin punctures on each hip are usually required to extract the requisite amount of bone marrow. We usually extract one to two quarts of marrow and blood. This may sound like a lot, but it really only represents about 2% of a person’s bone marrow, which the body replaces within four weeks.”
Eduardo nods this time. Mark looks even paler. The hand that isn’t clenched around Eduardo’s rests on his knee and is visibly shaking.
“For autologous transplants - meaning if you act as your own donor - the bone marrow will be frozen until we use it. It may first be purged - we remove any residual cancerous cells. Prior to the transplant you will first undergo several days of chemotherapy-“ at that Mark winces, “-which destroys bone marrow and cancerous cells to make room for the new, healthy bone marrow. This is the conditioning phase. Now, the dosage of chemotherapy given to you during conditioning is much stronger than dosages that you have already been administered.”
Dr Lewis stops when Mark closes his eyes and sighs audibly.
“Mark?” he asks.
“So it will be worse than what I’ve already gone through?” Mark asks.
“Exponentially,” he replies, and Mark takes a deep, shuddery breath, but nods.
“Okay. As long as I know.”
“Do you want me to go on?” Dr Lewis asks. He looks uncertain.
“Yeah. I just…wanted to know.”
“Of course. Now, the transplant is not technically what it sounds like. It isn’t a surgical operation. A day or two following the chemotherapy treatment, the transplant will occur. The bone marrow is infused into you intravenously, through your catheter, much in the same way that chemotherapy treatment is given. The effect on your body will be similar, only increased. I must warn you, it is a debilitating experience. Nausea, vomiting, fever, diarrhea and extreme weakness, such as you have already experienced, but lasting not for several days, but for several weeks following the transplant.”
“Oh, God,” Mark murmurs.
“Yes,” Dr Lewis agrees.
“What -“ Eduardo tries to say, but his mouth has dried up and he has to swallow before he can try again. “What could go wrong?”
“Complications such as infection - because your immune system will be so low - bleeding and mouth sores that make eating and drinking uncomfortable, as well as the risk of liver disease from the treatment or even the new marrow being rejected by your body. Psychologically, it is evidently a very trying period. Often the patients become confused and it can be quite frightening if they do not understand that it is only temporary. Patients are already traumatised by the news that they have a life-threatening disease. Helplessness is also a common feeling among bone marrow transplant patients. For many - and I have certainly recognised this within you, Mark - it is unnerving to be entirely dependent on a relative stranger for survival.”
There is a long pause. The air weighs heavy in the room. Eduardo is struggling to breathe evenly, to hold himself together. Only Mark’s hand in his, and the knowledge that Mark actually does need him right now, keeps him there.
Finally, Mark asks, “Is it worth it?”
Dr Lewis sits forward in his chair and links his hands together. He sighs quietly before speaking.
“Mark,” he says. “You are one of the most remarkable people I have ever treated. You have had a strength and honesty about you during your treatment so far that astonishes me, and as your doctor, I feel that I must at least attempt to carry myself the same way. I understand what you have already gone through. I was late to start my medical training, nearly in my forties. But I was young when I married, and when I had my daughter, Imogen. She was diagnosed with leukaemia when she was 13 years old. That is why I do what I do today - to help people the way that modern medicine helped her.”
“What happened to her?” Mark asks softly.
Dr Lewis smiles. “Six months ago she and her husband had their second child. A son.”
He turns around a framed photograph on his desk to show them a tired-looking but lovely young woman holding a bright red, sleeping newborn in her arms. Mark reaches out a hand, as if he wants to touch it, the photograph, to have some connection with this woman who survived. But he lets his hand drop.
“Throughout her treatment, Imogen wanted to know everything, every painful, gritty detail, and so we were honest with her, her mother and I. And I am going to be honest with you now, Mark, brutally so: without this treatment, you will almost certainly die.”
The words hit Eduardo hard, and he gasps inwards, sharply. It is Mark, this time, that squeezes his hand. He turns and Mark is staring at him, eyes bright now, head cocked slightly to one side as though he is figuring something out, deciding something.
“I don’t want to die,” he says finally, and Eduardo has never been so relieved to hear anything in his entire life. He is surprised at how calm Mark sounds. His hands have stopped shaking.
“The next few months are going to be tough, Mark. And as a doctor I am not encouraged to give out hope that could be seen as false, but I believe that you can do it.” Dr Lewis turns the photograph of his daughter back around to face him. He smiles slightly at the picture, and then at Mark and Eduardo. “I think that this can save you.”
To be continued