Once Doe calmed, Alice began. “It’s why we started early. One of the reasons anyway. I knew the disease was part of my family history. When you’re a child, that absence defines you. You form around it, you know? Then, you get older, you don’t know how long you have. Every friend — everyone we know, is busy trying to establish themselves, get their professional life going. I have ambition, too, I’m not Miss Merry Homemaker.” She sniffed, motioned with her hand, an absent gesture. “I wanted to make sure I had the chance. To — to be a mommy. I wanted kids while I’m young and can care for them and chase them. I get colds, all the time, but nothing of consequence, my entire life I’ve been healthy. So I thought, Okay, honeysuckle—”
Her voice cracked. “And now, this.”
She stared at the rack next to the door, cardboard boxes of light blue plastic gloves, surgical masks, hand sanitizer. Reaching around, so her child was still wrapped in her arms, Alice used the sleeve of her thermal, wiped at her eyes. Oliver was poised, ready with a slender stick of cheese wrapped in plastic.
“As I said, we really don’t know why leukemia appears in most patients.” Eisenstatt’s face was pink with health and closely shaven, but also had a shadow, stubble coming in. “This says you don’t have any brothers and sisters?”
“Correct.” She lightly rocked Doe. “I’m an only child.”
A pager in the room was vibrating on someone’s belt loop. Someone was laughing and walking down the hall outside the door.
A doctorish thought formed across the doctor’s face. Eisenstatt digested whatever he was thinking. When he said, “Okay,” his tone was more authoritative, the okay acting as a switch. Oliver withdrew a spiral school notebook from their bag. The doctor blinked and swallowed, tics that Alice would come to recognize as indicators he was preparing to speak at length.
“You’re on top of your treatments, that’s impressive. It’ll be helpful down the road. If you have any questions, make sure to ask. If I’m telling you things you know, I apologize, but I’d rather we’re all on the same page.”
Medical personnel, doctors and nurses alike, talked in this clipped manner: short sentences, quick back-and-forth exchanges. It was the same way in the design world, or dealing with magazine people, anyone who seemed to straddle the lines between corporate and creative worlds. Time was at a premium. Unless someone was above you on the hierarchical ladder, you didn’t have a moment to spare, merely enough time to explain what you needed, or wanted, or had to get across — then you waited for the person to catch up, nod that they understood, or stare at you looking glazed. Once the supervisor left, it was up to whomever to sink or swim. In the medical realm, at least, in Alice’s experiences there — all of which encompassed her pregnancy and these six weeks of insanity — doctors pretended it mattered if the patient understood, before continuing to the next thing.
“You have acute myeloid leukemia, or AML,” began Eisenstatt. “What this means: inside your bones there is marrow, a spongy red tissue responsible for producing your blood cells. AML is a mutation, or disruption, inside that marrow. Instead of producing a normal blood cell, your marrow produces purplish cells called myeloblasts.”
He checked to make sure she was with him, saw an eager student.
“Your red blood cell counts, your whites, your platelets — myeloblasts are what is produced instead, and when they replace your healthy blood cells, this causes a major disruption. Among what’s disrupted is the production of neutrophils — the part of the immune system that helps fight infections. We think this is what happened with your pneumonia. It’s why it was key for you to get diagnosed as quickly as you did.”
The sounds of Oliver scribbling. The conspicuous scratch of Bhakti’s nail file, now pausing. Alice gave Doe her forefinger. The baby’s cheeks imploded, her brow furrowed, her sucking rhythmic, fervent.
“With you, Doctor,” she said.
“Based on the genetic makeup of myeloblasts, AML has three possible courses of treatment. First: simple. The genetic makeup of the AML cells is, for lack of a better term, the most straightforward. Treatment: straight systematic chemotherapy. With simple AML we have a good—”
“You can spare us,” Oliver said. “We know we have the complicated kind.”
Eisenstatt nodded. “So you already know we’re looking at a stem cell transplant. And you know this is a serious procedure. We have to find a bone marrow donor with a genetic match of your DNA. There are ten categories that have to match. The more we can line up, the better we are.” He waited a count. “Since siblings have DNA from both parents, they often give us a chance at the best match. You’re an only child, so—”
“That option is not available,” Alice finished.
“We’ll look to the National Donor Registry. If and when we do match you with a donor, the next step would be an aggressive regime, followed by a transplant. You’ll be in the hospital for six to eight weeks, under a high-level quarantine.”
“The rooms on the transplant floor are very nice,” Dr. Bhakti said. She’d reemerged from whatever hole, her nail file no longer apparent.
Eisenstatt put down the clipboard next to him, picked it back up, tapped it against his upper thigh. “Transplants are a fairly recent development. And as far as the success rate—”
Alice cut him off. “Let me be as clear as I can make myself,” she said. “Any numbers or information that might upset me, I don’t want to know. I’m young. I’ve been healthy my whole life. I’m not another one of the seventy-year-olds in your waiting room, health and blessings to them all.”
She felt the bones inside her fingers vibrating, felt herself powerless to stop them, felt herself pulsing with strength, ready to vomit. “Please, just let me know what I have to do each day. Just put it in front of me. Do that, I promise, I will work hard. Because I am going to watch my child grow.”
Dr. Bhakti was looking at Alice in a manner that suggested, for the first time, she considered the possibility Alice might have legitimate thoughts and feelings. Dr. Eisenstatt was squinting lightly, his eyes considerate.
“I think your attitude is admirable,” he said. “I’ll only provide statistics if you ask.”
“Blinders on,” Oliver said. “That’s how we’ve been getting through this.”
“You should know,” the doctor said, “right now things are going extremely well. The work in New Hampshire was first rate. And getting you to this point was a big step. My job is to shepherd you to the transplant. I take this responsibility seriously. My modus operandi, I always operate on a worst-case-scenario basis. I’m going to assume the worst, give you the most conservative and oppressive possibilities. Consider me your new Jewish grandmother.” He met her eyes, gave a bit of a smile. “That’s my job. Get you to transplant. Once we find a donor, a transplant doctor will take over. You’ll go forward from there and be happy to be rid of me.”
Doe squirmed, kicking at Mommy’s chest.
“As I said, BMT is a fairly recent procedure,” Eisenstatt continued. “We’ve been doing it at Whitman for about five years. And while it’s no walk in the park, it can work: genetic matches do happen, people do find donors. People have this procedure and they get better. From what we’ve seen, new marrow acts as a cure.”
His words were punctuated by the redolent smack of hands against knees, Oliver rocking in place. Alice watched him flexing his feet, pressing forward from the balls of his toes; she was aware of her own stillness, the fussing child against the front of her right shoulder, her hand weak on the back of the baby’s head, supporting her. The child was sweating, her little fuzz of hair damp.