On the chalkboard he scribbled:
“During consolidation, you’ll stay in the hospital for five or six days. For another week or two, your counts will plummet, that’s typical, and you’ll need a fair amount of support. But we’ll also do your HLA typing, and get searching for your donor. HLA takes about three weeks to process. Gold-plated, best-case scenario, one consolidation, we find a match while you’re recovering, move right into the transplant.”
“That happens?” Oliver asked.
“It does.” The doctor’s voice trained on Alice, making sure she’d heard him.
“You are white, American, of European descent,” Eisenstatt continued, “so the numbers are as much in your corner as anyone could ask. If you were an Eastern European Jew, the history of pogroms and the decreased breeding pool complicates a lot of genetic structures. Or with African Americans, the donor pool isn’t as deep as we’d prefer. I don’t make a habit of predictions, and can’t promise anything. But in the case of Mrs. Culvert, it’s conceivable we’ll find a match. I’d say finding one quickly is within the realm of possibility.”
“And if not?” she inquired, from her little protective shell.
“We will,” Oliver said.
“I know. But if not—”
“We keep searching,” Eisenstatt said. “It’s not ideal. Time is a factor. And the way to solve this is a transplant. But consecutive consolidations” “are an available option.”
“I’ve got to get on top of the insurance thing,” Oliver said. “I’m going to get that taken care of.”
The doctor was quick, kept the discussion focused. “Let’s talk about time frame. It’s been seven weeks since you were diagnosed and started with induction. The normal waiting period between chemotherapies is about eight. Seven weeks is a bit early, but still in the ballpark.” With military precision, his marker tapped against the dry-erase board, two hard taps.
“There are issues with your blood work.”
The doctor spoke with a tone as even as was possible. “I took a quick look at your aspirate slides. Probably ninety-five percent of the cells look clean. But that five percent, they’re a question.”
Alice’s eyes were shut in a way that meant she’d retreated into a mantra, one of her private worlds, and the sight was both a relief to Oliver and a little scary. Eggs of worry had hatched through his stomach, spawning colonies at the base of his spine. Eisenstatt was saying that the structure of Alice’s leukemia cells was particularly complex: it was possible the cancer could go dormant for a time, then reemerge. He was saying those five percent cells might just be regular, small, dead, noncancerous cells, in which case everything was fine. “The other possibility”—he spoke as if he had no choice—“these cells are, in fact, cancerous.”
A skilled palm wiped the board clean. Eisenstatt waited, checking whether Alice wanted to watch. “We have to be vigilant. We wait a few days with these cells, see how they mature, what happens when they replicate.” The doctor’s cheeks ballooned, he let out a breath, glanced at Oliver.
“If the leukemia’s started to replicate,” he began, in Alice’s direction, “we have no choice. We have to deal with this. We’d be at an advantage in that we’re catching this early. Those first cells barely would have a chance to replicate. We go as aggressively as possible. I can’t say I’d call it a setback for your treatment. It doesn’t change any of our long-term goals. But what we’d need to do—” He raised the board. The marker tip squeaked on the slick surface:
Alice had indeed opened her eyes and was looking at the board, at the doctor.
“Obviously, going through reinduction’s not ideal,” Eisenstatt continued. “The stress on your body is not something to take lightly. But if, if we have to go this route, we’re fortunate in that, as we were saying, you’re young, you’re coming into this strong and healthy, you have your beautiful baby, a positive attitude toward your recovery. You’d be on the ward as an inpatient for at least four weeks. So what we’d shoot for:”
A small voice asked if she might see the board, please.
Alice held out an open palm. In two strides, Eisenstatt propped the dry-erase board against her sheet-covered thighs. Now he set the marker in her waiting palm. Without so much as a glance in response, Alice turned her attention to the board. One motion added a short, crooked line across the bottom of the T;
She kept writing:
“That’s not going to happen,” Oliver said.
“Blinders on, remember?” he pleaded.
“Let the record show, Mrs. Culvert, I’m not presenting what you wrote as a possibility.”
“No, Doctor.” Streams flowing fully down her face. “You are only proposing to pump toxic chemicals in me until I’m fluorescent.”
“Alice—”
“I don’t think anything is solved by heading down this road right now, Mrs.—”
“What other options do I have, Doctor? I mean, really now, wouldn’t it be at least humane to tell me what else I can do?”
“Ali. We’re going to find a donor. We are.”
“You can seek a second opinion at other hospitals,” Eisenstatt said. “It’s your body. You have every right to decide what kind of treatment you do or do not want. Nobody is going to stop you. We’ll help you get into contact with whichever hospital you choose. But let’s be clear: time is a factor. And with that in mind, I’d like to focus on the situation in front of you right now. Because you have a decision to make, Mrs. Culvert.”
He let the sentence sink in, gave her the chance to prepare herself. “One way or another, you need chemotherapy. If the results are clean, we want to keep you in remission. If they show up different, we need to get you back to remission. You’re right on the cusp of the time frame where we’d start consolidation therapy anyway. You have to decide if you want to start treatment here, of course. But in a sense, we’re just waiting on whether the treatment will be reinduction or consolidation, and when we need to start. Oh, and your green light, of course. Getting beds here has been a problem of late — at the moment, the ward’s at a hundred and seven percent capacity.”