Nine
“How was your night?” Doctor Dresdell looked perfectly put together as she sat down on the other side of the black desk.
Her hair was pulled back again, only this time, Cassandra saw silver streaks running along her temple. The woman might not have any wrinkles on her face, but she was older than Cassandra initially thought.
“It went well.” Bile rose in the back of her throat. Judy arched a brow. Slumping down into the chair, she fought back the tears. “It was awful. Horrible. Every moment I spent either thinking about having cancer, or worrying what in my daily life would make the cancer worse.” She squeezed her eyes shut and held her breath in an attempt to control her emotions. It failed, sending down her face as she gasped for air.
“It’s all right. I would have been concerned if it were any other way.” She gestured to a tissue box on the corner of her desk. “Part of your treatment is going to be a therapist or a group. You cannot do this on your own. Friends and family are wonderful, but you need to engage with others who understand you. There is a support group with the hospital, but you may, of course, seek out your own on the internet; just make certain you meet in person at times.”
“Isn’t that a bit . . . morbid? To surround myself with others who are fighting to live?”
“At times, yes. They will offer you insight into yourself that no one else can have. Their struggles will hurt you at times as yours will theirs. But their victories will fuel you. Cancer isn’t just treatment, it’s a mental fight. You have to want to live more than you want to give in and hope it passes.”
Anger brewed at the implication she didn’t want to live. “How dare you?”
A smile twitched at the corner of the doctor’s mouth and it stopped Cassandra from continuing on her rant.
“That is the fire you will need. I apologize you thought I was inferring you weren’t ready to fight, but I am pleased with your response. Are you ready to begin?”
Confusion warred with anger, but somehow, Cassandra knew neither emotion had any place in her world right now. “Yes. I did what you mentioned yesterday, and I’d like to know what’s next.”
“What’s next,” Judy tapped on a file on the desk with Cassandra’s name on it before flipping it open. “Is covering a possible treatment plan. I don’t know if you went on a Google binge, or requested help on social media, but I need you to understand that every treatment plan is different. What we do for you won’t match the doses and steps we do for someone else with Stage Three Non Invasive Breast Cancer. This is tailored to your body.”
The words fuzzed out for a moment, and the doctor sounded like the teacher in Charlie Brown.
“Cassandra, are you with me?”
“No. I’m sorry.”
“It’s fine. I just need you to acknowledge that you aren’t going to go and compare what we do with what anyone else has had done. This treatment plan is for you, Cassandra Marks, and you alone.”
She’d heard that before, on some show where the lead had cancer. “Yes, I understand.”
“Good. We need to run a blood test to ensure your body can handle this, of course, but this is our expected course of action.”
Cassandra looked at the typed up pages and bobbed sideways from a surge of unexpected wooziness. She could tell she was upright, but her body seemed to sway back and forth as the room blurred in and out of focus.
“I don’t feel so great.”
“That’s all right. It’s natural to feel overwhelmed. We’ll go very slowly. Just take deep breaths.”
What she wanted to do was lay back on a plush bed, close her eyes and wake up healthy. Instead, she sucked in a lungful of air and held it until her chest burned with the need to exhale. “Ready as I can be.”
“It shouldn’t come as a surprise to you chemotherapy is a part of the plan. The reason we start here is to see if the cancer is receptive. There’s no sense in a mastectomy if the chemo will do what we need it too. You will be on outpatient care to start, not the dreaded hospital stay some people go through. There will be four rounds of chemo over the next two months. Each round will be three hours. Does this make sense?”
The numbers swirled in her head, they meant nothing to her, but they should have been everything. “So I come in, you stick an IV my arm, and I sit with a book for three hours? What happens when I leave? What about after these four treatments? What do I do to prepare? How many times do we try this?” Her heart slammed in her chest so loudly she swore she could hear it.
“Slow down.” Judy’s tone was polite, and understanding splashed across her face. “This is common. Try to focus on my voice. We can cover questions as we go, one at a time.”
Hot liquid rose in the back of Cassandra’s mouth, one of the signs she might vomit. Swallowing the salvia back, Cassandra closed her eyes and took two deep breaths. “All right, I think.”
“Now, this chemo will be aggressive. I don’t want it to scare you. It’s going to be a mix of Adrimaycin and Cytoxin. I know you’ll go Google these, and I know you’ll stumble across the term Red Devil. I don’t want you to be alarmed, but it is because of the side effects. Your hair will fall out. It’s not a matter of if, but when. Typically, it starts small and escalates quickly during the second month of treatment. Many of my patients elect to shave their hair so it’s easy to cope with. My recommendation is to do what’s best for you. Only you know how important your hair is to you. You will be nauseous at times, experience a lack of appetite and the potential for sleep loss and mouth sores is common.” Judy grew quiet, her brows knitting together. “Cassandra. Try to focus.”
“Red Devil.”
“Yes. It’s nasty, but it’s your fighting chance. This drug is powerful, and that means side effects. But it means results as well. And we can fight off many of the side effects. Your IV will have a steroid bag to help control your stomach, it’s not infallible, but it helps greatly.”
“And this will take it away? The cancer I mean.”
Doctor Dresdell sighed, her shoulders slumping, and a frown tugged down the corners of her lips. “This will help, there are no guarantees with cancer—and there is more to your initial treatment.” The other woman did something unexpected, she stood up and walked to stand before Cassandra, squatting down. “This is a lot to take in. It’s necessary though. Do you need some time to digest this?”
An image of Gabe flashed in her mind, nothing more than how he’d looked the moment she’d accepted a date. Her panic seemed to quell as if merely thinking about something normal helped to calm her down. Her heart still beat rapidly, but she no longer thought she heard the quick pulse and though her mouth still felt filled with liquid, she wasn’t afraid she’d lose the little breakfast she’d consumed.
“I’m fine. Please continue.”
The oncologist nodded but stayed squatting. “After those first two months, we’re going to start you on a drug called Taxol. This will be every other week for another two months. It’s our hope that this will rid your body of the cancer.”
“Isn’t there a lump you should take out?”
“In the past, we’ve done surgery first. The more aggressive chemo treatments allow us to break down the cancer first. If for some reason it is ineffective, the next phase of your plan will be surgery. While it’s impossible to know if it will be a simple lumpectomy or mastectomy, radiation treatment has made it possible to avoid it in many instances.”
The first sigh of relief slipped out. The doctor thought there was a way to treat her without removing her breasts—she could live without her hair. You’ll live without boobs if that’s what it comes down too.
“And what are the percentages this is all I’ll need?”
“I can’t give you that at this time. Your body needs time to respond to the treatment. I assure you,” Judy took Cassandra’s hands and squeezed. “This plan may have been put together on short notice, but it is no less complete. This is the best possible chance to save you right now.”
Words stuck in her throat as the words from the doctor danced in her mind. Chemo. Best possible chance. Respond to treatment. There was no avoiding the flood of tears spilling silently down her cheeks. There was no way to even know if she was still sitting as the weight of the world crashed down on her. Sobs racked through her body, shaking her where she sat. The once silent tears became tumultuous as her cries filled the small office. Mucus filled her nose from crying, and she chocked. Her eyes flew open as she gasped for air. The tacky gray carpet seemed to taunt her as she stared at it, eyes burning with tears.
Only when she stopped crying did she realize Judy was rubbing her hand across her back in circles as a mother might do their child. Her face was a mix of wetness and red, and her chest hurt from the physicality of the fit, but she was done. There were either no tears left, or she’d simply tired herself out.
“I’m sorry,” the words croaked out, and she buried her head in her hands, embarrassment moving in.
“Quite all right. That is a natural response to this situation. As I mentioned, finding others who understand your journey will be important, but so will not being alone during this. While it might seem strange, I encourage you to have a friend stay with you at appointments.”
“I live close by, I use the T.”
“MBTA won’t be a valid option. Your body will be frail, both in between and right after treatments. You can, of course, take an Uber, but having a friend with you will make a difference.”
She was consciously aware of the way she sucked in a deep breath and stared at the other woman. Cassandra had close friends, but many were away in other countries. She had a few connections to uncles and aunts from her foster parents, but it didn’t feel right to burden them with this.
“I will think about it.”
Judy's eyes narrowed, likely displeased with the response, but Cassandra only had that to offer. Living life out of a suitcase for work meant ties were limited while home and being from the system left her with no ties once her adopted parents had died because they’d had no siblings or living parents. It wasn’t that she didn’t want one person to help her fight this, even if she believed she’d only tell work, she knew sooner or later someone else would learn of it.
“Splendid. We need to discuss some of what you’ll experience during your treatment to best prepare you. You need to be aware of what is to come, but if it is too much right now, I can send you to get your blood drawn for the test, and we can speak right after. The space might help you.”
“No.” Zero pause. “I want to know it all right now.” Looking down at her hands seemed more comfortable until she noticed the slight way they shook against her knees. She couldn’t handle staring at the doctor, so she directed her attention at a diagram on the wall. Tears still blurred her vision, leaving her uncertain what she the diagram showed, but still preferred. Cassandra had no desire to see any compassion or sympathy, not right now.
“Alright then. As we discussed briefly, your immune system is compromised, it will only continue to be so as the chemo starts. You will need a clean environment. I am not saying you have to live in a bubble, but you will need to carry hand sanitizer, keep your living area clean and be mindful of your surroundings. Contrary to what most people think, it is not cancer that kills a person, but another ailment caught because the body is too focused on fighting off the multiplying cancer cells.”
“Ironic I suppose.” The sentence slipped out, forcing her gaze over to the doctor. “I’m sorry.”
“It is a harsh reality, but your job is to keep yourself healthy. My job is to kill the cancer.” She smiled a genuine smile that warmed her dark eyes. “Now, we have to keep talking about the hard stuff, just a little longer.”
“I understand.” And she did. Bracing herself, Cassandra curled her fingers around the metal arm of the chair. “What’s going to be the worst part?”
“It is different for everyone—though most women deem the hair loss the hardest to cope with. Physically, the vomiting will take its toll. Your body will be weakened, and the heaving will hurt. That’s why we’ll be providing steroids for nausea, to mitigate any issues.”
She nodded, noticing a strange tingle in the tips of her fingers as she rubbed her hands together. That’s probably all in your head. “I can’t feel my hands.”
“That’s probably nerves, but if you can’t feel them after we take some blood, I want you to come right back.” She finally stood and walked back to stand behind her desk. “You will see your nail beds change—sometimes they grow yellow, other times they crack.”
“Because hair and nails are the same?”
“That is correct. You’ll find yourself having trouble sleeping, or possibly sleeping a lot. Sleep matters, get as much as you can. Your nerve endings will die, maybe not entirely, but at least partially by the third round of treatment. The smallest touch will feel like a hammer coming down. I’m sorry to say there is little we can do for that, except add necessary pain medications if you are in need. That is a bridge to cross once it happens, but I wanted to bring it up as many people were taken off guard by such sensations, and now they’re common disclosures during conversations of this nature.”
“What’s the point?” The bitter sentiment shocked her.
“The point is to live. This will be hard, but you told me you were ready to fight. Whether that’s changed or not, I’m going to fight for you. So will every technician, nurse, diagnostician and anyone else you come into contact with. But our fight only matters if you’re still fighting with us.” Disappointment cast across her face, though she held Cassandra’s gaze.
Tears filled her eyes again, and Cassandra forced off a growl. She didn’t want to cry anymore, crying was tiresome and encompassed more than enough of her youth. “So what I’ve gathered is I can’t travel for work. I can’t be in messy places, and there are going to be moments when my body will betray me more than it already has.” Anger dripped from the words. “And I’m going to fight every single day because there are kids out there that need me to help them get homes.” At that moment, she wasn’t fighting just because thirty was too young to die; but because people needed her more than she needed herself.
Doctor Dresdell nodded slowly, a smile on her lips. “Lastly, I believe the most important thing to cover with you, is a will.”
Once again, the room spun and actually seemed to have the lights dim. Swallowing, Cassandra closed her eyes for a moment, hoping that when she reopened them, the room would be right again. It was.
“I don’t think I’m ready to discuss that yet, but if there’s information on it, I’ll make myself ready soon.”
She pushed the file folder over to Cassandra. “This is for your records. There are pamphlets inside about everything we’ve discussed. Read them over. My cell number is there as well. Your first appointment has been written down. I hope you understand, we will schedule the rest around your schedule and how your body is responding, but we need to begin.”
There was a fine line between understanding, liking and wanting to throw up. Cassandra wasn’t sure where she fit on the spectrum.
Scared shitless.
“How will we know if I’m okay?” The question was barely above a whisper.
“We will draw blood routinely, but it is unlikely results will occur until after your Taxol treatment. The same blood cell counts that let us know you have cancer will let us know if it’s gone.”
She barely resisted the urge to press her on her breasts. “Why is the lump not being biopsied?”
“We found the marker while doing the blood test, the mammogram confirmed cancer—a biopsy would be overdoing it, and we want to put your body through as few procedures as possible. My main concern for today is finding out if your liver can handle the current treatment plan.”
“What else?”
“That depends, what else do you have questions about?”
Moments ago she’d hundreds of questions lurked in her mind. Now that she had the opportunity to voice them, they vanished. It was as if her brain had been sucked out her ears—minus being able to have that thought of course.
“I can’t think of any.” There was no mistaking the frustration in her words. “How is that even possible? I’ve got cancer, shouldn’t I want to know a million different things?”
“This is overwhelming. You have my number, and I want you to call it. Nothing is a silly question. Not even a small paper cut. Promise me you’ll do that.”
“I do.”
“Good. We’re in this together, Cassandra. I want you to know that. Now, you need to go get your blood drawn. Do you know where?”
A head nod was all she could muster. She was angry with herself for not asking questions. There had to be so many important things she needed to know. Why didn't she remember them?
“Yes, one level up. Same place as always.”
“Call someone, Cassandra. I mean it. It will help.”
“I’ll think about it.” She rose on shaking legs and paused for a moment to ground herself. Life was going to be hard enough without her brain causing her to have fake symptoms or panic attacks. “Thank you, Doctor Dresdell. I’m going to fight. I’m going to win.”
She swore the older woman had a tear in her right eye, but Cassandra couldn’t, wouldn’t, acknowledge it. Instead, she walked out of the office and closed the door.
A tear eked out and clung to the tip of her nose. An irritated laugh drew her eyes closed pulling the last of the tears free. I can’t do this alone. She sniffled and wiped her hand across her eyes to clear the tears.
Without taking time to think about it, she pulled out her phone and opened up texts. The blank recipient field stared at her, and her fingers began to type—Gabe. It was only when his name was actually on the screen that she realized he’d never taken her number. He’d given her his coat, comforted her and had not done anything to push himself on her.
Can I return the jacket tomorrow night? Drinks at Stephanie’s—six?
Clutching the phone, she began to walk to the elevator. She’d never asked a man out before, and even though he’d asked first, it was nerve wracking. She was suffering from cancer, and she’d asked a man out. Nothing seemed as ridiculous as that. Until Cassandra saw her phone light up out of the corner of her eye.
I’m glad you texted. See you tomorrow. Drinks on me.
Relief whooshed out on a sigh. She wasn’t going to drag a kind man into this mess, but she needed normal. Normalcy would help her cope, by acting like everything was normal. It had to work because she didn’t want a pity party from anyone in her life.