Chapter 3: Consult Room
This one is a little longer. Just a warning that you might want to grab a cup of coffee or a snack before you settle in 😉
Also, if you think a friend of yours might enjoy following along, I’m including a link here to chapter 1 so they can catch up:
Friday, May 21 - 7:13pm
Olivia settled back into her chair with a sigh. Mitch and Christine bringing dinner had been a helpful distraction; with them gone, the weight of everything returned—and with it, her deep longing for a hot shower and sleep in her own bed grew with every passing minute.
But she and Nico agreed that they both wanted to stay until they had answers. Then, she would go home and at least shower. If Betsy was going home tomorrow, they could both tough out a night of discomfort of sleeping on the chair and couch for their daughter’s sake. But if we’re here for the long haul, I’m going to need to tag out and sleep in my bed at some point, she thought and caught herself. She couldn’t think that way. Not when they didn’t know anything. Still, there was the laundry room the nurse showed her…
“You know, there’s a shower in the bathroom,” Nico said, reading her mind. Or, at least, her greasy hair.
She shook her head. “I feel like the labs and test results and whatever else must be back soon. I want to wait until then.” Olivia looked at Betsy, eyes fluttering back toward sleep. She had tried valiantly to eat the burger and fries that Mitch brought from work at Burger City. Olivia loved that he had her girls’ favorites memorized, but it was no match for the malaise roiling through her. Most of the fries and all but a bite of the burger had grown cold on the tray table across her hospital bed.
“Yeah, that makes sense,” Nico said, caressing her hand. “I’m hoping we can get Betsy home and showered soon, too.”
“Me too,” Betsy quipped with a half smile.
“Not as sleepy as you look,” Nico said poking her in the side.
Olivia smiled, thankful for any sweet moment they could get. She started to wonder what their girls were up to at Abuela’s house when the familiar knock-and-enter routine started at the door. It was Shanna, their nurse from last night.
“Hey y’all, I’m back with you tonight, I just wanted to check on Betsy and my other patients while I buiild my plan for the night,” she said, eyeing the monitors and IV pole. “Yep, it’s about time for a new bag of fluids. I’ll go get that started, and now that I know you’re both here, I’ll let the doctor know. I think he’s about ready to talk to you all in the consult room.”
Olivia’s mouth went dry. This is it. “Why can’t we talk in here, where Betsy is?”
The nurse looked from Olivia to Betsy and back again. “It’s just standard protocol,” she said and walked back toward the door. “Don’t worry, I’ll be here looking out for Betsy. I’m just gonna grab some supplies and that new IV bag and I’ll be right back.”
Betsy furrowed her brow. “Why do you have to leave?”
Olivia looked up at Nico, his dark eyes already on her. He looked at Betsy and licked his lips. “I’m not sure, my love,” he started slowly. “But just like our family does things in a certain way for certain reasons, I’m sure hospitals do the same. I don’t know why they do this this way, but I do know that we should pray about it.”
Betsy nodded, and all three of them bowed their heads. “Father,” Nico said. “We are scared for our—”
But there was a knock on the door and all hope of the moment evaporated.
Shanna walked in, a man in a white coat behind her. He was tall and mostly bald, jowls pulling down the corners of his mouth in a perpetual frown. “I’m Dr. Hansen,” he said, reaching out to shake their hands in turn. “Betsy, I’m glad to meet you. I’m going to borrow your parents for a little bit, and then when we come back, we’ll all have a little chat together, okay?” He pulled his jowls up into a smile, though Olivia got the impression that wasn’t their natural state.
Betsy shrugged. “I guess so.”
Nico kissed her on the forehead. “We’ll be right back, sweetie, I promise.”
They followed Dr. Hansen out the door, grasping hands as soon as they reached the hallway. She whispered a silent prayer and was certain Nico was doing the same. Then, Olivia took in the sight of the people around her: a janitor pushing a mop bucket down the hall, a mother cradling a crying baby, a pair of little kids shrieking as they ran from a nurse pretending to be a bear. Anything to keep her mind off what was coming.
But here it was. A generic placard on the wall for room 422, CONSULT ROOM. There were no windows, just fluorescent lights, half a dozen waiting room chairs lined up against two walls, and a side table with brightly-colored pamphlets.
When they were seated, Dr. Hansen wasted no time. “Betsy came in very sick. Our initial bloodwork showed elevated white blood cell count, indicating infection or some kind of blood disorder. Some things we test for take longer to get back and study, but we have all the information we need now.”
He took a deep breath. “Betsy has leukemia.”
Leukemia. Olivia felt Nico slump beside her.
Leukemia. Somewhere under her consciousness swam images from hospital fundraisers and TV shows of frail, bald children in hospital gowns. They were sad, but none of them were real to her; she didn’t know any kids with cancer, and the ones on TV were just part of a storyline.
Dr. Hansen cleared his throat. “I always start by telling our families, because you’ll have too much time to think about this and it will come up, I always tell them that this is not your fault and that you could not know sooner. Cancer is silent for as long as it can be. Some people bring their kids in for months and months because they can tell something’s off, but the lab work shows nothing. Until the cancer hits the tipping point.”
“The tipping point,” Olivia repeated. “Like throwing up blood clots.”
“Yes,” Dr. Hansen said.
“And the bruises that I didn’t notice.”
He shrugged a little. “Kids get bruises, Mrs. Rodriguez.”
“But I missed the red speckles.”
“Petechiae.” The doctor sighed. “I suppose if you had brought her in when that showed up, we may have run some labs and found something. But we can’t know that. We can only know what we have in front of us.” His voice was resolute, as if the matter were finished. He leaned forward.
“Specifically, we’re looking at Burkitt’s leukemia, which means that Betsy’s body has been making too many B lymphocytes, white blood cells, in her blood and bone marrow. It’s unique in that Burkitt’s usually presents as a lymphoma, meaning a tumor. The treatment for both is the same, and after years of treatment development, the survival rate is over 90%,” Dr. Hansen said.
Olivia felt the air rush from her chest and wondered how long she had been holding her breath. Nico grasped her hands tighter.
“Yes, it’s a good thing, a remarkable thing,” he continued. “However, this is a very aggressive cancer, which has its pros and cons. These cancerous B cells multiply very rapidly, which is why Betsy went from seeming healthy to sick so quickly, but their rapid growth is also their demise. They aren’t as stable as slow-growing cancer cells, meaning that when we start treatment, they’ll die off very rapidly.”
Nico stirred and spoke, his voice thick and raspy. “Where are the cons, then? This all sounds like it’s the best-case scenario. We found the cancer fast because it’s fast, and then we kill it fast.”
Dr. Hansen nodded. “Yes, it is best-case scenario in that way. But the die-off is so rapid that other parts of the body, like the kidneys, may become overwhelmed processing the waste of dead cells. This is called tumor lysis syndrome, and it can lead to problems throughout the body and require intense care to recover from. It’s not certain that will happen for Betsy, but either way it’s a brutal process, Mr. and Mrs. Rodriguez.
“On top of the risks inherent with this rapid die-off, chemotherapy in general is incredibly harsh on the body. The standard protocol for Burkitt’s is six rounds of chemotherapy, with a variety of drugs given at different times, along with immunotherapy on a specific schedule.”
He looked at them gravely. “This is where the wonder of modern medicine and the many who have come before you kicks in. When we only had chemotherapy regimens, surviving a leukemia diagnosis was a literal coin flip, right at fifty percent. Immunotherapy came on the scene just as I started practicing medicine, and the gains have been remarkable, which is why I can sit here and tell you that Betsy has a 90% chance of survival.”
“Thank God,” Olivia exhaled.
Dr. Hansen stiffened. “Believe what you want, but this advancement is the work of devoted medical professionals out to end human suffering. Not some man in the sky who allows it.”
Nico’s hand went slack in Olivia’s. She worked to keep her jaw from hitting the floor as silence crept awkwardly across the room.
The doctor massaged his brow a moment. “I’m sorry. My words were unprofessional. Faith is an essential part of the healing process for many. Obviously, I’m not the man to help you in the spiritual department,” he said, looking up at them. The anger that had flashed in his eyes was gone, replaced by a calm earnestness. “But I will do everything in my power to heal Betsy.”
“We’re sure you will. We forgive you, Doctor,” Nico said. “Please, go on.”
Dr. Hansen started at Nico’s words, like he’d never heard the word “forgive” before. Maybe he hasn’t, Olivia thought.
The doctor recovered and started explaining the course of treatment: six rounds of chemo and immunotherapy over about six months, and he listed every drug, noting its place in the chart, its purpose, and its potential side effects. It was too much to keep in her head. Olivia was losing track of time in the windowless room. She was overwhelmed by information that didn’t make sense to her and felt anxious that she had been away from Betsy for too long.
As if he could read her mind, Dr. Hansen smiled sadly and led them back toward Betsy’s room. “You just missed her being awake,” nurse Shanna said as they passed her in the hallway. “She didn’t want to take the Tylenol without one of you here, so we’ll try to wake her up in a bit to get that in. Her temp was back up pretty high.”
“Thank you, Shanna,” Dr. Hansen said. “The Rodriguezes and I have just gone over Betsy’s diagnosis. If they consent to treatment, I’ll put in orders for her pre-phase chemo to begin first thing in the morning.”
“Of course we consent,” Nico said, and Olivia nodded vigorously, clutching his arm. But Nico excused himself to the bathroom, turning fast on his heel and all but bolting down the hallway. Pain shot through Olivia’s heart: Superdad, the one who fixed every boo-boo and banished every monster from every dark corner—had hit his Kryptonite. Lord, give me strength, she prayed. I’m going to have to hold us together through this.
Olivia followed Dr. Hansen into Betsy’s room. He perched on the bed, one hand set lightly on Betsy’s fingers. He whispered hello to her in the dark and then sat in silence. The hard frown he’d worn up to that point softened, but his eyes narrowed in a near-wince. Sadness, Olivia thought, and though she couldn’t explain it, she felt a wave of emotion emanate from him, like he was the tide and she was the shore.. She had never been able to read a stranger like that before, and it gave her goosebumps.
He thinks she’s going to die.
Dr. Hansen never spoke these words; he only spoke of immunotherapy and the ninety percent survival rate. But deep in her heart Olivia knew that he was thinking of the ten percent who don’t make it. And that he was looking at one of their number.
He looked up and their eyes met across the room. “We’re going to do everything we can for your daughter, Mrs. Rodriguez.”
She nodded. “Please, call me Olivia,” she said quietly.
The doctor nodded. “Since she needs some Tylenol anyway and I’m still here, you should probably wake her up so we can tell her. Together.”
Nico walked back in, more composed. Olivia climbed into the bed beside Besty, leaving chairs for Dr. Hansen and Nico.
“Sweetheart,” she whispered as she stroked Betsy’s hair. “The doctors have been working hard and have figured out what’s going on in your body.”
Betsy blinked several times before she came around. “So, I’m going to be okay?”
Nico opened his mouth and closed it again, unsure of the right words.
When he opened his mouth to try again, Dr. Hansen spoke instead. “Betsy, my name is Dr. Hansen. We have a whole team of doctors who work together in our unit, but I’ll be your particular doctor who talks with you the most and watches over your treatmen. The reason that you’ve been getting those bruises and spots and throwing up is because you have a cancer in your blood called leukemia. Have you heard that word before?”
Betsy stared. “Wait.” Her breath came in ragged gasps and her eyes filled with tears. “I have cancer? How did I get it? How do we get it out?”
Dr. Hansen’s eyes softened. “You do have cancer. We don’t know for sure how you got it, but it’s not because you or your parents did anything wrong. With the particular type of cancer you have, it could be that cancer pops up in your family gene pool, it could be a virus that caused your white blood cells to develop incorrectly, it could be exposure to certain chemicals. We don’t know for sure why this happened in your body, but we do have a strong, well-researched program for treating it that helps almost all kids survive and go on to live full, happy lives.”
“Almost all?” Betsy cringed. “Not all all?”
“No, not all all,” Dr. Hansen said, his eyes narrowing in that sad wince again. “Unfortunately, Betsy, we’ve had a lot of sick kids come before you, meaning that your treatment is better because we have been able to fix the things that don’t work and improve the things that do. But even still, some cancers win the battle.”
Nico cleared his throat. “You mentioned family and genes. Betsy is a triplet; we have two other girls at home. Is there some way to get them tested or something? Will they all get leukemia?” His voice broke on the last word. Olivia’s heart rushed with hurt for her husband, but she also felt a stab of anger. Betsy needed them to be strong. Why doesn’t he get that?
The doctor leaned over and put a hand on Nico’s shoulder. “We will send off for some genetic testing when we draw Betsy’s next round of blood for labs. Those tests will take a while, so I won’t have answers for you immediately, but we’ll get them. And I want to encourage you all that cancer is rare. Just because one rare thing happened to your family, doesn’t mean that you’re somehow slated for more rare things. It is unlikely that either of your other girls will develop leukemia, but we’ll be sure to do the proper testing.”
He turned back to Betsy. “Betsy, the treatment is very good, very effective. But it will be very hard on your body. Your cancer is very fast-growing, so we have to give you very powerful drugs. You will feel nauseous and tired. Some people develop what’s called ‘chemo fog’ where they don’t think as clearly and some normal parts of life become hard.”
“Like a mom always forgetting her keys everywhere?” Betsy said, grinning.
Olivia was surprised by her own snort of laughter and willed the tears not to fall. “Hey now, it’s a hard day, and you’re trying to pick on me?”
Betsy shrugged. “I’m just trying to get all the information, Mom.”
Dr. Hansen smiled, his jowls sweeping upward. “Yeah, it’ll probably be like that. Or not at all. We know that our treatment, a mix of chemotherapy and immunotherapy, does what it’s supposed to. The part that we don’t know is how any person’s body will react to the treatment. Does that make sense?”
Betsy nodded.
“Good,” Dr. Hansen said, standing up. “We can talk through any other questions you have when I come again in the morning. We’ll start your pre-phase chemo, which is a lower dose than we use to really defeat the cancer. We want to see how your body handles the drugs. Now, the nurses here are the best in the whole hospital, probably the whole world. They are fully capable of running the chemo and meds on their own, but I always like to be around for the first dose, just to make sure everything goes according to plan. Okay, sweetheart?”
“Yes, sir,” Betsy said politely, but Olivia could feel her body shrinking down and in.
Dr. Hansen shook hands all around. “We’re going to do everything we can for you, Betsy. I promise. Get some good rest, try to find something yummy off the menu, and think of it like room service at a fancy hotel.” He laughed when Betsy gave him a suspicious look. “Well, you can dream, right?” he said and waved as he left the room.
Silence hung in the air. Olivia didn’t know what to do next.
“Mama,” Betsy said. “Dr. Hansen is wrong.”
Olivia sucked in breath. “Sweetheart, I would love for him to be wrong and for you to have something other than cancer, but—”
“No, no, no,” Betsy interrupted. “We don’t have to just dream. We can pray.”
Olivia looked down at her daughter, could see in her face every age and stage she had been through: newborn Betsy and round, pudgy toddler Betsy and turtle-obsessed kindergarten Betsy and trying-ballet Betsy—thousands of memories tied up in facial features that kept changing but somehow always stayed the same. Dear God, thank You for the resilience of children.
Nico squeezed Betsy’s hand and kissed it. “You’re absolutely right, mi vida, we can pray,” he said, bowing his head. Words tumbled out like rice from a bag, fast and rushing over each other. Sometimes in English, sometimes in Spanish. Betsy’s body began to shake, sobs racking her body, free to escape with no one looking. Olivia clenched her teeth to keep her own tears in check. Lord, make me strong for her, she prayed silently as Nico continued to pour out his heart before their God. And make me strong for him.
Need to catch up?
Chapter 4: Tea Party (next chapter!)
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