Part 21: Inconsistencies

Relieved that her appointment with Dr. Substitute was over, the woman walked over to the appointment desk and picked up her schedule. She casually reviewed it as she made her way back to the waiting room and at second glance noticed something slightly disturbing: there were no chemo treatments listed. She turned around and asked the assistant, "Umm...I'm supposed to have some chemo scheduled, but I don't see any of the appointments here?"

"Oh. You will have to go to the chemo desk for that," the assistant replied.

Ooookay. That would have been nice to know!

The woman tried to be patient and headed to the chemo desk. The response she received from the attendant there was equally disheartening: "We don't have any record of you needing chemo."

A bit frustrated, the woman replied, "Well, I know I'm supposed to have chemo today. The doctor told me so and I watched him order it."

Convinced, the attendant made some phone calls.

As the woman sat, thoughts of what should have been filled her mind. She was supposed to be 16 weeks along heading to OB appointments and worrying about buying pregnancy jeans. Instead, she was here in a room full of cancer patients waiting to receive chemo. The two extremes were irreconcilable, and somehow she would need to find a way to reconcile herself to the latter in order to move on with her life.

Thirty minutes later a nurse finally called the woman back to receive her injection. Upon entering the room, the woman noticed that the nurse had two syringes filled with chemo.

"Umm...Is that the correct dosage? I've only ever had one shot," said the woman nervously.

"Yep, it's the same dose as last time. It just depends on how the pharmacist mixes it," replied the nurse and continued preparing the needles without any noticeable concern.

"Are you sure it's the same dosage?"

The nurse looked down at the syringes and then back up at the computer screen. "Yep, it's the same."

"Uhh...okay," the woman said, hesitant.

The residual sting of the shots were like background music to her thoughts as she walked towards the elevator replaying the events of the day. It had been a long one scattered with inconsistencies that made the woman feel uneasy. In the midst of her anxious distrust, the only thing she could do was surrender, trusting that the doctor knew what he was doing, the schedulers knew what they were doing, the pharmacist knew what he was doing, the nurse knew what she was doing, and that ultimately God was in control of it all.

Part 20: The Substitute

The woman felt out of place amidst the sea of predominantly white hair. Not quite pregnant, not quite suffering from cancer—it was a queer state. It had been two weeks since her last visit. She had just come from her bi-weekly blood draw and now sat in oncology waiting to be the lucky one called over the intercom. Across from her sat an aged couple. They were both asleep.

Not very promising, she thought, hoping she'd have enough patience to make it through the wait.

A glance through a magazine and many daydreams later, she finally heard her name. The clinical assistant brought her back to a room where she took the woman's vitals and then promptly left, leaving her with the promise, "The doctor will be in shortly."

Either the assistant had made a good faith estimate on the time frame or she had lied through her teeth. The woman decided to take the silent advice from the elderly couple in the waiting room and pass the time by napping. She positioned herself in such a way as to be decently reclined, her feet hanging just off the edge of the bench cushion, but not so much that she wouldn't be able to quickly resume a somewhat normal seated position, were she caught off guard.

At last, the woman heard a knock. In walked a pot-bellied man in his sixties, the substitute doctor while her gynecologic oncologist was out of town. Generally pleasant, he seemed a tolerable replacement. It was obvious he didn't know much about her case. For the first five minutes he barely said a word to her and skimmed her patient notes. Great. I have some guy treating me that has no idea who I am or what's going on, she thought. He then proceeded to review her lab results. Blood counts and liver function looked good, but the HCG value, the one she cared the most about, had yet to post.

"Normally, if the initial run falls above the upper limit of detection, they will need to dilute the sample and re-run it," he said. "I'll just get started ordering up your next chemo dose while we wait."

"But don't you need to know what the actual value is before you go ahead and prescribe another round?" she asked. "What if the value is already at zero?"

"The likelihood of that is pretty slim. And even if it were at zero, we would still prescribe another round."

The answer slightly annoyed the woman. Then why am I even here in the first place? A call asking if I was okay would have sufficed, she grumbled to herself, the dollar signs multiplying in her head.

She glanced over toward the computer screen and noticed an error message pop-up. He had been sitting at the computer for at least ten minutes and was making comments to himself. Apparently the ordering system was not the most user-friendly. The longer it took him to place the chemo order, the more confidence she lost in his competence. Considering the personal impact this drug would have on her body, she was markedly concerned. Her mind raced to the close call at the hospital a few weeks back. She tried not to worry.

The doctor finally figured it out and had the woman get up on the exam table where he listened to her heart and pushed on her belly. She began to ask him all the questions that had been collecting in her mind over the last two weeks and she was disappointed by his answer. "You're getting out of my level of expertise," he said. "I'm not in gynecology, I'm in oncology."

Dejected, she decided to keep her mouth shut from there on out. Why do they have some guy who can't even answer my questions treating me? she wondered in frustration. He freed the woman to head to her next appointment—her first injection of chemo round two. "The girls will get you your schedule," he said and oddly ended with a question, "Do you have any kids?"

You've got to be kidding me. "Nope. This was my first," she said and walked away.

Part 19: Goodbyes

"What should we do for the service?" the woman asked her husband. She wondered if he thought it strange that she wanted a service in the first place. Her husband seemed okay with it, so she didn't worry too much about it. As they discussed the details, the woman made some notes.

"This looks good!" she said smiling. "It will be a wonderful service." 

Just then a faint emotion stirred within her and began to crescendo. Before she knew it tears were filling her eyes and she started to sniffle. At last an audible cry emerged.

The woman's husband took her in his arms and comforted her. "Just let it out," he said in a warm voice.

While she had cried different times over the past couple weeks, it had been about other things—the stress, her condition, the long road ahead. This was the first cry in awhile that actually grieved the loss of her pregnancy, yet it felt just as fresh as the first time and emotionally it was just as hard.

The cool Sunday morning air filled her lungs as she made her way to the backyard where she found her husband standing by the small spruce tree. Sunshine settled upon the tiny hole beneath the lower branches he had dug just moments before in preparation to receive the package she held in her hand wrapped in a white napkin.

Together they stood looking down at the site, the wind blowing and the sound of passing cars traveling along the nearby country road resonating in the distance. They began to sing:

How great is our God.
Sing with me, how great is our God.
And all will see how great, how great is our God.

She placed the tiny package into the small hole. After each shared a few words, the husband closed in a prayer.

“Dear Lord, we thank you for the gift of each other and for this pregnancy. Even though it wasn't a baby, it was still special. We pray for healing in the months ahead—spiritually, emotionally, and physically—so that someday we can try again and be blessed with a baby.”

With a small spade they took turns covering the newly filled space with a mixture of soil and wood chips. Every spade-full finalized reality. Dreams of starting a family, caring for a baby of their own, passing on the many things they wish to teach, and enjoying God's gift of a new person had been postponed. They offered up one more moment of silence, then turned and together walked away.

Part 18: The Delivery

It was just like any other Saturday morning. She awoke at her normal time while her husband lay sleeping under the mound of covers. He would be there till at least 9:30 a.m., to the detriment of the woman, of course. An early morning chat with her husband over coffee was her Saturday morning dream, a dream, unfortunately, crushed every week. Alternatively, she knew his dream was to sleep in, and somehow she worked up the weekly discipline to restrain herself from harassing him awake before the allotted time...most Saturdays, anyway.

Her first stop was the bathroom.

Ummm...that was weird.

The woman had passed clots before, and large ones at that, but this did not feel like a clot. Peering into the toilet she saw a dark shadow resting at the bottom. Curiosity got the best of her and she fished it out.

Upon further examination, the woman determined that what she had in her possession was indeed the mass from inside her uterus. It measured a little over 3.5 cm in length, just like what the doctor explained from her ultrasound a week and a half earlier.

She hurried to the bedroom.

"Honey," she whispered nudging her husband hoping he wouldn’t mind too much. "I think I just passed the tissue."

Looking at her with tired eyes he acknowledged the situation and lovingly rolled out of bed to take a look.

"Yeah, that definitely looks different than a clot," he confirmed, still a bit groggy.

They deliberated the meaning of it all, wondering, perhaps, if it was a good sign for things to come. Little did they know it would mark the end to two and a half months of the woman's bleeding. They questioned what to do with the the tiny mass. After a few moments of silence, the woman replied saying, "I think I'd like to have a funeral."

Part 17: Weeping Willows

A noticeable increase of golden brown strands collected in her brush daily during that first week of chemo. They draped over her fingers like weeping willow branches as she pulled away her hands when washing her hair. While sitting in meetings at work she would notice strays laying on the table and brushed them away hoping no one noticed. The doctor had said the drug would not cause hair loss. She, however, noticed a contradiction to that expectation, which began almost immediately after starting treatment.

After discussing with her friends, she concluded that hormones instead were most likely the cause. Many gals mentioned losing large amounts of hair after delivering their babies—a time when HCG levels would be dropping. It made sense to the woman because, in a way, she had "delivered" something during her surgery and assumingly her hormone levels were dropping drastically now that she was on the chemo. To the woman, having a similar experience to a post-pregnant woman, yet being so far from that place, felt odd.

Her bleeding, while lessened, still continued. One of the many things she had looked forward to in getting pregnant was the lack of monthly cycles. Life had certainly dealt her an ironic hand. Two and a half months, she thought. When is this going to stop? After her last injection that week she noticed her flow likened to a medium period—less than what she experienced the week of her scare, but heavier than "normal." It bothered her.

Friday night rolled around. The woman and her husband decided to stay in for a movie night. As the evening progressed she experienced something she hadn't felt for awhile. The muscles in her lower abdomen contracted, similar to cramps during a heavy period. This, combined with the "abnormal" flow and the fact she had passed a few more small clots over the past few days, heightened her state of alarm. Taking precautionary measures, the woman folded up a towel and placed it beneath her just in case.

The intensity of the cramps increased during the movie, but she made it through crisis free. Crawling into bed that night she prayed for protection, fearing the worst: another trip to the hospital. She laid her burdens down, rested her head gently on the pillow, and quickly drifted off to sleep.

Part 16: Serenity

Hours passed as the woman sat in her hospital bed dressed in the usual with a twist: a flowered gown, blue robe, tan slippers and black wind pants. Might as well be comfortable if I have to sit here all day, she thought. She and her husband threw around jokes to lighten the mood and pass the time while they waited for the beginning of this new phase in the seemingly never-ending drama—the chemotherapy. It had been an hour since the woman last checked on her bleeding so she hopped off the bed and went into the bathroom.

“The nurse wants to weigh you again,” the husband said as she came back out.

“Umm…okay,” she replied. She stepped out of her room and onto the scale. Turning to the nurse she asked, “So, why are you weighing me again?”

“I just want to verify we have the right information in your charts. The chemo dosage is based off these numbers and I just want to make sure we have it right,” the nurse explained.

The woman watched as the number on the scale rose.

“Huh. I thought so,” said the nurse.

“What do you mean? That looks right,” the woman confirmed. “81 kilograms—179 pounds, just like two hours ago.”

“Your charts say you are 91 kilograms. Just looking at you, I see you’re a head taller than me, but you didn’t look to be 200 pounds.”

The woman was shocked. “Is this standard for you to make sure the patient looks as heavy as their charts say?” she questioned.

“Actually, no,” replied the nurse. “It just occurred to me as I was looking at you. Now, I know you’ve been waiting awhile to get this first dose of chemo. They were just about done verifying your dose, but with this new information, they’re going to have to start the process all over again so it will be a little longer.”

“Not a problem,” the woman assured. “I think I’d rather have the correct dosage. Thank you so much for being so observant. This is a God-thing.”

The woman gave her husband a mutually understood look. The implications of an incorrect dose were unknown to them, but they knew they had been spared from yet another pot hole in this journey.

A few more hours later, the nurse returned ready to administer the woman’s chemo shot. It was quick and virtually painless, nothing like the images she had conjured up in her mind when she envisioned receiving chemotherapy. True, they did have to use special blue gloves and the woman had to utilize a special spatter screen over the toilet, but that was the extent, though somewhat alienating.

And so it began. For an indefinite amount of time the woman would have to undergo bi-weekly rounds of this treatment. Week one consisted of every-other-day intramuscular (IM) injections of Methotrexate. On the off days, the woman would need to take a recovery vitamin called Leucovorin to help her body replenish what was lost due to the chemo. Week two was her recovery week as her body would work to build  immune system back up in preparation for the process to begin all over again. They would also bi-weekly track her HCG levels to zero, after which point would begin the monthly draws for at least six months to ensure everything stayed that way.

Drifting off to sleep she thought about the long road ahead and a prayer came to mind:

God, grant me the...

Serenity to accept things I cannot change,

Courage to change the things I can, and the

Wisdom to know the difference

Patience for the things that take time

Appreciation for all that I have, and

Tolerance for those with different struggles

Freedom to live beyond the limitations of my past ways, the

Ability to feel Your love for me and others and the

Strength to get up and try again even when I feel it is hopeless.

Part 15: Submission

“Absolutely not,” the woman protested. “I will not get back on that stupid pill. Do you know how long I was on that thing? I’m already going to have to wait at least six months before trying again, probably more. Adding this to the mix will just make that wait even longer.”

The debate had already been going on for a few minutes, the gynecologic oncologist proposing one idea, the woman giving a counter argument for another.

“It is very important that you not get pregnant while on the chemo,” the oncologist rebutted. “If somehow you did, the results would be devastating to you and your baby.”

Beneath the professional façade a genuine concern pleaded from the oncologist’s eyes. It was not just the plea of a doctor who had witnessed suffering and the unthinkable over many years in her practice, it was the plea of a woman and a mother who understood the innate desire for new life. It was this sincerity that broke through the woman’s resolve.

“Okay, I submit,” the woman replied. “I still don’t want to take that pill, but if you think that is best, I will do it. I’m 100% on board.”

The oncologist moved on to speak of the specificities of the chemotherapy treatment. They would begin by giving her Methotrexate, a drug that inhibits DNA replication in rapidly producing cells, like the ones continuing to reproduce in the woman’s uterus. This would kill off the existing cells and prevent new ones from forming. There were other drugs that could be used as well and possibly would be if her body didn’t respond to this first one, but those were more aggressive and had more side effects. The oncologist wished to start with the lesser of the evils.

This does not sound fun, thought the woman reclining back in her hospital bed. She was discouraged. I hope this stuff doesn’t wreck my body.

“When this is all over, I want to see pictures,” the oncologist said, interrupting her thought.

“Pictures?” said the woman.

“Of your next baby. I ask all my patients to send me pictures. You will get through this. Your type of the disease is nearly 100% curable, and I am confident that you will make a complete recovery. When you are ready to try again and you have your next baby, I want to see pictures!”

The woman was taken aback. She had been so caught up in the weight of her present situation that she hadn’t much thought about the light at the end of the tunnel. I can’t believe how confident she is about this, thought the woman. Could it really be true? I can't even imagine, but maybe she is right. The time will come some day when I can try again and I will have another baby. The emotional wounds from the past two months were still too fresh for the woman to completely buy into the idea, but deep down a hope filled the empty space in her heart left over from the loss. A freedom came over her as she not only submitted her treatment into the hands of the doctor, but also submitted her all into the hands of the Healer.

Part 14: Beating the Odds

The woman turned her head, closed her eyes, and breathed deeply as the assistant released the blue dye into her system. A warm sensation quickly passed throughout her entire body. Initially, the nerd inside her was intrigued by the biological workings happening in her circulatory system at that moment, but the intrigue soon subsided. The thought that it was happening to her was disturbing, so she tried not to think about it and instead imagined herself relaxing on a warm beach. In reality she was laying on her back in a cold room tucked under a stack of white hospital blankets making her way towards the buzzing machine that would soon document her insides. She moved closer and closer when, suddenly, it all stopped.

“We need you to remove your bra and underwear,” echoed a voice over the intercom.

“Huh?” the woman replied, unsure if anyone could hear her as she was all alone in the room. She was confused by the request. This was a CT scan not a medical examination. She was pretty sure she could keep her clothes on.

“My underwear?” the woman asked the assistant entering the room and walking towards her.

“No—underwire. The underwire of your bra is causing interference,” said the assistant.

They had asked her at the beginning if she had any metal on and she had confidently assured them that she was good to go. Before she left her hospital room, she made sure all of it was gone. Apparently she forgot something.

The staff re-situated her and restarted the scans. It was painless. Her only complaint was that the room was freezing. The issued hospital gowns didn’t offer much warmth. The staff graciously offered her some warm blankets and she obliged. Then, they wheeled her back up to her hospital room where her husband and in-laws were waiting for her.

A few hours more hours of waiting passed and finally the CT scan results came back. Everyone held their breaths as they listened attentively to the doctors words: “The scans show no sign that the cells have spread. It is all contained within the uterus.”

A sigh of relief filled the room.

The doctor continued, “Based on these findings, we have diagnosed you with non-metastatic gestational trophoblastic neoplasia.”

The woman understood, but everyone else in the room looked a bit lost. The doctor translated, “Pretty much this form of the disease is invasive, but it’s not spreading and it’s not cancerous.”

More sighs of relief followed…and hugs…and tears…and smiles.

Finally, the woman could rest easy knowing that the cells weren’t attacking her brain, or any other part of her body for that matter. After two months of succumbing to what felt like the minutest odds, she was encouraged to know the odds were now moving back into her favor. Experience had taught her to mistrust potential good news, but she wasn’t going to let experience steal her joy in this moment. Thank you, Lord!

Part 13: Crimson Tears

She felt like a product on an assembly line. One by one the clinical assistants in radiology brought the patients into the dressing rooms, spouted off a memorized set of instructions, and handed them unflattering blue smocks to cover themselves. After changing, the woman went out to sit in the secondary waiting room, where she fit right in with the rest of the like-dressed patients. Shortly thereafter, she was escorted to a room to receive her ultrasound.

“I’m so sorry,” the woman apologized to the technologist, embarrassed by something she couldn’t control. It had been about an hour since she left the house for the clinic. The double-layer protection she thought would last a few hours had already lived its course and she was on the next round thanks to her husband who had packed extra pads against her wishes.

She lay on the exam table worried about how much blood she’d find underneath her afterward, while the technician maneuvered the ultrasound wand and diligently reviewed the images on the screen.

“Are you going to tell me what you see when you’re finished?” the woman casually asked.

“No. You’ll have to wait to discuss the findings with your doctor,” the technician succinctly replied.

Goodness. These technologists in radiology are way stricter than those in OB. Guess it won’t be the first time I’ve waited for answers.

The technician finished the scans and gave permission for the woman to leave. She met up with her husband and they walked over to the doctor’s office.

“The HCG results have come back and they have gone up again since your last draw five days ago,” the doctor began. “After reviewing the ultrasound, there seems to be re-growth of tissue in your uterus. We located a mass inside measuring about 3.5 to 4.0 centimeters and it seems to have grown into the uterine wall.”

A mass inside? the woman thought, shocked.

The doctor continued, “I took a look at your pathology results from the D&C and the cells did not have the appearance of choriocarcinoma, which is good. However, they have definitely started to invade into the uterine wall, which is a concern. We don’t want to do another D&C at this time because of the risk of possibly puncturing the uterus, which could cause uncontrollable bleeding and lead to hysterectomy.”

The word “hysterectomy” made the woman shutter.

“We want to preserve your fertility as best we can. The next step will be to get a CT scan to verify the cells have not spread to other parts of your body. We want to keep you overnight in the hospital to monitor your bleeding and make sure that goes down. And then we will also start you on chemotherapy treatments today.”

The woman felt like she was listening to the text book treatments she read on the internet and in online medical journals. The information was very familiar, but it wasn’t supposed to be her story. It was supposed to be some impersonal nice-to-know information that she didn’t have to worry about. But it was her story now, and somehow she would have to deal with it. All the times she had been given less than good news, she had been able to keep her composure, but this time was different. Though she didn’t know where else the crazy cells in her body may have gone, they had finally managed to get to her psyche and through her tears, she released the emotions that had been building inside her all day.

Part 12: The Scare

The woman was running late…again. Three years out of college and she still couldn’t get this get-up-early-like-an-adult thing down. She raced into her company’s parking lot. Haphazardly she grabbed her keys, purse, computer bag, and the plastic Wal-Mart bag containing the blueberry muffins for her 8:00 a.m. meeting, and walked briskly to the door. Her hair had already started falling out of her pony tail, but she didn’t have time to care. As she stepped up from the pavement to the sidewalk she felt a gush of fluid leave her body.

That was weird, she thought and entered the building. While jogging up the stairs, a voice inside her suggested she should go check things out. I’ll just have to do it after this meeting, she rebutted. I’m facilitating so it will just have to wait until afterward.

Arriving at her desk, she quickly sat down to check her calendar for the location of her meeting. It was then that the moist feeling around her inner thighs won over her attention. Looking down she could see a dark red stain contrasting against her gray pants which in no way could be inconspicuously hidden. Oh my gosh! What do I do? she thought, trying not to panic.  

The woman made her way back as carefully and quickly as possible to her supervisor’s desk. I hope she’s not at a meeting yet! As she approached the cube, she was relieved to see her supervisor sitting at the computer. Tears welled up in her eyes as the woman briefly explained her embarrassing situation. “I’ll be back as soon as I can,” she said, “but I need to go home and change.”

She fought off anxiety all the way home. The seven minute trip seemed an eternity. Luckily her husband hadn’t made it too far when he received her call to come home right away. His car was already in the driveway when she pulled in.

“I’ve bled all over!” she cried hurrying toward the bathroom.

“It’ll be okay, honey” the husband assured her.

The bleeding had soaked her entire pad and spilled over leaving her underwear and pants to do the rest of the job. She couldn’t hide her fear. There was too much blood and she was still bleeding. She called to her doctor’s office. The secretary took a message and said she would have the doctor call the woman back as soon as possible.

The woman began writing emails and making phone calls to keep her mind occupied in the short time while she waited. Prayer was a must in situations like these and she needed all she could get. She was just about to make a call to sister number three when the doctor’s office called her back. It was her nurse.

“The doctor wants you to come in right away,” the nurse said. “Can you get here in the next thirty minutes?”

“Of course,” the woman replied.

“I thought you’d say that. Head over for a blood draw, then go to radiology, then come straight over to the 12^th floor. No specific times. Just get here. When you’re finished with one area, head right over to the next. We’ll get you in. And, honey, don’t eat anything except for clear fluids. We may have to do another D&C today.”

After confirming the details with her nurse, the woman got off the phone and started gathering her things for the trip over. Before leaving, she dressed herself with two pairs of underwear, a pad stuck to each one. This ought to hold me over for awhile, she thought.

The couple made the all-too-familiar trip back to the clinic. Her heart was heavy. She didn’t know what to feel or think. The thought of another D&C was worrisome and undesirable. Her eyes gazed out the car window up towards the sky. Keep me safe, Father. I’m scared and need Your help.

Part 11: Conversation with God

“What are you doing, God? How could you let this happen? And why me? There are so many women with unwanted pregnancies, but I wanted this, Lord! You know I want to be a mother! I have been waiting so long to start trying for a family and now I’m going to have to wait an indefinite amount of time longer! I have been planning and preparing as much as I possibly could for the last 3 1/2 years!”

My dear child, in your heart you plan your course, but I determine your steps.

“Well, my course was a pretty good one, God. We paid off all our debts but the house. I stopped taking birth control for six months to make sure there wouldn’t be any interference when we started trying. My husband finally came around without me nagging, which was nothing short of a miracle, and after three months of trying we finally got pregnant. We were all set. Our basement would be all finished by the time the baby arrived. Nine months and it would have been fine. But, no. You took it all away before anything even began. From the very moment of conception this was hosed and You knew this would happen before I was even born! Thanks for the warning!”

I love you, my child. I know the plans I have for you—plans for good and not for disaster, to give you a future and a hope. I cause everything to work together for good. In time, you will see.

“Well, it certainly doesn’t feel very hopeful right now. And logically I don’t see anything good about the fact that this whole thing keeps getting worse and worse. I could handle a miscarriage. I could handle getting surgery. But I can’t handle this never ending unknown of what is going on inside my body. I have absolutely no control over this. It’s just too much!”

Without Me, you can do nothing, my child. Come to me. You are weary and carry heavy burdens. Give Me your burdens. I will take care of you and give you rest.

“I’m scared, Lord. What if this gets even worse? What if these cells are spreading? What if I get cancer? What if I can never conceive again?”

Be strong, my child. Do not be afraid or discouraged. I am with you. Do not worry. Come to Me with your needs and My peace which exceeds anything you can understand will guard your heart and mind as you live in Christ Jesus. I will never leave you nor forsake you. Trust in Me.

“I'm sorry, Lord. I know You care. I know You love me. I believe You’re in control and that You will take care of me through all of this. Forgive me for my unbelief. Even though I cannot see exactly what You’re doing and I certainly don’t understand it all, I will trust You, Lord. Please give me faith to trust You more. Take my worries, my cares, and my life. Use it for Your glory. I need You so much. ”

Part 10: On the Rise

Beep!

Beep!

Beep!

Like an alarm clock buzzing after the third snooze, a muffled beep sounded from her lower desk drawer where her cell phone, nestled inside her purse, annoyingly reminded her every thirty seconds of what she had forgotten to do the night before. Of all the times I forget to charge my phone it has to be when I actually care about receiving a phone call, she grumbled to herself and continued working. That morning she had gone into the local clinic for her second week blood draw. She had been waiting all day for the doctor to call with the results and now was not the time for her phone to lose battery charge.

Her work phone rang. It was her husband.

“Hi honey,” she said.

“Hey. Have you heard anything yet?” he asked.

“No! It’s driving me crazy! On top of that, my phone is dying and I don’t know if there will be enough battery for me to actually hear what my doctor has to say!”

“I wonder what’s taking so long?”

“I know. Maybe I should just call over there and…”

The crippled ring of her cell phone interrupted her.

“Ahh! It’s the doctor. I have to go. I’ll call you back,” the woman said and hung up her work phone, clumsily grabbing for her cell phone to quickly answer the call.

The doctor barely got a word out when the woman interrupted, "I'm sorry. Do you mind calling my work phone? My cell phone battery is dying." She apologetically chuckled hoping the doctor would find the situation at least slightly amusing.

"Of course," the doctor replied.

Within seconds, the woman's work phone rang. After getting the niceties out of the way, the doctor got to the details. “Well, your hormone levels have risen to 20,000.”

While the woman had been hoping that this would not happen, in the back of her mind she knew that rising levels were a possibility with her type of the disease. Her suspicion of higher levels had increased over the past week. She had been feeling mild symptoms again, so the unfavorable news wasn’t a complete surprise. After sharing this with her doctor she asked, “So, what are the next steps?”

The doctor replied, “The first thing we want to do is have you wait one more week to verify that the levels are indeed going up.”

The woman was concerned about this. Fortunately or unfortunately, she had absorbed like a sponge all information on the internet about her condition, officially termed gestational trophoblastic disease (GTD). The fact that her hormone levels were rising meant one thing: the cells were still rapidly reproducing inside her. This left her vulnerable to metastasis, the spread of these cells to other internal organs, including her brain. The next logical phase in the treatment would be chemotherapy.

“What about the risk of this spreading? Wouldn’t it make sense to start chemotherapy to make sure it doesn’t start to spread or spread any further if it has already started?” the woman asked.

“I wondered that, too,” the doctor said, “and so I checked with my colleague, a gynecologic oncologist who is more familiar with this, and was told that the risks of waiting one more week are less than if we started chemo right away. Once we can verify that the levels are going up, we’ll know for sure we need to start treatment.”

The risks of waiting were less? To the woman, having out-of-control cells start spreading all over her body sounded pretty grim. What does that say about chemotherapy? she thought to herself.

Part 9: Perspective

“Well, at least we know that it wasn’t really a baby,” said the husband.

She wanted to resent him for the comment, but the woman knew that he was only trying to help. Biologically speaking, she knew he was right. The pathology report came back diagnosing them with a complete molar pregnancy, which meant that her egg had no genetic material inside so when it was fertilized, only the DNA from her husband was present. Had it been a partial mole, as the doctors originally suspected, at least they would have both created a little life, abnormal as it may have been.

The woman found herself grieving all over again. First it was the little life that never got to be. Now it was the little life that never was.

“But, it’s kind of like we lost a baby, right? I mean, didn’t you think about what it would be like to be a dad or what you wanted to name it?” she asked.

“Of course,” he said.

“And this whole time we’ve thought it was a baby, so we still lost a baby,” she insisted all the while trying to convince herself.

As she pondered the situation, her mind wandered off to the “what-ifs.” The cells in complete molar pregnancy could become invasive, spreading to other parts of the body, including the brain. They could even develop into choriocarcinoma, the malignant cancerous form of the disease. Twenty percent of women with complete moles experienced a recurrence of cell growth after their D&Cs. She tried to block these thoughts out of her mind, but no matter how many times she swept them away, they always found a way back in.

A few days later, the woman went in for some blood tests. It had been a week since her surgery. Now began the weekly blood draws where the doctor monitored her HCG (pregnancy hormone) levels. If things were progressing as they should, the levels should be dropping. Once the levels hit zero, she would begin the six month long wait to ensure they stayed that way. If they remained at zero, she would then get the clearance from her doctor to begin trying again. She could picture that day in her mind. I hope I get good news today, she thought.

Later that afternoon she received the call from her doctor with the results. Her levels were down to 15,000, a 255,000 point drop from the week before! She could hardly believe it—good news two weeks in a row. The light at the end of the tunnel was a little bit closer and shined a little bit brighter. Things were definitely on the up and up.