Part 22: Anxious Thoughts

The woman watched as the nurse attached the needle to the syringe filled with chemo. The transparent yellow liquid glistened inside its plastic shell. It was the woman's second injection in her second round of chemotherapy and she was grateful that aside from some fatigue, watery eyes, muscle cramps, and occasional mild nausea, she had not experienced any overbearing physical side effects from the treatment thus far. Mentally, however, the anxiety of her last appointment still plagued her because the syringe in the nurse's hand seemed wider that day.

"Are you sure that is the same dose as last week?" the woman asked delving into the details of her traumatic experience from two days prior. "That syringe looks different from what I remember."

"Yeah. It's the same," said the nurse. The husband peered over to look the computer screen and concurred.

"Okay," replied the woman, still in need of convincing. 

She stood up and turned her back towards the nurse who, shortly thereafter, slowly dispensed the yellow liquid into the woman's backside—so slowly, in fact, that it caused the woman internal alarm. 

It's never taken this long for them to give me the shot. What's she doing?

"Um...are you almost done back there?" asked the woman, starting to become anxious while the needle held its ground. "This seems to be taking awhile."

"Almost, I'm just doing it slowly so that it doesn't sting."

“It usually hasn't taken this long, so I'm just trying not to..." The woman didn't finish her sentence. A tingling sensation began to flood her body and she fought the urge to close her eyes. "Umm...I feel weird."

"Just a second," said the nurse. "I'm almost done."

"I...I think I need to sit down or something," the woman replied trying to remain calm. 

Instinctively she began to sit back down the the chair, the nurse scrambling to get a band-aid over the injection site. She turned pale and her skin became clammy. She felt like she was going to pass out. The nurse quickly closed a blood pressure cuff around her upper right arm and began to get a reading. The woman's blood pressure had dropped in half. She breathed deep, trying her best not to freak out, but she was scared. Luckily, in a few minutes, she was back to normal, though noticeably shaken up from the experience. The nurse ensured that her vitals remained stable and then freed the couple to go on their way. 

It had been a shaky start to chemo round two, but on the bright side, her HCG levels had dropped by 90% since her first round—down to 2400! Prayers being offered up from around the country and around the world were notably gaining momentum. She only hoped that these next two weeks held similar results.

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 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!