Now that I’ve had time to think, I’m feeling very mixed up. Just when I thought Jesse and I might spend the summer together, the letter came. I want to do both—spend the summer with Jesse AND dance with the Denver company.
I took a time-out because Bailey called, and I told her what had happened. She said Jesse’s plans weren’t set in stone and I should tell him about the offer because she was betting that Jesse, being Jesse, would tell me to take the dance offer.
This just isn’t fair! I’ve wanted to be a dancer all my life, but now I want other things too. Why does it all have to be so complicated? Whatever happened to a straight course? I can’t imagine not dancing. But now I can no longer imagine my life without Jesse either. I love him so.… What am I going to do?
UNIVERSITY PATHOLOGY
CONSULTANTS
121 East 18th Street, Suite 318
Atlanta, GA 30020
Phone: (800) 555-4567 Fax: (800) 555-4568
BONE MARROW PATHOLOGY REPORT
Referring Physician: Janet Powell, M.D.
Specimen Number: JL01-99438
Hematology Associates
Emory University Hospital, Suite 2010
Atlanta, GA 30020
Date Collected: 4/04
Date Received: 4/04
Date Reported: 4/05
Diagnosis: Acute Lymphoblastic Leukemia
Gross Description
The specimen consists of 6 slides and 3 additional aliquots of 3 cc each, labeled “Bone Marrow Aspirate, Melinda Skye.”
Microscopic Description:
The bone marrow aspirate demonstrates extensive hypercellularity with normal bone marrow elements essentially replaced by infiltrating lymphoblasts. There are multiple mitotic figures seen. The lymphoblasts demonstrate a high nuclear/cytoplasm ratio and clumped nuclear chromatin. Some nuclei display a folded appearance. Scattered among the abnormal cells are small numbers of erythroid, myeloid, and megakaryocytic cells.
Flow cytometric immunophenotypic studies demonstrated a population of beta lymphocytes, which expressed the CD19 and CD20 antigens.
Cytochemistry was positive for TdT, further corroborating a lymphoblastic process. The findings represent a relapse of acute lymphoblastic leukemia in this patient. Prognosis poor, after so brief a remission.
Stephen R. Jones, M.D. Pathologist
Fallen Petals
I cried when I heard your news. I know it isn’t macho, but I couldn’t help it. Later, I went to the tennis courts and pounded the fuzz off a ball on the backboards. I hit the ball until I couldn’t lift my arm and then I smashed the racket on the concrete. It didn’t help. I’m still angry.
It’s not fair that you’re still fighting leukemia and that you have to go through chemo all over again. I’ll call you so we can talk.
Jesse
TO: All Concerned
Subject: Melinda
This is one message I never wanted to write. According to Melinda’s doctor, our daughter’s cancer has returned. Apparently when this kind of leukemia recurs after such a brief remission, chances for another remission aren’t so good. She begins a new round of chemo, but the magic drug they used before can’t be used a second time. It’s too toxic. What do they consider uncontrolled leukemia?
We ask you once again to keep our daughter in your thoughts and prayers. We’ll keep you posted.
Lenny & Elana
Elana’s Journal
April 10
I’m out of the habit of writing in this thing.… I got lazy, confident I’d not need to write in it. But now I turn to pouring out my feelings here once more because I am confused and, yes, angry too. We did exactly as we were told. Melinda endured months of chemo, but now it seems that those months were for nothing. Her disease has returned, and this time her doctors don’t act enthusiastic about her recovery. I’m smarter now. Before, I accepted all they said with a child’s innocence. Now I know that medicine does not have all the answers. I know that doctors are not gods and that victims aren’t just statistics.
Her doctors don’t always look me in the eye when we talk. I think it’s because they’ve thrown everything they have in their arsenal of drugs and potions at Melinda, and they’ve come to discover that her cancer is still stronger than their chemical weapons.
Lenny and I feel helpless. We watch her go through the same courses of drugs again. They didn’t work before. Why would they work now? We have not yet told Melinda about the grimness, because she’s struggling hard to endure the course. I can’t rob her of hope. Neither can I consider the alternative.
MELINDA’S DIARY
April 25
I feel like I’m locked in a time warp. Didn’t I just go through all this torture? I really thought it was over, but it isn’t. The doctors come at me with terrible drugs that make me so sick. Stronger doses and longer treatments. And this time, I have to stay in the hospital 24/7. Still, my enemy doesn’t retreat.
I’ve given up school. Too sick to even think about dance and the Denver offer. A dream come true and I’m too sick to consider it. Mom says I can make up school this summer, but that would mean not dancing in Denver.
Sometimes I think Mom and Dad are keeping secrets from me. What could be more terrible than this? If it wasn’t for Jesse’s constant e-mails, I would go insane.
Bailey’s Diary
April 27
I think it’s my fault that Melinda’s sick again. I’ve wished so hard and long for Jesse to be mine that the dark side of the universe heard my secret thoughts and allowed her sickness to return. Now I’m begging for her to get well and never be struck with cancer again. I have given up my hopeless love for Jesse (cross my heart). I would give up anything else I have if only she would get well. Please, please, let Melinda be all right.
May 3
We miss you, dear Melinda. The class is less lively, less competitive without your spirit of excellence to spur us on. Please know that we think of you every day and that all your friends and classmates look forward to your return to health and our studio. Keep up the fight. We’re on the sidelines cheering for you.
All your friends at the Atlanta School of Ballet
May 15
After speaking with your mother tonight, I know you will not be coming to Denver next month. I am sad for you, for your family, for our dance company, and for the world of ballet. But once you have beaten this monster, tell me and you will have another opportunity at an apprenticeship. I promise this. Your talent is pure and bright, and on the stage of life, you shine like a star.
With affection,
Natalie Blackbird
Elana’s Journal
May 25
Dr. Neely brought Lenny and me into his office today to say what we already know. Nothing is working for Melinda. “What now?” Lenny asked.
“A bone marrow transplant may be her only hope,” Dr. Neely said.
“Tell us more,” I said. And he did. He said that the best transplants are usually between siblings, but that because Melinda has no brother or sister, a parent could be considered. He suggested that both Lenny and I be tested to determine who would be the best donor. Naturally, Lenny and I agreed to be tested immediately.
But Dr. Neely also warned us that the procedure is risky, especially in Melinda’s weakened condition. He told us that her immune system must be totally destroyed, leaving her vulnerable to even the normally most harmless germs, but that unless her immune system is taken out, her body will reject the transplant automatically. Even if the new bone marrow takes hold, she will have to take anti-rejection medications for the rest of her life. In short, there is great risk in this procedure, but he feels it is our daughter’s) only chance.
We have not told Melinda yet about the transplant possibility. Lenny is withdrawn and remote, and we are both frightened by our choices. Destroying Melinda’s immune system is a huge risk. Yet not doing the transplant seems to be a bigger one. How can we gamble with our daughter’s life?
MELINDA’S DIARY<
br />
June 1
How much longer am I going to be stuck in this hospital? I feel like an animal in a cage. I want out. I want to go home.
June 3
Jesse called again and just hearing his voice made me feel better. He said he’s got a job bagging groceries six days a week because he wants to save up all the money he can. I thought about his plans to come to Atlanta this summer. I think about a lot of things these days. I have nothing else to do. I can’t concentrate on reading books, and daytime TV is pathetic. I’m the only person my age up here, so there’s no one to talk to except Mom. Sometimes Bailey comes, but I know she wishes she wasn’t here. I can’t blame her. I wish I wasn’t here either.
Elana’s Journal
June 3
Blood work results came back and it looks as if I’m the better match for the transplant. I want to tell Melinda, but Lenny says to wait until he returns from Europe, because he has something to talk about. I’m relieved about the test and for the first time in months, I feel hopeful. If my marrow takes, then Melinda really can be cancer-free.
June 6
Lenny and I had the worst fight we’ve ever had. While in Geneva, he looked into a special cancer clinic where extreme cases of the disease are treated. He talked with the head of the facility and now wants to transfer Melinda to Switzerland. I’m horrified. How can he even consider such a thing? I don’t want our child treated by potential charlatans and quacks with hocus-pocus herbs and questionable medical procedures.
“And this way is better?” he shouted.
“Bone marrow transplants are proven cures,” I shouted back.
“If she doesn’t die getting the treatment,” he yelled.
We stood staring at each other because that’s the first time either of us had used that word in a sentence: D/E. Melinda might D/E.
MELINDA’S DIARY
June 6
Something’s going on between Mom and Dad. Something bad. They hardly speak to each other and I can cut the tension with a knife when they’re in the room together. This is my fault. They’re having problems because of me and I don’t know what to do about it.
I told Jesse and he said he thinks my family’s one of the strongest he’s ever known and I’m worrying for nothing. I hope he’s right.
Elana’s Journal
June 7
Dr. Neely is negative about the clinic idea, because he feels that it’s the wrong choice medically. I told Lenny that Melinda must be told of her options—the transplant or the European clinic. Lenny wants us to decide, because Melinda’s still a minor. But I don’t feel that way. She’s almost sixteen and should have a say-so. I also feel that the choice is the only power she holds over her illness. Lenny doesn’t agree with me.
While Lenny and I are at this impasse, Melinda’s losing ground. A decision needs to be made … and soon!
MELINDA’S DIARY
June 7
Dr. Neely brought a woman named Jennifer to meet me today. She’s twenty, but she had leukemia when she was eight and underwent a bone marrow transplant when she was twelve. Today, she is well and fine, goes to college and plays serious tennis. She really impressed me and after she was gone, I asked Dr. Neely if he thought a bone marrow transplant might work for me. He said, “It’s a possibility.”
I asked Mom and Dad about it and that’s when I found out what’s been going on between them. “You’re fighting over what I should do?” I asked. “Don’t you think I should be consulted?”
Dad told me about the clinic in Switzerland. I know exactly what each one of them wants me to do, but I told them I’ll decide. I know they mean well, but I’m so mad at them for not talking to me sooner! It’s my body.
June 8
Talked to Dr. Neely this morning and he explained how my immune system would have to be destroyed before the transplant—three days of radiation and ten days of chemo. The worst part is that I’ll have to go into isolation! Ugh! I don’t like that idea. But isolation will cut down on the risks of secondary infection, he says, which is very dangerous. Only medical staff and my parents can come see me, and everyone will have to be “de-germed” before they can come inside my room. He told me Mom will be my donor.
He also cautioned me that the transplant may take, or it may not. There are no guarantees that it will work, or that I really will be “cured” of leukemia. Most of the time, a BMT improves a recipient’s life immensely and does produce a cure, but not always. This bothers me. To go through all this torture and have my cancer return would be the nastiest trick life could play on me. But if it works … well, I could dance again. I could be with Jesse.
Anyway, I’ve got lots to think about. I’ll e-mail Jesse and talk to him about it.
TO: Ballerina Girl
Subject: Transplant
Just get well. I want to hang around with you for the rest of my life.
Jesse
TO: Melinda
Subject: Transplant
Isolation? What’s wrong with that? Can I join you? Seriously, friend, I know it’s a big decision, but if the transplant works, then all this medical stuff will be over. That will be a GOOD thing, don’t you think? Besides, if you go off to Geneva, I’ll never see you. Here, I might be able to wave at you through a window!
Bailey
Elana’s Journal
June 11
I talked with a woman today who had been a marrow donor for her brother. She told me what to expect from the procedure. I’ll be under a general anesthetic and doctors will remove a pint or so of my marrow (which the doctor says I won’t miss, because my body will step up production immediately to replenish my supply). They take it from my hip bones, and afterward I’ll be sore, but back on my feet in no time. As soon as they harvest my marrow, they take it to Melinda for infusion. The downside is that I can’t be with her during the infusion, because I’ll still be in recovery. Lenny will hold her hand.
I asked Dr. Neely if there’s anything I can do to make my marrow “better” for Melinda and he said, “No. You’re not responsible for whether it takes or not, either. It either does or it doesn’t.”
Can I accept knowing my marrow didn’t work if it doesn’t take? That would be very hard for me. Knowing her chances are lowered because I’m not a “perfect” match is also hard. A sibling would be so much better, but Lenny and I could never have another baby after Melinda. We always wanted more children, but it never happened. Now Melinda’s life is in jeopardy and a brother or sister would be such a blessing. Still, Dr. Neely assures me that unrelated donors help cancer victims all the time. I pray my marrow does the job for her.
TO: All Concerned
Subject: BMT
June 12, noon
Melinda’s decided to go ahead with the transplant. Elana will be her donor and I’ll be around to support both of them. I’d give anything to do more. In a few days Melinda will go into isolation, where they will begin giving her drugs to destroy her immune system. We’re all scared silly.
Lenny
TO: Ballerina Girl
Subject: I’m coming!
June 13
Mom and I are coming to Atlanta BEFORE you begin the BMT process. When I came home from work last night, she gave me your dad’s e-mail message and said she has a little money saved up and that she’s going to spend it on the trip. She’s reserved a room for us at a residence-type hotel that’s near the hospital.
I hugged her big-time. I called my dad and told him I won’t be coming this summer. When I explained about you, he offered to send us some money to go toward the trip. I was shocked. My parents haven’t said two words to each other since the divorce, but now they’re banding together to give me something I want more than anything else—a chance to see you up close and personal. One miracle down (my parents) and one to go (you getting well).
Jesse
TO: Jesse
Subject: Trip
Come as soon as you can! There’s no time to spare.
MELINDA’S DIARY
>
June 13
Dr. Neely’s not happy, because I want to wait a couple of days before he begins “killing” me—all right, maybe that’s an overstatement. But I can’t go into isolation until Jesse’s here. Dad got Jesse’s and his mother’s fares comped by the airline, and they’ll be here tomorrow afternoon.
Mom and Dad are throwing me a party here on the pedi-floor on Saturday. Besides Jesse and his mom, I’ve invited Bailey, Mrs. Houston, four girls from my dance class and three friends from school. Dad will videotape it and we’ll have pizza, Cokes, ice cream and cake. I asked if I could have a pony brought up (ha-ha).
I’d love to spend some time alone with Jesse, but I can’t figure out how or when. I’ll think of something, because I WILL NOT go into isolation until the two of us can be together away from parents and nurses.
Dr. Neely showed me my “new” room. You get to it through an air lock, and anyone who’s allowed to come in must wear a sterile gown, a hair covering and a mask. It’s a bedroom with no decoration, but at least there’s an intercom and a large window that looks out onto the hall, where people can stand, look in and talk to me. I can pull a curtain for privacy. It’s kind of creepy knowing I have to stay inside the room while my immune system’s down. I hope I don’t go postal.
I’ll have a TV to watch, but anything that comes in from the outside must be decontaminated. I’ll be able to keep books and, of course, my diary, once all are “cleansed.” I’m not looking forward to this one bit.