“Are you saying there's nothing you can do?” April's mother gasped, her eyes wide with fear.
“No. We're going to try some things. First, a drug to reduce brain swelling. There are some side effects, but I want to get the swelling down so that you won't have so much pain.”
“What kind of side effects?” April swallowed hard, feeling slightly detached, as if they were discussing someone else.
“Water retention, puffiness, and an incredible appetite.”
April had always been tall and slim and able to eat whatever she wanted, and she didn't like the idea of a forced weight gain. “I'll look like a freak.”
“What else?” her father asked the doctor.
“We'll start her on radiation treatments.”
April remembered the radiation sessions from before. They had strapped her on a table, alone in a room, with a massive machine aimed at the back of her head. She'd shrieked and screamed, not because it hurt—it hadn't—but because she couldn't move. And because she was all alone. But she was older now and she knew that the technician had to leave the room to avoid the high doses of gamma rays emitted by the machine. Still, just the memory terrified her. “Will I lose my hair?” she asked. “Will I have to cut it off?”
“Just a little spot in the back. You can comb the rest of it over. No one will be able to tell. Radiation has come a long way. You'll have a radiation oncologist, a special doctor who does only these treatments. It's an exacting science and you'll be in good hands.”
“But she's already had radiation once,” April's mother interjected.
“It's the best treatment for this kind of tumor,” the doctor insisted. “We must radiate again.”
“And once it's shrunk?” her mother wanted to know.
“Then more MRIs and X rays to see if she's a candidate for gamma knife surgery.”
“I thought you said you couldn't cut out the tumor.”
“Not with a regular scalpel, but with a gamma knife, a high concentration of gamma rays aimed at the tumor.”
“Why can't you just do that right away?” April asked breathlessly. “Why do I have to go through all the other stuff first?”
“Because we can't use the gamma knife on anything larger than three centimeters.” He pulled a ruler from his pocket and held his thumb on a mark. “Right now, your tumor is larger, about five centimeters.”
She watched his thumb slide upward on the ruler and wondered how two centimeters could make such a difference. And yet it did. Surgery was out.
“What about chemotherapy?” her mother asked. “I have a friend who had breast cancer and they gave her chemo. She was sick for a while, but it worked. She's been cancer-free for six years.”
Dr. Sorenson shook his head. “Chemo is ineffective on this kind of tumor.”
April felt as if the doors of her options were being closed. “I don't have a lot of choices, do I?”
“Radiation's your best hope,” the doctor answered.
She felt sick to her stomach. “And if radiation doesn't work?” Her voice trembled, but she had to ask the question.
“We'll cross that bridge when we come to it,” he said.
But she knew instinctively that the bridge was a narrow rope hanging over a precipice that led down to a dark abyss. She turned her face into her mother's shoulder and hid, like a frightened child.
“You're leaving?”
Mark stood in April's doorway, and she turned at the sound of his voice.
“Mom's downstairs finishing up my paperwork now.” April continued to pack her small valise.
He came up beside her. “I'm getting out today too.”
“Oh, Mark, that's good. I'm glad for you.”
“I'm sorry your news wasn't better.”
“I guess I'm not destined to be normal and healthy after all.”
“When do you start your radiation?”
She should have been surprised that he knew so much about her case, but she knew that the hospital floor was a hotbed of gossip. “Next week. Five days a week for six weeks. So, I guess I can kiss my extracurricular activities goodbye.”
“I brought you a present,” he said. From behind his back he pulled a large red balloon with a hand-drawn smiley face on it and tied with a long yellow ribbon. “I blew it up myself … which is what I used to do when I was a kid to prove I was well enough to get out of the hospital and go home.”
The gift touched her. “Thank you.”
Their hands brushed as she took the ribbon from him. Her skin tingled from the contact.
“Take care of yourself.”
“I will.”
“Uh—my phone number is written on a scrap of paper inside the balloon.” A wide grin lit up his face. Then, more soberly, he continued, “Just in case you ever want to talk. Sometimes talking helps. And I'm a good listener.”
“I told you—”
“I know, you have a boyfriend. But if things change between you two, call me”
She held on to the bright yellow ribbon and watched him walk from the room.
A brain tumor! Oh, April, I can't believe it,” Kelli gasped.
Seeing her friend so upset made April want to cry. But she quickly took hold of Kelli's hands. “PU be okay,” she said without much conviction. “Some radiation, some pills, and it'll shrink enough so the doctors can operate.”
Kelli had come over the afternoon she'd returned from the ski trip. The two of them were sitting on the bedroom floor on plush pale lavender carpet. April's entire room was decorated in rich shades of purple accented with pure white. The down comforter on her four-poster bed was covered in white eyelet, and plum-colored pillows rested against the pristine whiteness. Without the drabness of the hospital surrounding her, April's diagnosis seemed like a bad dream.
“It's not fair!” Kelli blurted out. “You've never done anything mean to anybody. Why should you get sick?”
“What's being mean got to do with any thing?”
“Well, there are tons of bad people in the world. They're the ones who should get brain tumors.” Kelli sounded furious.
“I guess life doesn't work that way. I'm proof that bad things can happen to anybody.”
“Have you told Chris?” Kelli asked.
“I'll tell him tonight. We're supposed to go out to dinner.” April hugged her knees. “I'm dreading it.”
“Why?”
“I'm not sure how he'll handle it.”
“He'll be mad about it—like me.”
But Chris wasn't like Kelli. Kelli was her best friend. April and Chris had only been together a few months, and they weren't nearly as close as she and Kelli. How would Chris react? “I just don't know,” she said, chewing on her bottom lip.
Kelli blew her nose. “This is just the worst thing to ever happen.”
“Listen, do me a favor.”
“Anything.”
“I don't want this to get all around school. It's nobody's business but mine.”
“But everyone knew you couldn't go on the ski trip because you were in the hospital. They'll want to know what the doctors told you.”
“If anyone asks you, tell them I'm being treated for migraine headaches or something. I don't want them to know about the tumor.”
“But why?”
“I don't want kids whispering about me in the halls and treating me like I'm contagious or something.”
“But that's dumb. Everybody knows you can't catch a brain tumor like you can a cold.” Kelli paused. “Can you?”
For a moment, April couldn't tell if Kelli was joking, but then a sly grin broke across Kelli's face. “Just a litde humor,” she said.
April nodded sheepishly. She was tired of thinking about what was happening to her. Tired of feeling sorry for herself and for her parents, who had been in despair ever since she'd come home from the hospital. She wanted her life back to normal. She wanted to get on with the radiation treatments and get them over with and have her life the way it used to be. “So, let's
talk about something else,” she said crisply. “How was the ski trip?”
“All right. Not nearly as much fun as if you'd been there.”
“That's nice of you to say.”
“It's true.”
“Well, I am going to the shore with everybody this summer. It'll be our last blowout and I'm not about to miss it.”
An awkward silence fell between them. The summer seemed so far away. How could they make plans when no one knew if April would be well?
“What's that?” Kelli broke the silence. She pointed to the limp balloon tied to the doorknob of April's bathroom.
April told her about meeting Mark.
“I remember that he was cute, but gee … his being sick—it's kind of a turnoff.”
“‘A turnoff’?”
“I didn't mean it the way it sounded,” Kelli insisted. “You're not him.”
“That's exactly why I don't want kids to know about me,” April said emphatically. “It's all a big turnoff.”
Kelli hung her head and then mumbled, “Sorry.”
Already April could feel the gap opening between them. Kelli belonged to the world of perfect health, while she belonged …? Where? Suddenly she didn't know either. She thought of Mark and wondered how he managed to straddle the two worlds of sickness and health. How could she find a place for herself in this new world where all the rules had changed?
Chris picked her up that night and took her to the country club where most people in their Long Island community had memberships. Normally, April didn't mind going there, but tonight she didn't want the quiet country club atmosphere. She felt like loud music and pizza and having to shout above the noise. Maybe because that way Chris might not really hear her when she told him about her tumor. In the quiet elegance of the country club, there would be no mistaking her words.
“You look great,” Chris said, taking her hand across the table. “And I missed you like crazy.”
“I'll bet you didn't even have time to think about me. What with the tournament and all. How did your team do?”
His face clouded. “We came in second. We should have won, but Andy got a red card and we had to play a man down the whole second half of the final game.”
“Bummer.”
He grinned and April couldn't help noticing how different his smile was from Mark's. Chris's eyes didn't light up in the same way as Mark's. “But I want to hear about you. What did those doctors say?”
Her heart began to hammer so loudly she was afraid that he might hear it on his side of the table. “Well … the news wasn't great.”
“What do you mean?”
She forced a smile and said flippantly, “I have some wild and crazy cells growing in my brain. They've set up housekeeping and my doctor has to radiate them out of existence. Actually, it's a recurrence of a tumor that I had when I was five.”
He stared at her, as if sorting out her answer. “You've got some kind of tumor? Inside your head?”
“So it seems.”
He sagged back in his chair and stared at her. “Is this some kind of joke?”
Her face felt frozen. “No joke.”
“I don't believe it.”
“I wouldn't make it up.”
“I don't know what to say.”
Say anything, she thought.
“You had a tumor before?”
“When I was five.”
“Why didn't you ever tell me?”
His question made her hesitate. She wasn't sure what she'd expected from him, but she recalled how Kelli had taken the news. And Mark. In so many words they both had said, “I'm here for you.” Chris seemed almost angry at her.
She told Chris, “I thought it wouldn't ever be a problem for me again. My doctors told me it wouldn't, so I didn't see any reason to talk about it.”
“You shouldn't hide things from people you care about.” He sounded upset, accusatory.
“Would it have mattered?” April was feeling light-headed, but it had nothing to do with her medical condition.
“Of course not,” he said a little too quickly. “It's just that you should have told me. I would have liked to know.”
“I was only five. It wouldn't have made any difference.” But the expression on Chris's face told her otherwise. “Would it?”
He quickly reached across the table and took her hand. “No. I—I just can't stand the thought of you being sick. I don't want you to be sick.” He was picking through his words like a soldier inching through a field of land mines.
Chris was an athlete. In prime physical condition. Strong, muscular, and fit. To him, being sick must be a horror. “I hate what's happening to me, Chris.” Tears swam in her eyes. She didn't want to cry, but she couldn't help herself.
He sprang from his chair, knelt beside her, and pulled her against his chest. “I'm sorry, April. Really sorry.”
Everyone was sorry. She wept while he rocked her. As her tears slowed, she noticed other diners staring at her and Chris. Selfconsciously, she pulled back and wiped her tears on the linen table napkin. “I didn't mean to lose it like that,” she said hoarsely.
“You all better now?” Chris asked.
She wasn't all right. She never would be again. “Sure,” she lied. “But I've lost my appetite.”
“You want me to take you home?”
“Yes.”
They left and Chris was silent during the ride home. It was just as well. April wasn't sure what else to say to him. At her front door, he took her in his arms again, but his touch was tentative, as if she'd suddenly been turned to glass and he had to be extra careful in handling her. “I wish this wasn't happening,” he breathed into her hair.
“So do I.”
He kissed her and she wanted to cling to him and not let go.
He cleared his throat. “I have a game Monday after school. Will you come cheer for me?”
“I can't. I have a consultation with the doctor who's doing my radiation. Then the treatments start.” She explained the schedule.
“Every day!” He protested. “You'll miss my whole soccer season.”
“I don't have a choice.”
“So will you glow in the dark?”
He was attempting to be funny, but April wasn't in the mood to laugh. “No,” she said. “But if I'm lucky, the tumor will shrink.”
“Of course it will shrink.”
She asked, “Do you want to come in? I could make you a sandwich since I made you miss dinner.”
He shook his head. “I'm not hungry.”
Chris quickly said goodnight. And as she watched him climb into his sports car, maneuver it around the wide brick circular driveway, and drive away, she felt cold and empty. She wrapped her coat closer around her and hurried inside the house.
a cognizant v5 original release september 20 2010
Dr. Sorenson arranged for April to receive her radiation treatments at a Long Island hospital. She would still have to make the trek into the city to see Dr. Sorenson throughout her treatments, but at least she could be treated each day closer to home.
She tried to go to the hospital by herself Monday afternoon, but Janice Lancaster wouldn't hear of it. “I won't tag along for all your treatments,” her mother assured her, “but I want to be there for the preliminaries.”
April's radiation oncologist was Dr. Edith Hamilton, a short plump woman with graying hair who wore no makeup. She explained about the treatments thoroughly and then carefully shaved away a hank of April's thick red hair at the base of her skull. While studying April's X rays, she took a pen and mapped out the area that was to be bombarded; with the gamma rays. Next, Dr. Hamilton used a small needle to make permanent dots in the skin at the base of April's skull. It didn't really hurt; it felt like tiny pinpricks. “Little tattoos,” the doctor called the dots, “so that the technician can always align the machine precisely.” Her hands were quick and felt like the fluttering wings of small birds in April's hair.
April's mother watched intendy. “I thought
this was all behind us,” she said. “I feel as though we were lulled into a false sense of security.”
“April's case is unusual,” Dr. Hamilton answered. “This is rare—one in a thousand.”
Why do I have to be the one? April thought. It was a question no one could answer. April straightened her hair, combing it over the bald spot at the back of her head. She still felt as if everyone could see the blue marks through the veil of hair. Her mother assured her that nothing showed.
“Be careful when you wash your hair,” Dr. Hamilton said. “We'll re-mark the area from time to time, but don't get soap on the skin.” April couldn't imagine how she was going to wash her hair and not get soap on her skin. The doctor continued. “You will lose some of your hair, but because the treatment is so localized, I hope it won't be much. You may experience dry mouth and food may lose some of its taste, but don't let it keep you from eating. Your skin will get red at the site, but don't use any creams. Creams interfere with the rays. Toward the end of treatment you may experience fatigue. All these symptoms will vanish once the treatment is completed.”
“Can't I start today?” April asked.
“Tomorrow,” Dr. Hamilton said. “But let me show you the equipment we'll be using. It's state of the art.”
They went into a large room with a huge machine. It sprouted a thick mechanical arm with a cone-shaped device at one end. “We'll point this at your skull, aim it at the tumor, and zap the growth,” Dr. Hamilton explained as she touched the cone. “We'll take more X-ray pictures periodically to track the tumor's shrinkage.”
April felt her hands growing clammy. Memories from when she was five years old and terrified flooded her mind. She told herself that her fear was irrational. “I'll be back tomorrow,” she said, turning on her heel, eager to get away from the room and the machine.
School let out at three, so they set her appointments at four o'clock, the last time slot of the day. April went to bed that night and lay in the dark with her eyes open, trying not to cry, trying to grasp the monumental change that was occurring in her life. Just before she finally fell asleep, she realized that Chris hadn't called since their almost dinner date. She knew if it had been Chris going through this ordeal, she would have called.