Dessert First (13 page)

“Thanks,” Mom said. “Things have been tough for the whole family.” She glanced over at me.

Mrs. Umbriss clasped her hands together. “Well, God never gives you more than you can handle.”

“Excuse me?” I stepped between her and Mom. “I'm not sure why Beep has cancer, but it's not because our family
is good at handling stuff
.”

“Kat.” Mom's voice was a warning.

I took another step, as if crowding Mrs. Umbriss in a soccer game. “And I doubt God takes personal charge of dealing out the cancer card. To little kids. Even the assistant manager at McDonald's delegates the really crummy jobs.”

“Oh.” Mrs. Umbriss raised her puffy hands. “My.”

“Kat!” Mom grabbed my shoulder. “Go get sprouts for your sister.”

As soon as we were out of earshot and Mrs. Umbriss was in lurching retreat toward the meat counter, Mom started on me. “That was rude, and you are
never
to talk to our neighbors—or any adult—that way.”

“She started it,” I was fuming, almost shaking with anger. Our family definitely attracted cancer because we
handle
things: Mom has an anxiety disorder, Dad hides at work, Rachel hides in boyfriend-land, and I can't even turn in homework that gets completed by high school stoners. “She's lucky I didn't slide tackle her in the cracker aisle, because God thought she could
handle
it.”

We walked in silence for a long time except for the faint squeaking of one of the grocery cart wheels. Mom finally squeezed my arm. “I suppose. Let's count our blessings.”

Every minor triumph of self-control should be congratulated.

• • •

Evan was off at one of the part-time dog-walking jobs he does for amplifier money, and his cell phone was on the counter at home, getting charged—or so his mom said, when she answered it. So instead of complaining to Evan after I got home, I ended up emailing Hunter about getting Umbrissed.

K:
Grownups say the most clueless things about cancer
.
When you get well, if I commit assault, would you write to me in prison?

H:
I'll even send flowers and a hacksaw
.

I described our run-in with Mrs. Umbriss, then went on to list her earlier insensitivity crimes, when Beep first got diagnosed, the slew of questions she'd asked, like it had to be Mom's fault:

K:
Did you drink a lot of alcohol when you were pregnant with Beep? (No, but if you ask Mom again, while I'm around, you'll need a drink.) Is your house near a power line? (Not especially. And, by the way, Mom's a realtor, so definitely tell her that he got leukemia from her choice of house.) Does anyone in your family smoke? (No. That's steam coming out of my ears. In the future, though, we'll set people like you who ask that question on fire.)

H:
LOL
.
Wish I could sic you on everyone who hassles my mom. My favorite was the people who asked if I ever took steroids for basketball, to bring it on.

K:
It's like the cancer diagnosis comes with a portable stupidity field, which moronifies every grownup.

H:
They're afraid
.
You know—some people think blood cancer is scary.

K:
Yeah. Wimps. Maybe it makes them feel less scared if the cancer is somehow your fault. Or they tell you “Google vitamin D and cancer” because, you know, the cure for cancer must be just a mouse click and two million search results away.

H:
It's hard to accept something as unfair as fatal cancer.

K: Potentially
fatal. Let's split hairs here, cute bald guy. But, yeah. I don't know why people keep saying I have anger issues, when really life has will-make-people-paying-attention-angry issues.

H:
You have anger issues?

K:
Yeah, but they should go into remission
as soon as Beep gets well.

I stared at the screen for a long time, and thought about grownups being scared, then added some more.

K:
Actually, I'm afraid
.
Since they couldn't get Beep into remission, my bone marrow might be his last shot.

H:
Beep's lucky to have you for a sister. And also lucky you're a pretty close match.

Eight out of 10 HLA match. It was sweet of Hunter to put it that way. I hoped that was close enough.

Mom met with the medical team to work out a treatment plan to get Beep well enough to get a transplant. The docs were afraid they'd croak him, not just his bone marrow, when they upped the chemo and radiation. After the meeting, Mom went off to the bathroom to pull herself together and to get rid of the tear marks—you know, so Beep wouldn't
worry
.

So I talked to Beep. “For the transplant, you have to get better.”

“Right. So they can almost kill me with radiation and chemo again, then maybe kill me with the transplant.”

“Don't sugar coat it, Beepster. It might not
all
be fun.”

“Probably not.” He shook his head. “Tell Mom I'm holding out for whatever videogames I want. The chemo would only be two weeks, right?” He'd had courses of chemo that had lasted months.

“Just two. But bad.” And then months of isolation in the bone marrow unit, if it worked.

“Imagine. Bad freaking chemo.” He closed his eyes and rested between words. “Did you ever figure out what's up with Rachel?”

“No.” I'd seen Rachel's tampons in the bathroom trash can again, so if it was a pregnancy scare, it was over. “Don't change the subject. Can you get better, for the transplant?”

“Maybe. Sure. But that's it. If the transplant doesn't work, no more chemo. I'm done. You have to back me up on that, with Mom.”

I swallowed, then nodded. Of course, if the transplant didn't work, he wouldn't be around for more.

• • •

Mom and I wedged ourselves into the visitors' chairs of Doc Hanfield's small office, surrounded by her looming bookcases, to go over the “known risks” of being a transplant donor.

Doc Hanfield, in a white coat, sat behind her desk. She was a tall, light-haired woman older than Mom, with round glasses and a long face even when she was being cheerful. Mom was holding—clutching, really—my hand, while Doc Hanfield explained they'd give me Filgrastim, a drug that would produce lots of stem cells and make them run extra laps around my bloodstream.

“You may get headaches and joint pain for four days,” she looked at me over her clipboard. The brochure had said there was an over ninety percent chance of that. Fun. She went on to cover the incredibly unlikely “standard” risks of any kind of donation, which happen a tiny part of one percent of the time, like continuing bleeding or lingering pain.

“Mom,” I interrupted. “You're squeezing my hand too hard.”

“Sorry.”

Doc Hanfield leaned forward and explained the process, tapping the folder on her desk with a pen for emphasis. In an old-school bone marrow transplant, I would have gone to the hospital, had anesthesia, and then they'd suck goop out of my hip bone with a needle while I snoozed. I would have had a sore hip for a day or two, but I probably could have milked that for a whole extra week, pretending to limp nobly everywhere and making a delicate brave wince whenever I sat down, like it was as painful as fifty minutes of Algebra 2.

No such luck.

UCSF Benioff Children's was running a clinical trial of a more advanced approach, called peripheral blood stem cell donation. My stem cells were supposed to find their way where Beep's nonexistent marrow was and take over there, making all his blood cells after that. Stem cell donation was supposed to reduce the risk of rejection and of graft-versus-host disease, because they'd take some of the parts out that didn't match Beep as well.

“Mom,” I interrupted. “You're
still
squishing my hand.”

Doc Hanfield sat up straighter and explained they'd start killing Beep's marrow completely, which would take two weeks. Five days before they finished, I'd get the Filgrastim. Then, on the day of the donation, they'd “harvest” my stem cells (making it sound like tiny wet wheat) in a glorified blood donation. Then they'd stick those in Beep, so he wouldn't die. Because once they killed Beep's marrow, he would have no other way to make blood cells unless my stem cells became his new marrow. Behind Doctor Hanfield, hiding among the other books on pediatric oncology, was a big gray volume with large blue letters on the spine.
End-of-Life Care.

I swallowed.

“Your cells will fix him,” Mom said brightly. “They'll fight his cancer. And win.”

“Actually, Beep's body has to fight the cancer,” Doc Hanfield said. “But your cells will give him another tool to use.”

After all the other tools had failed. I squirmed. My hand was damp, in Mom's grip.

“So Beep will beat the cancer, with your cells,” Mom said.

Doc Hanfield looked over at Mom, then back at me. “There are no guarantees.”

No kidding. I'd had to read all the way to the very last page of the colorful
You're a Match!
booklet from the National Marrow Donor Program, to find a word about Beep's odds: The two-year survival rate for transplant recipients was “30 to 60 percent.”

“I'm feeling good about this,” Mom wore her determined cancer mom expression, chin raised. She squeezed my hand even harder.

Even though it was my hand getting crushed, Doc Hanfield wore a pained expression. She opened her mouth again, but I waved her off.

“I got it.” I nodded toward Mom. “I'm good with thinking my cells will totally fix Beep, even if there's no guarantee. I'm good to go.”

“Do you have any questions?” Doc Hanfield asked.

It felt like there wasn't enough air in the little office, probably from Mom's breathing so fast. “Yeah. Could you give my mom a Valium? She's
still
squeezing my hand too hard.”

Unfortunately, the answer to that was no. Hospitals, it turned out, have rules about access to drugs, and don't allow random family members to gobble anxiety meds off passing carts. No matter how much they need them.

So I signed my “informed consent” and Mom let go of my squished hand to sign too, because I could donate stem cells to save my brother's life but, as someone under seventeen, couldn't be trusted legally to understand what I was signing, so my crazy mom also had to scribble on the form.

If you distilled human despair and drank it in the dark while emo bands played funeral music, the result would be more cheerful than Drowningirl's poetry. That night, Drowningirl sent some to my online alias Cipher. If her high school has a literary magazine, the editors are probably organizing an intervention.

They're heartbreaking, but beautiful. She says she only sends them to me, in my secret identity, Cipher. Maybe she's afraid that if she shared them with someone who knew her in the real world, she'd get herself locked up, as a danger to herself.

I worry about her.

They stabbed me with the Filgrastim shot in the left buttock, as they say in hospital-speak, and the sting of the needle was nothing compared to the pain-in-the-butt side effects. The headaches and joint pain showed up the next day, right on time, promising four days of increasing agony before the harvest.

For once I had a real excuse for not doing homework or going to school—a massive throbbing headache from trying to save my brother's life—so I worked it. Added to the headache of dealing with the Tracies? Too much to bear.

Mom didn't want me in school anyway, in case some kid coughed flu germs on me before my cells went into Beep. Beep was busy across the Bay at UCSF, having his bone marrow killed, leaving him with no immune system; the last thing he needed was a potentially fatal virus hitchhiker with his last shot at life, my borrowed cells.

The afternoon before I was supposed to donate, after I'd missed three days of school to be bored lying in a dark room, posting blog whines about Filgrastim aches, Evan called to see how I was.

“I have a headache as big as Rachel,” I said. “She's a huge pain.”

“Why don't I come over and distract you?” It was after school for Evan, and I was home alone.

“I don't know.” I stalled. Technically, it was against the rules to have a boy over when there was no “parent supervision,” but Rachel had bent that house rule so many times, it was pretzel-shaped. “Probably because I'm almost bored out of my skull, and if that actually happens, my headache might stop.”

“I can be boring.”

“No, your sense of humor is too good.” Don't I get adventurous when my head hurts too much to retreat into my shell.

“I could bring brownies.”

“You have brownies? Now we're talking.”

“I have a box of mix to make them. They're a headache cure.”

“They are not.”

“Well, it hasn't been completely tested. We're doing a phase II clinical trial. Ford and Monroe, ‘Chocolate brownies as palliative care for Filgrastim side effects in stem cell donors.' Are you in?”