chapter six

My whole family is squeezed into one of a few cubicles in a row at the doctor’s office. A thin curtain shields us from the hallway.

Mom insists we pile inside and wait with Kristina after she changes into a blue paper gown. Kristina is pale, but still looks as pretty as ever. Her hair is pulled up high in a ponytail. It’s shiny and blond. She looks like she should be on a box of hair color.

Dad and I stand, but Mom sits with Kristina on the examining table, their legs pressed together. Kristina looks wrong in the papery gown, with her toned arm muscles, her square shoulders. Her trainer has worked her hard over the months and it shows. Her outfit and her expression don’t suit the image of the high-jumping spiker who makes the opposition quiver on the volleyball court.

Kristina bows her head and closes her eyes. I wonder if she’s praying. We’re not a church family, not like Melissa’s. Dad says he had religion forced down his throat when he was younger and he doesn’t want to do it to us. Mom doesn’t have a strong opinion one way or another. She doesn’t talk about her childhood much, and the last time we saw her parents was over five years ago. Far as I know she hasn’t even told them about Kristina.

We only go to church when someone dies. Not even at Christmas or Easter. Melissa told me once that she thought it would matter. As in after. It was the first time we had a real fight. Well, we’re wimps so it was more that we didn’t talk to each other for a few days. Then we pretended none of it happened. I never learned how to pray. I’ve thought about it and stuff, tried talking to God in my head sometimes, but mostly it makes me nervous and I wonder what he really thinks of me. Like does he think I’m a bad person because I don’t go to church or read the Bible? I don’t really feel like I have the right to ask for anything now. I mean, I really, really want to ask for God to fix Kristina, but I’m afraid it might make things worse. Like instead she might get punished because I’m only praying when I want something.

Dad stares at the wall, no expression on his features, but the blankness doesn’t mask the fear he’s hiding. I wonder if he’s worried he won’t be able to handle it. He’s always been the kind of guy who prefers not to face things head-on. That’s what Mom says anyhow. She says he inherited it from my grandpa, but he died before I was born so who knows if she’s right.

Mom fusses with her purse, pretending to search for something, rooting through her worldly goods to keep her mind busy, focused away from what is happening. She appears to be planted firmly in the soil of denial. Kristina will be fine, just fine.

In the room next to us I hear a woman moving around, probably changing back into her street clothes. I saw her walk to her room alone in her blue gown, following a nurse.

I wish I could ask Kristina if she’s okay, but I stand frozen, barely breathing, barely moving.

“Kristina Smith?” a deep feminine voice calls from the other side of the curtain. The raspy voice sounds like she should be on a morning show on the radio.

“Yes?” Kristina answers, her voice weak, frightened. She looks to Mom for courage.

A nurse pulls back the curtain and the four of us stare at her. She’s short. Her uniform is red with Scottish Terriers on it and it makes her look boxy. She wears a name tag that says “Pamela.”

“The doctor ordered a couple more X-rays, and when those are done, I’ll take you to her office where she’d like to speak with all of you,” she says. Her voice is rich with an accent. Scottish?

The nurse glances at the rest of us. “There’s no one needing this room so you can stay here or wait out in the waiting room where it’s more comfortable until the X-rays are done. You can join Kristina in the doctor’s office afterward.”

Her accent has a slight comforting effect on me.

“Can I go to the X-ray room with her?” Mom asks.

The nurse looks at Kristina for approval and then nods. Mom and Kristina disappear into the hallway, and Dad and I are left alone.

“I’d rather wait here than out there,” he says, and his voice catches. “Jesus Christ, Tess. What am I supposed to do?”

I don’t tell him that he’s the parent, not me. I say nothing. We don’t exchange another word until half an hour or so later when Kristina and Mom return.

“Okay, out,” Mom tells us. “Kristina needs to change into her clothes and then we’re to wait in Dr. Turner’s office. Room 2. The nurse showed me where to go.”

Dad and I stand awkwardly in the hallway. I pull my sketchbook from my backpack to see if I can get down some ideas or make a couple of rough thumbnails. If I’m going to get my entry in on time, I have to start getting inspired, but my brain won’t allow me to work. Dad doesn’t ask what I’m doing or even pretend to be interested. I still haven’t mentioned the Oswald Drawing Prize to him.

Instead of working, I dream of taking Kristina with me to San Francisco. We’d attend the awards ceremony together and then she could go shopping or do something else she likes. Man, I need to get my piece going if that’s going to happen.

Eventually, Kristina and Mom emerge from the changing room and I hurriedly put away my pad. Mom leads the way to the doctor’s office. We follow, quiet and slow, like kids being shuffled off to the principal’s office for doing something wrong.

The doctor’s room is stark. White walls, no examining table. There’s a big desk with a computer and monitor on top and a leather office chair pulled up to it. There are two cheap steel chairs opposite it. Kristina sits right away, her head bent. I lean against the wall close to the door and gnaw on my lip. Dad leans on the opposite wall, staring into space. Mom heads straight for the doctor’s desk and opens a thick medical book sitting on top of it. She starts flipping pages. I think she’s searching for something to tell that her daughter will be okay.

Minutes go by, painfully long quiet minutes. Finally the doctor walks in the room and all of us snap to attention. She looks young. She’s pretty, with wavy brown hair. She’s wearing makeup and jewelry and a blue dress under an open white lab coat. I think how unfair it is that she seems to have been dealt an overabundance of good genes. Brains. Beauty. She got it all.

She touches Kristina’s shoulder as she passes. I have an urge to yell at the doctor, to demand she tell us it’s all been a big mistake.

I glare at her, wanting her to fix my sister with her slender, pretty hands. Make the nightmare go away. Mom closes the book she’s been snooping in and moves back, sitting in the chair beside Kristina. Dad doesn’t budge, but follows the doctor with his eyes. The doctor walks around her desk, clicks a key on the keyboard, and checks the screen for a second before turning her attention to Kristina. My sister stares at her and her eyes fill with tears. When I look at Dr. Turner’s face, I know immediately. The news isn’t good. I feel sick to my stomach.

I blink rapidly, trying to keep my tears inside.

“Kristina,” Dr. Turner says, and shifts her hip against the desk, not sitting yet. She nods at my parents. They’ve already met, formal introductions have been made. She smiles at me. “You must be Tess,” she says, but doesn’t seem to expect an answer, which is good because my throat is so tight, nothing, no sound is capable of coming out.

We all stare at her, holding our breath as a family. Waiting.

She sits in her chair, and leans back. “The tumor is directly above the knee. As expected with this type of cancer, we’re looking at a Stage 2B. The mass is larger than I would like, but despite that, we’re going to do what we can to help you keep your leg, Kristina. Many osteo patients can have limb-saving treatment and that’s what we’ll hope for you.”

Bile boils around my stomach. I swallow a bitter taste, watching the doctor as if she’s insane. Help her keep her leg?

“Stage 2B means it’s a high-grade cancer, very aggressive,” she says as if one of us asked the question.

No one says anything. The doctor waits. Tears stream down my mom’s face. My dad’s face is stony, blank. Kristina stares at her hands, twisting them around and around in her lap.

“I assume you and your family have talked about the possibility of amputation,” the doctor says.

“Not really,” Kristina whispers without looking up.

I have an image in my head of Kristina with a stump at the end of her leg and want to throw up.

The doctor’s lips tighten. I wonder if she wants to give my parents a lecture. They certainly didn’t have a discussion with me about Kristina losing a leg, but not even with her? I want to scream at them. Blame them for what is happening.

“Osteosarcoma can spread quickly to other bones or even to the lungs if we don’t get it fast.”

My mom gasps. “The lungs?”

It’s obvious we’ve all been living in a state of denial. I’ve been busy trying to sketch and trying to study. I’ve even avoided googling osteosarcoma. God knows how my parents have managed to hide from it too, but here’s reality poking its ugly head out and forcing us to deal. Kristina’s cancer is serious. Very serious.

The doctor blinks slowly and stares at Mom. “Worst-case scenario is spreading. We have no way of knowing what will happen at this point, but spreading is, of course, a possibility. We’ll start treatment immediately.” The doctor smiles briefly, but it’s not a happy smile. “Fortunately, we have a team of specialists in our hospital, and we’ll be able to treat you here instead of shipping you off to another part of the country.”

I feel like someone punched me in the stomach and pulled the breath out of my lungs, clamping long fingers around my windpipe. This is the fortunate scenario?

“We’ll start the first round of chemotherapy right away,” the doctor says in a soft but businesslike voice. “The initial MRI doesn’t show any spread beyond the knee yet, but we took more X-rays today and we’ll repeat tests throughout Kristina’s treatment. I expect a few rounds of chemo.”

Although it doesn’t seem possible, my dad stiffens even more. I stare at him. He’s so rigid I imagine if I pushed him with one finger he’d go down like a statue.

“How soon will she start?” my mom asks.

The doctor leans forward. “Like I said, osteosarcoma is aggressive. We’d like to get to it right away and since you’ve indicated that waiting for insurance is not an issue for your family, I had my secretary book her into the hospital…” She clicks the mouse and waits a moment while she reads the monitor. “In four days. September 30. First thing in the morning. Pamela, my nurse, will give you instructions on where to go and what to do before the treatment begins.”

It feels like someone reaches inside with a long vacuum hose to suck out my insides.

“Four days?” my sister asks.

“It’s fast, I know, but we want to go after it right away. It happens like this a lot with bone cancer. I’m sorry there’s not more time to adjust,” Dr. Turner tells her.

“Will her hair fall out?” Mom asks, her voice soft but machinelike.

“Most likely,” the doctor answers and she turns to Kristina and studies her. “Not right away but usually after the first round.”

Kristina makes a tiny sound, like a kitten’s mew. Her face is as pale as the fresh snow that will soon be falling. Kristina stares at her hands, winding them around and around each other. “You should also know that chemo can be very damaging to fertility,” the doctor says.

“I don’t care about that,” Kristina answers and shrinks into herself even more.

Mom makes a sound like a bird in distress.

“Well, it’s a fact that has to be mentioned, but we want to get the chemo started right away.” She pauses, but no one says a thing. “Do you have questions, Kristina?” the doctor asks in a softer, more sympathetic tone. “I want you to feel prepared for what lies ahead.”

I wonder if the doctor has a sister. I wonder if her sister has ever been sick. Really sick. My heart thumps faster. It’s not fair, I think. It’s not fair. How can Kristina look so normal and be so seriously ill?

“How do I take it?” Kristina’s voice cracks. She clears her throat. “I mean the chemo. Is it a pill or, um, a liquid or what?”

My dad opens his mouth to begin speaking but the doctor lifts her hand to cut him off. It’s her specialty after all. His is university stuff. Not cancer treatment.

“Chemo has different forms and different ways of being ingested. It depends on many factors—the type of cancer, and the stage, and so on. We have developed drug protocols for higher response rates.” The doctor pauses and wipes a strand of hair from her eyes. Her eyes look tired. “Your type of cancer requires chemo to be given intravenously via a drip. It’s a fluid. We’ll put it in through a vein up your arm, or in your neck. Before you start chemo you’ll have an intravenous catheter, or a line, inserted into your chest. It threads through to your heart. Scar tissue holds it in place.”

I cringe and force myself to go numb, trying not to register what Kristina will have to go through. The thought of anyone inserting something inside me makes my limbs feel like jelly. I can’t imagine what Kristina must be thinking.

“The insertion will be done under local anesthetic. It isn’t terribly pleasant, to be honest, but once it’s in we’ll leave it there for the duration of chemo, which means you don’t have to keep having needles and lines put in all the time.”

“Great,” Kristina says and drops her head down again. None of us other Smiths manage to say a word. We’re not a chatty bunch today. The doctor glances at each of us as if she expects one of us to speak but when we don’t she reaches a hand out and pats Kristina’s hand. “I expect at least two rounds of chemo. We want to try to shrink your tumor. Save your limb if we can.” Her voice is calm but detached.

If.

My head snaps up. I am so not ready to deal with this. Kristina has squeezed her eyes shut and her face is tighter than the fists I’m making.

“We hope to be able to cut out the diseased bone and replace it with an internal metal prosthesis. You have full access to all available treatments. Financially. You’re lucky for that.”

Thanks, Grandpa Smith. Boo for mean drinking habits but yay for financial wizardry.

Mom nods and draws in a sharp breath, and Dad shifts his weight back and forth, his eyes on the floor.

“Money is not an issue. We want the best for Kristina,” Mom says.

Kristina doesn’t move.

“Is that the expected outcome?” my mom asks. “Metal in her leg? What about her athletic career?”

My mouth drops open. No, she did not just say that. Dad continues his fascination with the tiles on the floor.

Dr. Turner lets out a quick breath. “In our opinion, an internal prosthesis probably wouldn’t give Kristina back full mobility. I can’t tell you for sure which will be feasible until we begin the process. We can hope for endo-prosthetic surgery, the internal prosthesis; however, often with limb salvage there are a bunch of activities that a patient will not be able to do, especially aggressive sports. We often recommend amputation if the patient wants to pursue aggressive sports. An external prosthesis is better for that.” The doctor makes a note on her laptop and looks up.

“No,” my mom shouts. “We save her leg. It’s more important than volleyball.”

The room starts to spin a little. Amputation. Prosthesis. In my head I see a chain saw revving up and being held over my sister’s leg.

“No!” I echo out loud before my imagination carves off Kristina’s bone. All eyes turn to me. “She can’t lose her volleyball or her leg,” I say, and my voice is louder than I want it to be. Angry. “She’s the volleyball captain at school. The best player in the whole city. She’s going to play in college next year.”

“Tess,” my dad says, and I hear the warning in his tone.

“No.” I can’t stop myself. It’s unfair and I don’t want to hear it. Kristina can’t lose a leg or have a metal bone put inside her leg. She has plans. Plans that involve two legs.

“She needs her leg for a volleyball scholarship,” I sputter.

My dad steps forward and puts a hand on my shoulder. “She doesn’t need a scholarship. We can afford any university your sister wants to go to.” He says it softly, but his hand squeezes harder and it feels like it’s bruising my flesh.

I push his hand away. I don’t want to be touched. I don’t want people touching Kristina. I want to grab her hand and run from the room with her. Jump in her car and drive far away.

“But…” I sputter again, trying to put into words what I cannot say. “It’s not the plan.” I stop. She doesn’t have the grades, I want to yell. I’m the smart one. She’s the athletic one.

“Shut up, Tess,” Kristina hisses. “This isn’t about what you want.”

I deflate. She glares at me but her expression is unrecognizable. The life in her eyes is gone. They’re dull. Even her posture is different. Her back is bent over, hunched, and the glow of perfection has faded. I close my eyes tight.

“I won’t play volleyball if I keep my leg?” Kristina asks in a quiet voice.

The doctor clears her throat. “It’s too soon to say what is going to happen. It depends how treatment goes. It will take time to find out. I do have patients who go on to do sports.”

“No,” my mom says again. “Kristina, you’ll keep your leg.”

Kristina doesn’t even look at her. She’s focusing on the doctor. “Like Paralympics, you mean?”

The doctor doesn’t answer that question. “You need to be prepared for all the options.”

My mom sniffles loudly and pulls Kristina in tight, as if she can keep out the big bad world with her embrace. Dad returns to his spot against the wall, stiff.

The doctor clears her throat, watching our family fall apart. “There is support available. Because Kristina is eighteen she’s not considered a child, but we have resources for adults as well. Pamela, my nurse, will give you all the information you need.”

Dr. Turner stands. She bows her head and then looks up. “Okay then. We’ll be in touch. Please make sure you get all the information from Pamela.” She leaves the room and with her, normality flies out the door.

Kristina starts to cry but it’s soft and unbearable. “You can’t tell anyone at school about this,” she says to me. “I don’t want anyone finding out I might lose my leg. Not a soul.”

“But…”

“You listen to your sister, Tess,” Mom says, cutting me off as I’m about to tell her how impossible that will even be. “We’ll work out something. We’ll worry about breaking the news later. Kristina needs her privacy right now.”

She does? Or does she need friends who can back her emotionally and let her know she’s still okay? I suspect Mom wants to keep it a secret for her own reasons and I want to yell that Kristina is a person who needs people around to help her deal, but I don’t want to upset Kristina even more.

Dad says nothing. I stare at him and wait for him to tell them it’s a bad idea, but he’s mute. Anger flashes through me. How long do they expect they can pretend that everything is fine? And how can it be the right thing to encourage her to keep it quiet? Do they think people just won’t notice her absence? She’s not me. She doesn’t fly under the radar.

Is she supposed to be ashamed of her bones?