Diagnosis Part 1

October 27, 2007, Athena wakes up at 2:00 am with a horrible stomach ache. She rushes to the bathroom and empties her dinner into the toilet. Carson lives in his own apartment and Athena lives alone with her two cats: Waffle and Syrup.

"Meow, meow."

"Stop it Waffle! Don't lick the vomit from my shirt, get out! Darn cat. At least I held down food for a few hours this time."

Athena picks herself off the bathroom floor, washes her face, and rinses the vomit from her teeth using mouth wash.

"Back to bed for a few more hours."

Three hours later, Athen gets up for the day: due to the nature of her chosen profession, she normally gets up at 5:00 am. She goes to the kitchen, pours herself some water, and checks her phone. Carson sent a text last night.

Carson's text message: Hello Athena, it is 8:15 pm and I am now leaving the study group. Did you need me to grab anything on my way off-campus? Text or call me back. Love you lots.

Athena's response to Carson: Hey Carson, I went to bed early last night and did not see your message till this morning. I did not need anything last night and appreciate you asking. Hector is coming to Seattle today to accompany me to my appointment. We plan on getting coffee before the appointment. What would you like me to get you?

"If Carson does not respond to my text by 8:00 am, I am getting him a surprise."

Athena takes a sip from her water glass, refills Waffle's and Syrup's food bowls, and heads back upstairs. While washing her face, Athena thinks she hears a knock at her front door.

"Odd, it is 7:00 am already?"

She looks at her phone, and the time is 6:30 am...and Hector is calling. Athena answers the phone.

"Hello Hector, how are you doing this morning?"

"I am feeling splendid Athena. I wanted to get in touch with you and say Luis and I are on our way to Seattle."

"You are bringing Luis with you?"

"Athena, I am bringing Luis with me. He wants to do some sightseeing and shopping downtown. I already barred him from attending the appointment..."

"He did not bar me, Athena. I agreed to let you two have a day of bonding. Plus, I can keep Carson company when he is done with his exam."

Athena can't help but roll her eyes at her in-laws' antics.

"Are the two of you done teasing each other over today's events? And have you eaten breakfast yet?"

"Athena, Luis, and I have not eaten yet. Try not to go out of your way to make us feel welcomed. We will be at your house in roughly 30-minutes...traffic has picked up."

"I will see you two when I see you two."

Athena ends the call and continues her morning routine. She notices how many dark circles are under her eyes from lack of sleep, her skin has grown slightly pale over the last month, and she is worried about being able to hold down this morning's breakfast. After putting on a pair of loose-fitting blue sweat pants, a baggy Seattle University sweatshirt, and socks Athena goes back to the kitchen to cook breakfast.

"I know Luis drinks coffee, while Hector prefers tea...guess I am making both today. Scrambled eggs should be easy enough on my stomach, heat up a can of black beans jazzed up with cumin and garlic, heat up toast when my company arrives, and boom. Breakfast!"

Ten Minutes Later

Ding, dong.

"I am coming Luis and Hector."

....

"Come on in you two, the cats will try to escape."

"There is our sweet woman. May I have a hug?"

"Of course Hector, come over here."

Hector and Athena embrace each other for a minute, Luis puts his and Hector's shoes by the front door and walks into the kitchen to pour himself some coffee.

"The food is all ready Luis if you want to serve yourself a plate."

"Thank you, Athena, I have already started serving myself a coffee. By any chance do you have half-n-half?"

"In the fridge, Luis, and the sugar is in the pantry."

"Are you going to eat with us, Athena? You seem a bit famished." (there is a hint of concern in Hector's voice.)

"I made enough eggs for three people. Yes, I am going to eat with you."

By this point, Athena and Hector have joined Luis in the kitchen. Waffle, the cat, comes over to Hector and starts purring.

"That is odd. Waffle is usually a crabby mess in the morning. She seems to like you, Hector."

"I have a way with animals, my dear. After all, my cat is on his ninth life...and not deceased as you implied last night." (He gives Athena a playful wink.)

"Hmm, hmmm. I will keep that in mind. I have Earl Grey, Green, and Chai tea for you to choose from Hector. If I recall, Chai tea is best served in the morning with a splash of milk and a hint of sweetness. Earl Grey tea is ideal on an afternoon break, while Green tea has its chance once every New Year."

"I can't believe you remember my stance on teas! In that case, you have your answer Athena: Chai tea with a hint of sweetness with suffice. I prefer honey these days over refined sugar."

"Lavender honey or regular honey?"

"Surprise me."

After preparing Hector's Chai tea with lavender honey and milk, Athena takes her share of eggs and beans. She sees Carson's response to her earlier text message.

Carson's response: I am glad someone will be there to support you, again, I am sorry I will not be there. Give me some updates when you are done? I will take a scone and iced coffee, please. Enjoy your day off and try to rest. Talk later.

Athena's Second Message: Luis came into town too, and will be in the downtown area. Just a heads up, he may try spending time with you while Hector and I are at the Oncologist. I will bring the coffee and scone to you. Hugs and kisses.

October 27, 2007, Athena, Luis, and Hector finish breakfast and head out the door by 9:30 am. Luis is driving the car while Athena and Hector catch up.

"Remind me again Athena, what year are you at Seattle University?"

"I have three quarters left before graduating, so one year. Hard to believe!"

"It seems like yesterday when Carson graduated from the University of Washington...and now the two of you are sharing an adventure at Seattle University. What are your next steps in terms of work?"

"I would like to work in Pediatric Nursing...and hoping to make contacts at Seattle Children's during clinical. It is a bit rough given my health, yet, I know I will make it happen."

"I hate to interrupt your conversation, but we are here."

The car is in the round-about outside Swedish Medical Center on Broadway Street: a stone throws away from Seattle University.

"Very well Luis. Athena and I are off."

"Thank you for driving Luis and have a nice day."

Athena and Hector wave goodbye to Luis and he drives off.

"Shall we move on then Athena?"

"That would be a wise decision. It may take a while to fill out the paperwork in the office."

Athena and Hector enter Swedish Medical Center and make their way to floor seven where the Oncology Department is housed. Athena checks in with the front desk assistant while Hector takes in his surroundings: pamphlets of information regarding cancer treatments available for patients, placards with the physicians' names on them near the front desk, and a daughter-in-law who looks miserable sitting by the front door.

"The look on your face tells me you are scared. Is this an accurate assumption?"

"I am not happy or excited with all this, nor did I imagine I would have to visit an Oncologist during this lifetime."

Yep, she is scared and covering her feelings by avoiding my question. I will meet her where she is emotional.

"I hope you would not be excited to come here. I would have to worry more and endure pre-mature graying if I knew my daughter looked forward to specialist visits."

"Dang old man, there is no need to get too sarcastic. That is my job remember?"

Athena and Hector share a laugh.

There is the smile I like to see. If Athena, Carson, Luis, and the rest of the family are headed down the path of cancer, humor will go a long way.

October 27, 2007, Athen and hector are escorted to an exam room at 11:00 am on the nose. Athena makes a comment about this.

"Hmm, it looks like Dr. June and staff take punctuality seriously. I can get used to this."

Once inside the exam room, Hector finds a corner to sit in and takes out a book. He begins reading the book when Dr. June knocks on the door.

Knock, knock.

"Come in everyone is descent."

"Hector, that was my line."

"I beat you to the punch kid. Maybe next time I will let you give a cheeky comment."

Athena and Hector share another laugh.

Dr. June walks into the exam room and introduces herself to Hector and Athena.

"Hello everyone, I am Luisa June. You may call me Dr. June or Luisa depending on your comfort level. And who are you two?"

"I am June, the patient and he is Hector my obnoxious, fun-loving father-in-law." (Good, a young doctor with a sense of humor.)

"Nice to meet you June the patient and Hector the obnoxious. What brings you in today June?"

"I was referred by my family physician, Dr. Perkins because of some recent blood work results. She found leukemia cells but, wanted a second opinion. I have been feeling dizzy off and on most of the day, I have random nose bleeds, and it is hard for me to hold down food."

"When did you start noticing your symptoms?"

"Around June of this year: I started feeling tired all the time despite getting enough sleep. I am in nursing school and had an especially taxing quarter in June. I associated school stress as the cause for my fatigue."

"Are you a smoker, drinker, or take recreational drugs?"

"I have never smoked in my life, and I am not a drinker, nor do I take drugs."

"How frequently are the nose bleeds?"

"I get a nose bleed once every other day. They come out of nowhere and last anywhere from five to fifteen minutes."

"How have your joint and bones been feeling?"

"Why are you asking me about my joints and bones? I never mentioned anything about my bones or joints hurting."

"The symptoms you are describing to me, frequent nose bleeds, chronic fatigue, loss of appetite, and a diagnosis of anemia could lead to weakening joints and bones. The symptoms are also common in people who may have leukemia or other forms of cancer."

"In that case, my joints feel like they are on fire and my bones hurt too. On a scale from one to ten, one being the pain is not terrible, ten being it hurts to think about walking...I rank my pain at a five."

Dr. June is typing in Athena's descriptions on the computer: she also notes Athena's mood and overall demeanor. According to Dr. June, Athena looks like she is in physical pain, with a slightly depressed mood.

"How are you feeling mentally and emotionally Athena?"

Athena has to take a minute and think about her answer. She notices Hector has dozed off and no longer reading.

"Scared, uncertain, numb, and angry: the emotions come and go throughout the day and occasionally I feel happy." (She says this with a flat affect.)

"What you are feeling is completely valid and not uncommon. Are you experiencing any other symptoms?"

"No Dr. June, the only symptoms I am experiencing are the ones I have shared with you already."

....

"Here is my game plan Athena: I would like to order more labs today and schedule you for a bone marrow exam."

Athena takes an audible inhale and exhale. She is at her wit's end with blood work and hearing the phrase 'bone marrow exam.'

"I understand you are feeling frustrated, but the bone marrow exam will help us determine if you have leukemia, what type of leukemia, and give us an idea of where to start treatment should it be necessary."

"Are you saying I have leukemia, Dr. June?"

"I am saying it is possible you have leukemia, the leukemia cells found in your blood suggest the same thing, and a bone marrow exam will give us confirmation. Are you able to come back to Swedish Medical Center tomorrow for the bone marrow exam?"

"What time should I be back here? What type of preparations do I need to make?"

Hector is awake and pretending not to listen to the conversation between Dr. June and Athena.

"I will have the nurse bring in prep-work instructions when he comes to draw your blood. I have you scheduled for 8:00 am if that works with your schedule. What questions do you have for me?"

"I am scheduled for rotation at Seattle Children's Hospital tomorrow and have my lecture in the afternoon. May I get a note from you saying I have to miss clinical rotation and class for medical reasons?'

"I will send the note in with the nurse. If any more questions come up, please call this number or send me an email (Dr. June hands Athena a business card). And with that, it was nice meeting you Athena, and Hector the obnoxious."

Dr. June leaves the room and a heaviness fills the air like fog.

....

"How much of the conversation did you hear between Dr. June and I Hector?"

"I heard most of it, especially the part where you are coming back in tomorrow for a bone marrow exam."

"Great, that is just what I need! Another layer of stress during my last year of school. I was looking forward to my clinical rotation, and taking a trip to Victoria Canada with Julesa over winter break. But no, it looks like my health has different plans!"

Athena has not realized she is crying, Hector comes over to her with his arms extended. Athena accepts Hector's hug and sobs into his shirt.

"I am here to support you, Athena, Carson is here to support you, heck grumpy guys Luis will bend over backward to support you as well. Have you called your parents?"

"I let them know I was not feeling well after Carson took me to the emergency room a few weeks ago."

"Might I suggest you call them up at your earliest convenience?"

"You already made the suggestion Hector the obnoxious."

"If you calling me Hector the obnoxious makes you feel better, I will learn to embrace the nickname."