Phearful Symmetry

When Phin went to his 45-day post-bone marrow transplant checkup recently, his counts were great. The oncologist said that his blood was more or less indistinguishable from the blood of a person who had never had leukemia. Everything in his lab report looked wonderful. 

Everything except for one note very far down the report that indicated the presence of some atypical cells: “large, mononuclear cells with prominent nucleoli and fine chromatin.” 

Neesha and I both heard the same voice when we read those words, like a cold hiss in the darkness.

“Blasts.” 

Blasts are the ill-formed cells leukemia spits into the bloodstream. They are what a physician scans for in order to diagnose a patient with leukemia in the first place. Way back in 2022 when all of this began, when we took a jaundiced, frail, bruise-bespotted Phin to the doctor and then to the ER, it was the presence of blasts that ruled out simple anemia and scrambled the oncology team to assist us. The lab report we received that day also reflected the occurrence of these atypical cells. Now, after all of the chemo and remission and a bone marrow transplant and engraftment, there we were, yet again, with blasts.

I was at the hospital with Phin after his checkup when the lab report appeared. He was sleeping off the anesthesia from his latest bone marrow aspiration procedure. The oncologist sat me down in a private room. I called Neesha and put her on speaker. 

“We think these are recovery blasts,” the oncologist said, “where the new bone marrow is still setting itself up and not all the cells it makes are perfect yet. But there’s a chance it’s the AML again.”

The oncologist explained that when Phin got his bone marrow transplant, they shocked his immune system down to the lowest point it had ever been in order to give the donor marrow a chance to take hold without his existing cells trying to kill it off. But if there were any surviving leukemia cells in Phin at that moment, they could have exploited the weakness in his defenses and reestablished themselves. 

“So the blasts might indicate the bone marrow transplant worked,” the oncologist said, “or they might indicate the cancer’s back.” 

No one said anything for a long time. 

“When will we know?” Neesha's voice crackled through the speaker. 

The oncologist said the bone marrow sample collected from Phin that morning would provide the answers we needed about the blasts, but–and we knew this, having already been through it twice –the sample had to be processed in a lab in a distant state, and it would take days to get the results. 

“Hopefully, we’ll know something by the weekend,” he said. 

That was last week Monday. The oncologist was very kind. He told us to try not to worry. Then he departed to continue his rounds, leaving me to wait in a hospital room with my son and a feeling of infinite smallness from having become aware, in an instant, of two diverging universes, each exactly identical to the other except that in one of them his leukemia has returned. 

Just like when Phin was first diagnosed, and just like when he relapsed, it would be days before word would arrive about which of these two universes we now live in. 

And just like before, Neesha and I did what most cancer parents do, which is to try to buck up our spirits during the day to complete our individual tasks, to smile for the sake of our kids, and to project normalcy, sanity, and calm. Hope for the best and prepare for the worst! Like we’ve always done. While there’s daylight, anyway. But in the forests of the night where insomnia invariably deposits us, we were ensnared by the vines and brambles of what could have been and stalked relentlessly by the terror of what might be. 

Finally, at the end of the week, the oncologist called. I stared at my phone. 

Perhaps, I thought, I could make a new life for myself here in this moment. 

This was, after all, the vestibule of the future. What was stopping me from unrolling my sleeping bag and making this the place where I stayed from now on? And who would blame me? Twice before I’d burst through the door of an oncologist’s call about my son and on the other side found only anguish. I remembered that we’re 0-2 for hearing anything good when a health professional calls to talk to us about blasts.

If I could stay here forever, I thought, both universes could always still be possible, but as soon as I answer this call, one universe will disappear, and we’ll be trapped in the other.    

“Hello?” I heard myself say.

“Good news!” the oncologist said. 

Medical Updates

The large, mononuclear cells with prominent nucleoli and fine chromatin that appeared in Phin’s 45-day post-BMT lab report have been confirmed to be recovery blasts. We didn’t even know that was a thing. We’ll take it, though. 

When we asked about the likelihood that those blasts could have been the product of Phin relapsing again, the oncologist said he’d been cautiously hopeful that that wasn’t the case, but he added that AML isn’t the kind of disease you underestimate. 

Throughout the week as we’ve tried not to panic and to act like the worst thing imaginable wasn’t possibly about to happen to us again, Phin had an additional follow-up appointment, and everything else looks pretty good. He’s a little more than halfway through his 100 days of observation following his transplant now. One of his lines got clogged, but that’s resolved now as well. 

Phin On the Daily

Phin’s had his mom and sisters with him at the Ronald McDonald House for more than a week now. They’ve done crafts, played soccer, had movie nights, and explored some of the parts of the Atlanta area where it’s cool enough and isolated enough for Phin to safely go. His sisters will depart to go back to school when Neesha and I swap out tomorrow. A tearful farewell is expected. 

But sometimes farewells precede reunions. I stopped by Phin's classroom at back-to-school this afternoon, and his teacher is very excited to see him back this year. We don't know when that will be. It certainly won't be when classes start at his school on Monday. It might not even be this fall. 

Nonetheless, Phin's teacher is excited to see him, whenever it is that he is able to return.