Archive of Our Own

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“Goldenrod and the four H stone
The things I brought you
When I found out you had cancer of the bone.

In the morning, through the window shade
When the light pressed up against your shoulder blade
I could see what you were reading
All the glory that the Lord has made
And the complications you could do without.”

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Dennis wakes up when a packet of his chemo pills beans him in the face. 

The foil and plastic smack him right in the bridge of his nose hard enough to make his eyes well up with tears on reflex — they spill over and drip down his cheeks. The blister pack skitters across his chest and lodges somewhere near his clavicle. He pries one eye open with a groan, lashes not sticking together because they’ve been loosened by his tears. You don’t have to be awake to cry. He had hoped that the nausea of yesterday would have abated overnight; it did not.

“Why the fuck are you on Gleevec?!” Trinity snaps, looming in his bedroom doorway like an angry cryptid, backlit by the hall light. 

“It tastes good.” He croaks, voice raw. His spit tastes like rust.

“Oh, fuck you.” She storms into his room, nearly tripping over the detritus on his floor, and snatches the packet off his chest, dangling it in his face. The plastic rattles under her death grip as she shakes it at him, hard enough that a couple of the pills click against their blisters. “Imatinib? A tyrosine kinase inhibitor? You want to explain why you’re taking a first-line agent for BCR-ABL–positive malignancies, asshole? Or do I have to pull up your MyChart on your piece of shit phone to find out for myself?” She knows the answer, of course she does. But there’s peace in the not really knowing.

“I was going to tell you, Trinity.” He pushes himself up, swallowing a few times reflexively when his head spins like he’s on the Tilt-A-Whirl at the state fair again. His belly lurches, even though he knows there’s no funnel cake to upchuck. He didn’t tell anyone. He didn’t tell her. He didn’t tell Jack and Robby, even though he spends their lonely nights warming their bed. He didn’t tell his parents or his brothers. He didn’t say shit. He couldn’t. 

“No, you weren’t,” She shoves him back down with both hands; it’s in the same minute that he realizes she’s crying. “Because if you were, I wouldn’t be finding this in our bathroom cabinet like I’m doing a goddamn medication reconciliation on an unresponsive patient. Chronic myelogenous leukemia? Acute lymphoblastic leukemia with Philadelphia chromosome? Gastrointestinal stromal tumor? Which is it?” She’s still in scrubs from her night shift. He’d thought she was going over to Garcia’s, to talk. Her hair’s half fallen out of its yellow scrunchie, strands sticking to her temples, her neck. She absolutely hates flyaways and keeps this really sticky green gel in her locker — and in the bathroom cabinet, fuck. “Dose is 400 milligrams, so we’re not in escalation territory, which means either someone on your ass caught it ‘early’ or you’re being underdosed. How long? When were you diagnosed?” 

“Trinity,” He sits up too fast and immediately regrets it when a sharp wave of dizziness forces him to brace a hand against his crappy headboard — it’s only up because it’s pinned against the wall. He drags himself back anyway, shoulders pressing into the wood, the sheets beneath him damp and twisted into ropes around his legs. It reminds him of the tarot cards she keeps in her dresser drawer, the hanged man. With a shaky hand, he pats the space beside him. “C’mon, we can talk about it once you’re settled, okay? You must be exhausted.” She is, he knows she is. But she starts pacing instead, waving her hands.

“Stop trying to handle me! You gave me nothing to work with! Zero labs, zero imaging. Do you have a CBC trend? What’s your white count been doing? Any blast crisis indicators? Cytogenetics? PCR for BCR-ABL transcripts? Please tell me you at least have a baseline before starting therapy. Have you been monitoring for edema? Periorbital swelling, fluid retention, pleural effusions? Nausea, vomiting, muscle cramps, hepatotoxicity? Are your LFTs stable or are you just waiting to tip into transaminitis? Are you on anything else? CYP3A4 inhibitors? Inducers? God, please don’t tell me you’ve been drinking grapefruit juice, along with eating all my fucking avocados.” She’s beside herself and it’s all his fault. It’s usually his fault. Most things are. 

“Trinity.”

She doesn’t hear him anymore, she can’t. “Have you even been taking it consistently?”

“Trinity.” He pinches the bridge of his nose, “My oncologist wants the CML —”

“You have an oncologist,” She looks so hurt, it makes his belly flip sunny-side-up in the pan. He’s taking chemo, of course he has an oncologist. “Did you get a second opinion?” She doesn’t wait for an answer, not that he would have given her one she was happy about anyway. “Well, tough shit, because you’re getting one whether you like it or not. I want to see your labs, your biopsy report, and the molecular diagnostics.” She says it like a threat, still pointing at him with his own blister packet. He would do anything if she’d just lie down. 

“Trin,” He tries again, closing his eyes as he leans back against the headboard, nauseated, “I had a long conversation about my leukemia with a leukemia specialist. I don’t need a second opinion. It’s a childhood cancer late effect, shitty but that’s just how it is: a chemo-induced chronic leukemia, rarer than another acute or MDS, but still — a textbook CML diagnosis. I have a t(9;22)(q34;q11) translocation and I found out last week, a Philly. You were on the outs with Garcia, remember, I didn’t want to make your life even worse by dropping that on you.” He frowns, “I got my CBC like I always do. I wasn’t expecting leukocytosis. I was a little tired, but I’m always tired. You know that. I didn’t think it was going to flag a crit out of the blue. I would have brought you with me to the first appointment if I’d known this was the way it was going to go.” No, he wouldn’t have. 

“WBC count?” 

He winces, “Seventy-eight thousand.”

“Fuck.” Yeah. She finally climbs into his bed though, crawling on hands and knees through his splayed legs and up his mess to curl into his side, despite herself. He would liken it to an angry little black cat finally settling down on his chest. They get a bad rep, but that’s not true — they’re actually the best cats around. “Differential?”

“Left shift. Myelocytes, metamyelocytes, and a few blasts, but under 10%. Basophilia. Eosinophilia. You know the deal.” He’s hitting shit values all around. 

“Biopsy?”

“Hypercellular, granulocytic hyperplasia. Blasts still under threshold, thankfully.”

“Cytogenetics confirmed BCR-ABL?”

He nods. “PCR and FISH. It’s official.” He kisses the top of her head; they both need it. She smells a lot like the ED and a little like his blueberry and mango shampoo. It makes his stomach hurt worse. She needs him, the same way he needs her. He can’t leave her alone. “I had AMKL as a kid, M7. It was aggressive and shitty and I don’t remember most of those three years, but I got a bone marrow transplant when I was six, MUD. I’ve been mostly fine since, long-term side effects notwithstanding. Until, well—” He nods at the packet still in her hand. 

“This isn’t the same disease.”

He snorts, “Don’t I know it. CML’s just a clonal expansion of hematopoietic stem cells with constitutively active BCR-ABL. Different lineage, different kinetics, different prognosis. I like this one a hell of a lot better than the last.”

“You’re only on Gleevec?”

“First-line therapy, you know that.”

She crosses her arms. “Side effects?”

“I couldn’t get through a banana for dinner last night.”

Her hand finds his belly almost absently at that. She starts rubbing slow circles under the sweaty cotton of his cheap Hanes shirt, fingers tracing the curve of his swollen gut, then drifting along the path of his colon. He glances down at her hand, then back up at her tired face; her eye bags look awful. He really needs to get her down for a nap. She doesn’t even seem to realize she’s giving him a belly rub. “You need antiemetics on board. Do I need to write you a script?”

“I have some, they just make me rashy.” 

“Which one?”

“Ondansetron,” He groans, sourly, just the thought makes him itch. “Last time I took it, I broke out. Arms, chest. Pruritic. Probably some kind of hypersensitivity thing.”

“Urticarial? Maculopapular?”

“T, just leave it. I’m fine without.” 

“You couldn’t keep a banana down, Dennis. Clearly, the imatinib is irritating your GI tract. What, were you just going to white-knuckle it?” Her fingers start moving again, light pats, small presses, like she’s trying to physically coax his belly into doing what it’s supposed to do and leaving him alone. “You’re going to keep cycling through nausea until we get meds into you. We can try something else,” She decides, determined. “Metoclopramide. Promethazine. Hell, even low-dose olanzapine if we get desperate.”

“Promethazine knocks me out.”

“Great,” She snarls. “You can be unconscious and not vomiting.”

“I have things to do today.”

“Yeah, you do. First, you’re taking a bath,” She says, flatly. “Because you smell like sweat and ketones and I’m not letting you stink up the place. Then I’m changing these sheets and picking up the crap on your floor, before you crawl back into this bed so I can take care of you.”

He rolls his eyes. “Calm down, Trin. It’s CML, not AML. I’m fine.”

“I’m sorry.” She doesn’t sound like she’s apologizing. “Don’t you dare minimize this by comparison.”

“I’m not minimizing,” He pushes back, straightening a little despite the way his stomach protests the motion. All he wants is to lie back down, but— “Look, chronic phase CML has a completely different prognosis. We’re talking targeted therapy, high rates of cytogenetic remission, and near-normal life expectancy if I respond well. This isn’t bone marrow failure and blast crisis out of the gate. I don’t need you to take care of me through chemo, this is barely chemo.”

“CML can progress. You know that, blast phase is functionally indistinguishable from acute leukemia.”

“And I’m not there,” He stresses. “I’m in chronic phase and I need to get used to this. I’m going to be on Gleevec forever. Or I burn through TKIs, run out of options, and die. It’s just how CML works. If you suppress the BCR-ABL activity, you stay in remission as long as the drug works. If it stops working, you escalate. If everything stops working, you die. I don’t get to be precious about side effects. If I’m going to be on this long-term, I can’t bail every time my tummy gets upset.” 

“Oh, fuck you.” She swats at him without any heat behind it, “We need to manage your side effects so you can stay on therapy. You don’t get to play martyr just because you’re sick, cancer boy.”

“I told you, the antiemetics make me break out.” He pouts.

“Then we find one that doesn’t. CML isn’t suffer or die, genius. People live decades on meds. Some even achieve deep molecular remission and come off treatment under supervision.”

He rolls his eyes, flopping over a little so he can properly bury his face in her hair. “Stop trying to sell me a pipe dream. Let’s just take a nap, kay?”

“I’m not. I'm just not going to tolerate a world that you don’t exist in.” She wraps her arms tighter around his belly, not shoving him away like she usually would. “I am not losing you because you were too stubborn to take a fucking antiemetic.”

“Love you too, Trinity.”

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“Tuesday night at the Bible study
We lift our hands and pray over your body
But nothing ever happens.

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