Chapter 6: Chemotherapy, Part I
The car hit a bump and jolted Sarah awake.
"Are we there yet?" she asked, sleepily.
"No. Not yet. Getting closer," Naomi answered.
"So, Mom, is this a good idea or a bad idea?" Sarah asked, keeping her voice low so that she didn't wake up Sam.
"Is what a good idea?"
"Driving all night."
"I like it."
"You do?"
"Yes."
"Why?"
"I like not having to fight the traffic."
"I have such weird parents."
"Don't lump your father in with me."
"Oh, Dad's definitely weird, too. Just in a different way," Sarah said.
"Do you really want to walk the last sixty miles, Sarah?" Naomi asked, with a smile on her face.
"No."
"Keep that in mind while you're insulting your doting parents."
"You and Dad never doted."
"We obviously have very different memories of your formative years," Naomi said wryly.
"We must."
"Sarah, are you doing okay, sweetie?"
Sarah looked out the window. "Yeah. I'm fine, Mom."
"That's not a I'm fine expression."
Sarah's eyes filled with tears. "It's so...unbelievable, Mom."
"I know. Believe me, I understand what you mean."
"Tim was going to quit his job for me. I put him down and he put everything he loved on the line for me. Now, he's the one who needs the help and I can't do anything about it."
"Yes, you can, Sarah."
"What?"
"The same thing the rest of us are going to do."
"What's that?"
"Love him. No more, no less."
"I'm afraid to see him," Sarah admitted.
"You want to know something, hun?"
"What?"
"So am I."
"Really?"
"Yes. I'm afraid of seeing my son the way my imagination is picturing him." Naomi reached back a hand and Sarah grabbed it and held it tightly.
"We there yet?" Sarah asked, smiling through her tears.
"No," Naomi answered.
x.x.x.x.x.x.x.x.x
"How are you feeling this morning, Tim?" Dr. Scott asked.
"About as well as I have in the last two weeks. I guess there's something to be said for giving my body what it needs," Tim answered, smiling a little. "It's too bad it can't last."
"Think long term. You're giving it up now to get even better later." Dr. Scott looked at some notes on Tim's chart. "But it's good that you're doing better today. You ate breakfast?"
"Yeah. Such as it was," Tim said.
"We'll get started as soon as your family gets here."
"They should be here any time now. I called them to see."
"Good. We'll go over everything once they're here and then hold on for the ride."
"Yeah."
"Hey, are we late?"
Tim leaned around Dr. Scott. "Dad! You made it!" he said, smiling with relief.
"You don't have to sound so surprised, Tim," Naomi said coming in behind him. She faltered a little when she saw her son, but rallied quickly. "I am a very good driver."
"I didn't mean it that way, Mom," Tim said. "Did Sarah come with you?"
Naomi looked behind her. "She was right there just a second ago." She leaned out into the hall and gestured. Then, she looked back inside. "I'll be right back, Tim."
Sam rolled over to the bed. "Hi, I'm Sam, Tim's dad."
"Dr. Scott, the oncologist."
Sam looked at Tim sadly. "You're here to make him healthy again?"
"That's the plan."
"Sarah didn't want to see me?" Tim asked, trying not to sound hurt.
Sam shook his head quickly. "No. It's not that, Tim. It's quite a shock. Remember we haven't seen you in over a month. Just give her a minute to get used to you."
Tim swallowed and nodded. He knew that it would be hard for them, but he hadn't expected to drive Sarah out of the room.
x.x.x.x.x.x.x.x.x
"Sarah, come on," Naomi said.
Sarah was bawling. "He looks like a skeleton, Mom!"
"That's a little extreme, Sarah."
"How can he get worse from this?"
Naomi hugged Sarah tightly. "Hey, now, you need to get past this. Tim can't help the way he looks...and he will get worse."
"I know."
"Can you handle it?"
"Just give me a minute."
"Okay." Naomi hugged her for a while longer and then asked, "Ready?"
"Yeah." Sarah took a deep breath and walked past Naomi into Tim's room. She still couldn't believe how much he'd changed. They'd had lunch the last day of her exams. He had been fine, maybe a little tired, but he'd told her that he'd just finished a long week of cases during which he'd rarely been home before midnight. Then, he had turned the conversation to other things and she hadn't thought anything of it. He had been fine...and now he was dying.
"Sarah?" he asked, looking worried.
Sarah walked over to the bed and hugged him...tightly.
"Not so hard, Sarah," Tim whispered.
"Sorry. I'm sorry, Tim."
"It's not your fault. You hardly gave me cancer."
"But..."
"No buts, Sarah. This isn't anyone's fault. It's just really bad luck."
"That's true," Dr. Scott said as Sarah sat down. "We rarely discover what causes AML. It could be anything from environmental to genetic factors. Are you ready for the sordid details?"
Sarah looked at Tim and saw the flash of fear on his face. He was afraid. Tim was rarely afraid, at least not that he showed her. He took his role as a big brother very seriously.
"Lay them on us, Dr. Scott," Sam said. Naomi sat on the other side of the bed, holding Tim's hand.
"All right. We'll be starting the chemo in about an hour. The actual treatment will last for a week."
"That's all?" Sarah asked.
"The treatment only lasts a week. Recovering from it takes much longer. We'll be using a combination of two drugs, cytarabine which will be given to him for seven days and daunorubicin which will be administered for three days. The names probably won't mean anything to you, but both of them have severe side effects. In addition to killing off the leukemic cells, they destroy most of the white blood cells and can also affect platelet and red blood cell production. This is called myelosuppression, and what it means is that Tim will have a difficult time fighting off infection. Any bacteria could multiply and kill him if we're not careful. Once he reaches the nadir stage..."
"The what?" Naomi asked quietly.
"The period of time when his bone marrow is completely depressed. During the nadir periods, we'll likely need to put him in relative isolation. And even now, once we start the chemo, you'll have to take extra care during your visits. If you're sick at all, stay away. If you're healthy, you'll need to take extra care in washing your hands. In fact, the best thing to do is to shower before you come, sterilize your hands when you get here and try not to touch him too much while you're here."
"Think of me as a leper," Tim tried to joke.
"Actually, it would be better for you to think of everyone else as lepers," Dr. Scott retorted.
"How long do we do this?" Sam asked.
"Probably about a month. Tim's cancer is pretty advanced. We'll check on how his cell counts are throughout the recovery period."
"But if it doesn't work this time, I'll have to go through it again," Tim said.
"What about short term?" Naomi asked.
"The lowered cell counts will start pretty much right away, but more than likely, the first symptom you'll see is nausea and vomiting. We can use some antiemetics, but we can't always get rid of all of it and both the drugs we use cause vomiting. Alopecia will occur within the week."
"What?" Sarah asked.
"Hair loss, Sarah," Tim said. "I'm going to be temporarily bald."
"Temporarily?"
"Yeah. Once the treatment is over, it should start grow back."
"So...you'll be Mr. Clean?"
"Only without the cleaning part."
"Right. Okay."
"Any other questions?"
Sam looked at the rest of his family. Then, he looked up at Dr. Scott. "Francis Bacon said that 'a prudent question is one half of wisdom,' but I can't think any prudent questions at the moment...except...when do we start?"
"Now," Dr. Scott said.
"Then, let's go," Tim said.
x.x.x.x.x.x.x.x.x
It didn't take very long to give the first dose of chemotherapy. It took much longer for Tim to recover from it. Within an hour, he was vomiting...and when he wasn't actually throwing up, he was dry heaving. They tried antiemetics, but they didn't work. Naomi held Tim tightly every time he began to retch and kept him from falling over. After a couple of hours of throwing up, Tim didn't even cry anymore. He just let his body get on with turning itself inside out and hoped for a break in between bouts. Sam and Sarah couldn't take the vomiting and had to have a break, but Naomi never left.
x.x.x.x.x.x.x.x.x
"Hey, Sarah! When did you all get here?" Tony asked. He and Ziva had come over right after the day had ended. In a reverse of the day before, Abby had to stay to run a whole bunch of tests that had come in at the last minute.
"Just this morning," Sarah said, wiping away a tear.
"What's wrong?"
Sam wheeled himself over. "Tim's started his chemotherapy. He's been pretty much throwing up for the last few hours. I'm Sam."
"Tony."
Ziva held out her hand. "Ziva. Can we still see him?"
"Of course. Sarah and I tend to compound the problem when vomiting is involved.
Tony laughed. "I didn't think you liked vomit, Ziva."
"Does anyone?"
"Not as far as I know, but McGee told me about how you made him search through all the puke."
"Do not pretend that you would not have done the same thing," Ziva said as she strode down the hallway toward Tim's room.
"That's my job," Tony said, still grinning. It faded when he opened the door to Tim's room and saw him just being leaned back onto his bed, looking sweaty and extremely pale.
He looked at them. "Hey..." he panted. "Come on in. It's a regular party." He swallowed convulsively. "I've gone for a record thirty minutes without throwing up."
"Wow. Sounds great, Probie," Tony said, trying not to show his concern. "I don't know how you're standing the excitement."
Tim let out a short laugh, tinged with tears. "It's not like...I have much choice in the matter." He swallowed again and closed his eyes. "Oh, I forgot. This is my mom."
Naomi patted Tim's cheek and stood. She shook their hands. "I'm Naomi."
"Tony."
"Ziva."
"Isn't there anything they can do?" Tony asked.
"Nothing they haven't already tried, unfortunately," Naomi said. "Hopefully, his body will adjust to the drugs...or else the antiemetics will be more effective tomorrow."
"Mom?" Tim said, suddenly, his eyes flying open. She was beside him in a moment, one arm around his shoulders and a hand on his forehead as Tim began to retch. Nothing came up, but he was dry heaving for nearly a minute before the spasm passed. "Two minutes," he said, not able to hold back the tears that time. "Too much excitement."
"Could you two stay here for a bit?" Naomi asked. "I should probably see how my two weak-stomached family members are doing."
"Sure," Tony said immediately. If Naomi had been there for hours, she could probably use a break.
"Of course. That is why we are here," Ziva said, only a second behind him. "Take as long as you need."
Naomi smiled in gratitude and then leaned over and kissed Tim's sweaty forehead. "Hang in there, Tim."
Tim just nodded and closed his eyes again.
"How long will this last, McGee?" Ziva asked, once the door had closed.
"At worst, a week. At best, just today," Tim answered, breathing deeply.
"Man, McGee, I'm sorry," Tony said. "This really sucks."
"No kidding, Tony," Tim said and swallowed again. "So...what happened with those kids?"
"Gibbs dragged them into interrogation, got their parents involved and he let them know exactly what we could have done to them," Ziva said. She tried to stay light, but her heart was almost breaking at the sight.
"Good for him," Tim said. "I wish I could have seen it."
"The kids were nearly peeing their pants; they were so scared," Tony said, taking over the weight of conversation. "I think that if Gibbs ever retires...again, he could get a job scaring delinquents to death."
"Sounds like a good idea. You should suggest it, Tony," Tim said, his eyes still closed.
"I don't think so. I'd like to survive a little bit longer at NCIS. Gibbs would smack me out the window."
"That's an interesting image."
"Think about that a lot in your spare time, Probie?"
"You flying out a window? Not particularly."
"I am sure that McGee would be more creative, Tony."
Tim smiled faintly. "Exactly." Then, he swallowed again and clenched his teeth. "Could you guys do the talking for awhile? I think it might be best if I keep my mouth closed."
"Sure. I can talk," Tony said. He looked over at Ziva asking her silently what she'd like to say. She just shook her head. So...Tony started to talk. Half the time, he wasn't even sure what he was talking about, but Tim would smile...still with his eyes closed...at various comments. Ziva rolled her eyes...a lot, but she didn't interrupt. Tony jumped from movies to politics, back to movies, to work, back to movies, to college experiences, and back to movies again. He felt his throat tightening, but he kept talking. Tim lasted for an hour when he began to retch once more. Smoothly, Tony shifted from talking to supporting. He was on one side and Ziva was on the other. Both of them held him up as he gagged and coughed.
"We got you, Probie," Tony said. "Don't worry about a thing."
When he could talk again, Tim tried to smile...but he couldn't. "New record."
"Congrats."
He looked back and forth between them. "Thanks, guys. I'm sorry."
"What are you sorry for, McGee?" Ziva asked.
"For this."
"No. Do not apologize for something you cannot control. I wish I could help, but I cannot."
Tim let out a tear-filled laugh. "You are helping. Really."
"How?"
"By being here. It means a lot," Tim said, lifting a shaking hand to his head. Ziva put light fingers around his wrist.
"It is no trouble, McGee."
"I wish..."
"So do I, McGee," Tony said. "But we'll be here. When we can, we will."
"Thanks."
Then, visiting hours were over. The McGees came in to say good night, and Tony and Ziva left. Tim managed a smile but nothing more.
x.x.x.x.x.x.x.x.x
"And this is only the beginning," Tony said as they left.
"How much worse will it get?" Ziva asked.
"I don't know. Probably a lot."
