If God will send his angels

"Nobody else here baby

No one else here to blame

No one to point the finger

It's just you and me and the rain

Hey if God will send his angels

Hey if God will send a sign

Would everything be alright"

A long silence stretched in the A&E box, as both Anna and John felt like all air had left their lungs. Anna jumped out of her skin when her phone rang. Her trembling hand reached for it nervously and she took a hasty look at it.

- Shit, Mary… she breathed.

They were supposed to be at George's birthday more than an hour ago. She shut the phone down and threw it back into her bag. Looking back to the doctor, she opened and closed her mouth several times, before being able to stutter:

- Wh… What?

- I'm sorry, repeated the doctor.

John felt like he had aged by ten years in the space of thirty seconds. He asked in a hollow voice:

- How sure are you? I mean… Might there be an error? A test read wrong?

His world was slipping away through his fingers, and he grabbed at any foolish hope he could.

- No, I'm sorry, Mr Bates, said the doctor. Of course, we have checked several times before bringing you the news. There's no mistake. Joanna's blood is filled with cancerous white cells. These abnormal cells are choking the normal cells. This is why she's so pale: she's deeply anaemic. And the bruises and nose bleeding come from a very low platelet count. Her normal white cells are also very low, which makes her immune system very weak.

- Jesus…, whispered John.

Anna still looked at the doctor silently, her mouth slightly open, motionless. Her mind was a complete blur, and she felt like she had been turned into a wax statue. Joanna was still sleeping in her arms, and she had unconsciously tightened her grip around her, as if daring the world to come and take her child away.

- I know this is a big shock to you, continued the doctor. So I'm not going to bury you under information right now, because you would not assimilate them. The point is that further tests are needed to determine the precise type of leukaemia we are dealing with, and which treatment will need to be given. Whichever type we are talking about, there will be chemo.

Anna shuddered at the word. Chemo… That word sounded so ominous. Images of bald and sickly kids whirled into her head from movies and TV shows, and tears rushed to her eyes. How could this be real? How could it be happening to them? Would they ever be left in peace? As all this was flowing through her mind, she noticed that the doctor was still talking, and she made a tremendous effort to focus back on the here and now.

-… Organize Joanna's transfer to Leeds Children Hospital.

- I'm sorry, cut Anna. Leeds? You have to send her to Leeds?

- As I was saying, repeated the doctor calmly, we have no pediatric onco-hematology unit here in York. That kind of disease requires highly specialized treatment, and it is available only in Leeds' Children Hospital.

- When?, asked John.

- As soon as possible, replied the doctor. I already called the unit and talked to the on-call hematologist. They are waiting for Joanna this afternoon.

- How does it work, do we bring her there ourselves or…?

John was trying his best to focus on the practical details, not allowing his mind to wander onto the implications of the diagnosis the doctor had just delivered, for fear he would just break down.

- I can order an ambulance to drive her there. Only one parent would be allowed to go with her in it. But if you'd prefer, you can drive her yourself, since she's got no IV yet, or anything that would require permanent supervision.

- We'll do it, cut Anna.

If she could cling to the slightest bit of normalcy for one more hour before her daughter was officially admitted to hospital, she would take it.

- Alright. As you wish. I'll go and get the medical file ready for you to take with you to Leeds.

As the doctor left the room, Anna and John stayed alone with Joanna, stunned, looking blankly at each other among the remains of their shattered world. When Anna saw the tears shining in John's eyes, her own dam broke out and she went into harsh sobs, her tears inundating Joanna's hair.

- Oh God, oh God… she kept murmuring.

John came to her and they stayed embraced in a family hug, mingling their tears, for a long moment, until Joanna started wincing in Anna's arms. John picked up the little girl from Anna's arms and said:

- We should get ready.

- Yeah, said Anna in a ghostly voice.

As she got up from her chair, she suddenly remembered the world outside.

- Jesus, we have to call the others. They're still waiting for us! They must be worrying mad…

x x x x

Indeed at Crawley House, all the guests for George's birthday were gathered, except for the Bates family. Mary was clutching her phone nervously:

- What the hell is going on? she wondered out loud.

- You can't reach them? asked Matthew.

- She hung up on me, and now it's going straight to voice mail. I left her a bunch of texts and voice messages and she's not returning. There must be something wrong!

- Maybe try calling John? suggested Elsie.

- Yes I will, replied Mary.

But before she had time to dial John's number, it appeared on her screen.

- Oh, well, speaking of the devil. John! What's going on? Where are you guys? We're all waiting for you!, she started buoyantly.

Then she became silent and Elsie watched as her face fell and she blanched progressively.

- OK, OK, sorry, she whispered. Keep us posted as soon as you know more. Yeah, talk to you soon. Good luck. We love you.

Her hand fell limply at her side when she hung up, tears shining on her cheeks.

- Mary?! asked Elsie urgently. What's wrong? What did he say?

- They're in the A&E with Jo. They're transferring her to Leeds Children Hospital.

- What? Why?!

- She's… got leukaemia, apparently.

- What?! exclaimed Charles Carson.

A sudden chill fell over the birthday party as every one looked at each other in horror.

x x x x

Around four o'clock the next day, John and Anna were sitting in Joanna's new room at Leeds Children hospital. The baby was napping in her hospital bed, and they were themselves dozing, after a sleepless night at her side. The hospital did provide camp beds for parents, but they had not managed to get a wink of sleep. So they had spent the night holding each other, listening to their daughter's breathing, between each of the night nurses' visits to check on their patient.

As soon as they had arrived on Sunday afternoon, Joanna had received a red cells and platelet transfusion. After that, the baby had gained a little extra-energy. She was less pale, and there were no more new bruises appearing on her body. At the end of the afternoon, the on-call doctor who had done Joanna's first assessment had taken a bone-marrow sample. That was necessary to know what kind of leukaemia Joanna had, he had explained. That had been an even worse moment than the blood sample taking in the A&E. Anna knew she needed to harden herself regarding all those medical procedures, because they would likely be a daily occurrence in the upcoming weeks… Although she had already haunted hospital corridors in the past, at the time of John's leg wounds, then she had always waited outside when the nurses or doctors performed their procedures. Now, she was supposed to stay and be strong for her baby daughter. This time, she had forced herself not to look at the size of the needle the doctor was approaching near her baby's skin, and had kept her gaze locked to Joanna's, smiling and singing nursery rhymes in her ear in a wavering voice, while tightly holding her hands.

- Did you brief the Carsons today? asked John.

- Not yet, replied Anna. I was waiting until after we see the doctor. When we have all the information.

- Yes, sounds better, you're right.

At that moment, the nurse entered the room and said:

- Dr Jawad will see you now, if you'd follow me.

Anna and John looked at Joanna, still sleeping in her cot. Since they had arrived, she had spent almost all her time sleeping. She looked really exhausted.

- We can't leave her alone, said John.

- Don't worry, Mr Bates, you can just leave the door open, our office is just across the hall. If she wakes up I'll bring her to you.

- Thank you, said Anna.

The nurse showed them to the doctor's office. In a secluded part of the unit, several office doors stood in a row, with the doctors' names on them. The nurse knocked on the one that read "Dr Shaheena Jawad".

- Here are Mr and Mrs Bates, she announced.

- Ah, yes, please, come in, said the doctor.

She was a medium-height brunette, in her late thirties, with a warm smile and manners, and kind brown eyes. John and Anna had immediately felt confident when she had first come to see Joanna that morning, and had announced them that she would be Joanna's referring hematologist. They both entered the office, and took their seats, as the nurse closed the door behind them.

- So, started Dr Jawad. Now that the dust has settled a bit, we need to have quite a long chat about Joanna's disease. I received the leukaemia typing from the bone marrow sample my colleague did yesterday. Joanna has a type B acute lymphoblastic leukaemia. Of course that doesn't mean anything to you, so let me explain. The blood contains three main types of cells: red cells, that bring oxygen to our different organs, white cells, that fight infections, and platelets, for blood clotting. Among the white cells, there are three types too: granulocytes, lymphocytes, and monocytes.

As she spoke, the doctor was drawing a diagram of the different types of cells on a sheet of paper.

- And among lymphocytes, there are again two sub-types, called B cells, and T cells. Those B cells, she went on, circling around the words "B cells" on the paper, are the ones that have gone astray in Joanna's bone marrow. One precursor has mutated, and has started producing cancerous B cells. And they have started invading her bone marrow, choking the production of the other normal cells, and have invaded her blood too now. Now, I'm still waiting for the complete typing, which will give me a precise identification of the cancerous cells, so that I can adapt the treatment at best. To this point, are you still following me?, she asked kindly. It is very important that you understand what is going on.

- Yes, whispered both Anna and John, a focused frown on their face.

- Alright, very good. So, the first thing I'd like to tell you, is that in our world of children's leukaemia, a type B acute lymphoblastic leukaemia is good news.

- Really?! muttered Anna, plain disbelief on her face.

Dr Jawad looked at her with a confident smile.

- Yes, because it is the most easily treatable kind of leukaemia. The one that responds best to treatment. The one that has the best outcome. And moreover, Joanna is in the age group that has the best prognosis: children between age one and five.

- What kind of outcome are we talking about? What are the odds?, asked John.

- We usually prefer not to give parents raw numbers that apply to large groups, and not to individuals…

- Please, doctor, insisted John. You know if you don't give me the numbers I'm going to look them up on the internet.

The doctor let out a discreet smile.

- Five years after diagnosis of a type B ALL, ninety percent of the children are cured.

Anna let out a breath that she hadn't known she was holding. Ninety percent. Maybe things were not that dark after all. She tried very hard not to think about the remaining ten percent. That still meant one kid out of ten. No, they couldn't dwell on that now.

- So, really, there is a pretty good chance that one day all of this will be in the past, and a bunch of bad memories, said the doctor, encouragingly. Still, now, we are faced with a long path of treatment ahead of us, and I must warn you that this won't be a bed of roses.

She spent the next fifteen minutes explaining to them the course of treatment, and the different types of chemo and other medication they would have to give Joanna, and the side effects they could cause. The treatment had three phases: the first step was to be a six-weeks long "induction" chemo, intended to kill all cancerous cells, and thus induce remission. Then there would be intensification, then maintenance treatment.

- After the first phase that needs to be done as an inpatient, you'll be able to take Joanna home. The intensification will require that you bring her back to get her chemo once a week for six more weeks. Then, the maintenance medication can be taken at home. The overall course of treatment usually lasts for eighteen months.

- Eighteen months…, repeated Anna.

- Yes. It is a marathon we are running here, Mr and Mrs Bates. Of course, at regular intervals, we will repeat the bone marrow examination to check that the cancer has not relapsed.

- And what if it has? asked John.

- Then we have other treatment options, that we will discuss in due course. It can include higher-dose chemo with stem cell transplant, radiotherapy, or immunotherapy. We will talk through the options if needed. Chances are they won't be.

- Alright, replied John.

- So, right now, as I was saying, I'm waiting to collect the full results of the B cells identification, and tomorrow the medical staff will meet and decide on the personalized course of treatment we'll be offering Joanna. Today, there's one last exam I need to do. It's a lumbar puncture.

Anna tensed at those words. Another one of those giant needles piercing through her baby's body…

- Why? she asked. I thought those were done for meningitis?

- They are, indeed. But not only. I need to do it to check if any cancerous cells have invaded the medulla. That is a very important prognosis factor, and changes the course of treatment whether it is the case or not.

- OK… replied Anna, resigned.

- Do you have any more questions for me, Mr and Mrs Bates?

Anna and John asked a few more questions, which Dr Jawad answered kindly.

- Will she loose her hair? asked Anna.

- I'm afraid she will. There are many side effects that we can treat or prevent, but this one we cannot. Some parents prefer to have their child's hair cut very short before the chemo starts, it's your choice really.

John winced at the thought of Joanna loosing the blond locks that he loved so much.

- Don't worry though, reassured the doctor, it always grows back. Though sometimes in a slightly different colour or texture.

Then she concluded:

- As I was saying, you and Joanna are about to start on a marathon. This illness and the treatment brings an awful lot of stress and strain on the child and the whole family. If I might give you one piece of advice: take care of yourselves. I know you will want to be there for your child and support her, and it is natural and good. But you have to hold on for a year and a half, at best. So, do not forget yourselves in the process. Do not forget to eat, to sleep, to exercise, to take some time to look after yourselves, as individuals, and as a couple. You need to not burn yourselves out if you want to be able to be there for Joanna. And she will need you in good shape. There's no sibling I think?

- No…

- Alright. That's one less issue. It is often very complicated for parents to handle the sick child and the healthy ones. Still, you will have your jobs, your household, your couple to deal with. This will be hard. So, give yourself realistic expectations, and allow yourself to rest, or to break down from time to time if need be. Don't try and be a super-hero, because none of us around here are. Don't hesitate to rely on friends and family, if you have them.

- We have them…, said Anna with a small smile.

- Good. And of course, our unit psychologist will see you and Joanna on a regular basis. It's not mandatory but we strongly advise on it.

- OK, said John.

- Do you have any other questions right now? I know I gave you a lot of information, and it will take you some time to process it. Here is a booklet, said Dr Jawad, handing them the document, that summarizes everything we talked about. And if any more questions come to your mind, I or my colleagues will be happy to answer them.

- Thank you Dr Jawad.

- Now, you can go back to your daughter. I'll be there in a moment for the lumbar puncture.

x x x x

Anna wiped her eyes nervously as she was driving back from Leeds to York. Driving on the highway with a blurry vision wasn't so easy. After the doctor had completed the lumbar puncture, Anna and John had agreed that she should go home, and bring them back some clothes and other personal stuff for the upcoming stay. For now they had decided to both stay with Joanna, at least for the first few days, until the chemo had been started. They knew they wouldn't be able to both stay for the whole six weeks, that at some point they would have to alternate, but right now none of them could bring themselves to leave their baby's side. Even making the return trip home and back and leaving her for a few hours had been a tough decision for Anna. But they hadn't taken anything with them when they had rushed Joanna to Leeds the previous day, and they really needed fresh clothes, toothbrushes and the like.

Anna tried to keep her focus on the road, while everything they had discussed with Dr Jawad swirled in her head. "Ninety percent chance", she kept repeating herself. That was better than the eighty percent chance they had had of even having Joanna at all. She tried to hold on to that number, preventing her thoughts to dwell on the sheer unfairness of disease striking her child after all they had already been through. Otherwise she would just want to scream, yell and kick at everything in her reach.

When she parked in her driveway, she noticed Mary's and Elsie's cars parked in the street. She had given them a few informations on the phone, and obviously the two women had decided to arrange a receiving committee at her home. Both had spare keys. As she entered her house, both rushed to her side, taking her in a tight hug.

- Oh Anna… We're so sorry! exclaimed Mary.

Their warm embrace and solicitude made Anna's defences break, and she sobbed into their arms.

- Sorry, she sniffled, a moment later, when she managed to compose herself.

- Nonsense, stated Elsie. Of course you need to cry.

Anna chuckled bitterly. Oh yes, she needed to, alright.

- Now, continued Elsie. You go take a nice hot shower, and then we'll be there with a hot tea, and you'll brief us on everything.

- But I need to go back to Leeds.

- You will, my dear. But I daresay you can allow yourself one debriefing tea with us before. Nothing will happen meanwhile.

Thinking back on Dr Jawad's words earlier about taking care of oneself, Anna smiled.

- Yeah, alright, you're right, she admitted, letting her purse slide onto the floor.