The Ground Beneath her Feet
"All her life I worshiped her
Her golden voice, her beauty's beat
How she made us feel, how she made me real
And the ground beneath her feet
And now I can't be sure of anything
Black is white and cold is heat
Go lightly down your darkened way
I'll be down there in another day
I can't rest until you're found
Let me love you, let me rescue you
Let me bring you where two roads meet
Oh come back above
Where there is only love, only love"
A week after Joanna's birthday, the Bates family was enjoying a Saturday walk in the Yorkshire countryside. The weather was still mild for a mid-October, and they had decided to go out and enjoy the fresh air, which they thought Joanna had lacked during her prolonged hospital stay. Anna was carrying her daughter on her back in a Manduca baby-carrier. John had offered to take the baby, but Anna hadn't wanted to hear about it. Although Joanna was not very heavy, Anna wouldn't take the chance to put that extra-strain on John's knee. They had made the trip to Leeds two days ago for the doctor to do another control myelogram on Joanna, so that they could clear the beginning of the consolidation chemo the following week. As they were pausing to enjoy a particularly beautiful scenery and drink a gulp of water, Anna's phone rang. She fumbled into her jacket's pocket to retrieve it, and frowned at the unknown incoming number.
- Yes, hello?
- Mrs Bates?
- Speaking, replied Anna nervously, as she recognized her interlocutor's voice before she had introduced herself.
Her heart became to race. That voice on the phone on a Saturday could only mean trouble.
- Hello, Dr Jawad speaking.
- Yes, I'd recognized your voice, said Anna. I guess you're not calling for pleasantries. I'm putting you on speaker, my husband's beside me.
- Alright. Yes, I'm sorry to bother you on the weekend. I just received the results for Joanna's bone marrow exam.
A silence ensued. Both John and Anna already knew what she was going to say next, although they were presently praying fervently not to hear it.
- I'm sorry, repeated the doctor. They're not good. There's a relapse.
- Shit! muttered Anna under her breath.
Her chest was feeling tight and a big lump was forming in her throat. For all they had hoped for the worse to be behind them now, there they were, back to square one.
- What do we need to do?, asked John in a calm voice.
Anna would never comprehend how he managed to stay so composed. She knew it was not because he loved their daughter less than she did. But he did have a way to control his feelings and his bodily responses better than her.
- You need to bring Joanna back to the hospital.
- Now?, asked John.
- No. Monday morning, nine o'clock.
- So, are we going back to the beginning? asked Anna in a wavering voice. Has the first chemo been for nothing?
- No, no, replied Dr Jawad. Last time when Joanna arrived, things were pretty bad. Now, the relapse is only just beginning. If we took a blood sample, we'd probably see nothing yet. Not like the first time when her blood was filled with cancerous cells. But we must deal with this quickly. Monday morning then?
- Yes, alright. It's not like we have a choice anyway, said Anna.
- I'm sorry.
x x x x
- So? What do we do next?, asked Anna in a tense voice, as she stood across Dr Jawad's desk in her office.
John was sitting next to her, and Joanna was blissfully shuffling through the toys case stored in a corner of the doctor's office, oblivious to the drama that was taking place in her own body.
- We'll have to admit Joanna as an inpatient again, answered Dr Jawad. We have to start another induction chemo, but with a different protocol. A stronger one.
Anna shuddered at the thought. She had thought nothing could be worse than what they had been through during the summer, but apparently it could.
- And I… guess there's no alternative? I mean, apart from waiting for our child to die?
- I'm afraid not, stated the physician.
John extended his hand to Anna and gently squeezed hers, offering her a tight smile that didn't reach his eyes. The touch of his hand soothed her somewhat, and she briefly closed her eyes, inhaled, and looked back to Dr Jawad.
- So, how is this going to happen?, asked John.
- Well, Joanna will receive the chemo protocol over five weeks, just as last time. It lasts one week less, because it is stronger. Last time, the chemo wiped out almost all the cancerous cells, although we had hoped for it to erase all of them, and it also killed a good number of the normal bone marrow cells. That's why her immune system was weakened, and she was anaemic. But the growth factors we gave her were sufficient to help her bone marrow restart itself. This time, the chemo will wipe out everything. So there's a very good chance no cancerous cell will survive, but the thing is, none of the normal cells will either. Her bone marrow will be wiped empty. So this is more dangerous. She'll have to receive red cells and platelets transfusions on a regular basis, and she'll have no immunity left. At all, for a number of weeks.
- Can't you give her some white cells transfusions too?, asked John.
- Unfortunately not. It doesn't work like that. One individual's white cells are programmed to recognize their owner's body, and everything else foreign as enemy. So if we did a white cells transfusion, the donor's cells would turn against the receiver's body.
- Alright… But then how will she get her immune system back, if all of the marrow is wiped out.
- Through a stem cells transplant. During the time of the chemo, we'll need to monitor her white cell count daily, and as soon as it get under a certain level, Joanna will have to be moved to a sterile room, to protect her from getting an infection she would not be able to fight. These rooms have a special ventilation system to prevent germs from hanging out in the air. Every person who walks in, including you, has to wear scrubs, a surgical gown, cap and mask, and do a surgical hand-wash before entering. Every object, toy, stuffed animal or food that enters the rooms will need to be sterilized first. And of course she won't be able to get out of the room until her immune system is restored.
- Jesus…, exhaled Anna. But how long will it last?
- A few weeks, a month at worse, we hope. She'll have to go in when her white cells count gets too low, as I told you, then stay until the chemo protocol is finished, then wait a short period of time for the chemo to wash out of her body, then she can receive the stem cells transplant, and we'll need to wait for the new stem cells to take root in her bone marrow and start producing new cells. That could take a week or two, with help from the growth factors injections.
- Alright…, exhaled Anna, who was clearly struggling to process all that new and scary information.
- And how do we get the stem cells for the transplantation?, asked John.
- Very good question, I was coming to it, nodded the doctor. You know red cells come in ABO blood types?
- Yes.
- Well, there's some similar system for white cells, but more complex. It's called HLA system, for Human Leucocyte Antibody. We will need to find a donor for Joanna, who has the closest HLA type to hers, so that the graft is accepted in her body. The most likely donor is usually a sibling. A twin is the best case. Unfortunately in our case, there is no sibling. So, the next best thing is a parent. We'll have to take blood samples from both of you, to check out your HLA type, and compare it to Joanna's.
At those words, Anna's whole body froze, and her heart skipped a beat. Never had she expected that this part of the past would come back and hit her right the chest here and now. As if things weren't bad enough already. She bent forward, resting her elbows on her knees, as her fingertips pressed on her eyelids, in a desperate attempt to prevent the tears from falling. Dr Jawad looked at her, and saw John stiffen too. She sensed that something was going on, more than just the parents' reaction to her explanations.
- I'm sorry, she said. Is something wrong?
John sighed and rubbed is face with the palm of his hands, before saying:
- There is… some uncertainty as to Joanna's paternity.
- Oh.
Dr Jawad managed to keep an unreadable face at that announcement. In her fifteen years' career in pediatrics, she had heard countless of weird family stories and secrets, she was not shocked by them anymore. All families had their issues.
- I'm her legal father, specified John. But there is a chance I might not be her genetic one. We never sought the answer to that question.
He didn't go into the details. Now was not the time to tell the doctor how they had in fact sought the answer, only to back out when faced with it.
- OK, stated the doctor. Well now we'll need to find out, I'm sorry. Have you any idea who the other potential genitor might be?
- Yes, exhaled Anna in a trembling voice.
- And if neither of your HLA types show enough concordance with Joanna's, would you have a mean to contact this person?
Anna stifled a sob. She couldn't believe he was coming back to haunt her now of all times. John put a reassuring hand on her knee, and answered Dr Jawad:
- We could. But we'd really rather not have to do this, since the man is currently serving time in prison for raping my wife.
- Oh.
This time, the physician had a harder time concealing her reaction. She had listened to all sorts of weird family stories in the course of her career, but that one she had never come across.
- Well… I'm… very sorry to hear that. I understand that it's a very difficult situation for you, Mrs Bates.
- Yeah… breathed Anna, looking through the window, trying to avert the doctor's eyes.
- Mama?
Joanna's voice startled Anna out of her frozen state. She looked down to her daughter and managed a smile. The child had come to her with a book and held her arms out to her mother.
- Yes sweetheart, you wanna come on my lap?
As Anna picked up Joanna and sat her on her lap, the doctor went on:
- Well, I guess we'll have to hope that one of you two will prove compatible as donor.
- And…
John stopped, fearing to voice his next question out loud:
- If neither of us are, and if the other man isn't either, or doesn't want to? What do we do then?
- Then we will search in our volunteer donor's register for someone compatible. We might have to settle for a less close compatibility, with the risk of rejection, and thus the need for Joanna to take some additional anti-rejection medication.
A tense silence settled in the office, until the doctor went on:
- I suggest we cross that bridge when and if we come to it. Let's take the steps one at a time. The first step is the chemo. And for both of you to make an appointment with our lab to have your HLA test done.
x x x x
Anna had been in such a bad place after going out of Dr Jawad's office, that John had called the Carsons and asked them to come and pick her up at the hospital, and take her home with them. Anna had protested that she didn't want to leave Joanna, but John had argued back that their daughter didn't need to see her mother in such a distressed state, a fact which Anna had had to agree with. So later that day, she was sitting in the Carsons' sitting-room, twisting her fingers and rubbing her hands together. Mary had come down too, as a support committee.
- So, let me get this straight, said Mary. If neither John nor you are compatible, you'll have to go to the prison and beg that scumbag to save your daughter's life?
- Pretty much…, replied Anna, who had again hidden her face behind her hands.
- How twisted is that?! exclaimed Mary. I mean, is there someone out there pinning needles in a voodoo doll of you? I can't believe that's happening!
- Me neither…, muttered Anna.
- Now, girls, come on, tried Elsie in a soothing tone. It might not even happen. Maybe you or John will be compatible.
- I know, I know, said Anna. But the appointment for the lab is on Friday, then it'll take at least two weeks for the results to come back. So, basically, I'm faced with three weeks to chew on the idea that I might have to go and ask him to save my daughter. Oh my God, this is too much, I can't handle this…
Her words trailed into harsh sobs. Elsie bit her lower lip. She hated to see her like that. She came close and tied her arms around Anna's shoulders, gently rubbing her back.
- Hush, hush now. It'll be alright.
When the sobs had receded a bit, Elsie talked again:
- Don't you think you should go back to see Dr Crawley?
Anna sniffled and wiped her eyes with the tissue Mary had handed her.
- Yes. You're right. I'll make an appointment. I think I'm going to need to take her treatment again.
Later that evening, when Mary had gone home, Anna went to bed in her teenager's bedroom in the Carsons' house. She couldn't face being on her own in her house. As she lay down in her old bed, Elsie silently came and lay with her, taking her into her arms again. As Anna cried herself to sleep against her foster mother's shoulder, Elsie murmured:
- It's alright my dear. We're here. We'll always be here with you.
x x x x
At the end of the week, Anna and John were back together at the hospital with Joanna. The first days of chemo were starting to take their toll on the little girl, and she spent a good part of her days sleeping. Anna was standing next to the windows, gazing unfocused outside, and shuddered from time to time. Sensing her restlessness, John came behind her and engulfed her in his arms, his mouth whispering in her ear:
- What is it, love?
Anna sighed once more, and nervously wiped her eyes.
- I had not thought of him for months. I had not had any nightmare about him either. And now, he's back. Back in my every thought, back in my sleep. I dreamt about him coming back and taking Joanna away from us. I dreamt about him watching her die and laughing. I just… I can't stand it anymore, John. I hate him so much! I can't stand the thought of having to ask a favour to him. I can't bear to owe him something. I can't stand the thought of having to be grateful to him! It's just… it's too much.
Her voice broke down as she finished her sentence. John gently made her turn around and held her against his chest.
- Remember what Dr Jawad said? One step at a time. We shouldn't worry about that until we know where we stand.
- But I can't not worry about that! My brain won't stop thinking about that! Don't you?, she asked in an anguished voice. I'm so scared…
- I know. I am too. I do think about it too.
- I'm sorry I made you burn the test result. If we had looked at it, we'd already know…
- It seemed the right thing to do for us at the time. We couldn't have known…
- I never thought that choice would come lashing back at us in that twisted way.
- Neither did I…
- Jesus, sometimes I think we must have been very bad in some previous life, to deserve all this shit on our heads.
- It'll be alright… soothed John.
- But will it?, cried Anna.
- I don't know, admitted John. But we still have each other.
- Yeah…, she replied. Carry each other.
- And now we have to carry Joanna. Whatever comes. We need to be strong for her.
- You're right. However, whatever, whenever.
She pushed herself up on her tiptoes while he bent towards her, until their lips met in an unspoken agreement.
Sorry guys... You know by now I like to play with my voodoo dolls...