Tiny Note: I have gone back to chapter one and omitted the Staging comment that Jim gives; I have found out that at that point they wouldn't have been able to tell. Though ironically Barbara and I are walking a much more similar path than I'd originally believed. Anyhow, enjoy!
Phase Two: MRI and the Counsel of War
A handful of days later on a Monday Jim once more was pulled from school early, this time to the sympathetic smiles of his friends and classmates. Word had naturally spread quickly once permission was given by the Trollhunter and the principle for the impending bake sale, so by this point everyone knew about his mom. Though she'd assured her son that this particular test - an MRI with contrast to better see the tumor and find its progress - wasn't something he necessarily had to accompany her to Jim had been firm on his thoughts: every step of the way he would be there.
Heading outside Jim snagged his bike from the rack, moving to his mom's waiting car and managing to wiggle it into the backseat with the practice of several years doing that then took his place in the front.
"Are you sure you want to be coming with me?" Asked Barbara as she shifted gears to drive. "This is just a test, a simple MRI."
"I told you, mom: I'm with you ever step of the way on this." Barbara reached across to squeeze Jim's hand, expression thankful despite her earlier words, then pulled away and began driving. They were quiet for the drive, each lost in thought, then as Barbara parked and turned off the engine she spoke again.
"Do you have something to keep you occupied? This could take an hour or more."
"I've got some homework." Jim gave her a grin. "For once I know I'll be able to get it done without any Trollhunter business interrupting things. Draal, Aaarrrggghh, and Binky have promised to take care of anything in Trollmarket that comes up."
"You have some amazing friends, honey." Jim gave a short laugh, then they got out and headed into the clinic building. Jim wasn't surprised that his mom knew the way as this clinic, specifically for women's care, was associate with the main hospital. The building was the home for several services, many related including the MRI that was the test for the day. This would give the doctors the best view of the tumor they were preparing to help Barbara fight, as well as whether or not it had spread.
After checking in and waiting a bit, Barbara went back alone to register and get a bit of paperwork to take over, then they moved to the MRI area staffed seemingly only by a technician who took her papers and told them to wait a minute while she set things up. They took a seat to wait.
"These are easy," Barbara said reassuringly. "Loud, I admit, but all I do is just lay there and let the machine do everything for me."
"I know." Yes, and Jim knew why she was saying it. Hearing herself say the words in her confident doctor's voice was reassuring to herself. "And they'll be able to tell us something right away?"
"After my doctor takes a look at the results." The technician opened the door and called over,
"We're ready for you, Barbara." Barbara smiled at Jim, who smiled back and pulled a textbook out from his backpack to start on his homework.
Barbara gave her son one final smile, then followed the technician into the back where only the workers and the patient could go.
"Well, I guess you know how this works," the technician commented, opening a locker for the patient to put her things in and handing her a hospital gown and pair of booties like worn in the operating room.
"More or less," chuckled Barbara as she accepted the garments.
"Then get changed, take your time, and we'll get your IV set up for the contrast." Barbara nodded and stepped into the dressing room, making sure to remove everything metal including her glasses, then emerged and put her things in the locker.
"Ready?" Barbara blurrily turned her gaze in the direction of the technician's voice and nodded, following to a side room to get an IV inserted into her hand as she told them getting one into her arm might be a bit troublesome. Finally, she was led into the MRI room itself.
Though her vision was blurry without her glasses Barbara knew well what the machine looked like: the tube-like mass of it where the magnetic actually spun and the table she would lay on for the test and would slide her in and out of it.
The technician helped her get situated on the table and comfortable, hooked up her IV to the machine that would deliver the contrast, and slipped a ball like from an old-fashioned blood pressure cuff into her hand.
"If you need me, just give that a squeeze," she said. "But remember when I call that the contrast is going in, it's no turning back for ten minutes. Now which way are you going to lay your head?" Barbara tried to the left and to the right, then picked right, away from the IV and the tech arranged her hair to not get in the machine's way. "Comfortable?"
"Yes."
"Okay. Now just lay still." The tech pressed a button and the table slid into the machine, then she left. From her medical training days Barbara knew what was coming, having observed from the same room the tech was in right now.
Three loud beeps as a warning, then a lot of noise, she thought to herself, and a moment later the beeps told her the machine was ready to go. Barbara let her eyes close - not that there was much to see, even if she had her glasses on - and tried to ignore the loud commotion the machine made by thinking of other things. Her thoughts kept straying to her current situation, though, despite her best attempts otherwise.
Just lay still...at least the bed is comfortable... I wonder what Jim is planning for dinner tonight, he said he had something special in mind...it's good his friends are willing to help him through this...I hate that he's going to see me going through this, he has so much on his plate already...will he be okay, if -
Her dismal thoughts were interrupted by a change in the noises, just another phase of things, that caught her attention by how her ears twisted the sound. Hah! That sounds like it's going puppy puppy puppy pup pup pup! It was a welcome bit of amusement.
Twenty minutes later (and after one particularly annoying sound that made Barbara think of an emergency broadcast system alarm that someone forgot to turn off) the tech's voice came over a speaker.
"You doing okay Barbara?"
"Yes, doing okay."
"Alright, I'm delivering the contrast now. Ten more minutes to go."
Ten minutes, almost done. The warnings about the contrast ran through Barbara's mind; she'd feel heat, bad taste in the back of her throat, nausea, just bear through it for a few minutes. The machine gave its warning beeps again and started up, and Barbara focused on just breathing and laying still.
Where is the... Her thoughts were interrupted as a slight chill went into her hand. Ah, there's the contrast. Barbara could feel as the liquid traveled down her arm until it reached her elbow, cool like fresh water, then warmed up. But it never reached the heat she'd been expecting, nor did she feel the flushing and nausea she'd been warned about.
Maybe it'll come later. Just breathe, Barbara. Just breathe. Almost done. Ten minutes isn't such a long time.
Focusing on breathing and sensing for the nausea which never came helped to pass the time, and it was almost startling when the machine suddenly powered down.
"And we're done!" came the tech's voice as she came into the room. "Let me just get you out of there." The bed jerked then rolled out of the MRI, and Barbara felt free to shift a bit. The tech helped her sit up and removed the IV, banging the site with the typical gauze square and tape then helped her stand and let her go get dressed.
"I'll walk you back to the breast center," the tech was saying as she gathered Barbara's paperwork and led her back towards the waiting room where Jim was reading a textbook. "Doctor Barath well look over your test results and talk with you about it in a few minutes."
"That's fine," agreed Barbara as Jim gathered his things and stood, and they went across the hall back to the center.
"How was it?" Jim asked when they were seated again, waiting to be called back.
"Loud," Barbara chuckled, "but it wasn't bad. I even managed to avoid the nausea."
"That's good. Did - did she say anything?" Like her Jim was eager for news and information on what exactly they were dealing with.
"Well, the doctor will give the final say but she said everything looked clean. No other masses or signs of spread." Jim leaned back with a sigh of relief - that it had spread already was their greatest fear - then sat up when the nurse called Barbara back. Jim followed when his mom confirmed that he was allowed, and they were led to a small room that had a couple comfy chairs and an end table with magazines, a box of tissues, and some magazines.
"Doctor Barath will come in when he's viewed your test, Barbara."
"Okay, thanks." The tech left them there, and they got settled into the chairs. They waited in quiet, each lost in thought, until the door opened and the doctor came in.
"Hello, Barbara." They shook hands.
"Hello, Doctor Barath," replied Barbara, turning to Jim. "This is my son, Jim." They shook hands as well.
"Well, I've gone over your test results and things look good. There's no sign of lymph node involvement nor spread. No masses elsewhere."
"That's good." Barbara adjusted her glasses a bit, hesitating to ask but doing so anyhow. "I know you can only go off of the size, but what stage would you call it?" Beside her Jim tensed slightly.
"Well, as I believed before it looks to be about two-point-seven centimeters, so just a bit larger than an inch." He held his fingers approximately an inch apart to demonstrate. "When we stage cancer there's many things that go into it, as I'm sure you know. Lymph node involvement, size, if it's metastasized or not, all factor in. But based on size we would call it stage two." Barbara outwardly appeared calm at the news, worse than either of them had hoped but not as bad as it could've been, but Jim knew his mom. He knew her heart had just sunk a bit, just like how his had dropped right into his gut.
"I understand."
"Do you have an appointment to meet with your oncologist?" Barbara nodded.
"And with my surgeon and social worker."
"Good. They can tell you more about what your treatment plan is than we could say before. So you have ant questions for me?" Barbara glanced at Jim, But he just shook his head so she did as well. "No, none that I can think of." Doctor Barath chuckled.
"I'd imagine you're more informed than many of our patients. You work at the main hospital, right?"
"Yes."
"Then you've got some idea what's coming. If you need anything or have any questions feel free to call us, and I believe that Jenny will be in soon with some more information and paperwork for you to fill out in advance." He shook their hands again as Barbara thanked him for the offer, and he left.
Jenny, the Nurse Navigator who was helping to coordinate everything came in a couple of minutes later with a pink drawstring bag for Barbara to use as well a folder of information and a book about the breast cancer process, much of which she said Barbara likely already knew but it never hurt to have a reference did it? She also have a card with her number in case Barbara had questions or needed to talk, and clarified exactly whom she would be meeting in a couple of days. As neither still had any further questions she bid them farewell and walked them back to the lobby.
Back in the car Barbara glanced at her son.
"You okay, honey?" Jim gave her a wry grin.
"Shouldn't I be asking you that, mom?" Barbara smiled back at him, starting the car and pulling out of the lot.
"When we meet with my care team they'll explain everything in detail. But don't be afraid to ask them anything, okay?"
"I will." What Jim wanted to ask the most was what were the odds his mom would survive, but he knew it was the one question he would be too afraid to ask.
As Barbara was insisting that maintaining a normal routine was very important the next day she would be going to work and Jim to school, then to Trollmarket for training and fulfilling his duties as Trollhunter. But through school he was distracted, daydreaming more than his teachers were used to, not that any of them could blame him.
After the final bell had rung he collected his bike and made for the canal. The ride was something of a welcome break as he had to focus on the road and thus couldn't focus on his mom's cancer. With practiced skill the Trollhunter slid down the canal's incline and to a stop beneath the bridge, pulling his Horngazel from his backpack and drawing an arc to let himself into the hidden world beneath Acadia Oaks.
Stepping from the last stair to the stone ground Jim took a moment to look around, taking stock of the world he was sworn to protect and enjoying a simple moment of 'normal' responsibility. The Trolls were going about on their daily lives, with Gnomes running around underfoot and being chased away when they became too much of a nuisance. As he began walking towards the library he caught snippets of conversations here and there and was pleased to gather his absence hasn't caused anyone undue stress. He'd had to fight so hard to gain their respect that he'd worried that his sudden absence would be a step backwards.
"Good afternoon, Master Jim!" Blinky greeted cheerfully as they happened upon one another in the street, the Troll's arms full of books. "Where are Toby and and Claire?"
"Toby had to run a couple of errands for Nana," replied Jim as he helpfully took a few of the books; he hoped he wouldn't have to read all of them! "And Claire had to babysit Enrique for a few hours. They'll be here later."
"Ah, good. Thank you, Master Jim. I admit I might have been a bit overzealous in what I thought I could manage when Vendel said I could borrow some of his books." The Troll opened the library door when they got there and both of them gratefully put their stacks on the table.
"What are all these?" asked Jim, fishing out the Amulet to let him read the cover of the top one: A Treatise on Troll Biology
"Books I'm going to translate for your mother. I did promise her things to brush up on Troll anatomy, and she's already finished my admittedly meager collection on the subject. Speaking of Barbara, how is she? How did the test you mentioned go? An...MRI?" Jim sighed, sitting down.
"They think it's Stage Two, which isn't the worst it could be but is worse than I was hoping, and tomorrow she's meeting her care team." As he'd been speaking he heard Draal's footsteps entering, likely to see if they would be training in the Forge or studying today, and it was the warrior who asked,
"Care team?"
"The group of doctors and experts and stuff who'll be treating her."
"Ah, I see." Draal looked thoughtful. "So her Council of War." Eight eyes blinked at him in confusion. "What?"
"Council of war?" echoed Jim.
"As I said before I have seen fliers and posters for cancer benefits," Draal explained, crossing his arms. "Several referred to the patients as 'Pink Warriors.' Given I have witnessed her courage even in the most terrifying ordeals I thought the title fit. Thus she is a warrior in the beginning stages of a war. If these doctors are to be her guides and those equipping her, giving her the medicine she needs, then I would say they were her Council of War." Blinky looked thoughtful, then chuckled.
"A fair analogy, actually. If you place your mother as the Warrior, a Champion in her own right, then – by my studies – her surgeon would be something of an Army Ranger or Navy SEAL, removing the threat with minimum damage to surrounding 'civilians' if you will. I believe there is also an oncologist?"
"That's the doctor who diagnosed and is overseeing her treatment," Jim confirmed.
"Then her General, perhaps." Blinky was pleased to see Jim taking to the idea as he added,
"And her Nurse Navigator – she's the one who gives us information on things, explains and works with us to understand what's going on in normal terms."
"A military liaison, then, as they also maintain lines of communication between military personnel and other forces, which in this case would be you and Barbara." Blinky patted Jim's shoulder. "Yes, calling them a War Council would certainly be apt." Draal smiled proudly and Jim grinned at him, clearly feeling better. "I like that."
"Good. Now, Fleshbag, shall we train?" Draal lightly (for him) cuffed Jim in the shoulder and nearly knocked him from the chair entirely. Jim grunted from the impact though to his credit he didn't fall, then the Trollhunter stood up and pulled the Amulet from his back pocket, donning his armor.
"Lets go!"
The next day Jim and Barbara went to the team meeting. It was to be an all-day affair, so Jim called off from school again. They returned to the cancer center where they'd first heard the words 'biopsy,' and saw that this path lay before them. Barbara was calm, but Jim had caught her up late into the night with a cup of tea. Thus he had planned his role for today, his place in her 'Council of War.'
He had his backpack, emptied to carry anything they were given and a notebook and pen, scrounged from his closet, to write down information, questions, notes, just anything he thought would be important.
And as it turned out it would be useful.
Barbara held her calm demeanor as they went in and she registered, confirming that Jim would be able to enter with her after a point to listen to the doctors. Jim waited patiently while they performed the physical examination part, then was led back to the room to wait with his mom.
"Everything seeming okay?" He asked. Barbara nodded. "Good." He took out his notebook.
"What's that for, honey?"
"To take notes on what the doctors say, so you can look it over later." Barbara blinked in surprise, then smiled.
"That's very brilliant, Jim. Thank you." Jim smiled back at her and opened it to the first page when they heard a knocking on the door.
For the next five hours, they met with the Nurse Navigator again, Jenny; then the Oncologist, Dr. Coraline; the Surgeon, Dr. Sterling; several nurses who came in to take blood draws for genetic testing, and even a social worker, Ellen, who would help them with financial aid and even gave them a gas card as a gift with papers for applying for a more costly one. With each thing they said, every bit of information they gave, Jim started a section and made notes, jotted down questions he had and their answers when he asked them as well as answers to his mom's questions, and when given folders of information packets, support group fliers, and a brochure for wigs and scarves and a comment that a prescriptions would be given to her for a free one with a grant to be applied for one up to seventy dollars. Jim thought he saw his mother pale a bit at that – perhaps hearing the word 'wig' and 'hair loss' finally brought it home that this was really happening.
The treatment plan – or Battle Plan as Jim noted it in his book – was for Barbara to undergo chemotherapy first, then have surgery, then radiation. The tumor was finally placed at Stage Two based on size and the lack of any visible involvement with her lymph nodes, and the pathology report from the biopsy, included in one of the folders, gave them information on the cancer itself: it was what they called 'triple positive,' meaning it had markers for two hormones – estrogen and progesterone – and a growth hormone called HER2. Which in a way was a positive for them: HER2 cancers responded well to chemotherapy.
Finally they were with the oncologist again. Dr. Coraline, a woman about his mother's age by Jim's guess, was very friendly and informative when she spoke and gave Jim quite a bit of confidence in her abilities, as had they all.
"So, do you have any further questions for me?" She asked.
"None that I can think of," Barbara answered, and after glancing through his notes Jim shook his head.
"I'm actually quite impressed, Jim, with your notes," Dr. Coraline admitted. "Very organized."
"I'm lucky to have him," agreed his mom, giving him a hug.
"Do you have my number?" Jim flipped through the notebook to the first page.
"Right here."
"Good. You feel free to call me if you have any questions."
"We will," assured Barbara.
"And I believe you're scheduled to have your port put in on Monday by Dr. Sterling, and your first chemo treatment on Thursday."
"That's right."
"Then it seems you're all set." Dr. Coraline shook their hands. "Everything will be okay, Barbara."
"I know. Thank you, Dr. Coraline." She smiled.
"Make sure you've gotten everything you need from Ellen before you go." They nodded agreement, and after picking up a few more papers and checking in with the schedules ahead finally were heading home.
For a few minutes they were quiet, on Jim's part thinking, then he looked over at his mom.
"You okay, mom?"
"To be truthful, honey... a little overwhelmed." Barbara gave a short laugh. "Even being a doctor and knowing how complicated medical treatments can be, being on the other side of things is really being an eye-opener." She glanced at him in turn. "What about you?"
"Well, I've got a lot to review, but I think I noted down everything important that was said." Jim smiled at her, patting his backpack. "I decided that's one other thing I can do for you aside from cook, mom. I'm going to keep things organized for you and help you remember everything you have to. I've got it."
"Thanks, honey. That is so helpful." Reaching over she squeezed his hand. "Though I hate that I'm putting you through this, Jim, I'm really glad you're with me."
"Anytime, mom." Jim smiled at her. "How about chicken parmesan tonight?"
"That sounds great." For the moment the slightly dour mood was lifted in the vein of normalcy, and Jim was determined to do whatever it took to make this as easy as possible on Barbara.
((Okay, I know there was a bit of 'tell instead of show' in this chapter, but to be honest I was utterly overwhelmed by all the information that was given, and relied heavily on my husband to help keep everything straight. Which he was amazing at, thankfully! So I was trying to portray how that experience felt to me; everything just a blur of information and booklets and folders and appointments being set lol!))
