Look on the Bright Side

Chapter Twelve

A few weeks after she’d chosen her wedding dress, Lark left her shift at Mass General and headed to Justin’s for dinner. It was a thirty-minute walk, and she could cut through the Common. She was already mentally rehearsing the story she wanted to tell Justin—she had been bathing a man, rolled him on his side, his back to her, when eleven days’ worth of poop had exploded out of him, onto the bedding, the bed, the floor, the far wall and Lark herself. The other CNA had been more experienced and knew to leap out of the way.

Lark had had to take a shower in which she scrubbed her skin five times with the hospital’s sharp antiseptic soap. She went back to the patient’s room later to see how he was doing, and the poor man had been so apologetic. Lark said it happened all the time (not really, but…). These stories were the gifts of being a CNA, and she knew Justin would appreciate it.

While Boston would inevitably get one more snowstorm, just to test the endurance of New Englanders, today was one of those teaser days in late March that, if you weren’t careful, made you believe winter was over. The temperature was in the midfifties, the sky gently drifting into a darker shade of blue as the day came to a close. Birds sang from the trees, some of which were setting up to bloom in another few weeks, and the air smelled like garlic and, less noticeably, sewage, a hallmark of the fair city. Lark chose to focus on the garlic.

In the Common, early daffodils looked like scattered candy against the dull winter grass. Lark watched a young mother pushing her toddler in a tricked-out stroller. She and Justin wanted kids, after med school, of course. Addie, too, wanted kids and would probably be first. Maybe one of them would have twins. She hoped so. Pulling out her phone, she texted Addie to say she was thinking about her and couldn’t wait to hear how tonight’s “meet the parents” was going. Things between Addie and Nicole were getting serious, and while Nicole was kind of uptight, she had a good heart. Hopefully, Addie’s love would loosen her up a bit.

When she got to Justin’s, she punched in the code to the street entrance of the building and went up the stairs to his apartment. The door was locked, which was unusual, because he usually left it open when she was coming. No worries, she had a key, of course.

It was oddly quiet. She should’ve texted him, but they both agreed they didn’t want to be those people who needed to communicate every hour or texted each other from twelve feet away.

“Honey?” she called. Did she have the right night? Yes, of course she did. They’d talked about what they’d cook when he’d called her on her break this morning.

She turned on a light. The bedroom door was closed. She went in, and there he was, under the covers, curtains drawn.

“Honey?” she said. “Are you okay?”

He stirred, glancing over his shoulder before letting his head drop back to the pillow. “I feel like shit,” he said. “I left work at two.”

“You should’ve texted me.” She sat on the bed next to him and felt his forehead. It was warm, and sudden fear flashed through her. “You have a fever,” she said, keeping her voice calm as she pushed back his thick black hair.

“I know. The flu or something. I have a wicked headache. A rash, too.”

Her muscles gathered, the instinctive response to fear. “What kind of rash?” Her voice sounded almost normal.

“I don’t know. Little red dots.”

“Can I take a look?” she asked.

“I just need to sleep,” he muttered, eyes closed.

“Show me and then I’ll make you some soup.” She turned on the light, and Justin squinted.

“Hi, by the way,” he said with a tired, lopsided grin.

“Hi, babe.” She tried to smile, too.

He tugged off his shirt and held out his arms. Tiny clusters of red dots. She pressed on one red clump, and it stayed red.

And because she’d been studying acute lymphocytic since the age of fourteen, she knew this was not a rash. It was petechiae, a sign of a low platelet count. And low platelets came from abnormal cancer cells in bone marrow.

She felt under his jaw with both hands, but he jerked back. “What are you doing?”

“Checking your lymph nodes.”

“You’re not a doctor yet, Lark.” His tone was accusatory, but she heard the fear underneath.

“I know, honey, I know.” She tried again, and this time, he let her. There was a raised lump, round and hard.

“Ow,” he said.

Their eyes met.

She swallowed. “We need to call your doctor, honey.”

And just like that, their world disintegrated. Tonight’s plans, off. Work tomorrow, no. Driving down to New York City to see Jordyn Rae this weekend? Not gonna happen. They stared at each other, abruptly adrift in a dark ocean of fear.

“It’s probably just a virus,” he said, then cleared his throat.

“Right. You’ve…you’ve had viruses before. We’ll just be extra neurotic, okay?”

He nodded. “Actually, I feel better now. Better than earlier.”

“Good! Great! I’ll make something really nutritious for dinner. You stay put, honey. Did you take any Motrin? Actually, how about some Tylenol?” Because Motrin wasn’t good if you had low platelets. She got two tablets of Tylenol, a glass of water and the electronic thermometer. “One hundred point two,” she said. “Hardly anything. Want to watch TV while I cook?”

“Sure!” Justin said, and his voice was overly cheerful.

“Call Dr.Kothari, okay?”

“I will.”

They knew, though. As she chopped carrots and onions and garlic and ginger, added cilantro, sliced chicken, threw in some turmeric, she was aware that she was shaking. Her phone chimed with a text. Addie.

Everything okay?

That twin radar. She didn’t want to answer, but that would make things worse. Yes! Staying at J’s tonight. Love you.

They’d have to call his parents. Get in to see the doctor tomorrow. Spinal tap. Bone marrow biopsy. Lymph node biopsy. T-cell therapy. Stem cell therapy. Chemo. Bone marrow transplant. Radiation.

She stirred the soup, put in some brown rice and turned the heat down to a simmer, then went to the couch and cuddled up next to Justin. “You look incredibly handsome today. That bedhead looks good on you.”

He smiled, but not really. She understood. She turned his face to hers and kissed him. “I love you. I love you so much, Justin.” Their whole history flickered through her heart. Kindergarten, birthday parties, movies, dinners, the first time they held hands, the Copley Square Hotel, Venice, yesterday when he’d gotten up early to make her scrambled eggs with cheddar cheese on English muffins, her favorite.

“I love you, too, little bird,” he said, stroking her cheek. Then he smiled for real this time, and kissed her back.

“Whatever happens,” she said, “we’re in it together.”

“Exactly. But I bet it’s just the flu,” he said. “Which I just gave you. Sorry.”

“I’ll take it.” She’d happily take a flu, or Ebola, or give up a leg if it meant Justin had not relapsed.

Tonight, they’d be two people in love. One had a little virus. They’d eat chicken soup and watch something gripping on TV. They’d hold hands. They might even make love. She wouldn’t cry, because this might be the last day she would be able to stop herself from crying.

Tomorrow, she knew, their lives would be very, very different. But tonight…they had tonight.

It was the worst possible news. Three days later, they sat in Dr.Kothari’s office at Dana-Farber Cancer Institute—Heather and Theo, Justin and Lark—all of them white-faced as the doctor gave them the test results.

The leukemia had returned to his bone marrow and central nervous system. It would require immediate and aggressive chemo injected directly into his spinal canal and into a tiny catheter they’d place in his brain. Oral meds. Radiation therapy. And the most terrifying words of all…experimental treatment.

“I’m sorry it’s not better news,” Dr.Kothari said, “but I want you to know what we’re up against.” We. That was nice, Lark thought numbly. “When you’ve had ALL as a kid—and you had central nervous system involvement then, right?”

“Right,” his mother said.

“Well, I’m afraid this recurrence means your prognosis is a rough one.” He let that sit a minute, then said, “The median survival rate is six months.”

There was a moment of silence. Then Heather vomited right onto the rug, and Theo burst into tears.

“That can’t be right!” he sobbed. “There’s got to be a mistake! He has a ninety percent survival rate!” He dropped to his knees and bent like a tree brought down by lightning. “You’re wrong! You’ve got to be wrong.”

Justin and Lark just sat, white and hard as marble statues, clenching each other’s hands as their lives were eviscerated.

Six months? Six months?

Dr.Kothari handed over a box of tissues—the good kind, with lotion, because he knew the drill. He said he’d give them a moment, and left the office, and it was so odd, so surreal, Heather wailing, pulling on her hair as Theo tried to get her to stop. Justin said nothing. Lark said nothing.

“My baby, my baby,” Heather said, and Justin got up and hugged her. The smell of vomit was strong. Lark didn’t feel so good herself.

Dr.Kothari returned with a ginger ale, some crackers, Windex and paper towels. He gave the food to Heather, then very kindly cleaned up her vomit.

“I know this is incredibly hard news to hear and absorb,” he said after he’d washed his hands. “Of course, there are some promising therapies out there, and we have a clinical trial going on right now that I’ll get you into.”

“Good! Great,” said Theo. “So there’s hope.”

Dr.Kothari hesitated, then said, “Of course. No disease is the same, and we can’t predict individual outcomes. Of course, we hope you’ll respond well to the therapy. If you go that route, there’s no time to waste, so we’ll want to get you set up for chemo immediately.”

Heather nodded vigorously. “Yes. You’ll feel better when we’re doing something about this, sweetheart.”

Justin said nothing.

“Honey?” Lark whispered.

He glanced at her, almost surprised to see her, it seemed. Cleared his throat. “Yeah. A hundred percent. I wanna go for it. Throw everything at me. I have a lot to live for.” His words sounded strange and wooden.

“You absolutely do,” Heather choked. “You’ll beat this!”

“You’re young and strong, Justin,” Theo said. “You’ll get through this.”

“Yeah,” Justin said, sounding stronger. “You’re right. I will. I beat it once, I’ll beat it again.”

“You’re goddamn right,” Theo said.

“Of course you will. Attitude has a huge impact on treatment, honey, and you’re so healthy and young.” Heather’s voice broke on that last word.

Lark looked at Dr.Kothari. He returned her gaze, and in his dark brown eyes, she saw the truth, a terrifying black maw of fact. For a second, she thought she might faint.

Justin would die. Was, right now, dying, the end of his life now measured in months and weeks and days and hours, not years or decades. Of course, people beat the odds all the time…but in cases like Justin’s, most people did not. Maybe that was why it was called odds. Because it would be odd if you did beat it. A fluke.

Then came all the words, because there wasn’t any time to waste. Lark’s job was to know what the words meant—she’d be going to med school, after all, right? B-cell phenotype, leukemic blast cells, immunophenotyping, high disease burden, flow cytometry, allogeneic hematopoietic stem cell transplantation, CVAD.

Median survival rate, six months.

How…how could that be possible? Justin ran eight miles every other day. They didn’t eat red meat! They didn’t smoke weed or cigarettes or do drugs or even drink that much! A bottle of wine could last weeks in their house. He had very little stress, loved his job, loved her. They even did a corny little gratitude meditation every morning. He was healthy, damn it.

Median survival rate, six months.

Six months wouldn’t even get them to their wedding.

“Can I have a moment alone with Justin and Lark?” Dr.Kothari asked, and Lark gave a tiny nod. Theo and Heather left the room, arms around each other.

“You have very loving parents,” Dr.Kothari said.

“I sure do,” Justin said. “And the world’s best fiancée.”

“I think I hold that honor, actually.” She smiled, or hoped she did, but she felt her cheek muscles quivering with the effort. “We met in kindergarten.” So you better not fuck this up, Dr.Kothari. We are childhood sweethearts. That shit is sacred. The swearing, even though she hadn’t said it out loud, shocked her.

“I would be remiss if I didn’t mention another option,” Dr.Kothari said, again letting his words settle before continuing. “You could decide not to pursue any treatment, Justin. We’d focus on palliative care, keeping you comfortable, concentrate on quality, rather than quantity, of life.”

Though Lark had tried not to work on the palliative care floor of the hospital, she’d done a shift or two when it couldn’t be avoided. Some of the patients were there for simple pain relief during treatment for their illness. Some were there on hospice, which meant they’d been diagnosed with six months or less to live and had decided not to try to seek a cure for their disease…they were just there for comfort as their lives wound down.

“Are you saying Justin qualifies for hospice?” she asked, her voice a squeak.

“Absolutely not,” Justin said sharply. “I’m fighting this. Leukemia can be cured. Right, Lark? Don’t you agree?” There was terror underlying his words, and he needed her to agree. To believe.

She looked into those dark blue eyes. “Um…I—I obviously want you to live forever, honey. But you…I…I—I want you to be okay. To be…yourself.”

“See? We’re all on the same page.”

What Lark wanted to say was that she didn’t want him to writhe and scream out in pain, or have him endure the vomiting and diarrhea from chemo, the weight falling off him till he was skeletal…and then not make it. If there was a guarantee that this would cure him, different story. She’d put him through hell and back if he’d end up healthy.

Whole decades of her future shifted and slid and evaporated in front of her. Their three children—two girls and a boy. A lovely home on the Cape. The weddings of her siblings. Becoming Uncle Justin and Auntie Lark. Their tenth anniversary. Hosting dinner parties. Justin opening his own firm. Their twenty-fifth class reunion. Their kids’ graduations. Becoming parents-in-law. Having grandchildren.

Life without Justin? The idea was obscene. Impossible. She’d loved him since she was five. Five years old. That saying—two halves of a whole? They actually were. No one, not even Addie, loved her as much as Justin did. He had been her first friend, the boy who was nice, who’d keep the mean kids from picking on her for being shy. When he’d gotten sick the first time, he had given her a purpose in life, a mission that transcended being a Smith kid or a twin or a simple adolescent girl. She’d been needed. And she needed him, too. Forever. Till death, when they were both old.

But the odds were not in their favor. They were, in fact, overwhelmingly stacked against them. She wanted him to be comfortable and happy, not spending the rest of his life—oh, God!—the rest of his life in and out of the hospital for tests and infusions and more tests and infections and side effect management. She didn’t want him to die because fluid filled his lungs, drowning him in place, or because the chemo made him so weak that his beautiful, kind, thoughtful heart would no longer beat.

Please let this be a dream, she prayed. Please let me wake up.

Dr.Kothari had said something. She’d missed it. She was already screwing up.

“There’s got to be better treatments out there than when I was a kid,” Justin said.

“I’ve read about the monoclonal antibodies cocktail,” Lark said, surprising herself by pulling out that information. “That and radiation, it can be a game changer. Right?”

“She’s so smart,” Justin said. “Hasn’t even started med school.” He looked at her and smiled.

“Yes, of course, there’s always reason to be hopeful,” Dr.Kothari said. “Treatment can be pretty grueling, Justin, and hospice is—”

“No. Nope. We’re going for it. It’s the 2004 Pennant, game four, bottom of the ninth, and I’m the Red Sox, okay?” He smiled and squeezed Lark’s hand.

“I’m sorry, I don’t understand,” Dr.Kothari said.

Lark forced a smile. “He means we’re gonna win. Even when it seems like we’re not.” Yes. Yes. That was the attitude. Because if Justin thought he could beat this, how could she be the one to doubt him?

“Ah,” said Dr.Kothari. “Baseball. Got it, and I will look that up, Justin. All right, then.”

He told them where to go next, how to get their parking validated (seriously? Did that matter right now?) and shook both their hands.

Lark deliberately left her purse on the floor, so when they went into the waiting room, she said, “Shoot. Forgot my bag,” and went back in and closed the door behind her. Dr.Kothari looked up.

“If he was your son,” she said quietly, “what would you recommend?”

Dr.Kothari’s eyes grew shiny. “We all die, Lark,” he said quietly. “The last months of our lives can matter as much as all the months that came before.”

She stared at him, then nodded and rejoined the Deans.

Justin’s blood was drawn, an emergency CAT scan was done, and the Deans took them out to lunch, getting a table far away from other diners. Justin’s fever had passed quickly; he was ravenous and an oddly light mood settled over the three Deans.

“You’re as strong as a Clydesdale,” Heather said. “If you lined up a hundred people with this, you’re the obvious choice to beat it.”

“And you’re getting married,” Theo said. “If that’s not something to live for, what is, right, Justin? You can’t leave this beautiful girl!”

“I have no intention of it,” he said, kissing her hand where the diamond ring glittered.

At the end of the meal, Heather said, “Okay, we all had a huge shock, but now we have a game plan. We’ll get through this.”

“Absolutely,” Theo said.

They all hugged, long and hard, and finally parted ways.

Lark and Justin headed to the Common. “I’m in the mood for ice cream,” he said.

“Same,” she said, though she was lying. They got their cones—strawberry for her, chocolate chunk for him—and found a bench near the fountain.

“Let’s get married right now,” Lark said abruptly. “Today. We’ll go to city hall. They’re still open.”

Justin blinked at her. “Um…no. Absolutely not. Why? You don’t think I’ll make it? Jesus, Lark. You have to believe in me.” There was anger in his voice, rare and sharper because of it.

“I do believe in you,” she said. “I do, honey. I just…I just want to be your wife through this.”

He looked away. “You’ll be my wife after. I’m going to live, Lark. This life is too beautiful to even think about anything else. I want the big fancy wedding and I want to see you in a white dress and have your whole family there, and all my midwestern cousins and our friends. It’ll be all the better because I beat leukemia again. This is just a bump in the road.”

She felt ice run down her spine. “We can do the big wedding later. I promise, I’d feel like I won the lotto if we got married right now. Hand to God, Justin. Please.”

“No,” he said firmly. “We’re getting married in December. Wear white.”

“Justin—”

“No!” Then he rolled his neck, sighed and kissed her hand. “I won’t leave you, Lark. We’ll get through this. Positive thinking only. I mean it.”

She could’ve fought him on that. Later, she’d think she should’ve fought him. But for now, she knew he needed her faith. If he thought he could make it, she had to think that, too.

“Red Sox, 2004,” she said, taking his hand and sliding her fingers between his. His face relaxed. “Obviously, I’m moving in with you,” she said. “It’s me, or your mother.”

“It’s you. It’s always you. Always has been, always will be.”

His words made her heart quadruple in size. Even now, even on this horrible day, he could make her feel like the only woman on the planet. God, she loved him.

Strangely enough, Lark didn’t cry. For once, she didn’t cry. It was as if her tear ducts had been removed. She called Addie that night, because Addie knew something was off and had been texting and calling. In as few words as possible, she told her sister the news, asked Addie to tell the rest of the family immediately. Then she set up a group text so she could update everyone simultaneously and said she appreciated their love and prayers and told them she and Justin were feeling really optimistic. And also, please communicate only through this group text or Addie, because she was going to be too busy to respond individually for the next few months.

The rest of the week was spent going to the hospital lab for radiology and more blood work, a detailed CAT scan, back to Dr.Kothari’s office, over to another doctor’s office, to the surgical center for a spinal tap. Oncologists from every specialty—radiation, surgical, medical, hematologic—all weighed in. Lark quit her job, apologizing that she couldn’t give more notice.

Dana-Farber incorporated holistic treatments into its battle plans, so acupuncture, yoga, meditation, tai chi, strength training, music therapy were added to a strict calendar. Lark stocked the kitchen with organic food, tossed the cleaning products and bought nontoxic stuff instead. The smell of Windex made her sick to her stomach now, anyway, memories of Dr.Kothari cleaning up Heather’s vomit so humbly.

When Justin was at work—because he was going to keep working, isolated, wearing a mask—she and Addie took the day off and cleaned his apartment with the new stuff, washed all the clothes, sheets and towels. As if that would slow the leukemia. But no, no, everything could help. She had to stay positive. Busy and positive.

“How are you?” Addie asked after four hours, and Lark just shook her head, blinking. Addie nodded, understanding that if the dam cracked, it would crumble. Lark’s dam would hold, by God. She, champion weeper, would not cry. She wouldn’t be scared. She’d believe Justin would beat this. Hell, yes, she would. He had before. He would again. Period.

She went with him to every appointment and kept a notebook, taking copious notes broken down by doctor, specialty, treatment, medications, side effects, the medications to combat the side effects. She ran his schedule, talked optimistically to his bosses, who said he could do as much or as little as he wanted, and messaged their friends. She filed claims with the insurance company, talked to the asshole administrators who denied this treatment or that medication, and won every time. The Deans were well off, but she’d be damned if the insurance company would get off the hook.

She planned their meals for the next two weeks to minimize the number of times she’d need to go grocery shopping. She talked to Heather and Theo a few times every day, had them over as much as possible and didn’t go home to the Cape. There was no time for that.

Positive affirmations were written with a thick Sharpie pen and taped up everywhere, not the normal, smarmy stuff, but lines from movies they loved. From Band of Brothers, Justin’s favorite book and TV show, They hadn’t come here to fear. They hadn’t come to die. They had come to win. From the Avengers, I can do this all day, spoken by Captain America. From Lord of the Rings, I can’t carry it, but I can carry you, the words spoken by sweet Samwise Gamgee when Frodo collapses at Mount Doom. At dawn, look to the east. Helm’s Deep had seemed to be an unwinnable battle, and yet, on the morning of the fifth day, in rode Gandalf on his beautiful white horse, and they won. They won, goddamn it.

After that initial tremor, she banished the idea that Justin would die. He was strong, and as he said, he’d beaten leukemia once. He could do it again. That six-month prognosis…that was for other people. Older people, people who were more frail or had other health issues or were simply less determined to live. Justin would not go meekly into that dark night, no way. He’d charge into the dawn, like Gandalf on Shadowfax.

Justin had surgery so they could implant a catheter in his brain to get the medicine to his central nervous system. To attack the leukemia in his spinal fluid, he had to lie in a fetal position while the doctors told him not to move and drove a needle into his spine. They dug out bone marrow from his hip, twisting the needle like a corkscrew as Justin tried not to scream (so much for the Xylocaine shots that were supposed to help). And because his bone marrow was also invaded by the leukemia, he needed oral chemo as well, which took away his sense of taste.

That was just in the first ten days.

When the team of doctors, PAs, nurse practitioners and nurses learned that Lark wanted to be a doctor (and had scored in the top 2 percent on the MCAT), they included her in the conversation and narrated the treatments and procedures, as if she were a colleague. They were so positive and upbeat—and so used to this—that it made it seem, for a little while, like this relapse wasn’t such a big deal after all.

“It’ll get worse before it gets better,” said one nurse, and that became their refrain.

The chemo brought on a book of Job type of suffering. When Justin vomited until his throat bled, she sat on the edge of the tub, a cold cloth against his neck, clinging to that phrase like it was a rope tossed into a stormy sea. She wrapped that thought around her hand and clenched it so hard she couldn’t feel anything else.

“It’ll be worth it,” Justin panted in between retching. “I’m sorry, Lark. But”—retch—“worse before better, right?”

“Absolutely, honey. You can do this all day.” The Captain America quote always made him smile. “And don’t forget, we first bonded over puking. It’s all part of our sexy dance.”

He laughed, then retched again.

Twenty-three days after Dr.Kothari gave them the news, Justin had lost thirty-eight pounds and most of his hair. He forbade her from shaving hers when she volunteered.

“I love your hair. Don’t do that,” he whispered, his lips cracked from dehydration and the toxicity of his medications.

He had sores in his throat that made swallowing a study in agony, and his bones ached constantly. He got devastating headaches from the chemo, and the steroids made him irritable. Finally, Dr.Kothari prescribed him Dilaudid, which made him loopy.

“I love Dilaudid,” he said as they were lying in bed, watching the original Iron Man. “Let’s serve it at the wedding.” Their pinkies were linked, the most contact he could bear at the moment.

“Okay,” she said. “It’ll help Winnie loosen up. Grandpop would love it, I’m sure. Robbie’s been giving him gummies for his back pain, and Grammy already has medical marijuana.”

“But Dilaudid is next level. Can you see my mom stoned? That would be so fun. We have to get Mom stoned. Can you buy some gummies for her?” He was definitely a little high, but he was happy right now, and that was all that mattered.

“Sure,” she said. “She and I can have a girls’ night. Gummies and dancing, binge-eating potato chips…”

“You should. She would love that. She loves…” He was asleep before he finished the sentence. Hopefully, the Dilaudid would let him get a few consecutive hours of rest.

She watched Justin a lot when he was sleeping, studying his face for signs of improvement or decline. His face was gaunt now, and his eyebrows and lashes were sparse. Pretty soon, they’d be gone altogether. Something was going on with his teeth, too…they looked bigger and had a gray tinge. His skin had a yellow cast.

But he was still the boy she had loved since she was five. Still protective of her, still trying to hold the door for her, still asking about how she was holding up. “I’m sorry to put you through this, little bird,” he’d whispered just last night. “I wish we were rollerblading along the Chuck instead. I wish you didn’t have to do so much for me, honey.”

“I love doing so much for you,” she said. “Your turn will come when I’m in med school and weepy and exhausted. Or when I’m hugely pregnant and can’t see my feet.”

“I can’t wait for that, little bird. I can’t wait.”

How many times does your kindergarten crush end up your husband? How many times does the nice boy who first kissed you at age fourteen turn out to be the only person you’ll ever kiss? They were meant to be. They were Larstin, adored by everyone, held up as truth of the fairy tale.

The universe could not let them down.