Chapter 36
SAM
The waiting room chairs have this way of making time stretch like taffy. Ten minutes feels like an hour when your legs are dangling over industrial-grade vinyl that's just a shade too high for comfort. I should be in Professor Miller's mixed media class right now. Instead, I'm here in Dr. Wilcott's office.
I flip through a tattered magazine without seeing the pages. They're all the same in these places—celebrities with perfect teeth telling you how to live your best life. What would they know about sitting in an oncologist's office, waiting to hear how much time you might have left? I toss it back on the table.
The door opens and Dr. Wilcott steps in, her silver-framed glasses catching the fluorescent light. She's wearing navy blue today, with sensible shoes that barely make a sound on the linoleum. She's always been like this—professional, put-together, a woman who delivers life and death sentences with compassion.
"Samantha," she says with a small smile that doesn't reach her eyes. I've known her long enough to read her expressions. This isn't going to be good news. "I was hoping your mother would join us today."
I shake my head, fingers fidgeting with the frayed edge of my jacket sleeve. "I wanted to come alone first."
She settles into her chair, crossing one leg over the other as she opens my file. "Sam, these conversations are difficult. Having support can—"
"I need to understand it myself first," I interrupt, hating the crack in my voice. "Before I tell them. Before I see the look on my mom's face when she realizes we have to go through all this again. Before my brother starts googling survival rates."
"I respect that," she says finally, turning to her computer. "Alright, let's go through your test results."
I brace myself, shoulders tightening against the onslaught of medical terminology I've grown too familiar with over the years.
"Your complete blood count shows abnormalities consistent with your previous presentation of AML," she begins, her voice taking on the measured cadence she uses for clinical discussions. "White blood cell count is elevated at 38,000 per microliter, and we're seeing an increase in blast cells in your peripheral blood—about 30% currently."
Numbers and percentages that translate to one thing: my body is betraying me again.
"The bone marrow aspirate confirms what we suspected. The leukemic blasts have returned and are crowding out normal blood cell production." She pulls up a chart on her screen, turning it so I can see the colorful clusters that represent my failing bone marrow.
"The flow cytometry and cytogenetic analysis show the same genetic markers as your previous episodes. It's definitely a relapse of your original AML."
I nod mechanically. "How bad is it compared to last time?"
Dr. Wilcott removes her glasses, cleaning them slowly with a cloth from her desk drawer. It's what she does when she needs a moment to choose her words carefully.
"Each relapse becomes more challenging to treat, Sam. The leukemic cells evolve, developing resistance to previous therapies." She slides her glasses back on. "The disease is more advanced than your last relapse three years ago, though not as aggressive as it could be. We're catching it relatively early, which gives us some advantage."
"But?" I prompt, knowing there's more.
"But it's still concerning that you've relapsed again, especially within this timeframe. It's imperative that we begin treatment as soon as possible."
I swallow hard. "What are we looking at this time? The same regimen as before?"
She hesitates, just for a millisecond, but I catch it. Years of cancer teaches you to read these small cues, the tiny tells that doctors have when they're about to deliver bad news.
"Sam, I want to be straightforward with you. This is your third diagnosis of AML. A second relapse makes your situation more complex." Her voice softens. "The duration of remission typically shortens with each recurrence."
"Just tell me, Dr. Wilcott. How bad is it?"
She meets my gaze directly. "If we are unable to induce remission again, survival is often measured in months rather than years."
My heart stutters. I'd expected this, rehearsed this moment in my mind during sleepless nights, but hearing it still feels like being shoved off a cliff.
"Ho...how long do I have?" My voice sounds distant, like it belongs to someone else. My fingers clench around my purse strap until my knuckles turn white.
Dr. Wilcott leans forward slightly. "I can't give you an exact number. But without a meaningful response to therapy, we could be looking at months rather than years." She pauses, letting that sink in. "Without a strong response, survival beyond six months would be uncommon."
Six months. Half a year. One semester of college. Twenty-four weeks. The number crashes through me like a wrecking ball. However I slice it, it's not enough time.
Not enough Saturdays to call Mom every weekend like I promised. The tears build behind my eyes as my chest constricts, each heartbeat a reminder of how few I might have left. It isn't fair—I've already fought this twice. What did I do to deserve a third round? A final round?
"But," she continues quickly, "that's assuming no response to treatment. You've responded well before, and there's reason to believe you can again, especially if we take a more aggressive approach."
I stare at a small water stain on the ceiling, shaped vaguely like Australia. Six months. I'd never see another Christmas. Never finish my degree. Never—
"Sam?" Dr. Wilcott's voice pulls me back. "Are you with me?"
"Yeah." I blink rapidly. "What's the plan?"
"If we can get you back into remission, a bone marrow transplant offers the only treatment with curative potential."
The word "transplant" hits me like a physical blow. Suddenly, I'm fourteen again, sitting in a different hospital room, watching my father waste away after his failed transplant. The memory is so vivid I can almost smell the antiseptic, see his yellowed skin stretched thin over cheekbones that used to be full and laughing.
"No." The word comes out sharp, definitive.
Dr. Wilcott's expression is sympathetic but firm. "I understand your hesitation, especially given your father's experience. But transplantation techniques have advanced significantly in the past five years. And patients respond differently—"
"My dad died because of the transplant," I interrupt, my voice rising. "Not despite it, because of it. The infection, the graft-versus-host—it destroyed him." My hands are shaking now. "He went into that hospital walking and talking, and he never came home."
The memories flood in unbidden—how hopeful we'd been, my mother squeezing my hand as the doctor explained how the transplant would save him. "This is it," she'd whispered. "He's going to beat this." And then watching him deteriorate day by day, his body rejecting the foreign cells that were supposed to save him.
"Sam," Dr. Wilcott says gently, "your father's case was complicated by several factors. His advanced age, his prior health conditions—"
"He was thirty-seven," I snap. "That's not old."
"No, it's not," she concedes. "But your situation is different. You're younger, your overall health aside from the AML is excellent, and we've learned a great deal about matching donors and preventing complications."
I shake my head, wrapping my arms around myself. "Is there another option? Anything else?"
Dr. Wilcott sighs but nods. "We can pursue conventional reinduction chemotherapy—similar to your previous treatments, but with some modifications to address potential resistance. It would be intensive, requiring hospitalization for at least four weeks."
"Like before," I say, grasping at the familiar.
"Yes, but likely with more significant side effects this time. And there's also the option of an outpatient regimen—less intensive chemotherapy that would allow you to continue some of your normal activities, though with frequent hospital visits."
"The outpatient option," I say immediately. "That's what I want."
Dr. Wilcott's lips press into a thin line. "Sam, I need to be clear. The outpatient regimen is less likely to achieve a complete remission, especially in a second relapse situation. It might buy us time, but it's not curative."
"I understand." I don't tell her that time is all I'm hoping for now. Time to finish at least one more semester. Time to help my mom prepare for what's coming. Time to make peace with the fact that I might not make it to twenty-one.
"I strongly recommend reconsidering the transplant option," she continues. "The five-year survival rates with transplantation for someone your age, even with a second relapse, are significantly better than with chemotherapy alone."
"The same way they were better for my dad?" The words come out bitter.
"Medicine isn't mathematics, Sam. Statistics tell us probabilities, not certainties. Your father's outcome was devastating, I know, but it doesn't predict yours."
I look away, focusing on the framed diplomas on her wall. Harvard Medical School. Johns Hopkins Fellowship. Years of training and experience condensed into gold-embossed certificates. I respect Dr. Wilcott—I always have—but she wasn't there in those final days with my dad. She didn't see what that "life-saving" procedure did to him.
"I want to try the outpatient treatment first," I say firmly. "If it doesn't work, then... then we can talk about other options."
She watches me carefully, and I can see her weighing whether to push harder. Finally, she nods. "Alright. We'll start with the modified outpatient protocol. But I want to see you weekly, not biweekly like before. And at the first sign that it's not providing adequate control, we reassess."
"Deal." Relief washes through me, followed immediately by doubt. Deep down, in the part of me that's learned to interpret blood test numbers and bone marrow reports, I know this might not work. But I need to try it my way first.
Dr. Wilcott turns to her computer, typing rapidly. "I'm going to prescribe oral Venetoclax combined with subcutaneous Azacitidine. You'll need to come in for the injections five days each month, and you'll take the oral medication daily." She glances at me. "This regimen has shown promise in relapsed AML, particularly with your cytogenetic profile."
I nod, trying to focus on the details, on the mechanics of what comes next rather than the shadow of what might be waiting six months down the line.
"There will be side effects," she continues. "Fatigue, nausea, increased risk of infection. Your blood counts will drop about two weeks after we start, so you'll need to be vigilant about any fever or signs of infection."
"I know the drill," I say.
She prints out a treatment schedule and hands it to me. "We'll start tomorrow if your bloodwork today shows you're ready. The pharmacy will have your prescriptions ready this afternoon."
I fold the paper carefully, tucking it into my bag. "Thank you."
Dr. Wilcott stands, coming around the desk to sit in the chair beside me—an unusual move that signals she's stepping out of her strictly professional role. "Sam, I know this is terrifying. And I respect your decision to try this approach first. But please, talk to your family. Don't shoulder this alone."
I nod, not trusting myself to speak. The reality of what we've just discussed is beginning to sink in, turning my limbs heavy.
"And Sam?" She waits until I look at her. "I've seen patients defy every statistic and prognosis. The human spirit is remarkably resilient. Don't give up hope."
Hope. Such a small word for such an enormous concept. I used to have so much of it. Now it feels like a currency I can't afford to spend.
"I won't," I say, standing up on legs that feel like they might give way. Another lie to add to the collection. "Same time tomorrow?"
She nods, her expression gentle. "We'll get through this together."
As I walk out of her office, the weight of what I've learned settles around my shoulders like a heavy cloak. Six months without a meaningful response. A second relapse. Diminishing returns on treatments that worked before.
In the elevator, I lean against the wall and close my eyes. I should be in art class right now, worrying about finals and dating and what to wear to that party on Friday night.
Instead, I'm calculating how many sunrises I might have left, and wondering how I'll tell my mother that her daughter might follow her husband into that good night.
Morning sunlight spills into the lobby, cruelly bright. People move around me with coffee cups and appointment slips and lives that are continuing uninterrupted.
I step out and pull my phone from my pocket.
Two missed texts from my brother.
ZACH
Where are you?
ZACH
Breakfast? I'm starving.
Then I see Eli's name.
Not just once—several notifications. My heart stutters. He never texts me, never calls, but suddenly he's flooding my phone with messages.
I open his latest messages, my thumb hovering over the text bubble.
ELI
Sam, please call me back. I need to talk to you. It's important.
ELI
Are you okay? Why aren't you answering?
ELI
Where are you? Can we meet today?
Each message more urgent than the last, a crescendo of digital panic that makes no sense. We had a deal. One day together, and then I'd disappear from his life like mist burning off a lake. That was the arrangement—the price I set for ten years of unwanted attention. One day with him, and then I'd leave him alone forever.
Now he won't stop calling, won't stop texting, and I don't understand why.
Is he testing me? Seeing if I'll break my promise to stay away?
Or is he feeling guilty about what happened between us?
Heat blooms in my stomach as I remember our first night together, tangled in sheets, his hands mapping my body like he was memorizing terrain that might vanish. I close my eyes, remembering the weight of him above me, how his eyes never left mine.
I'd been dreaming about that moment for so long that when it happened, it felt like déjà vu—like I was remembering something instead of experiencing it for the first time. The curve of his shoulder under my palm. The way his breathing changed when I touched him just there.
Maybe he regrets it—regrets me? And wants to make sure I know it was just physical, just a moment of weakness?
The thought lands heavier than my prognosis.
Which is pathetic, really—facing death, and I'm still more afraid of rejection.
I should text him back. Should call. Should do something other than stand here frozen outside a hospital that's just told me I probably won't live to see next summer. But what would I even say?
Sorry, can't talk. Just found out I'm dying in six months. Rain check?
My finger hovers over the call button, trembling slightly. For one wild moment, I imagine telling him everything—about the cancer, about the prognosis.
Instead, I lock the screen and slip the phone into my pocket. Whatever Eli wants, it can wait. I have bigger problems right now.
I start walking, no destination in mind. The hospital stretches out in concrete and glass, ambulances idling near the emergency entrance, families clustered on benches with paper cups of bad coffee. People move in and out through automatic doors that open and close like mechanical breaths.
A young couple stands near the valet stand, arguing softly over parking validation. A little boy drags an IV pole twice his height across the sidewalk while his mother laughs and tells him to slow down. A nurse in scrubs lights a cigarette at the edge of the lot, shoulders slumped like she's carrying every patient inside on her back.
They all look so alive. So mid-story.
I'm only twenty, but I feel ancient. Worn smooth by years of illness, like a stone left too long in rushing water. Polished down to survival.
The sun feels different on my skin now that I know it's counting down. Every sensation sharpens, like my body is trying to memorize the world. The whisper of wind through the bare branches near the entrance. The distant wail of a siren fading into traffic. The scent of coffee drifting from the hospital food truck parked by the curb.
I breathe it in greedily.
Six months.
What does that even mean in practical terms?
It means I'll never finish my degree. Never sit through graduation with my name called over a crackling loudspeaker. Never have a real job. Never travel to the places pinned above my bed. Never grow old beside someone who loves me.
Six months means one more birthday. Maybe.
It means watching my mother's face crumple again as she prepares to lose another person she loves to this disease. It means my brother will have to be the one to sort through my things, deciding what to keep and what to give away.
I wander toward a small landscaped pond near the front entrance — the kind with decorative stones and a little fountain that sprays water in an optimistic arc. Ducks cluster near the edge, circling a man in scrubs who tosses them crumbs from a sandwich.
I sink onto a bench and watch the ripples spread outward.
The ducks fight over soggy bread, indignant and insistent. Survival, even in feathers and beaks.
My phone buzzes.
ZACH
Seriously, where are you? Caroline and I are at the cafeteria and they have your favorite pancakes. The good kind with blueberries. You're missing out.
Blueberry pancakes.
The normalcy of it punches a hole straight through my ribs.
I stare at the screen longer than I should before typing back.
ME
Sorry, had an early appointment. Save me some?
No mention of hospitals or cancer or six-month timelines. Not yet. I need to process this myself before I can handle their reactions. Need to figure out how to tell them in a way that won't destroy them completely. As if there's a good way to tell your family you're dying.
My phone buzzes again almost immediately. Eli. Again.
I stare at his name on the screen. In another life—the one where I have years ahead of me instead of months—I might answer. Might let myself believe that his persistence means something. Might take the risk of finding out why he suddenly can't let me go when he's spent years barely acknowledging my existence.
Instead, I put the phone away again and stand up, brushing off the back of my jeans. The ducks watch me hopefully, but I have nothing to give them.
Story of my life: disappointing expectations, coming up empty.
The bitterness of the thought surprises me. I'm not usually this cynical, even about my illness. I've always been the one reassuring others, putting on the brave face, making the jokes that let everyone breathe a little easier around the dying girl.
But something about this time feels different.
Maybe it's the finality of it. Maybe it's the knowledge that I've already used up my allotment of miracles.
Or maybe it's just that I'm tired.
Tired of fighting, tired of hoping, tired of pretending I'm not scared out of my mind.
As I walk, I think about Eli again, about the night we spent together. The way he looked at me in the darkness, like I was something precious, something worth keeping.
For one night, I felt normal. Desired. Whole. Not the girl with cancer, not the charity case, not the ticking time bomb—just Sam. Just a girl with a boy who looked at her like she might be everything.
The memory wraps around me, warm as a blanket against the chill of Dr. Wilcott's prognosis. Six months may not be enough for a lifetime, but it was enough for that night. It will have to be enough.