An Imminent Silhouette: The Path Towards the Acceptance of Uncertainty

My eyes strained to capture the cryptic black and white image projected at my bedside. The previously upbeat ER doctor that guided my gaze through a hazy anatomical maze became silent. “What do you see?,” I muttered. Without diverting her gaze from the convoluted shape that lay in front of her, she stated, “There is a large mass,” before continuing to gradually inch the cold probe across my bare chest. “Well, what do we do now?,” I questioned her with a calmness that surprised me. I had never been calm when it came to my health. I was a self-diagnosed hypochondriac who had spent the last several months convincing myself I had an autoimmune disorder. However, as I stared at the recently identified shadow before me, I coolly respired. The months of doctors visits and blood tests, which left me with unresolved pain and exhaustion, no longer held me hostage. I was approaching an answer. 

“I’m going to order a CAT scan. They’ll come for you in about an hour,” the doctor explained as she cleaned the ultrasound transmission gel from my exposed skin. She covered me with a warm, stiff blanket whose sterile smell I would come to know better than that of my own bed sheets. “Hang tight. They’ll be in shortly,” she assured, drawing the thin curtain that separated me from the controlled chaos - the cases of abdominal pain, head injuries, and broken bones- that persisted beyond my cubicular room (if you want to call it that) comprised of three cotton walls. A large mass. I sat alone with the shadow projected by the recent echocardiogram. Yet, its looming presence did not alarm me. I sit unbothered in a meditative state, unable to comprehend my body’s sudden metamorphosis. It had transformed from an inconsolable disarray of flesh that had sat sobbing in a crowded waiting room just a few hours ago to the reposeful spirit of a quasi Buddha. 

This inner harmony would last me throughout nearly the entirety of my twenty-seven day hospital stay between three hospitals; would accompany me through three biopsies; would guide me out of respiratory failure and into an acceptance of a future that did not resemble the future I had meticulously mapped out for myself over my last four years of undergraduate study. Here was my indissoluble roadmap: I would graduate with my BA in Spanish and Secondary Education with a minor in Women and Gender Studies in May of 2024. After a summer of working at my part-time job and squirling up money, I would move to Madrid in September of the same year to complete an MA in Hispanic Literature. I would return to Boston University to complete my PhD in Hispanic Literature one year later. In five years, I would be a professor of literature and, in line with my childhood dreams, a published author. Yet, now face-to-face with a malignant silhouette, I watched as each phase of the plan quickly decomposed into distant longings. 

There existed no margin of error in my previous plan. Therefore, illness could not exist and, if it did, it could not affect my steps toward self-measured success. My forehead burned with fever. A deep stabbing pain that no over-the-counter pain reliever could touch overwhelmed my chest and head. Internal chaos. However, as the start of such chaos coincided with my new field placement as a local high school teacher, I doused myself in the cool waters of distraction.  I knew that a fire burned within me, but I contained the smoke.

Then, the chaos heightened. It would be heard amidst my fixations on a five-year plan. A minor upper-respiratory virus I had contracted at the start of my Spring semester at Providence College soon converted into an untamable beast. The quiet, dry cough I had early in the month, roared without pause by the month’s end. My chest and head pain had returned, this time nearly unbearable. As January came to a close, my body raged with fever and no longer knew sleep. Despite my attempts to sleep as early as seven in the evening, I found myself eyes wide open when my five forty-five alarm blared the next morning. I popped some Tylenol in my mouth, knowing it was useless, and I crawled out of bed. I was drowning and it wasn’t even six AM. I needed something to hold onto; however, I found myself in ocean depths far from any indication of life or land. The day before my emergency room escapade, I went into my part-time job at the local Boys and Girls Club and clung to my Dunkin iced coffee as it was the only thing left to keep me afloat. Observing my state slowly worsen over the past couple of weeks, my coworker began to pose her daily question to me. “Are you okay?” No. I could no longer lie. Before she could get past “you,” I surrendered. Her concerned eyes begged me to save myself. I perceived the worried voices of my sister, best friend, and the nurse practitioner at my family medicine office as they echoed a similar plea. Uncombed hair fell into my red-hot face. “I promise I’ll go to the ER tomorrow.” 

I continued to decipher my newfound calmness as a nurse, who couldn’t have been much older than myself, drew back the curtain, revealing numerous patients in the hallway awaiting beds and grunting in pain. “They are so vulnerable,” I thought, “crying, agonizing out in the open like that.” I had never known a greater sense of vulnerability until I entered through the hospital doors on that bitter cold morning. February First. And I will never know a greater vulnerability than that of being patient. I did not know then that I would come to experience the vulnerability I saw in those grunting strangers first hand over the course of the next month and, in a new yet similar way, in the months that followed as more and more people became aware of my diagnosis. 

The young nurse notified me, “We’re going to take you for your CAT scan now,” and motioned toward the stretcher on the other side of the curtain. “Your chariot awaits,” I imagined him saying. As I mounted the gurney, I recalled the last time I was in this emergency room. I was eight and, in a game of tag with my cousin Jack, I broke my right arm. When the nurse indicated he would bring me to my X-ray in a wheelchair, that young and utterly stubborn version of myself uttered one word. No. I was not about to be seen in a wheelchair. I was not going to let someone push me around, in the most literal sense. The nurse defeated, having explained the hospital’s procedure without success, allowed me to walk myself to the radiology wing. Now, putting my prideful independence on a standstill, I layed back and felt the stale hospital air wisp by me as another gentleman grabbed hold of the gurney. He stopped in front of a room whose door indicated ‘radiology’ and put down the breaks. “They should be with you shortly.” Was he leaving me in the hallway like those patients I had just pitied? My entire body shivered. I looked down. My cold arms and legs, exposed in the hospital gown I had been gifted early that morning, had begun to resemble the bare, paper white walls around me. I closed my eyes and rubbed my hands together as if I were back in Madrid, waiting for the bus in the cold, early hours of la madrugada. I perceived the transient, indistinct chatter of passerbyers and listened closely, as I would have done at the bus stop. Visitors, a man and a woman, who had evidently gotten lost on their way to visit grandma. Did they see me with the same pity with which I had seen other patients? Was my vulnerability equally as palpable to this man and woman as those strangers’ had been to me just a half and hour prior? The reality was that they were so engrossed in getting themselves to their ill family member that they most likely did not give two shits about the 21-year old girl laying in the hallway; however, in this moment, I became conscious of my shifting role from caregiver to patient. I was no longer the teacher who stood up in front of the classroom the day before, guiding students in their search for answers. I was now the one who waited for guidance, who now relied on someone apart from myself, to lead me to the answers. 

The answers trickled in slowly. CT imaging confirmed the ER doctor’s initial finding. Breathing in the stale emergency room air once again, I reached for my phone. My finger jumped from folder to folder on my cluttered home screen until it located the patient portal app. Test results. I had spent the past fifteen years as a student who, at the sight of corrected exams, developed the same deep pit in my stomach. I considered each exam an indication of my worth and of my future success. The medical results that I confronted on the screen now dictated my life hereafter. CT Angio Chest Combo. My right pointer finger tapped the glass without hesitation. Findings. A 15 centimeter mediastinal mass surrounding the ascending aorta and compressing the right and left pulmonary arteries. My fingers curled away from the screen and reached for my chest. I sat looking straight ahead, my right hand resting on the center of my chest. A single tear rolled down my tired face. This test had no grade attached to it. No way of bestowing intellectual merit, nor of envisioning future intellectual pursuits; however, I examined it beyond any other results with which I had been presented in a classroom. I didn’t require medical training to recognize the gravity of the results; however, the consolation of knowledge, of now understanding the origin of months of physical agony, eclipsed any fear one may expect to have in the face of such a finding.

“Twenty-one year old female in room 121 will need to be transported for a biopsy.” As I waited for the doctor to verbalize the results I had dissected over the past thirty minutes, I eavesdropped on the reverberations of the ER doctor’s conversations that drifted through the paper-thin boundaries of my room and the rest of the emergency room. The objectivity and precision in her voice expounded a sense of urgency. I identified myself as the subject of their conversations, and sank deeper into the reality with which I had collided outside of the radiology room. I was now a patient. I was not the teacher who had the answers within her grasp. I was the student unaware and reliant on the answers that the doctor held beyond the drapery. Before my mind could drift further into this current of thought, the doctor’s voice decrescendo and I perceived her imminent footsteps. Expanding upon the CT scan findings, the doctor exposed a possibility I had not yet pursued: that of malignancy. The findings pointed toward lymphoma, a word I heard hundreds of times over the week that followed. “It’s very treatable and responsive to chemotherapy.” Upon my arrival at the second hospital of my three part hospital experience, doctors repeated this favorable prognosis. Albeit mere speculation, I confided in their claims and in their years of medical training and, therefore,  sustained my unbothered disposition.

Hope. I began to rebuild the four-year plan I had deconstructed the day prior upon seeing the mass for the first time. I would complete the four months of chemotherapy commonly necessitated by Hopshkin’s Lymphoma. I would be cancer-free by the start of summer and ready to depart for Madrid in late August. In the early days of my senior year at Providence College, I had ironed out a perfectly measured-out plan for the next five years, leaving practically no margin for error. The doctors’ speculations framed my disease as an insignificant roadblock whose timeline did not interfere with that of my clear-cut professional goals. I was satisfied, unafraid, and unrealistically valiant. Close friends filled my hospital room with balloons, teddy bears, cards, and laughter. We spent three days playing games, recounting college memories, and ordering takeout to combat the bland hospital food. We talked little about my medical condition. We didn’t need to. I would be okay.  “It’s most likely lymphoma, but don’t worry because it’s very curable and I’ll be better by summer.” I grasped onto the doctors’ hypotheses and regurgitated their conjectures unto my friends. I echoed again and again, “I will be okay,” even as my belief in the doctors’ diagnosis slowly faded into skepticism. 

The needle pierced my bare chest. A dagger in search of answers. My scream resounded within the large, sterile white room in which the operating doctor and attending nurses (attempted to) perform a needle biopsy. My eyes dampened by distress searched for the nurse at my side. His eyes met mine, “Are you upset because we plan to move your hospital room?” I was astounded. “No, I am upset because I can feel every bit of this operation right now.” The doctor proceeded to dig the needle deeper into my skin as my voice uttered with unadulterated affliction. Once again, I faced the vulnerability of being a patient - an amplification of the vulnerability I had felt days prior as my cold body lay on a stretcher in a bustling hallway. My body now faced a pain not self-inflicted, but inflicted by the very hands that I had entrusted to aid in its curation. My pain remained invisible to (or, more likely, ignored by) the doctor who gouged me with his metal hands. I closed my eyes for the remainder of the procedure and reminded myself that soon the pain would bear the fruit of a confirmed diagnosis.

Rotten fruit. The afternoon after the procedure, a doctor entered my hospital room. Straight-faced and unable to look me in the eyes, the nurse began to utter something and paused. She approached my bedside, rested her hand at the head of the bed, and proceeded to speak. “I have bad news.” I immediately suspected that this news concerned my recent biopsy. My hands, concealed by a blanket, formed fists. “The pathologist did not receive adequate samples from yesterday’s puncture biopsy to make a conclusive diagnosis.” I imagined myself swinging both fists at the doctor that had performed the biopsy before relaxing my fingers and directing my gaze toward the bearer of the recent bad news. “What does this mean?,” I asked sternly. I recalled the needle in my chest and shuddered. I would not allow my body to undergo the treatment it had just twenty-four hours before. “We could repeat the puncture biopsy, but there is a high possibility it could fail again. Your next best option is a surgical biopsy.” We had talked about the possibility of a surgical biopsy the day of my transfer to the hospital. It came with risks that I wasn’t willing to take at the time. The surgical procedure would require that I go under general anesthesia. However, the large tumor in my chest caused an immense strain on my heart and, as a result, difficultated my breathing. There was a chance that I would experience respiratory failure if I were put under sedation. Now, the doctor reintroduced the risky procedure as the “next, best option,” despite noting that I could end up in the critical care unit as a result of the operation. I struggled to trust the doctors, who had failed to properly perform a puncture biopsy, with a more complex procedure. I needed to weigh my options. I needed time that I did not have. The fruit that the pain of my first biopsy produced was rotten. 

The door to my hospital room swung open. Firm, assured footsteps marched toward my bedside. I expected friends later in the day; however it was still early Sunday morning. Visiting hour had only just begun. The furor with which each step advanced rapidly pulled me out of my TikTok-induced trance. My uncle, eyes wide and lip curled, omitted any “hello” or “how are you” and substituted these greetings for a lengthy and passionate sermon. Uncle Paul had endured chemotherapy and a bone marrow transplant eleven years prior immediately after he received a stage four Non-Hodgkin's Lymphoma diagnosis. I vaguely recalled his shaved head and pale face; yet, I had previously failed to recognize the emotional significance of these physical changes. Both hands on his hips, he paced the room, pausing to stare out the wall of windows that faced the Providence skyline. “I am not a religious person, but they came to give me my Last Rights, Sarah.” Despite the diversion of his gaze away from my hospital bed, his profile revealed a sequence of droplets that chased one another vertically on his narrow cheek bone. “They told me that I had only days remaining.” I sensed the pain in his eyes as they solemnly stared into the glass, as if his own fear of mortality stared back at him. He escaped the captivity in which the monster of his past had held him and slowly shifted his posture toward me. “But I’m here now. Those doctors saved me.” Suddenly a forced positivity overtook the horror-stricken paralysis that had overcome him just seconds before. “A few years into my remission, I returned to my oncologist to review follow-up PET scans,” he began. A timid oncology resident eyed the scans from the corner of the poorly lit room. “So, how long ago did this patient die?” His superior answered the question with a subtle nod toward the man that sat in the corner of the examination room. My uncle was ten years into remission. The numerous tumors that lit up across his body on this initial scan vanished over the course of six rounds of chemotherapy. He was cured, alive, and well. While my uncle’s accounts moved me, I struggled to understand the root purpose of his early morning appearance. The tough, know-it-all who has always unconsciously asserted traditional notions of masculinity at family parties was the last person I expected to be crying in my hospital room before breakfast. “Thank you,” was all I could mutter. I appreciated his bittersweet rawness, an outpouring of fear and hope, rooted in a boyish helplessness toward an illness that was not his. “Sarah, you need to get out of here. They’re killing you here. You need to go to Boston.” The discomfort and uncertainty I had experienced at the current hospital supported his demands. I would not base my medical decisions on my uncle’s accounts alone but, supplemented by my own wariness, I knew a third transport to Boston was my last hope at an accurate diagnosis. 

I arrived to floor seven of the third hospital by sundown. After four days of constant visitation, I craved solitude. The nurses entered and exited the room swiftly, my mother made herself comfortable on a nearby recliner. My craving for solitude would remain like a watering hole amidst a drought - insatiable. That night, I felt the stark contrast between this hospital and the previous one. I was no longer distracted by the presence of my closest friends nor was I blinded by the false diagnostic speculations of my prior medical team. I lay in darkness immobilized by the presence of a meteorite hurtling toward me, a rapidly-approaching reality of tests, pain, and waiting, in which doctors would uncover the truth about what lay inside me. A team of physicians would perform the surgical biopsy that the last hospital had suggested. I was confident in their abilities, but I doubted my own body’s ability to sustain itself through the operation. “As I am sure you are aware by now, there is a risk of respiratory failure,” the chief anesthesiologist cautioned as he stood assertive in front of my pre-op cubicle. I did know. I also knew, just as well as he did, that there were no other options. However, unlike at the previous hospital, I knew the medical professionals that stood before me would sustain my life when my body could not do so on its own. 

Rebirth. As I awoke, a cold rush of air substituted my breath. I felt as if I had been born again, having to learn, upon reaching consciousness, how to breathe for the first time. I clumsily moved my hand toward my mouth to perceive the large mask and tube that protruded from my face. This life would be shorter than the last. I entered it, however, with the acceptance of my own mortality - an acceptance that I cultivated in my previous life, with which I was now ready to coexist. In the days that followed my rebirth, I crawled. Despite the spiritual cognizance with which I had entered this life, I agonized over my lack of insight into the precise classification of the tumor that fed off me. Five days later, In a room impregnated with the unfamiliar faces of doctors, I began to walk. The rosy, four-month treatment plan for lymphoma painted by the previous hospital’s speculations deteriorated at the sight of the final pathology report. Angiosarcoma. “Sarcomas make up about one percent of cancers and, well, Angiosarcomas make up about one percent of sarcomas,” noted one of the faces. Further testing would reveal that the tumor had made its way into my right atrium, which made the diagnosis all the more unusual. My family members were and still are terrified by the rarity of the disease. Yet, amid what seemed like a snow storm of questions and answers between my family and the doctors, I lay making snow angels. “Well, how did she get this?,” my mother demanded answers. One doctor suggested a genetic mutation. Another chimed in and suggested that I undergo genetic testing. Their superior, a lead doctor with experience in Sarcomas, followed, “it could just be shit luck.” I preferred his answer to the others. It probably was just “shit luck.” I think of the doctor’s interjection frequently and often repeat it when asked about the probable cause of my cancer. The two word response has saved me from having to bullshit an answer that I do not know nor do I care to know. Although I hope that one day there will be a known cause that aids in disease prevention, it will not be in my lifetime. Instead, I focus on what remains within the limits of my lifespan. I have a terminal disease. I breathe deeply, smile at myself in the mirror, and repeat, “ I have terminal cancer, but right now I am alive.” Amidst my diagnosis, I observed from my hospital bed and angered at those whose questions whirled around me like unrelenting flurries. I paused before the anger overtook me. Breathe, Sarah. Breathe while you still can. I began to contextualize my life just as I do now in my bedroom mirror. “Out of all the people in this room, odds are you’re going to die first.” I struck myself with the undiluted reality and let it inform my actions. “They have more breaths to waste on hypothetical questions, more energy to waste on creating snowstorms in hospital rooms.” I sat back to watch the snow fall and inhaled deeply.