A Promise for Keeping

As I began taking her vital signs, she asked, "Eric, when am I going to start feeling better?"

"Oh, Alison," I admitted as I took her blood pressure, feeling her thin arm against mine, "First, it is going to get much worse."

And as I told her it would, Alison's physical condition continued to deteriorate.

When I began working on 6 North, a veteran oncology nurse had told me that in order to cure a leukemic, we had to practically kill them first. She was not exaggerating. Over the next two weeks, all of Alison's blood counts would drop to precariously low levels and the nausea and vomiting had become so relentless that she was unable to tolerate even the smallest amounts of nutrition.

Daily transfusions of donated blood and platelets became her way of life. She was placed on protective isolation and all visitors to her room were required to wear masks and gowns to defend her from even to most common of bacteria. When she began to spike fevers, IV antibiotics were added to assist her depleted immune system in fighting off any invading organisms. In order to avert malnutrition, she was fed intravenously, but still, the vomiting came in agonizing, unbearable waves.

Despite this misery, I never once heard her complain but I could feel her heartache nonetheless. Brian's visits were few but she would always have an excuse for him; "he is busy with work" or "he does not like seeing me this way." I did my best to support her through this terribly difficult time with a carefully blended mixture of humor and moral support.

With each shift I cared for her, this frail sick girl - who somehow managed through all the gloom to furnish me with at least one breathtaking smile a day - would become more and more dear to me.

Finally, on the fourteenth day, the induction chemo was complete. The full throttle assault against her bone marrow would conclude and the long period of waiting for her body to recover would commence. Slowly, her blood counts would return to safer levels and by day twenty-two, transfusions were no longer required and the isolation precautions were lifted. During that time she had received nine blood transfusions, eleven units of platelets, had cultured positive for a urinary, as well as a double ear infection and had been on no less than four different antibiotics.

I had told Alison that when her nausea subsided and she could once again tolerate solid food, I would prepare for her whatever meal she desired. She chose melon of all things and on the twenty-seventh day of her prolonged visit to 6 North, the two of us feasted upon fresh honeydew, tangy cantaloupe and succulent watermelon, seeds and all.

By now, her scalp was completely devoid of hair - short of a few lonely auburn curls - and she had taken to wearing a floppy purple beret that made her tiny head appear even smaller than it actually was. "How long until they know whether or not I'm in remission Eric?" she asked as I cleaned up the skeletal rinds of our all-melon dinner.

"That is a hard question to answer Kiddo. Everybody is different." I explained to her how in a week or two she would be started on daily infusions of what is known as 'maintenance chemo' - less potent doses of chemotherapeutic agents that were intended to keep her regrowing bone marrow in check and free of malignant cells. "In time," I continued, "the doctor will do another bone marrow biopsy and if all she finds are healthy cells, you my friend, will be in remission."

"What if she doesn't?"

"Hey, right now let's worry about getting you well enough to get the hell out of this hospital and back home where you belong. You have been in here so long, this stale hospital air is starting to stunt your growth."

"Yeah, that and about two weeks worth of high test Ara-C."

I laughed. "You've been hanging around me too long."

On the thirty-third day of her admission, Alison's doctor cleared her for discharge. With the exception of her first few days on the unit, I had been her nurse every shift I had worked. In two days she would begin daily maintenance chemo as an outpatient in the hospitals cancer center on the first floor.

"So, how does it finally feel to get out of this place?" I asked her the morning of her discharge.

"Scary," she confessed. "It's not over yet, is it?"

"No," I confirmed, "but the hard part is done for now. I'm so happy that you're going home, but I have to admit, I'm going to miss you a little."

"Will you be giving me my chemo in the cancer center?" she asked.

"No, but I can come down there and visit you."

She smiled, gave me a small kiss on the cheek and handed me a card, which I did not open, but put in my pocket for safekeeping.

Shortly thereafter, Brian arrived, the first time I had personally seen him on the unit since the day he barreled into me, sending me to the floor. He said nothing, only went to his wife's room and escorted her off the floor. The other nurses had gathered to say their goodbyes and I watched her step into the elevator from the sanctity of the nurse's station. As the elevator doors closed, stealing her from me, she smiled her wondrous smile one last time and pointed to the card I had stuffed in my pocket.

That night, in the solitude of my bed, I opened her note. A tiny card - much like its sender - on the front were two cartoon bears, one helping the other to stand, the words 'Thank You' in script over them. Inside, she wrote:

Dear Eric,
I cannot thank you enough for all the wonderful care, encouragement and support you have given me over the past month. I know my stay on 6 North would have been twice as difficult if not for you. I will never forget your kindness and compassion. You are the best!!!
With Love,
Alison

Also enclosed was a slip of paper, an e-mail address on it, with the words keep in touch inscribed underneath. I placed the address on my nightstand and tucked the card into a small cardboard box - one reserved for things special to me- that I keep in my dresser drawer.

I visited Alison when I could in the cancer center, but work being as busy as it can, it was rare that I would find enough time to escape to the first floor. She was always thrilled by my visits, rare as they were, and each time I called, she would look a little healthier, a little stronger.

We did most of our communicating by e-mail. She said that she was still suffering the occasional bout of nausea and every once and awhile, when her white blood cell count would drop, she would have to wear a mask when out in public, but otherwise, things were going well. She told me she had bought herself a wig, but added that she "took issue with the old adage that blondes have more fun."

According to her, she and Brian were also getting along rather well. He had even promised her that once her cycle of maintenance chemo was completed, he would buy her a plane ticket so she could visit her family in Indiana, whom she had not seen in person since beginning treatment. As nice as his sentiment was, it would have to wait.

It was about three in the morning when I received the call from the ER informing me of a patient they were sending up: twenty-six year old female with a history of leukemia, complaining of fever and shaking chills. They did not have to tell me the patient's name.

Alison had been doing so well, but after the last dose of chemo, her white cells had again plummeted to a dangerously low level. She had been running low-grade fevers at home and was prescribed oral antibiotics but had awoken shortly before midnight, feeling lousy, with shivers and a temperature of 102.

She had driven herself to the hospital.

"Why didn't Brian bring you in?" I asked.

"He has a big meeting in the morning. I didn't want to wake him up." Her teeth were chattering.

I only shook my head as I settled her into her room. She did not look good at all. Her skin was cool and clammy; the few strands of hair she had left, wet and matted to her pale scalp. Her heart raced. Her blood pressure was so low I could barely auscultate it.

"Hello Harry," I said as I started fluids through her Hickman and hung a dose of IV antibiotic. "Long time no see."

She neither laughed nor smiled. She was very sick. Her eyes where glassy and scared, her fragile body aflame with fever.

I continued to settle her, wrapping her trembling body in warm blankets, when she began to worsen before my eyes. Sweat began pouring from her hairless head and she was having trouble staying alert. Her blood pressure bottomed, her temperature spiked to 104. I opened her IV fluids wide and yelled for one of my colleagues to call her doctor.

"What should I tell her," she asked.

"Tell her Alison is septic."

Sepsis is a medical term referring to a bacterial contamination of the bloodstream, resulting in a total body infection. Unable to defend itself against these invisible trespassers, Alison's fragile body was rapidly shutting down and she needed to be transferred to the ICU quickly.

As we waited for her doctor, I supported Alison with fluids, assurances and even a few silent prayers. The Doctor arrived promptly and together we wheeled Alison up to intensive care.

"Are you coming with me Eric," she asked weakly.

"Only for the ride Kiddo, but the ICU nurses will take real good care of you. I'll make sure of it."

Her doctor told her that she would call Brian to let him know she had been transferred to the ICU and the last thing Alison said before drifting off into semi-consciousness was "No, don't wake him up. He has a big meeting in the morning."

Following my shift, I returned to the ICU to see Alison but found her asleep with Brian resting in a chair beside her. The doctor had called despite Alison's objections and he had come. He saw me but said nothing, nor did I approach him. Instead, I checked in with the ICU nurse to see how the rest of Alison's night had gone.

Alison was very lucky. Large volumes of fluid and potent vasoactive medications kept her blood pressure within an acceptable range long enough for strong antibiotics to suppress the infection and begin restoring her health.

Within five days, Alison was back on 6 North and I was again her nurse. Because her white cells were still very low, she was once again put on isolation but that only lasted three days.

Brian had brought in her new blonde wig from home and it became the subject of much banter between the two of us.

"I like the purple beret much better," I confessed.

"I'm just so sexy in this thing, you can't stand it!"

Brian had also, much to Alison's and my surprise alike, flown her parents in from Indiana to visit her. I was unfortunately off the two days they were in town and did not get to meet them.

As her health was improving, the doctor felt the time had come to repeat a bone marrow biopsy and the entire unit held it's collective breath awaiting the results, which would not be available until the following day.

Though she had told no one, the day of the biopsy was also her twenty-seventh birthday.

"What is this?" she asked as I entered her room that evening.

"It looks like a birthday cake to me. A small one, but still a birthday cake." I had bought a blueberry muffin in the cafeteria and placed an unlit candle in the middle.

"How did you know?"

"I'm your nurse. I know when the last time you went to the bathroom was. You think I can't look up your birthday."

I sung for her an inspired but out of tune "Happy Birthday" and right before she bit in, I took out a small Polaroid camera we keep at the nurse's station for documenting old ladies' bedsores and yelled, "Smile!"

"No, Please," she protested, but to no avail.

"Yes," I replied. "Now smile or I confiscate the cake."

And she did, that same brilliant, beautiful smile that I had fallen in love with months ago.

That night, as I lay in bed staring at that Polaroid, I admitted to myself for the first time that it was more than her smile I had fallen in love with.

As I contemplated the precariousness of falling in love with a married woman, I found I felt more threatened, not by Brian, but by her other suitor; the one who loved her from deep within her bones, the one who's jealously was a hundred times as deadly as Brian's, the one who would not relinquish her heart until either he had destroyed her or he, himself, was destroyed. If it came to it, Brian and I could vie for Alison's affection all we wanted, but still, leukemia would have the final say.

The following morning, Alison's doctor informed her of the outcome of the biopsy. Upon hearing the results, she burst into tears. The first time I had seen her cry since joining us on 6 North.

Her marrow was clean and cancer free - for now.

Alison went home two days later; again, Brian picked her up. Before his arrival, she called me into her room.

"Thank you again," she said. "Will we still keep in touch?"

"Of course. Just because your not my patient anymore doesn't mean you still aren't my friend."

"You saved my life, you know. When I came back from the ICU that day I would have kissed you if you didn't have to wear that awful mask."

I just blushed, saying nothing as she put her soft hand to my cheek.

"How come some lucky woman has not found out about you?" she asked as I slowly melted at the touch of her hand.

"Guess I just haven't met the right one yet," I said, looking down to the floor.

She lifted my chin and the two of us looked deeply at one another. As I was about to get completely lost in those soft brown eyes, the moment was stolen from us by an angry voice.

"What the hell is this?" Brian demanded angrily.

"We were just saying good-bye," Alison stated.

"We were just saying good-bye Brian," I repeated.

"Come on Alison. We've gotta go," he said as she stood to join him, his angry eyes never breaking from mine.

He said not another word, he didn't need to; his eyes said it all. They said, "Danger!" and "Stay away!" They warned, "Your fucking with the wrong jealous husband!" and "Don't even try it, because your gonna lose!"

That evening, I made an accord with myself to not permit my feelings for Alison to get the better of our relationship. While I could admit that I had fallen in love with her, I would not allow myself to be an obstacle between her and her husband. It was more than his warning to me; it was also my belief in the sanctity of marriage, regardless of how wrong I knew Brian was for her.

As promised, I did continue to correspond with Alison through e-mails however, despite her invitations, I no longer visited her when she made her weekly visits to the cancer center. Still, I would often find myself opening the small cardboard box I kept at my bedside late at night to gaze upon that beautiful smile.

During the next thirteen months, Alison would do exceptionally well. Weekly visits to the cancer center soon became monthly check-ups and she was even able to start back at work, if only part time. She told me that Brian was not around much, as he was "always busy with work", so life for her was quiet and peaceful. This notion made me happy.

I had known for some time where she and Brian lived and although it was out of my way, after many months without seeing her in person, I would often find myself driving by their house in the hopes of catching a glimpse. One time, as I rounded the corner before her driveway, I saw a small figure in a familiar looking purple beret walking down the street but dared not stop and continued on my way.

While I would have loved nothing more than to see Alison in person, I remembered my oath to myself and was content for now to open my e-mail and find her name gracing my inbox. Her messages told of wonderful happenings during those months; her hair had grown back, she had spent her twenty-eighth birthday in Indiana with her folks. Until, that is, the day her correspondence brought with it some rather unsettling news.

At her last check-up, Alison's blood counts had been worrisome and as a result, a third biopsy needed to be performed. Despite months of maintenance chemo and in spite of being in remission for over a year, Alison's bone marrow had begun growing malignant cells once again and the doctor would need to initiate a regime of new drugs immediately.

She was admitted to 6 North the next day. I was not scheduled to work but, knowing she was coming in, had signed up for overtime. While I was excited to see her, our reunion was somewhat melancholy.

"Hey there Kiddo," I said with the best smile I could muster.

When she saw me, her sad eyes filled with tears and despite my better judgment, I took her tiny body in my arms and held her close.

"I'm so scared, Eric. I don't think I can do this again."

I kissed the top of her head, her new hair thinner and curlier but still the bold shade of auburn I had remembered.

I helped get her settled and we would again begin at square one, induction chemo.

Harry the Hickman long gone - an angry scar across her chest the only evidence of his existence - she now had what is known as a Port-a-Cath; an internal central line that is implanted in the chest wall and accessed through the skin with a hooked needle. I accessed her Port and initiated her first new dose of chemo.

Brian had not come with her to the hospital initially, but when he arrived later that evening, he was not at all pleased to find me in Alison's room. My shift had ended over an hour ago and I was there on my own time, catching up on all the particulars she and I had forgotten to mention in e-mail over the past year.

"I need to talk to you outside," he said, addressing me as he entered the room.

I told Alison that I should be going anyway and that I would see her tomorrow. She was visibly concerned as her husband and I exited the room together, closing the door behind us.

"Why don't you stay away from my wife," he asked, and not very kindly, as we stood in the hallway outside Alison's room.

"Why don't you treat her a little more like a wife?" I responded.

"Listen buddy. I don't need you to tell me how to treat Alison. What I need you to do is keep the fuck away from her, understand?"

"I'm her nurse Brian," I said trying to contain my voice, as well as my anger the best I could. "If you're asking me not to take care of Alison anymore, the answer is 'No'. And if you're asking me not to be her friend, the answer is still 'No'."

"Listen asshole..."

"No, you listen," I interrupted. "Do you realize how sick Alison is? Do you even comprehend for a second how close she came to dying last year? She doesn't need some jealous thug of a husband that bullies around nurses, she needs one that'll support her and hold her hand every once in a while. Someone who'll give her a little encouragement and think about how she's feeling instead of only worrying about himself and how her illness impacts him. Why don't you try to help her through this for once, rather than making her feel guilty about it?"

He just stood there.

"You don't seem to be able to do that Brian. So I'm just filling in your void."

At this, he simply shook his square head and pointed a crooked finger my way repeating, "We'll see. We'll see."

The next morning, I arrived at work to find that Alison was not part of my assignment.

"What's this all about?" I asked my manager in the privacy of her office.

"Mrs. Lumm's husband is..."

"A jerk," I interrupted over her words.

"Is very concerned," ignoring my comment, "about your relationship with his wife. He has asked that you no longer care for her."

"He can't do that," I replied.

"True, but I can."

"Why? Why would you want to?"

"Because frankly, I agree with him."

I did not respond; I just stared at her in disbelief.