Here’s the story. As a warm-up for an interview, in a kind of playful spirit, I was asked last week to write a poem that contained my name. It wasn’t deadly serious; it wasn’t meant to be the road not taken or beasts slouching toward Bethlehem. Still, when I saw the request, I groaned a little. I’m not much of a poet. My husband suggested, only half-kidding, that I ask a poet friend to ghostwrite it for me.
But when I thought about my name, before I even considered what amusing little edifice I might construct around it, it was Joanna I heard. She wasn’t calling me, exactly, nothing as voodoo as that. There was just the soft mental echo of my name as she used to say it, her accent in my ear. A murmur across a void of years.
I can still see her. Somewhere in the ether, it is still 1988, a spring afternoon, and Joanna is my scheduled admission who has just arrived. She’s standing by the desk inside the double doors of the pediatric bone marrow transplant unit. She is all eyes, not much hair. A wisp of a thing, four years old. Her scalp gleams through the fragile black fuzz growing back after her last course of chemo.
She doesn’t look in my direction. As I walk down the long, gray hall toward her, she hops from one foot to the other and fidgets with her hands. She stares off into the space above the unit secretary’s head.
As with any admission, I know a few bare facts about her. Acute lymphocytic leukemia, and she has already relapsed after one transplant. This will be her second. The donor marrow will be sucked from the hips of her sister, a different sister this time than last. It’s not quite conscious—twenty other things compete for my attention—but my gut twists a little as it calculates her chances of surviving and thriving.
She’s scared, I decide, as I try to gauge the expression on her face. Who wouldn’t be? She’s been through it once already; she knows the score. These are her last few minutes in the outside world. I’ll walk her down the hall, the door of her sterile laminar-flow room will snick shut behind her, and there’ll she’ll stay, until her sister’s marrow floats to the center of her tiny skeleton and makes itself at home.
Over the next ten days, chemo and radiation will obliterate her own bone marrow, and along with it, her leukemia. Or at least, that’s the plan. Then she’ll receive the transplant itself, infused into a vein, an innocuous bag of what looks like plain old blood. And after that, the long, breathless wait for her cell counts to rise like a phoenix from new, engrafted marrow.
But blood cells fight infection. They carry oxygen and clot wounds. Before she engrafts, when her own marrow is gone and she isn’t making any cells of her own, infection could kill her. She’ll develop bruises; she’ll become anemic and exhausted. In her immediate future, then, dozens of blood products and potent IV drugs, so many there is barely enough time in a twenty-four hour day to infuse them all.
Sores will open up from inside of her mouth right through to her intestines. She won’t eat for weeks. There’ll be omnipresent nausea, bottom-scraping vomiting—scant teaspoons of stomach acid and bile.
At least three weeks in the room. Probably more. And submerged beneath the surface of the days, like undertow, the thought that she might never leave it.
There’s no way to put a good spin on any of this, I’m thinking, as I startle her from her reverie with my approach. She looks up, her dark eyes huge, and something in me braces itself, as for impact. I’ll be spending all my workdays with her for as long as it takes.
I bend down to shake her hand. “Hi, Joanna,” I say. “I’m Jennifer. I’m going to be your nurse.”
But then she grins. Her teeth—still baby teeth, after all—are a white surprise in the brown of her face. Her eyes crinkle up at the corners. They’re an elegant Pacific-Islander shape.
“Jenneefa,” she says, brushing my name with the tropical music of the Philippines. “I’m happy to meet you.” She covers my hand with both of hers. It’s a gesture she shares with her mother, Verna, who excuses herself to take care of some paperwork downstairs. I already wish my social skills were as good as hers. I pick up her belongings and we amble down the hall. Joanna leans in, companionable, her head at my waist. She chatters about the new toys in her bag—all bright plastic that can be wiped down with antiseptic solutions. She tells me about her brothers and sisters. They’re a large, Catholic family, a good thing when you need multiple transplant donors. I scrub, mask, gown and glove as she talks, before we enter her room. Neither of us notices the moment when the door swishes shut behind us.
She changes into the sterile pajamas I give her, still talking about her cat, and afterward clambers up on the bed to claim it as her trampoline. She gets impressive loft out of a lumpy hospital mattress.
The transplant rooms are set out in a row, like the rooms in a railroad flat, with windows between them. As she jumps, she makes faces through the window at the boy in the next room, a seven or eight-year old who has already received his transplant and is waiting for engraftment. He’s blonde, with spikes of hair sticking up every which way, and the greenish pallor of the transplant process is upon him. He’s got just enough energy to work the controls on a video game. But he waves and sticks out his tongue, the beginning of a silent friendship across plate glass, between two kids who will never meet face to face.
I’m banging about in the room, setting up IVs, stowing things.
Joanna whirls around in the air to face me. “My mother says I need a meeracle, Jenneefa,” she confides between bounces, laughing a little. Matter-of-fact.
And she does need a miracle. The cancer cells that bloomed again and again in the dark of her bones saw to that, imploding early hopes for her, middle hopes. The endgame is upon us.
“I know, honey,” I say.
She nods, satisfied.
Weeks later, Joanna’s mother rises from her bedside chair; she blocks the doorway as I turn to rush out of the room. Alarms I’m responsible for are trilling and chirring outside, the sounds exploding in my own neural net. I make handle-the-alarms-for-me gestures to a colleague through the window, and force myself to stillness.
Joanna is a slight, white bundle in the bed between Verna and me, asleep. The spring in her legs is a memory. Transplant received, engraftment awaited. No phoenix as yet arising from the ashes. The phoenix is a little overdue.
“I dreamed last night that the Virgin was holding Joanna in her arms, Jenneefa,” Verna says. “What do you think it means?”
Her dark eyes—Joanna’s eyes once removed—are on me above her mask, trained like gun barrels. She doesn’t blink.
What I think: oh-oh.
What I feel: some version of eternity, hanging in the balance.
What I say (could it ever, ever be enough?): “If the Virgin is holding Joanna, Verna … it can’t be a bad dream.”
In 1989, after I had moved on from the bone marrow transplant unit, my mother invited me to a May procession. She was herself a believer in the Virgin. She frequented a Filipino Catholic parish; she liked the simple fervor she found there, its warmth. It was as close as she could come, on the West Coast, to the flavor of the Italian parishes of her youth in Boston.
In the May procession, a statue of Mary, crowned with flowers, is carried aloft through the streets; parishioners follow behind, praying and singing. They carry candles.
A religious procession—it’s not my thing at all. But my parents were singers, and I spent my youth in their choirs. I like to sing. And my mother had the knack of turning any outing into a good time. So my mother and I lit our candles from the same votive at the church, and trudged out in the wake of the statue.
As we rounded a corner, I saw Joanna. I wasn’t expecting her. After she engrafted, after the day—the thrilling, hopeful day— that she emerged from the transplant room and I hugged her goodbye, I had lost track of her. But there she was, leaning out from the second-floor window of an apartment building. She was still in pajamas at two o’clock in the afternoon, watching the parade. And she still didn’t have much hair; she looked tired, tiny, a little bloated. She wasn’t smiling.
What I felt: a shadow.
“Joanna!” I yelled across the crowd. Never underestimate the numbers of Filipino parishioners who will turn out for a May procession. The atmosphere was carnival; it was Mardi Gras.
I saw her start, saw her scan the crowd. I waved my arms as a current of humanity swept me to the far shore of the street, but she never caught sight of me. Then she winked out of the window.
That’s all I know. But I think, somehow, that this is her poem.
Jennifer Culkin RN BSN CCRN is an essayist and fiction writer. Born in Boston, Massachusetts, she graduated from Russell Sage College, Troy, New York in 1979 and embarked on a bicoastal career in neonatal and pediatric critical care, high-risk obstetrics and emergency flight nursing. Though long of tooth (and wattle) to be a student again, she is pursuing the MFA in Creative Writing at Pacific Lutheran University and is currently at work on a collection of personal essays infused by her experiences in medicine. When she is not in the ICU, she is at her desk in her Bainbridge Island, Washington home, a testosterone-rich environment she shares with husband Howard and young adult sons, Kieran and Gabriel. An emerging writer of the most prokaryotic sort, she has published essays in Stories with Grace and The 2006 Jack Straw Writers Anthology, where "Ghostwritten" first appeared. She received both an honorable mention for fiction and third place for nonfiction in the 2005 Student Writing Contest at The Atlantic. Her work will be featured on Seattle NPR-affiliate KUOW's "Radio Intersection" and is forthcoming in The Georgia Review.