Chapter 4: The First Week

Day One

The doctor who came to speak with them the next morning introduced herself as Dr. Patricia Li, pediatric oncology, and had the unhurried gentleness of someone who had delivered this exact conversation more times than she could count and had never once let it become routine. She sat rather than stood, pulled a chair close enough that there was no table between them, and said the word neuroblastoma plainly, without softening it into something smaller than it was.

“We won’t know everything for several more days,” she said. “The mass, and what we’re seeing in her bloodwork, point strongly toward it. How we treat this, and what her odds look like, depend on staging — how far it’s spread, what the tumor’s biology looks like at a genetic level.”

Bea’s face had gone carefully blank in the way of someone refusing to let it do anything else. “Neuroblastoma,” she said, testing the word. “I’ve heard it before, I think, on some television thing. I don’t actually know what it means.”

“It’s a cancer that starts in nerve tissue laid down very early — cells a baby has in abundance in the womb and mostly outgrows. Most of the time those cells mature into ordinary nerve cells and cause no trouble at all. In neuroblastoma, some of them don’t mature properly, and instead they keep dividing, and form a tumor. In Cissy’s case, it’s sitting near one of her adrenal glands, above the kidney, which is the single most common place for it to start.”

“And it spreads,” Étaín stated. Not a question. She’d nursed enough oncology patients to know the shape of that sentence before it finished.

“It can,” Dr. Li confirmed. “To bone, to bone marrow, to lymph nodes. That’s exactly what the staging tests over the next week are going to tell us — whether it has, and how far.”

“Why her,” Bea said, not really a question, the way people ask it when there’s no answer that would satisfy them regardless. “Did I do something. Did she.”

“No,” Dr. Li answered, gently but without hesitation. “This isn’t caused by anything a parent did or didn’t do, or anything a child was exposed to. In the vast majority of cases, we never find a cause at all. It’s cells that made an error nobody could have prevented or predicted.”

“What happens now,” Bea said. “Today. What actually happens today.”

“Today, a urine test — it screens for chemicals these tumors put out, and it comes back within a day or two. Tomorrow or the day after, a biopsy of the mass itself, under sedation. Around the same time, a bone marrow biopsy, since this cancer has a habit of spreading there. And a scan called an MIBG, which lights this kind of tumor up on imaging in a way ordinary scans don’t.”

“And the part that actually tells us how bad it is?” Bea asked. “How long for that?”

“The genetic markers from the biopsy can take the better part of a week,” Dr. Li replied. “I wish I had a faster answer. I don’t.”

“A week,” Bea repeated, like the word itself might come apart if she said it slowly enough. “We just sit here. Not knowing. For a week.”

“You won’t be sitting with nothing happening,” Dr. Li countered. “Every single day, we’ll have done something. Run the next test. Gotten the next piece.”

Liam had gone so still in the chair beside his mother, knees drawn up to his chest, that Dr. Li seemed to only fully register him partway through her own sentence. She looked at him, then at Étaín, a silent question in it.

“He won’t leave her,” Étaín cut in, before the doctor could ask. “I’d ask that you let him stay for these conversations. He hears things about her that we don’t.”

“Such as?” Dr. Li asked, not dismissively — genuinely asking.

“Such as when she’s in pain and hasn’t said so,” Étaín replied. “You’ll see it yourself before the week’s out.”

Dr. Li studied Liam a moment longer than politeness required, then nodded — filing the oddity rather than dismissing it — and rose to go arrange the first test.

Day Two

The urine collection that afternoon was its own small battle. A nurse named Rosa arrived with a plastic hat-shaped collection device and an explanation pitched for a much less suspicious child than the one in the bed.

“We just need you to pee in this little hat here, sweetie, instead of the toilet.”

“Why,” Cissy said. Not a question. A wall.

“So we can look at it under a special light and see if it tells us anything about what’s going on inside your tummy.”

“That’s disgusting.”

“A little bit,” Rosa agreed, cheerfully unbothered. “Grown-ups do it too, you know. I’ve done it myself.”

Cissy looked past her, to Liam, sitting cross-legged at the foot of the bed. “Do I have to?”

“Yeah,” Liam said. “But it doesn’t hurt. It’s not like the blood ones. It’s just weird.”

“How do you know it doesn’t hurt?”

“‘Cause nothing in you is scared of it, the way you get scared of the needles. It’s just embarrassing to you. That’s different from hurting.”

Rosa, crouched by the bed rail, went still for half a second — an adult filing something odd away to think about later — and then simply held the little plastic hat out until Cissy, grumbling, took it from her.