The downward trend

“It’s too early for scans, but we can see a nice downward trend in your blood tumour markers, Josh.” Dr Tunmer, Joshua’s radiation oncologist, turns her laptop screen to Josh and shows him a spreadsheet of his test results.

We are in the middle of the weird, relay-race style handover. This is the last time we’ll see Dr Tunmer for a few months. She’s “handing us back” to our primary oncologist where Josh will resume chemo.

“You were at 4600 before we started the treatment, then 4400 and now 4200.” She continues.

“That’s great!” I say, “Well done Josh! What’s the normal range?”

“The tumour marker can also indicate inflammation. Whether it’s the tumours themselves creating less load or a reduction of inflammation we can’t tell. Either is good news.” She’s pretending she hasn’t heard me but by now I feel like I know her well enough to call her out.

“And the normal range is?” I asked again.

“Well the normal range is under forty.” She says.

For a beat the room is totally still. My heart seems to have stopped beating. The blood in my veins pauses mid-flow. My brain is frozen and my limbs weigh five million tons.

A truck in the road clunks into gear. The beep of its reverse warning breaks the silence.

“Try to focus on the downward trend. Josh is doing so well.” Dr Tunmer’s hand slides across the desk and squeezes his. “You are doing so well.” She turns back to Shannon and I, “We just keep taking baby steps.” There’s a hint of apology, like she feels responsible for Joshua’s tumour markers. My head nods and keeps nodding: a tiny, jerky up and down. I can’t seem to stop.

“It’s going down, Mom.” Josh smiles, “That’s good.”

And then the doctor is discussing blood thinners and next scan dates and weighing up the benefits of MRI’s versus PET scans.

Most oncology meetings go this way. We test. We cheer. We find that that the result we thought was a win is more of an infinitesimally small shuffle away from doom. But a step away never the less.

In company we focus on the wins and ignore the doom. Then, when we are alone, I rage at these people who make me explain (again) why the improvement isn’t a cure. How he’s too young to qualify for the novel trial treatments that sound so promising. Why transplant isn’t an option. Why there’s no reason at all to cheer.

Then, when the tears have dried, I pull out the scores. I draw mental graphs; I focus on the downward trend.