A Promise for Keeping

Attention kind reader: The following is a very sad tale of love and loss. While I chose to post this story in the 'Romance' section, be warned, there is very little sexual content to be found within the pages that follow. If it is blistering sex you seek tonight, please feel free to choose one of my other offerings. However, if it is a poignant love story that strikes your fancy, then by all means, please enjoy "A Promise for Keeping"

With unending appreciation,
M.A.Thompson

********************

"I died today. But I'm still breathing."
-Skindive

Why I still call her, I do not know. For some time, I did so only to listen to the customary "no longer in service" message but now, the number has been reassigned to an unfortunate someone who has to endure my periodic calls: "Is Alison there?" "No, Sorry. You must have the wrong number." Letters return to sender, e-mails never receive reply. I stand in front of her house, accepting that she is no longer there but taking some comfort in knowing she once was. People who knew her tell me to let go, but I cannot. There is a promise involved. One I intend on keeping.

Alison Lumm, ordinary as her name may sound, was to me, at least, anything but. She was the tiny girl with the sad eyes and brilliant smile. The first woman I ever dared to love, the first to ever truly love me in return. How foolish was I, thinking this love was strong enough to keep us from parting, how unwise.

I met Alison for the first time when she was admitted as a patient to the small community hospital - located in the Connecticut suburbs - where I am employed as a registered nurse. The sixth floor, or 6 North as it is recognized, specializes in oncology - the treatment of cancer - and is where I have worked since graduating from nursing school so many years ago. I did not choose oncology nursing; it chose me. Unlike most of my fellow classmates, I had no specific specialty in mind when embarking upon my nursing career, leaving my fate instead in the hands of a hospital recruiter who would use me to fill a vacancy where few other new grads were willing to work.

I love caring for cancer patients. When I first came to the unit, many of the seasoned oncology nurses looked to me with eyebrows raised in speculation of a male nurse delivering the compassionate care and tenderness that all cancer patients require. However, my gentle mannerisms - combined with a quick wit and sense of humor - soon won them over.

I have met and cared for so many unique and remarkable people working on 6 North and have seen every angle of humanity possible, both the good, as well as the bad. But I have never made a promise to a patient that I was unable to keep. That is, until Alison Lumm.

Initially, she had gone to her family doctor complaining of a nagging pain in her joints for which he simply prescribed high dose ibuprofen, however, after six weeks with little relief, he drew a blood sample which revealed something troubling, something he had not considered. The following day, Alison met with a hematologist who performed a bone marrow biopsy, confirming what the vial of her blood had insinuated: Acute Lymphocytic Leukemia.

While all of my patients are special to me, I have always harbored a certain affection for the leukemics. All cancers are dreadful ailments. Cancer is a hideous monster, slowly consuming its victims from the inside out, using their body's own natural life processes against themselves, discriminating not against grandmothers, uncles, husbands, best friends, children - cancer simply does not care. But, to me it seems, the leukemic has it the worst.

Unlike its solid tumor cousins that can be more easily targeted during treatment, leukemia is a covert malignancy that conceals itself inside its victim's bones, deep within the marrow, thoughtlessly producing millions upon millions of useless immature white blood cells, choking off the production of healthy blood cells. This intra-bodily turmoil leaves the leukemic feeling fatigued with aching joints, lethargic and prone to deadly infections and/or bleeding disorders. Left untreated, the patient will eventually succumb to anemia, infection, hemorrhage or possibly, organ failure.

Such was Alison's condition as I watched her step foot onto 6 North for the first time to begin treatment, one that can sometimes be as lethal as the disease itself.

The management of leukemia necessitates high doses of chemotherapy, corrosive chemicals which seek out and obliterate the patient's diseased bone marrow. Nothing short of poison, these powerful drugs do not discern between healthy bone marrow and its malignant houseguest, annihilating both good and bad cells alike. Ironically, this leaves the leukemic feeling sicker than they were prior to treatment, with few viable blood cells left to carry oxygen, fight infection or clot their blood. For months following treatment, the patient is supported with countless life saving blood and platelet transfusions and covered with an arsenal of antibiotics until their body slowly begins producing fresh bone marrow and still then, it is merely a fifty/fifty chance that the new marrow will not also be diseased.

If all this were not bad enough, just to mock the patient further, chemotherapy ravages the lining of the gastrointestinal tract causing severe nausea and vomiting, and as an encore - one final insult - chemotherapy exterminates the hair follicles, branding the offended with baldness, identifying him or her to the rest of the world a leukemic.

If leukemia is a holocaust then chemotherapy may very well be its concentration camp.

Unseen by her, this was the future that awaited Alison Lumm as she was admitted to 6 North to receive what is known as 'induction chemotherapy'- a fourteen day attack on her infested bone marrow. With crisp white linen, spotless uniforms and colorful floral paintings on her walls, 6 North is a cunning deceiver; misleading her guests upon first impression to the miseries she is capable of bestowing.

Alison would not be my patient that day but I watched with much curiosity as she was orientated to our unit by my nurse manager. She was a very pretty but diminutive girl, looking more like a teen-ager than the 26-year-old woman she actually was. But what made her look even smaller was the giant that accompanied her - a huge man with dark features and unsettling eyes.

As she was shown to her room, my heart felt for this young woman, knowing what dreadful roads lie ahead, what unpleasantness awaited. As for her enormous companion, something about him left me feeling uneasy, concerned.

"Who's your new patient?" I asked the doctor who was writing her chemo orders.

"Her name is Alison Lumm," she said as I took a look at what she was writing.

"Ara-c, continuous IV," I read over her shoulder. "Leukemic, huh?"

"Yeah, I just diagnosed her."

"She looks young. Who's King Kong there with her?"

"Her husband," she replied.

She barely looks old enough to have a prom date, I thought, returning to my work but still keeping an element of my attention tuned to the new young leukemic, Alison Lumm, and her monstrous husband.

From within her room, I could hear voices, mostly that of the nurse manager, but occasionally, a low gruff tone I knew could only belong to her husband.

"Is this going to take much longer?" he asked.

Jeeze buddy, your wife was just diagnosed with leukemia. My manager explained to him how his wife could be here for some time, as she was very sick.

"I mean right now," he clarified. "I'd like to go have a smoke."

Something about this Goliath had troubled me and he was quickly validating my assessment.

Always the tactful practitioner, my manager suggested he go do whatever it was he needed and she would finish up with his wife alone.

He simply said "Great," telling his wife that he would call her later in the day to see how she was. I heard what sounded like a small kiss and before I could look up to get out of the way, he burst from the room, plowing directly into me, sending me down to the hard tile floor.

"Excuse me," he said, not really meaning it by his tone but extending an extra large hand to help me up anyway. Up close, he was even larger than I had originally perceived. With jet-black hair, full thick beard and rugged features, he was not very handsome but more ape like in appearance. His neck was thick, like a fire hydrant, his body a bulky mass. He stunk of cigarette smoke and contempt.

"No problem," I said, rising to my feet, reaching only as high as his chest.

Watching him lumber off the unit, I anticipated that he would not make his wife's lengthy and complicated treatment any easier.

My day became quite busy following his departure and attention was soon required back to where it belonged, with my patients. I neither saw nor heard of Alison Lumm the rest of that day except for once, when I passed her room to notice her standing at the window, admiring the picturesque view the hospital has of Long Island Sound.

Stripped of her clothing and wearing nothing more than a green hospital gown, the transformation from civilian to cancer patient had already begun. Her wavy hair was an exquisite shade of auburn and it glistened in the dazzling afternoon sunlight that was streaming brilliantly through her window. Soon she will lose that too, I thought watching (possibly admiring) her.

As I was about to walk away, she saw me and offered the sweetest of smiles. Embarrassed at being caught, I smiled back, only for a moment, before returning my work and thinking about that lovely smile for the rest of the day.

Off for the next few days, upon returning to work to begin a long string of night shifts, I was a bit disappointed, I confess, to not find the name Lumm on my assignment. Alison was instead under the care of my colleague Maria and during that unusually slow night, I inquired about our newest patient.

"She is doing well," Maria told me. "Tolerating her chemo so far. She is a tiny little thing, barely says a word. And have you seen her husband?"

"No," I lied. "What about him?"

"He is a giant compared to her. And not very nice from what I hear."

"What do you mean?" I asked, very interested in her answer.

She proceeded to tell me about how another nurse had caught him giving his wife a hard time about being sick and in the hospital because it was going to 'infringe too much' on his life.

"Well, I'm sure this is hard on him also," I said.

"No Eric, the jerk was talking about her not being around to make his dinner and wash his clothes and stuff like that," she explained as a call bell rang, sending her off to a patient's room.

Five a.m. is blood work time on 6 North and it is the night nurses responsibility to draw their patients' morning labs so the results will be available when the doctors begin filing onto the unit to see their inpatients before rushing off to their offices. Most oncology patients have what are called central lines, larger, sturdier and longer lasting IV's than the small peripheral ones most hospitalized patients receive. Cancer patients, especially leukemics, require these lines for the highly corrosive chemotherapies they receive for weeks at a time. These catheters are also useful for drawing blood, saving the patient from never-ending, and sometimes harmful, needle sticks.

Maria was busy getting ready for her blood draws when I offered my assistance. I had purposely drawn all of mine early hoping that she would need help; she accepted my offer eagerly.

"Okay," I said. "I'll do Mr. Collins, Mr. Buttone and, um how about the new girl, Lumm."

"Great," Maria replied. "Collins and Buttone both have PICCs," (a type of central line) "and Lumm has a Hickman."

Hickman catheters are the most common type of central line our hospital uses for leukemics and, unfortunately for them, is also the most cumbersome of the lot. Inserted by a surgeon, the tip rests within a large vein directly above the heart and the tubing is then tunneled under the skin until it exits the body just below the right breast where the double-ended catheter simply dangles over the stomach. I have listened to more than my share of patient complaints regarding a bothersome Hickman's lack of practicality and attractiveness.

I readied my equipment and saw Maria's other two patients before knocking softy on Alison's door. Not hearing a response, I entered her room in silence, finding her still asleep. Through her window, the early morning sun had spilled across her face encircling it like a halo; quite fitting as I observed how angelic her appearance was upon seeing her up close for the first time. Her complexion was fair and her features light. Her pale skin, nearly translucent, was adorned with small purple spots known as petechiae, a classic symptom of leukemia. Her pink lips were small and delicate looking, like the petals of a fragile flower.

I approached her bed and knelt by her side, gently rubbing her warm shoulder. "Mrs. Lumm?"

Her eyes slowly opened and for the first time of many, I would be the first person she would see to start her day.

"Mrs. Lumm, my name is Eric. I'm a nurse here on the floor. How did you sleep?"

"Okay, thank you," her voice was sleepy and soft. "How was your night?" Terribly polite, it was not often that a patient asked me how my night had gone.

"Better than Maria's," I replied. "That's why I'm helping her out with her morning blood work. Is that ok with you?"

"Sure," she said rubbing her tired eyes. She lifted her head from her pillow, leaving behind the splash of sunlight and, already, a few stray clumps of auburn hair. When she turned and noticed, a worried look seized her pretty face.

Having seen that look many times before, I leaned forward, pointing to the large bald spot that had been growing steadily on the top of my head since my late twenties. "See this?" I asked looking up. "Yours is going to grow back someday. Mine? I'm stuck like this forever."

This brought a smile to her sleepy face; the same refreshing one I had admired the day she arrived on the unit.

"And with a smile like that," I added. "No one will even notice that you don't have any hair."

Her smile grew brighter yet and, already assimilated to our routines, she lifted her gown just enough for me to access her Hickman. As I flushed the line to begin drawing her blood, she spoke gently.

"Brian hates it."

"Brain?" I asked.

"My husband. He hates it. He says it looks ugly."

"What? Your Hickman?"

"Yes. He told me it makes me look like a cyborg."

"Well, let me tell you," I said, finishing my blood draw and hooking her back up to the chemo, "I don't know how many Hickman's your husband has seen in his days, but I've seen hundreds and I have to admit, yours is awfully cute. Have you named it yet?"

"The catheter?"

"Sure. It's yours now. Kind of like a dog that follows you home. You have to call it something."

She looked down to her Hickman then back to me. "I don't know. What do you think?"

I held the double lumen in my gloved hand and studied it intently with an exaggerated expression on my face. "Harry," I replied. "Definitely Harry."

"Harry the Hickman?" she laughed.

"Yep," I said, snapping my gloves from my hands and dropping them in the trash. "Harry it is."

"Thank you Eric," she said as that delightfully contagious smile once again graced her small, lovely face.

"You are entirely welcome." I replied, collecting my belongings and making my way to the door. "Is there anything else I can do for you?"

"Draw my blood again sometime?" she asked.

"Your Hickman and I are on a first name basis, how can I possibly say no," I replied. "It was a pleasure meeting you Mrs. Lumm."

"Alison, please," she replied.

"Now we're all on a first name basis," I smiled. "I hope you have a wonderful day. Alison!"

She waved, beaming the same captivating smile that still haunts me to this day.

For the next three mornings, I would draw Alison's blood, each time, learning a little more about her. She told me of her childhood in rural Indiana, growing up poor on her family's small farm and how the only thing that saved her from continuing the family legacy of toil and dearth was ambition, a love of the English language and a full scholarship to NYU. Upon graduating, she remained in Manhattan, using her degree in English to find work as a copywriter for a major financial publication.

Alison had embraced the big city but was seduced away by the large imposing man she had met at a company function. In stark contrast to her background, Brian had come from wealth and privilege and was 13 years her senior. Alison left Manhattan shortly after they met, becoming one of the masses who leave the Connecticut suburbs every morning to work by train. The unlikely pair were wed five months after and it was at Brian's insistence that she left her job in the city to take one with less pay, but closer to home. When speaking of Brian, she would often lose eye contact, her gaze drifting elsewhere.

"You seem sad when you talk about him," I offered one morning.

"He was my first love. He swept me off my feet and all I ever seem to do is let him down."

Such was Alison, so full of inner simplistic beauty yet so lacking in self-esteem, always putting others requirements before her own.

"Also," she added honestly. "He doesn't like you very much."

"Gee. I usually have to lay a couple of my bad jokes on people before they start disliking me. Besides, he and I have never really met."

"I told him about you. And about Harry here as well," she said lightly tugging her Hickman. "He said naming it was stupid and that he doesn't like the idea of another man taking care of me either."

"You tell him, I am a nurse first. That whole 'being a man' stuff, that's all secondary."

She smiled.

"You also tell him," I added in all seriousness, "that he is going to have to live with playing second fiddle for a while. You have a long road ahead of you Kiddo. Believe me, I know. And there is nothing selfish about taking care of your needs and yourself right now. Do you understand?"

She nodded.

"Just don't tell him I put you up to it, okay?" joking again. "I've seen him and I don't need that giant after me."

Leaving that morning, I told her that I would not be in for a few days but when I returned, I was hoping she would be part of my assignment and that I would be able to do more for her than just draw her blood.

"You are doing more," she replied. "You're being my friend."

When I returned to work, I was pleasantly surprised to find that Alison had in fact been assigned to my care. Upon entering her room, I found her appearance - even after such a brief period of time - already beginning to change. Her skin was much paler than before, riddled not only with petechiae, but angry purple bruises as well. Her auburn hair was losing its sheen; exposed areas of chalky skin already visible behind her thinning curls. An emesis basin in her lap, I had been informed by the nurse before me that Alison had been up most of the night, retching and nauseated.

The chemo had begun waging its internal war against her contaminated bone marrow, the rest of her body, collateral damage.

She managed a faint smile upon seeing me.

"This is where it gets real hard Kiddo," I told her honestly. "This is where you have to get tough."

"Get tough?" she said. "I've never felt weaker in my life."

"In here," I said, pointing to my heart. "And when you feel you don't have any left, you let me know and I'll give you some of mine."

When I informed her that I was going to be her nurse that day, she confessed to asking to be put on my assignment. I told her I was delighted she had.