Between Two Kingdoms

Her brother, Adam, is studying abroad in Argentina when Suleika receives the diagnosis of leukemia. He undergoes tests to assess if he might be a match for a bone marrow transplant. Adam is a perfect match, and soon everyone in the family begins to depend on him for support. Adam struggles to keep up with school and medical appointments. He begins taking anxiety medication.

Everyone has put some part of their life on hold because of Suleika’s leukemia. Will turns down a promotion. Her mother focuses on caregiving rather than painting, and her father drives her to the emergency room in New York City every time she gets sick. The medical bills pile up, and Suleika feels guilty and responsible (111).

The clinical trial doesn’t eliminate the leukemia, but the treatments lower her blast numbers enough for her to get a bone marrow transplant. Dr. Holland meets with her family to tell her what the transplant will be like: eight weeks in the transplant unit, chemotherapy to wipe out her bone marrow, likely a feeding tube, and a morphine drip (112). After that, they perform the transplant. If it’s successful, the doctors will help her body create a new immune system. The recovery will take several months, and she will need to live close to the hospital to attend daily checkups.

The process can include many complications. Graft-versus-host disease (GVHD) is one of the most serious. GVHD typically occurs within the first 100 days post-transplant. People start treating her differently because of the real possibility of death.

What scares Suleika is that she will be another “sad story of unmet potential” (115). Suleika uses some of her journal entries from the 100-day project and starts a blog. Her first post, “Good Afternoon, You Have Cancer,” is picked up by the Huffington Post, and strangers send her letters and emails. One letter comes from a prisoner, Lil’ GQ, on death row, who relates to her experience of waiting and isolation. A New York Times editor asks if she would like to write an essay. Suleika is ecstatic and proposes a weekly column. On March 29, 2012, she debuts “Life, Interrupted.”

Suleika transfers to Sloan Kettering Hospital for her bone marrow transplant. She misses Dr. Holland, Younique, and the rest of the medical staff at Mount Sinai, and when she leaves, she promises to come to see them. She packs the red suitcase that she used to move to Paris. In the transplant unit, Suleika works on her column despite the chemotherapy’s side effects.

On the morning of the transplant, Adam greets Suleika, “Salut, Suleikemia” (123). His nickname for her since her diagnosis. She hopes it’s the last time that it's applicable. When Suleika receives the bone marrow transplant, the doctors surround her bed. Adam’s cells drip from the IV bag. When everyone leaves, all she can do is wait in her sterile hospital room.

The goal is to reach Day 100, “Examination Day,” with a healthy immune system. On Day 14 she wakes up to a scream. The nurse walks into the room. Suleika realizes she is the one screaming, and in the drug-induced sleep she has pulled out her chest catheter. Notes from readers of “Life, Interrupted,” like Lil’ GQ and a young woman named Unique, and Katherine, a teacher in California, keep her going during these times. The other patients on her floor also sustain her. Johnny has the same diagnosis as she does. Though they can’t meet in person because they are both in their own Bubble, they communicate with each other online.

Suleika begins losing her hair again, and her cells take longer to graft than they expect. She is in pain and stays as still as possible to minimize her discomfort. Will visits. With his full schedule and her tendency to fall asleep from the medication, she feels like they are drifting further apart.

Adam’s cells start engrafting into Suleika’s bone marrow, and she and Will move to the Hope Lodge, a home for cancer patients in Manhattan. She still needs daily treatments. Will and Anne had planned to share the caregiving responsibilities, but due to the rules at Hope Lodge, Suleika must choose between the two. Only one caregiver at a time is allowed to go into the room.

Suleika’s body feels the effects of the treatments, but she continues to accept opportunities for interviews and works on her column. This blind determination builds tension between her and Will. Suleika gives an interview with a bad cough. Her mother and Will had asked her to reschedule, but she refused. At the end of the interview, the interviewer asks, “Are you facing mortality at this point?” (135). She feels unsettled but says that she feels very hopeful for the future. Later she reflects that she should have said she was “cautiously hopeful for the future” (136).

By Day 70, Suleika needs Will and Anne to help perform basic tasks, and Suleika is self-conscious of her body’s needs. On Day 80 she begins showing signs of a rash, an indication of GVHD. Her doctors increase her medication.

One night, Will decides to meet friends for drinks, and he asks Suleika if she wants to join, knowing that she can’t. She gets sick waiting for him to come back and help her with her medication, and when he gets to Hope Lodge late that night she’s throwing up. He responds with care and cleans her. She feels hate and love for him.

Day 100 arrives, and Suleika believes that she will know if the transplant succeeded. She gets an email from a young cancer survivor, Ned, who writes about the difficulty of life after cancer, but Suleika is still too mired in her treatments to consider the idea of life post-cancer. At the 100-day appointment, Will, Suleika, and Anne learn that while there are no cancerous cells in her bone marrow, it will take longer to know if the transplant was successful. Suleika finds out that she will need maintenance chemo. She observes that Will looks trapped, and looking back, she can’t blame him.