This personal essay is an abridged version of "Exit," which originally appeared in the Winter/Spring 2013 issue of Adventum: A Literary Magazine. It received an Honorable Mention from Glimmer Train.
The cold water strikes me like a hammer, with such force that I can hear it pounding. The vortex at the bottom of Nantahala Falls must have flipped me over upon impact. I botched the run down the rapids, but that disappointment will become irrelevant if I fail to free myself from this kayak. I yearn to scream, yet I must hold my breath. In the darkness, I don't know which way is up. I have 45, maybe 60 seconds to figure it out, or I will die.
***
Dr. Green is standing at the foot of my hospital bed. I try to focus on his words, despite the opiate that's numbed me. He's talking to my husband, Ryan, and my mother--not me. I don't understand the medical terminology, but I comprehend: "She may die within the week." Yesterday morning, my husband dropped me off at the ER entrance, and I gave my 18-month-old daughter only a peck on the cheek. It hadn't occurred to me that the cause of the pain in my left side might prevent me from ever seeing her again.
***
Four days before capsizing in the basin of the waterfall, I received my first kayaking lesson on Fanta Lake in Bryson City, North Carolina. During the following days of our week-long camp, we would be kayaking the Little Tennessee River, Tuckasegee River, and Nantahala River and Falls. The flat water of the lake mirrored the emerald green pine and deciduous trees that blanket the Great Smokey Mountains. The other young adults and I, outfitted with life jackets and helmets, huddled around the First Descents staff and local guides. They explained the "wet exit," a critical survival skill, which I had no intention of needing.
***
Ten days before meeting Dr. Green, during a routine, 20-week prenatal ultrasound appointment, my obstetrician frantically flipped through my chart. Her long, black hair hid her face. She wouldn't answer my questions.
"Tell me what's wrong."
"Shelley, the baby doesn't have a heartbeat." Dr. Lancaster gripped my hand.
Not possible. I was a healthy 31-year-old, who power walked with hand weights, and ate lots of organic vegetables. And most importantly: "You're wrong. I felt our baby kicking yesterday."
***
On the last day of camp, to summon my courage for the final challenge, and to enjoy the moment, I paused in my kayak at the edge of a concrete ramp. Across the calm channel, white blossoms of mountain laurel, against a backdrop of vibrant green foliage, bobbed in a gentle breeze. A stick floating on the water met the small waves that signaled the beginning of the rapids. I leaned forward, shifting my weight toward the bow of my vessel, and slid into the Nantahala River.
***
Our baby should have been born in a delivery room; not been ripped from me during a dilation and curettage procedure at an abortion clinic. When I'd asked Dr. Lancaster about the extraction, which her practice wouldn't perform, she'd told me not to research it on the Internet.
I haven't.
The morning of the procedure, Ryan dropped my dad and me off at the entrance to the brown brick building, so that I wouldn't have to pass the chanting protestors and their posters with images of discarded fetuses. A man behind bullet-proof glass directed us up a steep flight of linoleum stairs to the crowded waiting room.
A technician called me into the clinic and drew a vial of blood from my arm. He instructed me to go down to the basement, change into a gown, and put my clothes in a locker.
I sat with the other women dressed in blue surgical garb and waited. My mother had stayed home with Katelyn, who was unaware that she'd lost her sibling. I yearned to console her, even though it was me who needed comforting. A nurse gave me water and a paper cup with two pills to induce labor. I choked them down.
Dr. Koznik approached me. "Something's not right in your blood. We need to move you to the ER, where we can have a hematologist and blood transfusions on hand." He leaned down to look me in the eyes. "There may be something else wrong with you."
At the hospital, my contractions intensified as they defrosted the bags of blood. I begged for an epidural, but a doctor said no, with my abnormally low platelet count, I might bleed out from the needle insertion. If a needle could kill me, how would I survive the D&C?
***
With the confidence of an Olympian, I paddled toward a series of waves that would lead me to rougher water. The current strengthened and swept me toward the start of the first rapid. Using my hips and abdominal muscles to maintain my kayak's balance, I paddled through the chop and navigated around the boulders, drop-offs, and log jams that precede Nantahala Falls.
The stampeding current whipped me past the last bend, into the middle of the river instead of my targeted position near the left bank. I was traveling between the two easier routes through the falls, and directly toward the drop-off that finishes in a depression that acts as a whirlpool. I veered right and reached the ledge parallel to it--the worst possible position.
***
When I woke from the D&C procedure, my mother told me she loved me. Her grandchild had been a girl. I wondered if she'd had the beginnings of the full head of black hair with which I'd been born. I'll never know. Ryan and I named her Lily Elizabeth.
Back at home, thoughts of our lost daughter were more sleep-disrupting than a newborn's demands. Over the next four days, worsening pain in my left side and swelling of my face hindered our efforts to mourn Lily. Four o'clock Thursday morning, I woke Ryan and told him that he needed to take me to the ER.
Ten hours later, a hematologist introduced herself and said, "You have acute promylecytic leukemia." Leukemia had killed my daughter, and was trying to kill me. The lily is a symbol of purity and beauty. We'd given her a fitting name, for she had been perfect.
My body, however, was now far from perfect. I cried a waterfall of tears.
***
The noise from the falls rattles my core, and the churning of water around me keeps me disoriented. I must find the grab loop that once pulled, will detach my spray skirt from the kayak, allowing me to reach the surface, and breathe again.
***
Dr. Green is explaining to Ryan and my mother why my blood cannot clot. It's the day after my diagnosis. Hours earlier, I was transported to the John Theurer Cancer Center by ambulance.
"Try not to move, at all," Dr. Green says to me. "I had a woman here two years ago, about your age. She complained of a headache. Two hours later, she was dead."
I stare at Dr. Green's navy blue tie, avoiding the fear in Ryan's and my mom's blue eyes that would intensify my own. "I need to see Katelyn."
"Unfortunately, that's not possible until you're past the risk of internal bleeding. If she bumps you, it could kill you."
I don't know how I will survive without her.
***
I wave my hand through the water in an arc above my head, and touch nothing. I must be head down, surrounded by invisible dangers. My hand might catch in a crevice, or a surge might smack my head into a rock. Folding my body towards my legs that are trapped within the kayak will bring me to the grab loop, but my instincts scream to move away from the boat.
***
Books, drawing pads, even the television remote control, sit untouched by my bedside. I spend hours staring at the get-well cards and 8"x10" photographs of Katelyn taped to the walls. My parents and Ryan come often. Sometimes we talk, other times we rest. One afternoon, my dad manages to choke out a request: If I die, could I please be buried near their home, rather than on the East coast, so that he can visit me?
Yes, dad, that's fine. I've made no arrangements to the contrary.
I don't have discussions like this with my mother. We're both Scrabble players. Life had become so busy in recent years; we hadn't played each other much. The bedside hours present the perfect opportunity, but I can't muster the energy required for the trial-and-error process of reordering tiles on a tray. My parents shouldn't have to watch my decline.
Nine days after my diagnosis, and the day after my third dose of brilliant, red-orange chemotherapy, Dr. Green delivers the news: "Your daughter may visit tomorrow." The minutes tick past in slow motion. Will she still treat me like her mommy?
My husband and daughter enter the family room as a unit. Ryan's role as single parent has increased her attachment to him. I hold out my arms, but Katelyn doesn't run to me. It's been too long, or the hospital setting is too foreign. For Ryan's sake, I pretend her rejection doesn't hurt.
He knows it does, so he sets a pile of blocks on my lap, which draws Katelyn to me. She leans against me to play, and I relish her accidental touch. We need these minutes together, yet they're almost unbearable.
***
My oxygen supply is gone. I fight back against the pummeling, for I must survive. My hand connects with the fabric spray skirt around my waist, and I smack along it, feeling for the nylon ribbon. I can't move fast enough. I will die.
***
Six days after Katelyn's visit, acute pain in my right side wakes me during the night, intensifying my anguish over losing Lily and missing Katelyn. What new words has she learned? Does she still ask for me? I don't want her to feel my absence, yet selfishly, I worry that she'll forget me.
Late afternoon, Dr. Monroe arrives during Ryan's visit. The CT scan completed that morning shows clotting in my liver, and blood in my lungs--two opposing complications that are hard to resolve concurrently. The doctor continues talking, and I watch my husband consume jelly beans from a two pound bag that came in an Easter basket from my mom. Today is Good Friday, but not good for me.
They wheel me down to an operating room and perform a bronchoscopy. As the scope is removed, a doctor announces that my vital signs are dropping. I'm whisked to the Intensive Care Unit. An oxygen tube is inserted into my nose.
Ryan holds my hand. In his other hand, he's gripping the bag of jelly beans. Dr. Monroe debriefs the I.C.U. staff on my condition. "Since we can't treat both her lungs and her liver at the same time, we'll focus on saving her lungs."
The group disburses, and Dr. Monroe joins us. I might not make it through the night, he says to Ryan, not to me.
I'm mesmerized by how any individual can devour jelly beans at such a swift pace. Ryan may eat the entire bag before dawn.
A nurse introduces herself, and I ask, "Am I going to die?"
Instead of offering reassurance, she begins to cry and steps away. I try to think about jelly beans. Red, purple, green, I'm terrified. Ryan unfolds a blanket and lays down on a recliner next to me. I love you, I say. He doesn't repeat the phrase, but I know he's thinking it, even if he's too afraid that saying it might mean good-bye.
The elderly patients around us gasp with each breath. I try to console myself that if I die this night, I'll be with Lily, in heaven. Ryan will take care of Katelyn, and I'll take care of Lily. The blood in my lungs, threatening to suffocate me, causes me to cough. God, please let me live. I'm scared to fall asleep, in case He doesn't answer.
***
In the cold dark, I find the loop and yank the spray skirt from the rim of the kayak. The river rips the boat off of me, freeing my legs. My life vest pulls me to the surface. Light hits my eyes before air hits my lungs. The first intake isn't enough. I gasp for another, and another.
Like an angel, a hand grabs my lifejacket from above, and I bump against the guide's yellow kayak. He and two other professionals, who'd been waiting along the edge of the water basin, focused on my safety, had sprinted toward me as soon as I'd capsized.
"Breathe, it's okay, breathe." He keeps my body positioned so that my face points at the sky.
***
Bright light fills my vision. I blink to adjust to the glare. Sunlight shines through the window. I gasp from the realization that I made it through the night. I push the call button for the nurse. "Am I okay?"
"Yes, sweetie, you've stabilized."
Consumed by relief, I cannot manage a response. As the trembling subsides, I whisper, Thank you, God.
The following morning, Easter Sunday, I log into Skype. Ryan and my mom help Katelyn hunt for eggs in our backyard. The view bounces around as Ryan, carrying the laptop, follows her. She opens a pink plastic egg and pops the Cheddar Bunny into her cute mouth. It's a beautiful morning. The grass must smell sweet; the open sky must look limitless; my daughter's embrace must feel warm.
I will recover, and hold her close. I survived the first week. I survived my I.C.U. encounter. I miss Lily, but I'll be with her again, much later. She died so that her sister could have a mother, for her passing resulted in the doctors diagnosing me in time to save me. The photographs adorning my walls show only the beginnings of our family's happy times together before we're reunited with Lily.
***
The guide holds my lifejacket to keep me next to his kayak, and we're swept down the river. Gasping for more oxygen, I keep my feet at the surface, pointed downstream, as we've been taught.
Three weeks earlier, on the one-year anniversary of being in remission, my boss sat down across from my desk. "You should go on one of these First Descents trips for young adult cancer survivors."
After spending a cumulative 40 nights in the hospital, I never wanted to be apart from Katelyn again. The fear of my daughter losing me was keeping me in a constant state of risk aversion. I signed up for the First Descents camp with trepidation.
While floating in the calmer water, my breathing returns to its regular cadence. I feel the sun on my cold, wet face. My first descent may have been flawed, but it proved my ability to really live. It took Katelyn two weeks post my return from the hospital to resume her old rhythm with me. I'm sure she's missing me now, but I'll be home soon.
I start laughing, and can't stop. Finally, I say, "I want to tackle those rapids again."
Shelley Nolden is a wife, mother, financial analyst and a writer. In March 2011, Shelley was diagnosed with acute myelogenous leukemia (AML), subtype 3 (APL). Shelley is currently in remission and receiving treatments to maintain that status. Like the rest of the Cancer Club, she's trying to adjust to her new reality by keeping a positive mindset and living life to the fullest. Read more at www.shelleynolden.blogspot.com.
About First Descents
First Descents, a non-profit organization founded by professional kayaker, Brad Ludden, offers young adult cancer fighters and survivors a free outdoor adventure experience designed to empower them to climb, paddle and surf beyond their diagnosis, defy their cancer, reclaim their lives and connect with others doing the same. Learn more about First Descents at www.firstdescents.org.
About the John Theurer Cancer Center
The John Theurer Cancer Center at Hackensack University Medical Center is currently ranked among the U.S. News 50 Best Hospitals for Cancer. Shelley's in-patient experience there was excellent, and she will forever be grateful to its doctors, nurses, and staff for saving her life. She continues to benefit from the services the center provides during her ongoing treatments.