Most breast cancer patients don't feel sick at the time of their diagnosis.
We're fine one moment, a cancer patient the next. And that fuels denial's power to cloud our vision. Kristina allows Max's friend, Micah, who has special physical needs, to come for a sleepover. Adam exclaims how ridiculous that is, only three days after her (first) chemo treatment. Oh no, I anticipated while watching this unfold, just in time for the anti-nausea drugs to wear off. Kristina knew what could be coming, but later says, "I thought I was the only one who wouldn't get sick; I thought I could just power through it."
Apropros that illness crashes down on Kristina as everything around her is chaotic. Max is oblivious, playing loud videogames with Micah, demanding his tacos, the dog isn't taken out in time and pees on the carpet, the baby needs to be fed and is crying. Thus begins two days of hell for Kristina. Hell not only because she is in great pain and cannot take care of herself, but because she can't take care of her family. Max is disturbed by her condition and asks incessantly, "Is it because of the chemotherapy, is it because of the chemotherapy?" His reaction to seeing Kristina lying on the bathroom floor unable to move is to talk obsessively about how unsanitary that is, with all the germs. His rigidity and his own needs (wanting Kristina to intervene when he needs "alone time" away from Micah) do not mix well with the chaos and out of control situation he's forced to face.
Kristina, rigid as well, is unable to relieve her pain with her prescription medication, but regains some control over her body when she smokes pot. After her next treatment she'll be better prepared--she'll know when and what to expect, and she'll have an arsenal of pot to help ease her pain. I hope that when she starts to lose her hair she will shave her head instead of waking up to clumps of hair on her pillow; this will help her feel more in control. I also hope that she joins a breast cancer support group. Rarely does the series venture outside the insular world of the Bravermans, but it's not possible for her to get all she needs from the regular characters--she needs affirmation and hope that she can get only from others who have been there.
Chemo is, at the same time, life-saving and toxic. Which is why it is a breakthrough that tests have been developed to help doctors determine with greater accuracy which breast cancer patients will benefit from it. Traditionally, a certain-sized, certain grade of tumor automatically called for chemotherapy. Many patients were overtreated. A test, such as OncotypeDx, now looks at a tumor differently, breaking down its particular genetics, determining the need for chemotherapy in a much more individualized way.
When my oncologist told me she was not recommending chemotherapy for my early stage 1 tumor, I was elated but petrified. My OncotypeDx score was in the intermediate range, an area that was still being studied. It took some time and a second opinion for me not to feel vulnerable without it. If my tumor had not been found early, if it had been given more time to grow, the foregoing of the chemo might not have been an option. Early detection saves lives, but it also has other benefits which are not regularly touted. Early detection saves some from toxic treatments.
Kristina's tumor overexpressed a protein called HER 2 Neu. It was identified because of the ability we have now to study the many characteristics of a tumor. About 1 in 5 breast cancers are found to be HER 2 Neu positive and are more aggressive. There are drugs, such as Herceptin, which give targeted treatment to these types of tumors. Herceptin is administered in addition to other chemotherapy drugs, and Kristina will probably be treated with it for a longer period of time than she is treated with the other chemotherapy drugs. She has a long road ahead of her.
How does Adam deal with the first effects of Kristina's treatment? At the beginning of the episode, he says to Micah's parents who are going to Las Vegas, "I want to go to Las Vegas." And you know he means he would rather be anywhere else than in the cancer world where he is now trapped. But when Kristina gets sick, he no longer is in the excruciatingly helpless role he's been stuck in since she was diagnosed. He assumes a protective role which he fulfills calmly and effectively, taking care of the baby, dealing with issues arising during Max's sleepover, deftly packing up the three kids (Micah is in a wheelchair) and barging in on his brother Crosby's dinner party, baby in his arms, because he needs to get pot for his suffering wife. He is energized and focused on his mission. Kristina tells him he's "awesome," not just because he took care of everybody but because he didn't give her grief for her foolishly insisting that Max's friend sleep over.
His face has changed too. The concern is still visible, but his face does not appear tortured, tight, and pained as it was before. I don't see the fear as much because, now that cancer has truly made itself known, he can channel his energy to fight it and try to make everything better.
Episode 9 airs on Tuesday at 10 on NBC.