Sarah Byrne is a graduate student at Imperial College London, working on computational modelling of proteins involved in cancer. Outside of research her interests include science writing and science communication, and she also writes speculative fiction. She can be found online at sarahbyrne.org.
Her creative non-fiction story is the Winner in the imaginative science writing category of our 2013 non-fiction writing competition.
By Sarah Byrne
In the beginning we were all the same. Or so you'd think if you'd seen us back then, nestled identical in our bone marrow cradle. Millions of tiny cells: endlessly dividing, replicating, self-renewing. Haematopoietic stem cells, you'd call us: a big name for a little thing. Oh, but the possibilities each one of us had inside.
Because sometimes, some of us: we'd divide, and we'd change. Be released into the bloodstream, the borders of our world opened up, immense. There were substances in the environment that bathed us — hormones, growth factors — and these would guide our changes. But there was still a randomness to it, a certain amount left up to chance: who would change, and how?
Some of us would become the red cells, carrying vital oxygen around the body. Others the white cells of the immune system: the B cells that recognise invaders and sound the alarm, the T cells that come to their aid, helping them release the antibodies that lock onto the intruders that would harm you; the killer cells that engulf or destroy them; the memory cells, the ones who remember, primed and ready for next time. Others still would become the cells that repair you in a hundred tiny ways every day: healing your wounds, detecting the beginnings of cancer and quietly destroying it, clearing away the remains of the dead cells you shed: maintenance you didn't know you needed.
One thing was for certain, though — when we changed we lost that ability to self-renew. Suddenly life was short, without an eternal line of clones stretching into the future. But that is life. That is the order of things. At least, it was. Before everything changed.
It only takes a tiny error, a single mutation in the genetic code coiled helical inside us. Then, that chaotic random system, that delicate balance between chance and biology that controls our fate, suddenly it falls apart.
And then comes the flood. One mutation leads to another, then another. Abnormal cells, cancerous, leukemic cells: that's what we've become, an enemy within. Crowding your bones and blood, pushing out the workers, the helpers, corrupting the innocent stem cells still sleeping and waiting.
You fight; of course you do. Radiation, it burns us, wrathful, a cleansing fire, and so many fall but it isn’t enough. What are you going to do, burn your bone marrow bare and barren? And then what? Would you flood your veins with the chemotherapy that kills us until you poison yourself, too? Die slow or die fast, that's the only choice left. There's no stopping it now.
How did it come to this?
If you’d seen us in our pristine state, you’d never have imagined things could go so wrong, that we could do so much harm. Would we do things differently if we could start over again?
What if we could go back to the beginning?
# # #
In the beginning we were all the same. Didn’t we huddle together against the wide unknown expanse of adolescence: ironed-straight hair and lip gloss, school skirts rolled short and the same blank, bored pout we thought oh-so-sophisticated?
You couldn’t have picked one of us out from the crowd. So how could it have happened to one of us?
Leukaemia. It seemed a pretty word, like a girl’s name, like one of the names – Perdita, Annalise – we’d make up for our fantasy selves or our someday future daughters. But it’s an ugly thing; we soon came to know that.
It crawled into her veins slowly. At first it was tiredness, headaches. We thought nothing of it. Didn't we all have the usual pains and annoyances of growing into our bodies; didn't we all use them, sparingly, to sit out of gym class while the others slunk around in unflattering sports kit and were herded cringing through the communal showers that smelled of mould and humiliation?
And when she stopped eating, started winning the skinny-bitch contest hands-down, we were jealous, angry, she'd broken an unspoken rule and we whispered 'anorexic', attention-whore. Who did she think she was to distinguish herself from us like that? It shames us now, but that's how we were; girls aren't all sugar and spice.
But how could we have known? Wasn’t cancer something old people got: grandparents, maybe. It didn’t walk in our midst, us with our hair-flicking insouciance, our teenage invincibility. It had no place there. She covered up the bruises with long sleeves and we couldn't have known. Until it was too late.
We didn't know what to do, what to say. Some of us went to visit her, awkward, uncomfortable afternoons, clinging together in pairs. Some of us never went, making excuses until it was too late. Until there was nothing to do but avoid each other's eyes and touch our own fingertips to our own warm living skin and trace the outlines of our faces in the mirror and wonder how it was possible that someone could just not be any more.
We’d do things differently, if we could start over. We’d believe something was really wrong. Maybe we’d say something; maybe she’d get help sooner. Maybe she’d still be one of us.
But we can't. We can never go back to how we were before, those of us who were left behind.
It follows you, out of your schooldays and into adulthood, has you looking over your shoulder all the way. When your own babies come, it has you holding them close, listening to their breathing at night, questioning every fever and bruise, the what-if whisper in the dark.
For some of us, it has us signing up with the donor registry. For the injections that stimulate the stem cells, coaxing them out of the bone marrow into the blood where we freely give them up. For the needle slid deep into a hip bone: this is my body, this is my blood, take it, take it.
And maybe it feels like atonement, or catharsis, or maybe it just feels like we bleed and we hurt and nothing more than that. But still. It's for life. It's for a new start. It's the best we can do.
What if we could go back to the beginning?
# # #
There are some who'd say that's just what we were trying to do. In our leukemic state, we regained that ability to self-renew, to endlessly divide, to make more and more just like ourselves. As if we could climb back into that cradle, rocked into blissful oblivion by the eternal rhythm of renewal: all those pristine possibilities still ahead of us.
If that's what we were trying to do, it didn't work.
Nothing we can do works. Only this.
It turns out you can burn us all away, every last one. You do. Those of us who are the last ones left, we go on replicating; futile, mindless, but we do it because that’s what we do. We'll keep doing it right up until the end, the bitter, inevitable end, when the pure, healing, terrible beam turns our way. Then there will be nothing.
But no. The new ones will come. A donor's gift: healthy new stem cells, new and perfect as we once were.
They'll spread, replicating, renewing, replenishing. It’s rebirth. It’s hope. Of course it is. Isn't every beginning the same in that way?
May they have a better ending than we did.