On the shores of Lake Michigan.Darren Hauck for The New York TimesOn the shores of Lake Michigan.
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When people choose to have their leukemia treated aggressively, it’s a big commitment, more so than for almost any other cancer.
With this therapy — three days of the drug daunorubicin, which comes in a reddish color so distinctive that one of my patients, a former chemist, used it in his professional life as a dye for plastics, and seven days of the drug cytarabine, which is infused continuously over 168 hours — we offer them the chance to be cured of a disease moving like wildfire with a stiff breeze behind it at the height of drought.
The offer can be seen as a Faustian bargain, though. In return comes the very real possibility of dying from our treatment, along with immersion into a kind of purgatory of a hospital stay lasting four to six weeks. We joke with our patients that we love boring — it is, in fact, a medical ideal that our patients complain of nothing more than ennui on a daily basis. But the psychological mettle it takes to endure this experience is remarkable, and there’s little that can prepare a person for it.
We make our rounds as a group — nurses, physician assistants, residents, a fellow, a pharmacist, a case manager, me and occasionally additional observers. It can be quite absurd, really, this thundering herd walking slowly down the hallway of the leukemia unit, stopping at each doorway. A few weeks ago, when I was attending on the leukemia service, we came to our eighth patient of 25, a 72-year-old man whose leukemia persisted despite our first round of chemotherapy, so we gave him more. It was now his 36th day in the hospital, and his blood counts showed no signs of recovery, a wasteland of emptiness.
A few of us walked into his room, where his wife sat in a chair by his bed, reading. She looked up and gave us a half-smirk as we glanced over at him. His sheets were pulled completely over his head and then tucked underneath it, creating the image of a starched white cocoon.
“Don’t mind him. He always sleeps like that,” she said. “On the ship, the couch where he rested was directly under a vent, and this was the only way he could ever grab any shut-eye.” He stirred and pulled the sheets down, squinting against the room’s lights.
He was captain of a barge that traversed the Great Lakes, hauling iron ore for the steel mills, back when steel mills were still open and the Steinbrenners controlled a lot of this commerce. He steered these massive vessels from the back (“aft,” he liked to remind us landlubbers), staring out across the two football fields of their length.
“He’d be gone from March through October,” his wife said. “I was one of the lake widows!” She laughed, but stopped herself quickly, realizing the nickname threatened to become a reality. “But I knew what I was getting myself into. His father was a ship captain, too, so my mother-in-law sat me down before our wedding day to prepare me.”
I asked what it was like to go eight months without seeing each other.
“I missed her, but we’d meet up every month or two,” my patient chimed in, now awake.
“I would track the ship,” his wife added. “I knew what day they would set out from Duluth and approximately when they’d be getting into Chicago. So I’d pile the kids into the car and we’d go see him. We’d have 24 hours as a family, but if we were lucky, and there was a maintenance issue on the ship, sometimes we’d get 36.” She smiled at the memory. “But mostly, there was a lot of waiting.”
My patient said: “It got better when the kids went off to college. Then she could join me on the ship for two weeks at a time.” He gestured to a photograph on his wall, of the sun rising over a body of water in a cloudless sky. “It was beautiful, really, seeing that every day.”
“Beautiful,” his wife echoed. Everyone in the room was still, thinking about the expanse of water, the miles he had already covered and what lay ahead.
“So, I guess there’s no change in my blood counts?” my patient asked.
“Nope, not yet,” I answered. “But they could improve any day now.”
“It’s O.K.,” he said. “We’re not in a hurry. We’ll see you tomorrow.”
His wife waved goodbye and went back to her book as we left his room, the waters calm, the air without breeze.
Mikkael Sekeres, M.D.

Dr. Mikkael Sekeres is director of the leukemia program at the Cleveland Clinic.