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Macmillan Childrens Publishing Group

Fear of Missing Out

Kate McGovern

Farrar, Straus and Giroux (BYR)



I’ve always thought an astrocytoma sounds like a shooting star. Right? Like something you’d want to watch from the roof of your house or the top of a really tall hill, probably lying on your back on a wool blanket and eating popcorn. On the news, they’d be all like, “Don’t miss the astrocytoma shower tonight! It’ll be most visible from nine to midnight, weather permitting. Once in a lifetime!” You’d lie there on your back on the blanket, waiting for it, and then it would cross the sky over your head and you’d think, “That’s the brightest, most beautiful astrocytoma I’ve ever seen.”

And it would be.

* * *

“Astrid. Astrid.”

I blink. There are tiny bursts of light swimming at the corners of my vision. My astrocytoma.

An astrocytoma is not, in fact, a shooting star, though it should be. It’s a brain tumor, made of star-shaped cells. Astrocytes. Things of beauty, and instruments of death.

I blink again and my mother comes into view in front of me. She was sitting next to me a minute ago, and now she’s hovering over me, her face too close to mine. “Astrid?”

Yes, my tumor matches my name.


“Did you hear Dr. Klein?”

My mother’s face is splotchy. Her eyes are rimmed in red. I look from her to Dr. Klein, who’s giving me her Serious Face.

“I’m sorry, guys,” Dr. Klein says, clearing her throat. “I wish I had better news.”

Poor Dr. Klein. I shouldn’t be thinking about her feelings right now, but I am. Dr. Klein likes me. She already saved me once, when my brain first got tumored. Ninth grade. There was the surgery to remove it, and then the radiation, and then the chemo. It took nine months—my mother likes to say it took the same amount of time to start my life as it did to save it—and then everything looked good for a while. Like, doesn’t-happen-that-often, almost-enough-to-make-you-believe-in-God good.

I don’t believe in God, though. I believe in science, and there’s a reason for that. Science is a kind of miraculous thing of its own, miraculous enough to make a star-shaped tumor go away for two years, which a lot of people said was impossible. But science is also reality, and it can only do what it can do. And now, according to the scan we’re all staring at on Dr. Klein’s computer screen, science has run up against its natural limitations.

That’s my brain on the scan. My brain, the traffic control center of everything that makes me me. Just staring back at us in all its light and shadows. It never gets old, looking at a human brain.

Dr. Klein swallows. “Astrid, you know how to read this scan. I don’t need to tell you what it says.”

She’s correct. The thing Dr. Klein did, besides saving me the first time, was make me love the brain—which, if you think about it, was pretty badass of her, considering that I had only recently come face-to-face with my own brain’s potentially fatal flaws. She let me do an internship in her lab this past summer, and since my hair had mostly grown back by then, no one in the office knew I’d been one of her cancer kids just a year earlier. I was just a high school student with an interest in neuroscience, and she let me look under the microscope at slivers of normal and abnormal brain tissue, at scans just like this one, for patients with all kinds of astrocytomas and gliomas and medulloblastomas.

So she’s right—I can read this scan. And it is not a good one. There’s my brain, both hemispheres, and right there at the base of the brain stem, a foreign object of my body’s own making: a jellyfish, a bubble floating away from a child’s liquid-coated wand, a bright asteroid. A tumor made of stars.

“So where do we go from here?” Mom has her notebook out, the thick black one that’s fraying at the corners, her keeping-track-of-Astrid’s-cancer notebook. She clicks her ballpoint pen into action. My mother expects that there is always somewhere else to go from here.

I wait for Dr. Klein to break it to Mom: Do not pass go. Do not collect two hundred dollars. There is nowhere else from here.

“We can try more chemo, right?” Mom pushes.

“Yes, we can try a new drug combination. The options have improved somewhat in the last couple of years. There are no guarantees, but…” Dr. Klein hesitates. “There is one other thing that I think has some promise.”

Not what I was expecting.

“There is a clinical trial launching in the spring, for an experimental immunotherapy that targets Astrid’s particular type of tumor. You may be a good candidate for it.”

I feel Mom’s body physically lighten next to me, like she’s about to levitate. “Okay,” she says, her voice shooting up an octave like it does when she’s excited. “Okay! We can do that. How do we get her into that? You can get her in, right?”

“I don’t want to get your hopes up, guys. I need to be honest with you that this is … a long shot. At best. First we have to do more testing to make sure Astrid is in fact a candidate. Then she would have to be accepted—they’ll look at a lot of factors to make sure she is healthy enough, relatively, to be part of the trial.”

“So I have to be healthy enough to take part in a clinical trial for a cancer treatment?”

Dr. Klein cracks a smile. “I realize that’s a tad ironic. But yes. That’s why we’ll do a chemo regimen regardless. Look, obviously, it’s a trial. Some patients will receive the treatment; others will receive a placebo. We won’t know which one Astrid receives, and we’ll have no control over it.”

“But if it works well, they’ll cut off the trial and give the treatment to all the participants, right? They won’t withhold it if it’s working well?” Mom’s talking fast now. She’s read too much about all of this.

“They would, yes—but that’s pretty uncommon, to be honest. The early results would have to indicate that we are causing harm to patients by giving them a placebo, that it is an ethical imperative to deliver the treatment to all the trial participants. It’s a high bar.”

Dr. Klein pauses. Mom is scribbling in her notebook, probably notes of things she wants to google when we get home, or even when we’re stopped at a red light en route. (Some days I think I’m statistically more likely to die from my mother using her phone while driving than from cancer.)

“You should also know that the potential side effects from the trial could be intense.”

“Chemo intense?” I ask.

“Potentially, yes, or more so, depending on how you respond. And there would be a good deal of time spent in-patient because of the frequent infusions. I don’t say that to discourage you. I just think you should know the full picture there.”

We’re all silent for a moment. Mom’s still jotting notes. I can feel her energy vibrating next to me. I’ve spent so much time in hospitals already. The idea of signing up for more—volunteering for it—makes me feel like the room is tilting.

Mom looks up from her notebook. “We can handle the side effects.”

We? I love my mother. She’d do anything for me. But we do not have cancer.

Dr. Klein smiles gently. “Maxine, I want to be candid with you both. The trial has potential to lengthen Astrid’s life. It may, or it may not. But it’s unlikely to cure her completely. I’m really urging you not to pin all your hopes on this.”

“Alison,” my mother says in response, “you’re telling me this is our best shot, right?”

Dr. Klein takes in my face, my relative reticence in this conversation. Then she looks back to Mom and nods. “That’s where we’re at now. I’d say so.”

“Right,” Mom says. “Can you really expect me not to pin my hopes on it?”

* * *

In the car, my mother takes deep, calming breaths in the driver’s seat. I stare at the white of her knuckles, gripping the steering wheel as she drives.

“Astrid,” Mom says, finally breaking the silence in our more-than-a-decade-old Honda. “It’s okay. This is just a hiccup.”

I knew the tumor was back well before we saw the scan in Dr. Klein’s office. There were the light bursts clouding my vision, for one. Then I started tripping again, losing my balance. And there were the headaches. A headache turning out to be a brain tumor is one of those crazy things that almost never happens. Like, when you get a really bad headache, you might think for a single, fleeting moment, “Man, this could be the big one.” But it’s pure hypochondria. It never actually happens in real life. Until it does.

I didn’t tell my mother right away when it came back, because I knew she’d go all freaky maternal on me, and I wasn’t ready to hurt her again. Maybe I wasn’t ready to be sick again, either. So I lived with my tumor made of stars, just the two of us, for about a month. Until one morning, when the headache bloomed so hard and so fast that I puked all over myself, and fell on the way to the bathroom, and then I didn’t have to say anything, because she knew as well as I did. I wish I could forget the look on her face when she came bursting out of her bedroom and found me on the hallway floor, covered in vomit. I stared up at her, my only participating parent, and me, her firstborn baby, and watched the panic come into her face like a cloud rolling in before a summer thunderstorm.

“I think this clinical trial has real promise. I mean, immunotherapy, right? That’s what everyone’s talking about.” We stop at a light and, sure enough, Mom pulls out her phone and starts tapping away with one hand, the other still resting on the wheel.

“Mom, you’re going to get a ticket.”

“They can’t ticket me unless they pull me over for some other reason.”

“I think that’s for not wearing a seat belt, Mom. I’m fairly certain they actually can pull you over for using your phone.”

“I just don’t want to forget what I’m…” The light changes. Mom drops her phone and we lurch into the intersection. “This could really work. I feel good about this.”

I take my phone out and pull up Mohit’s last text: How’d it go? it reads.

He doesn’t need to ask. He knew, too, as soon as I told him the headaches were back.

I start to type a text in response: Doomsday. Then I delete it. I want to say something clever to Mo, to reassure him that I’m still me. But I can’t. I close my eyes, press my head against the seat of the car. I’ll call him when I get home. It will break my heart to break his heart all over again.

As we drive on, my mother keeps talking. About more chemo, more radiation, more trials, more, more, more.

“Mom. Please. Just stop.”

She turns to me. “Babe, we still have time. We have options. You know that, right? We’re not done here.”

I run my tongue over my lips, which have gone very dry all of a sudden. I want to tell her that she’s wrong. I know about clinical trials and new drug cocktails, I do. I know more than I should, thanks to my internship. Enough to be pretty much a shoo-in for the best neuroscience programs in the country for college, with Dr. Klein’s recommendation, which is what I’d imagined I’d be doing after high school, right up until the headaches and the light bursts came back. I know that the chance of any kind of novel treatment working for me now, given everything, is about as close to zero as you can get without already being dead.

And more to the point, I know that sometimes—often—the treatment is worse than the cancer itself.

Instead of saying that, though, I nod. “Yeah, Mom. I know.”

Copyright © 2019 by Kate McGovern