16. When It Rains

16

When It Rains

Brighton

Monday, May 15 th

9:00 a.m.

"Blakely is in room four-sixteen." Lauren offers me Liam's file as she passes me and continues to her seat behind the nurses' station.

I slide the file on top of the rest of the stack and continue writing notes in the chart I'm working on so I can return to finish the dictation once I have a break. "Thanks."

Two days alone with my thoughts should have been enough to clear my mind, but every time I walk past where it happened, my heart pounds in refusal. I'm not sure if others will notice I'm taking the long way around the nurses' station to get to the patient rooms, but as long as no one questions me, I think I can keep it together.

I pull out the CT findings one more time and go over them, trying to steel myself. I hate being the bearer of bad news. Maybe Luca was right. Maybe I should have taken some more time off. But I know the real reason I'm hesitant to see Liam. And it has nothing to do with needing time off.

Tucking Liam's chart in the crook of my arm, I continue my path behind Lauren and only catch a couple of wayward glances.

Pull it together, B.

Liam smiles at me as I enter his room. I drop my eyes to the floor, pull out the rolling chair, and take a seat as I set his chart on the counter beside me.

I can do this.

I yank at the collar of my scrubs. Swallow. Offer Liam a half-hearted smile. I glance around the room as if Dax could be hiding somewhere and frown. I figured he'd be here for this appointment for the CT findings.

No, I can't.

I wish I could excuse myself for some much-needed air when Liam interrupts. "Dax is running a little late. He had a work thing." He checks his watch. "He said he'd make it. Can we wait a couple of minutes?"

"Of course."

Thank goodness.

I try to still the tremor in my hands, rubbing my sweaty palm down the side of my scrubs. Liam's case is affecting me more than I had figured it would.

I didn't prepare well enough for this.

I glance toward the door and clear my throat.

How do I prepare him?

A quick scan of his file shows I've messed up yet again. I never bring anything short of my A-game, but his case has thrown me off. Dammit.

"I left the report on my desk," I say, blurring the truth between needing an excuse and forgetting his scan. I struggle to keep it together. I know Liam's chart inside and out. I don't need his report, but I need a breather, and this is the only plausible excuse I can come up with to give me a chance to regain my bearings. I hold up a finger, letting him know I'm going to give him a second and a little privacy. "I'll be right back," I mouth as I slip out the door.

I crash into Lauren. Charts fly out of her arms and skitter across the floor. I reach for her, trying to keep her upright. "I'm so sorry."

We kneel, shuffling through the mess of papers and files, trying to organize them. I cast a glance between her and the door to Liam's room.

"I was bringing you this." She hands me a sheet of paper. I hesitate a second too long. And she notices. "You left this on the counter. Everything okay?"

I snatch the CT report out of her hand and give her a pinched smile. "Of course. Why?"

Her brows lift into her bangs, and she uses her pointer finger to push her glasses up the bridge of her nose. She gives me the all-knowing look I hate. I can appreciate her reaching out to me without questioning my motives. "Need me to fill in for a sec?"

"That would be great." I give a stiff smile before I take off toward the back hall. I scan my badge and try the handle.

Shit.

I repeat the process again.

And again.

I close my eyes, glancing behind me, sure I'm making a spectacle, but everyone else continues in their business, not paying me any attention. I raise the badge and swipe it slow and deliberate—the green light flashes.

Finally.

I race to my office, close the door behind me, and collapse against it as I slide to the floor. I pull my knees to my chest and bury my head in my hands. I'm going to sit here until I get myself under control.

Maybe Kline was right.

Maybe I can't handle this.

I already did it once with Grady. Failed with Collins' case. And now this. Why am I putting myself through this torture?

I press the heels of my hands into my eyes until stars are swimming behind my lids. What is wrong with me? Why am I making this about me?

Liam's CT read sits beside me on the linoleum. I should pick it up. Go over the results. Reorient myself.

I grab the door handle, gather my composure, and stand. My heart continues to thunder in my chest as I make my way back to the main floor.

I settle my palm on the handle of Liam's room. Count to ten. I close my eyes, try to gather my bearings, and put on a happy face as I open the door.

"You ready?"

"I'm here, aren't I?"

"Are we still waiting for Dax?"

"I've already waited this long." He crosses his ankles, readjusting on the table. "Whatcha got for me?"

I give him a reassuring smile. "The results aren't what we hoped for, but we can do this. You all in?"

"Is that a rhetorical question?"

I slide his chart onto my lap and place his CT report at the front, handing him the copy.

His eyes gaze back and forth across the page. "Can you tell me what this means in layman's terms?"

"Your cancer has metastasized into your lungs," I say, ripping off the proverbial Band-Aid, "which is not ideal, but not something out of the ordinary."

"Typical."

"Do you have any questions?"

He tilts his head in disbelief, pinching the bridge of his nose. "Lauren said I would have to get another CT scan?"

"Not for a while. More like a month after we've started chemo."

He humphs under his breath. "To see if it's gone?" His chin lowers to his chest, and he squeezes his eyes closed.

"To see if the treatment is working. Are you okay? Do you need a minute?"

He shakes his head. "What does this mean?" He points toward the bottom of the second page.

"Your cancer has progressed into the pelvis and a few areas in your lungs, but it hasn't affected your marrow," I explain. "This isn't uncommon. The progression is further than we'd like, but we can still work with this."

I try to give him some hope. The odds aren't the best, but I've never let that stop me before. And I don't plan to now. Knowing when to quit has never been my strong suit, but in this case, my inadequacy definitely weighs in his favor.

"After you see the cardiologist to ensure everything's fine with your heart, we'll schedule surgery for the port implant. It's a quick procedure, but you should have your brother there."

"Maybe we should have waited for Dax." Liam hunches forward, sagging in on himself as his chin trembles.

"I'm sorry, I didn't catch that."

"I was trying to be strong, not put too much on him in case he couldn't handle it. I thought it was actually a good thing he was late. He has a history of running away when things get hard." His voice cracks as he cradles his head in his hands.

I'm not sure what he means or how to respond. "It's easier if you don't try to go at this alone."

"I hate to be a bother." He hops off the table, wiping his hands on his jeans. "Is that it? When do we do the surgery?"

"Let's start with the treatment plan." I rifle through his paperwork, thrown off by his desire to leave. I hold out a sheet of paper.

"There's more?"

"Only a couple of things." I try to reassure him. "Before we start the chemo, we need to do an autologous bone marrow harvesting."

His eyes grow large, and I can't help but grin. He gets on the exam table and leans forward, settling his elbows on his knees as he rubs his hands together.

"It sounds like a lot, but once they're in there, it doesn't take long. It's a swab for DNA testing so we can harvest marrow. You're going to want to bring someone with you since you won't be able to drive after the procedure." Dax. I can tell we're both thinking the same thing. Me out of morbid curiosity and him out of being let down one too many times.

"What's it for?"

"In case the chemo doesn't give us the success we expect. Using your marrow will help you recuperate quicker and reduce the chance of rejection. We have to do it as soon as possible since your marrow is still cancer-free."

He rakes his hand through his hair. "Well, okay then."

"Lauren can schedule this for later in the week. I want your brother to do a leukocyte antigen test to examine his genetic markers. He can do this while he waits for you. A sibling is most likely a match, and this would qualify him as a donor. If yours doesn't do the trick, we can use his marrow after surgery. Unless you have someone else in mind?" I need him to see the reality of his situation.

He shakes his head. He pulls out his phone. "He said he's on his way."

"It's a lot to process." I wish I could say more, but I'm unsure how to reassure him. "We can wait."

He hops off the table and leans against the door, crossing his foot over his ankle. "Why would I need his lyokecen genetic anti-thingy?"

His mispronunciation makes me smile. "Leukocyte antigen test. You need his marrow, and that test verifies genetic information. It's a quick mouth swab."

"Easy for you to say. Dax isn't your brother."

"I don't think you see how this is affecting him. I'm not one hundred percent sure about this, but from what I gathered at your first appointment, Dax is acting like any normal person left in the dark would. I don't think you're giving him all the information."

"Guess I should've waited for him to show. It was sorta important." He grins, but it slides from his face as he bites his cheek.

"We can fill him in once he gets here. We'll do the harvesting, get Dax to give a sample, and schedule the port placement. After that, we'll start chemo treatment. We want to eliminate the cancerous lesions found in the lungs first. Once we get that out of the way, we will do another CT scan to see what's left. With your state of progression, I'm going to assume we're going to do the hemipelvectomy to make sure we cover all our bases."

"When can I return to soccer?"

"I'd give it three to six months after surgery so we can finish your treatment with radiation if necessary." I step to the side of the counter, flipping the calendar's pages. "I'm thinking early February—if you do all your physical therapy and attend your follow-up appointments. We should schedule you with a psychiatrist for support too."

He tsks under his breath.

"We need to cover all our bases." I flip to the next page in his chart—the one that needs his signature—the part I've been dreading. I rub my temples, pushing away a migraine. "Unfortunately, with this metastasizing and spreading, the survival rate has dropped below fifteen percent. This is a rapidly spreading tumor, and we weren't expecting to find it this far progressed."

"That's what that meant." He grabs the report he left on the exam table. "The T, N, M, G?" he points at the last page of the report, holding it for me to see.

"Yes, you're at a G3 TM. It's considered high-grade, metastatic. Treatable"— barely —"with the outlined protocols we discussed. Do you have questions?"

"Nope. I got it." There's a tremor in his hand as he offers me the report. His face turns a pallid shade of ash as he stares off into the distance. His knuckles turn white as he grips the edge of the table.

I set a hand on his knee, and he goes rigid, giving me a hesitant smile as he tries to rein in his emotions.

"That's your copy."

He gives me a grin. "But I have no idea what it says. Do you go through training or something?"

"As an oncologist?" I'm a little thrown off by his question. "Or . . ."

"To give results. Tell patients they're gonna die."

My words catch in my throat, and I cough into my hand. "Is that what you think this means?" I take the papers from his hands, flip to the last page, and point at the findings.

He hangs his head.

"These are the facts. They aren't a precursor to the outcome."

"What if I don't want to treat it? Then what?"

"Are you serious?" There's no way I can keep the shock off my face or out of my voice.

"I'm weighing my options."

"You're young. What would make you think . . ."

"I can't focus on this right now," he interrupts.

Shut up, Brighton. You're overthinking.

Again.

Breathe.

It's okay.

You're going to figure this out.

You always do.

"There's a chance for remission if we hit this hard and fast. I strongly advise we move forward with the treatment as outlined." I offer the paperwork once again, turning to grab his chart. "Can you do that for me? You wouldn't be going through it alone."

"I might be. You don't know what it's like dealing with Dax." He takes the CT scan, rolls it up, and stuffs it into his back pocket.

"You said Dax was running late. I'm sure he'll be here any minute."

"I was just venting."

The way he hangs his head in acceptance makes him look like a vulnerable little boy. I hold out my hand, and he shakes it.

There's a knock at the door, and Liam steps aside as Lauren peeks into the room. "Are we ready to make some appointments?"

I grab the pen from my breast pocket. "I need a couple of signatures. Give us a sec."

"Of course. I'll be at the counter when you're ready." She smiles and shuts the door.

Liam takes the offered pen. "What's this?"

"Acknowledgement of what we went over. We'll be seeing you a lot. Remember, don't come to your harvesting alone. You won't be able to drive. And you'll need a ride after the port placement as well." Plus, I'd like to talk to your brother to see why you're so insistent on being the one to protect him instead of it being the other way around. "And Dax can do the swab."

The buzzing of his phone punctuates the moment. He pulls it from his pocket, holds it for me to see the screen, and grins from ear to ear. "It's Dax."