8. First Impressions

8

First Impressions

Brighton

Tuesday, May 9 th

9:37 a.m.

I try to remind myself that he doesn't know what a shitty morning it's been.

He stuffs his hands in his pockets as he leans against the edge of the counter, closing the distance between us.

The smell of aftershave and mint fills my nostrils, and I struggle with his proximity.

I don't have time for this.

"I got your messages—all of them." I offer him a pacifying smile despite my mild annoyance and suck in a steadying breath. "I had a meeting. Sorry I wasn't able to get back to you. It's been an eventful day."

"It's only a little after nine." The look I get from him screams that I've said too much.

And it hits me—he's the guy from the waiting room.

I don't know what he knows, but I'm sure he noticed the welcoming party of news vans.

I attempt to play it off and reorganize Liam's file. I turn and take a seat on the rolling stool, feeling his eyes heavy on me as I roll away from him and his distracting scent. I'm not sure what he'd think if he knew I'm named in the malpractice. I force the mental disconnect and offer a reflective smile.

Visible tension leaves his body. I get a reserved grin as he pulls his ball cap over his face, shielding his unreadable blue eyes.

I don't have time for pretty boys and their charm.

I roughly prepared myself for this conversation and went over the entirety of Liam's chart. I know the ins and outs of the protocol necessary for his treatment and how to deliver it. But nothing prepared me for Dax and the look of desperation I'm getting.

A smile sneaks across his full lips before they press into a scowl.

Pay attention. Read the room. Evaluate my next move.

A human can go through roughly twenty-seven emotions at once—I read this in the newspaper this morning, along with the information about the pending litigation—I plan on avoiding twenty-six of the emotions threatening to surface as I allow Dax to distract from my shitshow of a life.

Why don't days like this come with a warning?

"Where would you like to start?" I ask, pushing aside my desire to hunt for more information to help with my case. I open Liam's chart to the referral from Dr. Gibbons and offer it to Dax. "We only have a few minutes." I try not to appear pushy.

His eyes glaze over as they scan the page, and he drops back into his seat.

He won't understand the jargon and terminology describing the findings and what we will do with them, but I need a second to compartmentalize the other facets of my life. My mind is one hundred percent elsewhere.

What is Kline trying to do?

I sneak a peek and find Dax watching me. He fights a smile but loses the battle as he pulls his lower lip between his teeth and relaxes against the wall.

It's unnerving.

"Scans? Blood work? Treatment?" I cross my arms over my chest and mimic his posture. "After all the phone calls, nothing?"

I wait for his response, trying to hide my irritation. I have things to do and people to see.

His eyes drop to the chart, and I allow myself a moment to take in all six feet of him. He's quite the distraction. A collection of tattoos winds up his right arm and disappears under the sleeve of his fitted black tee. A cherub, roses, a couple of butterflies.

Interesting.

A trace of stubble covers his chiseled jaw, and a smile plays at the corner of his mouth. My eyes fly to his, and I feel a heat rush up my neck the second I realize I'm caught.

"Is this why he needs you?" His tone is a little rude and to the point. He leans forward, positioning the file in front of me as he points at the page, concern and confusion wrinkling his brow. He pulls his full lower lip between his teeth and stares at me as he waits for my response.

His question pulls me from my assessment of him, and I grimace. What is wrong with me? Blood drains from my face. I can't believe I'm not paying attention. "I'm sorry, what?" My words come out more apprehensive than I intended. I grab hold of the edge of the counter, trying to steady the tremor in my hands. Coffee on an empty stomach—that's what I'll blame.

He stands, stuffing his hands into his pockets. "You're the specialist. You know how to treat this, right?" He leans closer, our shoulders brushing, and points at the bottom of the page.

"Yes." My voice is confident and assured, one hundred percent opposite of how I feel about treating his brother, which is precisely why I'm going to refer him. My skin prickles where his body grazes mine, and I pull away, swallowing. It doesn't seem to affect him, the zing of electricity emanating from where our bodies touched. I try to stay focused on the chart, but I can't help watching him out of the corner of my eye.

"What's next? Why did he need to come here? Does he need more tests? Does he need special treatment? Is he going to be okay?" He grabs the bill of his hat and readjusts it, hiding his face from view.

There's no way to sugarcoat it. And it's not wise to go into details without Liam present. He mentioned wanting to know what to expect, but this is an instance where it's best if he's not alone. I can afford the time to explain what to expect and pass Liam on as planned.

"We can discuss more when Liam returns." I glance at my watch.

"You didn't answer my questions." Frustration flares in his dusky blue eyes.

"I'm sure he'll be back soon." I take the file from him and situate some paperwork inside.

"He needs you." Was there a crack in his voice at the end of his words? My heart jumps at the urgency in his tone.

"I understand where you're coming from." He doesn't know the half of it. "I assure you, I'll answer your questions before you leave."

"Can you fix this?"

I want to tell him what he wants to hear, but I don't lie. I am, if nothing else, a woman of my word. "I will do everything in my power to make sure your brother has the best care."

"Is that a yes?" His brow pinches together, and his lips fall into a straight line. "You're top-ranked, the best," he adds, exhibiting more confidence in me than I feel at the moment.

My heart whirs like an overheating laptop, and I stare at my crossed arms, trying to decide if now is when I should explain the complexity of the case and how Liam will need to be referred because of his age or if I should wait.

Our eyes meet, and all his resolve slips away. His eyes convey everything without him speaking a word, taking my silence as his answer.

It's days like this where I second guess becoming an orthopedic oncologist. A mountain of choices, but my brother's path led me here. And, when I'm honest with myself, I wouldn't want it any other way.

"Let's see what's taking so long." I tuck the chart under my arm and motion for him to join me.

"You know what you're doing? You can fix this?" His eyes narrow, and his lips fall into a thin line. The audacity of this man! It's obvious he's accustomed to getting what he wants. But I'm not easily swayed. And It's not like I can predict the future.

"I'm very good at what I do, Mr. Blakely. I'm sure you're aware." My defenses go up, and I clench my jaw from saying anything else. I don't know why he's questioning my competency, but he's not going to get the response he's looking for with that attitude.

His eyes soften as he reaches for me, pauses for a half-second, and slides his fingers into my palm before squeezing. I'm caught off guard. A jolt of electricity surges up my arm as I yank my hand away.

"Please," he begs, and my heart bounces against my ribs like a pinball.

"I . . ." I step away from him, cupping my hand to my chest.

"Please." He squeezes his eyes closed, pinching the bridge of his nose as he drops his head. "I need to know you can fix this."

I swallow the lump in my throat. "Liam will receive the best care possible. I can't promise more than that."

I have seen pain. I have heard pain. I have felt pain.

But very little compares to the agony on Dax's face when his eyes meet mine. "We need you"—he chokes on the words as he flexes his jaw, and a hollowness fills my chest—"to fix this."

I've seen a lot in the years I've been here, but something about his concern for his brother confuses me. The fear in his eyes shadows his laid-back behavior from earlier.

"He's all I have left." It's barely a whisper. A heartbreaking, gut-wrenching whisper.

"Let's see where they are." I walk to the door and open it, my eyes bouncing around the floor in search of Lauren. Dax stays a couple of feet behind me and leans against the doorframe. I have a sneaking suspicion this case isn't going to fit the norm.

"Has he told you anything?" I ask, glancing over my shoulder as I reach for the handle.

He shakes his head. "Everything I've found out is from Google. Liam mentioned the bone cancer, but I don't know the specifics."

Liam has to know why he needs to come here. I don't get patients who show up out of the blue without an inkling of what to expect. Something tells me Liam hasn't been upfront with Dax about what's going on, but it's not my place to give him information since it seems like Liam is keeping him in the dark.

Dax takes the lead once we make our way into the waiting room. Lauren stands from behind the counter, her expression questioning why I'm out here.

"Have you seen Liam?" I ask.

"He's not back?" Confusion fills her eyes.

Dax detects the edge of her tone as his eyes bounce around the oncology floor. "Where are the restrooms?"

Lauren points as the door opens, and Liam steps out, wringing his hand around a paper towel, his phone pressed between his ear and shoulder. "We're still good. Need a ride?" He sees Dax and nods at him with a smirk.

I guide the brothers back into the room, trying to avoid eavesdropping on their conversation.

"Crissy wants to know if we can give her a ride on Friday." Liam cups his hand over the mouthpiece of his phone.

"Sure. Let's focus on this first, okay?"

Liam hops up on the exam table and ends his call as Dax takes the seat near the wall. I consider standing, but when I glance in Dax's direction, I decide to take a different approach. I drop onto the rolling chair and open Liam's folder. The sooner I can get this over with, the better.

The air is heavy, and the silence awkward. I wipe my sweaty palms on my pants and clear my throat, glancing up when I sense eyes on me. Liam is scowling and redirects his attention to the chart in my hands. I try not to appear cold but need to get this over with.

I pull out a couple of stapled papers. "Here are the CT findings."

"And?" Liam leans forward, resting both elbows on his knees.

"How are you feeling?"

He throws his hands in the air with a grin. "I don't want to wait. Get it over with and tell me I'm dying already."

"Mr. Blakely." I snort a derisive laugh.

"That's him," he points to Dax. "I'm just Liam." He gives me a humorless smile, and embarrassment colors his cheeks.

I slide his chart toward him and point at the diagnosis. His eyes scan the page.

"Okay, Liam . Ewing Sarcoma. It's a rare and highly metastatic bone cancer. Have you heard of it before?"

He nods.

Dax receives the bad news with stoic composure. The color drains from his face as his eyes meet Liam's, and there's a silent exchange between them.

Something about their interaction makes me feel like Liam didn't want to fill Dax in on the worst parts. Dr. Gibbons would have told Liam what to expect. Maybe he didn't want to have to deal with the fallout of handling his brother's emotions alone.

"Usually, someone between ten and sixteen gets this diagnosis. It's not unheard of to find it in someone your age or older, but less common. Your doctor's note mentions you've had more frequent soccer practices?"

"Yeah, we went to two-a-days a couple of weeks ago."

I point at the calendar on the wall. "The middle of April?"

Liam confirms my question by leaning over the edge of the exam table and tapping on the calendar on the wall: the third Monday of the month.

There's a tug in my chest, and I have a strong urge to peek at Dax.

I give in to the impulse.

I wish I hadn't.

His eyes are closed, his face an unreadable mask as he absorbs everything I say without a word. Liam follows my gaze and places a hand on Dax's forearm.

Watching Liam's touch soothe his brother brings back memories I've kept buried for years. I brush them off, categorizing them into the tiny compartments in my brain like I do all the things I don't want to deal with and move on.

"This is most often diagnosed after a sports injury." Discussing this specific cancer is second nature, even though most of my patients are much younger, and the words roll off my tongue.

"Figures. I assumed I was sore from the extra training. It's my luck it's something serious."

Liam sits straighter after glancing at Dax and the frown that settles on his lips. I'm pretty good at recognizing family dynamics, but theirs has me second-guessing myself. There's a strong need for Dax to protect Liam, which has me questioning their situation and lack of parents. I could ask, but it's not my place.

"We would start with chemotherapy in treatment cycles, which necessitates surgical placement of a portal here." I point at the right side of my chest. "Monday through Thursday, one week on, one week off, for four weeks of chemo treatment, eight weeks in total. Each period of treatment and rest is one cycle. You'll have four cycles. If chemo is unsuccessful, surgery is an option. We could also look into radiation."

"He has to do chemo?" Dax grabs the trashcan and stands, walking it back to where I grabbed it from before setting it on the ground near his feet and crossing his arms over his chest. He shakes his head and shoots a petulant glance toward Liam.

"We're going to do a secondary CT scan to see how progressed this is and if it has metastasized in other locations first. Depending on the size of the lesion, we could consider experimental treatments, but I've found chemotherapy is the best place to start." If I learned nothing else from Collins's case, it's to play things safe and not risk trying to hurry things along. "Surgery would get any remnants after chemo, and we hardly ever need to proceed with radiation. At the midpoint of chemotherapy, we want a follow-up CT to determine if the lesion has shrunk."

"What's the likelihood of that?" Liam asks. His question is nothing I didn't expect, but I'm so focused on Dax's tight-lipped, sullen posture from near the door that I'm not paying Liam any attention.

"Of it shrinking?"

"Yeah."

I shrug, realizing too late that a non-committal body movement is not the best way to respond. "It depends on the initial size. With the original CT findings, I would suggest we start chemo to see if we can forgo the need for surgery altogether. There's a slim chance this has changed in the last three weeks since the initial scan, but it's not likely."

"Am I gonna lose all this?" He pulls his hat from his head and runs his hand through thick, golden-brown hair.

"Yes. And you'll lose some weight too." I try not to sound sterile, but it's second nature, and I lean into it because I need it like armor.

Dax stares off without a flicker of emotion on his face, his eyes focused and unblinking. The subtle clenching of his jaw is the only indication that this is affecting him. He wrenches open the door and steps outside. "I need air."