Chapter 32: Five Years to Zero

While Bucky took to working more fervently on his autobiography, Steve decided to take on a project of his own. A secret project. As far as Bucky knew, Steve just worked on random sketches every evening. In actuality, he had a very specific plan for these particular drawings, and he only had three to five years to get them done.

By the end of his course of higher dose steroids, his PFTs stayed the same. Steve didn't expect them to miraculously shoot back up to his baseline, but it still hurt to see it on paper and know that he could never go back. He'd spent years barely able to breathe without coughing, so starved for oxygen that he could barely walk across a room without growing lightheaded. Steve didn't want to go back there, but he had no say in the matter. They put him on a new standard anti-rejection dose, slightly higher than the one before, in the hopes it would give him as much time as possible. Thankfully, his roid rage faded. He hated how high-dose steroids stripped away his ability to regulate his emotions. The number of times he'd snapped at Bucky in the past six weeks for something completely unwarranted was far higher than he even wanted to consider.

They visited their parents after Bucky's three-month surgical follow-up, in which he was cleared for soccer and instructed to continue PT. By now, his chest visibly twitched in different spots with each nerve activation, but it could take up to a year for him to reach peak reinnervation. Steve was reminded of the time his mom found his advance directive sitting on the kitchen table, and was glad he was able to break the news kindlier this time. It gutted him to sit in front of them, his mother's wall of family photos in full view, and tell them how little time they had left as a family. Both his and Bucky's mom cried. His dad did too, though Steve didn't think anybody saw it but him. He spent the next twenty minutes sandwiched between the two women, wondering how to tell them it was all going to be okay when they all knew it wasn't.

Steve thought that would be the hardest part, but as Bucky reminded him, he still had to tell the Avengers. After much discussion, they decided to break the news on Steve's birthday, when all their friends gathered at the house to celebrate. Steve wanted to get it all out in one breath, instead of psyching himself up over and over again to devastate friend after friend with what he had to say. He and Bucky deliberated all morning about when to share as they set up the yard and the house. Ultimately, they decided to do it as soon as everyone arrived so they'd have time to digest it, talk to Steve, discuss among each other, or whatever they needed before settling in to eat and then watch the movie. But with every person he greeted at the door, Steve's heart ratcheted another notch up his throat. How was he supposed to stand up in front of all these people and announce he was dying again? Each and every one of them bubbled over with joy being here all together, and he was about to suck all that away.

Jim, Timmy, and Gabe were the last to show. Once they joined the horde in the backyard, Bucky dragged Steve over to stand on the step below the back door. Nobody noticed them, so Bucky cleared his throat and called loudly enough to be heard over several conversations, "Excuse me!" Two dozen heads turned to listen to him. Steve's palms started sweating.

"Thank you all for coming," he began. "You have no idea how grateful we are that we're all able to be here together every year."

"Thanks for hosting!" Tony called. Steve's gaze darted to him, where he stood between Parker and Bruce. He bit his lip, dreading the impending moment when that excitement turned to sorrow.

"Anyway, Steve and I have something we need to share with you all."

Steve gulped and felt the lump in his throat sink into his lungs. Bucky's preamble had rendered the crowd apprehensive, but Steve doubted they expected him to share anything this monumental. He wiped his palm on the side of his Yankee Doodle Dandy shirt and reached out to hold Bucky's hand beside him—he always made sure to stand himself on Bucky's right side when they were together. Bucky gave his hand a reassuring squeeze. "As you all know, the only reason I'm even here to celebrate this birthday is because a stranger donated their lungs. That gift has given me more than I ever could have dreamed, but it's…not a permanent solution." As the words left his mouth, he saw eyebrows furrow and mouths drop open ever so slightly as their guests began to foresee where he was going. He focused on a patch of grass between Monica and Wanda so he didn't have to see anybody's face fall when he finally said the condemning words.

"In April, I was diagnosed with BOS, or bronchiolitis obliterans syndrome. It's…it's a form of chronic rejection, and…it usually proves fatal in three to five years."

There. He said it. Steve listed towards Bucky and dropped his head to stare at his own feet, unable to bear watching anybody's reaction. No tears came, but he began to shudder. Bucky tore his hand from Steve's grasp to wrap it around his trembling shoulders. Seconds later, another pair of arms encircled him from the other side. Then another. And another. Eventually the entire party had surrounded him in a massive embrace. He heard not a single sniffle or sob, and the tension drained from his back and shoulders like air from a tire. His shudders ceased. In this moment, he understood them. They would save their breakdowns or their outbursts for later. Here, in front of him, they displayed nothing but strength and sympathy.

One by one, they splintered off again and got the party going. Nobody spoke a word of Steve's news for the rest of the afternoon, but after the movie, as they began to trickle out and say goodbye, he heard more "I love you"s than he'd ever heard in a single evening. They didn't all use those exact words, but he gleaned the meaning from their lingering hugs and whispered well-wishes.

~0~

A few weeks after his birthday, he returned to Gravesen for transplant and CF clinic. They did a basic post-transplant work-up every three months to monitor his PFTs and anti-rejection med levels, but once a year they did more thorough testing. What that meant for Steve was waking up at the crack of dawn to get to Gravesen before seven thirty, when he normally took his morning meds, so they could get a blood sample from him before that dose. It also meant no breakfast so they could compare his fasting blood sugar against all the later values for his oral glucose tolerance test. Needless to say, Steve didn't particularly enjoy these yearly appointments. At least Bucky accompanied him this time. They always scheduled his oncology check-ups on the same day as Steve's appointment. This way, they saved time, and compressed all their stress into the same day instead of drawing it out over multiple.

The night before, he packed snacks, his pill case, his transplant binder, and a book for the inevitable long wait times. Bucky and he parted ways in the lobby and headed to their respective areas of the hospital. Fortunately, they started with Steve almost as soon as he arrived. He had his basic vitals taken and weight recorded, then got sent straight to the lab for bloodwork. They chose a vein in his right arm this time, which annoyed him. With all the tests they ran, including blood glucose, anti-rejection levels, vitamin levels, white blood cell count, and liver function, they needed many vials and it took forever, but he wasn't very adept at using his phone left-handed. Instead, he just watched the blood leak from his vein and politely kept up a conversation with the nurse. Afterwards, he drank down the glucose syrup, which still tasted as awful as it had fifteen years ago. The nurse left the cannula in his arm for the four more samples they'd take over the next two hours, and sent him off for PFTs.

PFTs always terrified him. Now more than ever because he knew to expect a decline that at least somewhat matched what he recorded in his twice daily lung function tests. In the two years before his transplant, the tests had practically traumatized him, because his lungs had been so beat that blowing a PFT left him lightheaded and coughing harshly for twenty minutes. After the surgery, they'd become downright easy. At his peak, his PFT was higher than any value his doctors had ever seen. He'd done this so many times before that he didn't even need the technician's guidance to know what to do. Steve popped on the nose clip and put the device in his mouth. He took a few normal breaths first, then inhaled as massively as possible before exhaling with as much force and for as long as he could.

The value came back at one hundred percent. It should've satisfied him. For the majority of his life he could only dream of a PFT of one hundred. But after transplant he'd gotten up to one hundred twenty-five. That put him at twenty five percent below baseline. His last PFT, only three months ago, had been one hundred five, meaning he'd lost an entire five percent in that time. At this rate, he'd be down to zero in just five years. And from personal experience, he knew that anything below forty didn't lend itself to a great quality of life.

They took his thirty-minute post-glucose syrup blood sample, then he got a chest x-ray, then back for one-hour post-glucose syrup sample. With no more short tests to run between samples, they made him just sit and wait between blood draws. At the two-hour mark, they took the last sample and pulled the IV, leaving him with a gauze pad taped to the crook of his elbow. Last but not least, he got a DEXA scan. Long-term use of steroids could cause osteoporosis, so they checked his bone density every year. The scan required the least effort on his part, but he found it the most annoying.

The first time he had one, six months after transplant, his respect for Bucky magnified tenfold. He failed to understand how anyone could stay still for upwards of an hour on such an uncomfortable table, as Bucky did for his bone scans. Steve barely lasted the thirty minutes it took for a DEXA. When he got called back, he clambered onto the x-ray table and rested his head on the world's most uncomfortable pillow. In order to get the proper view of his pelvis and spine, they positioned his lower legs atop a box about a foot high. To avoid thinking about the awkwardness of this position or the possibility of his bones degrading within him, Steve took his mind elsewhere. He began daydreaming about the project he'd started while Bucky worked on his autobiography. The next thing he knew, the imaging arm had made its way from his feet to his skull and the scan was finished. Steve practically leapt off the table and texted Bucky on his way to the waiting room. It could take anywhere from thirty minutes to two hours for his doctors to go over his scan results and call him in to discuss them. Bloodwork would take longer; he'd get to see those results a few days from now.

"How's it going?" he asked him.

"Waiting for tracer to settle," Bucky texted back. "They said if next year's bone scan and echo are clean we can ease back to every two years."

"That's great!"

"But I'd still have to do blood and urine tests every year."

"Take what you can get."

"Absolutely. How about you?"

"All scans and tests are done. Just waiting to talk over results."

"How was dexa?"

"Uncomfortable as always. I don't know how you manage hour long bone scans."

"I take a nap."

"Wish I could do that."

"I get to lie flat for mine. Doubt I could sleep with my knees up like that."

"It's not a particularly comfortable position. Makes my toes cold because all the blood rushes out of them."

"At least you get to keep your normal clothes on. They always make me change into a gown."

"Ugh. That sucks."

"I have to specially request the ones that tie behind the neck and not just the back. Otherwise it just falls off my left side."

"Sounds annoying."

"It is."

Steve got called back half an hour later. "The Chat" lasted nearly forty minutes, but he really only remembered the highlights—well, some of them were more like lowlights. Steve had no clue how to read chest x-rays, but apparently the first indications of BOS were now visible on his. Last appointment, it hadn't really shown up. Steve already knew his prognosis, but seeing these physical signs of it really hammered it home. In good news, his glucose tolerance was still normal, that much of the bloodwork they could run within the span of a single appointment. However, his DEXA scan indicated osteopenia, or low bone mass not quite severe enough to be considered osteoporosis. The steroids he took every day just to survive with his functioning lungs in his chest were eating away at his bone density. To prevent it from advancing further, his doctor prescribed additional vitamin D supplement and told him to do more strength training as opposed to cardio.

"Based on what you've seen so far, between last appointment and this one, how long before the BOS kills me?" he asked matter-of-factly. When talking to doctors, Steve never sugarcoated, and he expected the same from them.

"Two data points is not enough to establish a trend, so I'm afraid I can't confidently estimate that right now. The best I can give you is the median survival for BOS in general, which is three to five years."

"Okay."

"Anything else?"

"No, I think that's everything. Thank you."

"You're welcome."

Steve hoped Bucky had overall better news to share than he did.

~0~

Bucky sat for half an hour with a heat pack in his elbow, and it still took them three tries to get an IV in him. At least three was better than seven. While the tracer pumped through his veins and settled in his bones, he worked on his autobiography. He currently faced the question of how much detail to go into for all the cancer stuff. Bucky didn't want to gloss over the horrific stuff, but he also didn't want to scare people away with too graphic a description. In the time it took for the tracer to finish, he actually got a decent amount done. And, because he and Steve had woken up obscenely early to get here on time, he napped almost the entirety of the actual bone scan. The echo, on the other hand, was another story.

When he walked into the darkened room, he suddenly remembered how atrocious last year's had been. For most of the scan, they needed him on his left side, which put a ton of pressure on the sensitive spot which he now knew had been a neuroma. It had taken everything in him not to just start crying or screaming. Hopefully, now that the tumor had been removed and his nerve endings were now on the front side of his chest rather than the side, it wouldn't hurt quite as badly.

He was right, sort of. Lying down didn't really exacerbate his phantom pain, but the ultrasound probe did. The tech ran it right under his new scar, over where his nerve endings now sat. Bucky clenched his teeth and pretended to be anywhere else. When it was over, he decided that was definitely a strong contender for worst forty-five minutes of his life. At least it marked the end of his exams for this year. He waited an hour before he was called back to discuss scan results: all clear. Bucky could breathe again, for the next year. No matter how far out he got, scanxiety still haunted him.

He and Steve finished within thirty minutes of each other and reunited in the lobby. Bucky glanced up to the second floor, remembering the time Carol launched a football at Dr. Lee and earned a sandwich for her trouble. "Want to visit our old second home?" Steve asked.

"Can we do that? Don't you need a visitor's pass?"

Steve waved his hand. "Nah. I'm practically the mascot. Besides, Happy knows our faces, so he won't sound the alarm."

"If you say so."

They took the stairs, at Steve's insistence. The wave of nostalgia that hit him smelled of antiseptic and felt warm and frigid all at the same time. They passed the poor, underused kitchen, although based on the rich aroma drifting into the hallway it wasn't underused at that moment, and almost immediately afterwards ran into Heimdall.

"What are you doing back here?" he asked, though his tone held no accusation.

"Just visiting, for old time's sake," Steve said.

"Okay. I'll let Sharon and Happy know you're here; they'll want to say hello."

"What about Peggy and Maria?" Bucky asked.

"Maria's not on shift today. And Peggy retrained. She works as a visit nurse for hospice care."

"Oh wow, good for her."

Heimdall nodded. "Glad to see you two looking so well," he said before heading back to the central desk. Bucky and Steve headed into the common room. The first thing Bucky noticed was the size of the gauntlet. It had been almost exactly ten years since its creation, and in that time, it had grown to take up nearly half the wall. He walked up to it and scanned the list of names scrawled in the handwriting of dozens, maybe hundreds, of other patients. Steve instead directed his focus to another wall, one that had remained mostly empty during their tenure here. Now, it was covered in drawings.

"Bucky, come look at this," he called. Bucky wandered over and looked at the particular drawing Steve pointed out. It contained two childish stick figures, one missing an arm and the other missing a leg. He wouldn't have thought much of it if it weren't for the net behind the one-armed figured and the ball by the foot of the other.

"Do you think that's me?" he asked.

"It could be. I'm not sure if you know this, but you are pretty famous. Maybe this was made by a cancer patient who also plays soccer."

"Maybe."

Bucky found another drawing, more advanced than the soccer one, with a familiar figure sitting backwards on a chair. "Hey, I think this one's you."

Steve choked on a snort. "Oh my God, you're right. That must be from the video."

"Looks like your Wish accomplished exactly what you wanted it to."

"Looks like it did. And I love this new tradition of having a drawing wall."

"Me too. It's nice to see that the new patients are keeping our old ways but also building their own."

"Yeah."

The floor was clearly very busy, because Happy and Sharon only popped their heads in for a few seconds before bustling off. Bucky was glad they at least got to see them. A few moments later, a small child cautiously wandered in and stopped in his tracks when he saw the two men looking at the wall of drawings. Bucky noticed him first and turned to say hello. The kid said nothing in return. He was staring at Steve like a child might stare at a mall Santa. Steve turned and smiled at him.

"You're a lot bigger in person," the kid remarked.

"Am I?" Steve asked.

The kid nodded. "And you don't have this." He pointed to his upper lip.

"No. I don't need that anymore; I got better," Steve explained. Bucky chose not to think about how he would inevitably get worse again and go back to needing oxygen.

"What are you doing here if you're all better?"

"I came here for a check-up to make sure I'm still all better, and I decided to come up here and visit this place."

"Oh, okay." The kid paused before asking, "Can I have a hug?"

"Sure." Steve took a few steps closer and knelt down. The kid threw his arms around Steve's neck and held on tightly. Bucky surreptitiously took a picture.

"Thank you," the kid said.

"You're welcome. I hope you get better soon, too."

"Thanks. Bye!" He dove out the door and scampered down the hall. Steve stood up and turned back to Bucky.

"That felt really good," he said.

"I'll bet it did. Want to go home now?" he asked. As much as he appreciated this trip down memory lane, he didn't want to spend any more time in this hospital if he could help it.

"Yeah."