Derek was not used to being on this side of things. He was used to being the one to deliver news about patient, to being the one to tell a family that their loved one was going to need to undergo surgery. He wasn't used to waiting and knowing that there was bad news coming. They had only been sitting in the small room for about ten minutes but it felt like ten hours as they waited for Arizona to
come and tell them what was going to happen with Ava.
"I wonder what's taking so long." Derek stood up, pacing the small space of Arizona Robbins' office.
"She said she was going to get Ava settled with the nurse." Meredith replied. They were going to run a few more tests on Ava while Arizona spoke to them.
"It shouldn't be taking this long."
"I told her after we would pick up a barbie or something...since she has to get more blood taken."
"If she doesn't have to stay here." Derek breathed.
"If she has to stay here over night I refuse to leave her."
"Me too."
"Hey guys...sorry to keep you waiting." Arizona walked in, pushing her blonde hair to the side before sitting down at the large desk. "Ava is winning over the hearts of everybody here. She's so cute."
"How is she?" Derek asked quickly.
"She's good...Alex is with her so I think having a lot of familiar faces here will help." Arizona opened a folder.
"Good." He breathed.
"Listen you guys are my friends and I've known Ava since she was five weeks old and I don't...I want all of my patients to be healthy but I am not every going to give up on Ava. I won't let you go back to Seattle without a healthy little girl." Arizona added.
"Which means..." Derek whispered, ready for the worst.
"Ava's Leukemia is still considered Low risk...that being said she's right on the line. The cancer has spread but I have faith we can remove the cancer from her stomach." Arizona replied. "She has a lump on her neck that is small and I may have to biopsy but I want to see how it reacts to chemo since it doesn't appear to be active."
"It spread." Meredith murmured.
"Only to two places...which is good news." Arizona told them.
"Derek and I want to know her treatment options. We're doctors but somehow...it feels like...we just want to know what you think."
"The first step is going to be removing the mass in her stomach. Once we do that, she can begin chemo."
"And you're going to be putting in an intravenous catheter?" Meredith swallowed.
"During the stomach surgery, yes." Arizona nodded. "That way she won't need an additional surgery."
"Okay..." Meredith looked over at her husband.
"When will that be...the stomach surgery?" Derek asked.
"I'd like to do it the day after tomorrow...six in the morning."
"Oh...wow." He breathed.
"And depending on how she does she can go home on Friday."
"She'll be in the hospital for three days?" Meredith frowned.
"It's an extensive surgery and we want to make sure there are no complications." Arizona told them.
"And you'll be performing the surgery yourself?" Derek questioned.
"Alex will be assisting but I will be heading the surgery."
"And the chemo?"
"We'll discuss that after the surgery." Arizona added. "I want her to heal as much as the possible before we start the chemo."
"Right." Derek nodded.
"But it will happen pretty quickly after."
"So she can come home tonight." He breathed, squeezing Meredith's hand.
"She can come home tonight." Arizona nodded.
"That's a relief." Derek laughed weakly.
"We want to make sure she gets as much rest as possible before the surgery. It will make recovery easier and she can start the chemo sooner the faster she recovers." Arizona instructed.
"So we'll make sure she relaxes." Meredith nodded.
"As much as she can." Arizona nodded.
"Is there anything we can do for the stomach pain and nausea?" Derek asked the doctor. He wanted to make sure Ava was as comfortable as possible.
"I will have the nurse give you the prescription so she can have something for nausea. I'll also have her give you the instructions for the night before her surgery."
"No food or drink after midnight...we know."
"We're also going to set her up with a rehabilitation therapist, we'll introduce you to her oncologist and she'll have several other specialists throughout the treatment." Arizona sighed.
"Rehabilitation?" Derek frowned.
"Chemo can cause some delayed growth as well as some cognitive issues." Arizona explained. "She may have some issues with simple tasks later on especially if we mix radiation into her therapy which is more than likely."
"Arizona..."
"It's unlikely that Ava will experience something so harsh but we have to be prepared. She's only five...a very small five...and the harsh drugs can have tough effects."
"What are her chances?" Derek looked up.
"We're going to do everything we can." Arizona answered.
"Is there a percentage?" Meredith asked.
"The overall cure rate for Pediatric Acute Lymphoblastic Leukemia is eighty percent." Arizona added.
"Eighty percent." Derek repeated out loud.
"If it reoccurs within four years once there is a sixty five percent chance."
"Oh my god..."
"But those are good chances." Meredith squeezed his hand. "We tell patients these numbers every day."
"She has a very good chance." Arizona tried to reassure them. "While it's spread...it's not in any vital organs which is excellent news. And the sooner we can start treatment the better. But that being said, we don't want her to go into the chemo still weak from the surgery because it will be harder on her."
"It's going to be a long road." Meredith whispered.
"It is. But she has a great team here and wonderful parents to get her through it." Arizona smiled sympathetically.
"Is there anything else we should know?" Derek asked.
"Seeing Ava go through this is going to be one of the hardest things you will experience. She's going to be horribly ill some days, she's not going to be the same Ava every day. Some days will be harder than others."
"It...we're doctors we see hard stuff all the time." Meredith replied.
"But this is your child." Arizona reminded them.
"I just...I have one request." Derek breathed.
"Yes?" Arizona looked up.
"Be honest with us...about what's going on. I...no sugar coating."
"It's going to be a tough road."
"Thank you."
"We'll let you sit with her and get her changed for her surgery and then we'll let you wait with her until its time for her to go back. Alex and I will be by her side the moment she leaves you guys." Arizona added. "Then once she's in recovery we'll come get you guys."
"How long is the surgery going to be?" He asked.
"I would guess somewhere about two hours but we won't know for sure until we get in there and see just where the mass is exactly."
"Okay." Derek nodded.
"She's going to have to fight and we're all going to have to help her through it." Arizona replied.
"Is there anything else that we can do to prepare?"
"Just don't ahead of yourselves." Arizona told them. "This is going to be a step by step process and we're just going to have to take it one day at a time."
"Got it." Meredith breathed.
"Take her home and spend some time with your family."
"Okay." Meredith nodded/
"Call me if you have any questions at all." Arizona stood up. "We're going to get her through this."
"Thank you." Derek breathed.
"Thank you Arizona."
"Take care."
"You too." Meredith breathed as Arizona left the room. Her hand moved from Derek's to wipe the hair from her face.
"I...I don't know what to say." Derek whispered.
"Mark Lexie and Amelia are coming over tonight." Meredith stood, reaching for her purse. "We should go get Ava."
"Yeah..."
"We just...we should go..."
"She needs to rest."
"She does."
"We can go to the toy store." He breathed.
"We can stop on the way home." Meredith replied, not wanting to spend another moment in this office.
"Let's go,." Derek reached for her hand again.
"Okay." Meredith kissed his cheek softly before they left the room. In a few days they would allow someone to cut into their child and even though they were trying to save her life, Meredith hated the idea. Ava was a little girl and there were things that just were not supposed to happen to a child. At five, Ava shouldn't even know what cancer is.