Max rolled Fran up to the check-in desk and the man scanned their bracelets, then directed them over to the small waiting area. A group of people were sitting along the wall, so Max parked Fran beside a chair and sat next to her. They both glanced at the other people quickly, and smiled softly- acknowledging their presence. Fran took Max's hand and they waited in the quiet. Max looked at her hand and stroked it, trying to settle her for the meeting that was to come. But he felt that action may have actually been settling him more than her.
"Hello again!" A familiar voice rang behind them. They both turned around to see the nurse from that morning coming towards them. "Are you ready? Come on and follow me this way, we'll see if we can get that IV out of you."
Max jumped up and hurried around the wheelchair to grab a hold of the handles to push Fran after the nurse. They followed her into the same room where she had her vitals taken that morning, and began the same process all over again. The nurse took her blood pressure and then her temperature and smiled.
"No more fever! That's fantastic!" Fran looked over at Max and they both looked like they were about to cheer.
"That's wonderful, darling!" Max said.
"I thought I wasn't feeling warm anymore!" Max squeezed her hand and caressed her back.
"Now, if you two can hang on one minute, I'm going to let the doctor know and get the approval to take out your IV." The nurse stepped out of the room, shutting the door behind her.
Max leaned towards Fran and they kissed each other, both feeling a little relief. That was one piece of good news- they wouldn't have to stay longer for her to have another IV bag.
"I'm happy the fever's gone," Max said, kissing her again.
"Me too. For both our sakes."
The nurse Tracy came back into the room, smiling. "Guess what?" She said, in a sing-song voice. "The IV is coming out!"
Fran sighed and sat back in the wheelchair, and Max took a deep breath and exhaled. He smiled. Fran pulled her sleeve up more to get it out of the way. The nurse stepped over and fiddled with the tube, shutting off the valve that let the bag drip. She got a cotton ball and a bandaid and peeled the tape from Fran's arm, then pressed the cotton ball against where the needle would be coming out. She held it, then slowly pulled the needle free.
"Can you hold down on that for me a sec?" She asked Fran. Fran pushed down on the cotton ball and the nurse set down the IV needle on a tray, then took the bandaid and put it over the cotton ball, sticking it to Fran's forearm. Fran pulled down her sleeve. The nurse disposed of everything and led them down the hall to the doctor's office. There was a large desk, five or six visitor chairs, and light boxes and large computer screens on the wall and on the doctor's desk near the wall, obviously there to show images to visitors in the office. Max parked the wheelchair on the end of the visitor chairs and Fran got up, wanting to sit in a regular chair next to Max.
"Can you get that envelope? So we can have our questions." Fran said to Max.
"Oh, glad you remembered that," he said, reaching into the pouch on the back of the wheelchair and sliding out the envelope that held the hospital papers and the sheet of questions they had written out. Max handed the envelope to Fran and sat down next to her. He took her hand and she leaned up against him. "How are you?" He asked her.
"Okay, I suppose. Let's do this." She said firmly, straightening up in her chair. Just then they heard someone coming down the hallway, and both looked toward the doorway. Dr. Carter appeared in it, hands full of papers and folders.
"Hello," he said, smiling, then shut the door behind him. He shook their hands again and walked around to sit at his chair at his desk. He made several stacks from the papers and moved a scribbled-on piece of paper in front of him. Their stomachs clenched as they waited for him to begin speaking. "So, Fran- may I call you Fran?"
"Of course," she responded.
"Fran," he smiled. "How are you feeling right now?"
"Well, a lot better than this morning. Not warm anymore. Not wobbly. I walked around a little while - holding on to the wheelchair," Fran gestured towards the wheelchair beside her. Max gave a nervous laugh.
"I didn't want her to walk without holding on to something," he said softly.
"Well, that's good to keep an eye on her. I have a feeling she might be pretty headstrong when she feels good," the doctor grinned. "I see that a lot here."
"Fran laughed. "I'm usually the one telling him what to do. But it's good to have someone looking out for me, I know he worries," she squeezed Max's hand.
"That's something I like to see too- that you have someone to lean on. Everyone needs that, especially when they have hurdles to clear." Fran gulped, and so did Max. "Now, without dragging this out and giving you both ulcers- let's get right to it. Fran, when you were admitted to the hospital when you came here before, once we determined what was going on and what likely was going to need to happen for you, we got you on the books for surgery and a pre-surgical meeting. We were pretty certain that the kind of tumor you have is a fast growing one, and we didn't want to wait for further testing to begin looking into getting a surgical date for you. We booked you in for surgery next Monday morning. A week from today." He let that sink in for a moment. "Which means your pre-surgical meeting is set for this Friday morning, at 10am. At that meeting, you can bring any other family members or friends you would like, but they need to be able to fit in here. We have four other chairs, as you can see, so any more than that would have to stand, so I wouldn't recommend any more than one or two standing, alright?" He looked at Fran and Max. Max looked at Fran, and she looked at him. Their hands clenched each other's.
The doctor continued. "So, let me address why today I don't recommend pushing the surgery date back. With the fevers you are continuing to get, and fairly frequently, it tells us that your system is sort of going into overdrive trying to protect itself. I ordered the ultrasound this morning to be on the safe side- to check that nothing had changed drastically with he tumor- primarily that it hadn't ruptured somehow. Before anything else happened, I needed to know that. Once the ultrasound tech confirmed that the tumor still appears intact, we moved on to the scheduled testing and got you on the IV to get some fluids in you. Having as high of a fever as you had can deplete you fast, and you may not be able to get enough water down to replenish it- especially when you are so out of it, unconscious or delirious or otherwise. The other part of the ultrasound that I wanted to know was that the measurements made on this scan correlated with your first one- that it would show us if there were any changes. Most of the time we couldn't expect much of a change in such a short time period, but knowing that your tumor may be of a type that grows rapidly- that would be confirmed when we compared the two scans. Well, Fran, I need to tell you that it was confirmed. There was definitely a change in size for your tumor. It has gotten larger. But thankfully, to the best of our determination, the wall that your body has built around it remains intact, we don't see any thin areas or anything that looks like it could leak tumor cells into the rest of your abdomen. That alone makes me feel better. We also confirmed that with the MRIs you had- we don't have any evidence that the tumor is compromised and no evidence of other tumors in your abdomen.
"So, we want this surgery to happen ASAP, because any increase in size means a larger incision to remove it, and the higher risk that it may start affecting the integrity not only of itself, but of your small intestine, which it is attached to. We can't let it get to that point. If we waited a month before surgery- that could be too late. Let me show you something-" he pulled open a drawer and took out a box. He set the small box on the table and opened it. It contained three balls of different sizes in it, and a strange piece of flexible rubber or something similar also in the box. He took out each item and displayed them in a row on the desk. He tapped on the small ball. "This little ball here- this represents what we believe the size of your tumor was around six weeks ago. This second, larger ball is your tumor nearly two weeks ago- a size we are certain of. This third ball- that is your tumor now. Let me set these next to each other." He rolled the two balls together so they could see the size difference. "You can see how much it grew in two weeks. You can also see how much it grew in a month, and you remember the progression of your symptoms. We believe at the moment that you have had this tumor in the neighborhood of about two months." He stopped again as Fran and Max stared at the items on the desk.
"Can I hold them?" Fran asked.
"Absolutely, you'll be able to take these with you. I thought, since you mentioned your son was very interested in all of this, that he might find this sort of thing valuable."
"Absolutely," Max said. He looked at the three small, or not-so-small, balls, in Fran's hands. The largest one really did look like the size of a golf ball. Maybe even slightly larger. Max looked back at the other strange thing on the desk. The doctor picked up on his interest.
"Now, what's this weird thing, I'm sure you're wondering-" he said. Max and Fran both looked back at what he held in his hand. "This is to represent the tissue- the skin and underlying layers that we'll have to get the tumor through. You'll see that there's an incision in here that is an inch long. If you take that smallest ball, you can see it obviously fits through that incision. Now, the other two- not so much. The incision would have to be opened up more to remove those. The intention is to keep the incisions as small as possible- there will be two incisions. The placement of those incisions will be settled on before Friday when you come back in. One, for the camera, will likely be on the inside of your navel, so when it heals it should not be visible at all. But there needs to be one large enough to remove the tumor through, and we'd like to keep it as close to where the tumor is attached as possible. This helps us remove it quickly and without the risk of damaging it or other tissues or organs. We absolutely do not want to risk spreading any cells from within the tumor into your abdomen, whether or not it turns out to be cancerous. Even a benign tumor can recur, and recur in a different place- possibly causing more damage." He stopped and let them think a little bit. He handed Fran the piece of rubber and she held the balls against where the incision had been made. That was a pretty noticeable incision as it was. Hers would likely be longer. She handed everything to Max so he could look at them.
"So," Fran began, "There is a chance it's cancer?" Her voice was a little shaky.
"Yes," the doctor said, matter-of-factly. Max looked up at him, and then at Fran. He set the items back on the desk towards the doctor and put his arm around Fran. "I would like to say at this point it's a 50/50 chance of it going either cancer or benign. We can't know until it's out and at the lab being examined. The next thing that will happen on our end is that the GI surgeon, who should be stopping by any minute, he and I will be meeting with the surgical board on Wednesday and we will discuss our plans for how the surgery will go. They ask questions if they have any, offer alternatives. Basically they are there to make sure every possible complication is considered and help prepare us for making plans in case anything comes up while you are in surgery- you know, like the tumor being connected to areas we weren't expecting and so on. And how we plan to begin the surgery and get access to the tumor, how we will remove it intact. We basically make our plan based on the ultrasound and MRIs, and present our case to them, and tell them why it must take place so quickly. So on Friday, when you come back in, we will give you all those details just so you can mentally prepare yourself, especially with where the incisions will be and what they will be like, and about the recovery process. At the moment the surgery will be an arthroscopic procedure with two incisions, and expect that you will be staying a minimum of one night in the hospital."
"I'll be staying overnight?" Fran asked.
"Yes, and that isn't so much because we're removing a tumor, it is more for caution given where the tumor is- that it's attached to your small intestine. Now, I should clarify- it isn't growing into your intestine- it is attached to the connective tissue that is spread throughout your abdomen and specifically that holds your small intestines in several areas. Most of the small intestine is loose so it can move freely in order to digest, but I'm sure you've noticed that your pains and discomfort stay pretty much in one spot." Fran nodded her head. "There are areas of connective tissue that sort of act like anchors, and that is a factor in how your tumor is holding itself still." Fran nodded again. "Since the tumor is attached to intestinal tissue- the connective tissue around your small intestine, there is always a small risk of the intestine being nicked by an instrument or being injured somehow during the process of surgery and the removal of the tumor. Now that is not likely to happen at all, we do need to let you know that that risk, however small, is still there. The consequence of something like that happening is increased risk of infection and the need for an emergency procedure to repair any damage. But that risk is tiny. That's why we take extra precautions regarding your diet before surgery, to try to make sure everything has moved through your small intestines before the surgery. You will be on a restricted diet this weekend, so if there is anything you've been craving, get it in before Friday."
"So she's fine to have regular food- there isn't any danger of any possible obstruction?" Max asked.
"No, not as far as we can tell. Her discomfort is more likely coming from the tumor itself- there are a lot of nerves nearby that can produce the symptoms se feels just from the tumor growing and being there, then the intestines are like- hey, what are you doing here, get out of here, you're in the way…"
Fran opened up the folded piece of paper their questions were written on. "Is it okay if we ask some questions?"
"Absolutely."
She took a deep breath. "If the surgery goes fine and you get the tumor to the lab, and they determine that it is a malignant tumor, what happens then?" She asked.
"Well, are you meaning like will you need any followup treatment? Like chemotherapy or anything?" Fran nodded. "Well, at the moment, we don't see that as being a necessity. The top hope is that it is benign. We get it out, and you go on your merry way. But you do need to know that you will need to be monitored long term to make sure it doesn't happen again. Since it has happened once- that a tumor formed in your abdomen- that means there is a higher risk of it happening again. You don't want to get another one- there is a chance it could form in a different area and cause worse problems. But that's why we follow up with you and make sure. It isn't certain that would happen, in fact the chances are very slim, but the chance is still there. Now, if it does turn out to be cancer- our top wish is for surgery to go as we plan and for the wall of the tumor to not be compromised in any way. That's why we can't take a biopsy and potentially use other measures to try to shrink the tumor- we can't even risk a needle potentially spreading cancer cells in your abdomen. Not only could another tumor form, but multiple tumors could form. That is the 'hell-no' scenario as we like to call it. That's a big reason for the ultrasound today- because of the high fever we needed to make sure there wasn't some other reason for that. Now, if you had been able to take the medication, you wouldn't have had a fever like that. You could have had a low grade fever that would have persisted even with the medication, but definitely not as high as it was. But we would rather do extra testing to be sure than to just blow it off. We need to know for certain. So, let's play it out that the surgery goes perfectly, tumor is removed and they examine it to be certain there are no breaks in it- even needle-sized ones. Once they can then do a biopsy and examine it, if they determine that it is cancer, then that diagnosis will go in the records. And that would be pretty much it. The only reason for us to want to do something like chemo would be for a risk of cancer cells spread through the abdomen. So imagine if you will that the body is like a car. If a part goes bad, you only want to change out that specific part. You don't want to damage anything else and end up needing to do more work, or have a cascade of failures in other parts. You might also look at chemo like the oil a part might need. If only a tiny part needs oil to fix it, you don't want to dump a bucket of oil all over the engine. Not only might you miss the tiny, hidden part that needed the oil, but you can damage many other parts that are not supposed to get oil all over them. Does that make sense?"
Max and Fran nodded. "It does," Max said.
"So if the surgery fixes that little part, we don't want to do any unnecessary work- or dump a bucket of oil when it won't help matters."
"Now, to be devil's advocate, because I need to know the other side of things- the worst case. If you go in to remove the tumor and find that it has been compromised- what would the plan be afterwards- whether it's benign or malignant?" She asked.
"Well," the doctor rubbed his beard, "If it is a benign tumor and it becomes compromised, once the lab determines the type of cells it is made up of, that would determine the followup, which would likely be a wait-and-see approach. Though there is a possibility new tumors can form, it isn't a certainty. Many factors may need to be at play to get a tumor formation to kick in. A few scattered, singular tumor cells might be killed off by your own immune system. But if they scatter in clusters, that may increase the risk they will multiply faster than your immune system can try to destroy them. So for benign- it would be a watch-and-wait- and monitor. Somewhat long term. But now for the other scenario- if you have a cancerous tumor that becomes compromised, and whether it is a few scattered, singular cancer cells that get spread in your abdomen, or a larger number, or clusters- well, then depending on the type of cancerous cells, it could potentially open up the need for chemo. A lot of folks ask about radiation- we can't do that in this case because with radiation you are targeting a specific point- like a tumor that can't be surgically removed. You want the radiation to shrink it, preferably down to nothing or as close to that as possible. Since yours is a perfect candidate for surgical removal, radiation is not a treatment. But like the engine analogy I gave you earlier, the spread of cancer cells in the body doesn't really work with that comparison. A rapid growth cancer, an aggressive cancer, is something we fight hard. And the type of chemo we might use could vary greatly. It may be a pill you take, it might be IV treatments you have to come in for over and over again. Either way, we don't want any of that. Which is why I can't emphasize enough about how urgent it is we get you in surgery as fast as possible. Ideally I'd even do it right now, but it doesn't meet the criteria for on the spot emergency surgery. I know you might want to get a second opinion, and I have no issue with that, but I can't adequately stress the urgency of your situation, either. If you need to speak with someone else for another opinion, do it now. But remember it can be hard to find someone who has the time to go over everything- especially by Friday. So talk with your family, your friends, everyone. Bring who you need to bring on Friday- even your son if you think it old be valuable to him, and if you think he is mature enough to handle it." The doctor sat back in his chair and went through his small stacks of papers and folders, seeing what he had discussed with them and what he still needed to mention.
"Now," he continued, "I did get the copy of the images on disk for you, as well as paper copies of the labs and the radiologist's reports. I want to put these images up on the computer screen for you, if you want to see them," he looked over at the both of them.
"Yes," Fran said. "Absolutely. I think we need to see that." She clenched Max's hand and he clenched back. They watched as the doctor went through the computer and pulled up her files, and then on one screen he put the MRI and another screen the ultrasound from earlier that day.
"I'll zoom in here, on the lower right pelvis- you'll notice that her right side is on the left side of the screen- and I'll cycle through the images. You'll see the tumor appears as a bright white round area," he pointed to the area and cycled through the layers, and then back again. "You see that?" They both nodded, unable to take their eyes off the screen. The doctor cycled again and then stopped on the image that showed the full diameter of the tumor. "Now, if you'll look over here, I'll just play the video images that focus right on the tumor- you can see it as the tech moves the wand just a little back and forth, to get the full tumor on the screen." The doctor set up the screen with the ultrasound and set it to play the same twenty seconds over and over. Max gulped, remembering the same view from that morning, the one that kept replaying in his mind. Max pulled out his bottle of water from the back of the wheelchair and chugged some down. He offered it to Fran who also chugged some down. The doctor stopped the video and shifted over to another image from the ultrasound- a still image of the tumor with the measurements on it. Max looked at the screen, then at the ball on the desk, then back at the screen.
"I'll leave those up there for a bit in case you think of other questions about the images. But I see you have a list there, was there something else on there you wanted to ask me?" Fran pulled herself away from the screen and looked down at her list.
"Yes, a few things. Um, if it's cancer, if chemo becomes a necessary thing- doesn't that affect things like- like, um, reproduction?" She asked nervously.
"Yes. That's why we don't want to use it if we don't have to. If that becomes necessary, and having a baby in the future is something you want- we can refer you to the reproductive specialist who works with us here. We do often have patients who go through cancer at young ages, and if they can't preserve the ability to carry a child, they may still want to preserve the ability to create a child, like by freezing their eggs. Or in the case of a male, freeze their sperm. Maybe even if they are married, they may want to preserve embryos for later implantation, either in the patient or in a surrogate. If you want that information, I can have the nurse give you some brochures that explains what may be necessary and what is possible."
"Yes, I guess all the information for every possibility. Whatever you have." She looked back down at her list. "You covered a lot of what we wrote on here, but, um, what is the ballpark for recovery if everything goes well and I don't need anything else after surgery?"
"Well, like I mentioned, expect a night in the hospital. Then when you get the all clear to go home, we would want you to probably spend about three days in bed, then only light activity around the house. No running up and down stairs, no cleaning, no going anywhere until you come back for your followup, about a week after surgery. You would be on a soft diet that week. If your followup is good, you introduce more of your regular diet, but in small quantities. In that time period, likely before you leave the hospital, you would have the results of the biopsy on the tumor and we would know what it is, and can make any necessary plans after that. But expect that it would just be a surgical followup to make sure you heal well. You should be completely back to yourself around six to eight weeks after that. You'd have several checkups, possibly another ultrasound to make sure you healed well inside, and to make sure the muscle has healed well from the incisions. Then you can start light workouts at that point, but before that would be restricted to things like walking and stretching, you would get information on that in a checkup."
"Okay, now, I think this is my last question, and would apply to now, in this time before surgery, and then in the recovery process, or after that six to eight weeks you mentioned…" she glanced at Maxwell and then at the floor, trying to figure out how to say it. "What about- intimacy-? Are there restrictions now or will there be after the surgery? I mean, I know not right after surgery, obviously, but how long after that would be okay, and is that not allowed now?" The doctor was the one to shake his head now.
"After surgery, imagining that everything goes as planned and there aren't any complications, it would possibly fall under the same umbrella that you would follow before going back to any workout routine. The checkups would determine how far you were in your recovery, how much exertion was safe, and obviously that the abdomen was healed. You don't want to do anything to rupture any internal stitches or a healing area. But you also would probably still feel a little pain there, so naturally you wouldn't necessarily be in the mood to mess around in that area. But all of that can be determined week to week as you recover. You might be one of the lucky ones who heals quickly, so you might be looking at closer to six weeks. Now, as for this next week before surgery, since the tumor is still there and we don't know what kind of cells it's made of- I would say be cautious. I believe I mentioned to you when you were admitted in the hospital that you shouldn't be doing any kickboxing…" Fran and Max laughed, lightening the mood. "I would recommend that you just take it easy. The tumor isn't in the area of your reproductive organs, so that isn't the issue. I guess I would say for anything you may do, be mindful of any kind of impact to the front of your pelvis. That would include even a seatbelt in a vehicle- you may want to avoid going places in a car just to be sure you can avoid any possible car accidents- even a sudden stop with a seatbelt around your pelvis can be rather hard. It shouldn't do harm, but think of your insides like your brain- your skull might not show any damage, but there's nothing to keep your brain still in an impact. Your insides are the same. But they also have a lot more space to slosh around in. "So if you are looking for an absolute yes, or an absolute no, I wouldn't say either. Sex should be fine if you are mindful and gentle. Maybe Fran needs to be the one in charge of determining how things progress in that department," he looked over at Max, who nodded slightly. "And I also know how when a couple goes through this kind of a situation, not only can the need for intimacy compound itself, it can also become a really scary prospect. You don't want to hurt her, and she doesn't want to cause any harm inside her. And I'm sure she also doesn't want you to be scared you might hurt her even if the chances of that happening are slim to none. But that is something you need to be open with each other about. If you decide to, that also doesn't have to be written in stone if either of you becomes uncomfortable at any point. Don't expect wild passion. Aim for attentive, loving kindness." Fran smiled and looked at Max.
"Yeah," she said. They sat together for a moment, and Fran showed him the list to see if there was anything else Max could think of to ask.
"You've been remarkably thorough, doctor. I can't think of anything else to ask, can you?" Max said.
"Not really, other than I guess this next appointment, getting ready for surgery. Oh, you said you would have something else for me so I could eat normally?"
"Yes, but that's less glamorous. One is a mild laxative I want you to take every day, just to insure everything moves along adequately and doesn't cause you any issues. I've also got the instructions for the diet for this weekend, and we can talk more about that Friday when we have the surgical plans finalized. The other is an anti-nausea medicine you can take if you need it. And you have your prescription for the fevers and pain. What I'm going to want you to do on top of that is to take your temperature several times a day so you can head off any fevers that try to kick in. First thing in the morning, middle of the afternoon, and before you go to bed. If it gets even to 99, I want you to take a pill, alright? I have those instructions here as well. And I want you to be consuming a lot of water, and electrolytes too."
"Oh, speaking of electrolytes- we got a big bottle of that Pedialyte in the gift shop- it says adults can take that too, would that be okay?"
"Absolutely, that would be perfect, actually. Just one small glass a day should be plenty. You don't need to overload on it, since we gave you that drink today plus the IV. If you want a few swigs before you go to bed tonight, you shouldn't need any more than that. Then a small drink glass- maybe 6-8 ounces, every day until surgery. That should be great."
"Oh good, then I'm glad we did get that,"Fran said. Max agreed.
"So, you have an envelope with you- would you like to put these papers in there, along with the CD of images? And I'll have the nurse grab those brochures and the other medications for you. The laxative is a pill so it's easy to take. You just need to keep consuming the water and electrolytes so you don't get depleted while you take it."
"Okay."
The doctor picked up his phone and spoke with the nurse, asking her to get the brochures and medications for Fran, and after a brief conversation, he hung up.
"So, have I answered your questions? The nurse said the GI surgeon just came in and is on his way over here. And remember to write any new questions down for the meeting Friday, we can go over everything again then."
"I can't think of any other things to ask, Max?" Max shook his head. There was a knock at the door and the doctor got up to let the GI surgeon in.
"Hi- you must be Fran Fine? I'm Dr. Gallahan, the GI surgeon, I'll be the primary surgeon along with Dr. Carter here for your surgery," he shook Fran's hand, and then Max's.
"Maxwell Sheffield, nice to meet you."
"I'm sorry I couldn't get here quicker, I've got surgeries and rounds all day today. But I will be here for the Friday pre-surgery meeting I'm presuming Dr. Carter told you about?"
"Yes, yes he did. I think he covered everything so far, and I guess anything else we'll cover on Friday," Fran said. The nurse appeared in the doorway just then.
"I'm sorry, I don't mean to interrupt-" she said.
"Oh no, I have to run out again- I just needed to make sure I didn't miss you before you left. Remember, even if you have any questions or if you have any problems come up before Friday, please call the office and talk to the on-call nurse. They can get a message to either one of us, or be able to answer your questions or concerns themselves."
"Thank you," Fran said, shaking his hand again. He waved to them and to the other doctor and rushed out of the room again. The nurse handed Fran a small white paper bag.
"The brochures are in here along with your new medications, I believe Dr. Carter has the sheets with the instructions for the pills?"
"Yep- right here. Thank you Tracy," He handed the stack of papers and the CD to Fran and Max helped her slide them into the envelope they brought. She peeked into the white paper bag to make sure she was given the right things, and then tucked in into the pouch on the wheelchair.
"So, I know this was a lot to take in, but are you feeling a little better about things? I mean, not just physically, but mentally as well? I mean, make sure you take some time to process this, talk to everyone you need to talk to, and decide who you want to bring to Friday's meeting."
"I think after it all sinks in, we'll feel okay. I think the big part will be getting ready for surgery. I mean, I knew it would probably be kind of soon, but that is a bit sooner than I was expecting. But whatever needs to be done, let's do it. I don't want this tumor anymore, it has not been a good houseguest." The doctor laughed at that one.
"That's a great attitude to have! Oh- almost forgot-" He put the balls and the piece of rubber back into the little box and handed it to Max. "If your son comes on Friday and wants to ask questions related to that school project- that's perfectly fine as well. I always want to encourage any kid that might show an interest in the medical field, no matter what part of it. We are always short on doctors in every department. If we can spark something in him, let's go for it!"
Max shook his hand and Fran got back into the wheelchair, then shook his hand as well.
"Thank you so much for everything, and even for that IV and that drink. I think that did a ton of good," Fran said.
"Well you are welcome- that's what I'm here for. You aren't alone in this, we've dealt with thousands who, believe it or not, have had similar issues as you. Hopefully all the work we've done with them has led us to do even better for you." He smiled and followed them out the door and down to the check-in desk.
"They're all set, Mary. I'll see you back here Friday at 10am, alright? And make sure you both go through all of those papers so you get a better idea of everything and write down any questions you might think of, alright? Even for the people you bring with you, have them write down questions too. We'll make sure everyone is on the same page and knows as much as they can. See you Friday!" He shook their hands one last time before turning to head back to his office, and the woman at the desk, Mary, held out the scanner to scan their bracelets one last time.
"Well you are all done! You are free to leave the hospital, and you can turn the wheelchair back in at the information desk where you came in on the ground floor. They'll take care of it for you," she said.
"Thank you, thank you very much," they both said, and Max pushed Fran in the wheelchair towards the elevators.
"Oh!" Max said. "I need to call the driver!" Max took out his phone and quickly called the driver to let him know they were ready to be picked up, then pushed the wheelchair into the elevator once the doors opened. They were alone in the elevator. "He should be here within about ten minutes," he told Fran.
"Oh good," she said. "I'm ready to get home!" Max smiled and rubbed her shoulders. They exited the elevator on the ground floor and Max looked for a spot to sit near the windows by the entrance, so he could see when the car showed up in the drop off/pick up area. He parked the wheelchair near an empty bank of chairs.
"Let me get the coats and everything else out of the back," he said, reaching into the pouch on the back of the wheelchair. He took out their coats and set them on one of the chairs and then got the bag from the gift shop along with the other items. Fran got out of the wheelchair and stood up, Max holding on to her hand. "Let me help you with your coat." He held her coat up for her and she slid her arms in, and then he picked up his own coat and put it on, then fastened the buttons in front. Fran put everything inside the gift shop bag, except for her new stuffed dog, which she insisted on holding onto. "Here, darling, sit here and I'll go take the wheelchair back to the desk," Max said, holding her hand as she sat down. He returned the chair to the front desk and came back to sit next to Fran.
"Thank you for everything you've helped with today, Max. And all weekend. It means a lot to me," she said. Max wrapped an arm over her shoulders and held her close.
"You're welcome, Fran. And I mean it when I say I'd do anything for you. We need to get you better so we can plan that vacation," he smiled, and she smiled back.
"The vacation! That will be fun to look forward to- and to plan!"
Max kissed her on the temple and glanced out the window, watching for the car. "Do you want to, or need to, stop anywhere on the way home?"
Fran thought about it a moment. "No, not that I can think of. You?"
He shook his head slowly. "No."
Fran looked at him closely. "You look really tired, Max. We need to get you back and get you a nap. Even a short one. I already had my nap for today," she grinned and elbowed him.
"Well, if you get tired, I want you to rest, too. It might take me a while to come down off the adrenaline so I can get to sleep. It's been intense, to say the least." He stroked the back of her neck and glanced out the window again.
"Yeah. A lot to take in today. Should we tell everyone right away, I mean about the surgery?" She asked him.
"Well, I was thinking maybe tell the children after dinner, and I don't know if Niles can keep it to himself if we told him when we got back. I mean, even if he wanted to keep it to himself until after dinner, I'm sure he'd blurt it out somehow. And if we wait, then everyone can get a chance to eat first, you know, in case there are any sensitive stomachs. But you know, if we go upstairs before the children get home, maybe we should leave some of this information downstairs for Brighton. He's probably anxious for some kind of news, for something to work on."
"True," Fran agreed. "We can take out the papers with the surgery appointment, and the Friday appointment too. Maybe ask him after dinner if he wants to go to that. And then after we talk to the kids and Niles, I can go call Ma and Val."
"I suppose I should check in with C.C. See if there is anything that needs attention before friday. I want to be free to be able to focus all my attention on you before and after the surgery. I mean, even if you get tired of me, I will probably still hang around you constantly…" he grinned.
"Baby, I will never get tired of you," she pecked him lightly on the lips. "But I do want you to make sure you're taking care of yourself. And you can take a break from taking care of me anytime you need to. I imagine Ma and Val will be coming by trying to help out. Maybe you can take breaks then. But I kind of think I don't want them hanging around all day. I'm gonna need my kisses to get me through."
"Aw, Fran, you're going to make me blush!" Max said softly. She caressed his cheeks and he kissed her forehead. He looked back out the window of the hospital. "Oh- I think that's the car- hang on, yes, that's it. You ready to go?"
"Yep. Let me get my purse,"
"Here, let me take the bag, got your dog…" Max got up and reached his hands out for her to take hold of them and helped her up. He put his arm over her shoulder and she wrapped an arm around his waist. Even though she was feeling good, he didn't want to take any chances. They walked casually toward the exit doors and outside into the cold toward the awaiting car. The driver got out and opened the back passenger door and Max helped Fran inside, then got in after her and the driver shut the door.
"Geez, it still feels as cold as it did early this morning! And I still had a fever then," Fran exclaimed.
"Sure does. We'll have to get the fireplace going when we get back. Get nice and cozy together."
He put his hand on her thigh as they drove, and she reached for the bag from the gift shop. She took out the envelope with all of their papers and the CD of images. She opened the envelope and slid out the papers, flipping through them to remove the pages with the surgery and friday appointment information, then put those into the bag. She double checked all of the papers in the envelope, then slid them back in and put the envelope back into the gift shop bag.
"You taking out the appointment papers? So Brighton won't see them?"
"Yeah. Maybe we can leave the rest on the kitchen table for him. You still have that box, don't you?"
"Yes, in my pocket here. We might need to write down what they represent, I don't think there's anything in the box that says what they are."
"Yeah, okay. You want to leave that for him too? I bet the girls won't even get a chance to look at it, he'll probably run straight to his room to read through everything."
"Yes, I suppose he might want to write about it if he's gotten his work started on the project. I wonder what he wrote in his proposal? Niles said he read it and it was very good, that we'd be proud of him. I still can't believe what an interest he's taken in this. I mean, I knew he would be worried sick about you, but to want to learn more about the medical side- I still can't get over that. It's a side to him I don't think I've seen before." Fran looked into Max's eyes, seeing the pride and the love he had for his son.
"I told you, he's like his daddy. He's a wonderful young man. I think he's giving us a glimpse of what he'll be like when he's grown." Fran reached her arm up in front of his chest and held his face with her hand. Max looked into her eyes, also full of pride and love for her.
"I think he's showing the kind of woman he'll be wanting as a partner in the future, too," they kissed each other softly and slowly, again and again.
"Yeah…" Fran sighed, "Definitely gonna need a lot of those to get me through…"
"You and me both," Max whispered, brushing the tip of his nose back and forth against hers. He wrapped his arms around her and held her the rest of the ride back to the house. They sat there in silence, smiling, and watched the buildings and cars pass by.
Fran really enjoyed this newfound closeness with Max. She really did feel safe with him, safer than she'd ever felt in her life. And she felt how deeply he cared for her, and understood why it was hard for him to finally let it show. But now that he had, she knew he would never stop. And she wanted to spend every day letting him know how much he meant to her, and let the children know how much they meant to her. She was home, with them. She rubbed Max's arm. She really wanted to be with him, completely. She thought about what the doctor had said earlier- about intimacy. That it would be alright. For them to take it easy, be gentle. And about how things like this could make a couple really want to express their love for each other, but that they could also be really scared to. She wasn't scared to, it almost hurt her to not be with him, but she had to let Max get there, too. He had already said how much he wanted to be with her, but he was so careful with her, like he was afraid she would break. Maybe now with what the doctor had said, he would be able to let himself get closer, to let himself be with her. After all, he didn't protest at buying the condoms. And that was even before they spoke with the doctor. Fran smiled and leaned back into Max. She pulled her stuffed Max dog to her and looked out the window as they got closer to home.
Max opened the front door for Fran and kept her close as they entered the house. They stopped at the closet and Max took her coat, then took off his and hung them in the closet. Niles heard them come in and came running from the kitchen.
"Oh! Hello! Welcome back, I thought I heard you come in. Come in, come in! Can I get anything for you?"
"Hello, Niles. I think we're alright, except that I bet Fran here is dying for that Thai tea if it's still in the fridge…" Max said, nudging Fran playfully.
"Oh, you know it! Is it still there, Niles?"
"It sure is, waiting for you! It's okay for you to have it?" They all headed for the kitchen, talking along the way.
"Yes, I can eat normally, just small portions. Especially since I haven't been eating a lot for a pretty long time. Need to slowly work my way back to my former piggy self." Max and Niles chuckled. Fran pulled Max close. "Aw, come on you guys, you aren't going to say 'Oh, Fran, you aren't a pig, you're so thin and svelte!'"
Max laughed and bumped her with his hip, but Niles turned around from in front of them, "Oh, goodness no! Ms. Fine, I didn't mean to imply that-"
"I'm kidding, Niles! Relax!" Niles saw the two of them cracking up.
"Oh, uh, well, still- I was going to say that, I mean, you can eat what you want, but it doesn't show on you, you know-" Niles stumbled over his words.
"It's okay, Niles- I'm teasing." Fran swatted his arm. Niles was nervously rushing back to the kitchen. He wasn't normally like this, especially around Fran, but he'd been so worked up all morning waiting for them to return and give him some kind of news.
"I'm sorry," he said, as they entered the kitchen. "I've just been stewing here all day waiting for you both to get back, to get some news, I just don't know what to do with myself. I've already gotten nearly everything ready to make for dinner, and the whole house is clean. I'm a bit stir crazy, I'm sorry."
Fran went to him and hugged him. "It's okay, Niles. I appreciate that you're worried about me. We'll talk to everyone after dinner tonight, okay? That way we just have to tell it once, well once to all the kids and to you. I still have to call Ma and Val later. Oh, speaking of the kids- did Brighton call? Max said you told him Brighton wanted to call on his lunch break for an update."
"Yes, yes he did. I told him what Mr. Sheffield said to tell him. That seemed to hold him, but I think he was still worried about what was going to happen when you talked to the doctor. So I expect he'll be the first one back here this afternoon after school. He did seem a bit nervous this morning. I do hope he got enough sleep last night."
"Yes, I hope so too. We need to keep a quiet eye on him, Niles," Max said. "Fran and I were talking about it- he uh, he seems to have gotten that twitch back. Remember the twitch that he had- the sort of facial tic- around his eyes?" Niles thought, and then remembered.
"Oh! Oh, goodness. Now that you say it, yes, I think I did see that before they left for school. What should we do?"
"Well, we don't need to hover over him and call attention to it. He might already notice that he's been doing it. But if he doesn't, well, then, we need to help him with his stress. If we need to take him to a therapist, we will, but we can try some other things first. Fran and I had been talking about seeing if he'd like to do some photography- like street photography. We got some books, and I want to get my old cameras out of the attic and see if he might take an interest in that. I think he'd really like these books we got. So we might talk to him about that tonight. I think we might also see if we can get him into doing some regular exercise. And I don't mean like his gym class- I mean maybe with some of our workout equipment- to see if he can work really hard and burn off some of the nervous tension. We'll talk to him about it. Oh, and we did get the CD with the images on it, and paper copies of the labs and other things. We thought we'd leave this envelope here with all of it for when he gets home. I expect that he'll want to run right up to his room to go through it all."
"Oh, yes sir. And before I forget- that proposal he wrote is right there, on the table, if you'd like to look at it." Niles went to the fridge and got out the large cup of Thai tea for Fran. "Ms. Fine, would you like any ice with this tea?"
"No thank you Niles, I don't want to let it get watered down, and it should be plenty cold. Thank you."
Niles walked over to the cabinet to get a tall glass to transfer the tea into as Max set the envelope he had taken out of the bag onto the kitchen table. He also took out the box he still had in his pocket and set it on the table. He picked up Brighton's proposal and Fran squeezed into him so they both could read it. Niles was busy at the sink pouring the tea from the cup into the glass and getting a straw for it while Max and Fran were riveted to what they were reading. It was only a single page, but it was very concise and to the point. It started with introductory information about a "patient" with a possible rapid-growth tumor, and then went into detail about the research he wanted to do not only on the tumor itself, but on how the medical professionals handled determining how to treat it. He also wanted to do further research into the type of tumor and how it came to be- if tumors of that type were preventable or could be screened for before they became invasive- before they created symptoms. Then it gave information on his advising teacher and also his friend Tommy's father who wanted to act as a mentor and advisor. Once they both finished reading the paper, they looked at each other.
"Holy crap," Fran said. "How is he not in college already?"
Max set the paper back down on the table. "Well, if that doesn't convince his teacher and school administrators to give him a directed study for credit, I don't think anything would. I can't believe he wrote that. I mean, he is a very good writer, but I've never seen him write something that serious before. That academic." Niles nodded in agreement. Fran clutched Max's upper arm.
"My baby boy's growing up!" Fran said. Max put his arm over her shoulders again.
"Niles, when he gets here, let him know how good we think that proposal is. It's really impressive. And tell him about this paperwork," he motioned to the envelope. "We need to go upstairs and rest a bit, and process everything. I might try for a nap if I can sleep."
"Yes, sir," Niles said. "What time would you all like to have dinner? Ms. Fine, I'll get all of that Chinese food warmed up for you, so you can pick what you'd like."
"Can you aim for maybe 5:30? Then we can talk to everyone afterwards. If we aren't down by 5:30, let the children go ahead and start. But we'll aim to be down here then."
"Very good, sir, I'll do that." Niles handed Fran the Thai tea and she took a sip.
"Oh god that's wonderful! I haven't had Thai tea in so long!" She took another long sip.
"Oh, before we go up, I need a piece of paper or something, to write down about the box," Max looked around and went to the side counter to grab a small piece of paper and a pen. "Niles, that box there goes with the paperwork, too. Brighton can look in it. I just need to write a description so he knows what the heck they are for." Max wrote out "Tumor size/growth" at the top of the paper, and then drew three circles, representing the different sized balls. For the small ball, he wrote "About two weeks after first appearance," then for the second ball, he wrote "Size at First Ultrasound," and then for the last he wrote "Size of Tumor Today." Then he made a note at the bottom of the paper explaining what the thick piece of rubbery material was, "Representing a one inch incision and how the tumor at it's current size will not fit though it to be removed, so incision will have to be greater than 1 inch." Max folded the paper and opened the box, and tucked the paper inside.
Fran had chugged a good amount of the tea as Max was writing. "Niles, is there any more tea in that cup?"
Niles smiled and handed it to her, and she held her glass over the sink as she poured the rest of it in. "Yea! Oh, Niles! Look at what Max found for me at the gift shop at the hospital." Fran went back to the table where she had set down the stuffed dog and handed it to Niles. He looked it over and chuckled- noticing the white patch of fur on the dog's head. He felt around the collar and pulled the name tag around so he could read it, then his eyebrows rose.
"You're kidding me! Did it really have this name, or did you make that tag somehow?" He was in disbelief. Max shook his head.
"I didn't make it, that's exactly what it said- so of course I had to show it to her." Max smiled.
Fran took the dog back from Niles. "I told him that there was no way we were leaving there without it. What are the odds that something like this existed, and was at that hospital gift shop where we would be? Isn't that freaky?!" She squealed.
"I'll say!" Niles agreed.
"Come on Max, let's get you a nap before you collapse. And I want to look at those photo books before we show them to Brighton. I gotta see if I recognize any more of those places in that one book, too."
"Okay, dear, I'll go take my nap…" Fran held her glass of tea in one hand, and had her purse, the stuffed dog, and Max's hand in the other. Max followed her up the stairs with the gift shop bag in his other hand. Niles watched them disappear up the stairs, happy that they were so happy. He looked back over at the table and saw the large envelope. He wondered what the papers inside said. He was tempted to go look, but something told him not to. They weren't left there for him, and he didn't want to act like his old nosy self. He was proud Max had finally devoted himself to Fran, and he wanted to honor that by backing off. So he went to the cabinet and took out a bowl, then went to the pantry and took out a bag of chips. He opened the bag and poured out a bunch of chips into the bowl, then put the bag back. He walked over to the fridge and took out a bottle of soda and shut it, then headed for the living room to turn on the TV.