At The End Of The Road: Second Edition

by StayGold4ever

"I understand you can't diagnose him, but can you please just tell me something? This is crazy." She was silent for a moment. "I'm concerned about an oncological event." I rolled my eyes, fed up with her dodging the question. "Dumb it down, doc." "Leukemia. It's a form of blood cancer. I'm not saying he has it, but the indications are there. I'm sorry, Darrel."

5. Chapter 5

Welcome back! Get comfy and ready to read, y'all. It's another long one and a lot of info being thrown out.
See end of chapter for medical glossary/ images!

(See the end of the chapter for more notes.)

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Sodapop

April 17th, 1965

The ride to the hospital was silent. Once Darry broke the news, Ponyboy seemed willing to proceed without complaint. Whether it was shock or he was too exhausted to push back, I didn't know, but it didn't matter. He tossed a few pairs of jeans and t-shirts and pajama pants in his backpack, along with several books and his toothbrush, then trudged out to the truck and got in the backseat before Darry and I were even out the front door. We exchanged a look.

"Go on," Darry prompted, handing me my own backpack while juggling a manilla folder bearing Ponyboy's name on it. I could see a plethora of medical documents and paperwork threatening to spill out. "I just gotta grab his social security card and our paperwork from the state in case we need it."

"But…" I didn't want to leave. It felt wrong to retreat so abruptly after such a blow, that we were missing something important, there were things we needed to do.

"Soda, come on. Ain't nothing here that's more important than gettin' him there. I know you're spooked, but we can't stall to avoid it."

For someone who had lately sucked at expressing his feelings verbally, he sure could read me well. "Shouldn't we call the guys though? Or leave a note in case they come 'round? You know they'd want to be with us."

"No. Not now. I don't know what the hell's gonna happen when we get there, but I have the feeling it's gonna be overwhelming enough without four extra people crowded around his bedside interruptin' and panickin' and gettin' in the way. Once he's settled in and I've talked with the docs, we'll call 'em."

I wasn't happy about it, but he had a point. Plus, I wanted Ponyboy to be honest about how he was feeling, both physically and emotionally, and that wouldn't happen with the guys around. Granted, it wouldn't happen with a bunch of strangers poking and prodding him either, but maybe this was big enough for him to let his guard down for.

When I joined Pony in the backseat, he immediately rested his head on my shoulder. "Don't cry, Soda," he said, though his eyes were closed. "I'm okay, really."

"How do ya even know I'm cryin', huh?"

"Cause I know you. And you a bawl baby, anyways."

"Hey, watch it kid!" I couldn't believe we were even talking like this, me trying to adopt a teasing tone, us trying to pretend that things were remotely okay.

Pony was right, though. I was the family bawl baby, notorious for tearing up when I was upset or stressed or angry. Of course, it was easier to hold back to save face when I needed to, like when I was in a fight or in trouble (bawling in front of half of downtown Tulsa and the fuzz that time Two-Bit and I got arrested would have been the final nail in the coffin for my reputation, after all). I recalled Darry's words moments earlier: "Once I've talked with the doctors." He thought he needed to shield both me and Pony, that I was too much of a kid to handle it. Well, one thing was for sure; he wasn't playing that game with me. I was just as involved in Pony's wellbeing as he was, and I intended to learn everything we could do to help him. Me crying like a little kid wasn't helping my case, though. I bit my lip hard and wiped my face on my sleeve.

As Darry got in the driver's seat and started the truck, I blankly stared out the window at the Johnsons, still gardening and listening to that godawful music like they didn't have a care in the world. Just thirty minutes ago, I was trying to escape Mr. Johnson's dramatic retelling of his experience in The Battle of Saint-Mihiel for the hundredth time. It was bizarre.

Ponyboy was leaning heavily on my shoulder, eyes closed and breathing deep and even. I couldn't believe it. I knew he was tired because he was sick (with cancer, my brain supplied unhelpfully), but glory, how could he sleep after news like that? Darry's face was a mask, blank and unyielding. I'd learned over the years that it wasn't because he was cold like some people thought, it was like that when he was feeling the most, turning off his brain and emotions to cope, but that didn't stop my frustration with it. I needed us to talk about it. But we just sat there mutely until we arrived.

Darry circled around the hospital so fast it made me dizzy, and parked haphazardly in a spot right in front of the ED, labeled "For Emergency Responders Only."

"Uh, Dar, I ain't sure you can park t-"

"Well, if someone got a problem with it, they can take it up with me," he snapped, swiveling to look at me. His eyes were glinting dangerously, and I was pretty sure most people wouldn't have the balls to cross him when he looked like that. Still, it was surprising. Darry was practically militant about not drawing attention to himself and playing it safe since the accident. He never went more than five miles over the speed limit, even on the interstate (it drove us all nuts). He wouldn't let the guys from work take him out for a beer anymore, in case a cop happened to notice he wasn't twenty-one yet. Hell, he wouldn't even come with us to the strip or drag races anymore, in case there was trouble.

I started as the back door opened, Darry already reaching in to rock Ponyboy's shoulder gently. "Pony, baby, we're here," he said, and his voice was soft, like it had been when he was reassuring him right before his biopsy. It was a tone I'd rarely heard since the accident. As the weeks passed and we returned to day-to-day life, he'd had a lot less patience and seemed more distant, not as willing to slow down and check in with us emotionally. Not unless Pony or I were real upset missing mom and dad, or when Pony had his nightmares, or like that time when Johnny got hurt, or when I had that stomach bug. I knew he was in survival mode and just going through the motions, but it didn't mean I missed that side of him any less.

Pony opened his eyes blearily but made no move to get out of the car. Darry sighed and hauled him to his feet, steadying him with an arm around his shoulders. I grabbed our bags, took Pony's other side, and we walked through the double doors together.

Darry practically elbowed his way past the few people waiting in a neat line at the front desk, eliciting noises of anger and protest. "Hi," he said matter-of-factly to the lady at the front desk. "My brother's doctor called us and told us to come and they would directly admit him. Ponyboy Curtis?"

I don't know what I was expecting, but it was almost anticlimactic. Her expression didn't change, and she barely looked up from her clipboard. "Yeah, they're waiting for him," she said in a monotone. "Curtis, right? Dr. Thompson's patient?"

"Yes, ma'am."

"Hang on. PHOEBE!" she hollered over her shoulder, and a girl with long braids who couldn't have been more than eighteen or nineteen appeared. "Yes?"

"Curtis is here. The thirteen-year-old male. Take him to bed eight and find Dr. Thompson and his assigned team."

The girl beckoned for us to follow her and we did so, weaving past the rows of chairs in the waiting room and through the doors to the main ED. It was packed, with staff congregating in huddles at desks in the middle of the bay or rushing in and out of the small rooms lining the long hallway. She stopped outside one and ushered us in.

"Change into that," she instructed, pointing at a pale green hospital gown with a blue diamond pattern lying on the bed. "Dr. Thompson will be with you in just a minute.

She left. I expected Ponyboy to protest or at least insist Darry and I turn around while he changed, but he trudged over, kicked off his jeans and shirt, put the gown, then flopped onto his back on the bed and stared up at the ceiling, slightly breathless. God, over winter break, I went with him to the track for some laps and he was clocking in at just over a five-minute mile pace. It wasn't fair.

"Fashionable, Pone," I said mockingly, trying to get a smile out of him. He just scowled at me.

"If they make me take my boxers off, I'm gonna start swingin' though," he said petulantly. His eyelids were already drooping again. His left arm was tossed across his chest, right arm hanging limply off the narrow bed, like he didn't even have the strength to lift it.

Darry was pacing, periodically sticking his head out the door and making noises of impatience. "Where the hell is everyone? They call us outta the blue and demand us to drop everythin' and rush down here 'cause it's so serious, then they can't bother to even show up?!"

And suddenly, the response we expected arrived. Dr. Thompson, dressed in rumpled khakis and a blue collared shirt under his white coat, arrived, flanked by three other staff members. They descended upon Pony immediately, congregating around the bed.

"Darrel," he said, shaking his hand and acting as if Pony and I weren't even there. "I'm very sorry that we have to meet again this way. We're going to my office so I can review the procedure for blood transfusion and get your consent so we can start immediately. I can give you a brief update on everything and get your opinions on how to proceed so we can get the referrals in as soon as possible, then we'll return here and I can discuss with Ponyboy. It will be a bit too much if I try to explain now while everyone's trying to get labs and examine him, he won't take it in."

"But-" I saw his stoic expression slip and anxiety flickered across his face as he looked back at Pony.

"He'll be fine," Dr. Thompson reassured. "My staff will take good care of him. My office is just down the hallway."

Darry nodded. "Sodapop, you don't leave his side, you here me?" he instructed as he followed Dr. Thompson out the door. I didn't bother responding. The suggestion I would even consider it was ridiculous.

I turned my attention back to Ponyboy. I could barely see him because of everyone crowded around his bed, but he was sitting up and looking thoroughly overwhelmed. A tall woman in a white nurse's uniform had wrapped a blood pressure cuff around his left upper arm and started inflating it. A guy in scrubs was lining up a plethora of tubes and medical supplies in a neat row on the side table, and a young, dark-haired nurse seized his right arm none-too-gently and tied a tourniquet around his bicep.

"Alright honey, I'm looking for a vein to put an IV in, okay? Have you had one of those before?"

"Uh, yeah, I-"

"Good," she said, already wiping off his forearm with an alcohol swab and advancing with a needle. "Big stick, okay?"

He didn't even have time to answer before she was sliding a needle in the crook of his arm, and he hissed through clenched teeth as she continued to prod around.

"Sorry," Justine muttered distractedly. "One more time, okay?" She reached around the nurse across from her and discarded the needle and tube in a little metal box, grabbed a plastic package, and started preparing a new IV to stick him with.

I'd never felt so useless in my life. I just stood at the end of the bed, watching. Ponyboy's eye's were wide and he nervously watched her every move, muscle in his jaw twitching. He no longer had the dazed expression and thousand-yard stare. It was like the sharpness of the needle had jolted him back to reality. I knew if it was just me and Darry in the room, he'd be bawling. Hell, I was still bawling, not even bothering to wipe away the occasional tear rolling down my cheek. But he'd always been tougher than me, really, on the inside.

The tall nurse pulled the thermometer back out from under his tongue, then started checking the pulse on his wrist. Justine was advancing with the IV needle again, and the man started to tie a tourniquet around the other arm. He started to look panicked "Soda-"

"Can y'all slow down a minute? Or at least tell him what the hell you're doin'? You're scarin' him." I snarled, bristling.

Her face softened. "I'm sorry. We usually take the time to explain things, but your brother isn't stable right now and we need to move quickly."

I realized I had moved closer to them and my shoulders were squared. Justine was still holding the needle, but had backed up several inches to placate me. The guy in the teal scrubs, however, had pulled the tourniquet reluctantly and was now tapping his foot impatiently, as if he had better places to be. I felt a surge of anger that definitely wasn't warranted for such a little thing, but didn't care. It was too much, and I was pretty sure I was only capable of feeling extremes at this point. But the tall nurse was looking at me warily with a hint of scorn. I had seen that look way too many times before. The kind I got when I went to the grocery store in my dirty work uniform or got speeding tickets or even just tried to walk around town with the guys, as if I was dangerous. Well, she was right about one thing- if my kid brother needed me to be dangerous, I would be. I could get fired up real quick.

I glanced at Pony. He was already meeting my gaze, green eyes pleasing. Leave it. I stepped back and tried to relax my posture. He didn't need this right now.

Justine continued, "His hemoglobin is extremely low. This transfusion needs to be started as soon as possible, so I need a good access site. Colleen there's getting your vitals real quick, and Josh is going to draw labs, okay? And we're going to be listening to your heart and lungs and asking you a lot of questions, okay?"

It wasn't okay. None of it was okay. I smiled, working to enunciate the dimple on the left side of my cheek towards the bitchy nurse. "Okay. Thank you. You ready, Pony?"

He nodded and quick as a flash, they were all swarming around him again. Justine had the IV in before he could even wince, but it didn't matter, because lab guy was back and I could literally see the color draining from his face. "Can I sit with him? He don't do great with blood draws."

Justine beckoned me over to her. "You can sit on this side of the bed, I'm going to just be setting up the fluids and blood around you."

I hurried over and perched next to Ponyboy, putting an arm around him and pulling him close. "It's okay. Just turn your head this way." The lab guy was prepping the tubes and wiping down his arm. "Don't focus on what he's doin'."

The tech tapped his arm. "Don't tense up. It hurts worse when you do that."

"I know, I'm sorry," Pony said, ears turning red. "I'm tryin' not to, I swear." I could see the muscles in his upper arm spasming as he fought not to pull his arm away. I grabbed his hand and held it tight, slyly keeping his arm still, and nodded at the tech to proceed.

He took almost ten tubes of blood before he was satisfied. Personally, I thought they should wait until he'd gotten all that nice new blood first, but what do I know? I was feeling pretty woozy myself just looking at it.

"Good job," Justine praised. "I'm just going to get the blood and forms I need for the transfusion, so hang tight."

Colleen was shifting through a sheath of paperwork. She was still sending me looks, as if my mere presence was a disruption. I could care less. They'd have to cuff me and drag me out before I left Pony's side at this point. I cleared my throat, not liking that she was otherwise ignoring us.

"He was a hundred and six pounds when he saw Dr. Mendez a few days ago. Do you think he's lost any more weight since then?" she finally spoke.

"I dunno, probably. Maybe a pound or two. What difference does it make?"

"A lot. Pediatric drugs are weight-based. I'm going to get a scale."

She walked out briskly. Lab guy had left, and I could see Justine emerging from a supply room with a tangle of clear tubing. Ponyboy rested his forehead against the side of my shoulder and I buried my face in his limp hair, kissing the top of his head.

"She was kinda-"

"Bitchy?" I supplied.

I felt him smile a little. "I was gonna say condescending, but that works too."

Unfortunately, she returned, wheeling a scale. "Alright, go ahead and come over here for a minute and step on this for me. You're not hooked up to anything yet so don't worry about bringing the IV pole."

I held out a hand and hooked it under his arm to help him stand, but he wobbled dangerously. "You good?"

He nodded, but was real shaky with every step. He balanced precariously on the scale, stepped down, and his knees buckled. To her credit, Colleen was at his side and hauling him back into bed with surprising strength before I could so much as blink.

"Are you dizzy?" she demanded, and he nodded again.

"When was the last time you ate?"

I answered for him. "He ain't had anything since this morning, that I know of. He had a little breakfast but pretty much slept all day until- until we got the call to come here."

"His sugar's probably low," she said distractedly as she scribbled something on a piece of paper. "We added a CMP in the labwork so that will tell us his glucose, but I'd rather not wait for it to drop lower while we wait for results. I'll ask Dr. Thompson to place an order for D5W fluids instead of normal saline so we can get those levels up, but we need to run normal saline during the transfusion first, they're not compatible."

I nodded, as if I had a clue what she was talking about. God, I wanted Darry here. I remembered his words that night on the porch, the beginning of this disaster. "What was the last science class you passed, sixth grade?"

She started examining him; shining a light in his eyes, pinching the skin below the collarbone, scrutinizing his skin, asking him to wiggle his toes. She pulled out a stethoscope and spent almost three minutes listening to various places on his chest and stomach. He just lay there sluggishly and didn't move when she asked him to sit up so she could listen to his back.

"Pony, did you hear her?" I asked.

He hummed sleepily, eyes fluttering.

"C'mon, kiddo." I gently prodded him, but he furrowed his brow and whined in the back of his throat, turning his head away from me. My heart skipped a beat. He'd never act difficult like this in front of strangers. He'd always worked hard to save face and look tough.

Collen frowned a little. "Is he usually like this?"

"No," I said, starting to feel alarmed at the look on her face. "I mean, he's been pretty out of it the last couple days. Like, didn't get out of bed once the other day, but he at least talks even when he's feelin' real bad. What's wrong with him?" My throat was burning and I could start to feel tears prick at the corners of my eyes again.

Her face started to look like the other nurse, a little more sympathetic. "It's okay," she reassured. "It's likely the lack of hemoglobin. That's what helps us carry all the oxygen around our body. Since he has so little, his cells and tissues aren't getting enough oxygen." Ponyboy had finally managed to roll over a little, and she started listening to his back with the stethoscope.

I ran a hand through my hair. There was a sick feeling in my stomach again. "Are you sayin' he can't breathe right?"

"No, no, his lungs sound fine. His blood just doesn't have the protein it needs to transport oxygen, and that's why he's been lethargic. Dr. Thompson ordered a special test to measure it, and the respiratory therapist should be here soon to perform it. But until then, I'm going to give him a little extra to help out until we can get an actual read on it. The blood transfusions should help. He'll perk up a bit after."

My chest was starting to feel tight, and my own breath quickened. Where the hell was Darry? How long could it possibly take to sign a couple of forms?

Justine entered the room again with a bag of blood, fluids, tubing, and a mess of papers. Another nurse trailed behind her, and Colleen met them out the door. "Going to put him on three liters," she murmured to them as she left.

Justine smiled at Pony. "Okay, we're gonna get this up and running. Silly question, but can you confirm your name for me?"

"Ponyboy Curtis," he mumbled, eyes still closed.

"Your legal name, hun," the other nurse clarified with a gentle chuckle.

"That is his legal name," I explained, trying not to sound as impatient as I felt.

"Birthday?" Justine continued.

"July 22nd, 1951," I answered for him, hoping to move along the process. Justine started reading out a jumble of numbers to the other nurse, the later nodding in conformation as she examined the label on the bag of blood.

Finally, after a lot of untangling tubes and messing with his IV line, the bag was up. Justine fiddled with a dial connected to the tubing, looking at her watch and murmuring to the new nurse. "No, we're not starting it off with that rate. I'm well aware of the protocol, Maureen. We can handle a transfusion reaction a lot easier than severe hypoxemia. Might start the second bag now too, long as Dr. T. still wants to."

She turned back to us and said in a louder voice, "I'm going to be checking your blood pressure and pulse every fifteen minutes, okay? And you need to let us know if you start feeling worse or different. That sound okay?"

Pony cracked an eye and gave her a half smile. The weight pressing down on my chest lessened slightly, a rush of affection flooding through me. I squeezed his hand. "Yeah, that's fine.

"Good," she said as she grabbed another thin tube from Colleen, hooking it under his nose and attaching it to a large oxygen tank under the bed. "You're doing really great. I know we've been poking and prodding at you and it feels like a lot, but you're tough. Better than the whiny middle-aged man with a broken finger down the hall," she winked. "He would have been screaming if we came out him with that many needles."

"Yeah he's tough," I agreed, ruffling his hair and smiling as he weakly gave my hand a half-hearted swat.

"What the hell?!" I heard a familiar voice and turned to see Darry rushing over to Pony, cupping his face in his hands; turning his head side to side as if looking for unseen injuries and taking in the oxygen tube with a panicked expression. "Can't he breathe?"

"I can if ya quit shakin' me," he mumbled weakly, a hint of his usual sass creeping in the lethargic tone. "'M fine, Dar."

Justine calmly intervened, "He's breathing normally. The severity of the anemia is likely causing fatigue and weakness. Obviously, we are treating the root cause with the transfusion now, but just giving him a little extra oxygen to help him out and make him more comfortable until his counts are up. Does that make sense?"

Darry relaxed slightly, but he still didn't look right. I'd rarely seen Darry afraid, at least in the way that most people expressed their fear. And in front of total strangers, too.

Dr. Thompson was there, too. "Hello, Ponyboy," he said almost formally, patting his shoulder. "How are you feeling, young man?"

If Pony's eyes were open, he would be rolling them. He hated being talked down to. I remembered laughing my ass off at our annual physical just last year, when the nurse tried to give Pony a high five and sticker after his flu shot, like he was a crying five-year-old instead of a sullen almost-thirteen-year-old. He'd been so offended that he begged mom to stop at the thrift store on the way home and find shoes that made him look taller. "Seriously, man? Do I look like a little kid? Be honest. I know I ain't had my growth spurt yet, but geez." It was too good a story to keep quiet and as the baby of the family and gang, it was practically our duty to tease him over it. Two-Bit swiped a pack of stickers from the dime store and started following Pony around, offering them at every mundane task. "Damn, y'all, did ya see that? The kid tied his shoes all by himself! You get a sticker, pal!" Pony would indignantly shout for me and complain and I'd feign sympathy, then put him in a headlock, pinning him until Two-Bit could put the sticker on his forehead.

"M'kay. Tired."

"I'm not surprised. Your hemoglobin is extremely low. I'm going to go ahead and get a second bag of blood running," he nodded at Justine, who reciprocated the gesture and left the room, "so we can get your numbers up."

"Is he gonna feel better then? Darrel said somethin' 'bout surgery and-"

Darry cut me off. "Let him take a look, Pepsi," he murmured, putting a hand on my shoulder. Dr. Thompson had turned to Colleen and they were quietly conversing. "He and I talked a little just so I could sign some consent forms and he wants to look at Pony and make sure they have all the labs they need and stuff. He's gonna talk to us all together then, okay?"

I bit my lip. I had hopped off the bed when Darry and Dr. Thompson came in the room and I wanted more than anything to go back and wrap my arms around Pony and not let anyone touch him. Dr. Thompson was standing over him and scribbling on a clipboard as Colleen spoke lowly.

"Dry, pale mucous membranes and dried blood in nares. He was pretty wobbly when I had him stand to step on the scale, definitely not safe to be walking independently. Sugar's probably low, brother said he hasn't eaten all day. Turgor was delayed and petechiae on the eyelids, cheeks, and palms. Enlarged cervical and axillary nodes bilaterally. Significant ecchymosis on upper and lower extremities and along spine…"

My mouth was so dry that I couldn't even swallow. I chanced a glance at Darry. His hand was so tight on my shoulder it was almost painful and he was rocking slightly on the balls of his feet. Colleen was back with another bag of blood and the nurse who had laughed at Pony's name; again reading out a sequence of numbers to her as she nodded in confirmation. It all swirled around me dizzyingly, colors and sounds muddling together.

"…lungs sound okay but capillary refill was pretty slow. I asked him if he felt he was having trouble breathing but I wasn't getting a clear answer. There's a pretty good precordial murmur that I didn't see mentioned in the pediatrician notes anywhere. And significant hepatosplenomegaly. He's alert but very lethargic and slow to respond. Heart rate was 122, respiratory rate 24, first pressure 90 over 58, repeat 86 over 54..."

"Labs?"

"Already drawn. Dan hasn't showed for the ABG yet though. Lisa at the front said she put in the request to squeeze him in the surgery schedule first thing tomorrow morning."

"Good. Can you go ahead and put another line in after they've done the ABG?"

"Yes sir."

He turned back to us. "When was his last nosebleed?"

"Uh, yesterday, I think? He had one in the morning that lasted maybe five minutes? At least that's what our buddy said."

"He- he had another one in the evening," I elaborated, hating the way my voice trembled. It had been after Darry had gone to work at the warehouse to pick up an extra couple of hours. Steve and I were sprawled out on the living room floor, lazily tossing a baseball back and forth while watching Dragnet when Ponyboy called out for me. I went to our room and had been met with a horrifying site. Ponyboy was sitting up in bed, clutching a pillowcase to his nose, but blood was streaming down his face, soaking the fabric, running down his hands and arms in rivulets. It took nearly twenty minutes to stem the flow, with me holding wet washcloth after wet washcloth to his nose, pinching hard, while he sat on the bathroom floor and Steve hovered anxiously behind us. "It was real bad, like more than usual."

"Any bleeding from anywhere other than his nose?"

"I don't know," Darry nearly whispered, face pale.

I winced. I was sitting on the closed toilet seat, brushing his teeth, while I carefully shaved in even strips down my chin. The smell of coffee drifted in from the kitchen, and I could hear Darry clattering around, probably searching for his ever- elusive tool belt. "Let's move it, kiddos!" I was about to rinse my face when Ponyboy knocked me out of the way, leaning over the sink. "Hey!" I was ready to shove him back when I saw the blood oozing from between his teeth. His gums were bleeding. "The hell?" "Sorry," he garbled, spitting out toothpaste and blood. "This happens sometimes." "You gotta floss more," I teased him, "Or you'll end up back at the dentist and we all know how much you love that."

Guilt was swirling, hot and stifling, in the pit of my stomach. That was ages ago. I remembered it because it was the first time Pony had laughed since mom and dad died, after I proceeded to remind him about when Darry was fifteen and reflexively swung at the dentist when he unexpectedly came at him with the drill. Maybe if I wasn't so dumb, if I paid a bit more attention, asked a few more questions, we would've taken him to the doctor sooner…

"-help with the platelets, too. That's actually what causes some of the most severe complications in kids like him. He needs to be very careful when not in the hospital- no roughhousing or sports, no using knives or cooking, no shop class, nothing that could cause any bleeding. Internal bleeding could be an issue, too. No blood in his stool?"

"I don't know," Darry repeated helplessly. "He- he'd be embarrassed, he wouldn't tell us stuff like that, he-"

"Has a doctor ever mentioned hearing a heart murmur with him?" He'd already moved on, now listening to Ponyboy's chest with his stethoscope.

"I don't think so. I mean, not when I've ever taken him to the doctor but that's- my folks would've mentioned that, wouldn't they? Ain't those serious?"

"Not always. I suspect this is new and due to the anemia. Severe anemia can cause serious cardiac complications-" Darry made a choking noise and I grabbed his hand that was clenching my shoulder and squeezed "-but that's not necessarily the case here and murmurs usually resolve as the anemia improves."

Pony had been lying on his back throughout this conversation, eyes occasionally flickering over to the corner where Darry and I were, as if to make sure we were still there, before closing them again. Dr. Thompson attempted an encouraging smile at him when his eyes opened again, but didn't quite pull it off. He was aloof, mechanical, clinical. I couldn't bring myself to care, I just wanted him to fix my brother. "Can I lift your gown for a minute, Ponyboy? Just going to check your stomach real quick."

He nodded and Dr. Thompson proceeded, brow furrowing as he gently palpated. "His spleen is extremely enlarged. His liver too." He turned to Colleen. "He's at high risk for splenic rupture. I'm ordering bed rest until it's resolved."

"Splenic rupture?" Darry exclaimed in a higher-than-normal voice. All I could do was inwardly wonder what the fuck a spleen even was.

"Yes, that's probably the main contributor to why he hasn't been eating. The stomach is compressed by the enlarged organs so there's not much room for food. The spleen filters our blood so rapid replication of the white blood cells have caused them to collect there and the organ to swell-"

"But what happens if it ruptures?"

"Well, obviously we'll do all we can to prevent it. That's why I want him on bed rest. It usually takes a direct hit to the area to cause rupture, but with how unsteady on his feet he was earlier and all the new medications he'll be on, I don't want to risk him falling and hitting the area. Ideally the swelling should start to go down within a few days of starting the first round of chemo..."

"Jesus Christ." Darry dropped into a chair by the door and put his head in his hands. My knees were feeling pretty weak, too. Chemo. The only things I knew about cancer were from what I had seen on those stupid soap operas and medical dramas Pony and my mom liked to watch together, and that all the adults and old people I'd ever known or heard about getting it had died. I didn't understand. He was practically a baby. And that people got chemo and it practically poisoned them and made their hair fall out but it was supposed to help them-

Someone rapped on the door and entered without waiting for a response.

"Ah, here he is." Dr. Thompson greeted the man, passing him a folder. "This is our respiratory therapist, Dan. He's here to get a blood sample to test his oxygen levels."

Colleen was turning a dial on the oxygen tank under the bed. "He's been on three liters for about ten minutes, but no respiratory distress without it. I'll give y'all some space, just put him back on three liters or whatever you see fit when you're done."

Dan smiled and turned to us. "Hi there. You're….dad?"

"God no," Darry muttered before he could stop himself. "Brother. His guardian."

"My apologies. I'm going to be getting a sample from his artery so it's a little more invasive than a blood draw. If you can just sign this form saying you consent…"

Darry was scribbling his name on the line before he could finish his sentence. "Whatever you need."

He'd taken over Dr. Thompson's rolling stool and scooted himself over to Pony's side. "Hey buddy," he said in a loud voice, tapping his arm. "I gotta get another blood sample, okay? Can you open your eyes for a minute?"

Pony squinted at him blearily. "Yeah?"

"Can you do me a favor and make a big fist for me with this hand? Good job. Now raise that arm up in the air, okay? Yup, just like that. Keep squeezing. I'm just feeling your wrist for the arteries. Perfect. You can relax now."

He glanced back at us. "How does he do with blood draws?"

"Uhhh. He gets a little woozy? Pulls his arm away sometimes but he tries not to."

"Alright, if you don't mind coming over here and giving me a hand? People don't tend to be a fan of this, especially kids. The arteries are deeper so he's definitely going to feel it more. A lot of people usually get lightheaded or queasy for a minute. That's normal, okay?"

Shit. Both Darry and I approached, and I sat back down on the bed, right next to him this time, holding him close. Justine was on the other side of the bed with Dan, lining up his supplies on a little table again. I rubbed his shoulder. "Do you hear that, Pone? Mr. Dan's gonna take another little sample and he's gonna be as gentle as he can but ya gotta keep your wrist and arm real still, savvy?"

"M'kay."

"Just cleaning off your wrist now. You're gonna feel a big sharp poke but you gotta stay real still, okay? Try to take deep breaths. Do you want me to count down?"

He didn't answer this time, just turned his face into my shoulder.

"Okay. One, two, three… hold still…"

If I'd thought Ponyboy was too out of it to react, I was sadly mistaken. My insides gave an unpleasant lurch as the needle slid deep into his wrist. Ponyboy immediately started pulling away.

"Oh god… ow ow ow please stop-"

"Don't move-" Dan's tongue was between his teeth as he leaned closer, angling the needle slightly. "No blood return…"

Ponyboy was getting louder. "Shit shit shit please-" He thrashed suddenly, eyes wild, and I pulled him into my lap, bear hugging him. Darry practically dived to hold down his legs as he started trying to propel himself away off the bed with them, and Justine grabbed his outstretched arm, putting her weight into it as she held it firmly to the mattress, trying to keep the needle from getting ripped out.

"I know buddy, I know, I'm sorry. You're not an easy stick, are you? We gotta go one more time. Let's do it now and get it over with, huh? Another big pinch-"

Ponyboy bucked frantically and as weak as he was, I could still barely keep him down. He was sobbing now, sick and overwhelmed and half-delirious with fatigue and apparently, lack of oxygen. "SODA! Make them stop, please, please I don't want it-"

My heart was breaking. It felt like the ultimate betrayal as I held him tighter, trapping him in place, as thick dark blood finally started to flow into the tube.

"Shhhh hey. Stay still honey, I know it hurts, you're doing so so good." I tasted salt as tears slid down my cheeks again, running into my open mouth. I could hardly stand seeing him so distressed. Darry looked disturbed, still holding Pony's legs and watching with wide eyes. He couldn't fix it and it was killing him.

"You're doing so well. We're almost done." Dan pulled the tourniquet.

He lay still and moaned softly into my shoulder. "Oh god… I'm gonna throw up."

"It's okay bud." I maneuvered him upright and reached over to the counter with my free hand, snagging one of those pale pink bases and holding it under his chin. "You can throw up if you need to. You're okay." He gagged once, bringing nothing up, then slumped into me, crying weakly. I pet the side of his face gently, whispering a jumble of hopefully soothing words. "You're so tough. He's almost finished."

Dan pulled the needle out, handing the tube to Justine and immediately covering the area with a wad of gauze, pushing down hard. "I'm sorry. You did great."

We sat in an awkward huddle for almost three minutes; Pony on my lap, Darry at his feet, Dan at the bedside, Justine and Dr. Thompson in the corner. Just when I thought it must surely be over, Dan lifted a corner of the gauze and a spray of blood shot out, dotting his scrubs. It was like one of those cheesy horror movies Two-Bit made us watch at Halloween.

He actually laughed. "That one's on me. The rule is hold pressure for at least five minutes, no peeking. I get impatient."

I was horrified and he must have noticed. "It's really okay. This is normal. Arteries bleed a lot anyway, and it's to be expected with his diagnosis."

Pony let out another broken sob and Darry finally snapped out of his trance, kneeling down next to us, cupping the back of Pony's neck and pressing his cheek to the crown of his head. "Good boy. It's over now."

---

April 18th, 1965

"His capillary refill's already improving," Dr. Thompson reported. "And he's getting some color back. I'd say we're headed in the right direction."

Three hours after the debacle, Ponyboy was blessedly asleep. Dr. Thompson had elected to give us some time to sit with Pony and regroup before talking shop again, and I was grateful. He still wasn't well enough to listen to what he had to say, but Darry and I weren't as discombobulated. We sat in the quiet corridor just outside the room, Darry and I facing the glass window so we didn't have to take our eyes off of him. There was always a nurse there, sometimes adjusting the machine and drips, sometimes just sitting and watching, waiting for the next crisis.

"As I was saying, in simplest terms, his bone marrow isn't working. Healthy bone marrow tells our body to produce a certain number of red and white blood cells and platelets. Lymphocytes are white blood cells that fight the viruses and bacteria that make us sick. Ponyboy's bone marrow is producing lymphoblasts, an immature version. They're supposed to mature into healthy lymphocytes, but that's not happening here. And this mutation in his bone marrow is telling his body to make more and more of these nonfunctional cells, and they continue to multiply rapidly and crowd out all his healthy cells."

Darry pinched the bridge of his nose. "Okay. Just- I got 'bout a million questions, but I don't think they're pertinent right now. I need to know what the plan is tonight. And tomorrow. What are we doing for him?"

"Pediatric leukemia is very unique. I'm not a pediatric oncologist, and he certainly needs someone specialized. Like we spoke about Darrel, the children's hospital in Oklahoma City is the best place for him. I just received word that Dr. Mitchell has accepted his case. We're hoping to have him transported by this afternoon or evening."

I glanced at the clock ticking away on the wall. Glory, it was just past midnight. Less than twelve hours ago, I'd been working on a Ford engine and getting excited about the prospect of going to the stables in the evening. I wondered if I'd ever feel excited about anything again, because if Pony wasn't- if he couldn't- I wasn't sure I could go on.

"Is he gonna live?" I blurted out.

"Soda," said Darry quietly. He took my hand. "We don't gotta-"

"Please." I was talking both to Darry and Dr. Thompson at this point. "I need to know how bad this is. I ain't smart enough to understand the stuff you're telling me about cells and bone marrows and shit. Just-." My voice was thick and rough, threatened to be overwhelmed by a tsunami of grief and disbelief and frustration. I didn't want this to be real. "What happens to other kids with this? What should we tell him? He already knows more than most adults. He's real smart."

He took his reading glasses off and sighed heavily, rubbing his forehead. Suddenly, I felt the exhaustion radiating off of him, the reluctance to speak the words that had seemed so rehearsed before. I felt like I was actually seeing him for the first time, realizing that this was a burden he had to carry, the fact that he couldn't fix everybody.

"Like I said, this is not my domain. I don't work with children. It would be inappropriate to speculate when I can't even detail his treatment plan to you. Dr. Mitchell can-"

"Please."

He looked me in the eye. "Okay. If you had brought your brother to me in this condition two years ago? I would have told you to take him home. Enjoy the time you had left with him. Any decent doctor would have done the same. It would be cruel to give false hope when there was no chance of survival and put him through painful treatments that would do little to prolong his life."

There was a horrible silence. For the first time, I felt like I couldn't even cry. It was like all the air had been sucked from my lungs. Darry's eyes were shining with unshed tears.

"But now? The last couple years have really given us hope. There have been children achieving periods of remission. That was unheard of before. The life expectancy was never more than a year at best. There's a new children's hospital in Memphis. They've really made some headway, and they're sharing their findings with pediatric oncologists all across the country. They're studying these success stories. Looking at their subset of leukemia, any genetic components, replicating their treatment plan for newly diagnosed patients. If you were to choose the traditional treatment plan for your brother in his current state, I wouldn't anticipate his body being able to compensate much longer. An infection or internal bleeding would likely lead to his demise within weeks. But if you are willing to follow different protocols that Dr. Mitchell sees fit? There's hope. He's an excellent physician. I've referred five children with cancer to him in the last couple of years."

Darry's eyes were still shining, but the tears hadn't fallen. "You say they can start treatment later today. How long will it take to start to work?"

"That I can't tell you. It will be about preventing complications now. Anticipating them and getting ahead with early identification and treatment. He's at high risk for sudden respiratory or cardiac distress. And stroke. We'll be checking his neurological status frequently to ensure we catch any early warning signs."

"A stroke?" Darry buried his face in his hands.

"He's scheduled for an x-ray around five AM. We need to confirm there aren't any mediastinal masses- it's quite rare but tumors in the chest well have been seen in some cases of ALL. I'm not concerned about this, there would be clinical indications- respiratory distress, pleural effusion, tracheal compression. His lungs sound good and the cough and wheezing he experienced not long ago likely was due to bronchitis rather than a growth. The spinal tap ruled out spread to the central nervous system but I can't speak to much on that- again, Dr. Mitchell will discuss with you. His ABG showed low oxygen saturation, so we'll keep him on oxygen for now and do a repeat one when he's under anesthesia later. I suspect the levels will have improved significantly with the transfusions."

"And the surgery?"

"A common procedure. The port is a small device that's going to be placed just under the skin in his upper chest, near his collarbone. It's like a permanent IV- we don't have to poke him as much and risk not having access because repeat IVs will eventually damage the veins. We can draw blood from it, too. The chemotherapy is also extremely toxic and can only be delivered via large veins as well. It's a little round disc with a catheter extending from it. We're going to thread that little tube into the subclavian vein, leading right to his heart. It's not as scary as it sounds." He glanced back at Ponyboy, still dozing, now curled up on his side, clutching a pillow. "When he wakes up, we can show him some pictures and explain so he knows what to expect. Honestly, he may remember very little of what's happened tonight, and that's a good thing. Even when he seems alert, his brain has been suffering from chronic oxygen deprivation and even small amounts of ischemia can impact cognitive function more than we think- brain fog, confusion, poor memory. I don't think it's wise to explain more than the bare minimum to him, at least until he's at Children's. They have real experts there who do this every day- I was a little relieved that you told him and I didn't have to page psych. Dr. Mitchell will be able to give him clear answers and I don't want him to feel I'm keeping him in the dark when truly, I just don't have the expertise to tell him what he wants to know."

"Thank you." Darry was all business again, getting to his feet and holding out a hand to shake.

"You're welcome. I'm sorry that you're in this situation. Truly, I am. I promise we're doing everything we can for him. I'll be on call and getting updates and will be back if there are any unexpected issues before he's transferred care. The ICU is full and there's no use in moving him to the oncology floor at this point- he needs one-on-one care, and he won't get that there. But for now- y'all get a couple hours of rest, then we'll get imaging, then he'll be taken upstairs to surgery."

By the time sunlight was breaking over the horizon, sending strips of light through the slates of the blinds to dazzle the sterile corridors, it was clear the blood transfusions had done Pony some good. He wasn't freaking me out as much- he was able to sit up and his eyes were clearer, voice stronger, and he seemed more aware of what was going on around him. Unfortunately, his mood hadn't been improved by Colleen returning with a thin rubber tube and the news that they had to put a urinary catheter in and get a sample. He was alert enough to argue, and it took nearly ten minutes of coaxing from me (and some choice words from Darry) before he relented and ordered us out of the room. When we returned, his face was blazing and he wouldn't look anyone in the eye. He was humiliated, exhausted, cranky, and as he incessantly mentioned, thirsty. Every ten minutes he'd goad us for a sip of water or ice chips, as if he was going to get a different answer this time. He was plenty hydrated, we were reassured, given the constant liter bags of IV fluids being pumped into him, but it didn't matter.

I wanted more than anything to give it to him. He was so sick, and so strong, and asking so little. My answers were patient and sympathetic and I did everything I could to lull him back to sleep so he wouldn't have to deal with the pain and discomfort. I rubbed his back, played with his hair, hummed old songs mom used to play on the piano, recounted good memories about when we were little, recited passages from books he'd read out loud so many times that they were blazed in my brain.

Darry's patience was stretched thin. I could see him struggling, unsure of how to interact with our brother now that he was in such a state. It's all well and good to snap at a kid who's pestering you over and over with the same questions, but when that kid is lying in a hospital bed, critically ill, confused, and frustrated because his basic needs aren't being met, it's different. I was sorry for him.

Justine the nurse had practically reached sainthood status in my mind. She hadn't left his room once. She checked his pulse and blood pressure every fifteen minutes, asked him his name and where he was and what date it was over and over again to test his neurological status; never wavering as his answers got progressively more frustrated and snarkier. She gave him a third unit of blood and something called fresh frozen plasma, changed out IV bags, scribbled calculations on a notepad, untangled tubing, placed a new IV, emptied the urinary catheter bag, gave him a shot, drew more blood, cleaned him up after he puked all over himself during said blood draw, moistened his mouth and lips with special swabs when he whined for water, reassured Darry when he jumped at every cough or groan Pony made. By the time the radiology guys arrived to take him to imaging, she was probably ready to book it out of there.

He was gone for twenty minutes tops, but it felt like hours. I took the opportunity to go to the bathroom and stretch my legs. I spotted one of Tim Shephard's gang sitting in the waiting area, swearing up a blue streak as blood streamed from a gash on the side of his head. If it was any other day, I'd be nosing around for details.

It was clear upon return that the x-ray had worn him out, and he drifted off almost immediately after the techs transferred him back on the bed. I was grateful. I would be able to rally and put up a front for him if I needed to, continue to tend to him, but I was wiped. I was starting to feel so tired and out of it that I almost felt drunk.

At half past six, the radiologist sent word that the preliminary x-ray results showed no masses and he was cleared for surgery. Not ten minutes later, we were walking up to pre-op with him, an odd parade of tubes and wires and monitors trailing after him.

It was strange. I could remember every detail of the night up until then, the memories sharp and painful. I don't think I could possibly forget them. But then, everything felt fuzzy. We eventually made it up to the floor and spent at least an hour in a little room with lots of staff coming in and out, asking question after question and examining Pony. I knew the anesthesiologist talked with him, and the surgeon, and they explained everything to him, but it was all a blur. It was like I blinked and we were standing at the end of a long corridor in front of a pair of double doors and a man in scrubs and a surgical cap was telling us it was time and we couldn't go with him beyond this point.

My heart was in my throat. I couldn't help but think that one week ago, we were in this exact same position, sending him off for his biopsy. It couldn't have felt more different. I was thoroughly convinced then that this was something minor, would be a quick fix after they gave him some medicine. I hadn't even been that scared when he went under anesthesia. The staff seemed so capable, so sure of themselves, and I thought we had reached our quota of tragedies, that there was no way something could be seriously wrong with him so soon after mom and dad. Surely the universe wouldn't be that cruel.

But now? I was more scared than I'd been so far. I suddenly thought just how fragile life was, how easily his little body could be affected by such strong medicine. How they would have to breathe for him, put a tube down his throat, cut into his chest. How he didn't have enough fucking oxygen going to his brain already and even a tiny nosebleed caused significant blood loss because his body wasn't clotting. What would an incision do?

"Soda?" Pony's voice was quiet and hoarse but didn't waver. He wasn't tearful and the fear in his eyes was muted by anxiety. Aboutme. I couldn't believe the kid. "It's okay. I'm gonna be fine." He wrapped his scrawny arms around my neck and I buried my face in his shoulder.

"I love you so much, Pony," I murmured in his ear, rubbing the back of his head. "You're just gonna take a little nap, then when you wake up you can have some of that water you keep houndin' us for, huh?" He laughed weakly and I kissed his forehead, pushing back his sweaty locks.

Pony turned to Darry, who was hovering behind my shoulder. "See ya later, Dar," he said, almost shyly.

Darry's expression was set but wavered when he looked at Pony. "I'll see you later, Ponyboy," he said, and his voice was slightly wobbly as he cupped the side of his face gently. "You'll be fine."

Pony buried his face in Darry's chest as he hugged him. "Okay," he said, but his voice was small and starting to sound hesitant.

Darry swallowed hard and glanced at the staff, who were starting to open the doors and pull their equipment in. "I- I love you, kiddo," he said thickly.

His eyelids were fluttering. "Love y'all too," he slurred and then he was gone.

---

The waiting room was large, but it felt suffocating, like the walls were closing in around me. Darry had steered me into a chair and told me he'd be right back. There was a payphone in the corner, but a middle-aged man was using it, whispering urgently into the receiver. An elderly couple were sitting on one of the little couches. They were both crying. A man with a collar and cross necklace was kneeling in front of them, speaking in a low, steady voice. A young mother soothed her wailing baby, pacing back and forth.

"Eat."

Darry appeared in front of me, holding out a biscuit wrapped in cellophane, a chocolate bar, and a bottle of water.

"I ain't hungry."

"I don't care. You haven't eaten since yesterday afternoon. And you need to drink. You been bawlin' all night, you gotta be dehydrated as hell."

"Only if you eat, too."

He rolled his eyes but relented. It was like chewing rubber but I managed to get it all down.

"Can I call the guys now? Please?" I couldn't stand another second sitting there, staring at the wall. I needed something to do, and someone to talk to other than Darry.

"Fine. But make sure they know they can't see him for another couple hours at least. Ain't like they won't come crashing in the minute you call, but if they come in here guns ablazing all gung-ho on seeing him, they're gonna delay us. And that's not happening."

I nodded, not really taking in his words. The phone was free and I dug in my pocket for coins as I walked over. I fed them into the slot, then dialed. There was only one number I would usually consider calling. We tried to avoid calling Steve's house, because if his father was in a mood and answered, he'd take it out on him if the call had interrupted something he deemed important. The Cades hadn't had a working phone in years. Buck would sometimes take calls for Dally, but it was hit or miss if he was even in his room at this hour. As usual, that left the Mathew's as our go-to.

The phone rang several times, and I was starting to get worried that no one would answer. Lilah had early morning choir practice at the elementary school sometimes, and Two-Bit or Ms. Mathews would take her. Two-Bit would sometimes go out at night and goof off around town if his ma wasn't working and could stay home with Lilah. I hoped he hadn't. If he was boozed up he would still show up in a heartbeat, but would have to see if Steve's car was available and he wasn't already out for the day. To his credit, Two-Bit was surprisingly responsible about getting behind the wheel when soused. Ever since Joey Mandroe got T-boned leaving the high school by drunk Old Man Bailey who lived down the street and his brains got splattered all over the windshield, he'd hand the keys over if he'd had more than two or three beers.

"Yeah?"

Relief flooded through me. "Two-Bit?"

"Soda? Geez man, y'all had us kinda worried. I mean, I know we all got other friends and we don't gotta always tell each other where we goin' but ya know some of us usually come 'round for dinner a lot and when Johnny and I dropped in the place was empty and all the lights were still on 'n shit. And you told Steve that y'all might do somethin' with Evie and Sandy and to swing by but ya never showed. So what's up?"

I'd let him prattle on. My throat felt too tight to interrupt. My palms were sweating.

"Soda?"

"We're at- we're at the hospital," I managed.

"The hospital? Oh Christ. Is it Pony? What's wrong with 'im?"

I couldn't even get the words out. "Two, he has c-." It seemed that unlocked everything in me, because suddenly I was crying harder than ever.

"Soda? Buddy, I can't understand what you're sayin' with you blubberin' like that," Two-Bit said, all gentle-like, as if I was a little kid. He never talked to me like that. Although I was younger than him by over a year-and-a-half and Darry was his best friend first, I'd always been an equal, not treated like a tag-along or a kid brother who needed looking out for.

Two-Bit was sounding real worried now. "Is Darrel there, pal? Can I talk to him?"

Darry had hurried over when I started crying. I looked up and saw the entire waiting room and a handful of staff all staring at me, wide-eyed. Darry snatched up the phone. "Hang on one minute, man."

He left the receiver dangling, closed his big hands over my shoulders, and pushed me into a chair. Now that Pony wasn't here, it seemed my body was giving me permission to totally lose it and Darry permission to focus his attention on me. "Shhh, I know baby," he murmured, rubbing my arm soothingly. "I know. I'm gonna talk to Two-Bit real quick, okay? I'm gonna come right back."

"Yeah. Mmm-hmm. It's bad, Keith." I could hear Two-Bit's voice, loud and anxious, words indistinguishable but the panic speaking volumes.

"Yeah, it's- it's what they thought. What I talked about with you, yeah. I know. I know, man. Listen, can you just call the guys? It's early, y'all don't all gotta come down if it's too much or they can't be cool 'cause to be honest I don't think I've got it in me to be doin' a whole lotta reassuring right now and I ain't dealing with Dallas and his shitty coping mechanisms. Just- just get Steve down here, at least. Please. Soda's a wreck. Yeah. See ya soon."

---

"Glory, he looks rough," a familiar voice said, and I felt my hair being tousled roughly.

"He held it together real well for Ponyboy, that's for sure. I ain't sure they could have gotten that test they did downstairs without 'im. I think it hurt Soda more than it hurt Pony, honestly."

"Why didn't you call earlier, Dar? Were y'all really here for that long tryin' to deal with this all by your lonesome? We would've been here. All of us."

"You don't get it. It was a nightmare. First the doc calls and tells me and says we gotta get here as soon as possible 'cause he needs a transfusion, Soda's freakin' out, Pony's gettin' worse, and then they start talkin' 'bout life expectancy and that he's at high risk for a stroke until the chemo starts to take effect. A stroke. He's thirteen years old.

"I ain't even sure what to say, man. This don't feel real. Like when your folks-"

"Don't." His voice was full of pain. "Please, just don't. I can't think 'bout them right now. I gotta focus on Pony. And Soda. I'm so in over my head already. How we gonna afford this? What if the State gets involved and think I can't take care of 'em when he's this sick?"

Their voices were fading in and out like a badly tuned radio. I was groggy and sore. My face felt tight and swollen from crying so much and my head was pounding. But Darry's shoulder was warm and solid and I was real comfy leaning against him, his arm around my shoulder. I didn't want to open my eyes, to be awake and face the world again.

"Darrel. Don't. Like I told you before. That night when your folks- and when we talked about Pony being sick. You're not there yet. You got so much on your plate already, you ain't got the energy to waste time worryin' 'bout things that might or might not happen. Take it one day at a time. Hell, one hour at a time. Savvy?"

My head was jostled against Darry's shoulder as he laughed a little. It sounded watery. "You sure you failed eleventh grade? For a self-proclaimed idiot, you can be real smart sometimes, y'know?"

His voice was so sincere that Two-Bit didn't immediately start gloating or joking like he normally would. I hoped he knew Darry was right.

"Darry!"

My best buddy's voice was gruff and impatient. I could hear multiple sets of footsteps thundering over.

"Christ, how fast did y'all drive?" Two-Bit sputtered. "I left first so someone could be here with them right away and you'd take the time to wrangle the crew and bring 'em."

"Never mind that," Steve snapped. "Darry, what the hell's goin' on? Two said that Pony was havin' surgery and he was real sick."

I squeezed my eyes shut even tighter and hummed to myself, trying hard to tune it out. Don't listen, don't listen, don't listen…

"… fucking serious?! Cancer? But he's a kid!"

"I know, okay? I know y'all weren't excepting this. None of us were. I just- I need y'all to be calm. I'm- I'm about to fucking lose it, okay? And Sodapop's a mess. And Pony-" he broke off.

There was silence. Darry never admitted to weakness.

He sighed. "We're just- he should be out of surgery soon. It's to put some catheter in his chest. That they'll give him chemo through. This afternoon."

"Chemo? Like you see in TV shows? That stuff that makes your hair fall out?"

"Yeah. It's an experimental trial or somethin'. At the Children's Hospital in Oklahoma City. They're gonna start treatment today. No visitors for the first round, so y'all won't be able to come visit."

"You're gonna let 'em experiment on the kid? Darrel, that's-"

"The doc said it was his best chance. That without it- he just really needs it, that's all. It's worked before."

"Jesus, man."

There was another long silence, then, "Soda?"

Darry was gently shaking me.

"What?" I'd been listening, but still felt groggy and half-asleep.

"The guys are here."

I finally opened my eyes and sat up. Two-Bit was pacing, face grim. Steve was next to me, hand on my shoulder. I realized I hadn't heard Johnny or Dallas speak yet, but there they were. They had clearly dropped everything to rush here, they were more disheveled than usual. Johnny hadn't even greased his hair. He looked even smaller than usual, knees pulled up to his chest, arms wrapped around them. He looked on the verge of tears. Dallas was standing behind him like a guard dog, hand on his back, face unreadable.

Steve squeezed my shoulder. "Hey, buddy. Wanna go for a walk?"

I did. More than anything, I needed to get away for a minute, away from the stifling room, away from it all. And Steve knew me, knew what to say, how to calm me down. "What if they come to get us and I ain't here? Pony needs me."

"We'll come find you if that happens," Two-Bit responded. "Go on." He pulled me in for a quick hug. "I'm so goddamn sorry, kid," he said in my ear, so only I could hear him.

"You'll stay with Darrel?" I asked softly. I didn't want him to be alone.

"'Course, I got Superman. I got it covered, man."

---

A quarter of an hour later, Steve and I were heading back up to the fourth floor. My lungs burned from the two smokes I'd gone through while we walked, but ironically my chest felt lighter than it had all night.

The guys were all right where we'd left them, with the exception of Darry, who was talking to a woman at the front desk. My heart skipped a beat. Pony definitely should be out soon, they said it would be about an hour and a half, tops. What if something was wrong?

I heard a sniffle from the corner and realized with a pang that tears were slowly trickling down Johnny's cheeks. We very rarely saw Johnny cry. He was small and quiet and timid, but still strong as all hell, toughened by years of living in fear and pain and taking it without flinching. He cried the night mom and dad died, too, but then, everyone but Dallas and Darrel did as well. Before that, the last time I saw him real worked up was when he was thirteen and his dad beat him so bad that a teacher called social services. They were about to ship him out to a group foster home in McAlester before he managed to convince them it was all a misunderstanding. He'd rather die than go to a foster home and be on his lonesome and away from us.

"It's gonna be okay, Johnnycakes," I murmured, sitting down and slinging an arm around him. "Ponyboy's gonna be okay."

He nodded, swiping at him eyes. "I'm so sorry, Soda."

"Thanks, bud." I patted his back and we just sat there for a while. There was nothing more to say.

Dally was still stone-faced, standing rigidly. I could feel how uncomfortable he was, whether from worry or how much he hated hospitals, I didn't know. I did know that it was taking everything in him not to run out of there or snap at someone to blow off some steam, and I was grateful.

"Thank you, Dally. For bein' here."

He nodded once. "Wouldn't be anywhere else."

Darry returned. "He's doin' fine," he told us. "They finished up and just took him down to x-ray to check the placement. Should be callin' us back in fifteen minutes or so."

I thought I would feel more relieved. I knew Darry wouldn't lie to me, but until I saw with my own two eyes that Pony was okay, I wasn't gonna relax.

We sat for another ten minutes, holding vigil. Darry was shuffling through a binder they'd given him of papers on leukemia and notes and forms for the new doctor at Children's. Steve was smoking, Two-Bit rocking back and forth in his chair, trying to balance it on two legs. I noticed a large plastic bag with the St. Francis Hospital logo next to him. "What's that?"

"Oh, nothin'," he said airily. "Just made a little detour to the gift shop on the way up, that's all." He looked entirely too pleased with himself. Clearly he was both grateful for the distraction and had been waiting for someone to ask.

"Stealin' from a hospital gift shop ain't real wise, Two-Bit," Johnny said, eyes still fixated on the floor. "If they caught ya, you wouldn't be able to see Ponyboy."

"I know. Which is why I bought it fair and square like the responsible citizen I am."

Steve scoffed. "You ain't been responsible a day in your life," he said, swiping the bag from him, tossing aside the neatly arranged blue tissue paper, and pulling out a stuffed horse. It was a light chestnut brown, with soft white tufts of fur above the hooves and a golden brown tail and mane. Black and white striped reins circled the snout, and its black eyes shone, lining a white diamond marking on its snout.

I laughed, unable to help myself. "He's gonna kill you."

"Maybe, maybe not. It's somethin' to look at, at least. Like when we can't be there, he'll remember it's from us. Put it in a new spot in his room every day to freak him out." He waggled his eyebrows. "Maybe he'll think it's possessed or some shit. Lord knows he got a wild enough imagination to believe it."

"Family of- um, is it Pony… Boy? Ponyboy Curtis?"

We all scrambled to our feet. A man I recognized as the surgeon was waiting in the doorway, but gestured for us to sit back down. A woman hovered behind him with a clipboard.

"We just took him to PACU," Dr. Kimball told Darry. "Everything went smoothly. There was some pretty significant bleeding, but that's to be expected. I've spoken with Dr. Thompson and we're going to give him another packed cell transfusion once he gets to the floor. We don't have any FFP of his blood type currently. His platelets are still low so we're letting the Children's Hospital know and they'll likely transfuse him there. His hemoglobin was trending upward but still not quite where we'd like to see it."

"But otherwise? No other issues?"

"Nope. We confirmed the placement with x-ray, got blood return and accessed it so he's got fluids running through it now. He'll be sore but nothing too severe. We'll keep pain meds every two hours as needed for the rest of the time he's here. We got another ABG to recheck his blood pH and CO2 and oxygenation status. No issues with the anesthesia… and he's definitely feeling pretty good given the circumstances. I wish y'all the best of luck with his treatment. It was a pleasure."

"Thank you. Thank you so much." Darry and I shook hands with him, and he disappeared through the double doors. The woman with him beckoned for us to follow. "If you'll follow me, I'll take you to the PACU. Family only," she said in a weary voice as we all made to follow her, looking at the gang.

Darry looked irritated. "They are family."

"Well, I know he's only got two brothers, so you can't use that excuse on me."

"They're our cousins," I improvised. I knew I looked a mess, eyes swollen and face blotchy from crying, but attempted to flash my award-winning smile to persuade her. She was unimpressed.

"Hmm." Her eyes traveled from Two-Bit's auburn hair and freckles to Dallas's dark skin and hair, then over Johnny's black eyes and the copper arrowhead necklace he always wore, the one his grandmother gave him back when his mom would still take him to the reservation to visit. "Y'all don't look like cousins to me."

Dallas bristled. "Well, you don't look stupid to me, but you doin' a pretty good impression of it now, ain't ya?!" He was standing less than a foot from her face, eyes blazing. To her, he looked nothing more than hot-tempered hood, always provoking a confrontation, but to me, the fear in his eyes was obvious. He was scared, and his knee-jerk reaction was to lash out like always.

To her credit, she didn't look the slightest bit intimidated. "If you really want to see him, that attitude will get you nowhere," she said icily. Then she sighed and surveyed us again; the bags under Darry's eyes, the tear tracks on my face, the way Johnny was biting his nails, Two-Bit tapping his foot nervously, the cigarettes Steve had been chain-smoking still smoldering in the ashtray. I knew the anxiety was radiating off of all of us, tough as we tried to look. "We don't normally make exceptions, but this isn't exactly a standard case. I know they'll be transferring him to Children's later, correct?"

Darry nodded. "Yes, ma'am." He looked like he wanted to say more, but I stepped in. Darry didn't exactly have the puppy-dog eyes that I could pull off.

"Yeah, and my buddi- I mean cousins, they ain't gonna have a chance to see him for a while then 'cause they were sayin' they don't want no extra visitors during his first round of treatment, and they're all real worried 'bout him, and he'll really want to see him. He's just a kid, and he's scared and it'll really-"

She held up a hand. "They can come. But I expect y'all to keep the noise down and don't go drawing attention to yourselves. The last thing we need is other patients and families noticing and start thinking it's okay to have family reunions in the middle of the PACU."

"Trust me, if it's anything like last time, my brother will be the one making the noise, not us. That anesthesia really did a number on him," I rambled nervously as we started down the hall again. I felt compelled to keep conversation going, to avoid the silence that could lead to me thinking. That was the last thing I wanted to do at this point.

The PACU was pretty much empty. There were several nurses at the main desk, chatting and all keeping an eye on Pony, who was in one of the front cubicles. His assigned nurse introduced herself and ushered us forward.

"He's doing just fine," she said with a smile. "No significant vital changes, still have him on the two liters of oxygen as a precaution until we get the repeat ABG back. His urine has slightly elevated uric acid levels and Children's recommended we start him on allopurinol prophylactically to keep it stable and decrease the risks of tumor lysis syndrome once he starts treatment, so that infusion is running now, along with his maintenance fluids."

Darry thanked her, and she pulled back the curtain to Pony's cubicle. "I'll give y'all some privacy, but I'll be right over here if you need me."

Pony was lying there, head elevated on several pillows. He was pale with dark circles under his eyes, oxygen tubing still under his nose. He was shirtless and just below his right collarbone was a firm, raised, circular area. There was a catheter and needle hub inserted, all covered with a transparent dressing. It was hooked up with tubing, just like an IV line, and I could see the medicine slowly dripping in the bag, right through into his chest. I ain't gonna lie, it was pretty gnarly looking, not to mention the entire area was red and swollen. But Pony didn't seem to notice.

"Heyyy!" he greeted enthusiastically, and for a minute, I could almost pretend he was just here for testing still, coming out of anesthesia happy and high and we'd be taking him home in mere hours. But I didn't have time to focus on reassuring myself. Seeing him talking and smiling and breathing almost brought me to my knees, I was so relieved.

"Hi Pone. Did you have a good nap?" I hurried over and grasped his hand in mine, ran a hand through his too-long hair, kissed his forehead. In the last couple years, Pony had gone from the clingiest kid known to man to someone who'd grumble in protest if I showed him that kind of affection in public (the guys didn't really count, although Steve and Dally might poke fun at him for being a baby or tease that I was coddling him). But I knew it comforted him and he was too out of it to be embarrassed. And selfishly, I didn't really care. I needed it more than he did, needed to reassure myself that my baby brother was really still here. Sick, but here. "Thank you Jesus," I sighed under my breath, leaning my forehead against his hand for a minute.

I wasn't planning on moving anytime soon, so Darry had to resort to squashing himself on the other side of Pony, knocking into the IV pole and trying to avoid moving the curtain too much. "Hey little buddy."

"Hey not-little buddy." We all snorted at that. "Why're there two of you?"

"Glory, two Darry Curtis's. Just what we need," I teased, and Pony laughed raucously.

He saw the guys hanging back, looking wary. Johnny was fully behind Dallas at this point, eyes huge, looking properly freaked out now. But Pony lit up. "Man, you brought everyone with you! That's so nice. Y'all are all nice. Even Dally. And Steve, even though he's annoying."

Steve's arm twitched, like he wanted to sock the kid, but thought better of it. "Only reason I ain't knocking your lights out is 'cause they got security here, you little shit," he said gruffly, but his eyes were soft and smile affectionate. "How you feelin', shrimp?"

"So awesome," Pony drawled, rolling his head side to side until Darry put a hand on his shoulder to keep him still. "Except the cancer. 'Cause they say I have that. Ain't that nuts?"

There was a tense silence. No one seemed to quite know what to say. You'd think they'd find it easier to express their worry and sympathy given Ponyboy would likely not remember any of it, but no dice.

Maybe feelings are easy for me because I am dumb. I don't overthink things or take the time to analyze them. Just say what you mean, simple as that.

"Yeah, it's pretty crazy, huh?" I sighed, rubbing the back of his hand with my thumb. "I know it gonna take a lotta time to get used to. And it ain't fair, but we're all gonna be here for you, right?"

"Yeah we got you back, man," Two-Bit said, clapping a hand on his knee to pat it reassuringly. I saw Darry wince, probably imagining the bruise that was already forming.

I noticed Dallas had disappeared, and Johnny was no longer hiding behind anyone, but moving closer to the bed. He was real nervous, I could tell.

Ponyboy had seemed to drift off for a minute, but when he came to he locked eyes with Johhny and looked positively delighted. "Johnny!" He reached his free hand towards him and when Johnny came to stand next to me, Pony leaned over and attempted to hug him, tube and wires from his chest and arms tangling.

"Hey buddy," Johnny said in his quiet voice, pulling him into a careful hug. "What's up?"

"Man, I don't even know 'cause I can't remember what the hell's even happenin' and time is infinite. They put this weird thing in my chest though. Like under the skin. How gnarly is that?"

"That's pretty wild all right. You like a robot or somethin'. Like in that movie we saw last month, 'member?"

The curtain was pulled back and the blonde nurse squeezed her way in. "Just checking in. Gonna take your blood pressure, alright? You doing okay? Any pain? Or nausea? You boys need anything? Coffee? Water? We got a coffee maker in the back."

I wanted to tell her Pony was unlikely to answer even one question coherently in his state, let alone keep up with her yapping, but kept my mouth shut.

Pony twirled his fingers around one of the cords hanging from the wall as she wrapped the blood pressure cuff around his arm and started inflating it. "This is Johnny. He's my best friend in the whole world," he informed her.

She smiled warmly. "Hi Johnny."

Johnny's face flushed. "Hi," he mumbled, staring down at his gold converse.

Pony hummed to himself as she finished taking his vitals, pushed a clear syringe of fluid through the IV that wasn't hooked up to anything, and left.

Two-Bit moved closer and reached into the gift bag. "Got somethin' for ya, man." He tossed the stuffed horse to him, clearly expecting him to catch it. I snagged it midair, knowing he didn't have the coordination to, and handed it to him. He just started at it, perplexed.

"A pony for the Ponykid!" Two-Bit teased, winking at him.

Ponyboy tried to scowl but failed miserably. "You're ridiculous. But he's real soft." He ran a hand over the velvety fur. "I'm namin' him Newman."

Steve scoffed. "Like Paul Newman? What kind of a name is that?"

"Well, it's my horse so I can name it whatever the fuck I want!" He said it so gleefully that Darry couldn't even scold him, he was laughing too hard.

The next half hour was spent with Ponyboy cheerfully chattering on about nothing and everything, from the book he was reading to his track buddy who'd just been dumped by his long-term girlfriend to his take on current events and politics. I was relieved he was so drugged up that he clearly not only couldn't feel any pain, but was happy and keeping the atmosphere light without even trying. He finally got to drink the water he'd asked for so urgently, then promptly scowled and asked for a Pepsi instead. Dallas, who had ducked in and out, looking more and more uneasy, gratefully ventured to get one for him. He cracked the cap for Pony on return and smacked him on the back of the head lightly. "I'm sorry, Pone," I heard him mutter as he bent down to hand it to him. "You're one tough kid."

Eventually, the medicine wore off and he was in and out of sleep again, using Newman the horse as a pillow. The nurse came to transport him to the med-surg floor, and surveyed our large group. "EMS will be here within the next couple hours to transport him. I suggest your cousins head out now," she winked.

Pony was real sleepy, but smiled weakly at the guys. "I'll see y'all later."

---

The medics couldn't come soon enough. The med-surg floor was jam-packed, with people hollering and crying and complaining so loudly we could hear it through the walls. His nurse, a frazzled looking woman, got report, took out one of his IVs, and started another blood transfusion. She stayed for about fifteen minutes, ensuring he was tolerating it well and then vanished. She returned only to wheel in a hacking elderly man an hour later, declaring him as Pony's roommate. Darry immediately protested, citing Pony's compromised immune system, but she told us his COPD wasn't contagious, and they didn't have anywhere else to put him. The man proceeded to bitch and moan about his IV, the lunch menu, the lack of TV, and, to our displeasure, the apparent loud volume of Darry and I's voices. Darry left for coffee after that, muttering angrily under his breath.

Just as he left, Pony stirred groggily and opened his eyes. His gaze was a lot clearer than it had been. "Hey bud. You awake for real this time?"

"Hmm…. yeah, I think. Golly, what time is it?" He didn't even attempt to sit up, just lay there, looking like it was taking energy to just talk to me.

"A little past noon. You hungry?"

Pony shook his head a little. "Too tired." He was wearing a hospital gown but I noticed he was still looking determinedly away where the tubing disappeared under the fabric at his port site. His brow furrowed. "How'd it go? I don't remember much. I saw the guys though, right? I kinda remember talkin' to them."

"Yeah, everyone was here earlier. They were real glad to see you, but they had to leave. They're gonna take you to the Children's Hospital, remember?"

"Kinda? Everything's sorta fuzzy. I don't even remember comin' here yesterday."

"You were real sick, honey. They gave you three bags of blood and something else. I ain't gonna remember the name, it was weird. And you're gettin' more blood now."

He fiddled with the edge of the blanket. "I'm sorry I made you worry."

"Hey, none of that." I cupped his face in my hands. "You're here now. And you're gettin' better. That's all that matters."

A hacking cough echoed from behind the curtain.

"You got a roomie though. Old geyser sounds like he 'bout to cough up a lung, but still has enough air to complain." I didn't bother to keep my voice down for that remark.

Ponyboy turned to look over and gaze fell upon the stuffed horse, now tucked under the covers next to him. "What the heck?"

"What?" I said, feigning innocence. "Oh, this little guy?" I dangled it teasingly in front of him.

"Two-Bit," he groaned. "Right?"

"Who else?"

"Oh my god, why is he so determined to embarrass me? You should go return it."

Darry walked back in the room with his third cup of coffee. "Return it? You'd really do that to poor ole' Newman?"

"Newman? Oh glory, y'all should just tape my mouth shut when I'm on that stuff."

I hugged the horse to my chest. It really was soft. "Hell, I'll keep it. Reminds me of Monroe." Monroe was my favorite horse at Ronald's barn. I didn't work there anymore since starting at the DX, but I was always welcome to hang out and ride any of the horses I wanted, long as I pitched in with some of the day's chores, and I was only too happy to oblige. Monroe was no Mickey Mouse, but I was real fond of him anyway. He was getting up there in age and could only hobble to and from his feed box on account of his three legs.

He tried not to smile at that. "You're crazy, Soda. I'm thirteen, not three. We could give him to Lilah."

"Oh, 'it's' a 'him' now? And you can't pretend you don't want him to cuddle at night. We all know damn well you still sleep with Lassie sometimes."

His ears were bright red by now. "Shut up, Sodapop," he hissed. Lassie was the old stuffed collie dog he got when he was around three or four. He loved that damn thing, and it was ratty and worn-out from years of play. Eleven-year-old Ponyboy declared he was too old for it after the guys ribbed him one day and stored it under the bed, but even now, when he was stressed or upset about something, Lassie would make an appearance. After mom and dad died, he slept with it for weeks. I found him napping with Lassie tucked under his arm the day after his biopsy, too. It was one of the few things Darry and I couldn't tease him about in front of the guys. If any of them, even Johnny, knew, he'd sworn he would die of embarrassment.

The transport team arrived a half hour later, clad in tactical pants and blue shirts, wheeling a stretcher and carrying a large, clunky-looking bag. They were friendly but efficient, and had lifted Pony on the stretcher and moved over all his bags and equipment to the stretcher's various hooks and monitors before we could blink. Funny as it was, Darry had taken mercy on the kid and saved him from humiliation by grabbing Newman and shoving him into Pony's backpack before he could be seen.

"Are we goin' now?" I asked. I was jittery and anxious to get Pony settled in for good. He'd be a lot more comfortable, not to mention could start treatment once he was there.

"Just waiting for the nurse to do handoff report." I tapped my foot impatiently until she arrived ten minutes later, looking harried.

"Sorry, sorry, had a situation," she said, fumbling with her clipboard. "Umm- Ponyboy Curtis, 13-year-old male, no significant past medical history until diagnosis of ALL yesterday evening, biopsy was about a week ago. Initial hemoglobin was 4.8, he got three units of PRBCs and a unit of FFP in the ED and just finished another units of PRBCs about twenty minutes ago. Repeat hemoglobin at 2200 was 9.9. BP was initially quite low but has been holding with fluids, initially was on D5W due to hypoglycemia but that self-resolved after he was taken off NPO, so now getting normal saline. ABG showed sats at 90% and he did endorse mild dyspnea so was placed on 2L NC, titrated off about three hours ago when repeat ABG was normal and he's tolerated well. He's got a 12 French foley in, last output 300 mL emptied thirty minutes ago. Port was placed at 0700 without complications, has been accessed and just finished allopurinol drip so it's saline locked. He's got an 18 gauge in the right antecubital that's got fluids running at 100 mL/ hour. No complaints of pain right now, he got indomethacin at 1100. If he's having pain on the ride over we could probably send a standing order with you to give whatever y'all carry on the truck. Oh, his brother is his legal guardian. Any questions?"

"Is he with it?"

"Sorry, yeah, he's pretty lethargic but he's fully aware."

"Great. If you could just sign here…" she scribbled her name on their clipboard and she was off again.

"Alright folks, let's get movin'. Keep all arms and legs inside the ride at all times," he quipped to Pony, who gave a half-hearted smile. He was starting to look anxious.

"You good?"

"Yeah," he said, picking at a hangnail on his thumb.

"You ain't worried 'bout goin' in an ambulance, are ya? It's pretty tuff. You can geek out over all the fancy technology they got on board."

"I ain't. Just don't wanna see anyone I know going through the hospital, that's all."

"We're goin' through the back entrance," the other medic reassured, and he relaxed.

The sunlight was blinding after being trapped with dim fluorescent lights for so many hours. They loaded Ponyboy in the back of the ambulance, and Darry turned to me.

"Don't drive like an idiot, you hear me?" he said as he handed me his keys.

"Huh?"

"You're gonna follow us to the hospital. Take the truck."

"No way, I ain't leavin' him."

"Soda, he's gonna be fine. It's an hour and forty minutes away. Just follow us. I got a copy of instructions right here in case we get separated."

"I can ride in the back with him!"

"Only one of us can go, and it needs to be me. I have medical guardianship over him as well. If somethin' were to happen, you wouldn't be able to consent or authorize any treatment. Come on, Pepsi."

There was no point in arguing. I looked at Pony. "I'll see ya in less than two hours, okay kiddo? I promise."

---

Medical Glossary

ALL: acute lymphoblastic leukemia.

Hemoglobin :a protein needed to transport oxygen in the blood. A hemoglobin 8.0 is the threshold to receive a blood transfusion. A hemoglobin 5.0 is life-threatening and can result in heart failure/ death.

PRBCs: packed red blood cells, a type of blood product used for transfusions.

FFP: fresh frozen plasma, the fluid portion of blood that contains platelets. It can be frozen, then used for transfusions to prevent bleeds.

Hypoglycemia: low blood sugar (70).

D5W:dextrose in water, a type of IV fluid that contains sugar.

NPO: nothing by mouth.

ABG: arterial blood gas, a type of blood test that draws blood from the artery instead of the vein. It tests the level of oxygen and carbon dioxide in the blood, as well as the blood's pH.

Dyspnea: shortness of breath.

3L NC:3 liters of oxygen via nasal canula, an oxygen delivery device consisting of a thin tube with prongs that go in each nostril.

12 French foley: foley is another term for a urinary catheter. There are a variety of sizes, 12 French is the typical size for an adolescent male.

18 gauge: IV size. The gauges range from 14-26. The higher the number, the smaller the size of the IV canula. Large gauges are needed for transfusing thick products such as blood, 14G is standard in adults but 18G is acceptable in an adolescent.

Right antecubital: inside of elbow, site where blood is typically drawn from and where IVs can be placed.

Saline lock: used when IV is not currently running/ hooked up to anything, keeps the patency of the IV open with saline.

Turgor: a term describing a medical assessment skill that consists of pinching the skin and releasing. If it is slow to return/ does not seem elastic and bounce back, the patient has poor turgor and is dehydrated.

Petechiae: small red, purple, or brown dots that form due to bleeding under the skin. Hallmark sign of pediatric leukemia.

CMP: comprehensive metabolic panel. A series of lab tests checking electrolytes, glucose, cholesterol, etc.

CBC: complete blood count. A series of lab tests checking white/ red blood cells, hemoglobin and hematocrit, platelets, etc.

Tumor lysis syndrome: disorder that occurs due to rapid destruction of cancer cells. Leads to waste build up and elevated levels of uric acid. Can be life-threatening.

Nares: nostrils.

Ecchymosis: bruising.

Hepatosplenomegaly: enlargement of the spleen and liver.

Capillary refill: assessment in which one presses down on the fingernail and sees how long it blanches/ takes to return to normal color. If greater than 3 seconds, it indicates poor perfusion (not enough oxygenated blood reaching tissues).

COPD: chronic obstructive pulmonary disease.

PACU: post-anesthesia care unit.

Prophylactically: preventatively.

---

Author's Notes:

Reviews make me happy

I couldn't resist because Newman is the described stuffed horse my sister had growing up.

Thank y'all SO much for being so patient. All is well, just been so insanely busy that I haven't had a time to breath, let alone finish editing the chapter. I've been having a blast and learning a ton during my ICU rotations.

The biggest reason this chapter has taken so long is my balance between keeping it completely accurate to 1960s medicine vs. incorporating modern elements in a realistic way because it's just hard not to and I really want to keep my plot/ outline intact. If anyone wants clarification about what elements are modern or not that I don't specify in my chapter notes, don't hesitate to ask. For years, I have been so passionate about St. Jude Hospital and several specific doctors and the work they did/ continue to do to treat pediatric cancer. Dr. Emil Freireich essentially eliminated bleeding as a cause of death in leukemia patients after experimenting with his own platelets and finding the correct way to infuse them. He then proposed that the method of treating tuberculosis (using multiple drugs at once) could also cure leukemia. In 1962, pediatric leukemia was a death sentence. People thought it was crazy that Danny Thomas and these doctors were stating that they would find a way to cure it. Kids diagnosed would die within weeks of diagnosis from infection or bleeding to death. Their experimental treatment of combining two or more chemotherapeutic agents was seen as inhumane by many doctors, who thought that would make these children sicker and it was better to let them die peacefully. To everyone's shock, they saw success. This treatment was trialed in the early 60s, but didn't become something doctors would refer patients to St. Jude to until 1968ish. In 1970, the man behind this extraordinary discovery, Dr. Don Pinkel, was able to officially proclaim that childhood leukemia was no longer a fatal disease, with the cure rate at 50%. Today, ALL has a 94% cure rate, but the treatment remains harsh and lasts approximately 2.5 years. And despite all the hard work of researchers, other pediatric cancers such as Wilm's tumor, Ewing's sarcoma, osteosarcoma, rhabdomyosarcoma, medulloblastoma, DIPG, and more have high relapse rates and higher fatality rates (DIPG is something I encourage everyone to research and support higher funding for- a pediatric brain cancer with 0% survival rate). I actually went to a conference at St. Jude when I was 19 for childhood cancer advocates as I was a top fundraiser that year and interested in a future career there. I cannot say enough positive things about it!

So obviously, my story will deviate the timeline a little and the fictional Children's Hospital of Oklahoma (which in reality was not established until the 21st century) will be offering this experimental treatment in '65. Some of the medications and medical devices I include were not available until after '65 (for example, ports/ central lines in this particular model were not a thing), but I also make a point to use meds that were more common during the time, not include certain devices such as heart monitors, pulse ox, etc.

This has turned into a really long ramble. The point is, I hope everyone is ready to learn a lot this chapter and I encourage you to let this motivate you to learn more about childhood cancer, the fact that it is not as rare as many think, and that it is severely underfunded.