Chapter 3: Examinations

Fred pulled his car into the parking lot of the hospital just before 9 A.M through the spring rain. The sun struggled to break through the thin layer of clouds as the morning tried to decide what kind of day it would be. Fred wondered this as well as he walked under his umbrella toward the entrance of St. Luke's. He stepped around the puddles, lost in his own thoughts. He had seen Ryan only a few days ago, but seeing him wasn't the same as when it was doctor and patient like today. Their friendship tended to ignore the unfortunate reality that Fred was Ryan's patient, but it was easier now that he only saw him once a year in this capacity.


He checked in with the receptionist and took a seat in the waiting area. Sitting with the rest of the patients was something he always found enlightening. As a Doctor, he rarely saw the reality of the waiting room. He observed the nervousness in each face and the awkward silence that filled room despite the television and the twenty-four hour news cycle. Fred didn't dare touch the magazines though, he knew better than to give into the temptation, to immerse himself in an absent minded diversion covered in every common ailment known to man.

After about ten minutes, Ryan came out to greet Fred personally. "Matthews?" Ryan called into the waiting room, pretending not to know him for the sake of the rest of those waiting for a doctor. Fred rose from his chair wordlessly and walked over to Ryan, who was holding back a smile. "How are you doing today, Dr. Matthews?"

Fred saw the restrained smile and played along with a sigh, "I'm doing well, Dr. Taylor. And yourself?"

"Quite well, thank you. Right this way," Ryan replied as he held the door open for Fred.

When the door closed behind them, Fred asked, "You love doing that don't you?"

"Doing what?" Ryan said, playing innocent as he followed Fred down the hall. "My office is the last one on the left."

"Yeah, that's what I thought. Anyway, I'll be a lot better in a few hours," Fred said as he walked into Ryan's office. He hung his coat and took a seat and watched as Ryan did the same.

"I"m sure, Fred. I will be too. What do you say we get down to business?"

"Sooner the better."

"Agreed."

"Okay, let's see, Fred," Ryan said while looking over Fred's chart. "Looks like we haven't had you in for an MRI for about six months, sound right?" Fred nodded in agreement. "Okay, and you've been undergoing regular blood tests and had a CT scan three months ago. Your last blood test showed a slightly elevated white blood cell count. What else?" Ryan asked rhetorically as he continued to flip through the pages. But he shifted his attention to Fred, who was slouching in his chair and nodding agreement to the items listed off by Ryan. He wasn't hiding his anxiety and maybe didn't care to as he leaned slightly to his right and rested his head in his hand.

"I think you know the rest, Ryan," Fred said with some mild irritation. Sure he hadn't seen Ryan in this capacity for six months, but his health and medical history was nothing new for his best friend.

Ryan closed the folder and placed in on the desk, "You're right, Fred, I do. Sorry."

"Don't worry about it, I understand. I know this isn't easy for you either, and when I get too close to a patient I fall back into routine as well." Fred replied. "Look, we both know why I'm here and what the last test could mean. I think this will be easier on both of us if we just keep this business moving along."

Ryan smiled across the desk at Fred, "Okay. Let's do it. I'll need to take you to an exam room first, just to get your vitals and..."

"Way ahead of you, Ryan. Just show me the way," Fred answered as he opened the office door.

Following Fred out of the office, he said, "Right. You know the drill. They say that doctors are the toughest patients, but I don't think this is what they mean though. Usually you guys are trying to diagnose your own conditions and butting in on my treatments. I mean, I would never try to tell you how to do my heart transplant!" Ryan joked as he closed his office door behind him.

Fred stopped in the hall and said, "Ryan?"

"Yeah?"

"Shut up and tell me what exam room to go to."

Ryan laughed, "Sorry. Room 4, on your left." He almost said something more about how this wasn't easy on him either, but thought better of it. Fred was known to become lost in his own thoughts from time to time, and a little soul searching was to be expected at a time like this. Ryan thought that it was best to give him some time, maybe Fred might open up more after he had relaxed and thought some things through.

"Thanks," Fred said. He found room 4 and took a seat inside, resting his head against the wall behind him. He thought about the blood test that had led him back here and what could be going on. He was not an oncologist and did not attempt to diagnose himself, but couldn't help but turn it over in his mind. His white blood cell count had been higher than normal, but he wouldn't have called it high. As far as he could remember, his numbers seemed borderline and shouldn't raise this level of concern; they were on the edge, but not unhealthy. But what had his dad always said? "Living on the edge means you're one step from falling off the cliff."

He also thought about the last time he had been in for an MRI, but that was under very different circumstances. Six months ago had been his final routine scan after going into remission two years ago. He remembered coming in and being excited to see Ryan and couldn't wait for it to be over and to move on with his life. Beating cancer closed a chapter in his life that he preferred to forget. Being back here and worrying cancer brought it all rushing back.

A knock came at the door and a nurse introduced herself. Fred didn't bother to remember her name and stayed lost in his own world, paying only enough attention to follow her instructions. He was anxious to be left alone again and was suddenly looking forward to the solitude of the MRI machine. Thinking about back then brought on painful memories; things too painful to try and hide, especially around Ryan. He would tell Ryan about his struggles later, he always did, but this just wasn't the time.

The world continued to move around Fred as he stayed in his memories, drowning in them. The nurse finished and mentioned his vitals in passing before stepping out of the room and closing the door behind her. She was used to seeing the blank face of someone in emotional shock before an MRI and didn't seem concerned with his mindless stare. It registered somewhere deep in his mind that he was alone again and he allowed a pained sigh to escape his body.

He stood and changed into the gown that had been left for him before collapsing back into the chair. A minute later the door opened again and a technician led him to the MRI room. Fred managed to exchange pleasantries with him, but nothing more. He laid on the table and waited for the scan to begin. The last interruption to his solitude was the technician coming to explain the process, as if Fred hadn't been here before, and to ask if he wanted the lights on or off. Fred feigned attentive listening and indicated that he would prefer the lights on.

As the lights dimmed and he slid into the machine, the present gave way to the past and he was dropped back into his treasured memories and his nightmares.



* * *



"Fred!" Sarah called from the kitchen, "It's time to go. Are you ready? I've got Ellie all set and in her car seat."

Fred came down the stairs in a pair of jeans and a comfortable t-shirt, ready and nervous for his first appointment. "Yeah, I'm ready. Just have to find those socks I left around here somewhere. You've got everything? You're ready?" Fred asked.

"I saw them on the couch, although I don't know why they ended up there. And yes, I've got everything. But I'm definitely not ready for this," Sarah explained as she put on a light coat.

"Ah, you're right, here they are. I know what you mean, though. I'm a doctor and know exactly what to expect, but you can never be ready for it," Fred said. He walked over to Sarah and hugged her. She leaned into him and relinquished a small portion of her tension and stress. "It will be okay, honey. Ryan will take good care of me while we're there and I'll have a couple of days to recover."

"I know. I know it will be fine. It's just hard having to deal with all of this, you know? You're my rock, my hero, and I just don't like seeing you like this," Sarah said. She started to pull away from the hug and with a sigh, she added, "I just don't want to lose you."

His heart sank. "Sarah. You can't think that, we have to stay positive. Attitude is so important to recovery, I see it every day."

"I know. You're right and I'm sorry," she confessed as a tear worked its way down her cheek.

"It's okay, I know it's hard. But we caught this early, we have every reason to stay upbeat, okay?"

She wiped away the tear and fought back more, shaking her hands and looking at the ceiling as she said, "Ah, okay. We have to go and quit talking about this. Come on, let's go."

Ellie was sleeping peacefully in her car carrier, like always, as Sarah brought her out to the car. Fred was behind her with a diaper bag and a few things for him in a separate duffel. Moments later, Ellie was strapped in and they were headed for St. Luke's to see his friend Ryan and for Fred's first chemotherapy appointment.

Something about this trip seemed monumental to Fred, like a turning point for his entire life. The three miles to St. Luke's was his Rubicon. After today he would be a cancer patient, a marked man. There is no back with cancer, victory or death. He faced this reality behind a veil of strength and confidence, allowing the tremors of doubt and fear to rumble underneath the calm surface.

They entered the hospital and waited to be called back. Ellie had woken up and Sarah entertained her while Fred watched the television in the corner. After waiting to be called, the three of them followed a nurse back to private room where he was prepped for the treatment.

"Do you think we'll even see Ryan?" Sarah asked, annoyed at having not seen him already. "I mean, he's your best friend, it seems like the least he could do."

"I'm sure he'll turn up. He always does. And maybe you're just taking out a little of your frustration on him," Fred answered. "And don't forget that while we are here he is Dr. Taylor, and he will treat us as a patient and family, mostly."

"Well fine. But he should still be here," Sarah conceded. Just after she said this the door opened and Ryan rushed in.



"Hey guys! How are we doing today? Good to see you, Fred, Sarah," Ryan said.

Fred looked at him and said to him dryly, "Cute, Ryan. We're doing alright, considering. Although, I would cut the crap or Sarah is going to take you down a peg a two." This cut the tension and brought a smile to Sarah's face for the first time in what seemed like hours.

"Okay, note taken," Ryan said with a laugh. Then he explained how the process was going to work and what to expect. It would take a few hours and he encouraged them to try and rest during it. Then another nurse came in and made the final preparations before the procedure and inserted the IV into his left arm.

"Any other questions before we get started?" Ryan asked.

Fred looked over at Sarah, gave her a smile and said, "No, I think we're okay."

"Alright, let's get started," Ryan said with a little excitement and he turned on the machine. "I've got to step out for a few minutes, but I'll stop back in a little while."

After Ryan and the nurse left, Sarah started to shed a few tears as she bounced Ellie in her arms, coaxing her back to sleep. "Sarah, why don't you and Ellie come over here and sit down, I'll make room," He said as he slid to his left on the propped up bed.

Sarah nodded softly and whispered through tears, "Okay." She sat gently on the side of the bed and snuggled up to him as he motioned her to do so.

Fred held her close with his right arm, kissed her on the head and whispered, "It's alright, honey. It's okay. It will be okay."

"But aren't you scared? Aren't you worried at all?" she asked.

"Sure I'm scared a little. Who wouldn't be? But I know I'll beat this. I just know it," he said. "Here, hand me Ellie, would you?"

She gave Ellie to Fred and he held her sleeping frame in his left arm, her ear over his beating heart. With Sarah nestled in under his right arm, he kissed her again on the head and whispered, "I love you." What he couldn't say was how scared he really was, how he pretended to be brave to protect her. He couldn't say how holding Ellie in his arms just now made him more afraid than he'd ever been before. He couldn't say that he'd crossed the Rubicon, and that only the conquerors made it back alive.



* * *



The lights in the room came up slowly as the table backed out of the machine, gently rousing Fred from a bittersweet memory. He buried his emotions back underneath his staunch stoicism and checked his cheeks for any stray tears that might beg for explanation and found none. He took a few calming breaths and sat up on the table, waiting for the technician to give him more instructions.

Fred listened to the clichéd message that the technician delivered to every patient and followed him back to the exam room where he was to wait for Ryan one last time before leaving. He was left alone again in dreadful silence as he changed back into his clothes. He fought against every incoming memory that threatened his confident façade as he waited patiently for Ryan. “Waiting for Ryan. Again. I can’t talk to him about this yet, I’m not ready,” Fred thought. There was a polite knock at the door before Ryan opened it slowly and entered the room. “Ryan will see through me if I don’t deflect him right away.”

“Hey buddy! How are you holding up?” Ryan asked. “Mike treat you okay?”

Fred paused just a moment, trying to read Ryan’s question correctly. Fred hoped that he only meant with the tedium of the scan and the stress of potential relapse and answered the question based on this assumption. “I’m doing well. I’m staying positive and not dwelling on it. I’ve beaten this before and I can do it again if necessary. I take it that Mike was the MRI Tech?” Ryan nodded. “Yeah, honestly I didn’t really pay him much attention. Seemed like a nice kid. I had other things on my mind.”

Ryan, not willing to miss this opportunity, asked, “Other things? You know, that as your doctor I am obligated to examine your mental and psychological state during treatment.” Fred laughed silently at Ryan’s construction of pretense for what was really a simple question. “What’s on your mind, Fred?”

“Well, I called Rachel. We’re planning getting together this weekend in Chicago,” Fred said cheerfully and slightly proud.

In sincere disbelief, Ryan replied, “No way! I don’t believe it. In all the years I’ve known you, you’ve never been the one to make a move. I remember that Sarah waited months to ask you out after finally growing tired of you dragging your feet. Anyway, continue.”

“Yes, as I was saying. I asked her out this weekend. We’re going to take in a few sights around Chicago and have a nice dinner,” Fred explained. He was slightly bashful to be talking about this with Ryan, knowing that the ribbing would only continue. “I’m sure that she’s been all over the city and the touristy things having gone to school at Northwestern, but she seems excited to show me around. It’ll be fun.”

“’It’ll be fun,’ he says. Fun. A beautiful woman… wait, she is good looking right?”

Fred laughed again quietly, saying , “Yes, Rachel is very good looking. Not that…” before Ryan cut him off.

“Yeah, yeah, not that it matters and all that, I get it. Anyway, a beautiful woman, who was all over you at the conference by the way, offers to take you around Chicago and show you a good time and you think it will be “fun”. Fun is an understatement of what this will be,” Ryan joked.

Fred stood up to leave and said with a smile on his face, “I knew I shouldn’t have said anything to you yet. It’s always a joke with you, Ryan.”

“Hey, you know that I just want you to be happy. I joke and I give you a hard time, but I just want to see Fred back to his old self,” Ryan said, dropping all the sarcasm and barbs and offered him a hug.

Fred embraced him and said, “I do, too.” The sober statement hung in the air for a moment as they separated, and then Fred spoke again, “Say hi to my little sister for me, would you? She might have gone against my wishes and married you, but I know she still loves me.”

“Ooh, ouch. Fred scores big with a right hook to the jaw. Working that angle, huh? I suppose I have it coming,” Ryan said as he turned to follow Fred out of the exam room. “I’ll tell her. But be warned, she is probably going to call and ask a million questions when I tell her about Rachel.”

“Oh man, I hadn’t even thought of that. And wait until she tells mom,” Fred groaned.

“You will have your hands full when those two get involved. If you thought I asked questions and that I have been in intrusive… But remember, we bug you and we hound you about these things because we love you,” Ryan said. Fred had stopped in the hallway, touched by Ryan’s heartfelt words. Ryan, who found the seriousness of the current situation to be more than he could comfortably stomach in his current upbeat mood, added, “I don’t know what it is about you, but people seem to like you.”

With the moment broken and passed, Fred responded, “It’s a curse.” He was more confident in his decision to pass on bringing up the past with Ryan. After all, Ryan had been there through it all, and probably didn’t want to relive the pain either. At least that is what Fred had convinced himself to believe.