#carcinos

The blonde looked at Connor, who had appeared out of nowhere. Ava usually met her friend down on the CT floor, since the oncology unit could get a bit overwhelming for them both. Still, he was there and she couldn’t help but feel a bit more calm seeing that dumb smile.

“Don’t remind me. I’ve been up for hours going over it all,” dark circles and bloodshot eyes told him all he needed to know about Ava’s sleep that night. It was worrying, knowing how much time and sleep she lost while trying to figure out this case. The epiphany she had had about the six year old’s tumour while she was on break seemed just crazy enough to work. Still, if Ava was as tired as she sounded it could be bad for her and her patient.

“You need to rest, Ava.”

“I’m aware,” she sighed, “But this has to go 100% perfect.”

“I know. Are you scared?”

She was looking at him as if he had two heads, silently wondering if he really had the audacity to ask such a thing. Connor was trying to gauge where her head was at, hoping he could ease some of her worries before she had a scalpel in her hand.

“Of course I’m scared,” Ava scoffed and set down her coffee cup, “I’d be a fool if I wasn’t. I’m terrified we’ll get in there and the margins won’t be right. Or the optic nerve will be too close to even touch the tumour.”

“I thought your plan was solid? You were confident about this, don’t let the fear change your mind.”

“Doctor Abrams and I have reviewed the plan and he says it’s just reckless enough to get the whole thing,” she answered, “But if we don’t get it… it’s on me.”

“Ava, you never let that stop you before,” Connor reminded her gently, “You can do this.”

“Love the pep talk, Connor, but I think your faith in me is biased.” 

He rolled his eyes, knowing she wouldn’t believe a word he said or at least she wouldn’t make it obvious. Ava ran on spite and false confidence, it was something he learned quickly about the oncologist. Once she stepped into that OR it would change, her mindset would shift and she would be back in her element. It was the waiting game that drove her crazy and gave her doubts, despite the hours she put into making sure her plans were foolproof.

“Hey, don’t say I didn’t try to help,” a light nudge to her ribs made Ava look up, “Good luck.”

“Did you want to talk about it?” Connor’s voice tore her attention away from the drink she had been mindlessly swirling in its glass. The furrow of her brow and questioning eyes told him he needed to elaborate more.

“Whatever is making you upset,” he continued, “You can tell me, Ava.”

“Nothing is making me upset. I’m fine,” her reply was probably meant to be delivered smoothly but the stiffness in her posture was easy to read.

“You asked me to go out for drinks without any prompting on my end and you haven’t said one sarcastic thing to me today. That doesn’t seem like you being fine.”

“Not everything is about you, Connor,” her snide remark lacked any playful venom, as if said just for the sake of it.

“I worry about you, Ava,” he sighed and nudged her hand to prompt her to look at him. The eye contact was fleeting on Ava’s end, broken almost as quickly as it was made. She just shrugged in reply, muttering something he didn’t quite pick up but knew it was probably dismissive.

He let the topic fall short, for his sake if not hers. The last thing he wanted was to annoy Ava while trying to comfort her, but it could be so frustrating. Something was clearly bothering her, why else would she want to go drinking on a Thursday evening? She trusted him, or at least he hoped she did, though it was beginning to feel like maybe Ava didn’t trust anyone.

A lull in conversation gave way to a stale silence, save for the chatter of the bar around them. Catching the tremor of Ava’s hand as she stirred her drink, Connor looked at her expectantly. She wanted to talk, that was clear, but getting the words out was too hard. A part of him was worried she was about to drop a bomb, like she was leaving Chicago or was cutting him off as a friend. Connor didn’t have a chance to run through every worst case scenario, though, because the woman finally spoke.

“It’s… just- it’s one of my patients,” her accented words were usually so eloquently said, yet she stumbled over these ones in a way that it couldn’t be good news.

“What about them?”

“Six year old Hispanic male, in and out of hospital for two years with the same diagnosis,” she recited the words like she was presenting to an attending, “Juvenile pilocytic astrocytoma.”

“Not good?” Connor inferred, sighed when she nodded.

“It’s low grade but I think it may be growing quicker. I’ve poured over these scans for hours, Connor, searching for a way to work around this. I had to tell his mother today that it’s inoperable; which makes me just another oncologist telling her there’s no hope.”

“Shit,” paediatric cases were the worst even for a doctor like Ava, “Why is it inoperable?”

“JPA commonly splits into more than one tumour, though it is localized in the brain. My problem is there’s a met almost directly on the optic nerve pathway, alongside another one taking up half his left hemisphere.”

“That’s a lot.”

“Yeah,” Ava sighed, “The margins are so well defined but every neuro attending I’ve talked to said it’s too risky. We could blind him or he would bleed out before that. It’s just not possible, even though the damn tumours look like you could pluck them out without picking up a ten-blade.”

“I’m sorry, Ava. Telling a parent what they don’t want to hear is hard. Is there anything you can do?”

“Chemo and more chemo,” she spat the words out like they burnt her mouth, “He’s been through two rounds with only minimal shrinkage and nothing will cure this like resection would. If we miss one cell it will come back in months, if he even makes it off the table.”

Connor nodded, mulling over what she said. He didn’t really know how to comfort his friend yet he knew it’s what she was seeking. She usually had all the answers and wouldn’t turn to a cardio surgeon for medical advice. Ava was seeking out the promised support of their casual environment, indirect reassurance that she wasn’t fucking up a sick child’s life.

“If it’s inoperable it’s inoperable,” he agreed, “Chemo sounds like the best bet, yeah? You’ll just have to consult with your attendings; see what they think is the best course.”

“I know. It’s not even that it’s just-,” she paused to knock back the rest of the whisky in her glass and coughed a little before continuing, “He- Tomas is his name- said something.”

Her eyes locked with Connor’s for a moment and he had never seen her so worried. Her brow had been stuck in a furrowed position the whole night and her usually focused gaze was quite the opposite. He didn’t speak, worried it would distract her from what she wanted to say, but reached out towards her. Ava didn’t pull back from the gentle hand that covered her own, despite his skin being roughened by harsh sanitizers, the touch was a fleeting comfort she hadn’t had in a while.

“He just said ‘I have a brain tumour,’ but it hit me so hard. I don’t know why it’s just… no child should have to say that but he was so nonchalant. It’s a gross reality, I guess? This six year old has been sick for so long that he’s accepted it; even though his mom is far from doing the same.”

“Ouch. That’s definitely a hard thing to hear.”

“He’s so little…” she hated the way her voice shook, “I don’t know… why does this hurt me? I’ve seen it all before, I’ve seen worse; so why am I so upset because a child has a tumour?”

“It’s normal, Ava,” Connor promised her, “You may be a surgeon but you are still human, we’re programmed to want to protect kids. You want to be the doctor who saves them all, especially the bleak cases, so it’s understandable to be upset.”

“I hate that you’re right,” she surprised Connor by tightening her hold on his hand, linking their fingers like she needed a lifeline. In that moment it was the one thing keeping her from bursting into tears, though she would never tell him that.

“Ava, I think you need to step back.”

“I can’t-.”

“Don’t argue with me. Please,” normally she would have hated that tone from him but all she could do was listen.

“Look, you need a break, okay?” he continued, “It’s almost the weekend and I know you have PTO available. You’ve clocked full hours and an insane amount of overtime this month, I promise the oncology ward will be fine without you for a few days.”

“I hate you,” she huffed, “I hate this.”

“I know.”

“You’re not gonna let me out of this, huh?”

“Nope,” Connor squeezed her hand a little, “You’re asking for a few days off, doctor’s orders.”

“Ass,” there was no venom in her muttered word though because she knew he was right. She had been working her ass off in an attempt to secure her spot as the most reliable fellow in her program. She didn’t have much competition at Gaffney but Ava would never let her guard down. She was exhausted and her head wasn’t in it, which was clear by the way she was fighting back tears.

“Thanks, Connor. I’m glad you care about me, Connor,” his attempt at mocking Ava’s accent was horrible, which he clearly knew. It did get the desired effect though because he saw the frustration disappear from Ava’s face as a stifled laugh replaced it. She still glared at him but he would gladly take the playful annoyance over tears, for both of their sakes.