The boy flicked his eyebrows up briefly, seemingly surprised by the new arrival. His dark eyes bored into Ryan as if trying to figure him out, like Ryan himself had done countless times before. More likely, he was trying to figure out what type of cancer he had. The cane probably gave him a clue.
The door opened and Dr Gareth's face appeared. "Finley Albaston?"
The healthy-looking woman next to the boy stood up instantly, but the boy himself - Finley - cast his gaze downward, as if trying to avoid being noticed. Naturally, it didn't work, as the woman huffed sternly at him. With a sigh of resignation, Finley stood up and trudged into the office, closing the door behind him.
"New friend?" Mike asked, having noticed their silent interactions.
Ryan just rolled his eyes in response, deciding to follow Finley's example and try and figured out everyone's cancers. Well, for starters, those with prosthetic limbs probably had osteosarcoma, like Joseph had mentioned. Oxygen tanks probably translated to lung cancer. Mobility devices, those were harder to deduct from. Some probably did have cancers of the central nervous system like him, but those clearly in the later stages were probably just too weak to walk.
In fact, when compared to every other patient - Finley included - Ryan felt as healthy as a spry young athlete. He wasn't looking forward to him looking like he was at death's door.
That, he reminded himself, was why he wanted this surgery - to stop the vicious cycle of treatments, remission and relapse before it started. He wasn't stupid, he knew that paralysis came with its own set of problems, but he would rather live at least sixty more years with those problems than one more year of rapidly deteriorating health that ended in a flatlining heart monitor.
"Did I ever tell you about my uncle Declan?" Mike asked again, suddenly.
Ryan frowned at him, before shaking his head.
"Well, my uncle Declan, my cousin Brian, my grandfather and his brother," Mike listed, "they all died of the same thing."
"What was it?" Ryan asked, intrigued and slightly suspicious.
"Kidney cancer," Mike admitted, rather sheepishly.
"Oh," Ryan said shortly. "Sorry."
"A few years ago, I started getting these pains in my side and abdomen, and I thought that I had gotten it too, but I was too scared to do anything about it," Mike went on. "It was a bit cowardly, really. I just wanted to make the most out of what little time I thought I had left, rather than go through everything my relatives had. In the end, it was Gina who knocked some sense into me - you won't have met her, she worked here before May-Li - and I went to the hospital to get it checked."
"And was it kidney cancer?" Ryan asked.
"No," Mike said. "It was only a kidney stone. It's not dangerous, but very painful, and I recovered not long after. Look Ryan, I'm telling you this because when I thought I had the same thing as what my relatives had, I more or less just resigned myself to my fate, because I was too scared to do anything about it, so I just want to say that it's good that you want to do something to stop yourself going through what your father did, even if I'm not totally in love with the way you want to go about it."
Ryan gave the man a small smile in response, the doubt still bubbling in his stomach settled a little with Mike's blessing.
After fifteen minutes, the door opened and Finley walked out, along with the woman who Ryan assumed was his mother. "Ryan Reeves?" Dr Gareth's voice called from the office.
As Ryan and Mike made their way towards the door, Finley and his mother passed rather close to them. At that moment, Finley took the opportunity to turn his head and whisper:
"Nervous system."
Ryan blinked in surprise at his deduction, but otherwise pressed on as if he'd heard nothing.
"The tumour spans across three vertebrae," Dr Gareth informed them, the MR image on the desk in front of them. "It's an anaplastic astrocytoma, as you know, and that can make it harder to treat. Fortunately, as it's only Grade 3 as opposed to a Grade 4 glioblastoma, that does make it more manageable. We can surgically remove some of it, but as we told you last time, it's a very stubborn tumour and may not fully detach from the spinal cord. In that event, we would remove as much of it as safely possible and then prescribe radiation to remove the rest of it."
Ryan and Mike nodded in response, though Ryan remained quiet before deciding to speak up. He figured that Dr Gareth would be more likely to listen if Ryan listened to him first.
"If all goes well, you should be cancer free without you having to have chemotherapy, and I know you hate that," Dr Gareth said, giving Ryan a knowing look, "but I have to be honest with you here - I can't promise that it won't recur. There's a chance that we'll be seeing each other again in a few years, or even in ten years, but only time will tell. Do you have any questions about the treatment?"
"Yes," Ryan said immediately, sitting up as straight as possible with his bad back and looking Dr Gareth straight in the eye. "Is there any way you could surgically remove all of it?"
"You asked this last time," Dr Gareth replied, before seeing Ryan's grave expression and adding: "Theoretically, it's possible, only the problem with astrocytomas is not only that they won't fully detach, but that during surgery, it's hard to tell where the tumour tissue ends and the normal spinal cord tissue starts, so the only way to be sure if the tumour was removed completely would be to cut out the entire section of healthy cord it's attached to."
Dr Gareth hid a smirk at the medical preposterousness of such an idea, before looking again at his patient's expression and proceeding to stare at him like he'd turned into a purple alien. "Ryan ... you're not suggesting ..."
Mike gave him an apologetic look from just behind Ryan, who at that moment was wearing his most defiant scowl - the one that meant he believed he was in the right without a shadow of a doubt. "Yeah, I am," Ryan said.
"Why?" Dr Gareth asked, before he could stop himself. "This is ..." he paused to think of a way to put it nicely, "... very rash. If we were to do that, you'd be disabled for life, along with a multitude of health problems that won't go away."
"I can deal with that," Ryan shrugged.
"It's all very well saying that but you'll probably change your tune when you're a paraplegic, incontinent and dealing with pain and muscle spasticity," Dr Gareth replied, trying to maintain professional patience.
"How different can it be from when you decide to chop people's limbs off?" Ryan retorted. "You don't seem to have much problem disabling them for life."
Dr Gareth glanced at Mike, who was doing his best to focus on the skeleton diagram pinned up on the board on the wall, keeping his eyes firmly away from the minor confrontation going on right next to him. He sighed, silently counting backwards from ten. "Amputation is a last resort, Ryan," he explained. "When someone is diagnosed with bone cancer, we don't immediately have the affected limb amputated. We only do it if there's no other way to save their life, after every other option has been exhausted."
"What if they wanted it amputated right away because they didn't want it to spread?" Ryan asked.
"There are less drastic ways to stop cancer from spreading," Dr Gareth replied. "Look, Ryan, just tell me why you're so desperate to have this surgery. There are better ways to manage this."
"I know why," Mike spoke up, feeling the need to finally step in. "You see, Doctor, Ryan's father died from the same cancer that he has now, and I think he just wants to reduce the chances of it becoming uncontrollable as much as possible."
Dr Gareth looked a little surprised, before turning to his computer screen and looking up Ryan's medical records and history for clarification. "Yes," he agreed, when he'd found what he was looking for, "I can see that, and I also see why you'd want to increase your chances of surviving. But when deciding how to treat a patient, we have to take into account whether it will do more good than harm - and a surgery like this would, in the eyes of every doctor, nurse and surgeon working today, be viewed as quite the opposite. You would be profoundly disabled for the rest of your life, with zero chance of the effects ever being reversed-"
"But I'll live."
His tone took both Mike and Dr Gareth aback. The way he'd uttered that statement meant that he was deadly serious about this matter and wasn't going to shake from his stance on it no matter what. "I know I'll be a paraplegic and I know I'll be incontinent and I know I'll be dealing with so many other things but I will live," Ryan repeated, his steely gaze fixed on the oncologist in front of him. "I can live with all that, but I won't live if I die from this because my doctor denied me the treatment that would've saved my life!"
"Ryan!" Mike reprimanded, placing a hand on the boy's shoulder. He understood and even admired his determination to get what he wanted, but he felt that his confrontational tone was crossing the line in terms of basic courtesy. "Don't speak like that to doctors!"
Dr Gareth didn't turn a hair at his tone. "If you're really that sure, then I'll speak to the department of neurosurgery about your case. We'll meet again in a few days, Mike can schedule an appointment at the front desk."
"Thank you," Ryan said, completely sincerely, as Mike stood up and made to leave.
Dr Gareth wanted to say, "Just doing my job," as he often did whenever patients thanked him, but this time he couldn't say it as it would feel like lying if he did. While he technically wasn't breaking any rules, Ryan's demands were definitely breaching medical protocols. Instead he said, "You're welcome."
Mike and Ryan stood up and left the room, but while Ryan kept going, Mike stayed behind for a minute. "Thanks for being so patient with him," he muttered to Dr Gareth. "I'm sorry he was so rude."
"It's not the first time I've dealt with stubborn teenage patients," Dr Gareth smiled slightly, thinking of young Finley Albaston. He'd known the boy for over a decade, so dealing with his bouts of stubbornness over the years had been almost like raising his own child. "It's just part of the job. You're a care worker, so you've probably run into some shockers yourself."
"You have no idea," Mike replied, Tracy Beaker coming to the front of his mind. "Thanks again, see you in a few days." With that, he left.
***
On the way home, Ryan was silent, staring at his reflection in the car's side mirror, absently fiddling with his cane. His successful persuasion of Dr Gareth had granted him some satisfaction, but there was still a dismal weight on his chest that the satisfaction couldn't lift.
There was another reason why he so badly wanted the paralytic surgery, though he would never admit it to anyone, Mike and Dr Gareth especially. Even though it had been several months since his name was cleared, part of him still felt very guilty for Chloe's fall. Despite how little everyone said he could've done to stop it happening, the feeling was akin to survivor's guilt. He'd always made sure to keep an eye on her and keep her safe ... and he'd failed her. No matter what, a part of him would always feel responsible for her accident, even though his direct action hadn't caused it. A part of him felt like if he deserved to go through what she had.
Besides, if Chloe could do it, so could he.
I feel the need to mention that osteosarcoma isn't the only cancer that would possibly require amputation, there's also chondrosarcoma (cancer of the cartilage, which is the connective tissue between the bones) and myosarcoma (muscle cancer).
You'll probably remember what Mike talks about here from the episode Esme. Although it's never clarified exactly what all his relatives died from, I went with kidney cancer because it's more likely to happen if you're a man rather than a woman, if you're around Mike's age and if members of your extended family have it too. It also has similar symptoms to kidney stones, so it makes the most sense IMO.
If you don't understand any of the medical mumbo-jumbo in this, feel free to say so in your comments or drop me a message, I'll explain everything in my A/Ns.
Thanks to RedReality for giving Finley Albaston his name.