* * *
"It's a tumor on the spinal cord." I said, looking up to the scans Ethan was holding.
"A hemangioblastoma." His voice tickled down my body. We were laying on his bed. My head rested against his chest as we both looked up to analyze the picture he was showing.
I had woken up to him staring at the scans. As soon as he realized I was awake, he asked me to come closer and take a look. What for? I didn't know.
"Have you seen one before?" I switched my vision to look at him, his face reflected pure conflict. He was trying to figure this tumor out.
Primary spinal cord tumors — tumors that originate in the spine — are usually benign. Although this one didn't look benign at all.
Anyways, they are so rare that they account for only a half of one percent of all newly diagnosed tumors. Malignant primary tumors of the spinal cord are even less common.
"Not this big." He answered, glancing briefly down at me. "You see how the tumor has worked its way up the spine?" He lifted the hand that used to be caressing my exposed back to point at the scan, tracing a line along the whole cord. "It's taken over the blood supply. It's a perfect tumor." Perfect in a bad way, of course.
"You know if the patient still has leg function?" For all I knew, this scan could belong to a defunct patient.
"He walks normally. It's incredible. He should be paralyzed, dead." He placed the scan on top of the nightstand as he ran one of his hands through his hair, sighing.
"Wait," I said, shifting my body so I was now facing him. "Are you implying that you're going to take this tumor out?" His face was freshly shaved, a trace of minty scent still emanated from his pores. His oceans found my light brown eyes only to give me one of his infamous grins.
"I'll try, yes." My eyes must've lit up like Christmas lights, reflecting every single bit of excitement my body held. "You're very welcome in the gallery." He let out a small chuckle, smiling at my passion towards medicine. "I would love to have you in the OR, but regarding the fact that it is a very complicated surgery, I'll have colleagues help me out, and they wouldn't be so happy about me giving you a spot over the interns." He explained, pulling me closer to him.
I took the opportunity to roll over him, my legs straddling his sides. My hands ran up and down his chest, slowly, enjoying the electricity he still managed to transmit with every single contact we shared. Tracing my fingertips up to the base of his neck, they finally found rest at his jaw and cheekbones, caressing every single bit of space they could find.
I shifted my stare towards his eyes, my favorite ocean looking back at me intently. He reflected nothing but complicity. His hands found my hips as he traced small circles against my flesh. I felt my body tense and relax under this touch, welcoming the wave of heat his hands emanated. No matter how less foreign his hold became, my body still reacted as if it were my first time melting into him.
I finally lowered my lips to his, dissolving into him. His answer was tender, there was no rush in the moment. We enjoyed each other's brims, wanting to forget where his lips finished and mines started.
I parted our distance momentarily, only to let out the words 'thank you', which he answered with joining our lips once again.
We stayed lazily in bed for a few moments, soft talk began to burden. After half an hour had passed, we decided it'd be ideal to get breakfast so we could start with our Saturday classes.
December was just around the corner, so was Christmas and New Years. I had spent thanksgiving's dinner with Kate and Chris. It was a surprise to know that, just like Kate and I, Chris's relatives lived outside town, therefore we kept each other company. Jacob and Sam arrived later, adding up to the celebration after spending time with their own families.
After that, I brought my left overs to Ethan's -who was thankful because he had been working all day at the hospital- and stayed the night.
The raw transition from fall to winter also implied finals at their highest expression. This past month had been crazy busy, I had been taught by Ethan every single Saturday as he promised, so Friday nights were our little pyjama parties. He also took me to the hospital as much as he could. Most of my visits were from the gallery, but it was still brain-watering.
Thinking back, the amount of information I had absorbed from Ethan in just this past month was mind-blowing. It was almost unbelievable how good he was at explaining -even though his only previous experience was teaching interns about surgery-. He was enchanting in every single way possible, and he knew it.
"What about the Cerebellous Aferences?" His husky voice resonated through the room. We were in his study, coffee in hand as we had lost track of time sharing information.
He happened to own a whiteboard in his art-room, so we had picked this location for the study sessions to take place. "Aferences of the spinal cord fibers are homolateral." I had a nervous system final exam next Monday, and we had been preparing for a while now, besides him teaching me about more advanced topics.
"That's right." He had flawlessly drawn the whole nervous system on the board for my better understanding. "I think we're done here." He said, taking off his ogling worthy of glasses.
"Tell me more about the tumor." I pleaded, taking the cup of coffee between my hands, slowly savoring the sweet delight of warm liquid running down my body on a cold morning. "Aren't you scared?"
"No." He said, staring down at me. Arrogance evaporated from his pores.
"But, you'd have to cut the cord, paralyze the patient, to kill the tumor." I took the scan displayed on the closest desk. "I mean," I continued while taking it up against the light to get a better view. "It's eaten five levels of his spine, right?" I said pointing at the cord.
I felt his arms circling my waist from behind, warmth entering my body. His chin rested on my shoulder before he spoke. "Yes." He ran his nose down my neck, until he finally found its base, leaving a soft peck. "This tumor is dangerous. Smart." I turned around to face him, leaving the scans back to the desk.
"To successfully take out this tumor would be an achievement you could brag about for the rest of your career." I said, raising my eyebrows at him.
"Exactly." A cocky smile played on his lips, threatening to be smacked out of his face by my own. I debated if rather being cocky helped him believe he could do anything, therefore it increased the possibilities of success or if he actually was unsettled by the idea of this tumor.
"Are you ready?" He said, walking out of his art room, motioning me to follow behind. We entered his room as he picked a dark blue button up shirt to put on. His muscles flexed against the material, I got closer, finding myself in awe of the art-piece before me.
"For what?" I asked, helping him button up his shirt, taking advantage of the moment, running my fingertips up his chest.
"The surgery. We need to be there in an hour." I looked up at him, surprised. I had no idea it was today. He lowered his lips to peck my head before walking away as he playfully slapped my butt. I gasped, dumbfounded. His only answer to my reaction was a wink.
* * *
"Microsurgery is about precision. The microscope changes your hand-eye coordination perspective radically." I heard Ethan through the monitor that connected the audio from the OR to the gallery. He was talking to an intern, motioning her to look at the surgical microscope.
We had been here for two hours and thirteen minutes. He had just been staring at the body.
After a while, he asked for a scalpel and held it between his fingers.
"The dura is opened, let's get our first look at the tumor." Vennberg instructed as I awaited, patiently. "The vessels are more intricate than the MRI showed." He spoke with hesitance. I found the uneasiness in his eyes for a few seconds, one that I was sure not many people noticed. "There's no way I can take the tumor out without rupturing one and killing the cord."
"W-what about the T2?" The young intern suggested, with a touch of fear in her eyes. It could be because of the situation or because of Ethan.
It was just then that I remembered who he was to everyone. Dr.Vennberg was a powerful figure, feared, respected, untouched. Ethan was someone not many people got to meet. The thought of it somehow made me feel special.
"If I start T-2 I could risk hitting the feeding vessels," he answered as if it were obvious. "So maybe I should go lower?" He asked. To whom he had spoken was the uncertainty.
"There's less vascularity around T-7, so that doesn't seem better, right?" He spoke again, to no one in particular.
"It does seem better, and you'd only get function loss below the chest." Another doctor who I assumed was there for support -because he wasn't operating- said.
"But I risk rupturing the anterior spinal artery there." He said, pointing at the vertebra.
"Probably the tumor tapers off there." Ethan pronounced, once again.
"Higher is better maybe? Either way I risk sending him into hemodynamic collapse." He was in a kind of trance, not talking to anyone but himself. For a moment, he just stayed there, watching the exposed patient lying on the table. He really had no idea what to do. But he stayed still, unaffected by the situation.
"T-2 shows less potential for bleeding." Time stood still, we were all observing his every movement. Expectant of what he would do next.
"T-3 the vessels have increased." Each and every time he got to a conclusion the next one would take even more time to come.
"If I clip the draining vessels without getting the feeders, they'll burst-"
"Vennberg." His colleague interrupted him. "It's been over eight hours."
"I could go under the tumor here, but I might cut the radicular artery." He kept going, ignoring the other doctor completely.
"The rate of infection of this patient is increasing every second you keep him open." It seemed like he not only was his colleague, but maybe a superior.
I stood up without thinking, walking towards the monitor. I pressed the button to speak.
"Were you able to do the decompression?" My voice came out as foreign. All heads turned towards me, even the people sitting in the gallery became aware of my presence. Most of them stared at me as if I had grown a second head. I guess not many people spoke directly at him so carelessly.
Ethan's head was the only one that didn't turn. He didn't need to.
"Yes." His plain answer must have come as a shock to everyone. One thing was me having the audacity to speak to him, but a completely different one was him answering me without a snap.
"But you weren't able to find a place to dissect." I said, thinking out loud.
"Nothing. It's just, there is no path, nothing distinct." He kept his stare focused on the tiny dissection he had made to observe the spine.
"Well, why?" I didn't know the answer myself, I was just trying to clear his mind.
"Because," he looked up at me for a few moments, his blue eyes now dark in confusion. "If I start here, the anterior spinal artery could rupture. The cord could die." He said. "Here, you could risk catching the radicular artery under the tumor. Cord dies." He spoke like when we had our classes on Saturday mornings. And I knew this would help him. We were alone now. Just him trying to explain something to me.
I stood there, thinking for a moment, until an idea came to my mind. "But why not just cut the draining veins at the top, expose the arteries?"
"The draining veins are very thin, you slip up and they burst. He gets paralyzed." He looked at me, the only thing visible were his eyes, even though we were separated from the glass wall and a considerable amount of feet, I could clearly see they held question, as if he believed I had the answer.
"Maybe the problem is that you're thinking too much." He raised an eyebrow in response. "You have high risks anywhere you start. So, either you close him up and send him home to die, or try dissecting anywhere, without a plan, and risk killing him, paralyzing him or saving his life." I turned my head slightly to see what his colleague might be thinking. His expression was of pure satisfaction, a small smile played on his lips, or so I could assume by the wrinkling of his eyes. "Worst case scenario, he dies. The man isn't naive, he knows that the percentage of success of this surgery is less than a 1%." I let the button go to sit back on the gallery's chair, without letting much space for Ethan to give me a reply. I didn't dare to turn my head towards the rest of the people in the room, they were probably wondering who the hell I was and why I had taken the right to interrupt Doctor Vennberg's surgery.
I saw how Ethan nodded, closing his eyes for a few seconds before opening them back again. They were now flooded in conviction. He asked for a scalpel and took it in his hands, dissecting at the act.
"Alright, one vessel down."
And so it went. The atmosphere was dense, everyone was anxious about the outcome. I didn't know how much time it had passed, but every single movement made was precise and slow, immaculate.
I wasn't counting how many cuts he had done, but it seemed to become harder by each second that passed. "I've cleared T-5, and if I continue along this way, I-"
"MEP trancing's losing amplitude." A nurse called.
"What's wrong?" Followed their intern, who looked like she was about to pass out.
"A vessel burst. It might have been connected to the cord." Ethan replayed curtly, as tranquil as ever.
"But if there's not enough blood reaching the cord-"
"I could've just paralyzed the patient, yes. Suction please." He was irritated, and scared, though people could only sense the annoyance in his voice. "More suction."
"There is too much blood ."
"We're losing him." The two phrases came from two different people whom I couldn't quite place. Cold sweat ran through my body as other people from the gallery started shifting nervously in their seats.
"I should've just cut the cord. This is too dangerous." Ethan let out in frustration.
"Wait, it's back. Amplitude is up." The same nurse said, as he gave a smile towards the surgeons.
"So the cord didn't stroke out? You didn't paralyze him?" The same intern from before spoke.
"The vessel was connected to the tumor, we were lucky." I saw how the rest of the surgical team let out breaths of relief.
"Fuck. I can't tell which one of these vessels feeds the cord and which one feeds the tumor." He said while taking his eyes out of the microscope. "I have to do a blind cut."
"How?" Another intern spoke for the first time.
"If I cut the wrong one, the entire cord strokes out." Ethan admitted. "But we'll sort that out later."
"So if you cut the wrong one this whole surgery would've been for nothing?"
"Exactly." I winced from pain, noticing I had pressed my nails against my palms from the anxiety. Basically, there were two vessels, one connected to the tumor and the other to the cord. He cuts the wrong one, the cord dies.
"How many inches are there left?" Ethan's colleague asked.
"Less than two." He took a look at the machine. "So if I do my math we have four or five more hours ahead." He then took the surgical scissors to cut one of the vessels. This man's life was hanging from a thread, quite literally. "Alright. Which one?" He stared at the exposed body for more than ten minutes, before he gave me a look, as if I could give him a Divine enlightenment. I stared back reassuringly, mouthing the words 'go' before he gripped the scissors firmly, exhaling and making a cut.
* * *
"Did he paralyze the guy?" Kate half said-half chewed her popcorn while we were watching Friends on Netflix.
"We don't know yet." I replied. "We won't know until he wakes up from the anesthesia." Even though the forecast was unknown, I had a feeling he would be fine.
"Ethan Vennberg is something else." Kate said, raising his eyebrows while taking a sip of her coffee. "I mean, who in his right mind would agree to perform a surgery like that one?"
«Oh believe me, I know.»
But I only stared back at her with a funny face and directed my attention towards the TV.
"Chris invited me to spend Christmas with his family in New York." My friend said rather quickly. I almost choked with the coffee circulating down my throat at the words. "But of course I said no, I mean, we- you and me- are spending it together."
I had lost motion of how serious Kate was about Chris. It made me really happy to see her committed to this, and him being the same with her. She deserved only joy after suffering so much over dickheads.
"No." I placed the mug on top of the coffee table. "You go."
"But-"
"I'll probably invite Ethan over, or the other way around-it doesn't matter. What matters is that he just invited you to meet his parents, that is huge." I said, smiling at her. "You go. I won't be alone, and we can always FaceTime each other to open our presents."
She hugged me in response. "Thank you, Lia." I squeezed my friend back for a few seconds until the sound of the credits rolling on the tv made us part.
"One last episode and we get that shit done?" I said, pointing at the pile of books on our table.
"Sounds good to me." But before we could start watching the next episode, a knock on the door echoed through the apartment.
"Are you expecting someone?" I asked my friend. She furrowed her eyebrows.
"You?" I said no with my head. I stood up, confused as to who it might be while approaching the door to open it.
At the other side of the door stood Jacob. He was carrying a hiking backpack. I scanned his figure until I reached his face. He had bloodshot eyes, the most sorrowful expression I've ever seen on someone. "Jake?" I opened the door a little bit more, feeling Kate's steps behind me at the mention of his name. "What's wrong?"
"Can I crash on your couch?" His cracked voice broke my heart as I let him in. He entered the apartment like a lost child as he started looking for the couch, but I took my hand in his as pulled him to my room, looking back at Kate so she could come too.
Jacob seemed truly bad. Whatever it was he needed proper rest, not a couch. He dropped his stuff at the side of my bed and laid down while Kate and I sat down at the end of it. "Tell us what's wrong, Jake." My friend asked softly.
He hesitated for a bit, fidgeting his fingers as he sniffed, holding back the tears. He was absolutely vulnerable. "I came out to my parents." He started, covering his face. "They kicked me out, and said I could come back whenever I'm cured of this shit-show." I felt blood boil in my veins at his words. I felt the deep need to go to his parents' house and give them a mouthful, but that would only worsen the situation.
I stared at Kate, who was already hugging Jacob and I joined them at an instance. "We're here for you, Jake. You can stay for as long as you need to." At this his eyes got teary again and we all laid down next to each other in silence. What could one say in situations like this? 'I'm sorry your parents are such retrograde assholes who can't accept their own child.' Didn't seem like the situation. So we just laid there, next to him.
After a while, when I was sure both of them were asleep, I decided to go to stand up and study. I wanted to wake Kate up, but staring at her face in the dark made me realize how exhausted she was, so I let her sleep.
Approaching the living room with a sigh, the sound of a phone ringing made me sprint back to reality. Realizing it was mine, I took it in my hands and all the boiling blood inside me from the anger I had felt instantly froze.
She never called. We hadn't spoken in years. I stared at the phone ringing in my hands, unable to answer. It was when I realized these things ran out of rings that I hesitantly pressed the green button.
"Amalia." Her voice had the same strict tone she always had. It was almost like venom. It took me back to when I used to flinch every time I heard those exact same words. I suddenly felt ten years old all over again.
"What do you want, mother?" I wasn't going to be nice. She didn't deserve that. Not from me.
"It won't take long, don't worry." I waited for her to continue, and when she realized I wasn't going to answer, she spoke once again. "I need you to come to Chicago."
I let out a bitter laugh. An actual chuckle escaped from my rib cage, resonating through my body. "Is this some kind of joke?" I spit out.
"No." She spoke, unfazed by my reaction. "We need to sort out legal matters."
"Legal matters?"
"My will, to be precise." I swear I had to hold my laughter this time.
"I don't want anything from you." I told her truthfully. The day I left Chicago was the day I also swore to myself I would never see her again. That I would never feel bad because of her ever again. "Why now, anyways?"
"I've got Glioblastoma Multiforme." She let out curtly. "I don't have more than three months." My breath hitched in my throat. "I'll be waiting for you, Amalia."
* * *
Fun fact: this chapter's tumor was the one Derek drew on his wall.