They didn’t want to waste time on the biopsy. Within the hour Brian found himself lying on a table on his side, as he had such a long time ago. Just like the time before, AJ was sitting in front of him. But this time AJ didn’t just hold his hands or silently offer support. He leaned in with one hand coming up to cup Brian’s cheek. It helped Brian get through the ache that came with the biopsy. No matter what anyone said, that fucker hurt!
With as tender as his body already was, Brian had realized that there was a chance it might hurt more this time. What he hadn’t been prepared for was how badly it would hurt. They put the needle into his hip and he almost came up off the bed. Instantly he squeezed his eyes shut as the pain flared in his hip and seemed to radiate from his very bone.
He clamped his hands down on AJ’s hands and squeezed his eyes shut. It didn’t stop a few tears from leaking out, though. That was when AJ had brought one hand up, the other still held by Brian’s hands, and cupped Brian’s cheek, his thumb wiping away the tears. Then he leaned in, kissing the wrinkles in Brian’s forehead. “I’m right here, baby.” He whispered. “I’m right here. You’re doing so good. There’s not much left for them to do. Just a little bit more and you’ll be done.”
Brian held on to AJ’s words, listening to them as he felt them finally pull the needle out. Then they were applying pressure over it, stemming the bleeding, and bandaging it up. Once he was all cleaned up they took him back down to his room in a wheelchair so that he wouldn’t have to walk with that sore hip.
The minute they were alone in their room, AJ helped Brian over to the bed and wasted no time in getting him inside of it. Brian appreciated that more than anything. Even when they’d been just friends, AJ had always been able to read him and react accordingly. Now that they were a couple he had only become better at it.
So Brian simply gave himself over to AJ’s care. He shut his brain off, refusing to allow himself to dwell on the fear, and just gave himself over to AJ.
AJ got him in the bed, his sore hip facing up, and then proceeded to climb in with him and spoon him. One arm flung over Brian’s waist, pulling him back against AJ’s chest, and AJ’s legs curled up behind his. Once the blanket was pulled up, Brian felt totally surrounded by AJ, and totally protected.
“Shut it off for a while, Bri.” AJ whispered in his ear. “Don’t think about it. Don’t think about anything. You were already exhausted. Just sleep for a while. I’ll be right here, and I’m not going anywhere.”
Brian laced his fingers with AJ’s, just needing the contact. “You’ll stay?” he found himself asking. “You won’t leave?” That hadn’t been what he’d meant to say, but it had slipped out anyways. Right then Brian realized that there was nothing more important to him, nothing he wanted more, than to have AJ stay by his side. He’d been so foolish before. This wasn’t something that he could do without him.
A soft kiss was laid against his neck. “I’ll stay right here, holding you. I promise. Now, go to sleep, baby.”
Very softly AJ started to sing in his ear. Almost instantly Brian found himself being soothed. He loved AJ’s voice. The rasp to it, counteracted by the way it could come out sounding so sweet.
“What can I do, to make you mine
Falling so hard so fast this time
What did I say, what did you do?
How did I fall in love with you?
I hear your voice
And I start to tremble
Brings back the child that, I resemble.”
Listening to AJ sing, Brian drifted off into a quiet sleep.
~~~~~~~~~~~~~~~~
Hours later they sat in that same bed, holding on to one another as the doctor dropped his bombshell. The cancer had spread deeper, and they were going to have to a bone marrow transplant. It was their best option. But just the thought of it sounded terrifying. “Dr. Reese, I know the general idea, but…what exactly are you going to be doing to me?” Brian found himself asking. The back of the bed they were in was raised, and Brian sat on the side that put his hip away from AJ and toward the railing. It allowed him to have AJ curled to his side the way that he wanted. The way they both wanted.
Dr. Reese stood beside the bed, his handsome face full of sympathy. “In a bone marrow transplant, your diseased bone marrow is destroyed and healthy marrow is infused into your blood-stream. In a successful transplant, the new bone marrow migrates to the cavities of the large bones, engrafts and begins producing normal blood cells.”
“How do you destroy the diseased marrow?” AJ asked him.
“Large doses of chemotherapy will be given to destroy the abnormal stem cells and abnormal blood cells.” Dr. Reese explained to them. “These therapies, however, not only kill the abnormal cells but can destroy normal cells found in the bone marrow as well. A bone marrow transplant, what we call a BMT, enables us to treat this with aggressive chemo by allowing replacement of the diseased or damaged bone marrow after the treatment. The dosage of chemo you’ll be getting is much stronger, like I said. You’ll most likely become weak, irritable and even more nauseous. We’ll prescribe anti-nausea meds, but those barely help you now, so that’s something you need to be prepared for.”
It sounded absolutely terrifying. Aggressive chemo? That thought had Brian’s stomach rolling in early sympathy. God, he had thought that chemo now made him tired and sore and sick. But making it more aggressive? Jesus. His mind was spinning with all of this, but he needed to know the facts. “What exactly will you do? I mean, procedure wise.”
“First we have to do a battery of tests to ensure that you’re physically capable of undergoing a transplant. Tests for your heart, lung, kidney and other vital organ functions are also used to develop a ‘baseline’ that post-transplant tests can be compared to, so we can determine if any body functions have been impaired.
“Next, you’ll undergo several days of chemotherapy to destroy bone marrow and cancerous cells and makes room for the new bone marrow. This is called the conditioning or preparative regimen. Before we start that, after all your tests today, we’re going to insert a catheter into a large vein in your chest just above your heart.”
“A catheter?” Brian squeaked out. “In my chest?”
The sympathy in Dr. Reese’s eyes grew. AJ reacted to Brian’s stress as well, one hand stroking up and down Brian’s stomach in a soothing gesture. It helped him bring himself back under control.
“This tube lets us administer drugs and blood products to you painlessly, and to withdraw the hundreds of blood samples required during the course of treatment without inserting needles in your arms or hands.” He explained quickly.
While Brian processed that, Dr. Reese grabbed a chair, pulling it over to sit down as he finished explaining this to them. There were quite a few details, and he wanted to make sure they understood what was going to happen. One thing he had learned since joining Brian’s medical team was that the two men wanted to understand everything that was going on. They wouldn’t agree to anything until they understood it. And he had learned that it was definitely ‘them’. If AJ didn’t understand something, Brian didn’t go through with it until his partner understood. Dr. Reese could respect that.
“The type of BMT we’ll do is an allogeneic BMT. That means that it’s from a donor, and not yourself. The new bone marrow must match the genetic makeup of your marrow as perfectly as possible. Special blood tests are done to determine whether or not the donor's will match yours. Even then, your immune system may destroy the new bone marrow. This is called graft rejection.
“A day or two following the chemo, the transplant will happen. The bone marrow is infused intravenously just like we do with blood. It’s not a surgical procedure. We’ll do it here in your room. You’ll be checked often for signs of fever or chills, hives, and chest pain while it’s being done. That part of things is easiest. It’s the next two to four weeks that are most important.”
“Why is that?” AJ rasped out. His voice sounded lower and thicker, and Brian knew that AJ was struggling to understand and process all of this as well. Dr. Reese was explaining it well, and they appreciated it, but it was so much to take in.
“The chemo given in conditioning will have destroyed the bone marrow, crippling the body's immune system. As we wait for the transplanted bone marrow to move to the cavities of the large bones and begin producing normal blood cells, you’ll be very susceptible to infection and excessive bleeding. Multiple antibiotics and blood transfusions will be administered to help prevent and fight infection. Transfusions of platelets will be given to prevent bleeding as well as medications to prevent and control graft-versus-host disease.
“We’ll also take what you might thing are extraordinary precautions to minimize your exposure to viruses and bacteria. Visitors and hospital personnel will wash their hands with antiseptic soap and, in some cases, wear protective gowns, gloves or masks while in the patient's room. Fresh fruits, vegetables, plants and cut flowers will be prohibited since they often carry fungi and bacteria that pose a risk of infection.
“When leaving the room, we’ll ask that you wear a mask, gown and gloves as a barrier against bacteria and virus. Blood samples will be taken daily to determine whether or not engraftment has occurred and to monitor organ function. When the transplanted bone marrow finally engrafts and begins producing normal blood cells you’ll gradually be taken off the antibiotics, and blood and platelet transfusions will generally no longer be required. Once the bone marrow is producing a sufficient number of healthy red blood cells, white blood cells and platelets, you’ll be discharged from the hospital, provided no other complications have developed. You’ll probably spend four to eight weeks in the hospital.”
Suddenly AJ raised his head, looking very worried and serious. “Am I going to have to stay away too?” he asked him. Brian’s eyes grew wide and he looked over to Dr. Reese, worry on his face. The last thing he wanted was for AJ to leave. They’d been that route before, and it had been horrible for them.
Dr. Reese shook his head, settling both their fears. “You’ll have to gown up most of the time. But you’ve been here with him, and we’ve tested you more than once. You haven’t brought anything in to his room yet. But, if you’re going to stay with him, sleep in here and everything, then we’re going to put you on the same restrictions he’s on. You can be without gloves or mask in here, but you step out that door you’ll gown up the same as him.”
“I can handle that.” AJ said, laying his head back down.
“Now, the bone marrow transplant is a debilitating experience. I want you two to understand that. Imagine the symptoms of a severe case of the flu. Nausea, vomiting, fever, diarrhea, extreme weakness. Now imagine what it's like to cope with the symptoms not just for several days, but for several weeks. That approximates what you’ll feel. During this period you’ll feel very sick and weak. Walking, sitting up in bed for long periods of time, reading books, talking on the phone, visiting with friends or even watching TV may require more energy than you have to spare.
“Complications can develop after a BMT, too, such as infection, bleeding, graft-versus-host disease, or liver disease, which can create additional discomfort. The pain, however, is usually controllable by medication. In addition, mouth sores can develop that make eating and swallowing uncomfortable. Temporary mental confusion sometimes occurs and can be quite frightening for you. The medical staff will help the patient deal with these problems. As I suspect AJ will too. It’s another reason we’re allowing him to stay.”
Dr. Reese rose to his feet, stretching slightly as he did. “We want to get started on the new chemo tomorrow. From there, we’ll go on to the rest of it. Luckily enough we have a donor listed on file that matches you almost perfectly, so we won’t have to do a search.” With a gentle look in his eyes, Dr. Reese reached out and covered Brian and AJ’s joined hands, squeezing lightly. “You two relax, discuss this together, and whenever you’re ready the nurses will bring you the papers to sign, ok?”
With that parting comment he left the two men to their thoughts, wishing that this part of his job wasn’t so hard.