Room 1013

Treatment Options

A few days later, Keith talked to his parents about withdrawing from Hospice care. They were both extremely supportive and took care of the paperwork. After everything was being done, an appointment was made for them to discuss treatment options.

Keith officially greeted the doctor when they were led back to his office. "Nice to see you, Dr. Sallow."

The doctor was an old and greying man with crows feet and a shaky lip. "I should be telling you that! I was very pleased to see your name in my calendar." He held a hand out to Lance, "Now who might you be?"

Lance shook his hand and gave him a nod, "I'm Lance Kogane." He took a seat next to Keith. The room looked like any typical office you would see in any medical show. Files were crammed into bookshelves or stacked behind the desk on the counter; various pens fanned out in a black mesh cup; sticky notes dotted the desktop with notes scribbled in different inks.

Dr. Sallow sat down in his black leather office chair, "A cousin? Or brother?"

Keith's shoulders tensed up as he leaned forward and lifted a hand. "Um-no, we're not-"

Lance let out a nervous chuckle and shook his head, "I'm not his-uh.."

They both shared a playfully confused look. Keith took Lance's hand and placed it on his own armrest, lacing their fingers together. Lance jumped in, motioning to Keith with his free hand. "I'm actually his-uh-his husband."

Keith gave the doctor a wide smile and showed off his ring. "We're married."

Dr. Sallow leaned forward to admire Keith's ring, "Well would you look at that." He let out a hearty laugh, "Congratulations!"

"Thank you!" Keith tilted his head and widened his smile.

Dr. Sallow nodded and retrieved a file from his desk drawer. He set it on his desk, but left it closed. "Well, this meeting is to discuss treatment options for your leukemia." He laced his fingers together and leaned onto the desk, "I will not lie to you; this may be a very difficult talk." He made it look like he was talking only to Keith, but his eyes flickered over to Lance.

Keith gave him a snarky grin, "I'm expecting it." He squeezed Lance's hand as his smile dropped to unveil a serious aura.

"Then let's get started," Dr. Sallow nodded and leaned back in his chair. He flipped open the file and thumbed through the papers. "We've already had you on many different medications. Almost all of them have failed to treat the cancer."

Keith jumped in, "What about Tasigna?" His voice flattened, "It worked for a while."

Dr. Sallow used his hands to explain, "Well, it may not work in this phase. With your case, there's a higher chance of it not working at all."

Lance felt a little excluded from the discussion. He didn't know a lot of details about Keith's cancer, so he was relatively new to the process. Half of the words they said didn't even make any sense. Keith's entire demeanor changed in a split second. He was joyful and hyper up until a minute ago. His lips spoke as if it wasn't his body at all. Like he was debating politics with an old friend over a cup of tea. It was a strange thing for Lance to wrap his mind around.

Keith brought his hand up to his chin, "I see." His eyes lifted, "Bosulif?"

Dr. Sallow shrugged, "Possibly, but unlikely."

"So you're thinking Iclusig?"

"That's the plan." He flipped over a few papers. "But just like the other medications, there are risks involved."

Keith nodded, "Of course."

He read off every one in a mundane fashion. As if he was bored with it. "There is a chance of arterial occlusion-including fatal myocardial infarction, stroke, stenosis of large arterial vessels of the brain, severe peripheral vascular disease, and the need for revascularization procedures. There's also venous thromboembolism, heart failure, hepatotoxicity, liver failure, and death." He lifted his eyes to meet theirs, "Now the chances of these are slim and-"

"How slim?" Lance surprised both of them by finally speaking up.

Dr. Sallow gave him a small nod and looked back down at the file. "Arterial occlusion is about thirty-five percent, venous thromboembolism is six percent, and heart failure is nine percent."

"But Keith's case is special?" Lance's eyes switched from Keith and the doctor.

Dr. Sallow took a quick breath, "Yes, it is. In my professional opinion, the chances of any of these things happening is forty-eight percent."

Lance's chest jumped, "Forty-eight?"

Keith's voice drifted between serious and interested, "But that's just the meds."

"Correct."

A hint of a smile tugged at the corner of Keith's lips, "And you're thinking of doing something more."

Dr. Sallow smirked, "You know me too well." He returned to his flat tone, "A stem cell transplant is something you will have to consider. It will involve some radiation, too."

Keith's eyes fell back in thought. "Allogenic?"

"Yes." Dr. Sallow lowered his voice and spoke sternly, "I think it's your last chance at a cure."

Lance let out a frustrated sigh and turned to Keith, "Can you explain what's happening in words I'll understand?"

"Oh," Keith perked up in realization. He gave him a nervous chuckle, "Sorry." He twisted his body to face him, "So they want to put me on a chemotherapy drug called Iclusig. Then, I'll get a stem cell transplant-small radiation treatments come with that."

"Well, it's a transplant." Lance turned to the doctor, "What are the possible complications?"

Dr. Sallow gave him a half-hearted smile, "Possible complications include: bleeding and anemia; infections; interstitial pneumonia; liver damage and disease; or dry and damaged mouth, esophagus, lungs, and other organs." He fiddled with the stethoscope around his neck, "There's also a chance that Keith's body will reject the transplant or the cancer will relapse."

Lance sat back in his chair to process all the information being thrown at him. It was a lot to wrap his mind around.

Keith's face filled with pity. He stroked Lance's arm and forced a smile, "It's a Hail Mary."

Lance sat in silence for a few more moments, then sighed and rubbed his face. "In your opinion, what are the chances of a life-threatening situation happening?"

Dr. Sallow thought for a moment, "About eighty percent."

Lance let out a frustrated breath, "So what are the chances the stem cell transplant won't work?"

"I would say it's fifty-fifty."

Lance bobbed his head to emphasize his sharp words, "And what are the chances of everything going according to plan?"

"If everything went according to plan? Thirty percent."

Lance swallowed his nerves and held Keith's hand tighter, "And what are the chances that Keith actually lives through all of this?"

Dr. Sallow leaned onto his desk and held his hands up in defense, "Mr. Kogane, I'm afraid this is the only option left."

Lance hardened his stare, "What are the chances he lives?"

Dr. Sallow let out a long sigh and leaned back in his chair. His lips hesitated as he thought it over. After a moment, he met Lance's eyes. "Twelve percent."