dreamlikenewyork | "Things can only get better."

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"Things can only get better."

Who: Lachlan Campbell, Billy Willis and Ajay Bellerose
What: You say curse, I say blessing
Where: Mount Sinai Hospital
When: After THIS

It was a good few hours after Ajay's exploratory procedure that Lachlan included him in his rounds. The lad had a rough trot with the anesthetic, so it was best to let him sleep it off before bombarding him with medical information. He was Lachlan's last patient of the night, which meant he could spend a bit more time with him. He had heard of Ajay's case when he got shot, and Patrick gave Lachlan the head's up after the procedure (which he had been his anesthesiologist for) that Ajay was dating Billy, Jude's brother. So he was a special case by default, as far as Lachlan was concerned.

He had Ajay's medical record tucked under his arm and knocked softly on the door. Billy was lying on the bed with him watching him sleep and Lachlan gave him a smile, voice hushed when he spoke. "You dinnae have to move. I'm nay going to kick you out, buddie. Promise. My wife used to the the same with me when I was a patient and it made the whole thing easier. I do have to try and rouse him a wee bit, though. Just to give him a check over for pain levels and I need to chat with him about diagnosis."

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Luckily Lachlan was interjecting before Billy panicked and tried to scramble off the bed where he had been lying with Ajay, or he probably would have done something like smash his face in and Ajay would have blamed himself for it. Ajay had been really groggy from the anesthetic, but relieved when he realised Billy was waiting back in his room for him. Ajay had asked Billy to lie with him, so Billy didn't even think about asking permission and Ajay had dozed off again with his head tucked in against Billy's shoulder while Billy held him.

"It's okay, he's been awake. The nurse wanted to make sure he was peeing," he explained sleepily, realising that he must have fallen asleep without intending to. "Ajay, honey, you have wake up and talk to the doctor. You lucked out, got a real nice one..." he murmured, giving Ajay's arm a soft pat and kiss to his forehead. He couldn't even remember what it was Lachlan specialised in, but he knew he had a fantastic reputation and an easygoing bedside manner, which Ajay needed. Plus, he had been shot too, so he probably understood Ajay's state of mind on some level.

"M'wake," Ajay mumbled, though he didn't really feel it. Anesthetic had this way of knocking him on his ass and it took a good few days to get over it. It was hard to stay awake, but they had told him in Recovery a doctor would come see him with the results. He was groggy and feeling kind of cranky being woke up. He just gave a look to Billy and then the doctor, eyes and nose scrunched up against the bright lights. "Hi..." he finally greeted the doctor croakily, his throat still a little stingy and dry from having the scope down it.

Of course, like anyone, he didn't want to be in the hospital. He had spent a lot of time in them and with the baby steps of progress with Billy, he just wanted to be home with him and have time with him. "Do you know when I can go home?" he asked. "You're not going to tell me I have cancer or something, are you?"

"Nay cancer," Lachlan assured him right off the bat. When a patient asks you that question, and/or whether they're dying, you don't beat around the bush in answering them. "My name's Dr Lachlan Campbell, you can call me whatever you feel comfortable with. I'm a hematologist, and they called me in on consult from the ER when you presented with the large bleed and distinct anemia. You had signs of that in the wake of being shot, but considering blood loss with that, it wasnae an immediate concern and your levels picked up with the blood transfusions at the time. There were a few anomalies with your blood results, which could be understandably factored to complications with the bulimia. I want you to know straight up that the results of the scopes and scans arenae caused by the bulimia, okay? What has been happening is that the bulimia has been exacerbating another underlying condition and aggravating it."

He opened Ajay's file and showed him some print-outs of the CT scans and camera imaging from the endoscopies. "See these patches in the lower intestine into the larger? It's inflammation caused by a condition called Crohn's Disease. The intestinal stenosis, or bowel obstruction, you had a wee while back would have been caused by the Crohn's, but at the time, the scans showed no distinct indication of it. Between now and then, it's gotten worse. It looks like your belly was aggravated by the inflammation which has become infected. With the purging and ingestion the large amount of laxative, it caused a bleed in the worst of the lesions in your bowel. You have probably been experiencing symptoms for some times, but the bulimia masking them. Most commonly, diarrhea which you might have just felt was ill eating habits, fever, fatigue, abdo pain and cramping, reduce appetite and weight loss. To cut a long story short, buddy, if we dinnae get your bulimia under control and get you eating a diet to encourage healing in your gut, you could run into all sorts of nasty complications that could lead to serious bowel surgery and colostomy bags. I dinnae want to scare you, but we need to get you on meds to heal this inflammation and work together to try to battle the bulimia to get you on a meal plan rich in iron and fibre. How are you feeling? Belly pain's completely understandable with what's going on inside at the moment."

Billy's mouth was hanging open a tiny bit by now as he just gaped listening to Lachlan. He was explaining things slowly in a way that was easy to understand. He was giving enough information for them to follow without throwing piles of useless information at them that would probably scare and confuse Ajay. But at the same time, it definitely sounded like it could be serious business if left to get any worse. There had been a lot of blood, like it had started quickly and Ajay hadn't even noticed. It made him wonder what else Ajay had desensitised to and what had been hidden under the bulimia veil. "So... it's treatable? You can give him stuff to fix this inflammation?" he asked, pointing to the medical images in the file that did, admittedly, look like they would be painful.

"He's probably had all of that. He's been so tired, never feels like eating, and he always feels cold like he's got a chill. How long do you think his gut has been like this?" he asked, a burst of even more intense sympathy coming over him at what Ajay must have been feeling if his stomach looked like that on the inside. All the while, probably assuming himself that it was because of his binging and purging. Or vomit fetish, as his dickhead sister accused him of. "Every time he's been making himself throw up, would it have been upsetting all this? He's been doing really well with the therapy. I know he doesn't feel like he is, but he's kept every appointment, even on the days he's felt worse. But he's had a lot of stress. Would that be making it worse? I should shut up. We haven't even been dating half a day yet and I'm sticking my nose in like a bossy wife. I just care about him.." he added sheepishly.

It was a lot to take in, and it was making Ajay's head hurt. He wasn't freaking out. It was true, he was kind of desensitised to medical things, but this that Lachlan was outlining gave him answers that weren't blaming the eating disorder. He wasn't even coming close to suggesting that if he fixed the bulimia, he would get better. What he was saying was that he had this other thing, and the bulimia, everything associated with it, was making it worse. He was looking at the pictures too with a small frown on his face. He had never wanted to know what his insides looked like, pretty sure they weren't healthy... and they weren't, but not from bulimia. Being bulimic was just making him more and more sick. That was a heavy load to have dumped in his lap, because psychologically, it was hard to fathom.

"It's okay, you're not sticking your nose in," he mumbled, resting his hand on Billy's chest. If anything, Billy was saying all the things he probably should be saying but his mind was just in one big brain fart trying to understand this. "I-If I... if I don't get better with the bulimia, I'll make myself sicker and need more surgery? I just... I'm trying. My head's just so messed up, I keep fucking up all over again. I didn't know I was sick. I guess I haven't been feeling well, but I never feel well. My stomach hurting was just like that feeling I got to tell me I succeeded with the purging and was empty. I didn't know any of this. I haven't taken laxatives in ages, I just got them as like some sort of security blanket. They would be there if I really screwed up and went overboard on a binge, but when I had them, it seemed like the easy way out. But they just made me bleed inside? I don't know how I feel. I... my stomach hurts, I though that was normal."

Lachlan rested his hand on Ajay's shoulder with a gentle squeeze. "I dinnae want you to think I have no understanding of your eating disorder, buddy. No, I'm nay a specialist in that field and I havenae had any personal experience with the condition. But I am a doctor in our Diagnostic Medicine team here, so it's my job to have understanding of many different conditions and fields. I know that this is a lot for you to take in, and that it's going to be a struggle for you to understand something beyond the control the bulimia has over you needs to take precedent. We'll work very closely with you, and with Gabe, to try to construct the best treatment plan you can cope with. I also understand that the pain and discomfort you feel qualifies to you in your mind that you have control over the eating disorder, but that's not the case, Ajay. It's making you seriously sick and internal bleeding is a serious thing. We caught it early, and what we're going to do it give you some intensive cortisone therapy to heal up the inflammation in the first instance."

Once Ajay gave his authorisation for Billy to be involved, Lachlan handed him some patient leaflets and information sheets on Crohn's Disease. "I also want to commence you on a couple of other medications used to control the flare ups. They will still happen, there's no way to truly avoid them, but we can keep is as controlled as we can and treat the flare ups when they happen. It's important to recognise the signs of the flares so you know when to get further treatment, and that's where the difficulty will be for you because the discomfort has become your norm via the bulimia. You need to start being able to take a normal balanced diet with lots of fluids, fibre and iron. The thought of that scares the living shit out of you, I know, buddy, but this is serious, okay? Either way, if we dinnae address this here and now either the bulimia or this will eventually catch up to you and all your systems will begin to shut down on you. But you have Billy here to help you and take care of you now, and my colleagues here are some of the best in the country. You dinnae have to suffer anymore. We're going to get you well, but you have to work with us."

Billy mutely took the leaflets and flicked through them. Maybe in a way this was a blessing in disguise if it was that push to help Ajay fight the bulimia, but at the same time, he felt sick inside thinking that he had just lived with the pain of this without even realising something was wrong. He lived with it because he thought he deserved it with the bulimia being self-inflicted, and he believed that because his asshole mother and sister had injected those thoughts into his mind for years. He looked at Ajay and was now softly rubbing his chest to try to comfort him. It wasn't nice to hear any of this, and he didn't know how Ajay would cope with it after everything already weighing on him. "Is there anything I can do to help here? Will he have to stay in the hospital or can we take the medication home? I can take care of him, I swear."

He liked the sound of Ajay not having to suffer anymore, but he knew what Lachlan was saying wasn't an easy fix. It would still be hard for Ajay to work on this... if not harder being ill. He was getting a little panicky now because what if Ajay couldn't get better with the bulimia and his systems started shutting down? This was, again, one of those moments he wanted his big brother there. But Jude wasn't here, so the panic was staying. "It's okay, honey. I'm here, okay? I'll help you with this, I'll look after you. We all will. Travis will. I mean, if you want to tell him. He just might like to help, to show you that he does care about you. We'll help you..." he repeated, kissing Ajay's temple.

Ajay nodded but he was getting upset and tearing up. He hadn't wanted to do that, and he felt guilty for not being stronger. "I'm sorry, it's just a lot to take in," he told them shakily. "I think I just need some sleep and try to understand it more a bit later. Is that okay? I'm okay, it's just something I don't really have any understanding of and my head is really hurting. I always knew that the bulimia could cause me problems, but I just buried my head in the sand about it. It's been a really long few weeks and I'm so tired. I don't mean to be difficult."

He wiped the tears away with his fingers. Being told he didn't have to suffer anymore wasn't something he could believe. It was also a little scary to think he had to face the eating regime again because his life depended on it. He knew what he needed to do, but it was always hard to battle it when he was at his worst. "Whatever you need me to do, I'll do. I just need to take it in and I'm not feeling so good right now."

Connor took the box of tissues from the cabinet by the bed and placed them in Ajay's lap for him. "Dinnae get yourself all distressed, buddy. It's going to be okay. You've had a rough ride of it and had a lot of stress to deal with over recent months, and even prior to that from the look of your old medical records. What I'm going to do is get the nurse to come in and give you something a wee bit stronger for the pain in your leg and your belly. I would like to keep you in for a few more days to hit you with a hard and fast dose of IV cortisone to heal up that bleed you had so it doesnae happen again, and we can start you on the meds you'll need to be on from now on. I know hospital sucks, buddy, I really do but over the next few days, we can monitor all your symptoms to begin building a picture of what happens in your flare ups. I want to get a dietician up here to start going over what you need and ways in which you can cope with your eating, but I want to start you on PEG feeding, Ajay. With the inflammation in your belly, the nutrient and iron deficiency and the severe B12 deficiency, we need to start combat that malnourishment. We'll take the burden of eating out of your hands for a little while until you get better. Even when we discharge you, the PEG feeds can continue at home for a short while. Do you think you would be okay with that? If you want, I can call Gabe up and see if he can pop in here to see you for a session. Would you like me to arrange that for you?"

"For now, get some rest, aye? I think we might get you on another bag of fluids and something for nausea so you can rest comfortably. I'm back on shift again tomorrow morning, so I'll come by and have another wee chat with you to see how you're going. But I willnae do anything without your authority, so if there's anything you dinnae want or dinnae understand, tell me, buddy, and we'll find other routes," he said and this time gave Billy a hospital print-out explaining what PEG feeding was and why it was vital for Ajay right now.

Billy wished Ajay could go home, but he knew all this was vital right now. It wasn't just bulimia that had been dragging Ajay down, it was the fact that he had been in pain and just generally quit eating besides the binges. It was all becoming clear now, the way Ajay nearly passed out when Billy brought his diary back to him. He was malnourished, anemic, and probably dehydrated more often than not. Sure, he didn't know the exact extent of Ajay's symptoms because it hadn't been any of his business, but he could guess the sorts of things he had been dealing, all just put down to the eating disorder. He was nodding listening to Lachlan, and relieved that they weren't going to try to start shoving food down Ajay's throat to try to combat the eating disorder. That just wouldn't work.

He took some tissues from the box and wiped away Ajay's tears. "What can I do? I'll call Gen, see if she minds having some time off so I can help him through all this. I-I'll... shit, I didn't sign that contract with Caden for the play, but I'll just tell him Ajay's gotten sick and I can't commit to it anymore. Getting him better is way more important," he decided, thinking out loud and trying to take in as much of this as he can so Ajay didn't need to remember it. "So, this PEG thing, it's a tube in his stomach so he doesn't need to worry about eating? That makes sense. And he can have it at home? He doesn't need to stay in here for ages, right?"

"Wait, no-- that's not happening!" Ajay immediately protested, even if he was still teary and trying not to get snot everywhere. He took some more of the tissues to wipe his eyes and nose. "You're not missing the opportunity with the show because of me. I know we've started to date here, but I'm not going to keep doing that if you sacrifice things that are important to you because of me... because of this. I've done all this on my own for a very long time, and I know it might seem like I can't handle it, and to be honest, I'm not coping the best, but I'm not dying and I'm not incapacitated. I've done this before, the feeding thing. I know what happens with it. I've done all this, okay? I know it's going to be hard and it means the world to me you want to help me and be there, but only when you're not busy with the play. I mean it. I'll end all this dating stuff right here if you try to quit. You need to do it for you, and for Justin. When you go home to get some sleep, you can sign the contract and send it to Caden."

This showed how strong Ajay could be. He might seem weak, and he might seem vulnerable and broken, which he was, all of the above, but he had also fought this hard battle for years so he was weathered to it. "You... you need to understand that my head is a messed up place, and on top of everything else, I can't deal with the guilt of you quitting the play because I'm sick. It's hard enough hating on myself for everything else already. Okay? Give me something to look forward to, seeing your opening night." He looked back to Lachlan. "I think I should see Gabe, thank you. I'm sorry I'm such a mess. Everything's so hard right now, I can't make sense of it in my head."

Oh, did Lachlan recognise this particular relationship battle. It would be one Ajay and Billy needed to work through together. He couldn't think of a single couple he knew that had faced hardships who hadn't been through a very similar push/pull give/take situation like this. It was just a higher stressor in this circumstance with Ajay's mental health needing stabilised. "Things dinnae need to be to that extreme, Billy. In fact, even with the PEG feed, Ajay can still be out and about. It's hidden under his clothing, he's not incapacitated by it. All it is is an alternative route of nutrition where there's been a compromise on oral ingestion of food. It has two benefits in this situation... it removes the psychological battle Ajay has at present with food, and gives the gut time to rest and heal from the inflammation that caused the bleed. We need to get nutrients into him in the most effective way to sustain him and replenish the deficiencies. He's very underweight. The biggest myth people have with any eating disorder is thinking if patients just eat, they'll be fine. It doesnae work like that. All his bodily systems are being denied the things they need, it needs to be a universal therapeutic regime to fight it. It probably doesnae even take much to trigger a purge. It becomes a norm."

He rested his hand on Ajay's arm again. "I just want to take a set of obs so we can see where to start with the meds first, okay? But tell me, are you musical like your dad, buddy? When we had you in Recovery you got a wee bit sick on your gown, so we changed it for you and I noticed the tattoo on your arm. The sheet music to What a Wonderful World. It's usually musical folk who get ink like that," he noted with a small smile, relieving the weight of the conversation just a little so Ajay had something else to focus on for a bit.

It was hard for Billy to be convinced about all this, but he knew his heart was overtaking his head. Ajay was firmly putting him in his place over the play situation and Lachlan was elaborating on the whole thing so he could understand more easily. And he appreciated it all. Ajay's words were very pointed. He wasn't saying he was okay or that he would be fine. In fact, he was admitting he was anything but. He was ready to do what it took though, and Billy wanted to help with it. "Okay, but I just... when I'm not working, I can still help, can't I? Until you start feeling better?" Ajay wasn't horribly skinny, but Billy knew from the close contact he'd had cuddling him and lying close that he was too underweight. This all seemed scary and extreme, but Ajay's condition had reached danger zones. Billy was glad Lachlan was his doctor. He looked at Ajay sympathetically. "Is that true? It doesn't take much for you to make yourself sick?"

Wait... ink? "You have ink?" he asked in surprise. He hadn't ever seen Ajay uncovered, though. In fact, he had never seen him in anything but a hospital gown that didn't have long sleeves. Lachlan was extremely musically talented, and did a lot of music producing and mentoring in his spare time, but it was cool to hear him recognise the song just by reading the music within the tattoo. He hadn't ever thought to ask if Ajay was musical like his father. He knew his sister was, and that she said Ajay was talentless and useless. That didn't mean anything, the stupid bitch.

"I know this is hard for you," Ajay murmured to Billy with a tiny frown. "It's hard for me too, we have to figure it out together. You've never done any of this before, and I've never done any of this when I've been dating. You can't give up on Footloose before it even starts. You opened up a whole new pile of confidence for Justin in resuming the play, and you deserve to have that role. It's Broadway. Even if I'm not feeling good and you're at the theatre doing your thing, we can still text or chat on the phone when you have breaks. Of course you can help me. You're helping me in ways without even realising it. And I... I... no. It doesn't really take much. I've done it enough, I'm kind of an expert. I'm not going to give you the gory details. You've seen enough in the aftermath."

He was surprised too, because he didn't know Lachlan's background. "That's my favourite song. It helps remembering things I seem to keep losing sight of. I'm a little musical, I guess. Just don't like to do it in front of anyone. Crowds make me nervous, I don't like being the centre of attention. It's more a personal thing," he mumbled with a self-conscious shrug. "Nothing like dad. Rock's not really my thing."

Edited 2014-11-23 06:21 (UTC)

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"Things can only get better."

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