Eight - Vivaan

Two and a half weeks later...

Vivaan had just finished with dinner when his phone rang, Payal's name flashing on the caller ID. He picked it up with a smile.

"I'm reaching the hospital in five." Payal said before he could say anything.

"Hello to you too." He said, amused. "Why the sudden visit at..." he paused, looking at his watch. "10 PM?"

"We'll talk when I reach." Payal said, ending the call.

Vivaan frowned, but got up from the table, much to the surprise of his best friend Adi, who was just coming in with his food.

"Payal's coming. I'm going to get her." He explained.

Adi nodded. Vivaan made his way out of the cafeteria, a sense of unease building within him. He was happy with the sudden visit, but Payal's tone over call was quite off - as though she wanted to say something but stopped herself at the last moment.

He waved as he saw her at the entrance to get her attention. As she came closer, Vivaan's heart sank. She was crying. Or she had been. She stopped before him, staring at him with a vacant expression.

"Hey." He whispered carefully. "What's the matter?" he asked when she didn't return the greeting.

And then he got the shock of his life when she laid her head on his shoulder, sobbing quietly. The sense of unease from earlier rose up his throat, threatening to make him sick. He forced it down, wrapping his arms around Payal as she sobbed. Their first ever hug, he realized belatedly. So not what he had expected.

"Payal. Look at me." he said, pulling away to make her look at him. But she refused.

"Payal, please look at me. Please." He said, his fright growing. "What is it?" he asked, as he finally managed to make her look at him. But she looked away.

"Let's go somewhere more private, okay?" he asked her gently. She nodded, tears spilling out non-stop. He led her to the staircase beside the utility cupboard, which was a little away from the bustle of the hospital. Making her sit down, he noticed for the first time, the file Payal had clutched tightly in her hand. It bore the insignia of the path lab close to her house. Ignoring it for the moment, he focused on Payal, putting one arm around her to comfort her.

"Now tell me." he whispered. "What is it?"

She handed him the file wordlessly. Confused, Vivaan took it and began to leaf through it. They were test reports of a patient. He looked at the upper left corner. Mrs. Deepa Shah. Payal's mother. Payal had said a few days back that her mother was getting very exhausted nowadays. She was also losing appetite, which she was trying to write off as stress.

With growing apprehension, he flipped the pages. There were test reports for ECG, abdominal sonography, liver function, urine function, even diabetes. What did Payal's mother need so many tests for? He checked the reports. They were all normal.

"Did your mother get a routine check-up done?" he asked Payal gently.

She shook her head, but she had stopped crying. "Blood work." She whispered quietly. Vivaan realized that there were a couple of papers remaining in the file. He checked them out. One was a general prescription for broad spectrum antibiotics. As he turned the page, the last two pages were hemogram reports, both of them a week apart.

The first one showed a WBC count of 90,000. He briefly scanned the differential counts, before reaching the impressions section. Tests recommended to rule out Chronic Myeloproliferative Disorder.

The urge to throw up was steadily increasing.

He flipped to the last report. It was taken a week after the first one. The WBC count was now 91,400. And the differential counts were noticeably skewed. Vivaan quickly scanned the impression. Signs of a Chronic Myeloproliferative Disorder. Recommend BCR-ABL test to rule out Chronic Myelogenous Leukemia.

Vivaan's stomach plummeted. Leukemia. Payal's mom might have blood cancer.

Beside him, Payal collapsed into sobs again, putting her head on her knees.

"Payal. Shh." He soothed, trying to comfort her, while battling his own sense of unease. He placed the file aside, pulling Payal into his chest and wrapping his arms around her as she fell apart.

"Shh." He soothed. "We need further testing, Payal. Nothing can be confirmed from this." He said slowly, but it sounded unconvincing even to himself.

"What else can it be?" she asked, between sobs. "I don't know what to do Vivaan. I just don't." she cried, wrapping her hands around her knees.

Vivaan placed the file on the step beside him and placed both of his hands on her shoulder. "Okay first calm down." He whispered. "Payal, she needs you right now. And so does your father. If you break, who will handle them?"

She tried taking deep breaths, but it didn't work. Her hands tightened around her knees as her arms shook. Her breathing began to get quicker and faster. Even without checking her pulse, Vivaan knew she was hyperventilating.

Panic attack.

"Payal listen to me." he urged. "Close your eyes, and just focus on my voice. Nothing else." He ordered. He released her shoulders, giving her as much space as she needed. Waiting, he watched as she closed her eyes, still struggling with her breathing.

"Take deep breaths." He whispered, reaching out and holding one hand. He gently rubbed her palm with a slow circular motion of his thumb. Repetitive and slow. "You aren't alone. We'll get through this. Breathe." He whispered again. A light sheen of sweat coated her forehead.

He waited, watching as she slowly leveled out. Exhaustion was plain on her face as she finally squeezed his hand, letting him know she was okay. This was a side to Payal he had never seen yet. He had always seen her strong. Always speaking her mind, always ready to offer support. Not like this. Never so... weak.

Cautiously, he inched his arms out, wary that she might react in her sensitive state. But he was yet again surprised when she willingly went into his embrace, burying her head into his chest, and fisting her hands into his doctor's coat. Assurance. That is what she needed.

He wrapped his arms around her, tucking her in what he hoped was a posture that conveyed security. Swaying gently, he held her as she cried quietly into his chest. It was natural to soothe her; to rub her shoulders comfortingly or stroke her hair. Vivaan let his instincts guide him to comfort her.

"We'll set up a consult with a haemato-oncologist. Okay?" he asked after a bit. When he felt her nod slowly, her face still in his chest, he continued. "Leukemia is a term that is used to describe a high number of WBCs. It does not mean cancer. Further testing is needed to prove that. Your mother might just have a blood disorder." He spoke soothingly.

She pulled away from him then, her hands still on his coat lapels. Her eyes were swollen, red and puffy. Tear stains marked her cheeks. "What diagnosis would you give?" she asked, her voice clogged with tears.

"I'm no expert." Vivaan answered, shifting a few wayward strands of her hair behind her ears. He wiped the tear trails on her face as he continued. "There is a visible issue with her blood counts though, so my first mode of action would be further tests. A bone marrow biopsy being the first. The problem is now visible in the blood. Meaning, the source is mostly the bone marrow. We'd get a clearer picture from there. And then maybe gene testing."

"Gene testing?" Payal asked.

"Leukemia needs a trigger." Vivaan explained. "Most often, it happens due to a gene mutation which triggers the proliferation. We need to find out which gene is mutated, stop that mutation and stop the effects it's been causing."

"There are different kinds of mutation?" Payal asked again, to which he nodded. "So then different kinds of leukemia, based on the kind of mutation?" she asked as if to confirm.

"Like I said, I'm not an expert." Vivaan said. "But yes. Leukemia is of different kinds. Aunty's reports indicate a chronic myeloproliferative disorder. CML is a kind of disorder too. But this is only guesses. And presumptions. We need better testing and more accurate results."

"Could this be an acute form of leukemia? The one that progresses very fast?" Payal asked. So, she had read up on the basics. As was expected of her. Payal was nothing if not thorough, as lawyers mostly were.

"Reports indicate chronic disorder. They don't progress that fast, but when they do, they progress to the acute stage. So, the faster we complete testing, the better." Vivaan said, thinking out his answer.

Payal considered that for a moment, before nodding and resting her head on his chest. Vivaan adjusted himself easily, holding her close and comforting her. In any other circumstance, his heart rate would have hit the roof, seeing as he had never held a woman (who was not his mother, aunt or sister) this close before. But his mind seemed to have understood that Payal only needed comfort. And it was natural for him to want to provide it.

"I'm sorry." She whispered after a few moments. "I just couldn't hold it in. I probably scared you."

"You were being strong before your family, weren't you?" Vivaan whispered. "But you are also scared. You also needed comfort. And I'm happy to be the one you're willing to cry before." He assured her, tightening his hold just a bit. She tensed in his arms, as though just realizing their position.

As she went to unentangle herself, Vivaan stopped her. "I don't mind it, you can stay." He said. She looked so vulnerable. He didn't want her to face the world just yet. "It's okay to take respite. To hide for a while. To let your walls fall, if only for a few moments." He said, looking into her teary eyes.

She sniffled, sinking back into his embrace. "I'm not strong enough." She whispered.

"You are." He breathed into her ear. Swaying gently, he went back to stroking her hair. "You just need to build enough courage." He whispered.

She turned her face into his chest, tears leaking out again. "Will you stay until I do that?" she asked, her voice raspy.

Vivaan just continued his swaying rhythm. "I'll stay as long as you want." He promised. "Even after that."

***

"Adi, I'll be on a break till this afternoon. I need to go to Payal's house to discuss her mother's condition." Vivaan said, entering the cardiology room, looking at the place where he knew his best friend was seated. Adi looked up from his book.

"All good?" he asked.

"Nothing concrete yet. The earlier the biopsy is done, the better." Vivaan said. "Also, irrespective of whether its cancer or no, they'll need to start medication to reduce the WBC count. I need to explain all that." He explained.

Adi nodded. "I'll cover your break, as long as Chief permits it." He said.

"I have his permission. Thanks." Vivaan said, ditching his coat and stethoscope in his drawer.

"How long have you been awake?" Adi asked.

Vivaan paused. "A little over twenty hours now." He said.

Adi tossed his car keys to him. "You wreck my car; I'll get you jailed." He warned.

Vivaan laughed. "I'll try my best to protect it. Bye." He said, leaving the room.

Payal opened the door to welcome him in. As expected, the sitting room was filled with their families. His parents, uncle and aunt were seated in the sofas, opposite to Payal's parents. Behind the sofas, Payal's brother and sister-in-law were seated on dining table chairs.

"Come in." Payal said with a weak smile. Her composure was a lot better than the night before, but she still seemed fragile.

"You okay?" he asked in a low voice. She nodded, looking down.

Sighing deep, he took her hand, which made her look up immediately. She looked over to the side, gesturing to their families. Vivaan just held her hand more firmly. But she pulled it out gently.

"Sit. I'll get you something to drink." She said, going to the kitchen without waiting for his response.

Vivaan moved forward and bent to take blessings from Payal's parents. Payal's mother's appearance had changed drastically from the last time he saw her a little over two weeks ago. She seemed to have lost weight, and her skin seemed dull and pale. She smiled as she blessed him, but it didn't reach her eyes.

How can such symptoms come at this stage? The WBC count is still below 1,00,000.

"How are you feeling?" he asked, holding her hands.

"I'm fine." She replied, with another smile, this one more genuine.

Payal came back with a glass of water for him. He took it from her, taking a sip and placing it on the table.

"Vivaan, what is the diagnosis?" His father asked.

"Baba-sa, I told this to Payal when she met me last night as well. The count in the reports and the symptoms are too general. We can't make a concrete diagnosis with it. We'll need more tests." Vivaan said.

"But you can give us a better run-down of the situation, right?" Aniket, Payal's brother asked.

Vivaan nodded. "I'm here to clarify as much as I can on all things that Google may have scared you with." He sat down on one of the two chairs that Payal had pulled out. As she sat beside him, he took her hand, not caring what their family decided to make of it.

"I spoke with the hematologist at my hospital and showed him the reports. He has suggested a bone marrow biopsy and a gene test known as the BCR-ABL test."

"That's the test written in the impressions." Payal's father said.

"Yes, as I told Payal, most often, leukemia needs a trigger. Usually, a gene mutation is the trigger. We need to find out which gene is mutated, tamp it down, and stop the leukemia. Think of it like a room with several lights. One light is malfunctioning. What do we do? We find the switch and switch it off. The mutated gene is the switch in this case." Vivaan explained.

"You can get the tests done at the hospital I work at. Bone Marrow biopsy requires general anesthesia." He looked at Payal's father again. "She'll need to be admitted for a day. Evening she can be discharged."

"Is a biopsy really necessary?" Payal's mother asked. "Blood tests aren't enough?"

"I know you don't like the prospect of admission, aunty. But this is necessary." Vivaan smiled in reassurance. "Don't worry. It will be over before you know."

"So, what now? We do the tests suggested, and then wait?" his baba-sa asked.

"We wait." Vivaan confirmed. "But we also need to start medication."

"Without knowing the diagnosis and the prognosis?" Payal asked.

"Yes." He squeezed her hand lightly. To his surprise, she squeezed his back.

"When we have a cold, do we wait for the viral effect to go away by itself, or do we take symptomatic relief medicine?" Vivaan asked. "If we don't have the time to rest, we do take it, right? Similar situation. We don't know the cause, but she is showing symptoms. So, we need to reduce the WBC count and give symptomatic relief."

"What is the suggested medication?" Payal's father asked.

Vivaan pulled out the prescription given by the hematologist. "It's called Hydroxyurea." He said, handing it to him. As her father read the prescription, Vivaan addressed everyone else.

"As of now, she needs to take two tablets after every meal for seven days." He said. "You'll notice several other tablets mentioned beneath it. These are all to counter the side effects." He added.

"Side-effects?" Payal asked.

"This medicine is practically oral chemo Payal." He said, sighing as she sucked in a deep breath. "Hydroxyurea kills the bad cells, in layman language. But it cannot always differentiate between good and bad cells. So, it can eventually lead to a decrease in the number of healthy cells." He said.

"Do you want me to go over the details of what the other medicines do?" Vivaan asked.

Payal took the prescription from her father, going over it once.

"I'll call you in case of doubts. Let us not get into detail for now. When can we come for the biopsy?" she asked, folding the prescription and putting it on a stool beside their telephone.

"You can come tomorrow. Whenever you're ready. I don't want to cause pressure, but the sooner the biopsy is done, the better." Vivaan said, thinking through his answer.

"Karsan bhai." Said Vivaan's baba-sa. "I'm not saying this just because of the relationship between the children. If you need any kind of help, be it financial, emotional or even someone to just talk to, please don't hesitate to come to us." He said with folded hands.

As their fathers continued to talk to one another, Vivaan turned to Payal. "I need to talk to you. Alone, if possible." He whispered.

She looked confused, but nodded, leading him to a room just inside the passageway. The moment he entered it; he knew it was her room. It was painted a light bluish-gray. A white laminate cupboard and dresser were on one wall and two single beds lay parallel to each other against two opposite walls, perpendicular to the cupboard. The wall opposite the dresser and cupboards had a huge window with a false balcony railing. Bright yellow curtains with floral patterns were drawn up on either side of the window, letting the bright afternoon light in.

Payal stepped inside to the middle of the room – between both the beds, so that they were reflected in the mirror on the dresser.

"What is it?" she asked him.

Vivaan sighed, gently taking both her hands in his. "Are you okay now? Any more panic attacks?" he asked.

She looked down. "None after yesterday."

"How long have you been having them?" he asked.

"I used to get them in my childhood. Only when there was a situation of extreme stress." she explained. "I guess yesterday was a good enough trigger. But it's been a long time since I last had them regularly."

"And you're okay now?" Vivaan pressed.

Her expression told him she knew what he was referring to. "I have to be." she looked away.

"I know. But you don't have to pretend before me." Vivaan said gently. "One of the things I like about you is how honest and upfront you have always been since the start. Honesty and frankness are a must in a relationship like ours. Don't hide anything from me Payal. Especially your pain." He cupped one hand around her cheek to make her look at him. Her eyes were wet. But Vivaan didn't wipe the tears away. He just looked into her eyes to make sure she understood.

She nodded, placing a hand on his hand cupping her cheek.

"Vivaan!" his ma-sa called him.

"We should go out." Payal said, and he knew he had to leave.

"Take care." He told her. "I'll see you tomorrow."

She nodded, accompanying him out of the room. If their elders noticed, no one said anything.

***

P – Hey good morning. We've left for the hospital. Dad, mom and myself. Just thought I'd let you know. No pressure to come over.

V – Good morning. Just keep me in the loop. I will drop by once.

P – Will do :)

Vivaan couldn't help but smile. It seemed that having a fixed track had helped Payal and her family step out of the depressive atmosphere they were in yesterday. He only hoped her mother was strong enough to fight it all.

"Girlfriend?" Mrs. Roy, the ER Head Nurse, asked. Vivaan had forgotten about her standing beside him as he checked his messages.

"Um" Vivaan paused. They were dating as it is, so why not? No need to complicate it all. "Yes. We've been seeing each other for about two months now." He admitted.

"Oh, that is so sweet!" Mrs. Roy gushed. Vivaan just shook his head in amusement at her excited mood.

"Shall we start the rounds then?"

It was nearly noon when Vivaan took a small break to go downstairs near the operation rooms. Payal had texted that they were in the waiting area outside the first room.

Payal looked up immediately when he entered. She was in casuals – jeans and a full sleeved top, with her hair tied into a ponytail. She sat on a chair beside a plastic bag – probably containing the report file she had shown him two days ago. Beside her, Mr. Shah paced around the area, staring into the distance, as though deep in thought.

"Vivaan." Payal said, getting up. Conscious of her father, Vivaan refused to hold her hands and stayed a respectful distance away from her.

"When did they take her in?" he asked Payal.

"About fifteen minutes ago."

"Okay." Vivaan said. "It should be done soon. The procedure won't be long, it's the anesthesia that takes long. Both before the procedure and afterwards."

Payal nodded.

"Should I get you both anything?" Vivaan preferred to talk to Payal, since her father had not done anything to prompt conversation. He had barely acknowledged Vivaan.

"You could get dad to sit down." Payal said. She sounded vexed. "He's been pacing since forever. It'll only tire his legs more and put more pressure on his knees."

"If it's your mom in there, its his wife in his case. Trust me, nothing will make him sit down." Vivaan chuckled. "I remember when kaki-sa had her knee replacement done. Kako-sa couldn't sit still until she was put in recovery. He kept saying he didn't want anything. Aryan eventually tied him down with wheelchair straps." Vivaan smiled, remembering the memory.

Payal cracked a smile. The first one he had seen in a while.

"Stop right there." Vivaan whispered. "Hold that smile."

Payal raised her eyebrows in confusion.

"That's the smile that can steal hearts." Vivaan said, all serious. "And though it puts me at a serious disadvantage, I want it to always remain on your face."

Payal blushed. "Cheesy. What if it ends up stealing your heart instead?" she asked as a joke.

"It already has." Vivaan flirted, causing her to blush deeper.

"And if someone else also gets their heart stolen?" she asked.

"You'll have to return it." Vivaan said nonchalantly.

"Oh?"

"We are going to be engaged madam." Vivaan teased. "You can keep my heart if you want, but not anyone else's."

"But what if someone tries to steal my heart?" she asked just as nonchalantly.

"I'll get it back for you... unless I steal it."

Her face now resembled a tomato in color.

"Stop it, you." Payal whispered, looking away, making him laugh softly.

They stood, laughing for a moment, before Payal's expression grew serious.

"Thank you, Vivaan." She said sincerely.

That threw him. "What are you thanking me for?" he asked.

"For everything. All the help you've given us. You could have easily avoided all this. But you stood by, without a complaint." She explained. Her voice held a ring of sincerity.

"And why are you thanking me for this?" he asked. "Didn't I promise I'd stay by your side through this?"

Her eyes shone with unshed tears as she nodded. "For as long as needed." She whispered.

"Correct." Vivaan stated. "So, don't thank me. Your family is my family as well. And you don't thank family for their help."

She looked away, wiping a tear. "Got it."

"Good." Vivaan said. And then even though her father was there, he raised his hand and gently placed it on her cheek.

"Bye." He whispered, before taking it off her cheek slowly.

And then he was out ofthere.