Title: CLEAN CUT (1/1)
Author: Josan, who asked a nice person *who regularly sends feedback* what story line she would like to see.
Beta: Linda Shan, who made the mistake of actually telling me what she wanted as a story subject, and then threw in the problem that is central to this episode. So (snicker), I made her beta it. Let THAT serve as a warning! <g>
Date: March, 2000
Summary: Alex has an operation.
Rating: Sorry, PG - 13
Archive: With thanks to CJK at:
Yes, to Basement, Ratlover, SKSA
OR, if you're getting bounced due to the anti-spam filter my server has added, try firstname.lastname@example.org
DISCLAIMER: If he doesn't want to use them, CC shouldn't be surprised others do!
Alex was sitting cross-legged at one end of the long couch, pretending to be watching the soccer game.
Walter knew he was pretending because he hadn't reacted to the very obvious foul the referee had missed against his favourite team. He sat back in his corner, feet up on the coffee table and watched Alex, eyes downcast, playing with a hole in one of the knees of his old sweatpants.
Something was bothering his lover again. Walter shook his head slightly. Damn! Getting Alex to spill what was on his mind took more patience than...than dealing with the X-Files! He would, eventually, tell him what was on his mind, but often he needed a little prod to get going.
Whatever it was, this time, it had been stewing in him for the past few weeks. And from the lack of attention, the day-dreaming, the occasional deep sighs, Walter had a feeling this one was not going to be something easily handled with just a few comforting words and a bout of hot sex.
Come to think of it, it had been a while since they'd had a bout of hot sex. More than a couple of weeks. Closer to three, no, four. They made love just as frequently, but more vanilla flavoured than the hot, spicy sessions Alex liked to initiate. Walter always made a few token protests at the start of these, more out of ritual than real meaning. Alex enjoyed considering it as a challenge, getting him to ignore his age and behave like a randy rabbit rather than a fifty-two year old man whom the statistics claimed should not be able to get it up several times in a night. He never protested very strongly: he hoped Alex hadn't taken the last set to heart.
"What?" Alex had looked up and caught him staring.
Walter decided to take the bull by the horns. "What's wrong, Alex? And don't tell me nothing's wrong. You've been far too introspective even for a crazy Russian like you."
Alex gave a ghost of a smile at that. Walter reached out a hand and waited. He saw the decision in his eyes before Alex moved to lie, head on Walter's lap.
So, thought Walter, his crazy Russian needed a little pampering. Alex only lay like this in his lap when he felt the need for comfort. Walter said nothing, just played with Alex's hair, massaged his back along his spine, stroking him like a cat. Kneaded the sore muscles of the truncated arm.
Alex made a soft sound, not of pleasure, but of pain. Walter immediately stilled his hand. So that was it: the arm was hurting again. Now that he thought of it, that would explain why the prosthesis came off as soon as Alex arrived home, why he didn't wear it at all on weekends. He moved his hand to Alex's neck and left it there, offering silent encouragement.
He snuggled more into Walter's warmth. After a few minutes he said, "I went to see Fischer about my arm. He wants to send me to a specialist. For an operation."
"I see." And Walter did. "What do you think?"
"Part of me knows he's right."
"And the other part of you?"
Alex didn't answer. He moved even closer to Walter.
Walter placed both his hands on Alex, silently offering support. One hand smoothed back the hair off his face so he could see whatever expression Alex allowed to show. The other continued rubbing in small circular motions along the tensed back.
"You remember that segment on 60 Minutes?"
Alex took a deep breath. "The one on how some people were just paralysed under anaesthetic, not knocked out? How they felt the knives?"
Oh, shit! Yes, he remembered that one. Alex had turned white and gone to get a beer. He'd returned only after the segment was over.
"I know it's stupid," began Alex.
"Hush! Not stupid, Alex. A very valid concern." Christ, a more than valid concern in this case. Walter kept his voice conversational. "Have you discussed this with Fischer?"
Alex shook his head.
"Alex. Joe's aware of what happened to you. He will take this seriously if you talk to him about it. He won't scoff off your fears. You know that."
"Yeah, I know that. But somehow that doesn't help."
Joe Fischer had no trouble taking Alex's concerns seriously: he too had seen the 60 Minutes segment on "awareness".
Walter had gone with Alex to discuss the problem. He listened while Joe explained about a special BIS Monitor that could be used. The monitor tracked brain electrical activity: the higher on the scale the BIS displayed, the more likely the patient would be aware and awake.
Could he guarantee it would be 100% effective? Joe looked from Alex to Walter then back to Alex. No, he couldn't. He personally had no experience with it. He had heard that Rush Surgicenter in Chicago had supposedly had a fair amount of success with the monitor, but nothing was 100%. And he would have to find out if the surgical team he wanted to recommend used it.
Would he be alone in the operating room? Well, normal procedures could be put aside in special considerations ...Joe would see to it that this one would fall under that category, so he could accompany...No, not him. Walter. Could Walter accompany him in?
Walter let nothing show on his face, but the thought of standing by, watching his lover's arm being further amputated...having to worry if he were really under or once more feeling the knives...
They both had things to think about after they left Joe's office.
Louisa dropped in unexpectedly that week for an over- night visit and found both her brother and his lover unnaturally quiet. Even for them. She kidnapped Walter from his office for lunch and used a fair amount of the loving blackmail sisters gather over the years to get the situation out of him. And then did something Ouisa did only for her nearest and dearest: she let Walter talk it out of his system without once interrupting, making only the most encouraging of noises when he needed them.
After leaving a Walter who felt the situation was clearer for having heard himself talk about it out loud, Louisa surprised Alex at his office. Insisted on going out for coffee. She couldn't use any of her usual methods on him: he wasn't her brother, he wasn't a musician she was tending through to the next level. But she had eyes and used them to register the shadows under his, the fact that his attention wandered a few times while she was telling him about the group she had come here to D.C. to hear, that he seemed more listless than his usual quiet.
She returned that afternoon to New York, thought about the situation during the flight, during the taxi ride home. On the fridge, Eli had left her a note about how he would be probably pulling an all-nighter at the studio. She made herself a sandwich, plopped herself on the couch and settled in for a long call to her mother.
Nadia asked her eldest grandson to find her the information she needed using her computer. She was adequate on it, but Gene Jr. was a whiz. It took him an afternoon to pool together all the information she needed. That evening, she sat in her favourite chair and reviewed all material he had found for her. She really wasn't too surprised to find that the son of one of her colleagues on the Church Board popped up often in the documentation on orthopaedic surgery. The man whose specialty was dealing with rebuilding the limbs of deformed children, of children affected by land- mines had quite a reputation. As she well knew since Cynthia often bragged about the work her son did.
Nadia thought that a man used to dealing with terrified children would be able to handle their Alex with the gentleness he needed.
The next morning she called Cynthia and invited her over for coffee and cake, ostensibly to discuss the campaign for raising funds to repair the church roof. Cynthia never realized what Nadia really wanted was the present itinerary of her surgeon son.
Of course, neither Walter nor Alex was aware of the family discussions and plans that were going on behind their backs.
Walter might not have been surprised if he had learnt of it: he was used to his mother and her involvement in her children's lives. Especially when Nadia thought she knew what was best for them. She had certainly presented Jilly and Gene with finalized plans to expedite them on their way when Jilly began having second thoughts, yet again, about Africa. And she had been right: Gene and Jilly had both found outlets for their energy. Gene was teaching American History in an integrated university: Jilly was involved, new baby and all -- yet another boy -- in a literacy program for women. Amy had returned from spending Christmas with them with the news that they would be spending another year in Africa.
Alex was completely taken aback when Nadia called one afternoon, about two weeks after Louisa's visit to inform him that he had an appointment with Doctor Leo Courville that coming Monday at the University Hospital in Burlington. That he should bring his latest x-rays with him, the results of his last check-up.
When Alex stuttered he couldn't possibly get there for Monday, Nadia informed him that the plane reservations were already made and to be certain he and Walter left early enough to avoid possible traffic jams on the Beltway. "Alex? What's wrong?" Walter wondered what the hell his mother had said to Alex to make him turn white the way he had.
Almost unable to speak, Alex handed Walter the phone and sat down, not knowing how to handle the fact that the decision as to the next step had been taken out of his hands. He was barely aware of Walter's protests on his behalf, his winding down under his mother's patient explanation that they couldn't wait too long since Leo was proposing to leave for Central America for six months of volunteering his surgical skills at small rural hospitals.
"Walter," she played her winning card, "he's used to trauma victims. He works with children who have been maimed by war. Alexei will need that kind of experience to get through this ordeal. And let's not fool ourselves, Walter, it will be an ordeal for him. Leo will make it easier for him. I promise, son."
Nadia was waiting for them when their plane landed. She accepted Walter's hello kiss, and then stood waiting to see what Alex would do. Walter stepped back: this was between the two of them. He watched as Alex, who had spent last night staring at the ceiling of their bedroom, stop about a metre away from his mother.
"Nadezdah." Then asked the question that had been plaguing him since the night of her phone call: "Why?"
"Because I love you, dear." She stepped up to him and placed her hand on his cheek. "And I can't stand the idea that you may be in pain." With a smile to comfort the lost child she saw in his eyes, she kissed him on the cheek.
And as if he were a child, she took his hand, held it tightly as they walked out to the car. Walter drove them to the hospital, watched as his lover held onto his mother's hand for dear life all the time that they waited for his name to be called.
For a moment there he felt a twinge of jealousy, that Alex should lean on his mother at this time rather than himself, but then he realized that what Alex needed at this particular time was not a lover, but a parent who would reassure him that all would be right. Still, he couldn't prevent the little thrill when Alex's name was called, it was he Alex looked to, to accompany him into the doctor's examining room. Nadia smiled at both of them, took a book out of her bag. The title registered on Walter only after the door had closed: "Amputations & Prosthetics".
Leo Courville was a teddy bear of a man, had the sort of face that would immediately put a child at ease. It took longer with Alex. They had both checked out Courville's credentials, found them to be impeccable. He had a superb reputation as a surgeon. Now Walter watched as the man himself earned a reputation in his eyes for his handling of Alex.
He was incredibly gentle, carefully explaining everything he was doing before he went ahead and did it. Explained why he was doing certain things, explained what he was looking for in the x-rays that Joe had taken just the day before as a special favour, to put Walter's mind at rest that the x-rays they brought with them would be the most recent.
There followed an intense discussion between doctor and patient as to the type of prosthesis Alex wanted to graduate to after the operation. It would be fitted onto him as soon as possible after the operation itself.
And then, almost with a nonchalance that belied the anxiety it was causing him, Alex brought up the subject of anaesthetic. Courville, used to parents accompanying their child into his operating room, immediately suggested Walter should do likewise. It hadn't taken him more than a moment to understand the relationship between the two men. And not more than one glance at the butchery that had passed for amputation to know that there had been a great deal of pain associated with it. The note about Alex's fears that Fischer had included in the medical file was a logical fallout.
Courville explained that in the Third World countries he often operated in, they didn't have the very latest drugs, anaesthetics. He could see no problems in this particular case about not using them. He proposed to begin with a local anaesthetic, making sure the arm was completely senseless before going to a general anaesthetic, which would knock him out for the operation itself. They would not use a neuromuscular blocker, though they would have to use restraints. Just in case. They would wait until he was asleep to use them. Was that agreeable?
Alex actually looked relieved. Walter sighed. Damn! His mother had been right again.
Nadia knew better than to gloat. Alex came out of the examining room, looking like he had gotten rid of a heavy weight. He kissed her cheek, whispered, "Thank you."
Courville set the operation for a date two weeks away. Time for both of them to arrange time off. Nadia merely raised an eyebrow at them -- looking very much like a certain ex-AD, thought Alex -- and informed them that they would both be moving into her house for the duration. Alex would need to be near enough to Burlington to have his follow-up examinations.
Besides, it was spring and Walter could go fishing. There were some nice trout streams in Vermont as he already knew. And then there were a few little jobs that needed doing around the house. Walter made a show of groaning, protesting that the "few little jobs" were probably several pages in length.
It had taken Walter a long time to fall asleep, but now that he had, his soft snores covered the small sounds of Alex slipping out of the bed. He pulled his sweatpants on in the hallway and quietly made his way down the stairs to Nadezdah's kitchen. With careful movements, he made himself a mug of tea and sat, in the dark, at the table to drink it. Early that morning, he would check into the hospital in Burlington, be prepared for evening surgery.
He knew it was the right thing to do: the arm hurt more and more these days. he couldn't bear the prosthesis any more, gasped at the pain whenever anyone accidentally touched it. The operation was necessary. He was all right with it. Well, he thought he had been. Now, he wasn't so sure.
The creaking stair warned him he would no longer be alone. But it was Nadia, not Walter, who joined him at the table.
In the two weeks since his quick in-and-out visit to the doctor, Nadia had been taken aback by the lines put on his face by the pain Alex could no longer hide. And by the fear that hovered just behind those eyes that she could now read so much more easily than that first visit.
She had been horrified when Louisa had told her how Alex had lost the arm in the first place. One of the things Walter had let drop in his conversation with her. When Louisa had mentioned the 60 Minutes segment, Nadia had immediately understood Alex's fears.
"Alexei. It will be all right. Leo has promised you a sure way of seeing that there is no pain."
Alex nodded. "I know."
Nadia smiled. "Yes, dear. I know you know with this." She touched his head. "But do you know with this?" She touched his chest where his heart lay. "And with this?" She dropped her hand to his stomach.
Alex gave a soft chuckle. "The heart is thinking it over, but the stomach is definitely not certain."
Nadia's smile widened for a moment and then she grew serious. "And do you hate me for pushing you into the corner on this?"
Alex looked at her. "No. Walter explained you thought you were doing it for my own good."
"I was. I am."
"He also explained that much to your children's disgust you're usually right when you push an issue."
Nadia smiled again. "True. I am."
"But for your children."
"Alexei," Nadia cocked her head, "*you* are the one Walter has chosen as his partner. That makes you my child as well. And what mother cares to see one of her children in pain?" She stood up and put her arms around him. "It will be all right. I promise you."
Alex hid his face in her shoulder. "I'm afraid," he whispered, voice rough with suppressed memories of the forest in Tunguska, the follow-up operation in the village by a doctor who had a scant amount of morphine.
"Yes, dear, I know. But you won't be alone. Walter will be in there with you. And I'll be outside waiting. Then Amy, Ouisa and Eli will be arriving from New York the next day and we'll all be there for you." She tightened her arms around him and gently rocked him, comforting him.
Walter sat on the bottom of the steps and listened to his lover cry out his fears in the security of his mother's arms.
Nadia looked up from her book to watch her son -- whose complexion almost matched the green scrub suit he wore -- come sit down besides her.
"How is he?"
Walter swallowed. "In recovery."
"I take it all went well?"
This time all Walter accomplished was a slight nod. Nadia went and got a ginger ale from the vending machine. She handed it to him, and then pulled a plastic waste basket closer, just in case it was needed.
"Your father never so much as flinched when he had to deal with a car accident. He was cool, calm in the face of any emergency that he had to handle in his job as sheriff. The first time I saw him wearing the look you have on now is when you fell out of the tree in the back yard. You were four years old and you had somehow managed to climb up about twelve feet. He saw you, went to get you but you slipped and hit the ground before he could get to you. Do you remember?"
Walter shook his head, managed a swallow of the drink: it managed to stay down.
"You weren't badly hurt. Had most of the breath knocked out of you, had a slight concussion. Your father held you all the way to the hospital. *I* had to drive. When we got there, the doctor thought he was the patient he looked so sick.
"You spent one day in bed and were back to normal. It took your father considerably longer. It's different when it's someone you love."
Walter nodded. Nadia stood and put her arms around him as she had Alex the night before. "You could have left once he was asleep."
Walter shook his head against her shoulder. "I promised him."
"Yes, dear. And even asleep, he needed you there." She hugged him tightly.
Courville outfitted Alex with a self-controlled demerol kit, though he closely monitored Alex's usage of it. He was please with the way the operation had gone. He'd had to remove about two more inches of the stump, but the nerves would be less inflamed, would hurt less. The phantom pain, a problem with any amputation, should also occur less often. He was rather proud of the fact that though not pretty, the new end of the stump would be a lot less difficult to look at.
He smiled at Alex as he finished examining him. "I must say the scariest moment was when I thought we were doing to lose your partner." He grinned at Walter who was watching Alex's face. "Went a very interesting shade of green there for a while."
Alex reached out for Walter with his hand. "Sorry." He was less groggy today than yesterday.
"Brat," answered Walter.
"We'll release you day after tomorrow," continued Courville, pretending he didn't see Walter stroking Alex's hand with his free one. "There'll be a prescription for painkillers with the others. I would prefer that you use them as needed only, not more than two every four hours. Then it's back in a week, for a check up and for fitting your new toy. We'll start you on your physio and Dr. Fischer said he would oversee your program once you got back to Washington."
He'd been gone about a minute when the door opened and Amy stuck her head in. "Uncle Alex, are you awake? It's okay, Gram, they're only kissing." And pushed the door to the sound of laughter.
Alex had been hurt before in his days with the Consortium. When that happened, he usually went underground, found himself a place to hide and stayed there till he was better. He preferred to depend only on himself, or, if he had to, maybe one other source to provide him with medical help, food until he could take care of himself, of his own needs.
But not this time.
He had thought he would move into the bedroom, ensconce himself in bed and maybe see Walter with lunch and supper.
Instead, once Walter had helped him with his morning rituals, he found himself installed in the tv room, on the couch that proved very comfortable. Nadia tucked a blanket around him, fluffed up the pillows that supported his back and head. Amy brought him a glass of juice, Ouisa breakfast on a tray. Not just breakfast for himself, but for all of them. Nadia had made him a soft boiled egg and toast soldiers for dipping into the yoke.
There was a fairly noisy discussion of what people would be doing that day: Walter roped Ouisa into helping him clean up the garden. Ouisa tried hard to convince Eli that he should join them, but Eli refused, saying he had more important things to do. Amy gobbled her food, hurriedly kissed everyone good-day and rushed off to school.
By the time he was left alone, Alex had the beginnings of a headache, and a shoulder that throbbed. Nadia didn't even ask him, she went and got his pills, held out two to him and made sure he downed them with the last of his juice. Then she helped him lie down, kissed his forehead and left him alone. When she checked in on him twenty minutes later, he was fast asleep. She stopped Walter three times from going in and checking on him before lunch.
By evening Walter appreciated the fact that his family was treating Alex like they had anyone in the family who had gotten hurt. Alex was simply overwhelmed. He broached the subject that night in their bed, his head on Walter's shoulder, waiting for his bedtime dose of medication to take effect.
"Your mother keeps kissing me on the forehead."
Walter made some kind of agreeing noise. "She's always checked for fever that way."
"And Ouisa gave me a head massage."
"Didn't it help with your headache?"
"Yeah." There was a slight pause. "Amy's forever bringing me juice."
"Hmm. Courville explained that some of the medication had a dehydrating effect. He told you to drink plenty of liquids."
"Right. So then I've got to piss and Eli follows me to the door of the john and back, like it was my leg that was operated on, not my arm."
"Well, love, it has been only five days. And you are a bit wobbly on your feet."
Alex scoffed. "I suppose I should be happy Jilly is in Africa. She probably would follow me into the john, lecturing me about the proper way to piss."
"No,' disagreed Walter, "she probably would hold your dick and make sure the last drop gets properly shaken off."
Alex laughed sleepily. "Still doesn't explain why they're all doing this."
Walter rubbed his cheek against the silky hair that he had washed himself that night before going to bed. "You still don't get it, do you?"
Alex opened his eyes and looked at his lover, a bit confused.
"You're family, Alex. That's how we take care of our own in this family. We overwhelm them with attention. Face it: you're just going to have to accept it all."
Alex nestled his head a little more comfortably on Walter's shoulder. He thought a moment about the rat holes he had hidden out in to recover from beatings, gun shot wounds. Alone. Then he thought about the day he had just gotten through, with people who were concerned about him. Who cared for him.
"Okay," he said.
The complete title of the book Nadia is reading is: Amputations & Prosthetics: A Case Study Approach by Bella J. May.
The BIS Monitor does exist, is being used at Rush Surgicenter in Chicago. It is still not widely used.
"Awareness" was a segment on 60 Minutes. According to AWARE (Awareness With Anesthesia Research Education), of 20M Americans who have surgery every year, anywhere from 40K to 150K experience some level of awareness.
I couldn't remember the name of the hospital in Burlington, Vermont, so I made one up. Hey! It's only a story.