Disclaimer: Unfortunately, I do not own the characters, not even the adorable Ryan Atwood/Ben McKenzie. The OC universe and all of its characters were created by Josh Schwartz and owned by him as well. Don't sue me Josh! I mean it! No copyright infringement intended!
A/N: First and foremost, I want to thank my lovely beta, beachtree. Once again, she's been amazing!
I have no words to express how sorry I am that it took me 10 years to update this story. Life happened. That's the only way I know how to explain. However, in the past year, I re-watched The OC for the first time in over a decade with my best friend (who inspired me to write again), and I regained the inspiration to finish this story. My amazing beta, beachtree, has also remained loyal and helpful all these years later. On the plus side, for anyone who patiently stuck by me and waited, this new chapter is fairly long...and I've already begun writing Ch. 6. As a side note, Kirsten and Seth will fully redeem themselves in this story. Don't be discouraged by anything either has done up to this point.
If anyone is still reading this story, please let me know by leaving a review. That will give me further inspiration to continue on and hopefully finish it. :)
I will also be publishing Ch. 1 of a new story I've been writing called "Sophomore Year" that follows canon with Ryan being a sophomore at UC Berkeley majoring in Architecture. I'll give a little more info about it in the end notes.
I truly hope this chapter was worth the long, unfortunate wait! Enjoy!
Sandy sat comfortably in his study, quietly scanning through a stack of documents in preparation for an upcoming case. He dreaded having to deal with his rich, spoiled Newport-bred clients, but that was the downside to leaving the PD's office for a high paying position in a private law firm.
Taking a sip of coffee, he glanced down at his watch and found that it was already one o'clock. The house had been relatively quiet all morning, and Kirsten had left an hour ago to attend a luncheon with her overbearing father at one of the lavish offices owned by Richard H. Dodd & Associates. (Sandy longed for the day when Kirsten stopped kowtowing to Caleb Nichol, always giving in to his every command). Meanwhile, Seth, who had mentioned having a lot of homework to catch up on, was holed up in his room, and Ryan was still at soccer practice.
However, Sandy didn't mind the quiet. After all, it was peaceful and conducive to getting work done. Plus, the silence reminded him of the hardworking kid he was growing to love more and more each day. Since Ryan had come to live with them, Sandy had lost count of the number of times he'd opened the pool house door to find him engrossed in a book or doing extra problems from his Pre-Calculus textbook even after finishing his homework. Ryan was proof that just because someone wasn't talkative or gregarious, that didn't mean that he didn't have a lot to say. The kid usually said more through a simple gesture or nuance than most teenagers ever could with words.
Suddenly the ominous ringing of the house phone pierced through the silence, disturbing Sandy's reverie. It was rare that anyone called on a Sunday afternoon, and all day he'd had the nagging feeling that something was going to go wrong. Guilt from not calling Dr. Canales the previous night was weighing on him, and as many times as he'd tried to reassure himself that Ryan was well enough to go to practice, he still couldn't stop thinking about how ill the kid had looked yesterday in the car after the game and later that night.
He picked up the receiver apprehensively and pushed the talk button, unaware that the rushed voice on the other end was about to deliver news that would send the entire family into a tailspin.
"Hello? Sandy Cohen speaking."
"Sandy, it's Coach Nielson..."
Even through the telephone, Sandy could sense panic in the coach's voice.
"Is...is everything alright? Is Ryan okay?" He asked, his heartbeat quickening.
"I don't know how to say this but...," Coach Nielson choked on his words. This was the kind of news he'd hoped to never have to tell a parent. "He collapsed in practice. I called for an ambulance. You need to get down to the hospital right away. I'm on my way there."
The next several minutes passed by in slow motion for Sandy. Feeling almost detached from his surroundings, he swallowed hard and tried to control the overwhelming fear that something terrible had happened to Ryan. He remembered hanging up the phone, but every action that followed seemed disjointed from his emotional state as guilt continually overwhelmed him in waves and all the worst possible scenarios played out in his mind. If only he had listened to his instincts last night and called the family doctor... then Ryan probably wouldn't be on his way to the ER right now. This was all his fault, he thought.
"Seth...," Sandy called out hysterically, knocking on the door to his son's room. Seth didn't answer so Sandy stepped inside, immediately spotting his earphone-clad son sprawled out on his bed reading a comic book.
"Seth," Sandy called out a little bit louder, tapping his shoulder. Finally, Seth looked up, his eyes locking with Sandy's.
"What's up, Dad?" Seth asked, slightly annoyed.
"It's Ryan. He's in the hospital."
Seth's eyes widened in shock. "Holy Moses! Is he okay? What happened?"
"I don't know anything on his condition yet, but we need to get over to HOAG right away."
Hastily removing his earphones, Seth hopped out of bed and scrambled down the stairs behind his father—his comic long forgotten. Ryan was okay. He had to be, right? Whatever happened to him couldn't be anything serious, could it? However, Seth had seen how run down Ryan looked over the past week. Panic suddenly enveloped him as he ran to his dad's BMW.
Jeremy Boyd was the chief medical resident at HOAG Memorial Hospital Presbyterian. He'd graduated from UC Davis School of Medicine at the top of his class, and everyone who knew him could attest to his keen ambition and over-eagerness to make a difference in the world. He had been enthusiastic about residency after graduation, but after three years of long hours on call and intense stress, he was becoming jaded. Still, the adrenaline rush always kept him going, and he truly believed this was his calling.
During his last year of medical residency, Dr. Boyd continued to get invaluable experience at HOAG. It wasn't the Los Angeles County/USC Medical Center—a hospital so busy that it was sometimes referred to as a "battlefield," where as many as 550 seriously injured or ill patients passed through each day. Nonetheless, HOAG was very busy in its own right, despite being a smaller hospital in Orange County. This past year at HOAG had proven to be simultaneously challenging, exciting, and disillusioning; and today was no exception.
Quickly finishing off his soda, Dr. Boyd threw the empty can into a trashcan, signaling the end of his lunch break. He swiftly exited the cafeteria and washed his hands thoroughly in a nearby restroom before taking the elevator to the first floor, where he paced down a long corridor leading into the emergency department.
Dr. Boyd had received a call from his attending physician, who wanted him to administer all necessary procedures on a new patient who would be arriving any second. Normally a surgical resident handled such procedures, but the surgical residents were tied up working on other patients. Dr. Boyd's hands twitched from nervousness and anticipation as a triage nurse approached him, filling him in on information about the new patient, including demographics and vitals. As Dr. Boyd put on a fresh blue gown and a pair of gray gloves, he could hear the faint whirl of stretcher wheels approaching just around the corner. The sterile smell of hospital air that he had become accustomed to was enough to awaken his senses. He was being paid to save lives, and he would damn well see to it that he did an exceptional job.
Taking a steady breath to calm his nerves, he noticed a scurry of activity down the hall as two nurses, an x-ray technician, a couple of second year residents, and what appeared to be a medical student, all rushed towards a small, rectangular room known as the trauma bay.
"This is it," Dr. Boyd thought, briskly walking towards the commotion, putting on his face mask and blue marshmallow hat to fulfill dress code. The new arrival was here.
"Okay, we've got a 16-year-old boy who complained of chest pain and shortness of breath before losing consciousness. Pulse ox is 82. Pulse is 180, and he's got tachypnea. Tension pneumothorax," A member of HOAG's trauma team read Ryan's vitals off a chart as a nurse readjusted his oxygen mask.
"His BP is dropping!"
"We tried bagging him on the way here, but his breathing didn't improve..."
"His trachea is deviated. Should we get a chest x-ray?"
"There's not enough time. We're losing him!" Dr. Boyd replied grimly, cutting everyone else off. He immediately took charge, noting Ryan's pulse ox stat, pallor, complexion, and the bluish hue his lips and nail beds had taken on—all telltale signs of oxygen deficit. He prayed the kid's brain was not affected. Quickly, he moved a stethoscope over Ryan's chest. "The note indicated by ascultatory percussion suggests compensatory hyperresonance and absent breath sounds. We need to do a needle decompression immediately. Get me the large IV catheter," He ordered as he sterilized and marked the insertion site along Ryan's chest around the second intercostal space in the midclavicular line of the affected hemithorax.
One of the nurses handed over the IV catheter and the trauma team watched as Dr. Boyd prepared to do the needle decompression. This would be the third needle decompression he'd ever do, and he fought to keep his anxiety at bay. Never had he performed this procedure on someone so young. However, the attending physician had confidence that he could do it. He glanced down at his patient and swallowed hard. A tension pneumothorax was a life-threatening condition. If he failed, this boy could die.
"Dr. Boyd, is everything okay?" The medical student asked. They all knew that every second counted.
"Yeah. I just needed to assess the patient one more time," He answered, sharpening his focus. Finally, after what seemed like hours, but was actually less than a minute, he executed the needle decompression. Almost immediately, a sound similar to a tire popping could be heard and Ryan's breaths became less labored, though he remained unconscious. The young doctor sighed in relief.
"Okay, the needle is in the pleural space. Air's escaping. Condition is stabilizing," Dr. Boyd confirmed, securing the catheter in place as a fellow resident jotted down the new information on Ryan's chart. Shortly after, Ryan began to stir.
"He's waking up," One of the nurses commented.
As Ryan's eyelids slowly fluttered, he reached towards his side where the needle had been inserted.
"Hurts," He whispered hoarsely, whimpering as his chest heaved painfully.
"I know, buddy, but it's there to help you breathe," Dr. Boyd smiled warmly at Ryan's reaction, gently moving his hand to his side. Ryan's eyes finally opened completely—his gaze flickering from the doctor to the other members of the trauma team and then around the room. His breathing became more labored, his body tensed, and his pupils dilated from fear and confusion. Where was he? Why did his chest feel so tight? How did he get here? Who were these people? Was he in trouble?
"It's okay. You're okay," Dr. Boyd assured him. "Do you know where you are?"
After several seconds, Ryan's eyes locked with the doctor's and he visibly calmed down, focusing on breathing. Suddenly it all came back to him: feeling tired all morning... falling to the ground clutching his chest during soccer practice... feeling like he was going to suffocate...
"Hospital?" He answered correctly.
"I see you're just as smart as I thought," Dr. Boyd smiled. He next asked Ryan his name and who the current president was, and much to his relief, the kid's brain seemed fine despite being deprived of oxygen when he'd been brought in and for who knows how long before and during transport. Given the amount of time, he was very fortunate. "Now this is going to hurt, but it has to be done so that your breathing can get back to normal. I have to insert a chest tube. The more you relax, the less pain you'll feel."
Too tired to say anything more, Ryan merely nodded and closed his eyes.
"Should we sedate him?" He heard a nurse ask.
"His breathing is more labored than it should be after a decompression, so we don't have time. We have to insert the thoracostomy tube now and reassess his airways," said a voice that sounded like the doctor who had talked to him just minutes before.
Ryan cringed inwardly, feeling somewhat detached from reality. He had heard people talk about out of body experiences, and he wondered if this was what one felt like. It was almost as if he were stuck in a nightmare, watching the medical team work on someone else from afar. He didn't know what "thoracostomy" meant, but he sensed that whatever was wrong with him was serious, and that scared him. He tried taking a deep breath to calm his anxiety, but breathing hurt too much. To make matters worse, he hated hospitals. He wished for the comfort of his own bed in the pool house—warm and cozy with a year's supply of fascinating books to read. He wondered where the Cohens were. Did they even know he was here? He knew Sandy and probably Seth would care, but would Kirsten?
"BP is dropping again. He may have a hemothorax," He heard the same doctor say. Ryan squeezed his eyes shut—a few tears escaping. He was terrified. Is this how his life would end? Here? Alone and in pain…surrounded by strangers in a hospital bed?
"He's still not out of the woods. We have to work fast," another voice commented.
It's not that Ryan was afraid to die, but...shit...he certainly didn't want to die alone. Plus, he'd come too far to die now. He finally had a second chance at life with a family that…mostly cared.
The doctor poked and prodded him—inserting the tube, and all he could feel was large amounts of discomfort coupled with buckets of dread before everything went black.
"Dad, watch where you're going!" Seth scolded as Sandy slammed on the brakes, almost missing a stop sign. "Geez, this isn't the General Lee from Dukes of Hazzard. You're driving like a mad man…"
"This isn't time for joking around, Seth. Ryan is in the hospital," Sandy replied, a bit too harshly. He couldn't lose Ryan. They'd come too far, and the kid deserved happiness, success, and a loving family. Seemingly out of nowhere, a police siren shrieked through the air followed by a set of flashing red, white, and blue lights that could be scene from the rear-view mirror.
"Yeah, well we're not even going to get to Ryan if we end up going to jail for vehicular homicide," Seth rolled his eyes as the police car pulled up behind the BMW.
Subconsciously, Sandy knew he had been driving irresponsibly, but right now he was running on autopilot, and he couldn't think about anything but his foster son. He pulled the car over and lowered his window, patiently waiting for the officer to approach.
"Sir, I need to see your driver's license and registration," a short, stout officer ordered as Sandy reached into his back pocket for his wallet. "You were clocked going 65 m.p.h. in a 45."
"I'm truly sorry, officer," Sandy apologized, handing over the forms of ID the officer had asked for. "My son's in the ER... I know that's no excuse for speeding, but if you could just put yourself in my shoes... I need to get to him as soon as I can."
Nodding sympathetically, the officer walked back to the patrol car.
"This day keeps sucking more and more. It would make a great chapter in my—"
"Seth, I'm not in the mood right now," Sandy sighed, running a hand through his shaggy black hair.
"Sorry," Seth mumbled, feeling guilty. His almost brother was in the emergency room and here he was making light of the situation, although deep down he knew it was his way of denying that anything was wrong. It was a coping mechanism. He already felt bad for blowing off Ryan's big game and for being a lousy friend the past week, and Seth wanted so badly to make it up to him. He only prayed he would get the chance. He had to admit, Ryan had been looking pretty bad when he last saw him.
"Dad? Do you... do you think Ryan is okay? I mean... people get taken to the ER all the time for things that aren't really that serious, right? Maybe he just sprained his ankle or something."
"It's not an ankle sprain. I wish it was. In case you haven't noticed, he's been coughing violently for a while now."
Seth inhaled deeply and chewed on one of his fingernails. His father's response did nothing to quell his worst fears.
Their conversation came to an abrupt end as the officer returned quicker than expected, handing a sheet of paper to Sandy.
"I hope your son is okay. My son was in a car accident last year, so I can relate. I couldn't get to him soon enough, but even in these situations, you've gotta stay calm and follow the traffic rules. I'm going to let you off with just a warning."
Sandy saw a look of sadness reflected in the officer's dull brown eyes and recognition hit him. He had seen this man on the news. His son had been killed by a drunk driver. Suddenly, Sandy became overwhelmed with guilt. His erratic driving had put the public, his son and him all at risk, and he wouldn't be able to live with himself if he was responsible for harming another human being. He needed to get to Ryan immediately, but he needed to do so without endangering others or harming himself. He was lucky that this officer who had lost his son to drunk driving was only issuing him a warning.
"Thank you, officer," Sandy shook the officer's hand respectfully and expressed his gratitude and sympathy. This man had lived through the very same nightmare Sandy was hoping to never experience. "And I'm very sorry about your son."
The officer nodded sorrowfully, taking a deep breath, but remaining silent and pensive until the BMW drove away.
"Forty-five bottles of beer on the wall. Forty-five bottles of beer. Take one down and pass it around, forty-four bottles of beer on the wall," Seth hummed to himself as he stared blankly at a wall clock in HOAG's waiting room—his right foot tapping automatically against the vinyl floor. His mind was racing with anticipation.
"I don't get it. We've been here for two hours already. When are we going to finally hear news on him?" Seth's voice could barely be heard over the waves of chatter rippling from across the room where other worried parents and friends sat nervously engaging in conversation while waiting for news on their loved ones.
"It doesn't work like that, son," Sandy replied, his harried words betraying his otherwise calm demeanor. He wanted to stay strong for Seth, but right now he couldn't help but feel helpless and flustered—fear of losing his second son overpowering him. On top of that, he still hadn't been able to get a hold of Kirsten. Every time he called, it rang a few times and then went straight to voicemail.
Coach Nielson had been waiting patiently on the other side of the waiting room. A number of Ryan's soccer teammates had also been seated near to their coach—all hoping that the star striker was okay. Sandy had spoken to Coach Nielson when he first arrived in the waiting area, but had spent much of the past two hours sitting with Seth. However, noticing how nervous the coach seemed, Sandy decided to approach him.
"How are you holding up?" he asked.
Coach Nielson looked up, meeting Sandy's gaze. Sandy could tell Coach Nielson felt guilty. It was written all over his exhausted face.
"Sandy. I'm so sorry. I shouldn't have let Ryan practice. This is all my fault. I knew something was wrong. I should have called you to pick him up."
"It's not your fault. I'm the parent. I shouldn't have let him go to practice to begin with. There's nothing we can do about it now. It's counterproductive to sit here blaming ourselves. Ryan is in good hands. He'll be okay," Sandy reassured Coach Nielson- and himself.
What seemed like an eternity later, a young, slender male physician with brown hair and glasses approached the group—his expression unreadable.
Sandy could feel his heart pounding wildly in his chest as he subconsciously tightened his fists—nails digging into sweaty palms. Meanwhile, Seth tapped his foot against the floor at an even quicker pace while Coach Nielson took a deep breath and prepared himself for the worst. He had seen Ryan's collapse first-hand, and he knew the kid was in bad shape.
"My name is Dr. Boyd. I need to speak with the parents of Ryan Atwood," He stated, his expression turning serious.
"I'm his guardian, Sandy Cohen."
Sandy stood from the hard chair—his stance unsteady. Seth followed suit and Dr. Boyd gave him a questioning glance.
"Seth is my son. He should be here to hear this," Sandy explained.
"And I'm his coach. I called the ambulance," Coach Nielson added.
Dr. Boyd replied, "I think it's best I talk to family first." Coach Nielson nodded in understanding and returned to his seat in the waiting area next to Ryan's teammates. He'd have to ask Sandy about Ryan's condition later.
Dr. Boyd then led Sandy and Seth down a small corridor. This was the part of his job he hated. There was no good or best way to deliver bad news.
"Is he going to be okay?" Sandy asked, concerned that the doctor had yet to update them on Ryan.
"Right now he's stabilized. He suffered a tension pneumothorax, which is a life-threatening condition. In more simple terms, there was a continual flow of air that got trapped in the pleural space of Ryan's lungs, causing his lungs to compress. You can think of it as his lungs being squeezed. He wasn't getting enough oxygen when he was first brought in. I performed a needle decompression on him that more than likely saved his life. Shortly after, we found that he also had a hemothorax, which is blood in the pleural cavity. We treated this with tube thoracostomy drainage, which seems to have been successful except..."
"Except what? He's okay, isn't he? You mentioned that he wasn't getting enough oxygen when he was first brought in. That didn't affect his brain, did it?" Sandy butted in impulsively.
"Mr. Cohen, his chest X-ray and EKG came back with abnormal results, and his breathing is being supplemented by oxygen. Even with that additional, external assistance, his oxygen levels aren't where they should be. His blood pressure and heart rate are also abnormal. He's currently in ICU under observation, and although he's stable now, there is still a small chance that he will develop an infection due to the hemothorax or have another tension pneumothorax while in the hospital. I think there may be some underlying disease that led to his collapse in practice today, but I'm not a lung expert so I'm referring him to a top-notch pulmonologist, Dr. Henry Stacey. On a positive note, Ryan's brain seems fine despite oxygen deprivation."
"How long does he have to stay in the hospital?" Seth jumped in.
"I can't give an estimate at this time. He will be examined by Dr. Stacey who will run more tests."
"Our family doctor had diagnosed him with asthma and bronchitis. Are you saying he may have been misdiagnosed?" Sandy asked, disheartened.
"I'm afraid so," Dr. Boyd nodded regretfully. "Ryan's a fighter though. I think he's going to pull through."
Dr. Boyd hadn't expected to say these last words, but somehow, he couldn't stop them from pouring out. In just a little over two hours, he'd become attached to this kid, and he had no idea why since he'd barely even spoken to him. But there was just something about Ryan. He reminded him a little of himself when he was younger. Most teenagers panicked and gave him trouble during such a painful procedure, but Ryan sucked it up. He wondered if the kid just had an unnatural tolerance for pain, or if there was something else going on in his psyche. Whatever the reason, even though he would no longer be Ryan's doctor, he wanted to stay updated on his condition.
"Can we see him?" Sandy asked, his voice pleading.
"Yes, but unfortunately space is limited, so it's hospital policy that only two visitors can see an ICU patient at a time. I'm just letting you know that for future visits. You can both see Ryan now. He's in room 411. Visiting hours end today at 8 pm."
"Thank you, Dr. Boyd. I appreciate what you've done for Ryan," Sandy said, his voice thick with emotions. "You saved his life."
Something about the encounter prompted Dr. Boyd to do something he had never done during his last three years of residency. Maybe it was his soft spot for Ryan, or maybe it was the intense love Sandy displayed for a kid whom Dr. Boyd presumed was not blood-related, based on their differing last names and physical features. He noted also that Sandy had referred to himself as Ryan's legal guardian despite occasionally calling Ryan his son. Whatever their relationship was, the kid meant something special to this family, and Dr. Boyd was intrigued.
"Please call me Jeremy, and…take down my cell number in case you ever need me for anything. I'll stay updated on Ryan's condition."
Sandy had no idea what to expect when he and Seth walked into Ryan's hospital room. However, there was nothing that could have prepared either of them for what they saw. Seth immediately gasped as he took in his best friend's appearance.
Ryan lay quietly on the hospital bed hooked up to various tubes and machinery that Sandy could only assume were pumping medicine into his ailing body and helping him breathe. Ryan's face appeared gaunt and ashen—his cheeks devoid of their usual color. The once strong and fit teenager now appeared so small, young, and vulnerable. His eyes were closed, and the only sign that he may be awake came from slight movement of his hands and face as he continued to breathe with assistance. Other than his labored breathing, the beeping of machinery was the only sound that could be heard in the room.
"Hey, kid. Can you hear me?"
Ryan's eyes opened sluggishly at the sound of his mentor's voice.
"Sandy?" he rasped. His throat was sore, his chest felt heavy, and his voice sounded faint and muffled through the oxygen mask.
"Yeah, it's me. I'm here. Seth is, too."
Even through the oxygen mask, Sandy noticed a small smile form on Ryan's lips. Ryan was relieved that Sandy and Seth had come. If he was going to die here, at least it wouldn't be alone.
"Hey," Ryan weakly greeted his foster brother, meeting his eyes.
Seth struggled to hold it together, and all the emotions he had been feeling came pouring out. "I'm so sorry, Ryan. You have no idea how sorry I am. I've been so selfish. I wish there was something I could do to make it up to you. I missed your game and…"
"S' okay," Ryan murmured to reassure Seth. Trying to breathe was hard enough, and he wanted to keep his words to a minimum. This was not the time or place to have a heart-to-heart conversation with Seth, although he did want to know why Seth seemed so distant and upset with him the past few days.
Seth's voice broke as he continued to say some of what had been on his mind. "I promise…from now on, I will be there for you. . .without fail. You're the Kavalier to my Clay. That story is just like ours, and we are such an epic pair, but I failed you. I know I sound like a broken record, and that you've heard this before, but you've totally had my back, and you deserve much better than what I've given you this past week."
"S'okay," Ryan managed to whisper again. Sandy could tell Ryan was trying hard to hide his feelings, but his eyes conveyed a mixture of hurt, understanding, and forgiveness.
"How do you feel, kid?" Sandy asked with worry, re-directing to what was essential and trying to spare Ryan from straining and talking more than necessary.
"Not good," Ryan whimpered. He swallowed hard and asked, "Am I…dying?"
Sandy's heart broke at the question.
"No," Sandy answered, doing his best to sound confident. He thought back to his conversation with Dr. Boyd. Ryan was a resilient kid, and although his condition was serious, Dr. Boyd believed he'd make it through. "You're going to get through this, and we'll be with you every step of the way."
"Thanks, Sandy," Ryan replied softly. "Kirsten here?"
Sandy's heart broke yet again. He had tried calling her cell again before entering the room, but still hadn't heard from her.
"Not yet, but she'll be here," he offered. Still, all it took was one look at Ryan's face and he could see that the kid was disappointed.
"Don't worry. Visiting hours are restricted in the ICU, but Seth and I will stay with you until the hospital staff kicks us out, and Kirsten will be here as soon as she can."
Talking was wearing Ryan out, so he made a slight writing motion with his hand, and Sandy got the hint. Sandy retrieved a notepad and pen from Ryan's nurse and handed it to him. Ryan was already in a sitting position, which was recommended for opening the airway in patients with breathing difficulties.
On the notepad, Ryan wrote, "I told Luke I'd visit him. Could you check on him please? Rm 201."
Sandy gently squeezed Ryan's shoulder and smiled. Ryan was such a selfless kid. Here he was in ICU, yet he was thinking about Luke's well-being. "One of these days…when you're not so out of it… I'm going to teach you what a mensch is," Sandy replied affectionately.
Ryan tried to smile, but the heavy feeling in his chest caused his expression to look more like a grimace. He continued to jot down his questions. "You'll check? Could you tell him I'm sorry?"
"You've got it, kid. I'll tell him, but you have nothing to be sorry about. Luke will understand."
Minutes turned into hours, and Ryan drifted in and out. Periodically, a nurse stepped into the room to check Ryan's vitals and add something to his IV. At some point, Sandy called Carson to let him know that Ryan had asked about Luke. Sandy explained that Ryan wasn't feeling well enough to visit Luke in the hospital this evening. He omitted the part about Ryan being in ICU. He'd let the Wards know when he knew more about Ryan's condition. Carson assured Sandy that Luke was okay and that he'd be getting out of the hospital in the morning.
Caleb Nichol was sitting in a plush chair across from Kirsten in the central office of Richard H. Dodd & Associates when Kirsten first noticed her phone ringing. The two of them had just wrapped up contractual negotiations with the company's CEO. The Newport Group's proposal had been a hit at yesterday's meeting, leading to hours of Sunday negotiations and a brand-new project. As a result, the father-daughter duo would soon be overseeing the development of seven luxurious high-rise hotels downtown.
Kirsten hadn't meant to miss ten calls from Sandy throughout the day. She had put her phone on silent and slipped it into her purse to remain completely focused during negotiations. When she finally glanced at her cell, she was astonished to find that it was already six o'clock in the evening.
As she saw Sandy's name flashing on the caller ID, she had a hunch that something was terribly wrong. After all, Sandy wouldn't have called her ten times that afternoon unless it was urgent. A feeling of dread came over her as she answered.
Sure enough, an agitated and frazzled Sandy delivered the devastating news. Ryan had been in ICU for hours, and she had been here—working—on a Sunday afternoon, unavailable to her family. Her heart sank. Ryan had collapsed on the soccer field. Ryan was fighting for his life in the hospital, and she was here with her father instead of at HOAG with Sandy and Seth visiting the child she was growing to see as a son. Ryan needed her and needed to know how much she cared about him, especially after overhearing the argument from the night before; yet here she was doing exactly what Sandy had accused her of. Those accusations cut her like a knife.
Family members are supposed to support each other!
She hadn't gone to Ryan's big game, and to make matters worse, she hadn't even considered that his health condition could be this serious despite how ill he had looked in the past week.
. . . You hardly spend time with the kid! Or either of our kids—not even Seth! . . . You're always in the office.
She hadn't even seen or talked to Ryan since he overheard her arguing with Sandy. She had tried to talk to him this morning in the pool house, but he had left early to visit Luke and she never bothered to call or check on him before or after his soccer practice.
You're always with that coldblooded, callous father of yours and no matter how much you work for him, I've got news for you… you're never going to please him.
"Oh my God," she whispered to herself. "Sandy was right."
Tears began to well in her eyes as she was enveloped with overwhelming guilt.
"Kiki, what's going on?" Caleb suddenly asked.
"Family emergency. I have to go, Dad. I'll explain later," Kirsten replied frantically, grabbing her briefcase, tossing her handbag around her shoulder, and running out the door.
By the time Kirsten finally arrived at HOAG, Ryan was once again fast asleep. She stayed until visiting hours ended, and then took Seth home in the Range Rover. Seth had school in the morning, and hospital policy didn't permit visitors who were minors to stay past 8 pm.
Meanwhile, on his way out of the hospital, Sandy spotted Coach Nielson and approached him, touched that he had stayed all this time for an update.
"Sandy," Coach Nielson said. "I'm so glad to see you. Is Ryan going to be okay? What did the doctors say?"
Sandy chose his words carefully. Ryan was not out of the woods yet, and Sandy was told by Ryan's healthcare providers at the hospital that much more testing needed to be done. He settled for a vague, but optimistic answer. "The doctors are confident that he'll make it through."
"Did they say what was wrong? Did he have an asthma attack?" Coach Nielson asked.
"He suffered a tension pneumothorax and a hemothorax. The doctors explained that his lungs were being squeezed, depriving him of oxygen. There was a collection of blood in the space between his lungs and chest wall. They are still trying to figure out the cause."
Coach Nielson's face was drawn with worry—the guilt from earlier in the day clouding his thoughts. I should've sent Ryan home, he thought. I shouldn't have let him practice. I should have phoned Sandy and told him that Ryan didn't look well.
Sandy sensed what the other man was thinking. "As I said earlier, don't blame yourself, Coach. Ryan can be stubborn sometimes. He would have tried to practice regardless of how he felt, and none of us anticipated that he would collapse. You called 9-1-1 immediately and that made all the difference."
Had you not acted so quickly, he might have died. Sandy fought to push that harrowing thought out of his mind. He almost lost Ryan today, and had Ryan died, he would have never forgiven himself.
Coach Nielson nodded gratefully and said, "Promise me you'll keep me updated."
Sandy promised, and the two men parted ways. Sandy then made his way to his BMW to head home. He needed to grab some clothes, toiletries, and food to take back with him to the hospital. He planned on spending the entire night there by Ryan's side.
When Sandy arrived home, he stormed into the kitchen where Kirsten and Seth were talking.
"Oh, hi, Sandy," Kirsten greeted her husband nervously. "Do you want some leftovers? There's some shrimp pad Thai left, and some of those dumplings you like."
However, Kirsten's talk about dinner was nothing more than a charade. She knew her husband well, and it was obvious he was vexed at her. Worse, she knew she deserved it. She was conscience-stricken over her behavior the past week.
"We need to talk," Sandy announced grimly.
Flushed with guilt, Kirsten knew she had to face the music.
"I agree," she replied apprehensively.
"Where were you today? Why the hell didn't you answer your phone?" Sandy's voice began to crescendo as he continued. "Ryan needed you—we all needed you, but especially Ryan—and you were nowhere to be found! He almost died, Kirsten!"
"Um, Dad," Seth interjected. "Your tone."
"Stay out of this, Seth!" Sandy shot back, unable to control his emotions.
"Seth. Room. Now," Kirsten ordered.
Seth squirmed under the irate stares of his parents and disappeared into the next room. However, he couldn't tear his ears away from the ensuing argument.
"I don't like to raise my voice…you know that. But I can't for the life of me understand what's come over you," Sandy added, throwing his hands up in frustration.
"I—there's no excuse," she explained, accepting full responsibility for her absence earlier in the day. "My phone was on silent and in my purse. Richard H. Dodd & Associates presented the opportunity of a lifetime to expand the Newport Group, and my father insisted I be involved, and present, during contractual negotiations. I was so engrossed in the business meeting that I lost track of time. . . and my phone."
"This is becoming a pattern, Kirsten! You told Seth he didn't have to go to Ryan's game because you had to work… you constantly choose work over our kids, and today when Ryan needed you most of all, you weren't there! You should have seen the poor kid's face in the hospital when he asked about you, and I told him you weren't around."
Kirsten recoiled at the thought of Ryan laying in the hospital bed—crestfallen and in pain—wondering why she wasn't with him today. Sandy's sharp words continued, pulling her out of her guilt-ridden ruminations.
"Have you even talked to Ryan since our argument last night where he overheard us fighting about his place in the family?"
Kirsten felt like she'd been punched in the gut. "I haven't. I—I tried, but he'd already left this morning to see Luke."
"And you didn't bother calling to check on him, did you?" Sandy released an exasperated sigh.
Kirsten remained silent. There was nothing she could say to counter.
"From now on, we do things as a family," he emphasized. "Caleb Nichol and the Newport Group can wait. There is no business opportunity that is more important than our sons!" The raw emotion and sheer conviction in Sandy's voice sent shivers down her spine.
"I promise. I'm so sorry, Sandy. Ryan is such an important part of this family. I care about him, and I'm devastated that I wasn't there with him. I want to go with you tonight to the hospital."
Sandy sighed and rubbed a palm over his face. Kirsten took a moment to really take in her husband's appearance. He looked worn, anxious, and extremely tense.
Lowering his tone and holding eye contact with her, Sandy simply said, "I think it would be better if you stay with Seth tonight. I don't want to leave him alone, and he wouldn't be able to stay in ICU at this hour. Plus, he has school in the morning. But tomorrow, I hope you'll take the day off and spend it with me and Ryan."
Kirsten nodded in understanding—her classic features conveyed a mixture of fear, shame, and sadness. "I'll call my dad tonight and let him know that I won't be coming into the office this week."
"You're—you're taking the whole week off?" Sandy was pleasantly surprised.
"You are right. Family comes first. Ryan's health and well-being come first. Seth's well-being comes first. I need to be here for the boys, especially Ryan right now as he recovers in the hospital. Richard H. Dodd & Associates and the new developers can wait. My family needs me."
Sandy softened his features, moving towards his wife of nineteen years and embracing her gently. A few of her tears escaped onto his shoulder. Knowing that Kirsten was not much of a hugger, and definitely not a crier, it was evidence that she was very shaken by everything that had happened.
"Oh, Sandy. . . you said Ryan almost died today—that he had a pneumothorax and a hemothorax. I was only in ICU with him for a couple of hours, but he looked so ill. What if he's not okay? I really do love him, Sandy, and I let him down… I need to make things right."
"Shhh," Sandy reassured her. "He'll be okay. Everything will be okay."
In the next room over, Seth had heard everything. Still reeling from the day's events and Ryan's hospitalization, he finally left to his room and shut the door behind him. Unlike Ryan, he had never been much of a brooder, but tonight he had a lot to think about.
The next morning, Dr. Stacey paced back and forth in his cramped office with a cup of coffee in hand. It was still very early, and he had many more patients to assess before noon. In the meantime, he couldn't get his new patient out of his mind.
Dr. Stacey had been a pulmonologist for decades. Over the years, he'd diagnosed countless patients with emphysema. However, most of those patients were middle-aged, or elderly, and had been chronic smokers for most of their lives. Only once before had he diagnosed emphysema in a teenager, and that young man had a rare hereditary condition which caused an alpha-1 antitrypsin deficiency. However, as Dr. Stacey settled near his desk, staring at a CT scan of Ryan Atwood's lungs, he was at a loss for words. He knew he'd have to run the necessary tests to determine whether Ryan, too, had that hereditary condition.
Dr. Stacey also was having difficulty putting Ryan's skittish expressions, and monosyllabic answers to questions about family history, out of his mind. He ran a pale hand through his graying hair as he recalled their earlier conversation. His gut told him that Ryan's perfunctory replies couldn't be attributed just to fatigue, discomfort, and difficulty with breathing. The boy was too withdrawn and guarded when asked certain questions, and too anxious when touched during his physical examination.
"Some of my next few questions may make you uncomfortable, Ryan, but it's important for me to understand what your lungs have been exposed to so that I can properly diagnose you. I know breathing and talking is exhausting for you right now, and it's okay if you give me short answers. Please let me know if you're struggling. I'm here to help you, and my goal is to make this as easy for you as possible."
Ryan nodded wearily.
"Have you smoked?" Dr. Stacey asked his young patient.
"Yes," Ryan replied, voice weak. At least Ryan's chest didn't feel like there was an elephant on it anymore. Whatever drugs they gave him had made him feel…weird…but relaxed.
"When is the last time you smoked?"
"Last summer. Before I moved in with the Cohens."
"And you haven't smoked since?"
Ryan shook his head.
"How old were you then?"
"How old were you when you first smoked?"
"7, but…not because I wanted to."
Dr. Stacey was taken aback by this information but maintained his professionalism, concealing his appalment.
"Did somebody force you?"
Ryan turned his head away and shrugged evasively.
"Did you continue smoking throughout elementary school?"
Ryan's body tensed, but he didn't answer so Dr. Stacey moved onto his next question.
Did you smoke at an older age?
"13 or 14," Ryan muttered, finally stealing a glance at the doctor before adding, "But not really."
"How often did you smoke between ages 7 and 15?"
Ryan offered another shrug, unsure how to answer. Trey had given him his first cigarette when he was 7. He remembered doubling over, coughing, as Trey and his friends made fun of him. He hated the taste of cigarettes, but the only way he had known to survive was to fit in, and everybody around him used to smoke, even Theresa, so sometimes he smoked around them. Smoking also used to help him settle his nerves when he was most frazzled and lost. Cigarettes were expensive, though, and he never had the desire to smoke like his family did. He hated addiction.
"I didn't do it much," he mumbled. "I didn't like it," he managed even more quietly.
"Between the ages of 13 and 15, would you say you smoked every day? Every week? Every couple of weeks? Monthly?"
Ryan shrugged warily.
"These questions are to help you, Ryan. The more accurate the information, the better I can figure out what's going on."
"It was on and off. Nothing consistent."
"Have you smoked any other substances other than tobacco?"
Ryan sighed. "Weed. But only once."
Dr. Stacey jotted that information onto his notes and continued his differential diagnosis.
"Who around you smoked growing up?"
"Everyone," Ryan shrugged again.
Dr. Stacey noticed Ryan steal a glance at him before quickly turning his head away. Instead, the boy's uneasy gaze settled on the white walls of the ICU room. It was blatantly obvious that Ryan wished his guardian was present, but visiting hours had ended an hour ago and his guardian had gone home to gather a few things so that he could stay with Ryan for the night. Nevertheless, Dr. Stacey couldn't wait for his guardian to arrive. He had to examine Ryan now. He had too many other patients to get to.
"Did your mother smoke in the house?"
"Yes," Ryan muttered.
"She's a chain smoker."
"What did she smoke? Was it just tobacco products?"
"Tobacco products…Weed…sometimes crack."
"Did she use any other drugs?"
Ryan arched his head back and closed his eyes, taking a shaky breath at the memory of Dawn's overdose.
"Heroine," he murmured, lowering his head, and making brief eye contact with Dr. Stacey.
"Did your father smoke tobacco products in the house?"
Ryan looked away again, his eyes becoming distant—unfocused.
"Ryan?" Dr. Stacey nudged. "Are you still with me?"
Ryan didn't answer—partly because he hated thinking about Frank. Frank was even worse than Dawn, and Ryan's last memory of Frank—before Frank went away for armed robbery—involved Ryan getting his shoulder dislocated…and a black eye.
"Did your father smoke in the house?"
Ryan swallowed hard and locked eyes with the doctor.
"Yes," he replied—his voice sounding more like a breathy whisper.
"How often did your father smoke?"
"He was also a chain smoker."
"Did your father use any other drugs?"
"Cocaine," Ryan replied flatly.
"Did anyone else smoke tobacco products in your house growing up?"
"And?" Dr. Stacey pushed.
"My mom's boyfriends."
Dr. Stacey frowned at the amount of secondhand smoke this boy inhaled throughout the years.
"Were they also chain smokers?"
Ryan appeared disgruntled as he slowly nodded.
"What other drugs did your brother use, if any?"
"How about your mother's boyfriends?"
"Heroine. Crystal meth."
Ryan closed his eyes again and frowned. Dr. Stacey could tell that his interrogation was wearing the poor boy out—physically, mentally, and emotionally.
"I just need to ask you a few more questions, Ryan. I'll make it quick. I promise."
Ryan nodded and motioned with his hand for Dr. Stacey to continue.
"Have you ever been in a fire?"
Ryan thought back to the model home incident. He thought everyone in Newport knew about that.
"How recent was that?"
"Last summer," Ryan replied.
"Were you treated medically for smoke inhalation?"
Ryan had been arrested that night and transported to the juvenile detention center. He was taken to the infirmary at the detention center, but it's not like medical staff at any detention center care enough to do a thorough examination. Sandy had urged Ryan to get his lungs checked out shortly after the Cohens became his legal guardians, but Ryan had been reluctant to see a doctor. The Cohens were already doing so much for him, and at the time, he didn't think his occasional cough was a big enough deal to add more to their plates. At Ryan's insistence, Sandy settled for taking Ryan to see Dr. Canales, the Cohens' family physician.
Dr. Stacey noticed his young patient again appearing lost in thought. "Ryan?"
"Not really," Ryan answered abruptly.
Dr. Stacey frowned and gently pushed his spectacles up the bridge of his nose.
"Let's talk about your symptoms, Ryan. When did your cough start?"
"Don't know. Shortly after the fire I guess."
"When did you notice the cough getting worse?"
"This past month."
"Have you ever coughed up blood?"
"Have you ever coughed up mucus?"
"Yeah," Ryan mumbled, cringing at the thought.
"What color was the mucus?"
"I have you listed at 5'7". I see that you weighed 162 lbs. last year during your soccer physical."
Ryan nodded. He wasn't used to talking about his weight. He had never given it a second thought until he started playing soccer for Harbor. It's not like he had a scale in Chino.
"And now you're down to 146 lbs. You've lost two pounds since your visit with Dr. Canales last week. Was that intentional?"
Ryan sighed and shook his head.
"How about the wheezing? When did that start?"
"Dr. Canales diagnosed me with asthma. I thought it had to do with that."
"Had you ever been diagnosed with asthma before that?"
Ryan pursed his lips and shook his head. "Not that I can remember."
"When did the wheezing start?"
Ryan's chest felt heavy as he answered. "Got worse after the fire I guess."
"But when did it start, Ryan?"
Ryan shrugged hesitantly, thinking back to his childhood.
"I guess sometimes when I played sports."
"How old were you when it started? Where did you live?"
"Chino. Maybe eight or nine."
"Were you ever given any medication for it, or perhaps an inhaler?"
"Have you ever had pneumonia?"
"I think so."
"You think so?" Dr. Stacey furrowed his eyebrows. "Ryan, I need answers that are as accurate as possible. Please explain what you mean."
"I think...when I was little."
"What makes you think that?" Dr. Stacey asked.
"My mom. I think she mentioned it."
"Have you ever lived near a factory or chemical plant?"
Ryan simply shrugged.
"How about the tightness in your chest. When did that start?"
"After the fire."
"How often have you had that heavy feeling in your chest?"
"For the past few weeks," he mumbled. He managed to quietly add, "Some days more than others."
"Do you get that feeling only when you physically exert yourself, or also when you are sedentary?"
Talking was wearing Ryan out. He tried to focus on his breathing.
"Both, but at first only when I did something physical," he murmured.
"But now you also get that feeling when you're sedentary?"
Ryan nodded tiredly.
"When did that start?"
"Few days ago," he admitted.
"And how would you describe that feeling?"
"Like there's an elephant on my chest. Like it's…hard to breathe."
"Do you happen to know if chronic obstructive pulmonary disease or emphysema run in your family?"
"No idea," Ryan shrugged. His eyelids became heavy and his breathing slightly more labored despite the extra equipment keeping his lungs oxygenated.
"M' tired. Can I go back to sleep?"
"Yes, Ryan. Get some rest. The nurse has already drawn your blood. I just need to run some more tests."
Upon reflection, Dr. Stacey was convinced more than ever that he needed to have a serious talk with Ryan's guardians. Reviewing Ryan's chart, he noted the name Sandy Cohen. He hoped Mr. Cohen had some more answers for him. Dr. Stacey's wife was a social worker, and something about Ryan haunted him. Dr. Stacey had a hunch that Ryan had been badly abused and neglected. Ryan's mannerisms and body language were consistent with that sort of upbringing. Getting an accurate family history would probably be next to impossible. Dr. Stacey wondered what types of injuries Ryan may have sustained due to abuse. Had he suffered any injuries to the lungs or rib cage? Had his cell growth suffered throughout the years due to neglect and possible nutrient deficiencies? Had he been exposed to other fires in his past that he was unwilling to share? Had he been exposed to harmful chemicals in addition to the secondhand smoke? Kids like Ryan tended to slip through the cracks, with incidents of abuse going undocumented.
Nonetheless, there was no denying what Dr. Stacey saw on the CT scan. Testing the boy's DNA, and obtaining his family history, were necessary for proper diagnosis and treatment. Ryan had emphysema. The question was why? How? Would this be Dr. Stacey's second patient to have an alpha-1-anti-trypsin deficiency? And if Ryan did suffer from this rare hereditary condition, which genotype did he have? Had he inherited the condition from both parents—leaving him with the worst possible genotype? Dr. Stacey dreaded the answers. Where was more coffee when he needed it?
A/N Ryan will get his official diagnosis in the next chapter, and you will begin to see further how this disease ties into his past and also his relationships with Sandy, Luke, Seth, and Kirsten.
Also, I will also be publishing Ch. 1 of a new story I've been working on that follows canon, where Ryan is a sophomore at UC Berkeley majoring in Architecture, and Luke is his roommate. I always believed Ryan would realistically have PTSD after everything he's been through in his life (prior to living with the Cohens, and even after moving to Newport - with Trey pointing a gun at him and Marissa dying in his arms). This story explores that. My college story is heavy on the Ryan/Sandy, Ryan/Luke, Ryan/Seth dynamics with Kirsten, Kaitlin, Summer, and Julie also being prominent characters as the story goes on. I've already written 8 nicely sized chapters, and am almost done with Ch. 9 - so rest assured, I won't leave you hanging on that one without chapters in that one.