"You want to do what" Jess said shocked at what she'd just been told, she was back stateside at Bethesda with Luca, they were talking to Doctor Masterson about what Jess's treatment options were
"Full pelvic exenteration with radical vulvectomy for the tumour in the pelvic region, I know it's a lot to take in, but currently you are still fit enough to handle a surgery of that magnitude, and it will give you the best chance of getting rid of that tumour completely, we've done multiple scans and measurements, and I honestly don't believe that there's much hope for any salvage anyway after chemoradiation therapy, you'll only be extending the inevitable" Doctor Masterson said to her, normally an oncology surgeon would have been speaking to Jess, but as the various doctors involved discussed the situation, they all agreed that they would need someone to act as the head of the surgical team as this would be a multidisciplinary effort, Doctor Masterson was already her treating specialist, and gastrointestinal would be very heavily involved with the operation, so he was the natural choice. He also knew how to handle Jess if she became uncertain, how to keep her focused on the goal, how to read her emotions
"So you're going to take the lot, my bladder, rectum, my genitalia" Jess said unable to hold the tears back anymore
"Hey my cuddle bug, it's going to be okay, whatever it takes to beat this okay, I'm still going to love you no matter what the surgeons take, we'll adapt" Luca said stepping in to comfort her, he pulled her in nice and close and wrapped his arms around her, she was getting his top wet but he didn't care, all he wanted was for her to feel safe and be okay. This was Jess's biggest nightmare, being diagnosed with cancer and he knew it, he also knew that no matter how bad he wanted to, he couldn't take that pain away, so the next best thing he could do was to make sure that he done everything he possibly could to help her realise she wasn't alone in her pain
"Doctor Zeuchner and I have discussed options for bladder and bowel management after surgery" Doctor Masterson said, most doctors would have taken a break, but Doctor Masterson didn't want to leave Jess without giving her the information she needed about what his plans were, he didn't need her thinking that that was it for her and her life was over. Doctor Masterson had already developed his plan of action to help Jess regain as much degree of normality as possible after the surgery
"Doing my business in bags right" Jess snapped unintentionally, she'd seen her mum do it, and she'd already spent time with a colostomy bag in the past, what had gotten her through that particular part of the experience was the knowledge that it wasn't a permanent thing, this was different, this was now going to be permanent
"No, my plan is to create the colostomy from your sigmoid colon, which is the section just above your rectal passage, now while there is no guarantee, faeces in the sigmoid colon is generally a lot thicker consistency, over half of patients with a sigmoid colostomy can get away with wearing a shield over the stoma and drain it manually instead of using an external collection pouch. Doctor Zeuchner is confident that he can create a neo bladder using a very small portion of your ileum and part of your large bowel called an indiana pouch, again you would have a stoma which you'll need to cover with a shield or something, but you would need to insert a catheter into the stoma to drain it, instead of it draining straight into a collection bag. You would still have control over your toilet routine, you won't loose everything if we go this path, and you won't need to worry about hiding collection devices under tops, or wedding dresses" Doctor Masterson said, he knew that the wedding was at the forefront of Jess's mind, and it was his intention of using the wedding as Jess's motivation to push through this
"Which you are going to look amazing in" Luca added kissing her on the forehead, Jess still had her head buried in Luca's chest, she wasn't looking at the doctor
"16 weeks isn't it, till you walk down the aisle" Doctor Masterson asked trying to get a response from Jess
"Like that's going to be happening now" Jess said sadly keeping her head turned away from Doctor Masterson
"There's no reason why you can't keep your original date Jess, sure some things will need too be different than what you and Luca planned, but work with us and we'll get you there, Doctor Leighton is even currently reviewing the chemotherapy drugs and is looking specifically for ones that won't cause hair loss" Doctor Masterson said putting his hand on her arm, he had no intention of taking the wedding away from them, he knew what Jess was capable off achieving and it gave her a date and goal to aim for, sure they could have postponed it, waited till Jess was fully recovered, but the couple had already postponed the wedding 3 times, not many couples would have survived that long, they could always do another ceremony later on, but for the moment, what was more important was showing them they could make it down the aisle
"There we go" Luca said stroking Jess's hair, she had turned her head to face Doctor Masterson
"Just remember that there is ways around everything, and I will always try to keep things as low vis for you as possible, no matter what the problem is" Doctor Masterson said assuring Jess he was on her side with this
"Thanks Doctor Masterson, I really appreciate everything you do for us as a family, not just for Jess, but Zah as well" Luca said to him
"What about the other tumours" Jess asked softly
"They can be removed surgically, you will loose part of your stomach capacity, and it may put you at risk of developing gastric dumping syndrome when you have any oral intake, but that's where Chelsea has already been briefed and will work on a plan to help you, your liver will regenerate as you know, and I'll end up using part of your stomach to replace the portion of esophageal tract I will need to remove, however your tube will not be affected, we may need to adjust the rate a bit while you recover, but I'll leave that to Chelsea and her capable hands" Doctor Masterson said
"The one on her larynx" Luca asked hopefully
"Is relatively small, Doctor James, who repaired your ear, will need to perform a partial laryngectomy, you will still be able to talk after the surgery, but he won't be able to guarantee how strong your voice will be. Now you will have a temporary tracheostomy tube in after the surgery, and unfortunately it will be in for the wedding, but you won't be hooked to any breathing device, and when I spoke to Aubree, she mentioned you haven't settled on a dress yet, so she's looking for seamstresses who may be able to modify one for you" Doctor Masterson said, Jess was happy that she was already familiar with most of the people who would be involved with this, Doctor Zeuchner was the only person that had been mentioned that Jess was unfamiliar with
"Hey maybe Hanna would be willing to take on that task cuddle bug, I can call her and explain the situation, I'm sure she'd be more than happy to do it" Luca said mentioning the name of one of the fashion designers who worked for Berassa, the company had found it easier to have their own team who worked for the company instead of each business having their own team. Each business had their own CEO based on who owned what percentage of shares out of the board of directors which Jess was a part off. Jess had started her own fashion brand 6 months ago, the designer Hanna, that Luca had mentioned, was the main designer for that brand
"Has the cancer been confirmed in my blood yet" Jess asked not really wanting to discuss wedding dresses yet, though she knew it was something Hanna would be keen to sink her teeth into
"Yes, acute myeloid leukemia, but its low risk, you'll have your chemotherapy for it, but you won't need a bone marrow transfusion and have a very slim risk of relapse. I know this seems overwhelming, but you really do have a good chance of achieving remission and maintaining it by doing the surgery straight up, the chemotherapy is mainly going to be for the leukaemia, we're talking maybe 4 months of chemotherapy all up. Doctor Leighton wants to do a couple of weeks of radiation as well just to cover all bases, hit this hard straight up, then you can focus on your recovery" Doctor Masterson said
"Will I have to stay in hospital for treatment" Jess asked, four months would put her spot on for her wedding
"No, Luca has the necessary skills to give it to you at home, Trent as well could do it once he gets back, we'll just need to get you the proper pump set-up, if you're okay with doing it at home Luca" Doctor Masterson said looking at him
"Wherever my cuddle bug is more comfortable" Luca said looking at her with a smile, he knew Jess would be more comfortable receiving it at home than in a hospital bed, pump system meant that it would be IV format, something his medical training was more than capable of handling
"Love you my love bear" Jess said snuggling back into Luca's arms
"Not as much as I love you my cuddle bug" Luca said returning the affection
"Permission forms that need to be signed for surgery, outlining the risks associated with this, you'll be in the ICU for a few days after the surgery, then we'll transfer you to gastrointestinal to finish out your stay. You'll probably need to stay put for 4-5 weeks, but by that time your radiation will be finished, it will just be your chemotherapy left. I'll send the request forms for tests to Doctor Shah at the base so you can have them done there. Aubree will pop out and check on you as well at home on a regular basis, and I'll see if Chelsea can see her at Saint Sebastian's clinic. I'll leave you love birds to have some quiet time now as I need to brief the surgical team, as soon as we have a bed in the ICU available you'll move up there, Aubree, Erin, Nicole and Leah from the speech therapy team will all come in and go over different things with you. We'll need to find a way for you to communicate straight after the surgery, until you have recovered enough to use a speaking valve. You'll be having surgery tomorrow, and starting treatment once you move to gastrointestinal, any further questions I'm sure the girls can answer" Doctor Masterson said handing a clipboard containing some forms over which Jess quickly scribbled her signature on before handing the clipboard back to Doctor Masterson, she wanted some alone time with Luca
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"Hey Luca, how is she" Trent asked happy to see the man's face pop up on the screen, Jess had left nearly 48 hours beforehand, everyone was anxious for an update
"Fast asleep thankfully, it's been a busy day, anyone else around" Luca said letting out a yawn, he flipped the screen so Trent could see her in bed asleep
"No, you look like you need to sleep as well" Trent said as Luca flipped the screen back around so he was looking at Trent
"I'll sleep tomorrow when she's in surgery, the prediction is about 30 hours of surgery" Luca said, Aubree had been able to organise a bed for Luca at the Navy lodge, and said he would be provided a pager so they could contact him if there was a problem, once Jess moved to gastrointestinal ward, Aubree would arrange it so he could sleep in the room with her, Laura would bring Zah up for day visits
"Damn, that's a lot, they go over everything" Trent asked anxious to know exactly what was happening
"Yeah, and we've talked about it between ourselves, and I know that deep down she'll be okay, despite her emotions over the next few months, they'll be haywire for a bit, particularly with regards to the surgery for the tumour in her pelvis, the other 2 aren't bothering her as much, nor is the leukaemia diagnosis" Luca said, the pelvic exenteration was going to involve a total hysterectomy, which included surgically induced menopause from the loss of her ovaries, not that Jess was able to get pregnant anyway, her injuries from Logan and Samuels had taken that from them already, plastics had salvaged what they could after that attack, but Jess had had to undergo a partial hysterectomy that night, now this surgery would take everything else that had been left, all plastics hard work. Jess had dreamed of the day when she could be intimate with Luca again and not experience the pain, but as fate would have it, it was never going to be a possibility for them, the only comfort Jess could take from the thought was that no man would ever be able to rape her again, she would have nothing left down there for them to use after the surgery was done, no way of getting into her
"So it's in her blood as well" Trent asked
"Yes, but Doctor Leighton is confident that Jess will only need a couple of months of treatment and she can get complete remission, they said the leukaemia is low risk for relapse as well, they're giving her a drug called arsenic trioxide for it, she has it everyday for 50 days through IV, then she'll do another 5 weeks where she has 5 days on then 2 days break, Doctor Leighton has given me a list of the other drugs Jess will be given as well, works out to a period of 90 days from start to finish, and she won't be loosing her hair with it" Luca said
"That was Sonny's concern" Trent said with a small smile
"Think he could worry sheep at times" Luca said jokingly
"You've got him worked out, can you send me a copy of everything you've been given with her follow up treatment" Trent asked wanting as much information as possible
"Already on it, sending you photo copies, she'll start it as soon as she's out of the ICU and stable, she'll be doing a few weeks of radiation as well, but that will all be finished by time you lot get back and she should be discharged, so we'll be back in Virginia Beach while she finishes out her chemotherapy, they're organising a pump she can use at home, so she won't need to stay in hospital while she has it. Now she will still be receiving it when we're in Italy, so they're going to send the prescription to Naples, we'll just need to pick it up" Luca said filling Trent in on what the plans were
"The wedding is still going ahead then I see" Trent asked surprised, they'd all expected it to be postponed
"Doctor Masterson has encouraged us to keep the date, think its more of an incentive for Jess to push through this though, keep her focused on the end result and not get caught up, he wanted her to trust him, he said it at the same time he talked about doing the pelvic exenteration with radical vulvectomy, that's what's thrown her" Luca said
"If he said its okay for it not to be postponed, we won't argue with it, I'll help you out with the chemotherapy side of things once I'm back, what's a pelvic exenteration" Trent asked, he was glad in a way they were given the all clear to keep the wedding date, and would do what it took to get them there
"They'll be removing the entire contents from her pelvis, as well as her genitalia, she'll have absolutely nothing left in there, she'll have a permanent colostomy and a neo bladder instead, they're creating a indiana pouch to replace Jess's bladder, she'll have to drain it manually with a catheter, so she won't have a permanent collection pouch hanging of her, and the colostomy, due to the location, Doctor Masterson is hopeful that Jess eventually will be able to get away with wearing a shield instead of a bag, and again, she'll drain it manually. He's using the sigmoid colon, he said that the faeces is generally a lot thicker by time it reaches that segment, she'll wear a shield to protect the stoma from the indiana pouch as well" Luca said explaining the outcome of the surgery
"At least Jess will still have some form of control over it then, going to the bathroom I mean" Trent said shocked to hear what was going to happen, but he knew the ability to retain some form of toilet routine would go along way with Jess's recovery mentally, she'd had some close calls with her colostomy bag last time she had one. She'd had a few leaks, had become self conscious about what she wore, even upped the size of her tracksuits, they were usually to big for her, but she started wearing even bigger ones because she'd become so afraid of things showing, she had only started wearing clothes that fit her better once she no longer had to worry about the bag and had had her PEG tube replaced for a button
"That's what I said to her, now the other thing you will see when you get back, is Jess will have a tracheostomy tube in, but its only temporary while her throat heals from the surgery, and her voice will most likely sound a bit different, it could be quieter or more hoarse, she will have it in for the wedding still, we've hired a member off the companies fashion design team to find the perfect wedding dress for Jess that will hide the tube in her throat" Luca said, he didn't want them surprised at the site off the trache tube when they got home, Hanna had been more than happy to take on the mission to find the perfect wedding dress
"Sounds like you've got it all under control, when are they taking her in for surgery" Trent said satisfied that Luca had things under control
"0600, we've got 8 hours" Luca said letting out another yawn
"You going to get some sleep" Trent asked curiously
"I will once she goes into surgery, got plenty of reading and shopping to do in the meantime, there's a new medical supply store in Virginia Beach that Aubree found, stocks everything you could think of, we're setting up an account with them, that way if anything is needed in an emergency, you can just go in and pick it up, save waiting for supply to requisition it" Luca said holding up a stack of papers for Trent to see
"Sounds good, send me the link, and a copy of your reading material" Trent said keen to check out the store, there was often times he would find himself stuck waiting for supply to send him something, and if Jess was to get the okay to eventually return, it would make it a lot easier to just go in and pick-up what she needed
"A night time story before bed" Luca joked
"Give me a chance to get as familiar as possible with everything before we get there, so I can prepare this lot for what they're going to see" Trent said with a smile