Jay and Hailey arrived at Med shortly after. Hailey guided Jay slowly through the ER entrance and got him settled in a chair before heading over to the triage window. By this time it was the late evening, so the ER waiting area was thankfully relatively empty. Hailey knocked on the triage window and a nurse appeared.
"What can I do for you, mam?"
Hailey responded, "I have my husband here," as she gestured back to Jay. "He's had worsening abdominal pain, diarrhea, nausea, weight loss for several weeks."
The nurse smiled gently and handed Hailey some forms on a clipboard. "Fill these out, bring them back and then we'll work on getting him in a room."
Hailey walked back to Jay and made quick work of the forms. She returned them to the nurse and took a seat next to him. He was slumped down in the the chair, his arms wrapped protectively around his abdomen. His face was pale and obvious signs of pain were present. Hailey rubbed his leg, and gave him a weak smile.
"We'll get this figured out," she said quietly as she gave his leg a gentle squeeze.
After what felt like an eternity, the triage nurse called his name. He stood up slowly, walking towards the door the nurse held open for him. She had him step on a scale and then directed him towards a nearby chair, with Hailey standing behind him. The nurse took his vitals and then reviewed his symptoms with him.
She placed a hospital identification bracelet on his wrist and asked, "Do you need a wheelchair?" Jay snorted at the idea. She continued, "Well follow me then." Hailey and Jay followed slowly behind her into a corner room in the ER. She directed him towards the stretcher and placed a gown in his hands.
"Change into this and a nurse should be in shortly, you can leave the sweatpants on for now if that makes you more comfortable."
A few minutes later, Jay heard a soft knock on the doorframe and a familiar nurse opened the curtain.
Maggie entered the room, giving Jay and Hailey a soft smile. "Will called ahead. Said you've been experiencing some abdominal pain, any other symptoms?"
"Lots of diarrhea, nausea, weight loss, not hungry," Jay answered.
"How long have you been experiencing these symptoms," Maggie asked as she walked over and started hooking him up to the monitor.
"About a month," Jay shrugged followed by a groan of pain. He laid his head back, closing his eyes.
"How bad is the pain now, on a scale of one to ten, with ten being the worst?"
"Seven," he uttered quietly without opening his eyes. Haileys eyes went wide, his honesty spoke volumes.
"Any nausea?"
"Alittle," he slowly responded.
"Okay, I'll pass everything on to Dr. Choi and send him in. Anything I can get you before I leave?" Jay didn't respond, a soft "I don't think so," coming from Hailey. Maggie walked out of the room, seeing Hailey's worried expression, she gave her arm a gentle squeeze as she left.
Shortly after, they heard a "knock, knock" from outside the door. Dr. Choi entered the room. He noted Jay's slightly elevated heart rate and barely low blood pressure. As he was typing on the iPad he began asking Jay questions and physically assessed him.
Jay remained quiet throughout, only giving short responses. His eyes were still closed. As Choi finished up his exam he sat down on the rolling stool next to the stretcher.
"So, here's the plan. I'd like to start an IV and get some blood work." Jay's eyes snapped open and he was about to protest before Dr Choi said, "Look Jay, you're probably dehydrated, you could use a bag of fluids or two minimum. We need to rule out any type of infection. I'd like to do a CT of your abdomen. We'll see how that looks and go from there. I'll order some pain meds and something for nausea."
Jay sighed and nodded in response. Laying his head back before covering his eyes with his arm. He didn't notice when Choi left and was startled when Maggie lightly touched his arm.
"I'm gonna start an IV and get some blood work okay. I know this isn't your favorite part so I'll try to be quick." Jay felt the tourniquet tighten around his upper arm, followed by a cold alcohol swab and a quick pinch. Before he knew it Maggie was already done getting his blood work and placed a clear dressing over the IV site. She continued to hook him up to some IV fluids.
"All set," she said. "Let me check if those pain meds are in." She left the room and returned quickly with some morphine and zofran.
"Alright, I've got some morphine for the pain and zofran for nausea, do you want both?"
Jay nodded after a few seconds, straightening his arm with the IV in so she had access to the port. She scanned the meds, confirming Jay had no allergies and hastily administered the meds. Jay despised the floaty feeling he got from the morphine, but for once welcomed the relief. Hailey nudged her chair closer to him, placing his free hand in hers, and started to rub his palm with her thumb rhythmically.
Half an hour later the transport attendant arrived with a wheelchair in tow. Before the attendant could say anything, Jay tried to stand up from the stretcher on his own, but swayed, the morphine making him dizzy. Hailey stood up quickly, as she saw Jay trying to find something to steady himself with. "Hey, be careful you got a lot of stuff attached to you right now," she said as she steadied him.
The attendant quietly removed Jay from the monitor and followed Jay with the IV pole as Hailey helped Jay walk over to the wheelchair. Jay sat down slowly and the attendant checked his ID band before leaving. Jay gave Hailey a wave goodbye and attempted a smile.
Thankfully the CT scan was quick, the scan itself lasted only five minutes. Jay begrudgingly removed his sweatpants, hating that he needed to hold onto the thankfully male radiology tech. While in the scanner Jay began to feel uncomfortable. He started feeling sweaty and knew he needed a bathroom urgently. He felt the CT scanner move out of the scanner sitting up quicky, not waiting for the tech as instructed. The tech saw his spastic, almost desperate movements and rushed back into the CT room. "You okay sir?"
Jay gave a quick "no," proceeding to stand up clumsily. The tech grabbed onto him. "Slow down buddy." Jay looked at him desperately, "I need to go to the bathroom now." Quickly understanding, the guy gave a firm nod and got him settled back into the wheelchair.
"Don't worry about the pants, I'll bring you back myself so you don't have to wait for transport." The tech weaved through the halls of the radiology department and brought Jay back to his room in the ED. Hailey first noticed the sweatpants sitting in his lap and the unwell look on his face. He repeated the same statement. " I need to go to the bathroom, now." This time with a bit more bite. Maggie, who was sitting at a computer next to the room, heard the commotion and hurried over.
"I gotcha Jay," she said quietly as she ushered him to a nearby bathroom. After hearing several painful groans coming from behind the bathroom door she decided to give Jay a few minutes of privacy. Returning to his room to get things straightened out only to find an anxious Hailey sitting in the chair. "Has he been this uncomfortable for awhile?"
Hailey nodded. "Yes but it's getting worse. He'd been refusing to be seen by anyone for weeks. But now, it's starting to scare me alittle. He's not usually this open about how he's feeling."
Maggie shook her head. "Those stubborn Halstead men," she remarked as she returned to her patient. She knocked on the bathroom door and Jay opened it quicky. He walked out hunched over, leaning heavily against the IV pole, all but refusing Maggie's aid. He only allowed her to hold the back of his gown together for the sake of his dignity. She adeptly got him hooked back up to the monitor and as comfortable as possible on the hard stretcher, working without saying a word. She knew he was embarrassed, loathing what felt like to him a violation of privacy. She quietly stepped out of the room, giving Hailey a sympathetic look as she closed the curtain behind her. Jay melted into the gurney, closing his eyes, willing the pain to return to pre-CT scan levels. The morphine had given him much needed relief despite his dislike for the drug. He had almost asked Maggie for another dose, but the words wouldn't come out of his mouth.
Dr. Choi returned soon after. He slowly sat down next to Jay and motioned Hailey to come closer. The noise of her chair moving made Jay jump, he had fallen into a light sleep. He sat up quickly, too quickly, causing him to brace his still hurting abdomen. Hailey laid a gentle hand on his leg, and murmered a quiet, "sorry." He nodded back at her in understanding.
Choi got promptly started going over the results. "So looking at your CT we definitely see quite a bit of inflammation in your colon, but that doesn't point to anything specific. Your white blood cell count is normal, therefore I really don't think it's an infection. I think the low blood pressure and elevated heart rate are a result of dehydration. As you can see," he gestured towards the monitor, " they have improved after some IV fluids. Plus you haven't had a fever. Your CRP and sed rate levels are quite high." He abruptly stopped speaking when Jay gave him a quizzical look.
"Both these markers generally tell us how much inflammation there is. While they can be high with an infection they are not usually this high. Most likely you've developed some type of autoimmune disorder, like inflammatory bowel disease."
"Ethan, what does this mean," Hailey prodded. Dr. Choi had tried to remain guarded and professional, but the use of his first name caught him off guard. Reminding him of how emotionally invested he was in the couple. He let out a sigh and explained, "basically your immune system is overactive and it's attacking healthy tissue in your GI tract. Their are several different types. But, this is just my best guess. You need a full GI workout. Your other lab work shows some evidence of malnutrition from all the diarrhea and your lack of appetite."
He paused briefly, looking at the overwhelmed couple. "I'd like to admit you to our medical service. We can do a much faster workup here and like I said your lab work is concerning. Your electrolytes are out of whack too, which can be dangerous. We need to get those properly adjusted with IV meds," Dr. Choi finished.
Jay huffed, giving a short, "fine" as a response. Hailey looked back at him, grateful he didn't put up much of a fight.
Dr. Choi asked before leaving if he needed some more pain relief. Jay, simply shook his head no.
Another physician saw him before he was brought upstairs, briefly assessing him and placing some orders in the computer next to Jay's bedside. He left without saying much, only explaining that he had consulted GI and the gastroenterologist would see him in the morning.
They didn't get a room until 2am. Maggie wheeled him upstairs. He grogilly stood and pivoted from the stretcher to the only slightly more comfortable bed. He situated himself under the thin blankets as Maggie raised the head of the bed. She waved goodbye as she pushed the stretcher out of the room. "Feel better Jay," he heard before she disappeared from view.
The young night nurse walked in and introduced herself. "Hi, I'm Katie, I'll be your nurse until the morning. I'll try to make this quick I know it's late and you're probably exhausted."
Katie asked him much of the same questions. He answered them without hesitation, just wanting to sleep at this point. She took his vitals and did her own assessment. She hooked him up to some new IV fluids, as well as potassium and magnesium infusions. She explained to that he would need just one bag of magnesium and four bags total of potassium. She reminded him that he was NPO and couldn't eat or drink anything, as Hailey hovered in the background.
Jay's pain had been gradually increasing since he left the ER. Katie spotted his growing discomfort. "Do you need something for pain, you have some morphine ordered." He hesitated briefly, so she continued, "it might help you sleep too."
He shook his head yes, "How about nausea" she asked
"I think I'm okay." She returned with morphine for Jay and some blankets for Hailey. Efficiently administering the morphine, Katie placed the call bell next to Jay with a quick, "Call me if you need anything."
Hailey was about to get settled in the recliner. "Do you want me to help you get to the bathroom before we try to sleep." Jay blushed but graciously accepted her help, knowing the morphine would make him dizzy.
Hailey gave him some privacy and made up the recliner. Scooting it closer to Jay's hospital bed, wanting to be the slightest bit closer to him while they slept. She heard the faucet start and walked over to the bathroom door, opening it before he exited. His butt was in full view hanging out of the back of his hospital gown,
"Nice ass," she joked, hoping to allow their usual banter to resurface. He pulled the back of his gown together and quickly retorted, "you wish Mrs. Halstead." Giving her a small smirk as they walked slowly back to bed. She helped him get untwisted from his IV tubing and they both hunkered down into their respective "beds" for the night.
Jay quickly fell into a morphine induced sleep.