The next morning Will stood in Jay's hospital room. He was dressed in casual clothes instead of his usual scrubs. His back was turned to Jay as he stared out the window, looking at the blue sky.
Jay woke up around nine am. He remembered Katie introducing the day shift nurse early this morning. The new nurse took his morning vitals and graciously told him that she would let him sleep. He rubbed his sleepy eyes and looked to his right, surprised the recliner was empty besides the crumpled blankets. He let out a large breathe as he assessed how he was feeling. He noted the ever-present pain in his stomach, but decided it was currently tolerable.
Will turned around slightly. "Oh you're up." Jay looked up at him, just now realizing he was in the room.
"Where'd you send my wife off too?"
"I convinced her to go home for a few hours, sleep in a real bed, take a shower."
"Thank you," Jay responded while letting out a big yawn. "A real bed sounds good right about now."
Will chuckled and quickly turned into turned into Dr. Halstead. "So what are they saying so far, what results have they given you?"
"Don't act like you havent snooped through my chart already."
Will sighed, "Despite popular belief I do in fact have to follow HIPAA laws Jay."
Jay glanced up at him with a obvious look of disbelief.
"Okay, okay," Will sheepishly admitted. "I tried to look over Ethan's shoulder this morning but he caught me. He said since your stable and awake I have to wait for you to tell me."
Jay grinned and was about to update Will as best he could when he was hit with a sudden urgency to have a bowel movent. He hopped out of bed on the left side, forgetting that he was hooked, up to an IV on his right, straining the IV line.
" Easy Jay, let me help," Will stated forcefully as he unplugged the pump from the wall and quickly followed him into the bathroom with it. "Almost pulled the IV out," he continued as Jay motioned him to leave him. He closed the door and took a seat knowing that it would take him a few minutes.
After what felt like too many minutes. Will walked over to the bathroom door and knocked softly as he heard Jay groan painfully. "You okay in there?"
He heard a barely audible "No, but yes," come from the other side. "I'm not sure if I'm done."
Will responded, "just take your time."
After a few more minutes Will looked up when he heard the door handle turn. Jay looked much more uncomfortable and was a pale sweaty mess. Will helped him back to bed without any protest from his little brother. Making sure he was comfortable in the bed before hitting the call bell. "Let's get you some pain meds little bro."
Jay quietly agreed, "Yeah, I think that's a good idea." The words slowly coming out of his mouth. He returned to a familiar position. One arm draped over his eyes and the other wrapped protectively around his midsection.
While waiting for someone to answer the call light, Jay was distracted by a burning sensation in his forearm, around his IV. "Will my IV's burning, did I mess it up?"
Will leaned forward looking at the IV and then up to IV pole. Noting the small bag of potassium he replied, "it's just the potasium Jay, it irritates the veins. Looks like this bags about done."
The day shift nurse entered to room, turning off the call light on the wall mounted screen. "Goodmorning Mr. Halstead, I'm Erica, you're nurse for the day. What can I do for you?"
The nurse notes his pained expression. After a lack of response from her patient she looked to the redhead beside him. "I think he needs something for pain," Will responded.
The nurse nodded and walked out of the room. Will looked to his brother, worried about how uncomfortable he was, knowing what probably lied ahead for Jay.
The nurse returned and quickly scanned the morphine. She administered it through his IV, noting the slight redness at the site. "We'll have to keep an eye on this IV, the potassium did a number on it." She unhooked the potassium infusion from his continuous IV fluids remarking, "thankfully this is your last bag for for now."
While waiting for the morphine to start working she busied her self in the room. Tossing the used blankets in the soiled basket, updating the communication board, and finished organizing her supplies.
Jay felt the rush of relief flood his system. His expression relaxed and he removed his arm covering his eyes. The nurse looked back at him. "Is it okay if I take a quick listen Mr. Halstead?
He nodded yes, "Call me Jay, please."
"Okay Jay," she stated as she moved her stethoscope from his chest to his abdomen. He gently moved his right arm away to give her room. Once she was satisfied with her assessment, she took a few steps back. "All set. You're still NPO unfortunately. The GI doc should be rounding soon though. Anything else I can do for you?
"I think we're okay for right now, thank you for bringing the pain meds"
Erica smiled, "Anytime Jay." She hurried off to her other patients.
Will glanced at his brother. Now that he was feeling better he was about to press him for more details but was interrupted by a knock at the door. Will recognized the GI doctor, standing up he extended his hand. "Hi, nice to see you Will, sounds like the Halstead Brothers are trying to keep me in business."
"Unfortunately so," Will responded as they finished shaking hands.
The doctor pivoted reaching out a hand towards Jay. Jay quickly looked the doctor up and down, noting his confident but humble presence, the athletic build hidden under his white coat. He looked to be in his mid 40s or so. Jay finally responded, shaking his hand, trying to cover his hesitation. "Sorry, I just got some pain meds, I'm alittle out of it."
Will smirked knowing that Jay was just sizing him up. Dr. Morelock did a brief physical exam, finishing by gently palpating his abdomen. He noted Jay's discomfort. "Does the pain worsen when I'm pressing down or letting go? Does anything make it worse or better normally?"
Jay breathed in, letting his breath out slowly before grimacing. "Not really, it's just always there."
Dr. Morelock pulled up a chair and sat across from Jay on the opposite side of the bed from Will. He quickly started. "I've looked over your lab work and the CT scan they did last night. You've definitely got some concerning inflammation in your colon, there's some very obvious colitis. I agree with Dr. Choi's assessment. I do think there's several markers here for inflammatory bowel disease. Your blood work shows some signs of malnutrition. You're electrolytes were low when you got here, most likely from all the diarrhea and lack of intake. However you're slightly anemic, which makes me wonder if you're actually passing small amounts of blood in your stool without realizing. How many stools are you having a day," he asks.
"Umm 10, sometimes twelve."
"And you're waking up in the night to go?
"Yes," Jay stated.
"When did all this start?"
Jay looked at Will and then back to the doctor admitting, "it started kind of gradually a few months ago. I was going to the bathroom maybe 4 to 5 times a day, having frequent abdominal cramps. I tried to push through but this last month it's gotten a lot worse. Relentless abdominal pain along with the diarrhea, nausea, no appetite, the weightloss." Jay finish and looked back at Will hoping he wouldn't tell Hailey how long he'd been hiding it.
"Has anything ever happened like this before?"
Jay thought back, "the only thing I can think of is when I came back from Afghanistan. I had a few months where I had very frequent abdominal pain that could come and go, but I can't remember having diarrhea like this. There was a lot going on back then, so I didn't give it much thought. I was kind of a mess, eventually the pain just went away." Will rolled his eyes, knowing that was the understatement of the century.
"Inflammatory bowel disease is a relapsing remitting disease. So it's possible that was your first flare and you went into remission spontaneously. But let's not get ahead of ourselves. I'd like to start you on some IV steroids to help with the inflammation and IV antibiotics just to cover all our bases, in case there is some sort of infection. Let's keep you NPO and give your bowels some more rest. I'm going to put you on the schedule for an endoscopy and colonscopy first thing tomorrow."
Jay was about to object before Dr. Morelock stopped him. "I know it's not what anyone really wants but, it's the only definitive way to confirm inflammatory bowel disease. We'll take a few biopsies and hopefully that should give us some answers. There's two types, Crohns Disease and Ulcerative Colitis. They present similarly and are often treated fairly similarly but, there are a few distinctions that will be important moving forward. Ofcourse there is a risk of bleeding and intestinal perforation with the procedure but the risk is minimal. I know this is a lot of information, do you have any questions?"
"I'll be asleep for the procedures right? Like surgery," Jay asked.
"Not quite like surgery," Will interrupted. "You'll be able to follow simple commands, but shouldn't feel pain. You won't remember it." Jay looked back at Dr. Morelock who was nodding his head in agreement.
"What about treatment options?"
"I'd really like to confirm what's going on first, before I overwhelm you even further. Plus it would be nice if your wife was here."
The doctor stood up and pushed the chair back to it's original position. "You'll have to start the prep for the procedure tonight. We need your colon completely empty so it will clear you out, you'll be in the bathroom even more I'm afraid. Just in case you have trouble tolerating the prep, I'll order some additional pain and nausea meds. There are other options if you're really struggling with it."
"I'll have a nurse get you to sign a consent for the procedure. Nice to meet you Jay, good to see you again Will. Don't get into too much trouble you two," he lectured as he left the room.
"You okay," Will asked "I know it's a lot, Dr Morelock is a good guy, he's exceedingly thorough, a good person to have in your corner." Jay shook his head yes and rolled away from Will.
"Get some sleep," he said, knowing Jay needed both rest and some space. Will looked at the watch realizing it was almost eleven. He was grateful for the time Dr. Morelock had spent with them and knew Jay would be too. He hurried down to the cafeteria for some coffee while Jay slept. When he returned he found a miserable looking Jay walking slowly back from the bathroom, his IV pole in tow. "That didn't last long," he muttered.
"Tell me about it," Jay croaked as he settled back into bed. Jay was up once again, just before noon. While Erica was giving Jay his steroids through his IV and starting his antibiotic infusion, Will convinced Jay to accept some much needed pain relief. He finally gave in, allowing her to administer the dose. She took his vitals, quietly rolling the vitals machine to her next room.
Will started scrolling through his phone as Jay slept, knowing that Hailey would be back soon.
Hailey returned just after one. She looked refreshed, Will thought. She walked into the room quietly noting that Jay was resting soundly. She handed Will a sandwich and some chips she had picked up for him on the way.
"Thanks," he mouthed.
"No problem, so what'd the GI doctor have to say?"
He updated Hailey, leaving out the part where Jay admitted he was feeling unwell for a few months. He continued to tell her about the procedures scheduled for the morning and the new medications they had started.
"Thanks for taking over and letting me get some rest."
"Of course," Will responded, detailing the prep Jay would have to do tonight before his procedures. "Sounds like you might have a long night tonight," he joked.
Hailey giggled, "I'm sure he's gonna love that. How long has he been resting?"
"About an hour or so, the nurse gave him some pain meds with the IV steroids and antibiotics I was telling you about."
Hailey asked a few for medical questions before they continued chatting quietly. Not talking about anything in particular, just whispering back and forth while Jay slept. She texted Kim giving her a brief but vague update, knowing she would pass it on to the others. She let her know that Jay had been admitted last night and that he was having a procedure tomorrow, but decided to leave it at. She knew Jay wouldn't want to give too many details just yet.
Jay was up and down to the bathroom frequently throughout the afternoon. The internal medicine doctor stopped by. He informed them that Dr. Morelock requested Jay's care be transfered to the GI service, but he had to do his due diligence before signing off. After a quick cursory exam, the doctor asked if they needed anything and wished Jay "good luck," before leaving.
Jay fell back asleep for another hour, before Erica brought in the aforementioned prep just before five.
She placed the large jug on Jay's bedside table, with a pitcher, styrofoam cup and plastic straw.
"So I need you to drink and glass of this every fifteen minutes. I mixed it with some Gatorade so it will taste better. It doesn't taste bad, just not particularly good, unfortunately it's just a lot of volume. I need you to finish this entire jug, but if your bowel movements turn clear before jts empty you can stop." Jay blushed but she continued, "Do you want anything to ward off the nausea before you get started?"
"Please," Jay gulped, staring apprehensively at the two liter jug.
"Okay, I'll be right back." She brought him back another dose of zofran and administered it, before pouring him him his first glass. "Let me know if you need anything, Dr. Morelock did put in for some extra pain meds and different nausea meds if you need them." She gave him a tight smile, before leaving.
As suspected Jay struggled to get down the large volume of prep. He required several additional doses of morphine in order to tolerate it. Jay was as high as a kite. Will and Hailey kept the mood light, the three of them played cards, of course having to pause their game for frequent bathroom breaks.
Jay returned to his spot in bed, dragging his IV pole behind him. Still looking miserable and only a third of the way done with the jug, he asked Will, "so what's this other prep option?"
Will smirked, "it's an enema Jay."
"Well shit." The three of them giggled and continued their card game.
"What's the history between you and Morelock, why'd he tell you to stay out of trouble?"
"Nothing really, he treated me for that stomach ulcer a few years ago. I do have a reputation of bending the rules when it comes to you being in the hospital," Will sheepishly grinned.
Around seven, Will left for the night, convincing Hailey to run down to the cafeteria while Jay seemed to be okay for the moment.
Shortly after she returned, Jay finished the last bit of the dreaded jug. He decided to park himself in the bathroom instead of making the frequent trips. Hailey kept checking on him, but he kept telling her he was fine, despite his painful groans from behind the door. He was in pain, but just wanted wallow in it. Let himself settle into his own misery for a while. For once allow himself to feel it. He just wanted to do it alone, that's all. Hailey got the message and let him be.
Jay eventually made his way out of the bathroom. In response, Hailey approached him cautiously. She didn't say anything, just slowly rolled the IV pole back to its designated spot. Jay silently climbed into bed. Discomfort was written across his face. He looked pale, green almost. "You okay Jay?"
"I think I'm gonna be sick," he whispered before vomiting all over himself. Hailey pressed the call light. Katie, his night nurse again, walked into the room slowly. "What can," she paused when she laid eyes on her patient. "Oh okay," she blurted out and quickly began helping Hailey get Jay cleaned up. She thrusted an emesis basin into his lap just incase his body wanted to go for round two. Her and Hailey got Jay into a new gown, got him to rinse his mouth and covered him with a fresh blanket. "I'm gonna go get you some meds," she said before disappearing down the hall. She walked back in quickly, ready with meds.
"Let's try something different Jay. It's not time for the zofran yet, so I brought some Phenergan. It's a bit heavier duty and will probably make you groggy, but it usually works really well. I have another dose of morphine too."
"Okay," Jay grunted, praying for a drug induced sleep. Hailey watched him visibly relax as the drugs flowed through his system. His eyes fluttered close. She kissed his cheek softly with a murmured, "I love you," before finding her place for the night in the recliner.
Hailey and Jay were awoken just after six am the next morning by a mild mannered anesthesiologist. He briefly discussed the plan for sedation with them and had Jay sign the consent for anesthesia. Jay sleepily signed the form, right as the pre-procedure nurse arrived, grabbing his chart from the nurses station, and wheeled him downstairs on a stretcher. The nurse showed Hailey where the waiting room was. Haikey quickly kissed his cheek and said "Good luck, love you" as the nurse continued rolling him down the hall. She heard a quiet, "love you too," before he disappeared behind a set of double doors.
After Jay was parked in the prep area, the nurse got his vitals, confirmed that he hadn't had anything to drink since midnight and that he completed the prep. "Dr. Morelock should be by in a bit," she said before leaving.
As promised Dr. Morelock arrived a few minutes later. He looked different, dressed in green OR scrubs, sans labcoat. Jay could see what looked like some sort of military tattoo peaking out of his scrubs on his upper arm, which surprised him. "How we feeling this morning?"
Jay blankly stared back at him.
"That good huh," Dr morelock remarked. Jay hadn't had any pain meds since before he went to sleep last night, so he was starting to get pretty uncomfortable. Dr Morelock could see his discomfort and proceeded, "Anesthesia should give you some fentanyl for pain with the sedation, so hopefully you should be more comfortable when you wake up. You were able to complete the prep correct?"
Jay nodded yes, before finally saying something, "last night was rough."
"Yeah, sorry about that. Hopefully we'll get some answers in return. I'll see you in there," he said, patting Jay's leg before continuing down the hall.
The anesthesiologist and nurse reappeared shortly after. "I'm going to give you something to help you relax," he muttered as they started to wheel him towards the endoscopy suite. Jay was out in seconds.
The procedure went as expected. Hailey waited anxiously in the waiting room. Will had stopped by briefly, but only for a minute, since he was working today. Dr. Morelock walked into the waiting area calling her name. She perked up, seeing her reaction, he walked over to her. "Are you here for Jay Halstead?"
"Yes," she blurted as he finished.
He sat down next to her. "He did great, everything went well. I did see evidence of inflammatory bowel disease in his colon. Esophagus, stomach and small intestine all look clear. We took some biopsies so, when those come back we'll be able to clarify what type of IBD it is. There was more inflammation than I expected so I'm going to increase his steroid dosage. Now that we have a better idea of what going on we can stop the antibiotics. I was hoping to discuss the larger plan going forward with the both of you once he's more awake. I can coordinate with Will and see if there's a time he can be present this afternoon, if you'd like?
"Yes, that'd be great," she said before Dr. Morelock continued. "He's still back in recovery, according to anesthesia he a bit of a light weight, so it might take him a bit to come around."
Earning a small chuckle from Hailey, he motioned her to come with him. He brought her back to Jay and gave her a quick smile. "I'll see you guys this afternoon Hailey, nice to meet you."
Jay was eventually awake enough to be brought back to his regular room. Both him and Hailey rested for the remainder of the morning and into the early afternoon. Jay waking briefly to use the restroom a few times and ask for pain meds. Will texted Hailey saying that he would be up with Dr. Morelock around four.
Hailey woke Jay up at three thirty, knowing Jay would want to be alert when Will arrived with Dr. Morelock. Jay was still groggy so she helped him back and forth from the bathroom.
Will walked in as Jay was getting back in bed.
"Hey buddy, how ya feeling?"
"Okay," Jay said softly.
Dr. Morelock knocked on the door promptly at four pm. He slowly entered, again pulling the chair up next to Jay, opposite Hailey this time. Will leaning against the wall, next to her. Dr. Morelock got into the details quickly. "Alright Jay, I updated Hailey briefly while you were still in recovery, but let's go over it more thoroughly together. Your endoscopy was normal, there was no evidence of inflammation in your esophagus, stomach or small intestine. However, there were heavy amounts of inflammation in your colon. We could see distinct ulcerations. The biopsies we took did confirm Ulcerative Colitis. Ulcerative Colitis is limited to the colon, it does not affect other parts of the GI tract. It's an autoimmune disorder, where your immune system attacks the inner lining of your colon."
"What causes it?" Hailey asked. Dr. Morelock responded, "usually people are genetically predisposed. We don't fully understand what triggers the disease to occur, but it is sometimes proceeded by a simple infection like strep throat, stress, or nothing at all. Not all people that are genetically predisposed will develop Ulcerative Colitis. It generally develops between the teen years and mid thirties. Sometimes it occurs with other autoimmune disorders."
'I'd like to talk about treatment but I want to break it up into two parts, let's talk about treatment during this hospital hospital stay first. You'll likely be here for a little while Jay, so we have time to figure out a plan for the future based on what works."
Ugh Jay thought to himself as he continued, "based on the severity of your symptoms and the level of inflammation I saw during the colonoscopy, you're definitely in the middle of a severe flare up. It's a relapsing and remitting disease, so you can have periods of little or no active disease followed by periods of active disease which people usually refer to as flares. The goal for right now is to get you out of this severe flare and set you up with a regimen going home that can potentially put you into remission or at least in a more manageable state. Sometimes we can control Ulcerative Colitis with just pills alone, but because you're having such a severe flare right now, I don't think that's a good place to start. I'd recommend we increase your IV steroid dose and start you on an IV infusion medication that you'd get every six to eight weeks. There are several medications we can try but I'd like to start with an infusion called Remicade. Remicade will inhibit your immune system and hopefully help stop it from attacking your own tissues. So we'll start you on that in the morning, but you'll get the larger dose of steroids tonight. I've stopped the antibiotics since there's no evidence of active infection. I'll order you a clear liquid diet for now, but don't push it. The medications will take a few days to start working, so try to be patient. The IV fluids, pain and nausea meds will continue as is for now," he finished.
Jay asked, " what if the remi...or whatever you call it doesn't work."
"If the Remicade doesn't help, there's a number of different medications we can try. There are several other IV infusions as well as injections available that can work. It can take some time to find the right one. Sometimes these medications don't work or stop working and we do have to do surgery, but right now we have alot of options to work with. What questions do you guys have."
"Can we briefly touch on what treatment will look like once he's out of the hospital," Will requested.
"Yes, absolutely. So you'll have to make some dietary changes. We'll have you take steroids in pill form for alittle bit in combination with some other drugs that suppress you immune system and help with inflammation. Most likely we'll continue the Remicade or whatever IV med that ended up working here, as well. It's hard to say if you'll need an IV or injectable medication longterm, since the other medications I just mentioned can take a few weeks, even months to fully take affect. You will be more prone to everyday infection, so you'll have to be more aware of that." He paused looking at Jay and then Hailey. "I can tell I've overwhelmed you, let all that information soak in. I'll come by in the morning and we can review things again then, okay?"
Both Hailey and Jay nodded. Will shook hands with Dr. Morelock. "Thanks, man. I really appreciate you spending the time."
Dr. Morelock smiled. "See you tomorrow," he said as he left Jay's room.
Will stood at the end of Jay's bed. "Is there anything I can clarify for you?"
Jay shook his head no.
"Well back to work I go. Let me know if you need anything, I'll be here til the morning." He walked out of the room, leaving them alone.
Jay was deep in thought. The only question he had was if he could still be a cop, but he was too afraid of what the answer might be. Hailey glanced over at him, not sure what to make of his distant gaze.