After Jess' outburst that day, Rory's visits to the hospital lessened. She still went everyday but she didn't spend as much time there as she had been. Her excuse was he was getting better and used to the hospital. It was a valid point, but did little to diminish Jess' pain at her absence.
It was now almost two weeks after the accident that injured and crippled Jess and Dr. Liese was talking to Luke and Jess about releasing Jess from the hospital.
"I'm going to need to examine him once a week, until all of the surgical would heals completely and I know the renal specialist will want to check him until we make sure that one kidney is functioning at its peak performance," Dr. Liese explained.
Luke nodded and recorded all the information on a note pad. Jess cleared his throat, "What if the one kidney doesn't work right? Then what?"
"Usually," Dr. Liese said, "When the remaining kidney is healthy, that's not a concern. However, if for some reason it becomes the case, we'll perform a transplant."
Jess nodded, 'But those can take forever, right?"
"Kidney transplants are most common from relatives but if no relative matches, it can take awhile."
Luke had a question now, "So when are you letting me him out of here? I'll need some time to prepare the place to accommodate…"
"Mr. Danes," Dr. Liese cut Luke off, "Jess spoke extensively with Dr. Camden and with Dr. Davis. He expressed his desire to check into a rehabilitation hospital." The doctor looked at Jess, "I take it you didn't discuss this with your uncle."
Jess shrugged, "I was getting to it, but by the time he gets here, I'm so tired of arguing about it, I never brought it up."
Luke nodded, "Well, I'll want to speak to Dr. Camden before we determine that. When would that be happening?"
"Well, Jess, Mr. Danes, we've done about all we can do here. You've healed well from the surgeries, the broken ribs are healing, the cuts and bruises are healing nicely. I'd say I'd be ready to kick you out of here in a day or two," Dr Liese determined.
Jess smiled, "Wow! That's unbelievable."
Dr. Liese rose, "Dr. Camden will be in a while to discuss therapy options with you. I'll see you tomorrow, Jess. Mr. Danes."
After the doctor left, Luke turned to Jess, "So, why didn't you tell me about the rehab?"
Jess shrugged, "Cause," he replied.
"Because why?" Luke countered.
"Knock! Knock!" Lorelai called as she walked in Jess' hospital room, "Hey, Lukey. Hey, Jess."
"Don't call me Lukey," Luke growled at her.
"Hey," Jess replied, "you solo?" He watched the door for a sign of Rory.
Lorelai shook his head, "Nope. Rory's hitting the ladies room. She'll be in here in a minute."
Lorelai took a seat by Jess' bed. Since the accident that nearly killed him and did cripple him, she'd learned for Luke's sake and Rory's to tolerate Jess and found in doing so how much he'd really changed. Jess talked more now, he was more attentive and communicative. Still, he clamed up when he had his feelings hurt or was angry about something, but at least one could hold a conversation with him without wanting to throttle him now.
Jess smiled. He missed the days before he argued with Rory when she'd sit with him, read to him, hold his hand and coax him through long minutes of mind numbing pain, which still plagued him. If only she understood. If only he understood. They had to have a serious talk when he got out of the hospital. They had to talk about her sudden change of heart and his new commitment to her, the commitment he planned to make to her when he could walk again.
"Hey, Jess," Rory greeted with a huge smile, "Look what I brought?" She held up a book, Ernest Hemingway on Fishing.
Jess smiled, "Wow! Come here," he smiled and kissed her cheek when she leaned over him, "I've got some news," he declared smiling. He couldn't stop smiling.
Lorelai spoke, "You look happy. Must be good."
"It is. I'm finally getting out of here in two days," Jess proudly announced.
"That's great!" Rory cried, "That's wonderful. I know you were really getting anxious to get out of here."
Lorelai looked over at Luke. Luke could read the question in her eyes. Before anything more could be said, Dr. Camden entered.
"Well, the gang's all here," he greeted, "Dr. Liese said he's going to release you in a few days. Congratulations."
"Thanks," Jess smiled and continued to hold Rory's hand.
"That brings up a whole other issue," Dr. Camden began, "Um, would you all excuse us while I examine Jess. Then we'll discuss our options.
The three of them filed out and stood in the hallway. Luke knew Jess and Rory argued over his prognosis, so he felt it best to warn her, "Um, just to give you both a heads up, Jess is thinking about going to a rehab facility," Luke told them.
Lorelai smiled, "That's great. Maybe he'll be able to walk again after all."
"Lorelai," Luke sighed, "We…heard the same doctor's report. There' no chance…"
"You can't take away his hope Luke," Lorelai said, "He needs to keep his spirits up."
"Mom," Rory said, "I'm with Luke. Dr. Davis said with Jess' injury there is no significant chance Jess will ever walk again. Luke doesn't want him, I don't want him to use so much of his strength trying to do something that can't be done."
Luke nodded, "I do agree with Rory. Jess will need all his strength for day to day things. He won't want to be dependant on me or Rory for that matter."
"Luke," Rory sighed, "you know I won't think of it like that. I want to take care of Jess, help him as much…"
Luke gave Rory's arm a squeeze, "I know that Rory."
"So do I, Kiddo," Lorelai sympathized, "but I don't Jess will want that for you. He'll want you to be free from that, his friend, not his nurse."
"I know that, but because I'm his friend, I'll gladly be his nurse," Rory told her mom and Luke.
"Well, Rory, those rehab places teach independence too," Luke said, "maybe it wouldn't be a bad idea. Maybe they can teach him to do things without exhausting himself."
Rory nodded, "Did you see him yesterday after he tried to turn himself over. He slept for three hours."
Lorelai sighed. She could see the severity of Jess' condition was tearing Rory apart, it was tearing Luke apart to watch him fight. Yet her own heart swelled with pride at how hard he was indeed trying.
"Well, let's see what Dr. Camden has to say. Maybe a little hope wouldn't hurt," Luke said, leaning over to gently kiss Lorelai's brow.
While Luke, Lorelai, and Rory argued about Jess' rehab, Dr. Camden finished examining Jess, "And how's the pain and cramping?"
"Bearable mostly, but at night, excruciating. And that weird hot and cold is getting very annoying. Luke put socks on my feet yesterday and it was okay, but when he took them off, it felt like they were immersed in a bucket of ice."
"Well, the medication should help with that. Now, let's call the family back in and discuss your therapy option," Dr. Camden said opening Jess' hospital room door, "All right, you can come back in now."
Luke, Lorelai, and Rory filed in and were seated, "Well, the good news is Jess will officially be released from the hospital on Friday. What we need to address is where to go from here."
Luke nodded, "Jess expressed a desire to try rehab."
"Yes, Jess and I have talked about his prognosis, therapy options, but you're all his family and so I'm going to go over the prognosis, my and Dr. Davis' recommendations, and the rest of the options," Dr. Camden explained.
Rory asked the next question, "What about the pain? Jess…"
"Let me explain first where we are, then if you're still having questions, we'll go back over it. First, thing to understand are there are two types of spinal injuries, complete and incomplete. Jess' injury, both the complete breaks at L1, L2, and L3 and the slip fracture at T10, T11, and T12. The spinal nerve here got pinched in the bone fragmentation, thus leading to the paralysis below that point. Everyone with me so far?"
They nodded so Dr. Camden continued, "Jess' injury is what we classify as a complete injury. Now, it is often assumed that a complete injury means that the spinal cord has been cut in two. This is not true! Instead, a complete injury is one in which no nerve messages are able to get past the injury at the time the examination is done. For example, no sensations can be felt below the injury because the messages cannot get to the brain and no voluntary movement is possible because the messages cannot get from the brain to the muscle. If even one nerve fiber is still able to carry messages past the injured area, the injury is incomplete. That is of course not the case here."
"Is there any sort of surgery that you can do to fix the injury so the nerves work again?" Lorelai asked.
Dr. Camden shook his head, "Not right now, unfortunately, but knew treatments and things are being discovered all the time, so…"
Jess sighed. He was getting frustrated with all this talk, "Doc, is there any chance of me walking again? What are my chances here?"
Again, Dr. Camden sighed, "Well, the severity of the injury determine whether or not recovery will occur. There is not definite medical test that tells us about recovery chances, so the best we can do is an educated guess. Patients with incomplete injuries, have a much greater chance of recovery than patients with complete injuries. That is not to say that no patient with a complete injury ever recovered some voluntary sensation and movement, but it's a lot less likely."
Jess gasped and Rory reached out to hold his hand. She knew how hard this was for him to hear, "But the hard I work the better my chances right?" he asked, his voice tight.
"No, I'm afraid not. No amount of hard work can make a nerve cell regenerate, Jess. Therapy does not cause recovery, the therapy and recovery sometimes occur simultaneously because the majority of recovery occurs within the first three months and the therapy is done within the first three months. I'm sorry I don't have better news for you Jess," Dr. Camden frowned.
Jess swallowed hard and nodded, "Thanks for being honest with me."
"There's more," Dr. Camden said, "some of the peripheral nerves were damaged as well. That is what is causing the temperature shocks and the tremors."
"Tremors?" Rory looked at Jess confused. "You never mentioned anything to me about tremors? Luke?"
Luke shook his head, "This is the first I'm hearing of it."
"What can we do about it?" Lorelai asked.
"Well, I've given Jess some medications to help deal with it and give him some relief. Jess' spinal cord is not completely severed and he may have some sensation in the lower extremities. The tremors are involuntary muscle spasms which often occur. The meds should reduce their frequency."
Rory sighed and tightened her grip on Jess' hand, "What about the pain?"
Again Dr. Camden sighed, "Well, paraplegics can experience five different types of pain and each has it's own cause and it's own treatment. Only three of these can really explain the pain Jess is experiencing, and we've all ready ruled our nerve compression, which leaves only two other possible causes," Dr. Camden explained, and I fear Jess is experiencing both of them."
"Well," said Rory, "What can we do about it? I can't…"
Dr. Camden cleared his throat, "Well, one type is related to mechanical instability of the spine, perhaps produced by incomplete healing of the fracture. This pain is made worse by sitting or moving, and is usually decreased by lying in one position or another. We can document the instability by the appropriate x-ray tests, and it's usually directly treatable by either external or internal stabilization. Part of Jess' pain probably is due to the fact that he does have six separate spinal fractures, three of which are complete. This pain should go away when the fractures completely heal, but if not a back brace or surgical intervention can relieve it."
"Well that's good," said Lorelai, "will we have to wait long to see how it heals?"
"Six weeks to determine if we have to operate," Dr. Camden replied, "but unfortunately, that's the good news. There's another cause for Jess' back and leg pain and this one comes from the injury to the spinal cord itself, and I'm sorry to say, it is very difficult to treat," Dr. Camden explained, "Unfortunately it is also constant so it cannot be relieve by position or activity, but it can be complicated by one or both of the other causes of pain. So, if the fractures do cause lasting trouble and we have to operate, we can fix some of it."
"Some of it," Jess groaned, "What about fixing all of it? This is getting a little old."
"There are several options to try and treat this pain, and Jess, since unfortunately this is what's causing those shooting pains and throbbing sensations. There are some oral drugs we can try to relieve it, usually localized anesthetics but if that does not work, we can deliver the medication through an intrathecal pump for long term pain management," Dr. Camden locked eyes with his patient, he was no sure is Jess had fully accepted the reality of his situation yet. "We are looking at the long term Jess, Dr. Davis and I recommend the pump in a situation like yours. Especially since the mexiletine is already not having the desired effect, neither is IV Demerol. It is of course up to you."
Jess immediately shook his head, "No, I don't want that. I don't…"
"Jess, if it'll help you get free from that pain…" Rory began to reason.
"No," he repeated firmly, "I'll live with the pain if I have to. I won't live the rest of my life in a wheelchair."
Luke let out a long sigh, "Jess, you heard what Dr. Camden said about…"
"Not you too!!" Jess snapped, "Whatever happened to 'I'm always here,' huh?"
Luke stopped talking and stared at Jess, hurt in his eyes. Lorelai saw it there. She saw it in Rory's eyes. They both loved Jess, they wanted to protect him from pain, frustration and disappointment. She looked at Jess' eyes. She saw pain there too. Luke and Rory were the only ones who ever gave him a chance now to have them doubt him…Lorelai knew this situation ws highly charged and needed intervention, "Doctor, is this spinal catheter thing the only option you can offer, or just the preferred one?"
"In Jess' condition, it is the preferred one," Dr. Camden answered, "but we can try to increase the oral medications and try opiates. There are also pain management techniques you can do without drug therapy, but like I said, the catheter is the most preferred and most successful option."
"Well, you see," Lorelai comforted, "at least try the other things first."
Jess smiled at Lorelai, who for once was on his side, then turned his gaze to Dr. Camden, "What about my therapy?"
"Well, there's inpatient and outpatient therapy. Some patients benefit from their home environment, being with the family and friends everyday. Dr. Davis and I recommend a two week period of intense physical therapy, to get you some independence Jess, and then continue outpatient physical therapy and occupational therapy."
Rory smiled, "That's great, Jess. That way we can go to the bridge and read together and talk. You won't be cooped up in a hospital with all the sunshine."
Jess kissed the hand he held and Dr. Camden rose from his seat, "Dr. Davis and I will make the arrangement to have you transferred to St. Barbara's. I'll leave you now, and I'll check back with you later Jess."
Lorelai caught Luke's eyes and nodded her head to one side, "Luke, let's get some tea and coffee and leave these two kids alone for a bit."
Luke rose and followed Lorelai out. He knew Jess and Rory had some talking to do.
Once they were alone, Jess turned to Rory, "Rory, I have to ask you a question. I was going to wait until I got out of the hospital, but I have to know now," Jess began.
"Okay," Rory said hesitantly, "Shoot."
"Well, the night of the accident, I went to talk to you, I never mentioned why I really was there. I…" Jess took a deep breath; this was so hard to say. "I went there to tell you something, not to say that nonsense about running away with me. I know that scared you and you didn't understand where it came from…but, I was so scared too Rory."
"Jess, don't…you don't have to be scared anymore," Rory said gently.
"Rory, I'm not a baby, just hear me out," Jess told her still holding her hand, stroking the back of it with his thumb. "I was scared to tell you I loved you just to have you reject me, so I did something, asked you something I knew you would reject so I could be prepared, so I wouldn't be hurt. But I was, because I wanted you to leave with me, I wanted to be with you then and I do now."
Rory sniffed and used her free hand to wipe away a tear that had escaped from her eye, "I want that too Jess, but I want it in Stars Hollow, with my Mom and Luke, not off in New York…"
"Rory, will you stop talking so I can finish this, I'm not good at…" he trailed off, "I love you, Rory. I'm not scared to say that anymore. And I know that you don't love me like I do you but…"
Rory pressed a finger to Jess' lips and squeezed the hand she held in hers, "Jess, for someone like you who's so smart, you sure do say a lot of dumb things," Rory laughed, "Of course I love you. I wouldn't be here if I didn't"
"Then you're not…you're not here out of pity then?" he asked looking at his legs.
Rory shook her head, "No," she said confidently leaning over to kiss Jess' slightly parted lips, "No."
"Rory," Jess continued after kissing her once more, "I know you don't think I'll be able to get out of a wheelchair ever again,"
"Jess, I just don't want you to upset yourself. But if you want to fix this," she gestured to his legs, "I'll be with you. I love you, Jess."
Jess kissed Rory again, "I love you, too, Rory," he affirmed, as she rested his head against his shoulder. "I love you too."
