"Jessica, how are you feeling" Doctor Masterson asked entering the room she was staying in, she didn't remember much of the 3 and a half hour drive from the base, yes Portsmouth Medical was the closest of the larger Naval Medical Facilities to Virginia Beach, but she'd been sent to Bethesda when she had returned from Djibouti to be treated by Doctor Masterson, General Blair had made enquiries with both Doctor Masterson and the head of gastroenterology at Portsmouth based on Jess's medical situation as it currently stood, Doctor Masterson had given General Blair the answers he'd wanted to hear, so she was placed under his care, the only issue that happened now, was anytime she needed hospitalization, she had to travel over 3 hours away to Bethesda, but Doctor Masterson always tried to make her comfortable
"All the usual when I feel crappy" Jess said looking at the doctor who oversaw all her medical problems, she had learnt to trust him, Jess had had some negative experiences with doctors as a young child, especially in regards to what happened with her mother, Doctor Masterson had taken the time to be patient, he was selective about who he brought in to work on her case, and they'd developed a solid working foundation based on trust, the extra drive was worth it just to have him looking after Jess
"So tired, lethargic, cold, body aches and pains, feeling weak, headache, nausea" Doctor Masterson said smiling as he reeled off the most common symptoms Jess reported when she was feeling under the weather
"Got it in one" Jess said smiling weakly, glad she wasn't having to repeat herself like she had to with certain nurses who weren't familiar with her medical history
"Well, we can start answering some of the questions as to what's causing you to feel like that" Doctor Masterson said moving in closer so Jess could hopefully pay better attention to what the doctor was saying and wouldn't have to move to much
"Yay me" Jess said, she'd been feeling worse as the day progressed, even if they didn't have all the answers yet, hopefully the answers they did have would be enough to start making her feel better
"For starters, you've preliminary tested positive for infectious mononucleosis otherwise known as glandular fever, I'm guessing you haven't had it before" Doctor Masterson asked looking at her and Luca
"No" Jess said shaking her head slightly
"Preliminary positive" Luca asked curious about what Doctor Masterson meant, he'd already had the infection as a teenager, so at least he knew he was safe from getting it again as it was primarily transferred through saliva, he'd still ask Alie to keep a close eye on Zah for it though, even though her asthma had improved, it still wouldn't be ideal her developing the infection, especially now she was getting close to competition in her first ever sporting competition, she had a swimming competition in a few weeks she'd been training hard for, she'd be devastated if she had to pull out due to illness
"There's 2 tests that we use to check for it, first one takes about an hour, but is not 100% accurate, second one takes between 48-72 hours to come back" Doctor Masterson said explaining the reason for calling it preliminary positive, thankfully it was the type of illness that required supportive treatment only, and not specific medication
"Anything else" Jess asked letting out a small yawn
"Your pancreas, liver and kidneys are swollen, most likely from infection, could be the mono, I have spotted a blockage in your bile duct, now we have had talks previously about me removing your gallbladder as a preventative measure as you remember" Doctor Masterson said, focusing slightly more attention on Luca this time, he was going to play the most important part of the decision whether Jess agreed to have surgery to get it removed or not
"Do you need to wait for the swelling to go down and do it" Luca asked, a blocked bile duct would need to be removed, or the bile could easily back up in the liver and cause a whole bunch of problems, most notably liver failure, the high birilibum levels could be explained by the blockage causing the bile to back up, quicker it was addressed, the less chance of complications, and they'd be able to see what was causing the blockage
"I'm confident I can get in using the laproscopic method and remove it, though I may have to do an open procedure, your ureters are basically swollen shut as well due to what appears to be lymph nodes being particularly swollen and enlarged near by Jessica, we need to biopsy them as well, see what's going on, I mean practically all your lymph nodes are on the larger side at the moment, but these are really enlarged" Doctor Masterson said, Jess was silent as she was trying to focus on what Doctor Masterson was telling her was wrong
"The bruise on her chest" Luca asked
"There appears to be a small mass in the connective tissue, we need to biopsy that as well, depending on what we find" Doctor Masterson said explaining what he'd seen on the scan
"They're due to be removed anyway, if I'm already out due to one surgery" Jess said softly to her doctor
"You want to look at doing both at the same time Jessica" Doctor Masterson asked looking at Jess intently, he wanted to be sure what she was saying
"One operation, one recovery period, they'd be about the same for recovery right" Jess said to Doctor Masterson, the Mastectomy surgery she'd had planned was to occur after Bravo team returned from their extended deployment, but if she was already going to need surgery to remove her gallbladder and they'd found a mass in one, why not just do the double mastectomy now as well, get it over and done with
"I'll need to talk to plastics see what would be required, and the new head of oncology will be involved with your surgery" Doctor Masterson said, he'd been thinking about doing the same thing himself, but wasn't sure if the swollen lymph nodes from the glandular fever would make it a more complicated procedure, even though Jess wasn't going to have any reconstruction performed like artificial implants, Doctor Masterson still wanted plastics to do the surgery so everything looked as neat as possible, he already knew the surgeon he wanted to do the procedure
"Not Doctor Pratt, I don't want him anywhere" Jess started to say frantically, she'd had a bad experience with the doctor, he'd spent 5 weeks trying to get Jess transferred to his care because of her Li Fraumeni Syndrome, he'd refused to sign of on medication orders Doctor Leighton had submitted, he'd cancel tests that she'd ordered for Jess, make appointments for her to see other doctors on his request, the final straw was when Doctor Pratt requested a psych consult as he tried to argue that Jess was not competent enough to make the best decision in regards to her treatment and that JSOC and SOCCOM had the final decision as she was to valuable of an asset, as the saying goes play stupid games, win stupid prizes, Jay ended up getting Rupert to come in and sort the problem out, who ended up talking straight to the chief medical officer of the entire US Navy about what Doctor Pratt had done, and that Jess had actually appointed a officer of the US Navy as having power of authority to make medical decisions if she was not capable, so she was clearly thinking about what was best for the military and her command, Rupert argued some other stuff as well about security by dragging all these other people in to do consults, how he was jeprodising Jess's safety, denying her medical treatment, and finally a threat was issued to sue him if the behaviour was going to continue promptly saw Doctor Pratt told by his own command that a decision was made by the chief medical officer himself to keep Doctor Masterson in his role and Doctor Pratt had to stop interfering in Jess's case for the good of the US Military
"He left last week, requested a transfer so now he's some other CO's problem and out of my hair, Doctor Ambrose replaced him, he's a surgeon, so he'll be handling the biopsies in any procedure that we perform here" Doctor Masterson said, not a single department head was upset to see Doctor Pratt leave, and so far Doctor Ambrose has shown zero intention of trying to take patients from other doctors when they had multiple medical problems besides oncology and hematology issues as the department would be overrun with patients and no one would get the care they required, so he'd prefer to leave the patients where they were comfortable, as soon as he told Doctor Masterson that that was his opinion, and that even though he was familiar with Li Fraumeni Syndrome as he'd treated 2 other patients in the past, he was going to leave Doctor Leighton on Jess's case and be a sounding board for her to talk to for guidance as it was a good chance for her to learn and familiarise herself with the condition, Doctor Masterson had become more willing to allow him to be involved with Jess's case
"So her bone marrow biopsy was clear then" Luca asked, hoping for some good news at least in that regard, Jess was clearly going to be down for a few weeks from what Doctor Masterson had already said was wrong, if she was at least clear of the leukaemia still, it would help minimise the risks of complications and delayed healing from the surgery
"Not back yet, it will take another 48 hours probably" Doctor Masterson said
"Kidney function" Jess asked looking at her doctor, she'd experienced acute renal failure before, she wasn't keen on a second round
"It's dropping Jessica, nephrology are borderline on whether to put you back on dialysis for a few weeks, rest your kidneys for a bit, however considering the uncertainties around whether you're still in remission or not, there is concerns about the ability to maintain vascular access in that time combined with your other needs" Doctor Masterson said
"And how do you rectify that problem" Jess asked sensing that a solution had already been decided on
"Replace your port with a double lumen, that allows us the potential to run 6 access ports instead of the 3, fluids and TPN take 2 of the access ports anyway, and dialysis will take another 2 when they're doing the procedure, they also did suggest putting a tube into each kidney to temporarily drain the urine away from them and into drainage bags, they're becoming backed up anyway due to the blockage in your ureters, see if your function improves" Doctor Masterson said taking Jess through the plan that Nephrology had put forward
"How long for" Jess asked sounding slightly defeated, she already had 3 artificial openings in her body she had to live with, she didn't want to add to it
"A couple of weeks probably, depending on how quickly the swelling resolves and if your readings improve, but it will help take the pressure of your kidneys as they won't be trying to filter all the waste in your urine, and the dialysis will help remove the built up waste toxins that's already in your blood and poisoning your body" Doctor Masterson said, he hoped that the surgery and prompt dialysis would help get Jess feeling better reasonably quickly, especially in case she needed chemotherapy again as her body would need to be relatively healthy to receive it, and currently she wasn't
"Where's the permission forms" Jess asked, she saw the logic behind nephrologys thinking of resting her kidneys between the tubes and the dialysis, and that a lot of cancer medications can cause kidney problems, she needed to do what's best for her body and try and get on top of the kidney problems now
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"Update on Jess's condition from Lindell" Lisa said handing the update she'd been provided by a member of the planes crew
"Thanks Davis, how are the team traveling" Eric asked wanting an update on the missions progress while also wanting to know how things were going back home
"On target to hit the rendezvous in 40 mikes, tell me it's good news" Lisa said updating him on the teams status, she wanted to know how Jess was doing as well, she had been missing the female EOD's presence on base and during the mission as Jess could help her sort through intel and get her hands on information quicker than if Lisa was doing it on her own
"They still don't know anything for sure, looks like she's got herself a case of mono, and potentially pancreatitis, they've also found a blockage in her bile duct in the liver, a small mass in the connective tissue of her right breast and her kidneys are shutting down again due to what looks like really swollen lymph nodes, they've booked her in for surgery to remove the blockage affecting her bile duct and they're doing the mastectomy surgery that was already planned for after our next deployment so she's only dealing with the one recovery period, they're also doing some more biopsies on those enlarged lymph nodes affecting her kidneys, and they plan on resting her kidneys for a few weeks to hopefully get them to start functioning properly again" Eric said letting Lisa know what was happening, it all sounded slightly scary to Eric, infection, acute renal failure, one mass confirmed, a blockage, possible pancreatitis
"Doesn't sound too good, so her cancer is back" Lisa asked
"They still don't know for certain, they'll need to wait till her biopsy results are all back" Eric said folding the paper up and putting it in his pocket for safe keeping, part of him wanted the biopsy results to be all clear, but another part was telling him that he already knew that they wouldn't be and he needed to be prepared for that
"Team is going to want time of when we get back if it does turn out to be positive" Lisa said to Eric, she could sense that there was some concern on Eric's behalf with Jess's situation still being uncertain at the moment, but he was trying to push it aside to focus on the mission
"I know, I'm sure Lindell will try to organise something for the team" Eric said as he turned his attention back to focus on the monitor in front of him
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