"Hey cuddle bug, time to wake up" Luca said as he felt his sleeping wife stir a bit while he was stroking her forehead again, she'd been fast asleep when she'd returned to the ward after her surgery was finished, the double mastectomy, cholecystectomy which was her gallbladder getting removed, the replacement of the port in her chest, placing nephrostomy tubes in both kidneys, and the biopsy and removal of some of the lymph nodes had taken nearly 12 hours for the doctors to do, Jess had returned to the ward late the night before so the decision had been made to leave her to sleep, she'd been back for 11 hours now, and it had been just over 48 hours since she'd had the appointment with Doctor Shah on base
"Surgery is all over baby girl, time to open those beautiful brown eyes of yours, there we go" Jay said joining in Luca's efforts to get Jess to wake up, his flight from Los Angeles had been delayed so he hadn't had a chance to speak to her face to face before the surgery yet
"Mouth is dry" Jess said, her tone clearly indicating she was still extremely fatigued as she was trying to move her tongue around her mouth to get some moisture back
"I'll go and grab some ice chips" Jay said knowing that they would be the best thing to relieve his daughters dry mouth
"Better not tell Nonna you're only giving me plain ice chips, you'll be in trouble" Jess said to her father still half asleep with a small laugh and smile appearing on her face when she said it, Jess was clearly still feeling the effects of whatever pain relief had been administered after the surgery combined with the tail end of the anasthetic
"It will be our little secret baby girl, I'll go and find you some gelato in a few hours, once Doctor Masterson gives the okay for you to have some, no need to tell Nonna on me" Jay said with a smile, something about her telling Jay that Simona would tell him of for giving her ice chips instead of gelato told him that she was going to be okay, she was extremely weak and fatigued, but her spirit was stronger than ever this time around
"Love you dad" Jess said softly as her eyes started to close again
"Love you to my sweet, brave baby girl" Jay said kissing her gently on the cheek before leaving to find the ice chips she wanted to moisten her mouth
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"Jessica, you're certainly looking a little brighter than before the surgery" Doctor Masterson said as he walked into her room with Doctor Leighton and another male doctor that Jess hadn't seen before later that day
"Think that might be the pain relief you've got her on" Luca said with a smile, he'd noticed a change as well
"Well that, and the bile is no longer building up and poisoning her liver and they've run a dialysis session to get the blood toxicity down a bit" Doctor Masterson said, he'd seen her latest blood work results, they were being checked every 12 hours to monitor her kidney and liver function, everything had shown improvement since the surgery which was what the doctors had been hoping would happen
"Gotta love it when my body decides to just randomly try to kill me, like my job isn't dangerous enough" Jess said with a smile on her face, Doctor Masterson and Doctor Leighton both let out a laugh at the comment
"Jessica, this is Doctor Ambrose, the new head of oncology I was telling you about" Doctor Leighton said introducing the new face they'd brought with them
"Hello Jessica, you've certainly got an interesting medical history don't you" Doctor Ambrose said flicking through the notes he had with him
"If you want me to transfer out from under" Jess started to say panicking slightly, Doctor Ambrose immediately cut her of by putting his hand up
"I'm not here to ask you to transfer your care to oncology, Doctor Leighton will remain the treating oncologist assigned to your case under Doctor Masterson's tender loving care" Doctor Ambrose said, Doctor Masterson had already warned him that there was some trust issues with medical staff, Doctor Ambrose didn't want Jess to see him as a threat in any way to her unlike Doctor Pratt had been
"Tender loving care, what lies have you been telling him" Jess said looking at Doctor Masterson, the panic now gone from her voice as she was laughing at the tender loving care comment
"Told you he's new, command told me I have to play nice for at least the first 4 weeks he's here, then I can resume being my usual jerk self that they know and love" Doctor Masterson said smiling, he knew there were some people who didn't like him, especially officers because he never believed in following protocol, he'd bumped a high ranking officers surgery to handle an enlisted sailors emergency that were more serious, the officer was requiring a minor procedures his resident could handle, the other emergency wasn't, when the officer confronted him about proper procedure, Doctor Masterson basically told them to go pound sand because he didn't have the energy to try and pretend that he tolerated that type of BS and walked away, he'd been called arrogant, insubordinate, un-diplomatic, he didn't care as long as it didn't stop him looking after the patients
"Doctor Ambrose is here because he has treated Li Fraumeni Syndrome before" Doctor Leighton said explaining why Doctor Shah was here, Jess was the first patient Doctor Leighton had ever had as the mutation was rare, neither had any of the other oncologists at the hospital, so having Doctor Ambrose here would provide some much needed experience
"I've had 2 families diagnosed with the gene in the past, I understand it's from your mother's side of the family" Doctor Ambrose asked looking at Jess
"Jess's mother died before she was diagnosed, it's never been confirmed it's from Sara's and her family, Jess was only 5 at the time of her death, the mutation was picked up when I had a genetic screening test performed about 6 months after her death" Jay said interrupting the doctor to fill in the gaps as their was no way to guarantee Jess would remember details accurately from back then
"She died from cancer" Doctor Ambrose asked realising that due to Jess's young age, Jay would need to fill in the gaps
"Complications caused from the chemotherapy she'd been receiving" Jay said
"Do you remember what type of cancer she had Mr Turner" Doctor Ambrose asked trying to get as much information together as he could, the one advantage of a genetic mutation like Li Fraumeni Syndrome was that there was always a family history to take, and because it didn't require both parents to carry the defective geneto be passed on, nor did it skip a generation, you would often find it as being easy to track the carrier's as soon as a family was identified
"It was in her stomach first, they removed what they could without having to take her stomach completely and started high strength chemoradiation treatment, 8 months later we found out it had spread to her uterus, we were 23 weeks along with Jess when we found out, Sara obviously put the loss of her periods and everything else down to the treatment she was receiving" Jay said explaining the situation to the doctor
"So she delayed her surgery" Doctor Ambrose asked, the fact that a tumour had grown and spread while undergoing treatment already was unusual, and it probably wouldn't respond to treatment, meaning that the best option would have been surgical resection
"We were told that if we could delay the surgery for her hysterectomy for 7 weeks, till she was 30 weeks, we would stand a chance of being able to bring our baby girl home from the hospital, they didn't know how the medication had affected her, but she wouldn't be classed as viable till the 28th week and due to what she'd been put through, they wanted to keep her in as long as possible" Jay said, these days medical care for premmie babies had improved so a baby was considered viable at 22 weeks gestation, but this was nearly 30 years ago, and Jess had been exposed to high levels of dangerous chemicals and radiation while she was developing, doctors hadn't given her much chance of survival
"But the next scan 4 weeks later I'm presuming is the standard time frame for monitoring a tumour" Doctor Ambrose asked
"The tumour on her uterus had nearly doubled in size and the one affecting her stomach was growing again quite quickly, they didn't realise how aggressive it was, Jess was 6 days short of the 28 week mark they'd given us for being viable, but we had no choice, she had to come out, they ended up putting Sara into isolation after the birth to try the internal radiation implant to try and save her from needing to have her stomach completely removed after the surgery to deliver Jess and perform the hysterectomy" Jay said, Jess hadn't been considered viable by the peads doctors when she had been born, nurses had been told by the specialist to keep her comfortable, it was only once Jess hit that 28 week mark and had gained weight that the doctors and nurses realised that she could actually survive
"Did the implant work" Doctor Ambrose asked curiously
"No, they ended up doing the gastrectomy surgery about 4 weeks after the birth, then she developed leukaemia, I think it was AML, then after she beat that, she ended up with tumours coming back, her large bowel, bladder, one of her kidneys all ended up needing to be removed over the next 3 years, it then went into both her breasts and lymph nodes, her chest wall and one of her lungs the following year, the doctors ended up having to do a double radical mastectomy and remove part of Sara's lung to try and beat it, then she ended up with the leukaemia again, but it was a type called BAL, she lost all ability to clot and her blood vessels became extremely weak" Jay said giving a list of Sara's history with cancer
"I'm aware of the type of leukaemia you're referring to Mr Turner, and you've basically just helped me confirm what we're dealing with here, I'm convinced that your wife did have Li Fraumeni Syndrome, if she has any living blood relatives, then there is a chance that they may carry the mutation as well, I would suggest that they get tested for it, some people carry the mutation but never develop cancer, but it still pays to check" Doctor Ambrose said
"I'm not sure whether Kahleed or the others have been checked, but I'll talk to them about it" Jay said
"Make sure you do, unfortunately once you carry the mutation, there's a 50% chance of passing it on to your offspring, however with genetic screening these days combined with IVF, that risk can be eliminated and they can produce healthy offspring that don't carry the mutation" Doctor Ambrose said
"Lucky them" Jess blurted out without thinking, she had never known the specific details of how sick her mother had been, only that she had been sick and was constantly in and out of the hospital
"At least we don't have to worry about Zah having it Cuddle bug" Luca said trying to lighten Jess's mood slightly
"The tumours your wife had Mr Turner, were they all soft tissue sarcomas" Doctor Ambrose asked Jay
"I think so, why" Jay asked curious
"Jessica has a type of tumour called leiomyosarcoma, I went back over the pathology reports from last time, it's the same type of tumour, they misdiagnosed it" Doctor Ambrose said
"So, what does that mean" Jess asked confused, had something been done that hadn't needed to be
"Jessica, this type of tumour is highly aggressive, it doesn't respond well to chemotherapy or radiation, and it has a high chance of coming back, usually within 6-18 months of your first diagnosis, it usually starts in the uterus or stomach and spreads from there, best treatment is radical resection as soon as a tumour is located" Doctor Ambrose said focusing his attention solely on Jess, so far all the treatment provided had been correct, but he needed her to understand what they were dealing with now
"So I'm not going to be rid of it" Jess asked the senior oncologist
"Completely, it's unlikely, it's already metasticised to some of your lymph nodes, and I suspect that it may have been the type of tumour that your mother was fighting" Doctor Ambrose said still focusing his attention solely on Jess
"The ones affecting my kidneys, you said they were more enlarged than the other ones" Jess said looking up at Doctor Masterson for guidance
"I biopsied the larger ones surrounding your kidneys and ureters, any of the ones that came back positive I removed, that's why I took so long in the surgery" Doctor Ambrose said explaining the reason for the delay
"That can't be good, it being in my lymph nodes" Jess said looking at Doctor Leighton now for her opinion
"It's not Jess, but we're certainly not out of the fight yet, and the information we've been able to gather on the tumour will allow me to specifically tailor your treatment plan moving forward to factor in for this" Doctor Leighton said trying to reassure Jess that things weren't all doom and gloom
"Was it anywhere else" Jess asked curious to know
"We found evidence of early leiomyosarcoma cells in both your breasts, as well as the small mass was one as well, the double mastectomy was a good call, another month and you would have been dealing with tumours in both breasts, not just a small 2 centimetre mass and some cells in a few lymph nodes, everywhere else I biopsied was clear, I need you to understand that these tumours can double in size in 4 weeks under the right conditions, that's why the first preference for treatment is surgical resection as soon as a growth is located, your tumour is also estrogen positive, it's rare for a leiomyosarcoma to not be estrogen positive" Doctor Ambrose said
"What does that mean" Jess asked not sure
"It means that the presence of estrogen in the body feeds the tumours growth, the hormone replacement therapy we had you on to help compensate for the surgically induced menopause, has unfortunately been helping the tumour develop" Doctor Leighton said apologetically
"Sara was placed on one following her hysterectomy" Jay said remembering the fact
"It's likely that her tumours were estrogen positive as well, and the delay in removing the first tumour completely wouldn't have helped her diagnosis, but we were dealing with a different time, different diagnostic methods were used, even the advances in the last 5 years" Doctor Ambrose said before Jess interrupted him
"Mum getting pregnant with me would have also pushed her estrogen levels up causing the tumour in her stomach to start growing again and spread, I'm the reason she got so sick so fast" Jess said trying to put the pieces together in her mind
"Jessica, listen to me, medical science 30 years ago when your mother first got cancer was primative compared to what's around today, the doctors most likely didn't know what they were dealing with, it was not your fault and you're not to blame yourself, and there's no way to know for certain that your mother had leiomyosarcoma, or if it was estrogen positive, Doctor Ambrose can only hypothesise that that may have been the case based on her medical history, and to help highlight the improvements in the knowledge we have that we can apply to your case" Doctor Masterson said moving right next to her bed, he reached out putting his hand on her lower arm and squeezed it gently trying to comfort Jess by getting her to focus on him and what he was saying, he could see the tears were starting to form in her eyes, he cast a quick look at Jay for help
"Baby girl, your mum wouldn't have changed having you even if we had known about any of this estrogen positive stuff, having you to look after helped get her through the tough times, gave her the strength to carry on, she loved being a mum, being your mum, it was all she wanted to do, Doctor Masterson is right, you can't blame yourself for this" Jay said moving in and embracing his daughter tightly as the tears started falling, all Sara had talked about when they'd gotten married was having a baby of her own and being a mum, Jay strongly doubted that even if Sara was aware of the potential risk from being pregnant, she would have chosen to get pregnant anyway and have a baby, even if it would shorten her life
"So, the blocked bile duct" Luca asked, Jay still had his arms wrapped firmly around Jess
"A stone, no signs of any malignancy" Doctor Masterson said, he'd been so relieved when he cut the gallbladder open after he had it out of Jess and he found what was clearly a stone and nothing more sinister
"My bone marrow biopsy" Jess asked releasing herself from her father's embrace, she'd settled enough to continue the conversation
"Was positive I'm afraid, AML again, whether there is any mutations however, we won't know for another week or 2" Doctor Leighton said looking at Jess
"So, can this be treated in the meantime" Jess asked looking back at Doctor Leighton, she appreciated Doctor Ambrose's efforts in trying to help Jess understand what was going on, but she needed time to process what had been said
"Why we're waiting for your results to be back, we'll start you on steroids and leukapharesis to try and get your counts down like we did before and we'll continue with the dialysis as well, then we'll start induction therapy as soon as your typing is back, until then you focus on your recovery and getting yourself as strong as possible to handle the treatment okay" Doctor Leighton said letting Jess know the plan for treatment
"When" Jess asked wanting to know when she'd have to start chemotherapy again, she'd most likely be admitted for the induction phase of treatment
"As soon as all your results are back, another 7-10 days, and we'll check your bloods before we begin, you know the drill, you've done it before" Doctor Leighton said reassuring her
"What about her eating" Jay asked looking at Doctor Masterson, he knew his daughter would only tolerate ice chips for so long before wanting something else
"Clear fluids only for the next 48 hours, combined with the TPN and tube feeding on a reduced rate, start to feel nauseous then drop it back, I also want you to have 2 banana bags a day till you're back on solids, really give your body a boost of the good stuff. Aubree explain how the meals work here now" Doctor Masterson said looking at Jay, Jess and Luca
"No" the three of them responded
"That's your menu, you can order anything of here between 0700 and 2030, visitors it's $16 per tray and delivered right to the room save going to the cafeteria, and they've got a clear fluids menu right there, dairy free gelato, jelly, broth" Doctor Masterson said pulling the menu out from the drawer and handing it over to Jess to look at first and pointed the clear fluids section out, the room service menu idea functioned extremely well in civilian hospitals, and it had the added advantage of allowing patients access to a wider variety of food at times that suited them, if they were fasting for procedures they didn't have to miss out, if they were on strict medication timeframe that required food to be eaten at a set time it was easier to guarantee compliance, it also had the social element of allowing families to eat together and created an all round less stressful environment with regards to eating, it was still in the trial period and not available on every ward yet, but Doctor Masterson had argued successfully that gastrointestinal should be included in the trial period as the patients he had needed the flexibility that this offered, and it allowed dietitians to provide better education to patients by giving them the ability to practice the skills needed for discharge
"So, if I leave a charge card here on file, can the meals be put on that for her visitors when they're here" Jay asked looking at Doctor Masterson, he knew that Jess was more likely to eat if others were eating around her, even if it was just a little bit
"Of course Jay" Doctor Masterson responded, he knew Jay was talking about paying for Bravo's meals when they were visiting as a way to encourage Jess to eat
"Right, then that's what we'll do" Jay said
"Dad, you" Jess started to say before her dad cut her off
"This isn't just for you, it's for Luca and everyone else as well, your brother's aren't going to be able to keep themselves away, especially once the induction therapy starts, if there stateside then they'll want to be here, if having the ability for them to get food delivered to your room is going to help keep everyone else even slightly more relaxed during the process, then I'm going to do it" Jay said firmly indicating that this decision was not open for discussion with her, Jess could have easily covered the meals out of her own pocket, her dad already paid for so much at times, she didn't want him covering another expense unnecessarily
"Your dad's right cuddle bug, last thing you need is anyone getting hangry when you're feeling lousy" Luca said letting Jess know he agreed with Jay's decision to choose to cover the financial cost of feeding the team when they were visiting
"And if you don't really feel like eating a meal, you can order a few snacks and drinks and graze through the day" Doctor Masterson said pointing out the appropriate sections of the menu, something that would be a lot easier on her body to tolerate when the chemotherapy started again
"Your brains about to take a dive in the deep end isn't it baby girl" Jay said seeing that Jess was exhausted and still needed time to process what was going on as it couldn't keep up, she needed space to relax and process what had been said, what was going on and what was happening in the immediate future
"I think we've been through everything important anyway for the moment, leave you to get some rest, Aubree is on night shift tonight with Camden and Poppy if you need anything Jessica, just ask her about it, and I'll ask one of the girls to help you wash and freshen up a bit later, get that surgery feeling out of your system" said Doctor Masterson
"Thanks" Jess said softly, her voice sounding a million miles away
"Rest up" was all Doctor Masterson said in response before escorting the other two doctors out of the room, stopping only briefly to draw the blinds so it would be easier for his patient to rest comfortably
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