Around two am she was sleeping, waking up after Jay shouted her name several times from the bathroom. "Hailey, Hailey," he yelled getting progressively louder. She groggily hurried to the bathroom, knowing he wouldn't call her if it wasn't serious. She found him bracing himself against the sink with a nervous expression.
"What," she muttered still trying to wake up.
"I think theres some blood," he said pointing to the toilet. She looked and agreed, "some, thats a lot Jay." She was certainly awake now.
"Alright no arguing, we're calling Morelock," she said as she guided him back to bed. Can you take pain meds right now, you look like you need them."
"No, it hasn't been long enough," he responded as she handed him his phone. He called the after office m by phone and spoke with the nurse. She took down all his info and symptoms, telling him the on-call physician would call him back shortly." He thanked her and hung up the phone, lying back down.
He got a phone call back in just a few minute. Thankfully it happened to be Dr Morelock. "Jay, go to the ER, I'll see you there."
Hailey had already started gathering the basics so they could leave quickly. They got into the car and Jay let Hailey call Will. He picked up far too fast for someone that was asleep, he must be at work she thought. "Hey Hailey, you bringing Jay in?"
"Uh yeah, how'd you know?"
"Hailey, it's two thirty in the morning why else would you be calling. Plus his doctor just called, wanted us to let him know when his labs were back."
"Oh okay, we'll be there soon."
They arrived at the ED shortly after. Jay was checked in quickly and brought to a room. A nurse that he didn't know came in, took some vitals, and inserted an IV. He got some labs while he was at it. Will peaked his head in. He'd been working a long stretch of nights so he hadn't seen Jay since last Friday when he brought him meds. Like Hailey he could see the weight loss on his already thin framed. He looked pale with dark circles under his eyes from lack of sleep. He could tell by his body language that he was in pain. His heart rate was elevated, blood pressure a little low but overall vitals were stable.
Jay was lying on the bed, his legs curled up, with an emesis bag next to him. The nausea had re-emerged on the ride over.
"Jay, what happened man?"
"The meds aren't working this time, it's just getting worse. I'm scheduled for a colonoscopy Monday, but I passed a decent amount of blood a little while ago. I finally called Morelock and he told me to come in."
"Bright red blood, how much?"
"Yes bright red, not a large amount…"
"But certainly not a small amount," Hailey interjected.
"How much are you in the bathroom?"
"Well if I'm not pooping, I'm vomiting," Jay said half joking.
"Are you keeping anything down?"
"I kinda stopped trying, small sips of water sometimes, but nothing solid."
"How's your pain right now?"
"A solid 8, I took 2 Norco's around twelve thirty."
"He just doesn't seem to be getting much relief, even with taking them every four hours around the clock," Hailey remarked.
"Dylan's on so I'll see if he can order some pain and nausea meds before he comes to see you. It's a little busy so might be a bit unfortunately. I gotta go but I just wanted to check on you first"
"Thanks Will," he muttered softly.
Thankfully it wasn't that long and the nurse returned with some morphine and zofran. He felt the head rush from the morphine and was grateful for the relief that soon followed. "Dr. Scott should be in shortly."
Dylan came in soon after. "Hey, Jay. I'm gonna keep it brief here, Dr Morelock is on his way in, he's kinda running the show now. I'm just the middle man until he gets here. We've got some fluids ordered for now and if you need anything else for pain or nausea let the nurse know. Let me examine you real quick."
Jay hardly said anything while Dylan examined him, giving brief answers to his questions, he groaned when Dylan gently palpated his abdomen. "Sorry man, all done." He took off his gloves and waved goodbye to Hailey, she mouthed thank you back to him and he nodded.
Will happened to be walking down the hall when Dr Morelock arrived. Will smiled at him and shook his hand. "He's in pretty rough shape in there."
Dr Morelock sighed, "Yeah from what I hear, sounds like he should have called me two days ago."
Will shrugged, "Yeah probably."
"Let me look at his labs and go see him. I'll give you an update after."
"Thanks, appreciate it."
Dr Morelock quickly looked over Jay's labs and headed in to see him.
Hailey and Jay heard a soft knock at the door. "I would ask how you're feeling…."
"Yeah I know," Jay muttered back.
"So I've looked over your labs. Your electrolytes are surprisingly okay, hemoglobin is low but nothing too concerning. CRP however, is the highest one I've seen in a longtime. How many bowel movements have you been having?"
"Fourteen maybe fifteen yesterday, I think. I kind of lost track"
"Just one bloody bowel movement, correct?" Jay nodded yes. "What about nausea and vomiting?"
"Comes and goes, worse when I try to eat or drink. My appetite is non existent, water's hard."
"I see they gave you some morphine, is it helping?"
"It's tolerable now, maybe a five out of ten."
"Have you been getting any relief at home," Dr. Morelock asked.
"Not really."
"Fatigue?"
"I don't know how to describe it, almost like I have the flu but not really."
"So here's the plan. Obviously you need to be admitted. We need to move the colonoscopy to tomorrow. You can do the prep tonight. You're night gonna like it, but I don't think you'll be able to tolerate the oral prep. So we'll have to do a series of enema's." Jay was clearly not pleased but knew he was right. "It's not as bad as you think. You'll get one at night and two in the morning to make sure you're all cleared out. Nothing by mouth of course. I've already ordered you IV steroids, pain meds and nausea meds. We've got zofran first line and then phenergen second line. If you need something stronger, I ordered a small breakthrough dose of dilaudid. Don't be afraid to use it. I want to see your colonoscopy first before I make any decisions about adding new meds. We'll continue trending your CRP level."
Jay simply said, "okay."
"I'll see you too tomorrow."
Jay didn't have to wait in the ED for long, he was brought up to the GI unit just before shift change. The night nurse got him settled, giving him another dose of morphine before she left.
Jay and Hailey got a few hours of much needed rest. The day nurse came in briefly to introduce herself and get his vitals, but tried to leave them be.
It was a blur of a day, Jay was either in pain or drugged. Will arrived in the afternoon. Last night was his last shift of this stretch, so now he was off for a few days. He was grateful that he could be there for Jay.
Jay looked like he was sleeping so he tiptoed in the room. Hailey was sitting in the recliner next to the bed. "How's he doing?"
"Still miserable, but a lot more comfortable for the most part. He just got a breakthrough dose of the dilaudid so he's out cold."
"He looked way worse yesterday compared to when I saw him last Friday," Will said.
"Ugh I know, he just kept getting a little bit worse each day. I think he was really hopeful that it would be like that flare a couple months ago, so he just kept waiting for the steroids to kick in. The only reason he finally came in was because of the blood."
"Old habits die hard I guess," Will shrugged. "Do you wanna go get some rest, I can sit with him for a while."
"Sure. We've both been sleeping on and off all day, but the last few nights have been so rough, I still feel exhausted."
"Go, I'll be here," Will replied.
Jay continued to sleep peacefully for another hour. He woke up desperately needing the bathroom. Will jumped when he said his name, "Will, help me up, I need to go now." Will quickly unplugged the IV pole and lowered the bed rail, helping him untangle himself from the sheets and blankets. He guided Jay to the bathroom and waited outside the door. Jay came out a couple minutes later looking a little worse for wear, "I can walk by myself Will."
"I know you can." Will smirked as he helped him back into bed. "So what's the plan, Morelock was going to give me an update but I didn't have time."
"Colonoscopy tomorrow, started me on some steroids, pain and nausea meds. Ya know, the usual."
"How are you gonna do that prep," Will asked. "Oh I'm not, he ordered enemas." Jay blushed slightly.
"They're really not that bad, I promise."
"Yeah, yeah Morelock said the same thing. Tell me that when someone sticks a tube up your ass and fills your colon with a liter of water." Will chuckled.
"You don't really have an alternative."
"I know, doesn't mean I have to be happy about it. Can you hand me a vomit bag," Jay asked casually. The nausea had been building and now his mouth was starting to water. He started vomiting a second later. Will presses the call light for Jay, rubbing his back as he continues to retch.
The nurse comes in, "Can I help you?"
"I just threw up, is it time for nausea meds yet?"
"Let me check," she responds as she pulls up his chart. "Looks like it's too early for the zofran so we can do some phenergen."
"Please," she says handing him a new bag. "Here, just in case." She returns quickly, "it's almost time for the steroids so I have those too." She administers the meds and completes a few task before leaving. "Can I get you anything else, how's your pain right now?"
"I don't think so, I think I'm okay for the moment." The phenergen was already started to make him groggy.
"Just rest Jay, I'll be here," Will stated. He turned the TV on keeping the volume low. Jay was in and out, half watching TV, half sleeping, tossing and turning for the next several hours. Naturally he had to get up to the bathroom and needed some more pain meds, but other than that the two brothers mostly sat in silence. He clearly wasn't feeling well enough to chat.
The nurse knocked on the door just before six. "Hey, it'll be shift change soon. Do you just want to get the first enema out of the way, then the night nurse can let you rest hopefully for most of the night."
He groaned, "I guess, lets get it over with,"
"Okay, I'll go grab the stuff."
Will took that as his cue to leave. "Hey, I'm gonna head out, Hailey texted me, she should be back soon anyways."
"Okay, thanks for keeping me company, I know I'm not much fun."
"You're sick Jay, you don't have to be fun. I'll see you tomorrow at some point okay. Try to get some sleep tonight."
The nurse returned a few minutes later. "Let me unhook your IV before we get started," she said as she maneuvred around the room. "Alright so I'm gonna need you to turn on your left side and move your right leg up towards your stomach." He did as told, and could feel the air on his backside. "I'm just tucking a pad underneath you. I assume you're just gonna make a run for it, but just in case." He just nodded, wanting to get it over with. "Here we go try to relax for me," she said as she slid the lubricated tube into his bottom. Jay did not appreciate the uncomfortable intrusion but didn't move. "Okay, you're gonna feel the liquid going in, If the rate is too fast I can slow it down." Towards the end Jay started gripping the bedrail. "Almost there honey," the sweet nurse said trying to comfort him.
"It's all in, I'm gonna slide the tube out and then you're gonna need to use the bathroom." Jay could feel the tube sliding out, he quickly got up to use the restroom. "Pull the cord in there if you need anything, I'll come back and check on you." She finished cleaning up and left him be.
Jay just sat there letting the enema do its things. He felt okay before this but his stomach was starting to cramp up. Once he felt like he was finally finished he slowly made his way back to the bed. As promised the nurse returned. "You get it all out?"
"Yeah I think so, can I get something for pain please?" She pulled up the computer, "What is it on scale of one to ten?"
"Eight."
So it's not time for morphine, do you need the breakthrough dilaudid?"
"Yes," Jay stated. "Can I get something for nausea too?" The nausea was building fast.
Hailey returned as the nurse was finishing administering the meds. "How we feeling," she asked Jay as she sat down."
Jay was zoned out, it took a minute to register. "Uh, okay. She just gave me some dilaudid."
"I can see that," Hailey chuckled.
Jay was just starting to wake after his procedure, still groggy he opened his eyes slightly. He could see Hailey in the corner, talking with Dr. Morelock.
He was explaining quietly to Hailey what he could see, "As expected there were obvious signs of severe ulcerative colitis. I think it's best if we keep giving him the high dose steroids and try a new infusion drug. We'll give it a few days and see if it's effective. His CRP is still rising. I'll come talk to him this afternoon."
"Thank you," she replied looking over at Jay. His eyes were half open.
Dr. Morelock chuckled, "Always a light weight Halstead. I'll be back later."
Hailey walked over to Jay, giving him a kiss on the cheek. "How ya feeling?"
"Great," Jay smiled, clearly still feeling the effects of the drugs. "Yeah, 'cause you're high," she giggled.