A/N: Thank you for your patience! This chapter details Sara's visit to her doctor so you will know what the bloodwork results are. We had pre-written several chapters before people begged to know what was going on so we had to make sure they all got posted :) We hope you enjoy!
Arriving at the doctor's office Sara had no idea what to expect. Since the office staff had been less than accommodating in giving her heads up about her results, she was in the dark. Grissom sensed her tense and squeezed her hand assuring her that everything would indeed be okay.
"Sara, your blood test showed increased prolactin levels. At least 20 nanograms higher than normal. Additionally your testosterone levels were much lower than average. Have you noticed a change in your menstrual cycle?"
Sara's periods had changed around the time she left Vegas a few years ago, but she'd always assumed the change was stress induced. When that didn't change with time she just assumed she must be going through early menopause and had not bothered it get it checked out.
"Well Sara when we see levels like this our first thought is a prolactinoma."
"A tumor on the pituitary gland?" Gil answered.
"Yes, a benign tumor. They're not life threatening but they must be addressed. For starters they can cause amenorrhea and infertility. While not life threatening, if left for long they can grow and with time cause more issues like osteoporosis. We can confirm the presence of a tumor with an MRI of your brain. If one is present then we have a few treatment options. One would be medication to try and shrink it and the other would be surgery to remove it. A rather routine procedure done through the nose. A last resort would be radiation if the other two options are not viable."
"Why would the first two options not be viable?" Gil asked. He could tell that Sara was still trying to take it all in so he was asking questions until she had time to absorb everything.
"Well there are two types of prolactinomas. Micro and macro. Generally we can remove micro tumors through surgery. Larger tumors we try to shrink with medication if a patient is a candidate. Unfortunately the two medications used are both dopamine receptor agonists."
Sara squeezed Gil's hand tightly. They both knew what those drugs meant. That class of drugs had a chance of causing schizophrenic episodes (hallucinations) and were not advised for anyone with a family history.
"Now Sara with your family history of schizophrenia it is not advised that you take those drugs."
"So what happens then if she does have a tumor?" Gil asked, not sure how he was able to get the words out. The doctor has said it wasn't life threatening but all he kept thinking was that Sara might have a tumor technically in her brain and he was willing himself not to panic.
"Well we need to see the size first. If it's small enough we can do surgery. If not we can discuss radiation as an option. But let's not panic. Let's order the MRI first and go from there. Remember this is a completely treatable condition."
They left the office in a slight state of shock. The tumor would explain why they'd never conceived a child. By the time Gil joined Sara in Costa Rica they had stopped using birth control. On the one hand they were both in a place in their lives where they would happily welcome a child and on the other Sara was convinced that maybe her wacky periods were a sign that she was hitting menopause early. Gil had told her that if they never had a child it didn't matter. What mattered was that they had each other. He meant that but that didn't mean he didn't dream about a child with curly hair and a gapped tooth smile.
Sara's MRI was scheduled in two days so they took the time to research all they could about prolactinomas and the various treatment protocols. They both decided that medication was not an option. With Sara's mother having schizophrenia it wasn't a risk they were willing to take. Both Gil and Sara, still maintained hope that there wasn't even a tumor but they knew at the end of the day they just had to wait and see.
Sara was a nervous wreck the morning of her MRI though she did a fantastic job of not showing it. When the test was done they said the doctor would be calling within a few days to discuss the results.
Two days later the doctor called and asked the pair to come down to her office. She said she'd fit them in later that afternoon. Gil held Sara's hand the entire time the doctor spoke. There was a tumor and unfortunately it was a macro sized tumor. It was one of the rare ones that didn't increase prolactin levels too much, leading one to think it would be small. This tumor was too large to be removed via surgery and so now the doctor said radiation was our best option.
"Now radiation therapy has come a long way. It's quick and painless. The biggest concern we have is deciding which type to use. Based on the location of the tumor relative to the optic nerve. I don't want to tell you there are no risks but since this is a rather large prolactinoma it is closer to the optic nerve than we would like but radiation therapy is still our best option. I am going to refer to a colleague of mine, Dr. Jeffers. He's a world class oncologist. And before you say anything, yes the tumor is benign but since you require radiation therapy it's best you see him for treatment."
They made an appointment with Dr. Jeffers for the following day. He was kind and patient and explained that since Sara's tumor was close to the optic nerve it ruled out the use of a cyberknife procedure, where a concentrated dose of radiation was given, usually all in one shot. This meant she would need small dose treatments 5 times a week for the next month. The doctor was confident about the prognosis and assured them it was the safest way to remove the tumor hopefully without affecting the optic nerve. The downside to this type of radiation was that it could lead the pituitary gland to stop functioning altogether and in that case Sara would need to be put on hormone replacement therapy.
They walked out of the office hand in hand. Sara's treatment was scheduled to start at the beginning of the following week. She'd be receiving treatments Monday-Friday for the next four weeks. Luckily each treatment lasted less than 20 minutes as Gil knew how much Sara hated doctors and hospitals.
The ride home was done in silence. Grissom understood that Sara had two modes when she was nervous, she was either an over talker or she was silent. It was in the latter moments that Grissom knew Sara needed time to process her feelings. As someone who responded similarly to stress he gave her space only holding her hand in his free one on the drive home.
When they walked inside Sara immediately went down to sit on the couch in the living room. She hadn't yet said a word since leaving the doctor's office. Grissom decided to make them both some tea and when finished, he sat next to Sara on the couch, silently handing her the cup.
She took the cup without acknowledgement. Sara thought about all the information she'd received. While still troubling, her prognosis was good, but that really wasn't what was bothering her. She thought about the past. About Costa Rica. About their decision to forgo birth control and see what happens. Nothing happened and Sara now knew why. She was the reason.
When Sara was younger she was adamant that children were not in her future. Her childhood had been far from ideal and she felt that she never learned how to be a mother. All the little things she should've picked up from her mother.
When she met Gil a part of her started to change. Once they were in a relationship a part of her delighted at the thought of a little boy with curly hair and blue eyes. One who's constant thirst for knowledge and adventure kept him exploring till his rosy cheeks were caked in mud as he smiled to show her his latest discovery.
Vegas never seemed like the place to raise a child. Their lives were always so busy and that would involve having their relationship out in the open. Sara had seen how Catherine had struggled raising Lindsey. While they were in Costa Rica something changed. Their lives weren't so hectic and their relationship was no longer kept behind closed doors.
Gil had confided that he'd dreamt of a little girl with dark curly hair and her mothers captivating smile. So they'd decided to see what happened. If a child was in their future great, if not that's ok too.
They'd said it didn't matter but somehow Sara didn't feel that way now. Her mind was a jumble and her emotions were all over the map. She appreciated that Gil wasn't pressuring her to talk because she wasn't sure she'd know what to say.
Gil reached over and silently squeezed her hand letting her know that everything was going to be alright.
When he rose and made his way toward the bedroom, Sara silently followed. She needed rest to calm her throbbing thoughts and Gil always understood her needs even better than she did. All was well intended in theory but she could feel every nerve ending in her body vibrate with awareness of her new situation and all her past thoughts and fears and dreams came rushing in. Sleep wasn't going to comfort her tonight.
