It was right after the New Year and I had instructed my staff to call Jesse and let her know we had all of her exam results back. She already had a tentative appointment, but I encouraged her to come in sooner if possible. Her problem with her monthly cycle was obvious, and unfortunately to common for women today. Endometriosis can be a debilitating and crippling disease for those who suffer from it year after year. And for a long time, doctors have only prescribed either medications or major surgery as a method of relief. But there have been new technologies and treatments being developed everyday. Medical Science undergoes an incredible transformation every ninety days with the introduction of new procedures and therapies. And I hoped that we, Jesse and I, could find a way to relieve her pain and sadness. If she would just trust me.

I immediately began studying and researching the newest methods of treatment, ones I had not used myself before. I knew I could always perform surgery on Jesse if that was the way she chose to go. However, she was a beautiful young woman, and I struggled through each new paper and study to put my personal feelings aside in the hopes of finding the best course of treatment for my patient. Her health and well being mattered the most to me. So that when I entered the exam room on the day of her appointment, I was prepared to discuss a number of options for her.

We covered new drugs and drug treatments available now. Endometrial ablation which I could do in my medical suite. Laporoscopy surgery also in the medical suite, but one upgraded for outpatient surgery. And, of course, radical surgery with the removal of her uterus and cervix, as well as her ovaries to stop the production or hormones done at the local hospital. Additionally, all of the endometrial tissue growing on the outside of her organs would be removed with either procedure, laporoscopy or hysterectomy. I spoke directly to her, trying hard not to show my own distress at her condition, and remaining hopeful that we could change her life. Maybe both our lives. Do you understand all of your options, Jesse? Do you have any questions? She looked down at her hands knotted in her lap and gave me her trademark nod. What would you do? I so wanted to take her in my arms and hold her, but instead I reached for her hands with mine and held them for a moment before looking directly into her eyes. I explained how I could not make the ultimate decision for her, but because of an extensive study I had read in the Endometrial Extension Program of Ireland, I felt a treatment of laporoscopy surgery and medications would be our best hope. We agreed to go ahead and I wrote out quick instructions for her to take to the scheduling desk. Right now the only thing we would find out today was when everything would happen in the near future. Before then, though, she would need several appointments for lab work, CT scan, pre-op physical, all to be completed and results to be studied before her procedure. Of course, relief could not come fast enough, so I promised her everything would happen as quickly as possible and I would see her again soon. As she turned to go, she stopped and turned to face me. I can't thank you enough for caring. I've had a couple rough months and now I finally feel . . . I couldn't stop myself from hugging her tightly and all I could say was "Jesse". It seemed like a long time passed before we slowly seperated, our faces so close. For a moment, I was sure our lips would meet, but my pager shocked me back to reality. I pressed the button on it and we released each other. Take care I said, and Jesse nodded.

Things happened quickly, Jesse's lab work and CT scan results arrived in my office within the week. And she was scheduled for her pre-op physical on the coming Monday. It was a quiet weekend for me and I was often preoccupied with thoughts of her. I stopped my home projects from time to time to sit down at my computer and look up more information for the procedure, follow-up and restrictions, possible complications and new medications, all of which I had read before but needed to reassure myself. I found another paper on a technique that could be used in conjunction with the removal of the bad tissue that could possibly enhance the healing process, and to my surprise, remained up nearly all night reading it. My first all nighter since college.

Jesse and I anxiously greeted each other on Monday in the exam room. She was already in her exam gown and I promised that this would be the last one like this that we would have to do for awhile since we had been in that same situation four times since out first meeting. For the first time, she looked at me and said, It's okay. You've already done so much to help me. Now I have hope. Now it was my turn to nod. I quickly checked her ears, eyes, nose, and throat. Felt the glands in her neck. I put the stethoscope in my ears and listened to the blood flow in her neck, then reached around behind her and instructed her to take deep breaths. For the first time, I was more aware of her smooth, clear skin, slightly tanned like that of an athlete in a sports top. Do you run? I asked. Yes. I'm pretty into conditioning. I partially lied and said I could tell because her lung capacity was exceptional. She laughed slightly and thanked me. With my scope still in my ears, I moved around to the front of her and lowered her gown so I could listen to her heart. Again, it was strong and steady. Great, Jesse. I removed the scope from my ears and stepped in front of her. Lowering her gown to her waist I asked her to put her hands on her hips. I was again amazed at how I could've missed how beautiful her skin and breasts were. Now behind you head. I palpated each breast and was secretly pleased to see her erect nipples. Okay, let's lay you back, and I pulled out the end of the table for her legs. I lifted each of her arms over her head as I checked her breasts again, moving my hands down her ribs and under her sternum. Ticklish? I asked and there it was, the nod. I thoroughly palpated her abdomen and slipped my hands under her back to feel each kidney. Do you have any discomfort anywhere I've touched, Jesse? She indicated no, so I continued to examine her belly. I tried to feel deeply in her pelvic region, and I was aware of the discomfort it caused her. God, I would be so relieved when this was over for her. I palpated her belly all the way down to her mons, and then put my stethoscope back on. I listened carefully to all of her belly sounds. I nodded, and removed it. Okay.

I ran my hands down her legs checking her knees and ankles. The strong muscles and joints of an athlete, and I placed each foot into the stirrup. Here we go again, I said, and we both smiled. I pushed the end of the table in and out of the way. Jesse easily half sat up and slid towards me. Great, I said. I already had a small intense light ready, so I quickly washed my hands and pulled two blue gloves from a box. The gown slipped back to her waist and she parted her legs. I quickly inspected her externally. First, today I'm going to do that pap since we've talked about but not done it yet. I remember, she said. I slipped a speculum in her, did a visual of her cervix and took three different scrapings, slipped them in formula bottles, slowly removed the spec so I could check the sides of her vagina. She exhaled a long, slow breath. Doing alright? Oh yeah, she said. I stood and lubed my fingers, and as I turned back to her, our eyes met. For a moment, I felt as if I couldn't move. I stumbled across a word or two and then said, Just a little pressure now. She held my gaze and barely smiled. My heart was beating in my ears. Feels good, I said, as I finished her exam. I removed my fingers and pulled off my gloves, and as I turned to get her a tissue, I knew I was blushing deeply. I turned again and handed the tissue to her as I extended my hand to help her sit up. We were both silent, but it did not feel awkward. Thanks, Jesse said. Jesse, I wanted to just say . . . I was about to apologize for my indiscretion the week before, but instead, I really feel confident in what we're doing. Please trust me, okay? She nodded and said I do. Then I'll see you next week. We both smiled.