Crash (4 page)

8

Pre-Op

Inside an ICU cubicle, there are no windows. There is no clock. Time is measured not by the sun or any timepiece but by subtler changes in routine and personnel.

At the Brigham, the residents rounded early, moving from bed to bed like a many-legged organism. Clipboards in hand, their ranking was given away by the length of their white coats. Medical students wore short jackets. Residents’ coats reached to their knees. Attendings could be distinguished by their names stitched in red cursive above their white breast pockets. Later the residents would be in scrubs of green and blue. But for morning rounds, they were all in their best civvies. The men sported pressed shirts and neat ties. The women wore skirts and blouses, nylons and pumps. Shifts changed. Seven-to-three nurses replaced their eleven-to-seven counterparts. Then there were the people who only worked the day shift: housekeeping, dietary services, social workers, ward secretaries. Lights at the nurses’ station that were dimmed for the night shift now gleamed brightly in all their white fluorescence. The long dark hours of my nighttime vigil gradually gave way to morning’s bustling routine.

A nurse came in and cranked the head of Neil’s bed so that he was sitting more or less straight up. She handed him a glass of water and a toothbrush and laid a kidney-shaped emesis basin on his bedside table to spit in. He looked at them. I waited. Finally he took a sip of water and began to brush his teeth. I exhaled; Thank God. He knew what to do with a toothbrush. At that moment I was again sadly aware of the terrible burden of knowing too much as a physician. What other mother would sigh with relief when her son put his toothbrush in his mouth? He doesn’t have apraxia! Yay!

The nurse and I continued getting Neil ready for the OR. We took turns wrestling with his long curls: combing, brushing, detangling. When the rounding team walked in, we gave up, stuffing the unruly mop under his paper operating room cap.

The doctors on the team included an orthopedic surgeon, an anesthesiologist, and a neurologist. Each came with several fellows, residents and medical students. Each team had its own list of risks they needed to warn us about in the name of informed consent. The orthopod’s plan was to insert a titanium rod into Neil’s lower leg and hold it all together with plates and screws. He warned us of the possibility of bleeding or infection. The anesthesiologist talked about the possibility of more invasive monitoring. Neil was going to the operating room with just a simple intravenous but may need an arterial line or a central venous pressure line, a CVP. The neurologist had his own worst-case scenarios to describe: intracranial pressure monitoring, a Richmond bolt. I listened to them all, understanding the lingo even as I had trouble acknowledging that the body they would be working on was my own son’s. But I was waiting to hear from the trauma surgeon, the ICU attending, who had ordered one more CAT scan, which Neil had had around 4:00 a.m. He wanted to be sure the asymmetry he had seen in Neil’s face hadn’t been a harbinger of a basilar skull fracture. The results of that scan would determine if he should be having surgery on his leg or his head. So when they handed me the consent form to sign, I did something very much against my nature: I refused.

The team was outraged.

“You’ll lose your OR slot,” one threatened.

“Give it away,” I dared them back. “I’m not signing anything until I see the CAT scan.”

Maybe I was turning into that pain-in-the-ass mother everyone hates. But I didn’t care. This was my kid. Meanwhile, Anesthesia was pacing around the room, fuming about their precious OR time. Tough. I wasn’t signing until I was satisfied.

Finally the trauma surgeon came in, examined Neil, and gave us the CAT scan results. Unchanged. I signed the consent form, still wary and worried that with his blood pressure so low, anesthesia would make it worse. There’s something called the watershed area of the brain, which is where the very ends of two blood supplies meet. That precious area can be at risk of having its oxygen supply cut off during times of low perfusion. The result could be devastating; Neil could essentially have a stroke.

They let Saul and me accompany Neil only so far. We kissed his forehead and said good-bye. My fingers reluctantly released their grip on the side rails of Neil’s stretcher as they wheeled him into the elevator. As the doors closed, they told us he’d be gone for a few hours.

“Go to the cafeteria,” they suggested. “Grab a bite.”

We tried. I salted my soup with tears. Saul pushed little bites of burger around on his plate, rearranging lettuce and tomatoes but not eating any of it.

We finally gave up and went back to the ICU waiting room, where we felt more comfortable, even just waiting. We made phone calls, updating friends and family. We worried.

9

The Waiting Room

There is a community that grows up around tragedy—an unlikely camaraderie forged among victims of similar, or at least similarly tragic, fates. Forced to wait long hours together for our loved ones, we gradually became aware of each other’s personal stories. Whether through observation, overheard conversations, or direct mutual disclosure, we came to know one another. Or at least that small, vital piece of ourselves that led us to this place where our lives intersected.

Alice’s husband, Frank, had prostate cancer. This was his second operation. The cancer had spread to his lymph nodes, and the doctors were going after it. He would be starting radiation once he got his strength back. Frank was seventy-two. Alice carried herself with a quiet inner strength. Her voice hinted of the South, a genteel lilt to match her regal frame. She didn’t own a cell phone. I never heard her speak to anyone outside of the nurses who rang us on the waiting room phone to update us on our loved ones or let us in to see them. She spent long stretches of time with her knitting in her lap, but often her hands fell quiet, her mind seemingly deep in thought.

Maura, on the other hand, had a vast network of support. Her partner, Julie, was trying to survive a bone marrow transplant, and her course was perhaps the rockiest of all the ICU patients whose families I met during my stay there at the Brigham. In the waiting room large flocks of women held hands, lit candles, and prayed together. Their community was not restricted to the confines of the ICU walls either. They had designed a web page to update their circle as to Julie’s condition. Friends and family could post photos and share memories about Julie, all of which gave Maura great comfort. She would read long passages aloud, laughing or crying in turns.

Not all the waiting room activity was maudlin. At one point a young hockey player was admitted next door to Neil: another head injury. He had brought a cheering college ice-skating rink to silence when he fell to the ice after a body check and did not rise or even move. He was collared and stretchered like Neil and brought here to the ICU, where now his friends in the waiting room gathered in terrified hugging packs. But the next day the danger was over—he had opened his eyes. He knew his mom. His spine wasn’t broken—and the tears turned to cheers; the hugs turned to chest and fist bumps.

One time a handful of brawny boys, friends of another accident victim, decided to rearrange the waiting room furniture. They stacked end tables on top of one another to make more room and turned a couch to face kitty-corner instead of against the long wall. I watched Alice and Maura for signs of irritation or impatience, but there was none. That’s the other thing tragedy does: puts things in perspective. None of us were sweating the small stuff anymore. I even found the boys’ youthful cheeriness an uplifting distraction from my own constant worry.

While Maura used her turn at the computer to update friends about her partner’s progress and gather family support, Saul and I used ours to keep updated about Trista’s condition and the charges facing the drunk driver. By now we were all over the news, with names and photos. No one knows how the news outlets got hold of the photo that ran everywhere. It was taken at Trista’s semiformal. Trista wore a shimmering blue gown and an even brighter smile. Neil’s haystack of unruly hair sprang out from under his favorite top hat as he grinned into the camera. At first the local newspaper listed both kids’ conditions as “extremely serious,” leaving me some scant hope that Trista would make it. But her eyes with their fixed and dilated pupils had told me differently.

Mary called us often during that first night and the following day, checking on Neil’s condition, updating us on Trista’s. I was so impressed with and grateful for her tremendous generosity of spirit. For her to think of my child as hers lay dying was benevolent beyond words.

The Zincks ultimately made the terrible, beautiful decision to take their daughter off life support and donate her organs. It was the day after the crash. It was the day of Neil’s surgery. I thought about it often: Neil was being intubated for his surgery as Trista was being extubated for hers. We were being told Neil was “gonna be just fine.” Trista was being declared dead. Neil’s surgeons were opening his leg to repair his broken bones. Trista’s surgeons were opening her so that others might live. Each was lying on an operating room table in the same city. Two different Boston hospitals. Two different teams of doctors. Two very different fates. I imagined their two souls mixing in that sweet unconscious space. It gave me some measure of comfort over the following days and weeks to think about that: Neil and Trista, somewhere together, in spirit and unconsciousness.

The phone in the waiting room should have been our lifeline. It was, after all, how the nurses taking care of our son communicated with us. But from day one I disliked that thing. Even though I had been a nurse and was now a doctor and knew the rules of the ICU very well, I always resented the barrier, those rules placed between mother and son, husband and wife, partner and partner. Maybe it was different for me, being a pediatrician. On the children’s ward we recognized the role comforting parents could play in their children’s recovery, or even their reaction to a painful procedure. There have been many articles written in the medical literature over recent years about the positive effects parents report when allowed to remain at the bedside of their children, even during code situations. Apparently no one here at the Brigham had read that literature.

The time we spent listening for that waiting room phone to ring was stretched out, tense. Whenever it did ring, we all looked to one another, wondering who would answer it. There were no rules. If I answered the phone and it turned out the call was for me, allowing me to see my son, I felt vaguely guilty leaving all the others stranded out there, still blocked from their loved ones. If the call wasn’t for me, if it was for Alice or Maura, I would make silent eye contact and lift the receiver in their direction. But if the name was new, if I didn’t yet know who their family was, I would be forced to say their names out loud, then hand off the call. It felt so awkward and impersonal, giving over a phone so casually when the news could be so grave. What was the proper look? A slight smile? Pursed lips and worried eye contact?

Sometimes we learned what happened to people. Sometimes we didn’t. Regal Alice just one day stopped appearing. The hockey player was discharged to his family, a bad concussion but no brain bleed.

Maura’s partner did not survive her transplant. Small crowds hugged and cried in the waiting room. Maura still drew comfort from her web page. She read fitting tributes aloud through tears. Family and friends again lit candles and prayed, this time not for Julie’s survival but for her peace. Sitting on the corner of the couch, waiting for Neil to return from the operating room, I tried to make myself small, to give the room over to Maura in her grief. Part of it was out of respect, but part of it was also out of fear. Being part of the waiting room community was one thing, but I did not want to be a part of this new group: the grieving community. I felt a great gratitude in that moment. Neil was alive. He was coming home. We didn’t know what awaited us. But we knew it wasn’t this.

The surgeon finally came in to say that everything had gone well. He showed us the X-rays, smiling. So proud of his work. None of my fears had come true. Neil’s blood pressure had remained stable, his heart strong. No bandaged head. No ventilator. Nothing more invasive than a simple IV. He came back to us just the way he left us: sleepy and confused.