As I lay unconscious on the gurney, a nurse clamped a mask over my mouth for a couple of minutes to make sure I would have enough oxygen in my system while the attending team performed the intubation. After removing the mask, she tilted my head back as a young doctor approached with a hand-held device topped by a long, curved beak. The doctor opened my mouth, extending her first and third fingers like a pair of scissors to insert the smooth, dull blade of the laryngoscope on the right side of my mouth. She swept my tongue to the left and lifted it off the back of my throat to provide a clear view of my glottis and vocal cords. This in turn revealed the dull, wet, contextless flesh of Gigerian nightmare, ready to be invaded by a life-giving endotracheal tube.
The clear PVC tube was about one centimetre in diameter. A thin blue line of radio-opaque material running along its length was intended to make it more visible in a chest X-ray and gave it the appearance of a long, child’s straw. To make it easier to pass through the curtain of vocal cords, and give the inserting physician a better view ahead of the tip, the end of the tube was bevelled. The doctor passed it just under a foot past my incisors and secured it at the corner of my mouth with surgical tape. The laryngoscope was withdrawn, an X-ray confirmed correct positioning of the tube, and the ventilator was attached. Now the tube could do its quiet work and wait for the moment its surprising length would be dragged out like a string of magician’s handkerchiefs, lamprey mouth permanently agape.
I was spared a feeding tube. The official line was that this would not be necessary until a number of days had passed. Beth fretted that the decision was due to a medical conviction that I would be dead or unplugged soon enough in any event.
They measured my blood pressure three times, on three different monitors, because each time they thought the monitor was malfunctioning. No one could quite understand what exactly was going on, so I was rushed in for a CAT scan. While the resources of a major Brooklyn triage unit were being allocated to saving me, a man on the other side of the curtain was shouting his frustration that no one was attending to his mother. They’d been waiting a while. Mother hadn’t been lucky enough to achieve a nine-in-ten chance of death, I guess.
In fact, apart from the 90 per cent likelihood of my impending death, our luck was holding up. As well as being lucky that Methodist was so close to our apartment, we were fortunate that, although I had just lost my job, I had been able to keep the health insurance I had maintained through my work. Healthcare in America relies on a system of hospitals mostly owned and operated by private business and paid for by private insurance. People aged under 67 get their health insurance either through their employer, or a family member’s employer, with their premiums coming out of their pay each month; people on low income who meet certain other requirements are eligible to receive government help with medical costs. I was able to continue my insurance for an initial period of eighteen months pursuant to a statute commonly known as COBRA – so long as we could find the $769 a month to pay for it. At least for a while we didn’t have to worry about, for example, me being denied new insurance coverage due to having a pre-existing condition – like, for example, the toddler who hit the news in the States when he was denied coverage for the pre-existing condition of being too fat. Or, you know, a toddler.
I had pretty decent coverage, too. Which was good, because Beth had enough to worry about without finding out, say, that after four days of treatment my insurance wasn’t going to cover the costs and the bill was standing at $80,000. There was still going to be plenty of paperwork and co-payments and suchlike to take care of. It’s hard to explain how forbidding the US healthcare system is to someone who’s grown up with the NHS unless you’ve experienced it.
When the CAT scan was complete, the young doctor who had intubated me came out into the hallway to explain the situation to Beth. She was young and serious, with her long, dark hair pulled back into a bun.
‘Beth? The scan has confirmed that Ricky has suffered a bleed in his brain.’
‘Is that good or bad?’ Beth asked, instantly wincing at how daft the question must sound. ‘I mean, is that better than a clot?’
The young doctor explained the thing about clot-busting medication.
‘So what do we need to do?’
‘We’re going to work on trying to get his blood pressure under control. The earliest we can schedule a procedure to reduce the pressure on his brain is 8a.m., after the surgical staff report for work. You need to rest.’
Beth wouldn’t leave the hospital, so a nurse escorted her to a little waiting room. It wasn’t a place made for sleeping. It was furnished with a short, two-seat, faux leather sofa. Beth curled herself up in it and started sending texts. She started with her best friend, a junior doctor. Dr Cowen to his patients, John to his fellow residents, and Sparky to his friends. Then she texted her mother.
In the morning, Sparky called for the latest news, and heard that I was due to enter surgery. Then he rang Beth’s and his former flatmate, Mat, to tell him that he shouldn’t expect to see me again. Beth’s mother Kathy called back to make plans to come to Brooklyn. Beth felt guilty about that.
She felt guilty about that. She felt guilty about being alive. She felt guilty about the M&Ms she’d been eating from the hospital vending machine. She felt guilty about trying to get some sleep. She felt guilty about everything. She couldn’t sleep. How could she sleep, while I was under the knife somewhere between life and death? Would she feel it, when I died? She scanned her mind, searching for a feeling that I was still there, or departed.
She felt neither.
Meanwhile, around nine hours had passed, during which my hair had been shaved and two holes had been drilled into my head, an inch or two above the hairline, each a couple of centimetres off the midline. The holes had punctured my skull, and a plastic tube had been inserted into each hole. The other end of each tube had been placed in a receptacle by the side of the bed, so that gravity could start to do its job. The process was similar to the siphoning that was involved in my father’s home wine-making. The receiving containers had been checked, measured and recalibrated every hour, and the strength of the suck had been adjusted by changing the height of the containers. The big difference to home wine-making was that in that case, you’re siphoning the good wine away from the sediment. In this case, the bad stuff – the sludgy mix of brain fluid and blood – was being removed from the brain. Also, they hadn’t started the extra-ventricular drain by sucking on the other end.
There may have been other differences, too.
It was a relief for Beth when another doctor eventually came in, for a second at least. Then she remembered what he might be coming in to tell her.
‘Miss Monahan?’ He extended his hand. ‘I’m Michael Ayad. We’ve finished Ricky’s procedure.’
‘And what procedure was that?’ They were both sitting by now, and Beth fixed Doctor Ayad’s eye. ‘Why won’t anyone tell me what’s going on?’
Beth was lucky in the doctor she was talking to. Michael Ayad had a nerdy and vocational devotion to medicine, just like Sparky. He was the sort of doctor who credits his patients and their loved ones with enough intelligence to be able to process properly channelled information. In a pleasant voice – sonorous, with that hint of the South that suggests an appropriately unflappable attitude – he explained what had been happening for the past eight to ten hours.
The brain doesn’t react well to a sudden influx of blood. One of its design flaws is that blood is an irritant to it. Blood gums things up. Meanwhile, the body continues to produce cerebrospinal fluid. ‘A Coke can’s worth of the stuff every day,’ Ayad told Beth.
The body has to drain all this fluid somehow. It turned out that the projectile vomiting hadn’t been some sort of fight or flight reaction, nor the nausea brought on by the sickening touch of the fingers of Death. No, the news was both better and worse than that.
I was experiencing increased intracranial pressure; a rise of pressure inside the skull. This can resul
t in one of two events. The first is a midline shift, a shift of the brain past its centre line, which is A Bad Thing, because it’s commonly associated with a distortion of the brain stem, which, in turn, can cause serious dysfunction. The second possible event, downward pressure on the brain, on the other hand, can cause death. This brain herniation puts extreme pressure on, and cuts off the blood supply to, various parts of the brain as one part of the brain is squeezed across structures within the skull. The pressure might even push your brain tissue down through the small opening in the skull near the brainstem, resulting in irreparable brainstem damage, paralysis, coma or death.
Beth decided that she would never look at one of those brain-shaped stress toys in the same way again.
‘What happens now?’ she asked.
‘We wait.’
They waited.
Beth stayed all day, not least because she couldn’t face going back to our apartment. Cole and Neal, a couple of friends from her business school, came round to express sympathy and disbelief. Eventually, Sparky drove over and he and Beth went back to the apartment, where he stripped the bed and cleaned up the mess. Then, while Beth fed and watered our cats, Seamus, impish Geronimo, and soft, shy, one-eyed Cyclops, he went to the airport to pick up her mother, Kathy Monahan, who had arrived from South Carolina to help fill the now vast and empty bed.
Beth would continue to look after the cats and continue the most basic level of maintenance of the flat, but would remember nothing of that. What had happened to us was all-consuming. Each morning before she went to work, Beth would cue up ‘Classy Girls’ by the Lumineers on her phone and walk the few blocks from our apartment to Methodist to sit by my bed and knit, or practice her needlepoint. It was all very homey, and the needlepoint was something she had had a yen to try for a while. She had picked up two beginners’ kits. One picked out the words, Don’t Be A Dick. The other read, I Will Cut You.
Yeah, Beth was a classy girl all right. It made sense that the Lumineers’ track would be one of our songs; she even had a T-shirt she wore on our first date that described its wearer, in strategically ornate and illegible script, as Fucking Classy.
That first date had followed a series of chance encounters at Harry Boland’s Pub, which Beth passed just three blocks to the west as she made her way to Methodist. I had given Harry’s a wide berth when I first moved to the neighbourhood. With its name painted in a coagulated and curdled blood red above heavy black window shutters, Harry Boland’s looked as though, were it in Edinburgh, it would have been the perfect place to go to get a good kicking. Harry’s, however, turned out to be a quiet drinkers’ pub that was open at whatever late-night hour I made it back from work. At my regular stool at the far left of the old, intricately carved bar, surveying the options thickly packed into the shelves of liquor, I could let the booze and the music from the jukebox wash over me, relax, and not worry about complicating a busy life by running into temptations of the flesh.
So it still feels a little ridiculous that even now, I can vividly picture the version of Beth Monahan who sat at the end of the bar at Harry’s. Like me, she didn’t want to deal with being hit on when all she really wanted was a Guinness and some time with her book away from her flatmates. Outside of this bar of hardened drinkers, that might have been difficult. Beneath her long, straight brunette hair and funky glasses, she would smile with her whole face. Lithe and slim, her jeans cleaved to her hips as perfectly as the shirt that outlined her small, jaunty breasts, and she moved with an alluring confidence and comfort in her body. She hated the attention that the accident of her beauty and the amused confidence of her intelligence drew. The word she hoped people would use to describe her was irreverent.
She had nothing to worry about from me, though. Her don’t-bother-me vibes didn’t have to work too hard to discourage a jaded guy in his mid-thirties from Scotland’s famously repressed capital. There’s a reason Danny Boyle had to turn to large cases of money and heroin addicts to get a few movies’ worth of emotion and action out of the city of Edinburgh.
The bar was tended by Andy, a tall, slim guy who was missing a toe. Grinning beneath a mass of light brown hair, he had an air of Shaggy from Scooby Doo about him that belied a wicked sense of humour. Our bartender and mutual friend, he introduced Beth and I one evening in November. It was a work night, and we were the only three people in the bar.
‘Do you guys know each other? C’mon, sit together. I think you’ll get along.’
Andy probably just wanted to cut down on the time he was spending walking the length of the bar. Regardless, it turned out that despite an initial caginess, the intriguing, enchanting young woman and I couldn’t help but get along. We discovered a shared passion for Scrabble and graphs representing the lyrics of rap songs. We began to play online games and email from time to time. After we had spent many hours over some weeks chatting in the bar, Beth sent me a Facebook quiz about herself. Playfully, to find out if I had been listening. Taking it, I discovered that she considered her long, smooth neck to be her best feature. Her guilty pleasure was a fondness for the movie Die Hard.
Our mutual attraction gradually began to assert itself. Like the sun, it was always there. It provided me with the light I needed to live, cooped up under fluorescence all day, every day, thousands of miles from my natural habitat. We couldn’t look at it directly, though; after the failure of her first marriage, the young divorcée had decided that a long-term relationship was not for her. My marriage had fallen apart, too, and when I had visited a therapist to discuss the ensuing situational depression, she had asked what I wanted to do next. I had told her that I just wanted a nice little flat where Elizabeth would be comfortable visiting, and I could read my books and learn to play my guitar again – no complications.
Then Tall Jamie came for a visit.
Jamie was a friend of Beth’s from South Carolina. She was matter-of-fact about sexual matters, and curious about what other folks got up to in the bedroom. When she visited Beth on her way home from a work trip to the north-east, they went to Harry Boland’s together. That night, Beth and I chatted as usual, and when she went to the restroom, Jamie and I passed the time.
‘Have you ever had a threesome?’ she asked.
I hadn’t. I didn’t want one now. Not because I wasn’t sure how the mechanics work so that one of the three isn’t relegated to checking their Twitter feed on the phone, although I wasn’t. Not because Jamie was unattractive; she wasn’t. Not because I’d fallen for Beth and simply wanted to focus on the way her arms would wrap around me, and the painful pleasure of her nails tearing my back . . .
No, wait. That was exactly it.
I confessed to Tall Jamie my attraction to her friend, and she retreated, job done. A short while later, Beth and I found ourselves sitting on the wooden bench that faced away from the bar. It was hard and unforgiving. The ornamentation was minimal.
‘You know,’ I told her, ‘this reminds me of the pews of my mother’s church in Scotland.’
‘Really? You don’t strike me as the religious type.’
‘I wasn’t. I’d sit there in the front row of the balcony, thinking of my latest crush. Just like this.’
We both smiled, and our eyes locked, looking for confirmation. For the first time, we kissed.
Chemicals reacted, fireworks erupted, lights exploded.
On that casual first date when Beth wore her Fucking Classy T-shirt, I presented her with a crash course in single malt whiskies. She immediately graduated to Laphroaig and other smoky Islays.
‘It tastes of salt and sea and sex,’ she declared, and I abandoned the sweetness of my former Speyside favourites for something more complex.
We discussed the circuitous routes that brought us to New York City. She, by the escape pod of business school after her parents had moved her as a sixteen-year-old from Rhode Island to South Carolina, and she had become an accountant after studying at the University of South Carolina. Me, via a series of exchanges and scholarships th
at had led to a decision to spend a couple of years in the city, ten years, a million dreams and a young daughter ago.
We played darts together. I found out about her geeky interest in the NYC subway system. We wandered late-night streets after forgetting coats at parties. She discovered my obsession with downbeat British pop music. We picked up temporary tattoos of black hearts at a local coffee shop together.
One night, as we lay in bed, Beth told me about the time her former marriage counsellor had shared her own strategy for dating. The counsellor hadn’t wanted to waste time on relationships that didn’t have the potential to last, so she asked potential suitors a series of questions to separate the wheat from the chaff. Beth had come up with her own set, and shared them with me. Would I consider having another child? This was something I hadn’t previously considered, but the answer was suddenly obvious. With the right person, of course I would.
Would I contemplate raising that child as a vegetarian? Again, the answer was ‘Yes’. The ideal version of me that was buried deep inside the hard-nosed financial lawyer who ate whatever he could pick up at his desk before getting a couple of hours respite at the bar and starting again didn’t want to eat meat. He wanted to be better in so many ways.
A month later, we were walking from the bar to Beth’s apartment when she gave me a meaningful look. ‘You know what I love?’ she asked.
My heart didn’t have room to beat in my chest. It squeezed up through my throat to catch a glimpse of the woman who was causing adrenalin to flood my body.
‘Grapefruit juice.’
She smiled, and I knew what she meant. Things were moving quickly, and a girl and boy each with a failed marriage behind them were too canny to say it yet.
I could only reply, with enthusiasm, ‘Me too. I love grapefruit juice, too.’
The exchange of signals was clear, and a week later, we were back at Harry’s again, choosing tunes together at the jukebox. I sat on the counter, a low wooden dividing wall that jutted into the bar space on the right of the jukie. Beth nestled between my knees. Our eye-beams twisted, and threaded our eyes upon one double string. I could see her thinking, weighing her words.
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