The Perfect Predator

by Steffanie Strathdee

  I waited for what seemed like an eternity. Tom’s eyelids fluttered, but they were glued shut with yellow crust. Chris wiped his eyes with a warm cloth. I stroked Tom’s cheek with my blue-gloved fingers, willing his eyes to open. Then suddenly, they did. His eyes were slightly unfocused at first, but when he looked at me and smiled faintly, my insides went to jelly. Tom’s lips were gooey and cracked and his teeth were furry, but I couldn’t care less. My husband was back. As I leaned over him to give him a little kiss, his lips puckered to kiss me back and he nuzzled my neck. I heard a whimper and realized it was coming from my throat. Tears streamed down my face. Tom looked around the room, bewildered, then he looked back at me. I could tell that he didn’t know where he was and that he was surprised to see me crying. But at least he knew who I was. Or at least I thought so.

  “Welcome back, babe,” I whispered, wiping away my tears. “You are in the Thornton ICU. Do you remember getting sick in Egypt?”

  Tom stared at me blankly and shook his head no.

  Oh no. Here we go again. How many times had we gone over this? Was he going to have amnesia? Or worse, permanent brain damage? Or was this just another round of the old ICU psychosis? I looked at Chris with alarm.

  Chris read my mind and put his hand on my shoulder. “Don’t worry,” he said quietly. “It’s common for patients coming out of a coma to be disoriented or to have no memories of how they got here at first. Just be patient. For now, just tell him the basics.”

  That made sense. We couldn’t overwhelm him. Deep, cleansing breaths.

  “Honey, you went into septic shock after your drain slipped inside your gut and the superbug infection spread throughout your body.” So much for the basics. I took another deep breath and began again, my voice trembling. “You were in a coma for… for a while.” Yeah, as in off and on for nearly two months, I thought. But maybe he didn’t need to hear that right now.

  “Chip and I gave you the experimental treatment I told you about before. Phage therapy. After a bad turn, we think it’s working. Things were touch and go for a while, but you are going to make it now, babe! I love you so, so much. Just please, hang in there. You’re doing great.”

  Tom still looked confused, but my explanation seemed to placate him. He squeezed my hand and his lips moved to speak, but he couldn’t talk since he was still on the vent. His hands thrust almost reflexively to his neck, to pull at the ventilator hose. But after so many days of the same routine, Chris and I were ready. I grabbed one of Tom’s hands and Chris grabbed the other before he could yank the ventilator tubing out of his neck. Tom glared at us, me especially, his eyes full of betrayal.

  Chris gently took Tom’s hand in his and crouched down so he could look Tom in the eye. “Tom, buddy. You had a tracheostomy so we could put you on a ventilator. To help you breathe. Just trust me, OK? Keep your hands away from your neck and try to relax.”

  Hearing this, Tom stopped straining and let his head fall back on the pillow in frustration. His lips started to move again. As he processed Chris’s words, he gurgled, suddenly remembering all over again that he couldn’t talk. I waited to see if Tom could mouth the words to whatever he wanted to say. Maybe something profound or momentous, suddenly freed as he was from the months-long prison of the coma.

  Water, Tom’s lips said. Not profound. Obvious.

  I was almost positive he wasn’t allowed to drink anything, but after the death stare Tom had just given me, I wasn’t going to be the bad guy. That was Chris’s job. I asked Chris innocently, “Can he have water?”

  Chris shook his head no, vigorously. “Not while he is on the trach,” he replied, giving me a sharp look like I should know better. “But he can have this.” He approached Tom with one of the tiny sponge lollypops we could dampen and use to wet his mouth. Tom’s face blanched and he turned his face away. Selective memory, I guess.

  I heard a voice from the doorway. It was Dr. Kim Kerr, the director of the ICU. “And no, he can’t have ice chips either,” she said, wagging her finger at us. “But the fact that we are even discussing this has just made my day!” She was beaming. Dr. Kerr had just been named Physician of the Year, and I knew why. She made every patient and their family feel special. Behind the reception desk, Joe, Meghan, and Ray had heard the news. They were glowing, and gave me a wave and thumbs-up before going back to their duties.

  Marilyn joined Dr. Kerr at the doorframe to Bed 11. “You saved his life, you know,” Marilyn said softly.

  “We all did,” I responded, my voice catching. “We all did. Your team here is awesome. We can’t thank you enough.” I stepped back to take a photo of Tom with my cell phone. I wanted to remember this moment forever. Under my breath I whispered “thank you, God.”

  Behind her was Joe Ix. “Well, I’ll be damned. Look who’s awake! My God.” Joe’s jaw practically hit the floor. “It’s a miracle. Really, I have never seen a turnaround like this before. And phage therapy. Just… wow. Congratulations, Steff! At this rate, he won’t need dialysis. My team will keep monitoring him for the next few days, just in case.” And with a little wave, he joined the nephrology fellows and proceeded on his rounds.

  Within the hour, Frances arrived. Her face was pale and drawn and I suddenly noticed how thin she had become. She came to a dead stop down the hallway as she approached Bed 11 and looked at me in a panic. She had immediately drawn the same wrong conclusion I had earlier, assuming the worst when she saw the throng of doctors and nurses clustered at the doorway of Bed 11 to bask in the glow of our medical miracle. In an ICU, more often than not, a crowd like this usually meant code blue, or that a patient had died.

  “Fran, your dad just woke up!” I exclaimed as I pranced around the bed, ending up in front of her. We gave each other a bear hug. I could feel her rib cage, and I knew her heart was beating wildly within it. “He’s sleeping now, but it looks like he is finally on the mend.”

  “Do the doctors say he’s going to live?” Frances asked me in a quiet voice, in case her dad could hear.

  “They haven’t said that exactly, but there is more hope around here than we’ve had in a long while,” I replied carefully.

  Frances sat down silently, taking it all in. After a few minutes, she picked up a small whiteboard that was used to communicate with patients who couldn’t talk. With a black marker, she started drawing a picture of a flower. I looked over her shoulder as she wrote above it:

  No Mud, No Lotus.

  She looked at my puzzled expression. “It’s one of my favorite parables by the Vietnamese philosopher Thich Nhat Hanh,” she said, as she wrinkled her nose. “I’m sure I’m mispronouncing his name, but basically he says that just like the lotus can’t bloom without mud, we can only achieve enlightenment if we embrace suffering, rather than trying to avoid it.”

  I looked at her in wonder. Like Tom, Fran and Carly constantly surprised me with a kind of grounded energy at times when it would be easy to be overwhelmed by the emotional charge of the moment. At least it was a positive charge, for the first time in a long time.

  “We should all be well on the way to nirvana by now then!” I replied.

  Tom reopened his eyes, as if on cue. He and Frances exchanged a tender embrace, and there were more hugs and tears all around. Minutes later, Chip appeared, wearing his white coat over a pair of Dockers and a plaid shirt. “I ran into Kim in the parking lot,” he grinned, taking in the scene.

  “Honey, Chip led the protocol for the phage therapy that saved your life,” I told Tom proudly. “What do you think of that?”

  Tom looked up, and gave Chip two enthusiastic thumbs-up and a big smile.

  Chip clapped his hands together and let out a belly laugh. He opened his mouth to say something, but had to pause as his eyeglasses steamed up and he removed them to give them a wipe. Gathering himself, he finally responded to us.

  “Moments like this remind me why I became a doctor,” he said, his voice wavering. “I couldn’t be happier!”

  Over the next week, Tom�
��s clinical status continued to improve and life in the TICU returned to its own kind of normal. One morning, Carly took the early morning shift so I could sleep in. When I arrived at the hospital later that morning, the commotion from Tom’s room as I approached made my heart skip a beat until I heard the excitement in the voice of Will, the respiratory therapist.

  “Oh my God! He’s locked in! Is he in the tube? I can’t see!” It was Will, shouting from inside Tom’s room. Excited—in a good way. In their shared surfing world, the “tube” is the barrel in a breaking wave, where you want to be.

  “Hey! I could hear you guys hooting all the way through the glass walls, for cryin’ out loud,” I said, gowning up and stepping in. Will was on tippy-toes trying to get a better view. He absently fiddled with the settings on Tom’s ventilator, but he was riveted to the TV screen overhead. So were Carly and Tom.

  The three of them were glued to the Rip Curl Pro Bells Beach surfing competition. White-knuckled, Tom gripped the sides of the bed in anticipation as they watched an Aussie, Matty “Wilko” Wilkinson, attempt to clinch first place. Carly craned her neck to see as she rubbed cream on Tom’s feet, which continued to slough off papery snakeskin. Wilko was cutting back, expertly carving out each section of the wave. It would be a long time before Tom would be back in the water, but Carly had taken up bodysurfing and was keen to take him out to catch a few sets. The mutual father-daughter delight might as well be genetic; in SoCal, surfing isn’t just a sport, it’s a way of life.

  “Hoooo!” Will bounced up and down on his cross-trainers, exuberant. He held his hands out and waved his arms gracefully, positioning his feet as if he were riding a wave of epic proportion. “Will you look at that! I can’t remember the last time a goofyfoot took a title. And he’s been chucking his tail all week. Dude, what a ride!” Will put his right foot forward ahead of his left and teetered on his imaginary board, mimicking a surfer who sported a “goofyfoot.”

  “Will, speak English, will you?” I teased, leaning over to inspect the ventilator settings. Then I promptly had to shift to medicalese, everyone’s second language here. “Hey, how long has Tom been sprinting off the vent?”

  Dr. Kerr had explained to us that the lungs are a muscle and Tom needed to do breathing exercises every day to give them a workout. They call it sprinting. As much as people had told us this would be “a marathon and not a sprint,” Tom was sprinting after all. Or at least his lungs were.

  Tom held up two fingers.

  “Peace, baby?” I grinned, and ruffled what was left of his hair.

  Carly chimed in. “Nah, he means, two hours. He’s been rockin’ it this morning.”

  Breathe. In through the nose. Out through the mouth. In, out. In, out. Relax.

  Each day, Tom breathed off the vent longer and longer. One morning after rounds, Dr. Fernandes stopped by. “Today is your lucky day,” he said, snapping on his gloves. “We are going to extubate.” Tom stared at him, uncomprehendingly.

  “Hon, he’s going remove the respirator tubing from the tracheostomy hole in your throat. Finally!”

  “Yes, and then we cap the stoma, just leaving the cuff,” said Dr. Fernandes. He turned to a resident, Christine, who prepared his equipment.

  “Leave it in—why?” I asked.

  “We don’t want the stoma to close up quite yet. Just in case we need to put him back on the respirator later,” Christine explained.

  Tom’s eyes widened and he shook his head wildly. Vent or no vent, I knew he was thinking: Not bloody likely. I’ll tear the damn thing out myself!

  Dr. Fernandes could tell this wasn’t exactly the news we were hoping for. “We don’t expect any more problems, but given the course of this illness and the—er, unconventional aspects of this phage treatment, we need to be very cautious. When it’s time, we will remove the cap and the trach hole will close up very quickly,” he reassured us. “It’s almost like having your ear pierced.”

  Yeah, not quite. I reached for my left earlobe, pulling it absentmindedly.

  Within a matter of minutes, Tom was no longer technically on life support. He was breathing fresh air. Well, almost fresh. The smell of urine, antiseptics, and other hospital accoutrements wasn’t exactly aromatherapy. And Tom hadn’t had a real bath in four months.

  Will had been off for a few days and was in awe to see that Tom had been taken off the vent. He put his hand on his own collar, cleared his throat, and preened, as if he were wearing an ascot like Tom’s stylish stoma cuff.

  “Dude, you look awesome!” Will gushed. “You’re going to be back in the tube in no time!”

  Coming from a fellow surfer, that must have been music to Tom’s ears. He gave Tom the hang loose sign with his thumb and pinkie, and disappeared into Bed 12.

  After hearing that Tom had been extubated, Chip texted congrats on the good news. His message included a smiley face emoticon. His sense of humor was recovering, too. I imagined Connie had probably showed him how to use emojis so he could impress his grandkids. Signs of life all around.

  Mail call now included get-well cards I could finally read with Tom, and one day it brought a small purple stuffed toy. Tom looked ready for a nap, but he gave the toy a quizzical look—it looked a lot like a spider.

  “Babe,” I said, “it’s a phage. A toy phage, from the team at AmpliPhi that donated one of your phages!”

  He nodded, amused, and then closed his eyes gently and dropped off to sleep.

  No rest for the weary those next few days. Tom had work to do. He was learning—relearning—to swallow, drink, and talk. A speech pathologist came in to work with him twice a day. He had to practice moving his cheek muscles, which had atrophied because he hadn’t used them in so long. Before he could be given water or ice chips, he had to pass the three-part “swallow test,” which went like this: The first day, they give you an ice chip. The second day, they give you a spoonful of applesauce. Finally, on the third day, they give you a cracker. Don’t gag. Swallow. He swallowed and got an A+. Now he could graduate to a liquid diet.

  Talking doesn’t come easy after a tracheostomy, either. He had to learn to speak with a special valve, which attaches to the outside opening of the tracheostomy tube and allows air to pass in the stoma, but not out. The speech pathologist had him practice vowel sounds, first, then consonants. After a few days, he was ready to say his first word.

  “Steff,” he whispered.

  I had been sitting beside to cheer him on in these lesson times, but the first time I heard Tom say my name again, I bawled like a baby. Tom patted my hand and we laughed; for the last several months it had always been the other way around. It felt so good to laugh again, even if Tom’s came out like a wheeze. Managing a sentence was much more difficult. Those sounded more like a croak.

  “It’s okay,” I told him. “I love you all the same, my froggy prince.”

  “Knock, knock,” said a familiar singsong voice as the door to Bed 11 slid open. It was Amy, the physical therapist. Today, her long hair was in a ponytail and she wore blue scrubs beneath her yellow gown. “Is now a bad time?”

  Tom grimaced. Now was always a bad time for physical therapy. All work, no play. But he knew it was the only way to recover enough to be discharged.

  Amy stood at the foot of his bed. “So, what do you feel like doing today?” By now, she knew that giving Tom this modicum of control was the best way of motivating him.

  “A walk?” Tom croaked.

  Amy gawked. “Walk? Are you pulling my leg?”

  “Walked… to the end… of the hall yesterday,” he croaked back haltingly. And grumpily.

  Amy looked at me in dismay. I looked at Tom. The only place he’d walked since Thanksgiving was in his own mind—what I later learned was the trail to his family cabin, the desert, the swamp, and maybe joining Carly on her journeying visions of their walks together.

  Amy sat down on the corner of his bed and pulled her ponytail tighter before looking at him. “Tom,” she said softly. “You haven’t walke
d in four months.”

  Tom looked at me in alarm. All I could do was nod. She was right. He was… mistaken.

  God knows what he was thinking, but he wasn’t thinking straight yet. That much was clear.

  Tom: Interlude VIII

  It’s not like the movies. In the Hollywood version, the patient awakes from a coma, sits up in bed, stretches their arms like they’ve had the nap of the century, and asks what’s for dinner. What you may not know—if you’re unlucky enough to fall into a coma yet lucky enough to wake up from one—is that you may have to be taught how to swallow again before you can eat, drink, or talk. Your brain is kind of fuzzy. Your muscles forget how to do things. You might not even know where your hands and feet are, or how to move them. And at first, staying awake even for a few minutes is an effort.

  At least that’s the way it was for me.

  Waking up was gradual. In the beginning, everything was a haze, like I was a mummy being unwrapped by an unseen hand, layer by layer. If someone was standing right in front of my peephole, they were a part of my world. If they were offstage even a tiny bit, they did not exist. But as I gained greater awareness of my surroundings, there were times when my body was like a tree struck by lightning. A simple touch from Steff or resurfacing of a childhood memory felt like an electric shock, setting off a cascade of neurons that would light me up, branch by branch and leaf by leaf. It was jarring, but I knew it meant I was alive, and hopefully that I was getting better. I could tell by the endless stream of visitors, family, friends, students, doctors, and nurses, many of whom who were crying, that they had not expected me to live.

  How long had I been out for the count? I tried to read the date that the nurse, Chris, wrote on the whiteboard on the wall, but it was too blurry. Surely it had only been a few days? I wasn’t sure. There were dozens of get-well cards taped to the walls, along with a bunch of sagging birthday balloons that were clearly past their prime. Whose birthday was it? Mine wasn’t until February. And there was a contraption on my neck Chris said was a ventilator. Itched like hell.