“I will. And you want some. Don’t you?”
“Yes. Get six.”
We make the ferry on time. On board we eat and agree; the sushi is very good. I inhale a beer and crave another but by now the dark spirit crowds me, reaching in and tying knots in my gut and head at will. I sense another difficult interface, this one between my health-nut wife on the one hand, and the American Medical Association up ahead on the other. She only yesterday took the first two aspirin of her adult life. She eats no red meat and hardly any fish or chicken. She knows an antioxidant from a free radical and understands the beneficent nature of bioflavonoids and the innate danger of polyunsaturated fat.
She believes we are now engaged in a nuisance, that we’ll soon be on our way, sloshing green beer, black beer, many beers, having a grand Irish time in town. She pulls a new compact disk from my glove box, a digital re-recording of Billie Holiday’s greatest hits. “I got you this,” she says. “If anything happens to me, and you don’t like it, take it back to Fred Meyer’s. The receipt’s in there.” I scan her for sincerity but need not look too deep. She hates wasting money. At least she recognizes the potential here, even if casually, in passing humor. Then again, I really can’t tell if that’s her strength showing or her lunacy.
I’m amazed at this juncture how the milestones arise and connect, in this case her subtle reference to a refund on a Billie Holiday CD and the realization that we’re heading casually over to Seattle for brain surgery. We don’t want surgery of any kind and in fact have a history of declining surgery, yet surgery will be served up with no option. This knowing comes on like gangbusters—on the certainty of brain surgery with no option I would bet the farm. Yet I repress. I side with my wife. Do we not know what we have learned? Is there not another way, what the American medical complex so deftly calls an alternative? Is not every invasive procedure balanced by another, more sane approach? I think so. Yet I fear the entities whipping my periphery, emboldened by such a grip. Of course what I feel is fear. It holds form when I turn to look: Puget Sound is gunmetal gray and frothy white with gusts to fifty knots. Spindrift swirls and smacks the windshield.
“Better get the car mushed,” she says. She means washed but winces sweetly in compensation for her mistake.
“Look,” I say. “I need to call Sue.” Sue is her sister who expresses herself freely and stays extremely busy with her children and family concerns. Sue is plugged into two-twenty and makes Rachel appear to be complacent.
“No! Are you kidding? You’re making this into some kind of big deal, and I’m telling you it’s not!”
“Listen.” She’s listening. I’m not sure how to tell her the truth that is now so evident, that they will want her to check in, and I may agree with them, but I will never go along with brain surgery, not now or ever, without her consent. No, don’t even mention surgery. “I’m going to need help on this.”
“Help? With what?”
“They may want you to stay the night.”
“Do you know what happens in there?”
“I’ll stay with you. I won’t leave you alone. But I have to drop the dogs off. We can’t leave them in the car. I have to call Sue so she can stay with you while I drop the dogs. Please. Please go along with me on this.”
“I don’t like it. I don’t like it one bit, and you’re making it worse.”
“I don’t want to make it worse. I don’t know what else to do. I need your faith. You must believe that I can get you out of this as soon as possible. Please.”
She mumbles; out of what? What is it that anyone needs out of? I dial Sue. I keep it brief, but the operative phrase sets Sue off. “Cerebral hemorrhage! Do you know what that is? . . .” Yes, yes, yes Sue; we know what that is. Sue will be down as soon as she can.
Finding a parking place feels miraculous, as if events are random and extreme with a will of their own; who could ever anticipate a cerebral hemorrhage or a parking place in downtown Seattle? We walk Molly and Dino down the block for another pee. Rachel thinks this unnecessary; they only just peed an hour ago, and we’ll be done here in what? Twenty, thirty minutes?
What the hell, I explain; sometimes I have to pee every hour. And besides, we don’t want to be rushed. We want to do this right so we won’t be bothered again, so we can get on with our St. Pat’s, our beer, our fun and our lives. I’m speaking to her like a parent to a child. To my chagrin, she accepts my explanation.
We give Molly and Dino water in their dish. And when Molly walks a short distance and squats for a massive dump, a surly fellow much bigger than me walks by and says, “Where’s your fucking plastic bag.”
I surprise myself with dynamic range, displaying street diplomacy off the cuff, at night. “If I had one it would go over your head,” I tell him with practiced certainty, because ambient pressure has built up subtly and now seeks the smallest opening through which to ventilate. This is only one more hazard of changing pressure. I regret my behavior, not for reasons of etiquette or personal development but because a brawl could significantly inconvenience us just now. But the surly fellow perceives our need to move along and leave a few dog turds in the grass, which, after all, will go away much quicker than all these cars or even a single plastic bag.
He mumbles something about assholes and dog shit on public streets and keeps walking. I agree with him on all levels. We tuck the dogs back in and explain to them, “Stay. You stay. Stay.”
And hand in hand under a clear, starry night in Seattle in early spring we stroll down the promenade. She smiles my way. “Don’t get all fluster-caked in here. Okay?”
“Fluster-caked?” She gives me the look that says to bug off. “I’ll try my best,” I say. “You can help, you know.”
“They just better not try to mess with me.”
“Damn straight,” I agree. What a woman. We approach the marquis, Emergency Room, and the big double doors. Several people of the street are outside in hospital-issue pajamas. Each stands beside a portable intravenous feedbag rack on wheels, with a monitor and injection tubes in their forearms. One smokes a cigar. Two are lighting butts, hardly used. One scratches her butt. They all need a shave. “Well, here we are again,” I say. Rachel looks up. “Walking through life together.”
“Pshh.”
A squat young woman with sallow skin sits inside behind a window with a talk hole. She asks our name and address and insurance program and employer and on and on down her list to, “Are you an organ donor?”
“That’s premature. Can we let you know?”
“I have to fill this in,” pleads the receptionist.
“No,” I tell her.
“Yes. I am.” Rachel smiles. She’s not attached to the flesh and likes the idea of giving to make a difference.
I remind her, “You know they get excited in here. They’ll take your spleen if you don’t belch on time.”
She shrugs. “I just want to get this over with.”
Me too. So we answer mechanically to questions of name, age, address, diseases in the family, insurance carrier and type of coverage and who will guaranty payment if the insurance company reneges. With documentation clearance we are signed off on accuracy, truth in lending and indemnification of all debt herewith and forevermore, and so we enter what feels like the Valley of the Shadow—what feels like the wrong place for us, the uniquely healthy.
Six rows of gurneys stretching to the horizon can make you smile and think that there must be some mistake here, that we are not part of this. A hundred people in blue scrubs scrabble among the drunks, droolers, crashes, burns, heart attacks, assaults, batteries, knife fights, gangbangs and the generally mortally forlorn. We have entered the single Trauma Center servicing the five nearest states. States of the union, that is; states of consciousness are wider ranging, favoring the shrill end of the spectrum. Wailing is universal and rises like a chorus. Moaning is the refrain. The staff is a study in movement, fast but slow, orderly, chaotic, non-stop, driven, dedicated, caffeinated, compulsive and gra
tified.
The blue team doesn’t drop a beat but injects, cuts, squeezes, slices, pokes, wraps, swabs and otherwise strives to contain the world of squirming flesh around us. Pulse is everything, and it also rises in waves from the blur of activity. Human industry and agony meet in cross currents; the wave breaks forever in a din of white noise so profuse you must yell to be heard. Or maybe it’s just the excitement that raises our voices. The best beer in the world and corned beef and cabbage are only down the hill and around the corner but a world away. This is not what is seen on TV. This is as different from showbiz as three dimensions are different from two. Or four. This has teeth that rip and tear at composure for the newly arrived. All join in the frantic sense of urgency, as if it’s contagious and airborne.
A nurse strides forward. She is bigger than me, possibly three of Rachel, and she comes on, as strong as the giant just down from the beanstalk, busy, late and peeved. She grabs the film negatives, pulls them out, nods once, states a wrong name and says, “Finally. You made it. We didn’t think you would.”
“That’s not us.”
She holds up the negative. “This isn’t you?”
“That’s us. You said, ‘Jones.’ We’re not Jones.”
“Psh. Never mind. Come over here, Sweetie.”
“Where?”
“Right here.”
The big nurse wears a nametag: BETTY. Betty is big but not fat, and she wears her hair in a butch. “Squeeze my fingers. Okay. What month is this? Who’s the President?”
“You mean the President of the United States of America?” Rachel toys with authority, and I think it a good sign that she’s holding her own. Betty glares and hunches low. I read the blitz and tell Rachel to squelch the levity. Oh, baby, Betty’s body language seems to say; you wanna tango? Well, come on then.
Betty wears three ball bearings in one ear and one in the other. Moving smoothly as a time-lapse sundown, she smothers Rachel with a hug, reaching behind for shirttails and a sweater hem. She is undressing my date, who tells her, “Stop it. What are you doing?”
“Tell me what happened,” Betty says, unfastening Rachel’s pants and dropping the zipper. “Slip out of these.” Betty works it like a puppeteer, deft at disrobing a patient. Rachel goes along with hopeless resistance, babbling about the bookcase, the fumes and the sheep, meaning dogs, the many people arriving at the house, one after the other, and the aerobic push to meet their needs down the hall, meaning the driveway, at the gate. She sees things out there to the side and points to them as she is quickly wrapped in a green seersucker gown too big for Betty.
“Okay, here,” Betty says, leading the patient to the gurney and firmly guiding her onto it. “Lay yourself down right here.”
Rachel stops, a certain rock in a rising stream, and she explains to Betty, “We’re not staying here.”
Betty meets this resistance with a sudden grin of lumberjack proportion while easing her own body briefly from tension to camaraderie. She takes a rare breath uncluttered with words and says, “Of course you’re not. I just need you to help me out with this for a few minutes. Then we’ll get you out of here as quick as we can. Okay?”
Those are my lines. But I sense alliance with Betty. She sees these symptoms as often as not—the denial and resistance. Though I doubt she often sees such a patient who knows a thing or two. And though I like big Betty, she feels too hurried on a fixed agenda designed to serve a group called average that, in our world, generates stats factoring into a woefully low denominator. That is, we should not be likewise factored, because, because.
I strive for etiquette if not good taste, to hide my distrust. I am on—on guard, on alert, on the ready to stand forward and stop the juggernaut. I have heard what they can do. I am doubtful that a machine like this with so many cogs can cohere at this level without a misfire. Well, of course it can’t, and that’s the basis of our apprehension—that and medical malpractice, medical jurisprudence and medical associations, beginning with the American, with its codes, practices, policies and safeguards.
I will not lose sight of our faith in the human body to heal itself. Call it the God within or homeostasis. We understand what a very small percentage of the viewing audience at home understands, because we’ve taken the time to learn these things. Betty doesn’t know that about us, but she’ll learn, as soon as we can chat. It shouldn’t take long, say a minute or two.
You might think a woman so liberated, as Betty appears to be, would understand that some people are different. Don’t many women agree that only a woman can properly know what a woman feels? I thought they did. Yet Betty leads the next charge, interrupting Rachel in mid-sentence as Rachel explains the need for a door at the end of the hall so the sheep won’t get out, you know, in the thing. Betty dives in with two intravenous spikes to the right forearm and a hearty accolade, “My God! You have gorgeous veins!”
Rachel sits up to protest but Betty pins her back with one big paw in the center of the chest. “Lay back, Sweetie. I need these to keep your pressure up.” Betty’s behavior seems forward if not obtrusive. We haven’t even begun our chat.
Rachel whimpers, but not from pain. Her pain threshold is extraordinary. More than tolerance to pain is her good cheer in the face of blood and gore.
In a few short hours she’ll have her scalp parted with a nine-inch incision so it can be peeled back to expose a three-inch section of her skull. That section of skull will be removed with a remarkable little buzz saw so the left temporal lobe of her brain can be lifted by hand, so the clot can be removed, and a titanium clip will be fastened to the blood vessel with the aneurysm. She will listen to the plan. She will ask why she needs general anesthesia just for that. The “team” will laugh at her question, but she’ll wait for an answer. When she gets none, she will rail, and they will note once again her paranoia. But I get ahead of myself.
Betty rounds the gurney in two strides, grabs the other arm and wraps it tight in a blood pressure bladder. The bladder inflates. Betty explains that we shouldn’t worry, because this pressure monitor is automatic and will inflate every few minutes. Meanwhile, she grabs the left wrist with a vice-like grip and pokes first the wrist and then the forearm with two more spikes on plastic tubing.
Rachel is a munchkin next to Betty but rises to the occasion by throwing the big nurse off. I am neither proud nor embarrassed but rather stunned. Engaging in fight-or-flight response and fortified with adrenaline, Rachel achieves the strength of an opposing linebacker. This is natural, and she’s no weakling in the first place. What stills our frantic little radius and tinges the air with dark laughter is her sudden metamorphosis. No word-dropping here, she speaks with clarity, with volume and strength that resonates round the arena. “Will you get away from me?” Heads turn: for the first time, she is heard. “Just get the fuck away!” She is trembling now and changing color.
Big Betty moves in, moves back, goes side to side and calls me away. Maybe now, I think, we can get to know each other and make an informed decision after viewing the unique needs of the individual patient and the options at hand. Is that not reasonable? How much time could it take?
4
Doogie Howser
Betty is up to the action. Hardly discouraged, she leads me to the periphery of our space five feet away. This short distance insulates us from eavesdropping by the difficult patient. Betty says I must now take over.
“Take over what?”
“She’s demented. She’s irrational. You’re going to have to make some decisions here.”
“It sounds like the decisions were made before we got here. Betty, we need to talk to somebody. We don’t mind talking to you. Or we can talk to a doctor. We need information, plain and simple. We’re perfectly willing and able to make decisions, but we don’t know what our choices are. Nobody has told us. Can you tell us?”
Betty shakes her head, marginally hiding her impatience. In two strides she’s back with the difficult patient. She simply touches Rachel’s cheek gently and
says, “Sweetie, if we have to give you anything quick, you’ll be glad these are in place. We can pump anything we want into your system now in less than three seconds flat.”
“We’re leaving!” Rachel says. “Take these things off me!”
“Listen. We’re going to get you out of here as soon as we can. Just be quiet for a little while.” Betty glances around as if checking the perimeter. “Then we’re going upstairs for an infusion CAT scan. That’ll tell us exactly what’s going on.”
“What’s an infusion CAT scan?” I ask.
Betty takes another step back and another to the side. Three feet instead of five now insulate us, but she’s tired of pussyfooting around, and the agony audio is up. “It’s just like the first CAT scan, but this machine is more sophisticated. It gives us much more information. Besides, we’ll inject her brain with iodine for more detail.”
“They said we’d get an MRI. We don’t want an infusion CAT scan. We don’t want anything invasive. We want an MRI.” MRI is magnetic resonant imaging. It’s different than a CAT scan because it shows more detail, but not as much detail as an infusion CAT scan with an iodine injection, I think. Betty explains the difference between MRI and infusion CAT scan and the detail provided by each. I tell her we’re very comfortable with less detail if it means avoiding the iodine infusion to the brain, and I ask when, in this process, do the patients and families gain the benefit of discussing the options.
She smiles and walks away toward three new crash victims. “That’s not my decision to make,” she says. “Doctor is on his way.”
“Yes, well, we’d like to know a few things.” But Betty is out of range, tending to the more receptive. I stoop to Rachel who is now acutely upset. “He’s on his way,” I tell her. “They want to do an infusion CAT scan. I’ll see if we can’t substitute the MRI.”
“What’s an infusion scratch can?”
“It’s different. They use a needle.”
Brainstorm Page 5
