Brainstorm

by Robert Wintner

  “Fine. Don’t eat. I’ll put some clear broth in a cup. If you don’t like it, we’ll throw it out.” I hand her the cup.

  She sips and says, “It’s delicious. I can’t eat.” She sets it aside. I sit. We stare. Rachel drifts in and out of sleep. The wailing is chaotic and painful, without rhythm. The beeps and buzzes up and down the ICU are syncopated. The system is automatic, so that a critical margin in any vital function of any patient on the corridor will override all other monitors on the corridor. So anyone approaching the big D will trigger the alarm on all monitors with concurrent flashing of the room number and vital function(s) of the patient on the brink at the moment. So I don’t need to panic every time our monitor goes off like a nickel slot jackpot. It’s a child down the way in trouble. I wonder what happens when several kids trigger alarms at once. I’m told it gets insane on the ward, and I’m again amazed at the dedication required for a single shift, yet this level of activity seems addictive—or maybe personal satisfaction keeps them going. It’s an adrenaline rush at any rate, along with fundamental goodness in most of them.

  An alarm sounds on the monitor, and I look up to see that it’s us. Not to worry—a plastic crinkle follows the intermittent flashing, and I relax as another bag of Gatorade occludes. Nate is there with a full bag. He moves deftly and appears to be happy with his work. So I ask how we’re doing. “Are you kidding?” he says. “She’s conscious. She’s talking. She has no apparent limitations. She’s off the charts.”

  Off the charts. I suppose the Zen-fountain woman is at the base of the bell curve. Nate is cooking something up. I ask what he’s doing. “Oh, this. We’re changing—. Well. We’re changing the . . . Oh. Well . . . Well, heck, I guess it’s okay to tell you this . . .”

  I guess it’s okay to tell you this? Whatever it is, I’d like to know what’s not okay to tell us. Why is secrecy so integral to the system? Of course some risks are calculated, and an educated team with data to drawn on will presumably choose best. It’s a difficult moment, realizing that these scenes may be revisited in court. “You guess it’s okay? What could possibly not be okay to tell us?”

  “I mean, it was written up in the New England Journal of Medicine. We’re changing her anti-seizure medication. The Dilantin is attacking her white blood cells. Her count is dangerously low.”

  “What?” I react in a personal way. He’s a good nurse—at least he tells the truth. But ignorance is not best for us, and our two cents should be worth more than that. Still, the assessment/advise and consent format will not factor our opinions, as if that exclusion is necessary to serve in a timely manner. That exclusion is also the likely cause of tension, redundancy and error, given the staff assigned to profile patients and psychiatric needs.

  “Yeah. It happens. We’re going to put her on Valporic Acid. It’ll prevent the seizures without taking her white blood count so low.”

  “You said dangerously low.”

  He shrugs, tight-lipped, afraid to go further. I think he’s only as good as the system allows, and the honesty of the system is compromised. “How will this change in medication show up on the chart?”

  He shrugs again. “Here. See? It says the time and Valporic Acid and the dosage?”

  “But I see no reference or any mention of dangerously reduced white blood cells. Or any reference to Dilantin as a source of danger. And why didn’t we use Valporic Acid in the first place?” I scan the chart in reverse, from now to yesterday. It logs each dose of Dilantin right up to the first dose of Valporic Acid but never mentions fewer white blood cells. Could the system be so sinister in its self-defense, to the point of cover-up? Is this a symptom of systemic paranoia?

  “Can you believe that?” Rachel groans. The process feels experimental. Nate assures us that nobody wants a lowered white blood count, but seizure is a very real threat now, and Dilantin gives the most clinically significant results historically.

  “We’re experimenting here?” He doesn’t know the answer to that, which may be defensible. “Go, Nate. Make your rounds.” He smiles and complies. Yes, we are a pain in the tuchas, but a moment of inclusion could have kept me busy, calling around to find a less risky remedy for seizure prevention.

  We sit. We stare. We wait. Nurse Janet arrives with a serving tray of unguents, orange ointment mostly, which she sets aside during examination of the wound. “Oh, my,” she says, her happy face in mild alarm.

  “What?” we ask on cue.

  “Whoever did these sutures really laced you up right. It’s so flat and tight. I think you’re fine.”

  “What are you looking for?” I ask.

  “Leaks,” she says casually.

  Rachel’s good eye opens wide. “My brains are going to leak out?”

  “Oh, ho, ho, ho . . . No, ho, ho,” Nurse Janet assures. “But they could! We had to cut the seal. You know the brain has a waterproof seal all the way around it, and we had to cut yours open, you know.”

  “So now she could leak?” I ask.

  “Oh, yes. Until you heal.”

  “You mean the seal restores itself to waterproof?”

  Nurse Janet nods. “It takes about a year.”

  Rachel asks, “So stuff could leak in too?”

  “No, ho, ho.”

  “What if I’m snorkeling and I dive down and hit my head on a rock.”

  “Oh, my,” Nurse Janet says. “To tell you the truth, I don’t know if I would snorkel anymore, if I were you.”

  Rachel and I turn to Nurse Janet in disbelief. Nurse Janet responds as a friend in confidence. “You know this could happen again at any time, driving down the road, in an airplane. On an elevator. Snorkeling—Oh, my.”

  “What difference does it make?” Rachel asks. “It could happen right now, right here, talking to you in this God-forsaken room.” Nurse Janet droops in resignation to our woeful outlook. She pats Rachel’s head, as if to commiserate. Rachel looks away. “I’d rather be under water with friends.”

  “Now, now.”

  “Are you done?” I ask. She is, and like a good listener if not a good conciliator, she leaves. We sit. On the overhead TV Hollywooders in tuxedos and fabulous gowns present each other with prizes for excellence. We don’t listen because the sound would be tedious, and anyway, the lips are easy to read. Many thanks for making this possible and all those who helped, without whom we could not blah, blah, blah. I think we’re getting old; we recognize so few of the newly fabulous.

  Sue arrives. Rachel brightens, anxious to share. “Look what they’ve done! Look at my face!”

  To Sue’s credit, she shrugs it off. “Oh, I know! But you’re doing so well!”

  “This place is so . . .” In three seconds Rachel’s heart rate on the monitor goes from sixty-five to ninety. I call Sue outside abruptly and explain the need for calmness. I ask that she please keep an eye on the monitor to know how Rachel is doing. Sue understands, but back at the gurney the sisters wind up again, waving their hands and racing their hearts. Sue brought hats and scarves, and now they try them on over the gore and stitching, roughing up the works. I ask, please, for calmness. I am told to go, have some fun. So I go to another ninth floor, which is my office a mile away, where I drink many beers and fall asleep on the sofa.

  Sunday and Monday pass slowly, mostly sitting, watching the overhead TV, standing guard, listening to nonstop dings and alarms and the endless lament of the Zen-fountain woman. I take breaks, walk downtown and back up the hill. I stretch and breathe deep and wonder what I’d be doing if this had gone the other way. I’d sell the house. I’d move, I think. I don’t know where. I’d find homes for . . . well, Clarisse, I think; she’s so new and would make a good pet with proper care. Ed and Stella could stay together, but Dewey and Flojo . . . I couldn’t . . . Nor with Molly and Dino. I’d . . . Never mind. It didn’t go that way. I take Elmer Fudd’s car back and get my car. I make calls to family and friends.

  Rachel eats only yogurt and juice, refusing further bulk until she’s allowed to get up
and move. Sue comes daily with the scrabble board. They play. Rachel wins. I would suspect Sue let her win, but they’ve played for years and take it personally.

  A woman named Nancy visits daily with an array of electronic gadgetry, including amplifiers and sensors. She reads the flow and pressure in the vessels of each square centimeter of the brain. Then she marks the chart. This is Doppler Ultrasound. The final rating is a function of multiple denominators over the cosine of the logarithm divided by the discount and surcharge or something or other. A final rating of thirty and above indicates vasospasm, a constriction of blood vessels indicating the onset of a stroke. Rachel rates 29.3, which is technically below the line, but it’s too close for discharge from the ICU, where stroke potential is best monitored and urgent procedures best implemented in the event of a stroke.

  We’re marginally comforted by constant assurance that everyone has some vasospasm and a convulsion or two may be normal in this tender phase. Rachel wants to know what this daily Doppler Ultrasound procedure is going to cost, because to her it’s bells and whistles, and she is still able to tell if she’s not feeling well, all by herself. I tell her the insurance will cover, but she insists that a rip is a rip. Nurse Nancy tells her it’s only four hundred dollars per test, and she proceeds with another test.

  Monday is a milestone; the dipstick comes out of her skull. The steel spike screwed through her head to monitor brain pressure is no longer necessary because we’re beyond the critical risk time for brain swelling. Dipstick removal is a tangible relief but comes with searing pain. “How much pain?” Nurse Amy wants to know.

  “How much pain? It hurts,” Rachel says.

  “On a one to ten scale, one being the mildest, and ten being the worst.”

  “Five,” Rachel says. Nurse Amy enters five on the computer and dispenses Tylenol.

  Worse yet, when Rachel tilts her head from dead level, yellow goo spills out. This is demoralizing.

  But the shift soon changes and Nurse Leah is back, which is a great thing, because she’s the best of the staff on comfort and mechanical assistance. She makes us wonder about the education and job-interview process. Surely compassion cannot be taught, but it could be reviewed with a few pointers. Leah dabs the hole and sets a piece of gauze on top and restates the staff shibboleth: “This is normal.” Her touch is soft, her demeanor warm and reassuring, until the next arrival.

  Nurse Claudia, the angry woman with the crewcut and granny glasses who runs the floor this shift, announces that the hospital is full. Rachel no longer qualifies for intensive care and would be moved now, but with no vacancy on three, she must wait till tomorrow. Rachel has hovered less than a point below the line for three days, but in view of her impressive progress, Nurse Claudia is willing to forego the critical risk period for vasospasm, seven days. They warned us of seven-day risk, but in view of our unique recovery potential, I’m grateful for the shift in policy. I concur with Claudia.

  “Jesus, I want to go home. I’ll never get out of here,” Rachel moans.

  “Oh, the third floor feels like a hotel with room service after this,” Leah says, stepping forward. “You can close the door down on the third floor. No noise.” We ponder no noise, briefly. Nurse Claudia reminds us that early departure from intensive care can only occur after a favorable reading on the Doppler Ultrasound measuring flow and pressure in Rachel’s cranial blood vessels.

  “Boy oh boy,” Rachel mutters, counting the coupons she had to clip to save the four hundred dollars spent on one day’s testing. But she smiles; parole looks possible. Tuesday should be the big day. If the machine needs another few hun, so be it. We want out.

  But it’s not to be. I take Tuesday morning to stretch again on a long walk down to Rainier Square for new underwear and a new shirt and return to gloom. Doppler Ultrasound Nancy did it wrong, Rachel says, blowing our chance for freedom. Rachel is distraught among the beeps and dings and flashing lights. The Zen-fountain woman wails and groans, and Rachel seems oddly aligned with the chorus. She hasn’t slept fifty minutes in a row now for seven days.

  “What do you mean, she did it wrong?”

  “She pulled my neck. It’s still killing me. And she took the reading right when Sue was here, and we . . . I . . .” She can’t speak. Tears well up.

  “You were excited?” She nods, crying now. “You think that changed your reading?” She nods again. Now she sobs; Sue was winning, but then Rachel saw an opening for a triple-score multiple word play in a tight corner that would give her the game—a thirty-six-pointer! She got excited and now thinks the machine read her wrong. Besides that, the ultrasound woman pulled her head so far to the side that it ripped the sutures from the gang valve in the jugular vein. This occurred, Rachel says, because the woman didn’t want to move the machinery cart around to the other side of the bed, where the reading should be taken.

  For the first time she’s openly crying, practically in harmony with the Zen-fountain woman. The difference between the two is that Rachel always took care of herself as well as those around her. Yet here she is, feeling trapped, devoid of autonomous care and no better off than an obese geriatric or a perfectly good dog waiting to go home. She regrets again that she consented to surgery. She doesn’t mind dying, she says; she wants to die. She wants out of this horrible, horrible place.

  Of course she’s whining, feeling the effects of sleep deprivation, mild starvation and endless trespass on her body, inside and out. Worst of all, she can’t stand her hair, shaved off in a minute, and now it won’t grow back for years. Her head is covered with crusty yellow snot, and it itches. She hasn’t washed in five days, and her skin hurts from lying down for seven days, and she can’t sleep more than two winks without some cheerful attendant waking her up for a triviality. I can’t stand to see her cry, especially now, having weathered the worst with courage, only to falter on the small stuff. But I sense fundamental weakening from the core again, from the source of her relentless happiness. She is not happy. She is sad. Along with that comes an ashen color suggesting death.

  The bells ring, the buzzers buzz. It’s like Vegas. We can’t go home, and we’re crapping out. Children up and down the ward pre-empt each other with more daring proximity to death. Alarms transcend final buzzers, and the Zen-fountain woman drowns them all with, “Oooohhh! Whaoa! Oaooooh!” Rachel places a hand on her left temporal lobe. It hurts.

  I tell her I’ll be right back. I don’t know if she can hear me or if she cares any longer what I have to say. But I can’t help seeking usefulness. I think depression can resolve independently more easily than with a significant other constantly shooing it away. I find Nurse Leah and briefly relate the headache and the onset of depression and its possible cure. She takes me at face value, perhaps the only person here to do so. Rachel is not her patient today, she says, but she’ll see that hair washing is scheduled. If it’s not done by the end of the shift, she’ll stay and do it.

  I go back to the binging bonging flashing space and tell Rachel that her hair will be washed. She wants to know when. I tell her it could happen any time but it may not happen till the shift change. That could be twelve hours, she says, weeping hopelessly as a child suffering a loss in the family.

  The open space where the curtain once hung is now filled with Nurse Jane, the stridently happy one who looked for leaks. Jane’s happiness seems rote and practiced; she doesn’t know us but says she’s seen it many times. She sounds like day-in, day-out with another testimonial to lowest common denominators. Nurse Jane assures us that she knows what we’re feeling, what we felt and what we’ll feel next. She means well but doesn’t know squat about us.

  “Now, now,” she offers. “You’ll be out of here in no time.” Her deep, grating voice is that of a sternly loving mother to a deeply saddened child. We wait to see why she’s here, crowding our little space. She bats her lashes and asks, “Do you have a headache?” Do we ever. I tell her Rachel’s is five point five four. Mine is a solid eight. Can you help? She complies, record
ing vital data for Rachel, telling me not to worry, that nobody will miss these two Tylenol; they’ll be just our little secret.

  She perks up, as if this interlude between depression and Tylenol is a perfect opening for counseling. It’s not, but she proceeds: “Do you have children?” She’s all smiles and sparkle now on the subject that all people love. Ah, children; that’s the ticket. Because if you remind people they’re doing something for the children, they’ll stop bawling and be happy, thinking of the children. “Yes,” I say. “We have seven.”

  “Seven! Oh, my!” She beams joyfully. “Seven children!” Eight would be better and would make us appear more rational. Rachel gives me the dirty look but has no strength to back it up. “How old is the youngest?” Nurse Jane is quite engaged now.

  “Not even a year,” I say. “Stella is what? Ten months?” Nurse Jane stops in mid-beam to eyeball our chart. She’s taken aback, perhaps considering an addition of DELUSIONAL to PARANOID. I’m past the big five oh. Rachel is forty-seven. We are not so far removed from procreative viability, and for only a few hundred grand and the resources available here, we could have a litter.

  But Nurse Jane smells a bullshitter in the woodpile. Over a fragmenting gush she realizes that this warm and fuzzy chitchat is with two nutcases who think they had a child ten months ago. Rachel pulls my plug. “We have five cats and two dogs. We have no children.”

  “Oh!” Nurse Jane titters. “Five cats and two dogs! Weh, heh, hell, I’m sure they’re just like children to you!”

  I want to challenge Nurse Jane’s and the team’s presumption on rationale and the perception of paranoia relative to stability. We’re all under pressure here feels more like a credo defining a value system, in which many children and the miracle available here are rational and best. We are apparently peas of a very different pod. Nurse Jane is here for sympathy and understanding, but she’s not of our context. Well intentioned, to be sure, she is presumptuous and not applicable.