Crash

by Carolyn Roy-Bornstein

  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 happ
ened 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.

  10

  A Bad Dream

  If having my youngest son in an ICU in Boston with a head injury after being struck down by a drunk driver was a nightmare, then trying to reach my oldest son in Mexico to give him the news about his brother was a real bad dream. Dan was in between semesters of his freshman year at Goucher College in Maryland and was spending three weeks in Cuernavaca living with a Mexican family and learning to speak Spanish. He had been sending us short, newsy e-mails from a cybercafe in town every day or two: descriptions of the countryside, the food, and his host family. Funny stories of linguistic missteps—like the time he tried to tell a cab driver he was hot, meaning the environment was warm; only it came out “I’m hot,” as in “hot for you.” I tried not to be jealous when he told us how much he liked his madre there.

  When Dan left, he had given us an emergency contact number for the language program coordinator at his school. We gave him a phone card he could use in an emergency. We thought we had our bases covered. We hadn’t counted on this.

  We thought about sending Dan an e-mail, but we couldn’t count on him checking it right away. Besides, striking the right tone in an e-mail can be difficult. How would we convey the seriousness of the situation without throwing him into a total panic? We called the program director and explained our situation. Dan’s brother was in an accident. We needed to get word to him. She promised she would try.

  Since all we could do now was wait, Saul decided to book us a room in the hotel for hospital patients’ families across the street. We figured we could take turns getting some sleep. Shortly after Saul left to bed down, the Goucher College study abroad director called me on my cell phone. She told us she had left word with her Mexican counterpart at the language school. She also gave me the number of the family that was hosting my son. From Dan’s description of the area, it sounded pretty rural and quite indigent. So I was glad to learn they had a phone.

  My Spanish is limited and informal. I never took it in high school or college but have learned on the job from my patients over the years. Saul’s Spanish is nonexistent. So once again, I was on. I tried dialing the number from Neil’s room, but the nurse told me cell phones weren’t allowed in the ICU. She said they would interfere with patients’ monitors. I knew that with newer cell phones this just wasn’t true, an urban legend perpetuated, but I wasn’t going to argue with the woman who had control over when I got to see my kid. I went out to the waiting room to make the call. That’s when I learned that we don’t have international calling on our plan and it would take four days to get it. And no, she couldn’t connect the call, even if it was an emergency. I tried going through the hospital operator, but she couldn’t connect me either. I tried charging the call to my home phone, but there was no one physically there to accept the charges, so the operator said her hands were tied. I finally got a supervisor at the phone company to place the call for me. The line crackled and rang with an unfamiliar tone. A woman answered. I used my best Spanish to ask for my son. The woman replied with an energetic round of rapid-fire Spanish I did not understand. Then the line went dead. I didn’t know if I had been understood or not.

  I felt lost and alone. I thought if only Saul were in charge, everything would be better. He was the rock of the family, the decision maker, the doer. I was thrust into this position of family leader first because of my medical background, now because of my Spanish. But I felt anything but in charge. I slammed the dead receiver into its cradle several times in an unusual display of frustration. I was glad there were no other families in the waiting room to witness my outburst. I just sat there, my face wet with tears and snot, not knowing what to do.

  Then my cell phone rang.

  “Hello?”

  There was no sound. No reply.

  “Dan?”

  “Hey, Mom, what’s up?” He sounded so upbeat I knew he couldn’t have gotten the entire message from the language school or from his madre. His voice was crackly and time-delayed. It made me feel far away from him, but it was beautiful just the same. I hated giving Dan this news during what should have been the trip of a lifetime. I didn’t know how to begin.

  “Your brother’s been in an accident,” I said, quickly adding Dr. Chuck/Mitch’s reassuring words. “He’s gonna be just fine though. Don’t worry.”

  But I was worried, and Dan knew it. I filled him in as best I could. The broken leg, the crooked smile. I told him about Trista. I didn’t tell him yet that she had died, just that she was in worse shape than Neil. I didn’t know how much he could take in over the phone. I paused, waiting for his response. It came in three words.

  “Get me home.”

  11

  A Nurse First

  When I was a little girl, I didn’t know exactly what I wanted to be when I grew up, but I knew I would be in one of the helping professions. I thought about becoming a social worker or a teacher of the deaf. In high school I finally settled on being an operating room technician. The idea of being a witness to the drama of surgery was very enticing. A guidance counselor at the time suggested I go to nursing school instead. I could still become an OR nurse, she reasoned, but I would have many more options available to me. I followed her advice and started out at a hospital-based diploma program, an endangered species nowadays. Ultimately I graduated from Quinsigamond Community College with an associate’s degree in nursing.

  My first job as a graduate nurse was at a tiny community hospital in rural central Massachusetts where I rotated between the labor and delivery suite, the postpartum floor, and the normal newborn nursery. I loved the joy and drama of L&D and ministering to new mothers on postpartum. But it was in the normal newborn nursery where I first fell in love with caring for children.

  Saul and I owned a wholesale doughnut business at the time. We would get up somewhere between two and three o’clock in the morning to mix, roll, and cut the dough, then fry, glaze, and package the doughnuts. We had a radio going all night; Dire Straits and the Cars, as well as debates and news from the National Press Club. After a breakfast, often fresh corn on the cob from our garden (never doughnuts!), Saul would load up the truck and head off to deliver our product to stores and restaurants and I would head to the hospital for my seven-to-three shift.

  After I passed my boards and became a registered nurse, we moved to the city of Worcester. Saul opened a bakery, and I took a job in the pediatric intensive care unit of a large private hospital. My first patient was LiliBeth, a lovely four-month-ol
d baby who was brought in not breathing by her distraught father, who had fallen asleep with her on the couch. He must have rolled onto her. I took care of her for days, suctioning her breathing tube, placing ointment in her eyes so they wouldn’t dry out, sponge-bathing her tiny body. We all understood that she was brain dead, being kept alive only by her ventilator, but her parents took some time to accept that diagnosis.

  In the meantime I changed the dressings at her IV sites and put clean sheets on her crib every day. We did all the tests to gently show her parents she was not alive: Her EEG showed no electrical activity in her brain; her eyes did not move when we irrigated her ears with water (called the caloric test) or turned her head from side to side (called the doll’s-eye maneuver). When her parents ultimately agreed to take LiliBeth off life support, I turned off her ventilator and heart monitor. I gently slipped the breathing tube from her throat, unclipped the leads from her chest, wrapped her in a blanket, and laid her in her mother’s arms while her father sobbed.

  As a nurse I was not generally the one to give parents bad news—that was the job of the residents or the attendings—but I was there for the before and after. I answered their questions. I hugged them when they cried. I handed them tissues. And I took their babies from them when there were no more tears left to cry.