Passing

by Michael Korda

  Most people who do dangerous things are superstitious. Margaret never competed without her “lucky coin,” a ten-dollar gold piece; a four-leaf clover she had found in our fields and preserved in Scotch tape; and her rings and bracelet. She had never had a serious injury, and mostly won, so perhaps they worked. I knew how vulnerable she must feel without her “things,” as she called them, and how scared she was that she would never put them on again—in fact she wouldn’t, when her world began to revolve around a regular MRI. But all that was thankfully in the future on April 12, 2016, as Margaret took the all-important brain scan that would guide Dr. Alain in his surgery on April 20.

  About an hour later Margaret appeared, fully dressed again, to reclaim her handbag and her jewelry. Her face was strained—the care and precision with which the brain scan was taken were enough to emphasize how serious her surgery would be. “Let’s get out of here,” she said. She sat upright and silent in the car on the way home, staring at the road ahead. Whatever was on her mind, she did not want to discuss it in front of Rob Tyson, our friend and driver now that cataracts prevented me from driving any farther than our local supermarket or to the Dunkin’ Donuts for morning coffee, but when we got out of the car she felt for the missing bracelet and said, “My whole world is unraveling,” then went indoors to put together a late lunch for both of us.

  I listened to the telephone messages, including one from Dr. Alain’s secretary Bonnie to call her as soon as possible. I did so at once. She had forgotten to tell us, she said, that Margaret would need a physical examination to certify that she was fit for surgery. I gave a small, silent sigh. Margaret liked her internist Dr. Adam Rosenblüth, but the last thing she wanted at this point was to drive down to New York City to see him—her patience with doctors, never infinite, was coming to an end. Still, after I explained what was needed, she bit the bullet and I made an appointment with “Dr. Adam” (his father, “Dr. Michael,” was my internist, and they shared an office) for the day after tomorrow. As it turned out, the visit was short, sympathetic, and to the point. Margaret was that rare person of seventy-eight who was 100 percent physically fit except for the tumor that was trying to kill her—apart from that Dr. Adam could find nothing wrong with her. He too thought that she would benefit from going somewhere for rehabilitation after the surgery, but I could see from the set of her jaw that she didn’t want to hear about it. Dr. Adam and I exchanged significant looks as Margaret got dressed, meaning one step at a time, and I made a mental note to talk to her neurosurgeon Dr. Alain about this.

  I realized that I had not given enough thought to what Margaret would, or more important would not, be able to do once she was discharged from the hospital. We lived in a big eighteenth century house, about the many inconveniences of which I had written a whole book, Country Matters. Would she be able to get up and down the stairs, or to use the old-fashioned bathtubs? To what extent would she be handicapped, and for how long? When I returned home from Johns Hopkins after prostate cancer surgery over two decades ago I had a nurse for some time, a burly former paratroop medic named Emory who had helped me bathe, dress, and exercise, looked after my catheter bag, and was invariably cheerful and optimistic. As military veterans (he of the Eighty-Second Airborne, me of the Royal Air Force) Emory and I had bonded instantly. Would Margaret need someone similar? But Margaret was adamant, she did not want a stranger living in the house.

  Margaret had already asked Megan’s mother, Colleen Sinon, a neighbor, friend, and licensed practical nurse, to come over and tell her what she needed to take with her to the hospital. Staring at a yellow legal pad and trying to imagine what she might find useful or necessary for a long stay in hospital had not so far produced anything helpful. The list was either too short or seemed endlessly long, as if Margaret were trying to pack for a cruise. In her previous marriage, to Burt Glinn, she had traveled all over the world to places unimaginably remote and difficult, so she was of necessity a disciplined and well-organized packer, but this was not a trip during which she would be expected to look her best, or style her own hair.

  It was clear she was not going to need makeup, nightgowns, or even a hairbrush. It was more a question of what she needed to leave behind, as Colleen explained when she came over for a drink on Friday. She would not need her cell phone, or an alarm clock, or even her watch, still less the collapsible Brot magnifying makeup mirror without which Margaret never went anywhere, even to horse events where she got up before dawn to compete, or to tented camps in Tanzania where they brought you a cup of tea, two biscuits, and a lantern in the dark so you could get out on safari as the sun was rising.

  Basically, everything Margaret needed would be provided by the hospital, anything else that she found she wanted I could bring from home since I would be visiting her every day. Margaret looked a little skeptical at this—she did not rate my ability to find exactly the item she wanted very highly—but over drinks we cut down the list to what she regarded as the bare essentials. At least half a dozen ChapSticks—Margaret always carried one in her purse, scattered them throughout the house, had several in the car, she was never without one, even on horseback in competition. If she found herself without a ChapStick it was necessary to get one at once, the absence of a ChapStick was one of the few things that made her panic. She would need her four-leaf clover, her own slippers, Clinique face moisturizer, toothbrush, toothpaste, handkerchiefs, dressing gown, and underwear. I could see from the expression on Colleen’s face that much of this was not going to prove useful, but at the same time I thought Margaret would feel better knowing that she had it all with her in the Vuitton tote bag that had accompanied her around the world.

  Colleen too thought that Margaret might need some rehabilitation before she came home, but she was too tactful to press that to the point of spooking Margaret. She was confident that nurses could be found locally if needed, and spoke highly of the outpatient rehabilitation services of MidHudson Hospital in Poughkeepsie, where she had worked as a nurse for many years. I tucked this in the back of my mind. Among her many skills, Colleen was good at calming Margaret’s anxiety—it wasn’t merely a technique, there was a genuine affection between the two of them. Margaret would listen to Colleen without any of the skepticism she felt about doctors. Colleen was an attractive woman, sympathetic, full of practical advice, and although both a mother and motherly, which Margaret was not, she lived surrounded by her own shifting cloud of animals, dogs, cats, ponies, horses, and miniature donkeys; in fact, we had first met her shortly after we moved to the country when her father turned up early one morning looking for one of her missing ponies, which, it turned out, had managed to cross two busy roads and walk a mile to graze on our property. Whether it was Colleen’s presence or not, Margaret seemed to relax a bit after she had completed the list of what needed to be packed. At least she had a plan.

  For the next few days we had glorious spring weather, perfect for riding, the kind we’d had in mind when we bought the house in Dutchess County, not as yet having experienced the March nor’easters which dump vast quantities of wet snow and bring down the trees and power lines, or the bugs, humidity, and sullen thunder of August. Margaret rode her horses in the sun, determined not to show any signs of fear or anxiety to "her people." In my spare time I cruised the internet, reading up on brain surgery and rehabilitation as if I were going to be examined on the subjects, while she went through her riding routine. Did she want to imprint in her mind every jump, every foot of the trails on which she rode her horses, all the things she loved doing, and the small world she had made for herself? She had created it step by step over the years, it was like a magic kingdom, a perfect place to ride her horses, and she must have wondered if she would ever ride over it again. She had the kind of eerie calm that comes over people—I had seen it in the Royal Air Force—who are about to make their first parachute jump, when it is too late to back out of it and there is nothing left but to throw oneself out the open door into space and hope for the best.

&nb
sp; Behind the calm, however, things were not going well for her as the date for surgery approached. In fact, things were bad enough for me to email Dr. Alain about my concerns. “Margaret’s ability to speak has deteriorated very sharply over the past 24 hours, also her ability to use her fingers . . . Her diarrhea symptoms have diminished, but she is still hampered by great (and increasing) difficulty to chew and swallow. Lips, facial muscles, etc., all worsening.”

  Dr. Alain was swiftly reassuring on all these subjects. The worsening symptoms were to be expected as the tumor continued to put pressure on her brain. I did my best to pass these reassurances on to Margaret, who by this time just wanted to get it over with.

  4.

  MARGARET DIDN’T SAY much on the way down to Westchester Medical Center at dawn on Wednesday, April 20, 2016. We had been up at five a.m. for a six o’clock departure, the day already seeming endless before it had even begun. She wore her biggest, darkest sunglasses, her “Audrey Hepburn sunglasses," I called them, and which I reminded myself I would have to take home with me. The reality that Margaret would not be coming home with me was beginning to sink in. As we pulled into the parking lot she said, “I hope I have everything I need.”

  “You have everything on the list.” Her bag seemed to weigh a ton, despite Colleen’s efforts to pare the list down.

  “I don’t have my wallet.” Margaret’s wallet was one of those big leather ones that fold over, and it contained a lot more than bills and change. It weighed down her handbag like a brick. Some people’s wallet is a thin case for bills, credit cards, and driver’s license, but Margaret’s practically defined her, it contained almost everything that was important to her. She carried an astonishing weight in quarters and pennies alone—she liked to have on hand a good supply of quarters for places where you can’t get a shopping cart without inserting one, the pennies I have no idea what for. Also included: a gold-plated “New York Veteran Police” shield, a gift from one of our dearest friends when he retired from the NYPD as a deputy inspector; good-luck charms of every kind acquired over the years; photographs of me and of her favorite cats and horses; a formidable number of keys on a heavy silver key chain; an emergency key for her car; credit cards; a thick sheaf of membership cards for everything from the AARP to the United States Eventing Association; small pieces of paper with lines from her favorite poems; and a London bobby’s police whistle. Leaving it all behind must have felt to her like being naked in the street. Colleen had been adamant, however, that she was to take nothing valuable or irreplaceable with her to hospital. Margaret could see the logic of that. After all, she wasn’t going to need money or credit cards, and there wouldn’t be any place to lock it all up, so I had put her leopard-print handbag and her wallet in her closet, where she could retrieve them when she returned home, but she didn’t feel good about it. Neither did I.

  You always imagine there will be more time to talk things over, until there isn’t. I had thought the admissions process would be long and complicated, but in the computer age this is no longer necessarily so, at any rate not at WMC. All the paperwork had been done electronically by Bonnie, so in minutes we were upstairs, Margaret had changed into a hospital gown, and she was lying motionless in a narrow curtained-off space, still wearing her sunglasses. Her stoicism in the face of serious adversity was on display; it was the small things in life that drove her crazy, not the big ones. I stuffed her clothes and shoes into my bag, which was already heavy enough—we had been told the surgery would take at least four hours, so I had brought down my laptop and a thick batch of files to keep me busy while I waited.

  Margaret, I noticed, elicited a certain amount of curiosity among the nurses, which at first I attributed to her sunglasses until it dawned on me that the brain surgery Dr. Alain was about to perform was a big deal, high up on the list of the most difficult, precise, and complex procedures one can undergo. Margaret was the star of the day, medically speaking. She was given a tranquilizer and had a brief talk with her anesthesiologist, who seemed absurdly young for such a serious responsibility, and who like all anesthesiologists promised her she would feel nothing. Then there followed a long wait, so long that I wondered if something had gone wrong, then at last Dr. Alain arrived, again faultlessly dressed in street clothes, to apologize for the delay. The previous surgery had taken longer than anticipated, the operating room was being prepared for him now, he would begin shortly.

  There was a brief flurry of activity. One of Dr. Alain’s assistants arrived with a consent form and a pen, a nurse put an IV into Margaret’s wrist. Margaret finally handed her sunglasses to me—there were no tears in her eyes—and I kissed her forehead, which was as cold as ice, and squeezed her hand. “Don’t forget to feed the cats,” she said, then she was gone.

  I had some paperwork to bring to the hospital accounting office, so I took the elevator down to the basement, set off carrying Margaret’s tote bag and my own, and promptly got lost. I circled endlessly, weighed down like a donkey, for what felt like miles. It was as if I were trapped in a maze; some corridors ended in a blank wall, others ended at locked doors with signs that read “No Entry” and warned of contagious diseases or radiation. This was the working part of the hospital, no windows, not a place for visitors. There was almost nobody around, and those few I encountered either had no idea where accounting was or told me to turn around and go back to where I had started from, which I couldn’t find.

  It was like a labyrinth; the legend of Theseus and Ariadne’s ball of string came to my mind. There were several different banks of elevators, and by the time I had completed my errand and finally gotten back to the right floor again I was no longer sure which of the many surgical waiting rooms I had been told to sit in. Nothing looked familiar, I did not even recognize the place where Margaret and I had been waiting earlier, still less any of the nurses, none of whom in any case seemed to know in which operating theater Dr. de Lotbinière was performing surgery. There was a desk and telephone in each of the waiting rooms but they were all empty. There was nobody to ask, so I picked a room at random, hoping Dr. Alain would find me there.

  By now I had worked myself into a state of acute anxiety. How would Dr. Alain find me? What if I were needed for some reason? I thought of calling Bonnie in his office, but I wasn’t getting a cell phone signal, for some reason. I had experienced a sudden panic attack like this some years ago the night before I was going down to Johns Hopkins in Baltimore early in the morning for cancer surgery. I became convinced that I had lost our airline tickets, I was unable to find them anywhere in the house, and I experienced a full-blown panic attack, covered in sweat, struggling for breath, heartbeat surging out of control, I was ripping open envelopes, dumping the contents of my bag on the floor, shouting at the top of my voice. Margaret had succeeded in calming me down, and we eventually found the tickets just where I had carefully put them, on the hall table.

  I had recognized then, and some part of my mind recognized now, that what I was doing was transferring anxiety about the impending surgery, then mine, now hers, onto an inconsequential or imaginary problem. The tickets could have been replaced at the airport when we checked in, Dr. Alain or one of the nurses would surely find me sooner or later wherever I sat, but panic, like terror, is beyond reason. Perhaps an irrational burst of panic at things that don’t matter is the price of remaining calm about the things that do, a compensatory mechanism for the fabled English stiff upper lip. The English pride themselves above all on not displaying emotion or fear in difficult situations, no tears, no sobs, no lamentations, “Keep calm and carry on” may be the unofficial national motto, but no doubt it comes at a cost. Anxiety is bound to emerge somewhere, like water from a hidden leak, but this time I didn’t have Margaret to calm me down.

  I sat down, took a sip of water, and regained control of myself. Many hours seemed to have passed, but when I looked at my watch I was startled to see that it was only half an hour since I had said goodbye to Margaret. The surgery would probably not even hav
e begun yet.

  I didn’t want to risk getting hopelessly lost again, so I decided not to set off in search of the cafeteria. I had a granola bar and a bottle of water in my bag, and that would have to do. As I tried to read what I had brought with me, I found myself wishing that I had not watched Dr. Brett Osborn’s video of himself performing a craniotomy. I could remember only too clearly what it looked like, but this time the patient was not a stranger whose face one never sees, but Margaret. Only a year and a half later, when I read Dr. Alain’s “Operative Report” on the “Left-sided frontoparietal MRI-guided stereotactic craniotomy for resection of tumor,” dictated after performing the surgery, did I fully realize what was involved. Margaret was “placed under general anesthesia . . . following a smooth, atraumatic intubation, electrodes were attached for the purposes of monitoring somatosensory evoked potentials and motor evoked responses . . . an arterial line was them inserted along with a Foley catheter following which the Mayfield head tongs were applied to the patient’s skull . . . The position of the incision was mapped out onto the skin of the patient and a small amount of hair clipped in the adjacent territory.” Alain clearly kept his promise to Margaret about her hair.

  He then made an incision in Margaret’s scalp, peeled back the skin and the muscle from the cheekbone to the top of the skull in exactly the arc he had traced on her head with his finger when he first saw her in his office, marked the position of the tumor on the skull as determined by her most recent MRI, and performed “a generous craniotomy.” The bone flap was set aside and the dura mater, the membrane enclosing the brain, was exposed, revealing “an expanded gyrus immediately underneath the center of the craniotomy,” in other words a raised place or bump in the dura at the point where the tumor rose toward the surface of the brain. This too reconfirmed Alain’s diagnosis on reviewing Margaret’s first MRI: “Fortunately for the patient, the tumor comes to within a few millimeters of the cortex,” he had written, meaning that “relatively little normal brain tissue would need to be sacrificed in order to remove the tumor . . .” The closer the tumor is to the surface of the brain, the easier it is to reach, of course, and the less brain tissue would have to be removed to get at it. Alain then performed a cross-shaped incision in the dura and folded it back toward the edges, exposing the brain.