Passing

by Michael Korda

  5.

  Why should I have been surprised?

  Hunters walk the forest

  without a sound.

  The hunter, strapped to his rifle,

  the fox on his feet of silk,

  the serpent on his empire of muscles—

  all move in a stillness,

  hungry, careful, intent.

  Just as the cancer

  Entered the forest of my body,

  without a sound.

  —MARY OLIVER,

  “The Fourth Sign of the Zodiac”

  IT WOULD BE nice if Margaret had changed her opinion over the next twenty-four hours, but she did not. The life she was clinging to was not one she wanted. She, who had always been in control of things, was helpless. Her nurse, and the night nurse who replaced him at the end of his shift and who was equally caring, sponged her, monitored all the instruments that surrounded her, tried to get her to swallow a little water mixed with gelatin or a spoonful or two of Jell-O, administered her medications, antibiotics against infection, steroids to bring down swelling of the brain tissue, painkillers, a medication to prevent seizures, and much more, all injected into a port in one of her IV lines. They rubbed ice on her lips; they were never farther than a few feet away behind the glass wall of the nurse’s cubbyhole outside the room.

  Their total concentration and undivided attention were impressive. They were, to use a word that may seem old-fashioned in the high-tech and often impersonal world of modern health care, unfailingly kind. Margaret slept, or dozed, her eyes were closed or unfocused, she occasionally mumbled something, but the words were unclear. On the second day I felt her hand squeeze mine, and our eyes met. Wherever she had been—who knows where the mind wanders to after more than four hours of full anesthesia and brain surgery?—she was back.

  Over the next couple of days she was able to sit up a little more, and to speak, although it was still a struggle for her to find the word she was looking for, and harder still to pronounce it. She wanted to know how the horses and cats were; she did not ask about her own condition. In any case, the most Dr. Alain and the other doctors would say was that she was progressing normally, or “as expected.” I emailed a progress report to one of Margaret’s friends that sums it up: “Margaret still struggling to speak or choose the word she wants . . . Still VERY uncomfortable, much pain, words still very unclear or simply wrong . . . dozens of wires, tubes, monitors, alarms, &c. and of course she is terrified and angered at her inability to communicate. Also beginning to realize that it’s a long, hard road ahead, no overnight miracles. She has lost much, MUCH weight, the words I heard most clearly from her today were ‘Belsen’ and ‘Dachau,’ but she did eat most of a bowl of butternut squash soup tonight, her first food in four days . . . All her food is puréed of course, and she can’t drink liquids, like water, they have to be mixed with gelatin to make a kind of slush . . .”

  Margaret could not hold a knife, fork, or spoon, or even her own ChapStick. She could not lift a glass, it had to be held up so she could sip slurry through a straw. Her nurse, who was unfailingly cheerful and confident, made the first step toward progress on this front. He took the metal cutlery from the plastic tray home and brought it back the next morning twisted into strange shapes, so that the handle was set at a ninety-degree angle and carefully wrapped with several layers of surgical cotton pads held in place by surgical tape. With these Margaret could just bring a bit of food to her lips if it was puréed for her. It required constant supervision to prevent them from being taken away when the tray was removed, but over the next year we managed to hold on to them in the hospital, at rehabilitation centers, and at home, all a tribute to his expertise. Certainly there was nothing on the internet that was nearly as useful or better designed.

  By the third day Margaret was a little more animated, although she was still tethered firmly to her bed by the various tubes in and out of her body and by the cables and leads that connected her to the monitors that recorded every heartbeat, breath, and variation in her temperature, their presence producing a constant low hum and occasional pinging. Clearly, she was going nowhere until these had been removed. Her speech had improved to the point where she was able to ask when she would be able to get her hair washed, which I took as a good sign. I talked to Dr. Alain about this on his rounds. His judgment was that the dressing on her head could come off on the fourth day, and if everything looked good, then one of the nurses could shampoo her hair the next day. Perhaps more important, her catheter could be removed. This was all good news for Margaret. Dr. Alain reminded us that about three weeks from surgery she would need to have Gamma Knife radiosurgery, a procedure about which we should have no concerns, despite its name. No knife was involved, it was simply a powerful, precisely focused dose of radiation to kill off any remaining cancer cells in the tumor bed, an outpatient treatment without serious side effects.

  When did he think Margaret could go home? I asked him. He thought she could be discharged on the sixth day, although he was still strongly in favor of her going to a rehabilitation center before going home. I tried that on Margaret several times over the next few days, but she still shook her head vigorously at the suggestion. In the mornings, before I left for the hospital, I interviewed speech and physical therapists, trying to get everything lined up for Margaret’s return. All of them seemed well qualified and helpful, but none of them was enthusiastic about the house. Was I planning to replace our bed with a hospital bed? Had I given any thought to how she would get in and out of the bath? (Our house doesn’t have any showers.) Some years ago, in anticipation of old age, I had asked our friend and neighbor Sam Reichelt to put a handhold at every place where he thought I might need one. Sam was an artist with wood, a man who stocked his own guns, and at my suggestion he looked up the handholds on the big ocean liners of the thirties, and reproduced them so perfectly that they looked as if they had always been there. It was the kind of big project he loved. He installed a separate bannister against the wall so I would be able to grip with both hands going up or down the stairs, and put checkered stainless steel handholds in the bathrooms as well. Here, at least, was one area in which I was reasonably well prepared, but the general feeling was that I had seriously underestimated the difficulties the house would present to Margaret. Nobody liked the polished eighteenth century wide-plank flooring that is one of the house’s more appealing features, still less the rough stone walkway to the front door, which would be hard to manage for someone using a walker.

  When I arrived at the hospital one morning I was astonished to see the dressing on Margaret’s head had been removed, her hair had been washed, and she had been freed from most of her tubes and wires—I felt a combined sense of relief and apprehension. She was beginning to look like herself again, but she did not seem to me anywhere near physically ready to go home. Dr. Alain had been as good as his word, he had only cut a neat strip of Margaret’s hair from below her left ear to the top of her scalp, but even without the white gauze turban that had covered her head fully, she still had a layer of white bandages.

  Nobody’s first steps with a walker after serious surgery are easy—Margaret just managed to shuffle her way up and down the corridor of the Neuro-ICU trailing her IV pole behind her, with her nurse and me at her elbows. There were, of course, no steps, no stairs, and no wooden floors there to trip her, but she returned to bed exhausted. I personally thought a few days more in the hospital would be good for her, but in the absence of any medical necessity Medicare and the hospital discharge the patient from the Neuro-ICU after a fixed number of days, this is simply not negotiable, so I busied myself finding an ambulance to take Margaret home on the day of her discharge.

  But when the day finally came and I arrived at WMC, Dr. Alain met me and took me to one side. “Margaret has agreed to go into rehabilitation before going home,” he said. I was astonished, and asked how he had persuaded her. He shook his head; it was her own decision, she apparently came to the conclusion herself that she w
asn’t ready, so I quickly signed the paperwork and the ambulance I had hired to take Margaret home took her to the Burke Rehabilitation Hospital in White Plains instead before she changed her mind. Margaret was always a realist when it came to what she could and could not do, she had always known exactly how far she could push herself and her horse. She was not one of those combined-training riders who are so eager to move up a level in competition that they end up with a lame horse or a broken neck. She could not be forced into doing something she didn’t want to do, but she could be guided toward it gently until she made up her own mind. Clearly Dr. Alain had done that.

  Margaret’s arrival at Burke was not a happy one, she would later compare it to entering hell. The move from the hushed ambience of the Neuro-ICU where she had her own nurse to a busy, crowded rehabilitation hospital dismayed her. I could keep telling her until I ran out of breath that she was going to do fine here, but I could see she was miserable—all the more so since there wasn’t a private room for her. There was a zippered curtain between her and the other patient, who talked nonstop on her cell phone at the top of her voice, and whose large, noisy family filled the other half of the room, playing video games, watching television at high volume, and shouting at each other.

  I could see that at any moment Margaret was going to demand to be taken home, so I pushed the curtain back and asked as politely as I could for them to quiet down a bit, explaining that Margaret had just had brain surgery. That made no difference, it simply raised the voice level, and produced an instant wave of hostility. I went off in search of a nurse, but she said she couldn’t do anything about it. The nursing supervisor, when I found her, said she had more important things to do, there were no private rooms available anyway, so I went downstairs to find someone in authority. I couldn’t find anybody in charge, and nobody in the admissions office seemed to know what to do, but by chance I managed to collar a doctor, who said it wasn’t his job. “Well, make it your job,” I shouted.

  Concern for Margaret had managed to turn me into what I least like to be, an angry, combustible, unreasonable pain in the ass. With a sigh, he followed me to the elevator and we went upstairs. The people on the other side of the curtain were making as much noise as ever, but he ignored that, called for a nurse, and began to take Margaret’s blood pressure instead.

  It had been a long day that seemed to have gone on forever, although there were a least four hours to go before visiting hours were over. It had been less than three weeks since Margaret’s diagnosis. All the tension, fear, anger, and concern simply boiled to the surface and I heard myself screaming like a madman. Later, after the explosion, I was reminded of Lear’s words: “I shall do such things—What they are yet I know not, but they shall be the terrors of the earth.” Impotent rage. I cursed, I threatened, I promised lawsuits, I would take Margaret home at once . . . The entire floor fell silent, while I raged on, temples throbbing, drenched in sweat. I should not have been surprised; although he never turned it on me, my father was known to have had a temper that could bring a soundstage to a halt and leave people quaking.

  I paused for breath, and the doctor made a quick call. Within a few minutes Margaret was in a quiet private room, not quite as nice, or with as good a view, but hers. She squeezed my hand gratefully, and from then on I was treated by the entire staff as if I were a hand grenade with the pin pulled.

  Now that Margaret had a room of her own, I was able to bring her clothes from home the next day, hang them in a closet and store them in the drawers, and put her things in the bathroom. I took it as a good sign that her sense of color and choice of what clothing she wanted returned to her. She was specific about exactly which shirts, bras, panties, trousers, and jackets she wanted, as well as exactly which handkerchiefs and socks I was to bring. She liked colors to harmonize rather than to match. Often, in the past, when I came downstairs dressed to go out to dinner she would send me back to choose a different pocket square or tie. One of the things she liked about Dr. Alain was that his clothes always harmonized, he too obviously had a discriminating taste for colors. Her second husband Burt had more neckties and pocket squares than any other man I’ve known, bought over the years at Turnbull & Asser in London, from Sulka in New York, or from Hermès in Paris, and could spend a long, thoughtful time picking out the right combination while Margaret paused from finishing her makeup to give him her advice. When they separated after a long and acrimonious divorce, Margaret carefully cut the tail off all Burt’s neckties with a pair of pinking shears before leaving the apartment.

  It cannot be said that Margaret grew to like Burke. It was big, busy, and noisy, visiting hours seemed to go on until late at night with no apparent restriction on the number of visitors, and there was of course not the intimate, one-on-one connection that had existed between patient and nurse in the Neuro-ICU. On the other hand, she had a vigorous daily schedule of physical, speech, and occupational therapy that kept her occupied, and kept me busy pushing her wheelchair back and forth from one session to the next. At the end of every session there was a crush of wheelchairs at the elevators, which took considerable time to sort out, and Margaret was as determined to maneuver her wheelchair to the front of the crowd as she had been to win a horse competition.

  Not unexpectedly, she was superb at physical therapy, her balance and her strength in the gym astonished the therapists, but speech therapy went slowly, and so did occupational therapy. Remembering words and pronouncing them was a challenge that almost reduced her to tears. I was deeply impressed by the speech therapists—I felt, as I would come to feel about so many people over the next year, awed and humbled by their devotion and the degree to which they were determined for Margaret to succeed. Still, her progress was slow.

  I had not given much thought to occupational therapy, but it turned out to be much more difficult than I had imagined. Margaret quickly mastered putting square pegs in square holes and round pegs in round holes, but she still found it difficult to use a knife, fork, or spoon, or to take the cap off a pill bottle. The connection between her mind and her hands was still tenuous and unreliable, and she still seemed to have very little control over the fingers of her right hand. Writing was a slow, difficult process, something she had to learn all over again, like going back to first grade. Margaret’s occupational therapist was sympathetic and briskly practical. Since our house has stairs, she made Margaret put her walker to one side and go up and down the fire stairs over and over again, with one hand on the railing.

  Burke seemed to have thought of everything, there was a model kitchen off the gym so the patient could practice household skills and tasks, there was even a refrigerator with milk cartons, and more important a neat model bathroom where I could practice getting Margaret in and out of the empty bathtub, and she could practice getting on and off a toilet. The bathtub was the most difficult challenge of all. Getting her into it was hard enough, but getting her out of it was much more so—and she was dressed in gym pants, a hoodie, and sneakers; it would be a very different story when she was wet with soapy water and the Johnson’s baby oil she always poured into her bath! We experimented with a number of different solutions, the most promising of which was a “medical adjustable bathtub shower seat chair with removable back,” which had rubber anti-slip tips on the legs, although that meant that Margaret would not be able to lie back in the water. She would in effect be sitting in the tub to have a sponge bath. The most far-fetched device was an electric bath lift, which would lower and raise her out of the tub, but it proved more of a hazard than a help. A mat to prevent her from slipping would obviously be necessary; I made a mental note to add one to the list of things I needed to buy. Combining all this with a handheld shower that attached to the faucet by means of a rubber hose looked like the best way solve the bath problem without totally rebuilding the bathroom, which we didn’t have time for. Anyway, the whole process of a bath seemed precarious to me, and I wasn’t confident in my ability to lift Margaret out of the bath or to prevent her from s
lipping. No matter how many times we practiced this, it still felt risky.

  Margaret characteristically downplayed the risk. She understood that Burke was something like the convent she had hated so much as a child, where she wasn’t allowed to go home for the weekend until the nuns gave her passing marks for her classes and her behavior during the week and the Mother Superior had approved. Here, she would not be discharged until she had made enough progress in all her therapies to satisfy the medical director, and that was all the incentive she needed. It did not make her like the medical director any more than she had liked Mother Superior. She had an ingrained distrust since her convent days of all authority figures. Thus, when it came time to have the sutures removed from her scalp she did not trust anybody at Burke to do it, so Dr. Alain volunteered to come down to White Plains with a pair of surgical scissors and tweezers in sterile bags and take them out himself, which he did with his usual precision. There are surely not many neurosurgeons who would take the time to leave their office and perform what amounts to a physician assistant’s job in a hospital not his own, but he had an understandable pride in his own skill, and a real interest in his patient—had he not become a neurosurgeon he would have made a good psychoanalyst. Margaret always felt that he was on her side whatever the circumstances, and also assumed that whatever the problem might be, he would take responsibility and would solve it, not a viewpoint that necessarily endeared her to nurses, PAs, other doctors, or hospital administrators, since it undermined their authority. Dr. Alain’s patience was remarkable; he did not mind, or did not object, to being drawn into disputes about whether or not she could wear her own clothes to the gym or how soon she would be able to go to her hairdresser in New York City.

  He perhaps understood as well as I did that these concerns masked the reality—she preferred not to ask the questions that really worried her. Would she be able to walk, talk, ride, drive, and eat normally again? Was she ever going to be the person she had been? What were the chances of the tumor recurring? Was she “cured,” or was this merely a reprieve?