by Lauren Marks
And in a certain way, it was.
I appreciate the sentiment, I replied. I really do. But when people go in for an intestinal surgery, they don’t have to fear that they are going to wake up an entirely new person.
Understood, he said. Sorry.
We touched hands briefly before my horse trotted ahead of his.
My legs gripped the saddle, my jeans drenched in sweat, but I didn’t have to wrangle with the horse at all—it knew its way. At least someone did. And when Jonah rode up next to me, I asked him to do me a favor.
Anything, love, he said. Name it.
Can you bring a tape recorder to the hospital? I would ask my parents, but don’t want them to have another thing to worry about.
He said it was an easy request and he would be happy to get one for me.
But do you mind telling me why? he asked.
I mentioned the stories people had told me about what I was like after my first surgery. But they didn’t always correspond with one another, and they didn’t match some of my own personal recollections. And I didn’t produce any audio recordings then. So if I had to go through all of this a second time, I wanted a more objective mediating force in the mix.
I see. He nodded and smiled. A woman after my own heart.
THE SIX STEPS OF A CRANIOTOMY
1. Prepare the patient
No food or drink after midnight the day before. Not like you will be able to eat anyway. You won’t be able to sleep either, even with your boyfriend in your bed. He will wake up when you wake up, and cradle you in his taut arms, but he will fall asleep soon after that with the ease of someone who won’t be going under the knife the next day.
Your younger sibling and his redheaded doppelgänger will be asleep when you leave in the early morning. But your brother will have given you a proper send-off the night before. He will have hugged you and offered you reassuring words, and you’ll recognize how these earnest expressions have been lifted straight from your own glossary, things you said to him years ago as a toddler with a skinned knee, as a fifth grader taunted by a classmate. You’ll be impressed by the ways your brother is turning into a kind man. Your boyfriend will come with you and your folks to the hospital, bringing the tape recorder you requested.
The nurse will check your blood pressure. She’ll ask you to take a pregnancy test, too. You realize that all of your towering preparations for this day can be undone by pissing in a cup, so fingers crossed.
Before the general anesthesia, the paperwork you have been expecting will be set before you. And you will probably write in “Catholic” on the formerly vacant line. Then, you’ll get your IV.
You’ll be asleep before your head is put into a three-pin, skull-fixation device. Since all brains float in cerebral spinal fluid, a lumbar drain will be inserted to release some of that liquid to let the brain relax.
2. Make a skin incision
Your scalp will be prepped with antiseptic, and a little past your hairline, an incision will be made. The surgical team will remove about a quarter of an inch of the hair around the site. Often, half of the scalp is shaved, and sometimes all of it, though female patients are occasionally treated differently than their male counterparts on this point. But this decision is purely cosmetic, and up to the discretion of the surgeon.
3. Open the skull
The skin and muscles of your head will be folded back from the bone. A machine will drill into the cranium, creating one, or several, burr holes. A bone saw called a craniotome will cut a curved section of bone. When this bone flap is removed, the outermost layer of the brain, the dura, will be visible.
4. Expose the brain
With a pair of surgical scissors, the operating team will pull back your dura like peeling the skin off of an overripe plum. Holding back surrounding brain tissue, retractors will be true to their name, as they isolate the area of interest.
5. Correct the problem
A brain is a sloshy product inside an inflexible container. The compact surgical arena of the skull will limit all of your doctors’ actions. The brain surgeons will wear magnifying gear over their eyes. They’ll manipulate instruments with long handles and tiny tips. Everything is done in miniature in this work, like a Fabergé artist building a palace inside of an egg. Your surgeons will attempt to pass through this terrain without disturbing it too much, since there is always the risk of another rupture. Even in the surgical world, aneurysm interventions are often compared to defusing a bomb.
Your aneurysm will be resting on the Middle Cerebral Artery, and the surgeons will take a metal clamp and try to close off the opening of the aneurysm. For the next second or two, they’ll have to watch for the artery’s response to this device. The surgeons will hope the clamp will fit there, because if not, they’ll have to try something less orthodox, and perhaps less permanent.
6. Close the craniotomy
People have been cutting into skulls for centuries, and not just in aggression, but in kindness, too. Sometimes it was thought that the easiest way to release the demon, the wandering spirit, the evil air, was to create an opening through the head and just let it out. These trepanations extend into the prehistory of the human race and their visible marks and gaping holes remain on the bones left behind. The vast majority of craniotomies do not leave openings in the skull anymore, though. Sutures will close the dura and the surgeons will return the bone flap to its initial location, securing it with plates and screws. But this closure will be carried out whether or not the problem has been corrected.
PART FOUR
UNFINISHED
I never lost as much but twice,
And that was in the sod.
Twice have I stood a beggar
Before the door of God!
Angels—twice descending
Reimbursed my store—
Burglar! Banker—Father!
I am poor once more!
EMILY DICKINSON
1
Morphine was dragging through my veins as I tried to make out the shapes before me. Two figures stood in front of a bank of windows, but the blinding sunlight streaming through made it impossible for me to look into their faces. I knew that they were my doctors only by their voices—Dr. Giannnota and Dr. Teitelbaum. The surgery was all done, and they were telling me that it had gone pretty well, considering. But very early on, the procedure had encountered a major complication.
I knew the doctors wouldn’t try to remove the existing coils in my aneurysm because that operation had been deemed too dangerous ahead of time. But relying on the recanalization was a key component to the surgery they did plan. The coils were expected to have compacted farther into the aneurysm, so a metal clip could be easily fastened across the loose “neck” of the structure. However, once the surgeons had opened up my skull, they discovered the aneurysm was not as pliable as they’d hoped. There was not enough material to clip the structure closed. So, they had to improvise. Instead of clipping the aneurysm, they wrapped it—a rare procedure, but they had some experience with it. Careful to maintain the coils inside the structure, they coated the outside of it with cotton and superglue.
It was shocking to hear the material list, like an arts and crafts project filling my skull. My papier-mâché aneurysm.
I had prepared to ask the surgeons certain questions when I woke up. “How long will I be in the hospital?” And “Will I have to return to speech therapy?” Instead, though, I asked something that hadn’t been part of any prepared list beforehand:
Will I still be able to have children one day?
Can’t see any reason why not, Dr. Giannota said. Characteristically, his statement was blunt, and it was clear this topic didn’t interest him in the slightest.
I am told that my parents came to my bedside in this period of slow awakening. Jonah too. When the drugs wore off and I was much more alert, I wanted a sense of how my spoken language had fared. Everyone told me I sounded fine, but I wanted to hear it for myself. So the day after the surgery, Jonah ho
nored my request and turned on a tape recorder. Click.
ME:
Hey, it’s me.
JONAH:
Then it’s recording now . . .
ME:
Oh. Well hello hello. It’s me and Jonah.
JONAH:
Hello.
ME:
We are at USC. I’m up on my feet. I’ve seen my scar. It is disgustingly badass.
JONAH:
It is wicked.
ME:
It is very wicked. Uhhmm. My speech seems pretty good.
JONAH:
It seems great.
ME:
It seems great. Uhhmm. I don’t know. What else can I tell you? My speech seems great. My, my head . . . I wore some blood around my, my chest for a few hours. They have just taken it away and Doctor Schmieeeeekaliebop just gave me an extra stitch. As he was doing that. Now I am wearing a very chic beanie. Anything to say?
JONAH:
Uhh, I think you’re doing great. You’re better than I thought you’d be. Mmm, yep.
(A rustling sound and mutual laughter)
ME:
He grabbed my butt.
It was the still hour after dawn and a nurse had unhooked my IV, promising to return in a few moments to take me on a walk down the hall. After a few minutes, I heard a knock at the door. I got out of bed, impressed with the strength and the evenness of my gait. But to my surprise, it wasn’t the nurse who greeted me. It was a priest.
He had a barrel chest and his black clerical shirt pulled at the paunch near his midsection. He was balding, with a resilient ring of white hair covering the final third of his head. With a crooked nose and unsmiling lips, he had the look of a boxer. Or Dick Cheney. His heft was blocking the doorway.
Good morning, he said. Would you like to receive the sacrament?
I felt I had received several sacraments already. It was a sacrament to wake up from surgery. It was a sacrament that I could clearly read the calendar on the wall; in fact, I was hugely grateful I could read anything. I hadn’t developed any visible seizures, and there were no traces of visual deficits. And, most important, I was still able to write. What sacrament was I meant to receive now?
Sorry? I asked. Could you explain what you mean?
Communion, he said. Would you like to receive Holy Communion?
Hmm . . . I considered. You know, I don’t think so. But I can’t thank you enough for coming to see me!
To this day, I am not quite sure why I turned the priest away. A sense of gratitude and sanctity was abounding in those moments, so why didn’t I want to receive communion from this holy man? If I hadn’t survived the operation, this was more than likely the cleric who would’ve administered my last rites. I suspect if one of the missionaries from my neighborhood had arrived at my hospital door instead and asked me the same question, I would have happily accepted the invitation. However, this priest had the face of a brawler, and I was in no mood to fight.
As his loafers clomped away, my aching face cracked into an uneven smile. I saw my reflection in the window—my lips were even on both sides of my face. Just another of today’s sacraments.
2
Fewer than three days after I was admitted to the hospital, I was discharged. My parents and I were astonished. Jonah was still in town, and we were overjoyed we could spend more time together before he returned to New York. He was very careful with my face. My entire head was a tender coloring book. I had developed a tremendous black eye with splotches of green around it. There were blue lines from the surgical markings, and a red scar pulled together with jagged black stitches. The surgeons had shaved only around the incision point on my head, leaving me the vast majority of my hair. This was all hidden under a beige cap that the hospital had given me, and eventually, the whole thing could be easily disguised with an artful comb-over. But it itched like hell.
My first night home, Jonah and I climbed into bed in my newly red room. The equanimity I had felt in the house before the operation was not exactly holding fast. With six adults on one floor, the quarters were feeling a little tight. Jonah and I were sharing the unlockable bathroom with the Michaels, and the area was showing the general disorder produced by two boys in their twenties. But I liked that the two were bonding. From time to time I overheard Materson asking my brother for tips on picking up American girls, and in turn, Mike had confided in Materson about his issues with Amber, hoping to get some insight from a fresh perspective. It was nice they were getting along. That being said, they also went to bed late and woke up late, and tended to slam the bathroom door at all hours.
After a particularly vigorous slam of that door one night, Jonah did not try to disguise his annoyance.
Your brother is a real piece of work, he said.
Tried to tell you. I laughed.
Jonah didn’t. I was with your parents in the hospital all day when you were in surgery, he said. But neither of the Michaels showed up. They didn’t make an appearance at all, even in the recovery ward. And when we all came back to the house, those slackers were on the couch watching TV.
Typical. I continued to smile, and shook my head. Now you know what I’ve been dealing with!
Jonah remained unmoved, though. When we returned from USC, I gave them the evil eye, he said, and that finally got them motivated. Or shamed them into submission.
Well, they got there eventually, I said, pulling back the covers and climbing into bed. That’s what counts.
Does it? Jonah asked. I know that Scottish kid probably can’t drive in the US, but your brother should have known better.
It’s not a big deal, I said, surprised Jonah was still focusing on this.
I sort of think it is, Lauren. Your brother should have been there for you, and he just wasn’t. He really dropped the ball.
This comment brought out a mixture of emotions from me. It was sweet that Jonah was being protective, but I thought he was also being much more judgmental than necessary. He hadn’t even gotten into bed with me yet, and at this point, there was a coastline of pillows separating us.
They are just kids, I said, hoping to defuse his mood. Don’t you think you might be overreacting a little?
To tell you the truth, he snapped, I think you might be underreacting.
• • •
What Jonah was not emphasizing was the fact that the Michaels did eventually arrive that day. It was just when everyone else had left, and visiting hours were long over. The windows of the ward were black, with only dim working lights on the floor, so when a nurse came over to me, her voice was like a tiptoe. I only heard every other quiet word, but was able to make out, brothers and exception. Then a broad blur of red appeared, flanking me on both sides of the bed.
Can’t believe that worked! Materson whispered gleefully. We had to fib a little to get in at this hour, but Mike gave an Oscar-winning performance! Told the nurse that we were both your brothers, both in from Scotland. And he put on this rubbish accent, too, but somehow fully convinced the staff that our flight came in late at LAX.
I had it under control, Sis, Mike said. You know I would have done anything to get to you.
My brother looked like a man who had been camping for days, with disheveled hair and a spotty three-day beard. Then he started to take off layers. First one bag, then another. On a nearby chair, he deposited his keys, pens, matches, Zippo, gum, and then his jacket. He was an urban sherpa setting up base camp. He was making himself lighter and I was feeling lighter because of it. He held my hand and kissed the part of my face that wasn’t swollen.
Love you so much, Sis. Mike breathed out heavily. So glad you are okay. And I squeezed his hand. This visit couldn’t have gone better if I had planned it.
My brother’s intentions are good, I told Jonah. They are just not always visible. My eyebrows wrinkled, an action that I wasn’t usually conscious of, but this time I could feel that the left side of my brow was still leaden and sluggish.
Well, I think your brother needs
to take responsibility for his actions, and his inactions, too. It seemed to me that Jonah was trying to emphasize his point because he stood in his underwear on the cold wood floor instead of climbing under the covers with me. Mike’s not a kid anymore, he said.
Now I sat straight up myself. But he is still my kid brother, I said.
It was only then did I realize Jonah and I perceived this situation in fundamentally different ways. I knew my brother often got uncomfortable in hospitals, and I hadn’t expected him to leap into action when I was going into surgery. It wasn’t at all a surprise that he procrastinated until the last possible minute, and, regardless, he had gotten to me.
There were decades I had shared with Michael that I still couldn’t access in detail. But I knew intrinsically that before the stroke I often took on a custodial role with him, and I also knew that the roles had largely reversed over the last several months. Yet even in my most detached states, it was abundantly clear to me that even though the bond between us had changed, it had never disappeared.
Mike is very invested in what is happening around him, I said to Jonah. He’s emotional—sometimes overly so. If he looks disinterested, it’s usually a defense because he gets overwhelmed.
You might be right, Jonah said, finally getting under the covers. But what I saw today was a man who doesn’t care about anything.
Then you missed it, I said, now too agitated to drift off to sleep.
It seemed that Jonah didn’t understand my family at all, or the particular ways we expressed our affection. I felt I needed the final word before I turned off the lamp that night, and I tried to gather the most specific language I could muster.
It’s not that my brother doesn’t care, I told Jonah. He can’t help himself from caring. He cares without abandon and without being able to stop caring about everything and everybody. Like most of my family members, I said, he probably cares a little too much.