All eyes turned to Jack, as he said, “Bernie Myers may be the best interventional radiologist in the bay area. Let’s get him down here, and see if he can find the bleeding vessel and put a clot in it.”
Twenty minutes later, with Harvey still applying pressure on Lisa’s belly, the operating room was filled with radiological equipment and staff. The room looked like a platform full of commuters, as the train pulled into its first stop.
Bernie prepped Lisa’s left groin area, and then inserted a long, tan catheter into the femoral artery. When he moved the catheter deeper into her body, he squirted small amounts of dye to visualize his location. As the catheter reached the approximate location of the arteries to the uterus, he injected a large bolus of dye, and took several images.
Three minutes later, Bernie brought the images to the screen. “I don’t see any bleeding,” he said.
“Let’s have Harvey release the pressure on her abdomen for the next set of pictures,” Jack said.
Bernie again manipulated the catheter into place. He grabbed a large syringe filled with radio contrast dye, and then said, “Any time you’re ready, Harvey.”
Harvey leaned back, lifting his bloody hands from the incision.
Bernie injected the dye as he stared at the image on the video screen. “There it is!” He shouted, as he pushed and twisted the catheter. “I’m going to inflate the balloon to block the vessel, until I see the films. That may give us control of the bleeding.”
In another three minutes, his tech brought up the images on the screen. “There it is,” Bernie said. “See the catheter and the white blush beyond its tip? That’s blood leaking from the open blood vessel.”
“How’s she doing, Mickey?” Harvey asked.
“Pressure is holding at 74/52.”
Mickey had drawn a syringe-full of Lisa’s blood at the beginning of the procedure. He squirted the partially clotted blood into a sterile basin. Bernie selected an appropriate sized clot, and then said, “I’m going to pull back, inject the clot, and try to get a picture right away to see if we’ve blocked the artery.”
Bernie turned to his tech, and said, “Do twenty shots as quickly as possible on my count.”
“Ready?”
He pulled back on the catheter, and then said, “I’m injecting the clot,” as he grabbed a new syringe filled with dye, and injected it. “Shoot,” he cried as the machine rumbled like a Xerox machine on amphetamines.
After three more minutes, they looked at the images.
“God damn it,” Bernie said, as the blood was still leaking from the artery.
“She’s crashing,” Mickey said. “Her pressure’s down to 60 over nothing, and her pulse is racing.”
“Pump the blood in as fast as it will go,” Jack said.
“Let me try, again,” Bernie said. “I’ll use a larger clot, this time.”
“We’re out of time,” Harvey said. “I can’t stand here and let Lisa bleed to death. I’m going in.”
“Her pressure’s coming up,” Mickey said, as the new unit of blood ran in.
“Let’s let Bernie take another pass at it,” Jack said.
“That’s it,” Harvey said. “Then we’ll get that uterus out as quickly as possible.”
Bernie took several clots, and squeezed the largest one he could into the catheter. “Are you ready?” He asked his tech.
“Ready.”
Bernie again injected the clot, and then, seconds later, followed it with, “Ready—shoot,” as he injected the dye.
After an agonizing three minutes, the series of images appeared.
Bernie smiled as he saw a clear outline of the uterine artery. The visualized vessel traveled three inches beyond the catheter tip, and stopped. They could see no bleeding from the artery, which was now sealed with Lisa’s own clot.
The room filled with applause and laughter.
Chapter Sixty-Seven
Brad attached the baby’s endotracheal (ET) tube to the ventilator, while the nursing staff took turns looking at Lisa’s baby.
Her 2100-gram baby boy was large by NICU standards, since they cared for extremely low birth weight infants, many under 1000 grams. They all knew, however, that, while risk was higher the lower the birth weight, the odds never applied to an individual baby.
“Why do physicians and their families have all the bad luck?” Brad asked.
Sharon Bridges nodded paternalistically. “It’s only because it affects you more.”
“Maybe, but Mike’s condition, and Lisa’s near death, the delivery at thirty-four weeks, and the baby requiring intubation, is proof enough for me that the adage survives, because it’s true.”
“How’s Lisa doing?” Another nurse asked.
“It was getting pretty exciting in there,” Sharon said. “We had to get out of delivery to treat the baby. Brad will let us know.”
Brad wrote orders for the ventilator, oxygen, IV fluids, surfactant, and blue lights to treat the yellow jaundice of prematurity.
When Brad stood to hand the baby’s chart to Sharon, he stopped. “Maybe I should put him on oral antibiotics?”
Good idea, he thought, remembering Mike’s lectures when Brad first came to Brier.
“I’m heading back to surgery to see how Lisa’s doing,” Brad said. “Call me when the baby’s labs and x-rays return, or if anything develops.”
When Brad re-entered the operating room, he expected the worst. Instead, he found the room quiet except for the beeps of the heart monitor, and the shuffling of feet and medical equipment. They’d removed all the special radiological equipment and the extra staff.
Harvey turned to the circulating nurse. As she wiped his brow, he looked over his surgical glasses at Brad. “We’re closing up.”
“Did you do a hysterectomy?”
“No, thank God. Bernie Myers injected a clot into the uterine artery. It stopped the bleeding.”
“Getting fancy in your old age, Harvey?”
“That technique saved her uterus, and her life. How’s the baby?”
Lisa had been sleeping, but her eyes snapped open at the question. “How’s my baby?”
“I must say that he had us scared for a moment. When we reached NICU, we had to intubate him. I’m waiting for his lab tests and x-rays.”
“Brad, you must get him through this. You know what it means to me, and to Mike, too.”
“Lisa, I’m…”
“I’m sorry, Brad. I know you’ll do everything possible for him.”
“Don’t worry. The minute I know something, you’ll know, too.”
“Brad…”
“Yes?”
“Forget that I work in NICU. Knowing too much may make things tougher for me. I’m a frightened mother. Please treat me that way.”
Brad leaned over behind the draping that separated Lisa from the surgical field, kissed her cheek, and whispered, “It’s like he’s here.”
“He?”
“Mike, I mean.”
“He is here. He’s upstairs. I know he’s getting better.”
Brad jumped as the pager on his belt vibrated. He looked at the small screen, and said, “It’s the NICU. I’ll come back when I know more.”
“Brad…”
“I know…”
Carla Watts came on for the ICU evening shift, and even before she saw Mike blink wildly, she knew something was wrong.
“Mike, are you okay?” She asked.
No.
“Do you want the alphabet board?”
Yes.
She propped it up before him, and started the tedious process.
Where’s Lisa?
What’s wrong?
What’s happening with the baby?
“Lisa had a rough delivery. She bled massively, and Harvey nearly had to perform a hysterectomy. Finally, they got the bleeding under control. She’s worn out, but doing well.”
The baby?
“Thirty-four weeks, and 2100 grams.”
Not too bad.
“He has
IRDS. They had to intubate. Brad’s taking care of him. He’s working his ass off.”
Details?
“I’m sure Brad and Lisa will be up soon. They’ll fill you in.”
Carla watched as Mike closed his eyes. She could only imagine the nightmare of a man frozen in his own body, but denied the bliss of ignorance. She shook him, and then said, “Can you move? Will you try to move your hand for me?”
No.
“No, what?”
No.
Chapter Sixty-Eight
Brad Rosin had baby Aaron Cooper’s chest images in the NICU computer. He looked at the tiny baby shape on the screen. His first look at x-rays had been of adults, and their chests filled the entire screen. Here, the real image occupied a quarter of the available space; however, the computer could enlarge all or portions of the image.
“What does it look like, Brad?” Sharon Bridges asked. “I’m with the baby until the end of my shift.”
He motioned her over, and then, waving his hand over the image, said, “Do you see that haziness over both lungs?”
“Yes.”
“It’s the ground-glass appearance characteristic of Infant Respiratory Distress Syndrome (IRDS). Let me see his labs.”
Brad studied the computer printout. “His oxygen saturation is low, and there’s too much acid in his bloodstream. That all goes along with IRDS. How does he look?”
“About the same. I hate to see such a small baby struggle to breathe—it’s heartbreaking.”
“Get the respiratory therapist up here,” Brad said. “We’ll try to adjust the ventilator, and start surfactant. Let’s insert a feeding tube and begin nutritional support.”
Thirty minutes later, Brad, Sharon, and the respiratory tech stood beside the incubator. The first impression of someone looking through the Plexiglas was tubes and wires, and then, somewhere in the background, a baby. The monitor electrode patches—even the pediatric kind—looked like targets on his chest, with a wire attached to each. An additional wire came from a strap that Sharon placed across his right ankle, a pulse oximeter, to measure the baby’s oxygen saturation. A clear tube entered the baby’s nostril, and sat in his stomach.
When Lisa arrived in the recovery room, Phoebe was waiting. “Don’t ever do that again. You had me scared to death.”
Lisa grasped her hand. “You’re always thinking of yourself, Phoebe.”
“Right. How’s the baby?”
“Brad should be back any minute,” Phoebe said. “The baby’s about 2100 grams, but he was struggling to breathe when they took him to the NICU. This whole thing—the bleeding, the cramping, the placental separation, none of it could have been good for him.”
“You, more than anyone, know how lucky we are to be at Brier with this first-rate NICU. We’ll get through this.”
“I only wish Mike was here to see his son. He said he didn’t care whether we had boys or girls, but I knew that he has wanted a son. Have you heard anything new about his condition?”
“No, nothing.”
“I feel flushed, Phoebe. Every time I think of Mike, it’s like he’s here with me. It’s weird, but nice.”
“In many ways, he is. He’s part of you, and part of your son.”
“It’s more than that, Phoebe. It’s like he really is here.”
Phoebe placed her hand on Lisa’s forehead. “Thorazine will fix that.”
“I love you for any number of reasons, Phoebe, but one is because you remind me of Mike. That’s exactly what he’d say.”
“Mike was a smart guy. Grounded in reality. Not flaky, like some people.”
“Mike is a smart guy, Phoebe.”
“You’re right, Lisa. I’m sorry.”
Brad parted the curtains around Lisa’s bed, and walked in.
“Is he okay?” Lisa asked.
“He has IRDS, and so far, he’s holding his own.”
“What does his x-rays show?
“How’s his saturation?
“Is he still on the ventilator?”
“Easy, Lisa,” Brad said. “You know it’s too early to be sure of anything. We’ve adjusted the ventilator, started surfactant, oral antibiotics, and nutritional supplements.”
“Why the antibiotics? Is he infected?”
“I’m playing all the odds, Lisa. I think, if we can avoid complications, he will come through this.”
Sometimes I can’t tell when I’m fully awake, for dream and consciousness confuse my reality. It’s only when they poke or prod, startling me awake, and then peel the tape from my lids that I’m sure. I’ve done this poking hundreds of times to patients, and it’s a good thing that locked-in syndrome is so rare, because being on the receiving end is intolerable.
I think of myself as an invisible man, for, although they instructed the staff to be careful what they say in my presence, they don’t always remember that I’m a sentient being. They’re not cruel, just human.
When you lose so much, nature compensates by heightening your senses, or perhaps it’s just that sensation is all that remains of this great life I’m living.
I saw little, felt quite a bit, but heard nearly everything. I learned about everyone’s love life, the institutional gripes, the gossip, and, of course, I heard the throbbing beat of each Code Blue. They were careful, but not careful enough, with their expressions about my condition and Lisa’s problems. The information wasn’t good for either of us, but it was so fragmentary that I couldn’t fully understand. I felt warm when over and over again, they managed to augment their observations with loving care and sensitivity, and I knew it had been people like these who drew me to the healing arts.
I wake up this day—morning or night, I can’t be sure, to the sound of my friend, the ventilator. I take comfort in its mechanical clicks as it completes one cycle of breathing for me, and begins the next. I feel my chest rise and fall, and hear the flow of the air and oxygen mixture as it bubbles through the humidifier, and passes through the coiled tube into and out of my lungs. I think the ventilator is set on demand—that it’s waiting for me to initiate a breath, but since I can’t, it follows a regular machine-driven pattern of breathing for me.
I’ve come to recognize and dread the arrival of the respiratory therapist , who’s responsible for the machine and my lungs. It startled me the first time I heard the distinct snap of the off switch on the ventilator, and then silence. Then comes the reassuring, although less regular, ventilation of my lungs by somebody’s hand squeezing an Ambu bag. Next, the therapist passes a tube into my trachea. We call that suctioning, to remove excess secretions. It’s essential, and horrific.
Anyone who has ever “swallowed the wrong way” or had something “pass through the wrong tube” understands the cough reflex. Something inhaled into the upper airway provokes the body’s exquisitely sensitive reflex. It's nature’s way of protecting the lungs from any intruder. My inability to move voluntarily was suddenly replaced by coarse shaking of my body wracked with the involuntary cough reflex, as the technician moved the suction catheter in and out of my trachea. Tears streamed from my eyes, and my face flushed. My mind screamed in pain, as my brain sent urgent messages to my paralyzed muscles to escape—to grab the hand of the technician to stop the assault, or to simply turn away.
Like a blocked freeway without a detour, my injury has jammed the frantic messages to flee in the lower part of my brain. Physical escape is impossible, so all that remains is escape from consciousness, a break akin to psychosis, or death.
If the suction catheter wasn’t bad enough, I had to deal with physical therapy (PT). Like the masseuse giving a deep muscle massage, the physical therapist knows when he’s gone too far when his client groans, or sits up, and punches him in the mouth. I didn’t have that option. After the first few sessions of stretching and kneading, I tried to explain that it’s painful, that he’s hurting me, through the alphabet board. In truth, without feedback, the therapist cannot tell when he’s hurting the patient he’s trying to help.
Jack Byrnes wouldn’t like it, but he has my undying gratitude for his kindness in doping me up with morphine prior to physical therapy and suctioning. Recently, I’m looking forward to the premedication and the relief from pain and the narcotic bliss that follows. I could get used to—a faint shadow of life.
Chapter Sixty-Nine
Harvey Russo moved Lisa to the postpartum ward, but asked that the nurses place her directly across from the nursing station, just in case.
Surgery had exhausted Lisa, and, needing morphine to control her pain, she slept until four forty-five in the morning.
When she opened her eyes and looked around, she grabbed the phone, and called the NICU.
“NICU, Brenda speaking,” came as the ward clerk answered the phone.
“Brenda, it’s Lisa. I just woke up. How’s my baby?”
“Lisa, how are you feeling?”
“Sore and tired. Who’s taking care of my boy?”
“Sharon Bridges. I’ll get her.”
Lisa drummed her fingers against her over-bed table until she heard, “Lisa, sweetie, how are you?”
“I’m fine. How’s little Aaron?”
After a moment of silence, Sharon said, “I think you should be talking with Brad. You know we’re limited in what we can say to a parent.”
“Please, Sharon, it’s me. Don’t leave me this way. I’ll only think the worst.”
Sharon hesitated, and then said, “I’ll fill you in, but please ask Brad if it’s okay in the future. We’re going all out with the baby. He has IRDS, and we’ve started surfactant and steroids. He’s still working hard to breathe, but at least he’s stable.”
“I want to see him.”
“If you’re up for a trip to the NICU, it’s okay with me.”
Lisa paused, and then said, “Sharon, what are you doing working the night shift?”
“They needed help, so I’m pulling a double.”
“Sharon…?”
“Okay, I asked to stay on so I could be with your baby, Lisa. I had to be here to help. I couldn’t go home—I couldn’t sleep, anyway.”
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