Cal’s expression changed from guarded hope to grave concern, his friendly smile vanished. He reached into his pocket to retrieve a small black leather pouch, and took out a penlight, shining the painfully bright light into one of her eyes and then the other.
“Her pupils are equal, round, and reactive to light and accommodation,” he said. “I know you all write the acronym in your notes every day, but you better damn well be examining your patients’ eyes before writing it down.” Something in Cal’s voice told Alison something was off, an undercurrent of tension in his tone.
“The next thing to do is check the tracking of the eyes, looking for fluidity and nystagmus,” he said, holding his finger over her left temple and moving it slowly to the right. “Any hitching or beating of the eye movements could indicate an injury.”
What kind of injury was he talking about? Grant had assured her the AVM was treatable, that he had done this surgery hundreds of times and that he was confident he would be successful. Was he referring to the problem with her arm or the fact that she couldn’t make the words come out? Maybe both. She wished Cal would stop with the doctor speak and tell her what the hell was going on. And that’s when Grant and Cynthia walked in.
CHAPTER THIRTY - ONE
Grant
March 25, 2019
WHEN GRANT AND CYNTHIA RETURNED from the cafeteria, Cal was at the bedside doing a neurologic exam, the whole team looking on. Alison’s eyes were wide open in panic. Cynthia hurried to the other side of the bed and grabbed her hand.
“I can’t believe you’re awake,” she said. Grant was relieved to see Alison breathing on her own.
“Yes,” Cal said. “I just need a few minutes to conduct a thorough exam. Would you mind waiting outside? I’m sure Michael could use some company in the waiting area.” Grant knew Cal would never ask family to wait outside unless there was a major problem, but he held his tongue. He didn’t want Cynthia’s anxiety level to skyrocket.
The nurse guided Cynthia toward the door. “Can I get you a cup of coffee while you wait?” she asked.
“We just had breakfast,” Cynthia said. “I want to stay with my sister.”
The nurse continued speaking to Cynthia in a soothing voice, successfully leading her down to the hall and out of earshot.
“What’s happening?” Grant asked. The ponytailed med student eyed him again. “Any chance you can do this exam without an entourage?”
“Yes, of course,” Cal said, turning to the group. “Team, let’s reconvene in fifteen.”
When they all cleared out, Grant turned back to Cal. “What the hell is going on, Cal?”
“She woke up quicker than I thought.” Cal tracked his finger in front of Alison’s face, focusing his attention on her eye movements. “I was trying to get the exam done before you came back, so I would have a complete update.”
“Well, I’m here now, so I’ll watch you do it.”
Cal asked Alison to squeeze his hands first on one side and then the other. He then tested the strength in each leg by asking her to push against him as hard as she could in different directions. Next, he used a sharp pin and a feather to test her sensation.
The panicked look on Alison’s face was getting worse. One of them needed to say something to calm her down.
“Everything’s fine,” Grant said, even though he had a sinking feeling this was far from the truth. He couldn’t think of anything else to say.
Cal lifted the sheet from Alison’s feet and took a reflex hammer from the pocket of his white coat. Using the pointed end of the metal handle, he scraped the bottom of her left foot and her toes curled downward, a normal response. Grant breathed a small sigh of relief, before he realized her other foot would be the one affected. Injury of the left side of the brain affected the right side of the body and vice versa.
The omelet he’d had in the cafeteria swirled in his stomach. When Cal brought the handle of the hammer to Alison’s right foot and dragged the sharp end from the heel upwards, Alison’s big toe pointed backwards and the other toes splayed. Textbook positive Babinski sign, a telltale indication of brain injury.
“Fuck,” Grant said, forgetting that Alison was awake and listening to every word they said.
“Do I need to ask you to step out, too?” Cal asked. “I don’t want you upsetting my patient.”
Alison’s eyebrows raised in question. Grant noticed that her left eyebrow was slightly higher than the right.
“We’ll explain everything in a minute, okay?” Grant said. When he took her hand, her smile made his stomach drop. The right side of her mouth remained neutral, the nasal labial fold flat, while the left side turned up normally.
“I’m almost done,” Cal said. “Then we’ll talk.”
Hearing the word “talk” made Grant realize that he hadn’t heard Alison say anything. The whole time Cal had been conducting the exam, Alison hadn’t said a single word.
Grant leaned down over the bed. “Alison, how are you feeling?”
She looked back at him and nodded.
“How are you feeling? I need you to tell me.” He brought his hand to her cheek and turned her face toward him. “Tell me how you feel.”
Her eyes darted around the room. Her mouth gaped open and the only thing that came out was a thin line of saliva trailing down the right side of her chin onto her neck.
“Dr. Shin, can we speak in private, please?” Grant said.
Cal assured Alison they would return soon and met Grant in the hallway outside the room.
“Is she aphasic? Because I can’t get her to say a fucking word.” One of the residents at the nurses’ station looked up at them.
“Keep your voice down. You’re yelling.”
“I think I have the right to be yelling right now.”
“Listen, you know better than I do that aphasia is not always permanent. With effective therapy, the patient can regain some or all of the speech they had before.”
“Cut to the chase, Cal. What else did you find?” Grant asked “She has some sensory loss. Any weakness?”
“Definitely some in the right leg and right arm, and you saw the facial asymmetry. We won’t know how much the weakness affects her until we can get her up and walking.”
“Well let’s do that now. I need to know what we’re dealing with.”
Cal made a quiet down motion with both hands.
“The sooner I know what we’re dealing with, the sooner we can all wrap our heads around it,” Grant said.
“What’s going on?” Cynthia asked. Grant had been so upset he hadn’t noticed her coming down the hall, Michael at her side.
“There are some complications,” Cal said. “Why don’t we sit down so we can talk things through?”
“I don’t need to sit,” Cynthia said. “Tell me right now.”
“What kind of complications?” Michael asked.
“Sometimes with brain surgery, we don’t know the full story until the person wakes up. Patients with large tumors or big bleeds can wake up totally intact and those with smaller lesions end up with big deficits. We always hope for the best, and cross our fingers for good measure.”
“And?” Cynthia looked from Cal to Grant, trying to glean information from their faces.
“And the outcome for Alison doesn’t seem to be as positive as we had hoped,” Cal said.
“What do you mean?” Michael said.
“She’s got some weakness on her right side,” Grant said, trying to take some of the pressure off Cal.
“Okay, that’s doesn’t seem so bad,” Cynthia said. “There’s that great physical therapy place right in Newton Centre. Lisa Newmark took her mother there after her stroke last year. I’m sure there’s a therapist there who specializes in patients with brain injury.”
“There’s more,” Grant said, placing a hand on Cynthia’s arm. “She also has some speech deficits.”
“Deficits?”
“She’s not able to speak right now.”
You’r
e joking.” She tried to break away. “I’m going to see my sister.”
Grant pulled her back. “It’s not a joke. The bleed damaged the speech part of her brain. She can’t talk.” Grant couldn’t bear to look at Cynthia.
CHAPTER THIRTY - TWO
Alison
October 30, 2019
ALISON SETTLED IN AT THE CONFERENCE TABLE, resting her cane against her chair. The blinds were raised, sunlight pouring through the windows overlooking Boston Common. The swan boats had stopped running for the season, but the park was filled with people: tourists with baseball hats and sneakers, businesspeople eating their lunch on benches, kids riding scooters and chasing soccer balls. The idyllic scene gave Alison hope that one day she’d be able to enjoy a hot dog in the park. Swallowing a hot dog was still out of the question, but the thought of the salty meat smothered with sweet ketchup made her mouth water anyway.
Over a month since Michael had moved out, Alison hoped he would come to this meeting with a good attitude. So far, he was still fighting her every step of the way, making everything more difficult than it needed to be. The glass door opened and a tall woman entered.
“Good morning,” she said, reaching her hand across the table. “Shelly Green. You must be Mrs. Jacobs.”
“Alison.” There was no chance she could stand on such short notice. Like a child learning to ride a bike, she needed a good push to get going. “Nice to meet you,” she said, returning the handshake from her seat.
“Likewise.” Shelly took a seat across from Alison. “I’d like to thank you for sending me all the information I requested. The more I have, the easier this process will be for everyone.”
Alison couldn’t imagine this would be easy, especially with Michael involved. She was surprised Michael had agreed to mediation at all, and accepted her choice of mediator to boot. Becca’s neighbor had used Shelly Green for her divorce a few years back.
“No problem,” Alison said. In reality, it had been quite a problem. Gathering all of her financial information—pay stubs, car titles, insurance policies—hadn’t been an easy undertaking. You don’t realize how much you owned until someone asks you to make an exhaustive list of your possessions. There was nothing like a divorce to make you want to simplify your life. Plus, with Rhea constantly insisting she give Michael another chance, Alison had to do it all on her own. When Rhea said Michael was a good man, what she was really saying was that Alison’s relationship with Becca was unnatural and immoral. Alison couldn’t deal with her judgment on top of everything else.
Shelly rubbed her lips together to smooth her lipstick. “We’ll get started as soon as Mr. Jacobs arrives.”
“Michael,” Alison said, trying to keep this meeting as casual as possible. When they’d looked Shelly up online, Becca had said she looked like Rose Byrne from that movie about the bridesmaids and Alison saw the resemblance now, the same slim nose and sleek hair. Michael knocked and came in. He looked worn, dark stubble on his cheeks and his hair tucked under a Red Sox cap. He introduced himself to Shelly and then starting pulling out a chair beside her.
“If you don’t mind,” Shelly said. “I’d like you two to sit side by side. It’s better for negotiation. Less adversarial.”
Michael nodded and came around the table. When he got closer, Alison smelled a familiar unwashed odor, like after he’d gone for a long jog. She wondered if he was taking care of himself.
“Before we get started, let me tell you a little about myself,” Shelly said. While she went into detail about her college career, law degree from an Ivy League law school, position as vice-president of law review, and who knows what else, Michael made a show of moving his chair farther away from Alison before taking a seat. “I’d like to thank you both for reaching out to me,” Shelly continued. “You’ve taken an important first step. It says a lot that you’ve decided to use a mediator instead of lawyering up.”
“You are a lawyer,” Michael said.
“By training,” Shelly ignored his attitude. “But I’ve chosen to serve as a mediator instead of divorce attorney. I like to keep things amicable rather than pitting one team against the other.”
“So, I have a question for you,” Michael said. “What if we decided to sue the doctor who did this to Alison? How would we do that?”
“Well, that’s outside of my area of expertise and also not the reason we’re meeting today. Why don’t we focus on mediation for now?”
“That sounds like a good idea,” Alison said, shooting Michael a stern look.
“We’ve got some work to do,” Shelly said. “Why don’t we talk things through. See if we can come up with solutions that meet both of your needs.”
“Seems pie in the sky to me,” Michael said. “You’re going to convince me that Alison deserves my money. This isn’t cocktail hour.”
“It sounds like you’re bringing some anger to the table,” Shelly said. “That’s quite common and understandable.”
“Damn straight, I’m angry.” Michael stood up and started pacing in front of the window. “My wife, who pledged to love me forever, has all of a sudden decided she bats for the other team. I think I have the right to be angry, Shelly.”
“It’s not about you,” Alison said. “You didn’t do anything wrong.”
“Well, I can’t help but take it personally, Alison.” A spray of spit flew out of Michael’s mouth.
“Very good,” Shelly said. “Airing your grievances at the outset is healthy. We can’t begin negotiation until both parties have agreed to participate.”
“This whole thing came out of nowhere,” Michael said to Alison, “and you’re acting like I should get over it already. It’s going to take me a while. I can’t just turn on a dime like that.”
“I know.”
“I thought we would be together forever,” Michael said. “I can’t picture myself without you.”
“I never wanted to hurt you,” Alison said. “I mean that.”
Michael looked at her, and she caught a glimpse of the old Michael, the one who made her laugh with his stupid sayings and silly jokes, the one who had who sat by her side all those months in the hospital, the one who would do anything and everything for her.
“Why don’t you sit down?” she said.
Michael collapsed into his seat with a groan.
“Well, that was a productive conversation,” Shelly said. “Shall we get started with the details?”
The following afternoon, Alison sat by the window at Starbucks watching people passing outside, mothers pushing strollers, men in business suits, teenagers texting while they walked. Two women at the table next to hers discussed the pros and cons of hot yoga. She breathed in the earthy smell of roasted coffee and sighed. It felt indescribably good to be out in the world.
Alison had told Rhea she was meeting a colleague from work, conveniently forgetting to mention a name, and Rhea agreed to drop her off. When Becca picked her up, she was literally in the driver’s seat and Alison wanted to meet on her own terms today. She was here to tell Becca they needed to slow things down. After the scene in the bookstore, she’d been doing a lot of thinking. Rushing right into another relationship wouldn’t be fair to either of them. Alison needed time to breathe, to figure out the details of the divorce and what her life would look like going forward.
She looked up and noticed Robin Weintraub, Cynthia’s annoying tennis partner who was always on some diet or other. As Robin claimed her Frappuccino from the counter, Alison saw she was wearing one of those ugly rubber bracelets. She wondered if Cynthia made them for all of her friends and if any of them found it as odd as she did. Turning to the window, she hoped Robin would pass without recognizing her.
“Alison, is that you?”
“Robin, “Alison said, as if she had no idea Robin was there. “How are you?” She hoped Robin wouldn’t take the opportunity to tell her about the ups and downs of her latest diet. Given the five-hundred-calorie milkshake in her hand, Alison figured she was on a downswing at the
moment.
“Can’t complain,” Robin said. “I haven’t seen you in forever. Maybe since you were in the hospital. You really look great.”
“Nowhere to go but up,” Alison said.
“I guess so.”
Alison looked out the window, hoping Robin would take the hint and leave.
“Have you spoken with Cynthia lately?” she asked.
“No.”
“Maybe you should give her a ring.”
“Thanks for the advice.” Sarcasm crept into Alison’s voice. It had been almost two months since their fight in the craft store, but with everything going on with Michael and Becca, Alison hadn’t had much time to dwell on it. Plus, the ball was in her court, as Michael would say. Cynthia had essentially called Alison a prissy bitch and stormed out the door, so Alison wasn’t about to go crawling back to her. She still had her pride. Out of the corner of her eye, Alison saw the door open. Becca wore a full peasant skirt and a white tank top, her hair draped over one shoulder.
“I hope I’m not overstepping my bounds,” Robin said. “It’s just that Cynthia’s been so upset about your fight. And since Grant moved out, she keeps rehashing it and asking me what she should do. She feels like she lost her whole family all at once.”
What was she talking about? Sadie had mentioned they were fighting, but she hadn’t said anything about Grant moving out. Alison decided to pretend she was in the know.
“And what did you tell her?” Alison asked.
“I told her that a sincere apology goes a long way, but she’s afraid.”
Becca was placing her order at the counter. Alison hoped she would wait for Robin to leave before coming over.
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