by Joan Didion
Qué bonita, qué hermosa, the picture of Ginger Rogers.
John and I had been in Bogotá together. We had escaped from a film festival in Cartagena and gotten on an Avianca flight to Bogotá. An actor who had been at the film festival, George Montgomery, had also been on the flight to Bogotá. He had gone up to the cockpit. From where I was sitting I could see him chatting with the crew, then sliding into the pilot’s seat.
I had nudged John, who was sleeping. “They’re letting George Montgomery fly this plane over the Andes,” I had whispered.
“It beats Cartagena,” John said, and went back to sleep.
I did not that day on Canon get as far as the Rite Aid.
11.
Sometime in June, after she had left UCLA and was in the sixth of what would be fifteen weeks as an inpatient at the Rusk Institute of Rehabilitation Medicine at New York University Medical Center in New York, Quintana told me that her memory not only of UCLA but of her arrival at Rusk was “all mudgy.” She could remember some things about UCLA, yes, as she could not yet remember anything else since before Christmas (she did not for example remember speaking about her father at St. John the Divine, nor, when she first woke at UCLA, did she remember that he had died), but it was still “mudgy.” Later she corrected this to “smudgy,” but she did not need to: I knew exactly what she meant. On the neuro floors at UCLA they had called it “spotty,” as in “her orientation is improving but still spotty.” When I try to reconstruct those weeks at UCLA I recognize the mudginess in my own memory. There are parts of days that seem very clear and parts of days that do not. I clearly remember arguing with a doctor the day they decided to do the tracheostomy. She had by then been intubated for almost a week, the doctor said. UCLA did not leave tubes in for more than a week. I said that she had been intubated for three weeks at Beth Israel in New York. The doctor had looked away. “The rule at Duke was also a week,” he said, as if under the impression that mention of Duke would settle the question. Instead it enraged me: What is Duke to me, I wanted to say but did not. What is Duke to UCLA. Duke is North Carolina. UCLA is California. If I wanted the opinion of somebody in North Carolina I would call somebody in North Carolina.
Her husband is right now on a flight to New York, I said instead. Surely this can wait until he lands.
Not really, the doctor said. Since it’s already on the schedule.
The day they decided to do the tracheostomy was also the day they turned off the EEG.
“Everything’s looking good,” they kept saying. “She’s going to get better sooner once we do the trach. She’s already off the EEG, maybe you didn’t notice that.”
Maybe I didn’t notice that?
My only child?
My unconscious child?
Maybe I didn’t notice when I walked into the ICU that morning that her brain waves were gone? That the monitor above her bed was dark, dead?
This was now being presented as progress but it had not seemed so when I first saw it. I remembered reading in Intensive Care that the ICU nurses at San Francisco General turned off the monitors when a patient was near death, because their experience was that family members would focus on the screens rather than on the dying patient. I wondered if such a determination had been made in this case. Even after I was assured that this was not the case, I found myself averting my eyes from the blank EEG screen. I had grown used to watching her brain waves. It was a way of hearing her talk.
I did not see why, since the equipment was sitting there unused, they could not keep the EEG on.
Just in case.
I had asked.
I do not remember getting an answer. It was a period when I asked many questions that did not get answered. What answers I did get tended to the unsatisfactory, as in, “It’s already on the schedule.”
Everyone in the neuro units got a trach, they had kept saying to me that day. Everyone in the neuro units had muscular weaknesses that rendered the removal of the breathing tube problematic. A trach involved less risk of windpipe damage. A trach involved less risk of pneumonia. Look to your right, look to your left, both sides have trachs. A trach could be done with fentanyl and a muscle relaxant, she would be under anesthesia no more than an hour. A trach would leave no cosmetic effect to speak of, “only a little dimple scar,” “as time goes by maybe no scar at all.”
They kept mentioning this last point, as if the basis for my resistance to the trach was the scar. They were doctors, however freshly minted. I was not. Ergo, any concerns I had must be cosmetic, frivolous.
In fact I had no idea why I so resisted the trach.
I think now that my resistance came from the same fund of superstition from which I had been drawing since John died. If she did not have a trach she could be fine in the morning, ready to eat, talk, go home. If she did not have a trach we could be on a plane by the weekend. Even if they did not want her to fly, I could take her with me to the Beverly Wilshire, we could have our nails done, sit by the pool. If they still did not want her to fly we could drive out to Malibu, spend a few restorative days with Jean Moore.
If she did not have a trach.
This was demented, but so was I.
Through the printed blue cotton curtains that separated the beds I could hear people talking to their functionally absent husbands, fathers, uncles, co-workers. In the bed to Quintana’s right was a man injured in a construction accident. The men who had been on the site at the time of the accident had come to see him. They stood around his bed and tried to explain what had happened. The rig, the cab, the crane, I heard a noise, I called out to Vinny. Each man gave his version. Each version differed slightly from the others. This was understandable, since each witness proceeded from a different point of view, but I recall wanting to intercede, help them coordinate their stories; it had seemed too much conflicting data to lay on someone with a traumatic brain injury.
“Everything’s going along as usual and then all shit breaks loose,” one said.
The injured man made no response, nor could he, since he had a trach.
To Quintana’s left lay a man from Massachusetts who had been in the hospital for several months. He and his wife had been in Los Angeles visiting their children, there had been a fall from a ladder, he had seemed all right. One more perfectly ordinary day. Then he had trouble speaking. Everything’s going along as usual and then all shit breaks loose. Now he had pneumonia. The children came and went. The wife was always there, pleading with him in a low mournful voice. The husband made no response: he too had a trach.
They did the trach for Quintana on the first of April, a Thursday afternoon.
By Friday morning enough of the sedation for the breathing tube had been metabolized out that she could open her eyes and squeeze my hand.
On Saturday I was told that the next day or Monday she would be moved from the ICU into a step-down neuro-observational unit on the seventh floor. The sixth and seventh floors at UCLA were all neuro.
I have no memory of when she was moved but I think it was some days after that.
One afternoon after she had been moved to the step-down unit I ran into the woman from Massachusetts in the Café Med courtyard.
Her husband too had left the ICU, and was moving now to what she called a “subacute rehab facility.” We each knew that “subacute rehab facilities” were what medical insurance carriers and hospital discharge coordinators called nursing homes but this went unmentioned. She had wanted him moved to the eleven-bed acute rehab unit at UCLA Neuropsychiatric but he had not been accepted. That was the phrase she used, “not been accepted.” She was concerned about how she would get to the subacute facility—one of the two with an available bed was near LAX, the other in Chinatown—because she did not drive. The children had jobs, important jobs, they could not always be driving her.
We sat in the sun.
I listened. She asked about my daughter.
I did not want to tell her that my daughter would be moving to the eleven-bed acute rehab unit
at Neuropsychiatric.
At some point I noticed that I was trying like a sheepdog to herd the doctors, pointing out edema to one intern, reminding another to obtain a urine culture to check out the blood in the Foley catheter line, insisting on a Doppler ultrasound to see if the reason for the leg pain could be emboli, doggedly repeating—when the ultrasound indicated that she was in fact again throwing clots—that I wanted a specialist on coagulation called in to consult. I wrote down the name of the specialist I wanted. I offered to call him myself. These efforts did not endear me to the young men and women who made up the house staff (“If you want to manage this case I’m signing off,” one finally said) but they made me feel less helpless.
I remember learning at UCLA the names of many tests and scales. The Kimura Box Test. The Two-Point Discrimination Test. The Glasgow Coma Scale, the Glasgow Outcome Scale. My comprehension of the meaning of these tests and scales remained obscure. I also remember learning, both at UCLA and before, at Beth Israel and Columbia-Presbyterian, the names of many resistant hospital bacteria. At Beth Israel there had been Acinetobacter baumannii, which was resistant to vancomycin. “That’s how you know it’s a hospital infection,” I recall being told by a doctor I asked at Columbia-Presbyterian. “If it’s resistant to vanc it’s hospital. Because vanc only gets used in hospital settings.” At UCLA there had been MRSA, methicillin-resistant Staphylococcus aureus, as opposed to MRSE, methicillin-resistant Staphylococcus epidermidis, which was what they first thought they had cultured and which had seemed to more visibly alarm the staff. “I can’t say why but since you’re pregnant you may want to transfer off,” one therapist advised another during the MRSE scare, glancing at me as if I might not understand. There were many other names of hospital bacteria, but those were the big hitters. Whatever bacteria was shown to be the source of the new fever or urinary tract infection, it would mandate gowns, gloves, masks. It would provoke heavy sighing among the aides who were required to suit up before entering the room to empty a wastebasket. The methicillin-resistant Staphylococcus aureus at UCLA was an infection in the bloodstream, a bacteremia. When I heard this I expressed concern to the doctor who was examining Quintana that an infection in her bloodstream might again lead to sepsis.
“Well, you know, sepsis, it’s a clinical term,” the doctor said, then continued examining her.
I had pressed him.
“She’s already in some degree of sepsis.” He had seemed cheerful. “But we’re continuing vanc. And so far her blood pressure is holding.”
So. We were back to waiting to see if she lost blood pressure.
We were back to watching for septic shock.
Next we would be watching for ice floes on the East River.
In point of fact what I watched from the windows at UCLA was a swimming pool. I never once saw anyone swim in this swimming pool, although it was filled, filtered (I could see the little swirl where the water entered the filter and the bubbling where it reemerged), sparkling in the sun, and surrounded by patio tables, with parasols. One day when I was watching it I had a sharp memory of having gotten the idea to float candles and gardenias in the pool behind the house in Brentwood Park. We were having a party. It was an hour before the party but I was already dressed when the gardenia idea presented itself. I knelt on the coping and lit the candles and used the pool skimmer to guide the gardenias and candles into a random pattern. I stood up, pleased with the result. I put the pool skimmer away. When I glanced back at the pool, the gardenias had vanished and the candles were out, tiny drenched hulks bobbing furiously around the filter intake. They could not be sucked in because the filter was already clogged with gardenias. I spent the remaining forty-five minutes before the party cleaning the sodden gardenias from the filter and scooping out the candles and drying my dress with a hair dryer.
So far so good.
A memory of the house in Brentwood Park that involved neither John nor Quintana.
Unfortunately I thought of another. I had been alone in the kitchen of that house, late twilight, early evening, feeding the Bouvier we then had. Quintana was at Barnard. John was spending a few days at the apartment we had in New York. This would have been late 1987, the period during which he had begun talking about wanting us to spend more time in New York. I had discouraged this idea. Suddenly a red flashing light had filled the kitchen. I had gone to the window. There was an ambulance in front of a house across Marlboro Street, visible beyond the coral tree and two cords of stacked wood in our side yard. This was a neighborhood in which many houses, including the one across Marlboro Street, had side yards in which there were two cords of stacked wood. I had watched the house until the last light was gone and the ambulance left. The next morning when I was walking the Bouvier a neighbor told me what had happened. Two cords of stacked wood had not kept the woman in the house across Marlboro Street from becoming a widow at dinner.
I had called John in New York.
The red flashing light had by then seemed an urgent warning.
I said maybe he was right, we should spend more time in New York.
Watching the empty swimming pool from the window at UCLA I could see the vortex coming but could not deflect it. The vortex in this instance would be the memory’s insistent appointment-in-Samarra aspect. Had I not made that call would Quintana have moved back to Los Angeles when she graduated from Barnard? Had she been living in Los Angeles would Beth Israel North have happened, would Presbyterian have happened, would she be in UCLA today? Had I not misread the meaning of the red flashing light in late 1987 would I be able to get in my car today and drive west on San Vicente and find John at the house in Brentwood Park? Standing in the pool? Rereading Sophie’s Choice?
Would I need to relive every mistake? If by accident I remembered the morning we drove down to St.-Tropez from Tony Richardson’s house in the hills and had coffee on the street and bought the fish for dinner would I also need to remember the night I refused to swim in the moonlight because the Mediterranean was polluted and I had a cut on my leg? If I remembered the gamecock at Portuguese Bend would I also need to remember the long drive home from dinner to that house, and how many nights as we passed the refineries on the San Diego Freeway one or the other of us had said the wrong thing? Or stopped speaking? Or imagined that the other had stopped speaking? “Each single one of the memories and expectations in which the libido is bound to the object is brought up and hypercathected, and detachment of the libido is accomplished in respect of it…. It is remarkable that this painful unpleasure is taken as a matter of course by us.” So Freud explained what he saw as the “work” of grief, which as described sounded suspiciously like the vortex.
In point of fact the house in Brentwood Park from which I had seen the red flashing light and thought to evade it by moving to New York no longer existed. It was torn down to the ground and replaced (by a house marginally larger) a year after we sold it. The day we happened to be in Los Angeles and drove past the corner of Chadbourne and Marlboro and saw nothing left standing except the one chimney that allowed a tax advantage, I remembered the real estate agent telling me how meaningful it would be to the buyers were we to give them suitably inscribed copies of the books we had written in the house. We had done this. Quintana and Friends, Dutch Shea, Jr., and The Red White and Blue for John, Salvador, Democracy, and Miami for me. When we saw the flattened lot from the car, Quintana, in the back seat, burst into tears. My first reaction was fury. I wanted the books back.
Did this corrective line of thinking stop the vortex?
Not hardly.
One morning when Quintana was still in the step-down unit because the persistence of her fever necessitated an echocardiogram to rule out endocarditis she lifted her right hand for the first time. This was significant because it was on the right side of her body that the effects of the trauma could be seen. Movement meant that the traumatized nerves remained alive. Later that day she kept wanting to get out of bed, and fell into a sulk like a child when I said I would not h
elp her. My memory of that day is not at all mudgy.
It was decided in late April that sufficient time had passed since the surgery to allow her to fly to New York. The issue until then had been pressurization and the potential it presented for swelling. She would need trained personnel to accompany her. A commercial flight was ruled out. Arrangements were made to medevac her: an ambulance from UCLA to an airport, an air ambulance to Teterboro, and an ambulance from Teterboro to New York University Hospital, where she would do neuro-rehab at the Rusk Institute. Many conversations were held between UCLA and Rusk. Many records were faxed. A CDROM of CT scans was prepared. A date was set for what even I was now calling “the transfer”: Thursday, April 29. Early that Thursday morning as I was about to check out of the Beverly Wilshire I got a call from somewhere in Colorado. The flight had been delayed. The plane was in Tucson, where it had landed with “mechanical difficulties.” The mechanics in Tucson would look at it when they came in, at ten mountain time. By early afternoon Pacific time it was clear that the plane would not be flying. Another plane would be available the next morning, but the next morning was a Friday, and UCLA did not like to transfer on Fridays. At the hospital I pressed the discharge coordinator to agree to the Friday transfer.