Brainstorm

by Robert Wintner

  “I don’t want that. I want out of here.”

  “Patience dear. I’m going full speed.”

  I set my hand on her arm, high up on the shrinking, unpunctured space remaining. And so we wait with our thoughts and assessments in this world of dramatic reaction. I know they’ll press for surgery immediately. It’s what they do. And though I know that Rachel is also aware of their drive, she seems still somehow secure in her belief that we’re leaving.

  The emergency room is big, because this hospital is the single major trauma center serving five states. It feels like an arena, with the roar of a crowd in pain, and athletes of heroic medicine striving to do their best. We feel like the ball. But of course we’re traumatized at this point. At any rate, we feel puffy and abused. Rachel’s arms are swollen and bruised, and we sense a goal line we’re being pushed toward, inexorably stuck in a struggle that is not ours but is between the blue team and the phantom death. Worse yet, the blue team appears to be well seasoned with a game attitude. They hardly fluctuate in pace and emotion in the closing minutes, all tied up against stiff competition. They seem to know and accept that they’ll win a few, lose a few; it’s the season that counts.

  In other times, other terms, this profile might be different, might reflect a dedicated staff attempting to maintain a high standard of survival under difficult conditions and often long-odds situations. The problem at the moment, however, is that analogy is deficient at best; it’s not an arena, and the staff are not athletes. We are in a downward spiral, a matrix of apprehension and non-communication; preconceived notions are assumed to be an acceptable substitute for informed dialogue. With no dialogue, no explanation, no options offered, our anxiety is compounded.

  Perhaps we’re naïve and ungrateful. Or maybe it’s the legal system and those pesky consequences of what, in fact, Your Honor, was represented. Of course we are ungrateful, caught between two systems in apparent opposition. I recognize this situation but have yet to engage in any communication, so that I might be corrected or clarified. What will happen next? Who knows? Ultimate faith here is presumed.

  Agony is ambient. Wails and shrieks perforate our faint recollection of sanity. Nothing can surprise us. Still, I wonder why such a system so sensitive to legal defense would allow a random orderly to approach us out of nowhere and introduce himself as Michael. I think he must be a part-timer, possibly on a drug-rehab program or otherwise enrolled as a halfway house trusty—or maybe he’s working out a community service sentence. I wish him well; he seems civil and lacks only proper diet and exercise to begin his difficult struggle back, to be counted among the living. He appears to be anorexic in his painfully thin and slumped posture, his yellowing and blemished skin suggesting liver malfunction, late acne and mineral deficiency.

  He offers his hand, and taking it I am taken with another apprehension. I look up, into his eyes to ascertain that he is not of the phantom entourage. I can’t feel it, the hand; like squid under water, it is one with the air around it. I have released flounder with more life than Michael’s handshake. He feels intangible, so I release him with care. He says, “Tell me about yourselves.” The formally printed name on his tag is defaced by a busy scribble and under that is written: Michael. And I realize in another searing moment of knowing, that this is Doctor, another young fellow who only a few summers ago was a sickly kid who wanted to be a brain surgeon.

  I want to accept Michael. I want to see him as an eccentrically shaped young man of uncanny skill, but I can’t. Of course I’m critical, perhaps acutely so. But I must take responsibility for what happens here, and I can find no confidence. Call me subjective. I’m comfortable with that. I see life as a series of choices that will be based on information and intuition.

  Michael displays humility on his chest, what there is of it. He’s the same size as Rachel, about a hundred pounds, but he transcends fragility and appears to be eminently, fearfully frail. His voice is a timid lilt like that of Michael Jackson. He’s too soft to be heard unless you lean in. I lean in and hear him speak with gentle authority like a man who has found the only calling available to him. His basic social skills seem withered, because he doesn’t need the voice or the posture or the appearance of health to answer his calling. He lives in his mind, because he’s a brain surgeon. He asks, “Are you new to the area?”

  His wary eyes shift in and out of focus, first finding me then looking through me for meaning, real meaning. Are we new to the area? I think he means the Seattle area or one of the five nearby states, though I stumble on another possibility, that he may be referring to the area of rational behavior; are we new to it? Well, clutch situations call for face value, so I tell him we’ve been in the Seattle area for a few years. Prior to that we were in the Hawaii area for decades. “Ah,” he says, nodding sanguinely at the mention of Hawaii. I wonder if Hawaii is known for resistance to what is best. I sense that the word is out on the upscale white couple with a cerebral hemorrhage making trouble on the line.

  I see that young Dr. Michael speaks with a heavy lower lip; it drags across his B’s and D’s and most other consonants like it’s filled with sand. I think his embouchure is surgically altered or otherwise short-circuited, perhaps from an aneurysm and cerebral hemorrhage. “Have you been?” I ask. He looks startled. “To Hawaii.”

  “You know. Everyone is going to Hawaii. Everyone but me. I have no time. I haven’t been. But I should go some day.”

  “If you do, you should be careful. You’ve had no exposure to the sun.” Though Michael’s complexion matches the drop ceiling, tepid beige with pockmarks and stains, he reddens, not with a healthy blush but in splotches on his face, neck and chest.

  He smiles with practiced patience and murmurs, “I know.” I’d like to chat more on fundamental health habits, but we must move on. “Yes. Well. I’m going to examine you. Okay?” Rachel nods, so he plugs his stethoscope into his ears. He wants his fingers squeezed. He wants to know the day and date and current President of the United States. He asks her to hold her arms out, now up, now turn your palms inward. “I’m going to give you three words. Ball. Cake. Metamorphosis. Remember those words. Okay?” He listens there and there and there. “Tell me what happened,” he says.

  By this time I see the ruse; a talking patient is not a resistant patient. But Rachel is more cooperative and less cynical than I am, so she is spared the difficult view. “I was painting the library. I mean staining. I was staining it. And the . . . the . . . fumes! . . .”

  He taps there and asks for a deep breath. And there. And there. “Do you have any history of cancer in your family?”

  “Yes. I was diagnosed with breast cancer.”

  He stops, opens his eyes wide and asks, “When?”

  “Six years ago.”

  “You had mastectomy?”

  “No.”

  “Radiation?”

  “No.”

  He looks peeved, as if we don’t have all day here and nobody is well served by a frickin’ guessing game. “What mode of treatment did you choose?”

  “And not chemotherapy. There are other ways.”

  He smiles; he understands. “Hmm. Yes, I’m sure you know about those.”

  “And I’m sure you don’t.”

  “I’d like to give you a breast exam. Okay?”

  “Fine.”

  But he says, “I’ll be right back.” He walks away but stops and turns. “Do you remember the three words?”

  “I’m. Leaving. Here.”

  “No. The three words I told you. You don’t remember?”

  “Ball. Cake. Metamorphosis. Hurry up.”

  He leaves. Rachel reminds me that we are leaving. She feels fine and wants away right now. Michael is back with another woman from the blue team whose stethoscope dangles from her neck. “Okay. I’m going to give you a breast exam,” he says.

  Rachel shrugs and nods; he already said that.

  “Okay.” He looks at the other woman, who nods. Then he slips the green seersucker from R
achel’s shoulder to reveal a breast. Two orderlies crane on the periphery. I don’t care. Rachel doesn’t care. I honestly believe Michael doesn’t care. He cops a few feels and covers her back up. The other woman leaves.

  “What was that?” I ask. “A political thing?”

  Michael reddens unevenly again. I suspect a colleague gave too many breast exams, but I make no comment about a heavy-handed tit man who ruined it for everyone. “No. It’s a courtesy. It assures everyone that a breast exam remains a breast exam.”

  “You guys . . .” I say, shaking my head.

  He rolls his eyes in mutual incredulity and takes notes and then explains the urgent need for an infusion CAT scan. I tell him we don’t want a CAT scan. We want the MRI. He says that it’s not time for the MRI. I ask why not. He says we need to know the full measure of the aneurysm, whether it’s a single or a multiple, whether it burst or simply leaked, where it is and the soundness of the vessels surrounding it. I ask, “The MRI won’t tell us this?”

  He rolls his eyes again. I sense his avoidance of the answer we both anticipate, which is yes, it will tell us this, which may lead to other questions of a delicate, perhaps legal nature. He says, “Different tests reveal different data. Please, let us do our job. We may need an MRI. And we may opt for an angiogram. Angiogram is the gold standard of detailed information.”

  “And what is an angiogram?”

  “We go in through the femoral vessel in the groin area. We go up through the torso, along the neck and into the brain with optic fiber. It’s the only way we can really tell what’s going on.”

  “And that’s it?”

  “We need two; one clear and one with radioactive dye. It’s the second that gives us the gold standard.”

  “Then why waste time with iodine and no dye? Why not minimize the invasiveness?

  “I can explain all these things, but not now.”

  “If not now, when?”

  “Soon. I can tell you this aneurysm popped out yesterday—”

  “You mean the hemorrhage occurred yesterday.”

  “No, I mean the aneurysm occurred yesterday. More can occur today. She’s coherent but suffers speech loss. She’s not making sense, and we need to do our job.”

  “I’m sorry, but I disagree with you. She’s dropping words, but she’s making as much sense as she ever does. She’s high energy. She hits the ground running every morning at sunrise. She feeds the animals, works the garden, cooks and cleans. She runs the feral cat program on Bainbridge. In the last year alone she saved a hundred twelve cats.”

  He rolls his eyes: yeah, yeah, yeah.

  “She passes out every night in front of the TV. I watch the rest of the movie, and at bedtime I wake her to go upstairs. Every night she says something like, ‘But we can’t paint it green. It all goes downhill. And how can we get the garage down from upstairs.’ Or something like that. She’s done this for years.”

  “She has?”

  “Yes. She has. I think the aneurysm has been there for years. I think it was possibly present at birth.”

  “How many?”

  “How many years has she done this? I don’t know. Five or six that I know of.”

  “Hmm.”

  “Michael. I think the aneurysm is old. I think it’s possibly congenital.”

  “Hmm.”

  He ponders, back-pedaling in the inner sanctum, his mind. Of course this is a university hospital, a learning facility that accommodates young students in that amazing transition from adolescence to doctor. So it should be no wonder that I worry over Michael’s confidence; he feels dismissive of what I’ve experienced and know and am willing to discuss. I proceed to explain that we’re not part of a statistical average—boy, what a pain in the ass. But we’re having a very hard time of accepting this inflexible application of medical school theory with no questions, no dialogue and no inclusion in the process. We understand that we need help, but we think we have choices. We wish he were better versed in alternatives to the scalpel. It’s okay with us if he’s not up on those alternatives, as long as we can share some rational discourse with mutual respect, which we deem necessary at this juncture.

  But Rachel sighs and closes her eyes. I think she can hear me, so I let my insistence go. After all, I’m here to advocate her beliefs and decisions; if she doesn’t mind the infusion CAT scan, I should let it be, I think. Everyone feels adversity in the air, but confrontation is not our objective. We in fact regret that we feel necessitated to behave defensively and would like to get on with a more productive exchange. We want to be informed and included, and in fact we require as much, because we won’t step blindly into this good night.

  I’m confused as well as defensive and must sort my alliances carefully. I can’t believe this unusually small, sickly man, yet I can’t ignore him. Adversity feels risky, too close to sudden death. Michael sees his opening, nods, takes a few more notes and says, “We’ll be going right up.”

  Rachel opens her eyes. “What comes after?”

  “Angiogram,” he says.

  “And then?”

  “We need to fix you,” he says.

  “How?”

  “It’s a simple procedure. We need to remove the clot and clip the aneurysm.”

  “You mean brain surgery?”

  “Well . . . Yes. That’s the only way we can . . .”

  “I’m not having surgery. You can forget that. It’s not going to happen.”

  “Listen. If you . . .”

  “You’ll want to shave my head.”

  “That’s right. But you could die any instant. I’m not saying you won’t die anyway—”

  “We all die someday.”

  “That’s right. You might not die until tomorrow or next week. But I can tell you this: a third of the people with a subarachnoid bleed of this size die instantly. Another third die within the week . . .”

  “You mean here in the hospital?”

  “Yes. You may die in surgery. You may have a stroke. You may be severely debilitated any minute. If you don’t have surgery, you have a fifty-percent chance of surviving six weeks. Beyond that, you run a five-percent risk of death annually. You’re . . . let’s see . . . forty-seven. So if you live another twenty years, your risk goes to a hundred percent. It can happen when you’re driving down the road or working in the garden. It can happen anytime.”

  “Hey. It can happen anytime, anyway. And you need to listen to me. I don’t believe you. I don’t believe anything you say to me. I don’t believe you. Do you hear? And you’re not shaving my head.”

  He laughs short. “We won’t shave all of it.”

  “Who’ll do the surgery?” She closes her eyes, instantly gaining our attention with a deep sigh. We scan for failure, Michael and I. She breathes easily, so we proceed. Only moments ago she refused to buy the car, yet now she asks what are her color choices.

  Bedside demeanor restored, young Michael assures her, “I will be your doctor.”

  Rachel opens again and looks at me. I return her gaze, no words necessary. We’re old enough to remember the TV series about the regular teenage boy who had to process the rigors of the teen years while—the crux of the drama—exercising his genius for medical practice, which played out each week in a TV hospital, where Doogie Howser was a head surgeon at fifteen, or some such nonsense.

  We have no doubt that our very own “Doogie Howser” continues to get excellent grades in school. His complexion may improve, and he may one day have an interest in girls. But he appears to be, in a word, unhealthy. We know the difference between healers and mechanics, and we have a history of choosing the former. This format of urgency and heroic cutting is why we have a history of choosing the former—physician, heal thyself and all that. Prospects for a scalpel between Doogie and us are untenable.

  “Listen,” he says. “You could die any minute. I can assure you… .” But he stops short when a nurse steps forward with a new IV bottle. He goes mum as a mob man wary of a wire, as if this nurse i
s a potential witness. Assurance has been sparse since way back in Bremerton, and I observe that it’s doled out in very small dosage and only by those of nurse status or lower.

  This pattern will continue to weave. We first sense it casually, then irritatingly. Positive expression must be restrained by anyone above nurse status. Anything beyond a marginal nod can be construed later, in court, as a promise if not a guarantee. Only nurses can dispense compassion and hopeful dialogue, because you can’t sue a nurse. Well, you can, but your odds on collected damages are clinically insignificant.

  Practitioners may argue that by conveying nothing or a worst-case scenario, they guard against assurance, hope, promise or positive indication in front of witnesses. Positive comments can turn on you in court. Anything is deniable without a witness. The nurse might be willing to corroborate, and who can take such a chance?

  Perhaps this well-intentioned young doctor only safeguards himself and his professional future. That too seems familiar. In serving us he has reminded us many times of potential death but has yet to suggest recovery at any level. “You listen,” I tell him. “Please accept what comes your way.”

  “What?”

  “Please. I’m suggesting that you open your mind to a new idea. I think you understand the basis of our hesitation. You seem to be familiar with it at any rate. We’ll agree to the infusion CAT scan. Please facilitate that now and leave the rest until later. Let’s take this one step at a time. Okay?”

  “One step at a time,” he back-quotes with a hard stare in classic profile; he will go along with so-called understanding but only with continuing amazement at those who don’t know what’s best for them. I meet his stare, and soon he nods. Then he fades, drifting ever so gradually backwards. I’ve seen fish do the same thing, into the murk, for protection.

  We will neither see nor hear of him again, ever.

  5

  An Exercise in Faith

  We wait. We recall our experience and faith. Healing is a matter of empowerment; body follows mind. Empowerment comes from confidence, and confidence stems from faith in the face of extreme adversity.