Brainstorm

by Robert Wintner

  I catch up and walk alongside. “Yes, we learned about the gold standard last night. But I . . . I have one more question. Please. I’ll be brief.” He stops. “If you have five-percent odds on an event, and those odds renew annually, what are your odds on the event in twenty years?”

  It’s a long time since the head closer crunched the front-end numbers, but his instinct is tuned to trick questions. I see him thinking: Ah, ha! That repartee about explaining things in acceptable terms was not the set up; this is the set-up. Finally, he says, “I’m not sure I understand your question.” He scans for motivation.

  “Okay. Let’s say you’re at the track. You really need some money, so you pick a twenty-to-one shot. You lose, so you pick another horse in the next race with the same odds, same payout. Twenty to one. You keep losing all day and all week, and by Friday, you’ve lost a hundred times at twenty-to-one. So you make another bet, another twenty-to-one shot. What are your odds?”

  He smiles clearly, picture resolving. He won’t speak until the words line up defensibly. I help him along—“The odds are still twenty to one. Aren’t they?”

  He shakes his head slowly but won’t address the front-end. “This isn’t the track. I don’t know how the numbers were presented to you. Our statistics don’t reflect what we think will happen. They measure what has happened. Fact. Nobody sustains a subarachnoid hemorrhage and survives twenty years without the surgery.”

  I nod. He has effectively conceded the blunder of his staff and at the same time overruled me with rational explanation. It’s all we’ve waited on for forty hours. I want to ask how the team can dive into a wholesale brain shuffle when the point people can’t pass muster on Statistics 101. But this face-off is over. Ambient pressure is dire; I too am resolved and relieved. I defer to circumstance, miffed and frustrated by so much delay in filling our simple need with a brief exchange of straight talk.

  He allows me an ounce of encouragement with a slap on the back. He says nothing, as in no more words coming from him, but he cracks a marginal smile, bringing home the point, which is that nothing else can be said. So I say, “I just . . .”

  “I know,” he says. “It’s time to move on. Surgery tomorrow morning. Eleven.”

  He goes his way. I go mine, back to the curtained space. I tell Rachel that we’re scheduled for tomorrow morning. She shakes her head very slowly and only an inch to either side, and I see another IV on the right side of her neck, a gang-valve with four leads on quarter-inch valves into a matching spike piercing her jugular. “I don’t know about this,” she says of things in general. “I don’t like it. I can tell you right now I wouldn’t do this if you didn’t tell me to.”

  She’s crying. I want to say something but it sticks in my throat. Two nurses sweep the curtain aside and step in to check the valves, to measure this and that and take notes. I ask about the neck cluster. They say it looks worse than it really is, because it’s only a back-up system, mostly, that was put in place as long as they were tapping the jugular. The really important one right here, is a tiny tube that runs to the top of the heart, just in case, you know.

  Their simplistic explanation again presumes two levels of comprehension on the ward, the elevated one and the one for street level. They need the small tube in place for several reasons, they concede. Like pumping adrenaline on a quick shot to the heart, just in case. Or like drawing off blood quickly, just in case.

  I think staff assessment of patient needs may be as numbed as we are. They talk goo goo, as if we can only work a puzzle with big, rounded pieces, then they serve up some downside potential, cold. Of course we asked for it, but their biomechanical safety net sounds gruesome and severe, drawing blood off, dosing the heart muscle with adrenaline, both procedures indicated by death or near-death conditions. I think my complaint is for lack of nuance, what no trench in any war has ever enjoyed. But why would they say something like that in front of a woman so upset? I think it was not because I asked them to, but then it is. So we’re all annoyed, so I ask, since we’re on the subject of blood. Will we need some? Is this not the time to make sure we have some?

  They say we won’t need some, because this procedure doesn’t call for blood. One nurse moves to the file cabinet for another form; as long as we’re here, we might as well get this out of the way. It’s the blood pool consent form. I scan it and ask what’s the difference between using the blood pool and unprotected sex with the donors.

  Oh, but it’s not that way at all, because blood donors are screened, they say. They crumble in cross-examination; screening is an interview, a series of questions on sexual preference, sexual history, sexual habit, intravenous drug use and general health. The end. I shitchu not. Purity of the blood pool is further ensured by the requirement that no blood in the pool can be paid for but must be donated.

  “I’m not signing that,” Rachel says. “Are you nuts?”

  The curtain whisks again on a small woman with a large smile who seems apologetic and silent, no offense. I think she’s heard about us. Her eyes roll brightly over our little space as if seeking a place to light, and she chirps, “Hi! I’m Frannie! I’m your family liaison social worker. I’m here to help you with any problems you might have!”

  I think we no longer have a problem, other than the obvious problem of being here, waiting for brain surgery. We’ve made the difficult decision, thanks to brief exchanges with Lawrence of Neurology and John Upledger three thousand miles away. We only have to process the time between now and post-op.

  Frannie says, “I want you to know that your complaint has been duly noted.”

  “What complaint?”

  “About Dr. Visnawara.”

  “We didn’t file a complaint.”

  “I did,” Rachel says.

  I shrug. “Who’s taking note of this problem?”

  “The team,” Frannie says,

  “We appreciate your effort,” I tell her. “We have no complaint against anyone. Dr. Visnawara upset Rachel, so we’ll want to avoid further contact with her. Okay? We don’t want to get Rachel upset again. Okay?”

  Frannie nods quick as a two-stroke engine and begins writing.

  Intercepting the first two nurses on their stealthy exit, I ask what is Rachel’s blood type. They dissemble. They don’t know. “You don’t know? You take blood every hour. You must know.” They shrug and say we won’t need blood anyway; we’ll take care of it later. I will later learn that Rachel is B negative, not the rarest in the book but hardly available, not from me or her sister or her parents.

  They take their leave as Frannie finishes with her notes and perks up to see what else might ail us as the curtain sweeps again on a black man in a shiny, sky blue suit, who steps inside unannounced. He wears a matching tie in baby blue and carries a matching hat. His shirt is lemon yellow. I am reminded of the reef, but this man is niele, which is Hawaiian for nosy and intrusive rather than curious and innocent. His Louie-Armstrong eyes roll over the scene with as many teeth. His voice is also deep and graveled but instead of What a wunnerful world this would be, his lyric is somber. “How do you do? I am The Reverend Brown. I make my rounds here. You see?” He glances toward the next space over, behind another curtain, where a very large woman bemoans the imminent loss of her life. “I am here. How do you do?”

  “We do fine,” I tell him. “Thank you. And thank you for stopping by, Reverend Brown. Have a good day.”

  “Ah! I see . . .”

  “Thanks again. Bye, now.”

  He nods in retreat, his smile shrinking and uncertain. Rachel ups the volume on the TV overhead where a rural woman is being interviewed on a FOX special on Presidential morality and what the country needs to do. The woman harks back to better, simpler times: “Ah tell ya what Ah thank is ’at we shouldn’t oughta have one ’at’s got no morals. Ah thank we oughta get one ’at has morals. At’s what’s wrong wif all ese dang politicians. ‘Ey ain’t got no morals! ‘Ey jiss havin’ sekshull relations with all they damn interns. It’s enou
ghta mike me sick!” The studio audience whoops and cheers in wild appreciation. They hush while the rural woman sings a ballad about love and morals. Rachel mutes it because the Reverend Brown is gone, leaving us to our needs and morals in private.

  Frannie excuses herself, and we’re alone at last for a blessed moment. Rachel sighs, “I can’t let them shave my head. He wants to slice half my scalp off. He wants to cut away my skull.”

  “You remember on TV a few weeks ago they had an ad for hair transplants, and I asked if I should get one, and you pounced on me?”

  “I didn’t pounce on you.”

  “Yes you did. You said, ‘What’s that about? That’s so you can look good for the young ones. That’s the only reason men do that.’”

  “This isn’t the same as that.”

  “So I thought about the young ones and figured maybe you were right. Maybe I’m only lusty. But they don’t come on like they used to, and I realized that you’re the one I love, because you’ll love me back no matter what I look like. Won’t you? So what’s with the shaved head and titanium parts in your skull? What’s that? I’ll buy you a floppy hat.”

  “I don’t want a floppy hat.”

  “Yeah, well, I don’t want a floppy date, and I promise, if you don’t forget about your goddamn hair, I’m going to get my head shaved.”

  “You won’t have a scar.”

  “I’ll get one at the party store, red and green with festers and oozes. We’ll cruise.”

  “Please don’t.”

  “I won’t. You please don’t too.”

  We share another silence with no place to go, until the curtain opens on the new nurse with fresh quart bags. “Oh,” Rachel moans. The day nurse proceeds to change the bags. They say Potassium Chloride.

  “It’s Gatorade,” I console.

  “I have to pee.”

  The nurse reaches for the bedpan, but Rachel is up. “You can’t do that,” the nurse says.

  “Do what?” Rachel asks, hiking her jammies at the sit-down.

  I step out to preserve what privacy remains between us. My cell phone rings, and it’s Sue, asking if Rachel wants to talk to their parents who live near San Francisco, who are eighty, who called last night and were told by Sue’s daughter Katy that Sue was at the hospital to be with Rachel. I say no, not yet, because Rachel is only now coming to terms with the situation and herself. She should be ready to speak to her parents in a short while, but not just yet—Rachel is only hours from a craniotomy. This is not her call; it’s mine. She needs time to absorb her schedule peacefully and thereby gain the ability to discuss it peacefully with her parents. At the current moment, only more anxiety would result from a dialogue. “Give it an hour or two. Okay?”

  Back in the room the nurse admonishes us in general to try for more stillness. She knows Rachel feels fine, and frankly, by appearances, everything is fine. But these drugs need cooperation to be effective.

  “What drugs?” we ask in unison.

  “Dilantin, to protect against seizure. Nimodopin to protect against spasm.” She says both seizure and/or spasm are likely now. We must be still. She leaves. I sense a more frank honesty now. It gains momentum as our prospects reveal themselves. Then again, maybe they need us fully informed on these details, these consequences of misbehavior. I sense this disclosure is mandatory, informing Rachel of her rights. I know I’ve established my own legal record of challenging every incidence of non-disclosure. They think me difficult. They mean only to do their jobs. I sense these things, and I also sense, unfortunately, that I’m correct.

  Rachel sighs and says she has given the situation some careful thought and knows she’ll be better prepared to process things in a few days, after a brief return home to square the animals and take care of a few loose ends and get some additional information, which she sure as heck can’t get around here. I remind her that we were in direct contact with the Pope of alternative cranial-sacral therapy only a short while ago. “I don’t know what other information you have in mind.”

  “I can’t know what other information exists as long as I’m smothered in this place, surrounded by these aggressive, smothering people.”

  I tell her that Sue has made a valuable contribution by retrieving the information she hungers for. I tell her I have reviewed it, and the apparent danger now is not so much from additional bleeding, because she’s strong as a horse. The danger and urgency now stem from the hemorrhage itself. I suspect the aneurysm has been present for years, possibly since birth, though it has enlarged over time, stretching its own walls thinner to the point of leakage. At least it didn’t burst.

  “So if the hemorrhage was there for a long time, how do we know I’m not perfectly capable of processing it? How do we know I didn’t have a simple headache, and now they want to cut me open?”

  I remind her that only the aneurysm may be old, that yes, it was likely there for years, and now it has leaked. “The hemorrhage is new. It shows up bright on the CAT scan. That means it’s fresh; as it congeals it darkens. Then it clots. Then it breaks down. It’s the decomposition of the blood clot that changes the chemistry inside your cranium, in your brain. The other blood vessels cringe in contact with an aging clot. Seventy-two hours is the critical time. The other vessels shut down. Then you die or stroke.”

  “Listen. I might go along with this. But I want to go home.”

  “Rachel. You bled forty-five hours ago. Do the math. You can’t go home.”

  Well, I’ve chosen the wrong words myself, but I’m bound to stumble sooner or later. Once spoken, they can’t be retracted, but I back up and try again. “Listen. If I could lie down there for you, I would. If I could go outside right now and fight twenty muggers to get you out of here, I’d do it.”

  She listens, but I’m having no effect against the last roundhouse punch, that she may never again go home. “Well, maybe not twenty. They’d kill me. But three. I’d take on three.” She half-smiles. “I’m right here with you, and we both know you’re stronger than me. You’re the strongest person I know. Physically, emotionally. Except for your hair. That’s a disappointment, your hair anxiety. But you’re a hero otherwise. You may be my new hero for all time. Who’d a thunk it? I’m here and I’ll be here.”

  Her half smile relaxes now as her face puffs up, and she says, “You know I want to be cremated.”

  I nod. “Yes. You’ve mentioned that. And spread over Apple Tree Cove, because it’s a place you love.”

  “Only a little bit. Take most to Hawaii. I love Hawaii. Hawaii is my home.” I nod again. She looks worried and says, “But if you move away you won’t be near me.”

  “I’ll figure it out. Okay? I want to get through this. Fast but slow. Slow but fast. I’m on guard. I’m pretty good at this sort of thing. You know?”

  “I know. I just wish . . .”

  “Sh. I know.” I let our wishes and knowing drift like smoke but not too far. “Do you want to talk to your parents?”

  “What for?”

  I don’t tell her that it’s a good thing to tell your parents you love them or they did a good job or something or other if you know you might die tomorrow. I say instead, “I think they’ll feel left out if you have surgery and don’t talk to them first.”

  “I can’t. They’ll just be so upset. Why should I put them through that?”

  “They know.”

  “You told them? Why did you tell them?”

  “Katy told them.” She looks glum again. “I’ll ring them up. They want to talk to you.”

  She nods. “I have a headache.”

  I ring for the nurse. We wait. In five minutes I fetch the nurse and report the headache. The nurse asks how bad is the headache. Rachel says not too bad. The nurse needs a number. What kind of number? One through ten. One is mild. Ten is major. “I’d say a four.”

  “Not a five?” asks the nurse.

  “Okay. Five. No, four.”

  The nurse records four on the chart and in the computer and dispenses two T
ylenol, also recorded.

  Her parents are sitting by the phone. I turn around and tell them everything is fine. They respond quickly that they will not talk to Rachel if I think that best. They will defer to my judgment. I assure them I only wanted to wait so acceptance of the surgery could have a chance to sink in. They assure me that she must have the surgery. I assure them that we’re well aware of their convictions on this, but we needed a little more time to process our own convictions. I now share their opinion on the need for surgery, and so does Rachel, but the subject is still tender and would best be left untouched.

  “Rachel may still think she’s going home,” I tell them. “Talking to family can generate a fuss, and we’ve had plenty. But now, well, maybe she understands. I can’t be sure.” They concur. I tell them we have proceeded to schedule the surgery.

  They repeat together, “Well you have to have surgery!”

  I remind them to stay as calm as they can, especially on the surgery issue. I turn back and hand off the phone. It’s small talk mostly, about the expedience of modern medicine and the pesky bother of an aneurysm with a massive hemorrhage. They talk a few minutes on life and love, the weather, small crises at home and a few bargains that really can’t be beat. Rachel bids farewell to her parents, assuring them that she loves them as always and that she sorely hopes to talk to them tomorrow. They ring off, and another bridge has been crossed.

  For the first time we hold hands in resignation; the abyss must be leapt into. This will be easier for me, it would seem, but then it’s not, for I blow no smoke on relative strength. I’m merely a pup beside a she-wolf who understands winterkill. But assessments of relative courage are also brief. The curtain opens again on a middle-aged man with an apology. “I’m sorry,” he says. “Is this a good time?”

  “No. This is not a good time,” I assure him. “What do you want?”

  “I’m Dr. Goldfarb. I’m a psychiatrist. Do you have a few minutes? I understand you have questions. I’d like to answer them for you and find out a little bit more about your concerns. Is that all right?”