Rachel nearly swoons with excitement at proximity to familiar objects like a desk and rugs and a computer and a couch and windows that open to fresh air and a locked door and perfect privacy. She raises her arms and grins. Then she lies down just for a bit, for a four-hour nap.
She wants to be held now and again, to claim her place among the living.
It’s been twenty years, but the next two months were another adventure. Nothing brought her back up more than homecoming with the dogs and cats, and the thousand flowers crowding the garden, blossoming in celebration. She stood before a tulip cluster thick with baby’s breath. She opened her arms in salutation to life.
We did not return to routine, nor was she physically whole for a year or two. But then neither am I. Those first days passed like life anew, in happy surrender. We stretched and walked and ate well. The days took what they required and returned an intangible that I think of as light. Rachel strapped on the harnesses in the kitchen and the yard. She knew she couldn’t handle the wheelbarrow if it was completely loaded. Nor could she shovel, unless it was only mulch. What could mulch weigh? We had our ups and downs on what must not be done. I think she remained in denial for a while on her close encounter with death. She accused me frequently and unjustly of overbearing demeanor and judgmental disposition. She resented my accusation of drunkenness when she had in fact sustained a massive cerebral hemorrhage. Processing the event allowed her to sit still, so we sat and talked it over.
I didn’t mind her accusation. I asked: if you take the judge from judgmental, what’s left but the mental? And what’s wrong with seeing the difference between right and wrong? Isn’t personal perception part of instinct and intuition and therefore prerequisite to rational behavior? Besides, I don’t judge anyone but people.
What you get, she said, is a nice man who knows how to keep his mouth shut. She was wrong, but I loved the repartee. Nor did I care if she used wrong words sometimes. I still can’t tell if the frequency of misuse is diminishing. For a long time she said her CDs when she meant CAT scans. She might have called the lawn mower the vacuum cleaner or referred to her brain as her motor. She said they put the Titanic in her head, meaning titanium. Then again it could have been the Titanic. She told her friends it didn’t matter at all. She meant that the titanium didn’t matter relative to airport security. People didn’t know that’s what she meant, but that didn’t matter either.
Her denial faded slowly, I think, making room for the awful realization of what an outing in town for a few beers turned into. She read aloud to me from the hundred pages she pulled down from the Internet. Given time and breathing room and distance from the war zone and the nonstop assault, she could accept and believe what she resisted so stridently. “Listen to this,” she said. “‘One third of people with ruptured aneurysms die before they get to the hospital. One third die after they get to the hospital. Of the remaining third, forty percent end up with neurological problems that make life difficult.’” These stats were taken from www.brain-surgery.com/aneurysm.html.
I reminded Rachel that young Dr. Michael, the frail fellow who first examined her, gave us these stats as part of his presentation. She insisted he did not, but she concedes large gaps in her memory of those few days, so maybe he did. She knows he did not give her the average on post-op hospital time for this condition. The average post-op stay is three more weeks in intensive care followed by two more weeks in a regular room. If he had, she would never have gone along.
As it was, she was back on the street six days after surgery, which makes the statistics suspect, possibly polluted with the dire bad habits of a slovenly society. If you eat burgers and get no exercise and take pharmaceutical drugs for whatever ails you and carry too much fat, then the statistics are yours to bear. Avoid those things, and the stats are usually beaten.
Moreover, she stared off in thought more often, as if realizing at last the long odds against a full recovery. She doesn’t drool or limp. She’s still a dynamic chef who would rather play around in the kitchen than cruise a mall. She still turns heads in a classy dress, maybe mine most of all, and she’s still back at work in the shipping department.
Her shaved head grew out an inch in the first two months. She still flopped hair from the other side like a bald guy in denial, but it worked much better on her. She rolled the scarf like a headband and wore it over the top, tying it off behind her neck. And she grinned, taking it off for those who wanted to see, perversely balancing her self-consciousness with zero inhibition.
We lost ourselves in motorcycling for many more miles after that, and she could still hang on with the best of them.
On the first the anniversary of our marriage after the aneurism, I give her a pendant, an aquamarine surrounded by diamonds. She was taken aback with the extravagance and blushed, saying she had no place to wear it. I told her that the pendant was in gratitude for a lasting lesson in imagery and strength; that sooner or later everyone wakes up dog-butt ugly, and she took her turn with Olympian spirit. But she no longer fears the loss of physical beauty, reminding me of her strength.
“I don’t know if everyone sooner or later shines,” I said. She thought I’d begun my usual sentimental pap, but I’d thought things over. I advised her that the aquamarine charm was not for her. It was a gift from her and me to the angels who were all over her one night only a few weeks prior and still are. I assured her of this reality. “I saw it here, just over your face, with my own eyes. This charm says thank you. You wear it in the garden or shagging stray cats or thumping melons, squeezing tomatoes or splitting firewood or packing snorkel gear—wherever you go. You wear it for them.”
She asked if I thought she would die of cancer or aneurysm. I told her I thought she would go quietly of old age. She said she couldn’t be so sure of that, and given a choice, at least aneurysm is quick. I conceded that her swan song may be quick, but I thought it would be decades away, in her sleep. “You sense phantoms around every corner once you’ve been mugged,” I said. “Give it a few years, you’ll be your old, cocky self.”
“No, I don’t,” she corrected me. “I don’t sense bad things. I never did.” She taught me that widows and widowers might think they know what a gone spouse would think or say or feel. But they don’t know. She confided that she no longer saw things in her peripheral vision like she did, but something was present. She saw it mostly in the old part of the house, the original part built in 1927 that has held generations of people in their best pursuits, cooking, eating and talking. I asked if this presence felt ominous, and she says it did not. She thought in fact that we were welcome there, that these things, if they were things, may have played a part on the day of her hemorrhage.
“You think that was a good day?”
“Well, sure it was good. It was for the best. They let me know my brain thingie was, you know, in there. Oh, I think it was all for the best.” What a nut. Yet she reminded me of my affront to society, peeing on the floor at Home Improvement World, a behavior not yet resolved. I shrugged, indifferent toward Home Improvement World and its floor and the little yarn I had to spin for the greater good. She prattled on, “Somebody had to clean it up.” I reminded her of depression verging on death, and the distraction I was able to provide with imagery of me pissing on the floor at Home Improvement World. As if that counted for nothing, she repeated, “Somebody had to clean it up.”
I reminded her that I was pushed beyond the limits of polite society and its appropriate standards. She repeated the cold, hard fact. I suggested that a bathroom janitor has to deal with worse. But she waited for contrition, so I conceded, short of telling her the truth. “Okay. I’ll go and say that I’m sorry and offer to clean the bathrooms.”
She granted reprieve. “No. Just, please, don’t do that again.”
I could have reminded her that Home Improvement World sits on what was recently a lovely field fronting a woodland. But I didn’t—and I didn’t unravel the yarn, because a good story had worked its magic and we surv
ived, adapting to more or less.
The cats surrounded her every night, each stretching a paw to touch her. They missed her, or maybe they were on assignment. I wanted to get them social security numbers and take the five-hundred-dollar deduction on children. Stella, our youngest, presented her with small snakes. Rachel coddled them, easing them from their fearful coils if necessary. She talked goo goo to them on her way out to the garden, where she released them with everyone’s beliefs intact.
I thought about the team for a long time—good people under pressure, often traumatic pressure. But the team huddled by itself, excluding the ball, who was us. You may lose identity on the playing field. You may become an object to be pushed up the field, and the football analogy works. I thought the team needed emotional detachment to better pursue its valiant effort, and that was fine, but the team also needed secrecy to protect itself.
Worse yet, the team presumed idiocy in the patient and the patient’s family, who were not pigskins. The team was wrong in its headstrong insistence on correct beliefs.
The legal system requires the team’s wily ways. Take Rachel and me, shacked up for years before we were married. Marriage was a formality for us, a social convention. Yet had we been unmarried, we would have been denied communication. Without the social, legal credential, I would have been unqualified to stand guard in the interests of my mate, not allowed on the playing field and hardly the object of the team’s appeal to take over for this demented, irrational woman. Without me as legal spouse, Rachel would have been cut and dried, and maybe she’d have done all right.
The team came on strong, assuming that strength necessary to beat the odds. But with no referee to oversee fair interests in comfort and dignity—without someone to blow the whistle in soulful terms, the odds can go longer still. Even if you grant the team the benefit of all doubt, the team may want to frenzy, as seen on TV. Worst of all is the statistical directive of the team. That is, all decision is bound to data-based protocol. Decision defaults to the double blind standard based on the scientific method of theory, experiment, data and conclusion.
Any theory not proven to within the acceptable margin of error, which is four percent, is deemed wrong.
All anecdotal evidence or strong personal belief is deemed wrong. Only those decisions based on the scientific method are defensible in court.
I pondered my behavior and rationale. I considered my overbearing nature. I discounted wrongness and rightness and assessed myself in terms of the difference I made. I factor with consequence at a few junctures. My initial insistence on visiting the corner clinic proved critical. The fundamental importance of that visit to Rachel’s survival was the key difference.
Conflict characterized our hospital time. The threat of the condition was made worse by authoritarian dominance and our resistance to it. Most of the turmoil was avoidable with rational dialogue on the front end. Our belief system is based in part on modern medical system error. Horror stories feed prejudice that can only be calmed by calm discourse willing to recognize opinions outside the AMA.
But the AMA paradigm may be changing with the leadership of a few open-minded practitioners who remain mindful that alternate cure can occur, even if only anecdotal. The system changes too with public pressure.
What would we change? We felt segregated from the process. Many people insisted on a nine-inch cut with a scalp peel for removal of a two-inch skull plug so the left temporal lobe of the brain could be lifted, so the clot could be swabbed and the bubble clipped. Close it up, over and out. Yet we got no explanation and disclosure on alternatives or lack thereof. I suspect that the declaration of no alternative was purposefully withheld, on account of potential litigation. Maybe they have a treatment in Podunk Holler, calling for three lizard teeth, a salamander tail and some hind tit pig milk—a recipe that made Old Clem’s aneurdiddle flat fucking go away!
But the system cannot share that anecdotal success, since a patient could choose that route and die, and then sue the system. That wouldn’t make sense, but the same lawyers who screwed up the system would screw you up again if you try to work around the mess they’ve made.
But surely some clear and present language could factor the Old-Clem remedy in a practical truth in, say, half a minute or so.
Anxiety is counter-productive. I still feel correct in declining the medivac helicopter, if not for the pressure, then surely for the trauma. The assault would have begun sooner. She would have felt alone and defenseless.
I think postponement of the final angiogram scheduled for ten hours after surgery may have been critical. I think they could have killed her without looking into her eyes or sharing a few words. I think they placed faith solely on the digital readout.
I think Rachel could still be waiting removal from Intensive Care without my insistence on some service around here.
And I suppose all the noise we made resulted in Lawrence of Neurology at the helm. In a system so overwhelmed by legality, rights and representations, the problematic cases gain attention and warrant the best technicians.
But this subject is now polemical.
We got the beer, by the way, hardly green and two months late, but oh, so good. I had three pints, an Irish Blonde, a McCaffrey’s Cream Stout and a Harp’s on tap. I made acquaintance as well with a Mr. Paddy Jameson, who made perfect sense in a most mellifluous brogue.
Rachel nursed a mango iced tea; she was so reasonable, deferring to Lawrence of Neurology, who proved adept in the other skills, besides those of the invasive technician.
“Oh, gee, you’re looking great,” he said. He smiled freely at last as he felt the dents and curvature, checking for skull symmetry, left to right, feeling the muscles that were severed just around the corner from the eyebrow, feeling the jaw and nodding in approval. “This aneurysm is gone,” he pronounced with vivid finality. Furthermore, “You may resume all of your old activities. You can strain and lift and work out. You can do anything you used to do.”
We shared a bright and happy moment, and Rachel said she wanted to be sure he understood her gratitude. Because she was grateful, and she wasn’t sure that had come across yet. Lawrence said he understood fully; she should not worry about what came across, because she was very confused.
He turned to the movement in his periphery, which was my eyebrow arching. But it settled back down quickly, and I smiled. I didn’t remind him that her confusion came from the avalanche rolling down his mountain. Because I didn’t need to, because some beliefs will not be understood by others. But I was grateful.
“Uh, Doctor, I have a question. We like to travel. Some people might frown on this, but we like to visit, for example, Mexico, and drink tequila. We like to . . . smoke hash in Amsterdam. Do we have any constraints here?”
“No. None. You can do anything you like. But . . . you may observe a more acute sensitivity.”
Acute sensitivity is another story. For the time, a civilly cordial exchange was enjoyed by all. I did slip on the way out when the receptionist wanted my parking ticket for validation, “Don’t I need psychiatry for that?”
She laughed, “No. I’ll make you real.” She stamped my ticket, and out we went, into the world of the breathing, joking, living life.
“Where was their sense of humor when we needed it?” I asked. But Rachel was lost in the clouds, drifting happily over the trees. Our cordiality lasted into twilight, in a happy hour of note that started two months late.
Here is what we spent, on our way to clicking our mugs with the Irish, starting out one memorable morning in March:
Physicians’ Services (the team)
Intracranial Doppler Stud $149.00
Twist Drill Implant Rec D $1,571.00
Craniec Intracranial Aneu $6,663.00
Use of Operating Microsco $614.00
Intracranial Doppler Stud $149.00
Intracranial Doppler Stud $149.00
Intracranial Doppler Stud $149.00
Craniect Evac Hemat Intra $2,571.00
TOTAL $12,015.00
Hospital Services
Daily Service: 1 Day @ 704. $704.00
Daily Service: 7 Days @ 2,200. $15,400.00
Pharmacy $2,815.57
Med-Surg Supplies $14,107.28
Laboratory $1,773.50
Pathology Lab $83.00
DX X-Ray $4,250.75
Nuclear Medicine $1,573.00
CT Scan $2,860.00
OR Services $11,615.20
Anesthesia $1,517.25
Blood Stor-Proc $468.00
Respiratory SVC $12.00
Occupation Therp $86.00
Speech Pathol $127.25
Emerg Room $612.50
Pulmonary Func $26.75
Recovery Room $878.00
Other DX SVS $66.50
Other Vascular Studies $3,129.00
TOTAL $62,106.05
Bringing the total outlay for the team and the arena to $78,121.05. Add ninety bucks for the very first guy, Bill Varne, who insisted on a pit stop for a CAT scan. It’s still very fair, considering the ferry was only $3.75 and the medivac helicopter and limo service would have run another $8,500. The insurance covered eighty percent, so we went out-of-pocket only sixteen grand or so, which is a bargain any day, if you don’t count the inconvenience.
We were also gratified that speet patorogy was a pittance at $127.25. We declined the speet patorogy, so we can only presume that the $127.25 was for the consultation. Occupation Therp was also amusing—and a steal at only $86.00. I’m still not clear on what the therapy was, but I’m certain Rachel was rendered more functional. Moreover, you can’t get hung up on a few bucks here or there; a month out we got another invoice for $8,205.76 for “additional services,” putting us just over eighty-six grand, plus a few bucks for the parking, beer and so on.
Of course I quibbled, but isn’t that another certain improvement over judging and insisting?
Brainstorm Page 20