by Diana Kane
Andrews doesn’t argue. Alex is quickly wheeled down the hall for a head and abdominal CT. I call downstairs for the team to set up an OR immediately, telling them they have 10 minutes. I hang up and realize I need to warn them, they need to be informed and ready. I call back and inform the charge nurse who our patient really is. She is shaken but assures me that they are already preparing the OR. I pace the hall outside of CT, waiting for the results, assuring myself that a GCS of 6T can be recovered from. I need the information, these minutes are taking forever.
The CT is finally finished, the longest two minutes of my life I can remember complete. I scan them quickly. Subdural hematoma, 3 mm midline shift, no noticeable lesion, no cervical injury and abdominal organs do not appear to be bleeding. The best case scenario I can hope for given the circumstances. I still need to intervene, to relieve the pressure from her brain before further damage is done. We are on our way down to the OR less than two minutes after the scan is complete.
The elevator ride to the basement seems to take an eternity, even though it is only one level. During this unending ride my brain somehow manages to make me realize I have another call I need to make. I take out my phone and call Abby, the closest thing to family Alex has. We are off the elevator and half way to the OR before she finally picks up. “Catherine?”
“Abby. There’s been an accident. I’m taking her to the OR now. You should probably get here soon.” It takes all I have to force the miniature sentences.
“Catherine, who?”
“Alex. It’s Alex.” In my panic I have forgotten that Abby has a daughter.
“I’m in San Antonio, I’ll be on the next flight out.”
Shit. I need someone here for Alex. “I’ll leave my phone with the nurse and will call you when we are out of the OR.” I make to hang up the phone when I hear Abby shout my name. “Abby?”
“No extreme measures, she doesn’t want extreme measures.”
*****
The house and my soul are empty shells. Everywhere I look I see Alex, only Alex is gone. Images of her cold, lifeless body flood my mind when I close my eyes. I couldn’t save her. I failed her when I couldn’t admit my feelings for her and I failed her when her life was on the line. Despite Taylor, Abby and her daughter staying here the past few days, the house feels more empty than ever. I haven’t left my bedroom since the night Alex died. They bring me food that I leave untouched and water that I drink when they force me to.
The day of Alex’s memorial service arrives and I can’t bring myself to get out of bed. It takes the combined efforts of Abby and Taylor to push me out the door. How can I go? How can I stand there with Alex’s chosen family when my failure is the reason we will all be there? I could’t save her. A part of me has died with her.
We arrive at the memorial, not a service or funeral. Abby had been entrusted with a copy of Alex’s will a few years ago. Alex was adamant that she wanted to be cremated and there was to be no funeral. Her instructions were that she wanted us to move on with our lives, take care of one another, love each other. Abby takes my hand and squeezes it, looking over at me when she discovers how sweaty my hands are. “She loved you you know?”
I nod my head hoping that I could have been so lucky. “I’ll never get to tell her how I feel though, that I am ready.”
“She knew.” But she didn’t know really. The thought of my failure compounded by my inability to love Alex the way she deserved sparks a rage in me like I’ve never felt before. I take in the scene around me. The picture of Alex they have chosen is wrong, it doesn’t do her eyes or warm smile justice. The urn is wrong, it is too plain. It fails to reflect any of the beauty or complexity of the person whose remains it now holds. I look at the foods people are eating, none of them Alex’s favorites. Even the music is wrong, I’ve never heard Alex listen to any of these songs. Did these people even know Alex, the beautiful woman that she was? I realize that I have failed her again, that my inability to function these past few days has resulted in a memorial that disappoints her memory.
“I need to get out of here,” I inform Taylor as everyone listens to Abby’s speech. My skin itches being here, the anger is growing at a fever pitch, I feel an urge to scream.
“Catherine we can’t.” I am flanked by Taylor and Sara, each of them holding one of my hands.
My agitation is growing by the second, threatening to spill over beyond my control. “No Taylor, I need to get out of here now!” I am shouting by the time I finish the sentence. Abby stops in the middle of her eulogy and looks in my direction. Everyone is looking in my direction, but I do not care. My blood boils and I am ready to rage.
“Catherine.” Someone is calling me. I turn looking for the source. “Catherine!”
I sit up, covered in a cold sweat. My hand is holding Alex’s. “Catherine. You were having a nightmare. I thought you were going to toss yourself out of that chair.”
Abby has arrived. I look to the clock on the wall, it is after 4 am. The cold sweat and lingering images from the dream give me the chills, despite the room being plenty warm.
“Well?”
I sigh. “I did all I could do. I relieved the pressure, GCS is still at 6T, small midline shift, no lesions on the scan, her ICP is looking good. I gave her a few burr holes and drains. All we can do is wait and continue to evaluate.” Abby looks to Alex, then back at me. I know that her weariness and heartbreak match my own. Her chosen sister, lying in this bed, both of us helpless to do anything to help.
“Prognosis?”
I don’t want to think about this, to put the same weight on Abby. I know she won’t let it go though. “Fair. Any GCS below 8 has a much lower rate of full recovery than scores above 8. That is scoring without intubation. The paramedics tubed her when they arrived on the scene. They indicated that witnesses said she was initially conscious but wasn’t speaking coherently. She lost consciousness before they arrived. They tubed her to protect her airway. Positives are that she is young, healthy, and was treated very quickly following the accident. If there had been any sort of delay the outcome would likely have been much worse than where we are now.”
“What are you telling me?”
“There is hope. The next 24 hours are pivotal though. I have another CT scan ordered in the morning. I don’t see anything that gives me extreme concern on the original CT other than the bleed. Pray if that is your thing. I’m not leaving her side though, unless I have to.”
We sit in silence for a long while. My sole focus is Alex. I barely register that Abby is there. I am not sure why it occurs to me but I realize that someone else should be notified. “Alex’s phone wasn’t on her. I have no way to call Brooke. You should call her.” It tears at my heart to tell her this, but I know it is the right thing to do.
Abby looks at me, her brow furrowed in confusion. “Brooke? Why would I call Brooke?”
Why is she confused? I know it isn’t a sensitivity issue. “Because they are together, at least they were before Alex moved out.”
Abby’s look shifts from confusion to amusement. She accidentally lets out a small snigger. “Sorry that was inappropriate.” She sits for a minute, composing herself and staring at me. I feel like I’m under a microscope. “You think Alex and Brooke are together?” I nod my head. “Look, it isn’t my place to tell you, but they aren’t together. Sure they were a couple many years ago and they may have been together for a night recently but Brooke is usually a reaction for Alex. She lives in Seattle. Occasionally she comes home to see her family. When she does, if they are both single, they get together. They have…good chemistry I guess you could say. Anyway Alex typically turns to Brooke when something is wrong. What you saw was Alex’s way of torturing herself over your situation. Alex tends to get a little down that time of year anyway and all the stress between the two of you didn’t help. She and Alex communicated and Brooke arranged a trip home. Simple as that.” Abby’s eyes stay fixed on me, but the more information she shares with me the less I actually see her.
I feel it then, a small blossom struggling for the sunlight. Hope. Abby’s words have given me hope. Alex isn’t with Brooke, maybe there can still be a chance. All I’m longing for is a chance. A chance to tell her how I feel, that I want to be with her, that I’m sorry for not figuring it out sooner. I just need the chance to say the things that I’ve left unsaid.
“You love her, don’t you?” Abby’s question interrupts the endless string of promises I find myself making Alex in my mind.
“Yeah.” I refuse to deny it anymore. Abby finally shifts her gaze back to Alex, and smiles.
*****
Transport personnel arrive to take Alex down for her CT scan. As much as I want to go with her I need to round on my other patients. Abby wakes at the commotion.
“They are here to take Alex down to her CT scan. I’ve given them the ok to bathe her when she comes back. I need to do my rounds and should grab something to eat. She will be back from CT in a twenty minutes or so.”
“Ok. Will you be here? I could take this chance to go home, shower, change, check in with my daughter. Update her on Aunt Alex.”
“The only way I’m leaving is if a trauma comes in. Otherwise I’m not going anywhere. Take your time. I’ll update you when you get back.”
“Can I bring you anything? Food, something else?”
“Thanks. I’ll survive off of the cafeteria though.” We walk out together, the two of us behind the head of Alex’s bed. This is the longest I’ve gone without her hand in mine since she got to the ICU. My hand feels cold and empty, I can hardly stand it. As if we possess a psychic link Abby takes my hand and squeezes it.
“Our girl is going to be ok. I know she is.” Even at a time like this Abby’s optimism never ceases.
*****
I check the time and realize I’ve finished rounds too quickly. Alex’s latest CT will not be in the system yet. I head downstairs to the cafeteria for some food. I settle for an omelet and a fruit smoothie. I head up to the overflow floor, hoping to find it empty. Breakfast finished I find myself staring out the window, recounting everything Alex and I have been through. Could it all have been for nothing? Somehow I start thinking about Taylor. We haven’t really spoken since her visit aside from a few text messages here and there, the time difference and our conflicting schedules make it difficult. I check my phone and see that it is just before 10 am, still quite early in San Francisco. I know I’ll be waking her up but I go with the urge and dial her number anyway.
“Cat?” I’m greeted by a raspy, groggy voice on the fourth ring.
“Hey Taylor.”
“What time is it? Everything ok?” I’m not sure why, but her words set something off in me, the avalanche of emotions that I have been suppressing along with those as yet unreleased from last night become too much. I completely lose it and am sobbing in seconds.
“Whoa, hey I’m up.” Taylor is certainly awake now. “Cat? Cat take a deep breath, try to calm down.” It takes me a few minutes to finally regain some composure. Taylor quietly waits for my breathing to settle and the sobs to stop. That or she has fallen asleep. “Cat what the hell is going on?”
“Everything Taylor. Everything is wrong.” I proceed to fill Taylor in on all the events I can recall since her visit, starting with Alex’s accident. She listens with only a few interruptions to ask questions or for clarification. I finish and take a deep breath. I know I shouldn’t but somehow I feel slightly better having just said everything out loud.
“Let me get on a plane, I can be there tonight.” Taylor’s offer surprises me, it is a level of support we’ve rarely shown one another.
“I truly appreciate the offer Taylor but there isn’t anything you can do. Time is the factor right now. I did all I could last night, of that I am certain.”
“Are you sure you don’t want me to come out? It isn’t an issue. There may not be much I could do for Alex but at least I could be there for you.” Again I find myself shocked, who is this woman that I am speaking with?
“No really, stay out there. I can keep you updated on any changes.”
“Ok. If you change your mind let me know.” A silence fills the line for a few moments. “So you never told her?”
“Never told her what?”
“You never told her how you feel about her? That you love her. You do love her right?”
I sigh. “Yeah, I do. I wanted to tell her, intended to try to talk to her yesterday, never had the chance.”
“So go tell her now! Get off this phone and go tell her!” I’ve never heard Taylor so passionate about expressing one’s emotions.
“Taylor maybe I wasn’t clear before but Alex is comatose right now.” The thought drives another dagger into my aching heart. The tears threaten to return to the forefront.
“So what. I’ve heard about people in comas waking up and reporting that they remember hearing all sorts of things. Cat go do it! At least then you will have told her. You need to do it for yourself.”
“You mean in case she doesn’t wake up, or doesn’t recover?” Tears are burning trails down my cheeks again. Either a possible reality, neither one I can accept or wrap my mind around.
“Yeah, unfortunately. Just think about it.”
“Ok. I will.”
“Go now Cat! If you change your mind about me coming out I’ll be there.”
“Thanks Taylor.”
*****
I go down to the OR locker room for a quick shower before I head back to the ICU. After my talk with Taylor I’m sure Alex is back from CT and bathed. It adds 10 anxiety filled minutes to my absence. I need to get back up there.
I return to Alex’s room and discover she is back and indeed bathed. I don’t need to inquire with the nurses, the smell that greets me is wrong. It doesn’t smell like Alex. I check her drains and see that the drainage has slowed to very minimal output. I will check them again later today and if the output is still minimal remove them, reducing the risk of infection. I looked over the facial lacerations caused by the glass from the window. They all look clean and dry. I had essentially forced Sara, the on call plastics attending, to come look at them after I finished the burr holes last night. She was initially pissed off and fought it but quickly changed her tune when I told her who the patient was. We spent half an hour examining each cut, ensuring that the small wounds were clear of glass and adequately washed out. After closing the deeper gash, she assured me that she thought the facial lacerations would heal nicely and leave minimal to no scaring. As if I cared about a few scars when the risks were so much greater.
I want to run another GCS diagnosis to check for improvement but decide that I should look at the new CT results first. I pull out my laptop and log into the server. Alex’s films are available. I don’t bother reading the written report. I want to see them and form my own conclusions first. The scans show what I have hoped for and expected. The bleed is under control, the midline shift is shrinking, her pressure is still good. I pour over the films searching for the smallest of defects indicating permanent damage. I still cannot find any. I open the written report to confirm. My findings concur with those of the radiologist.
I take up my post next to her bed taking her right hand in mine. I rest my chin on the safety, oblivious to the discomfort the cold plastic causes. I can’t get any closer to her without crawling into her bed. Taylor’s advice keeps crossing my mind. At one point I realize that I have started caressing her face, alternating between slowly running the tip of my thumb over her cheek and the backs of my index and middle fingers down her jaw line. I don’t bother to stop. I need to feel close to her. Without warning words start spilling out of me. “Alex, I’m sorry. I’m sorry for the hell I’ve put you through. Sorry that I haven’t been honest with you or myself. Sorry that you felt like you had to sacrifice your feelings to save me from my own. Most of all I want you to know that I love you. I need you to wake up. A part of me will die if you don’t, I am sure of it. I love you Alex and I am ready. Please come ba
ck.”
A knock at the door interrupts me. I assume it is either a nurse or Abby. I give a cursory swipe at the tears on my cheeks as I tell them to come in. My back is to the door and I don’t bother turning to see who it is.
“Dr. Waters?” Erin is the unexpected visitor. I barely recognize her without her scrubs and a bonnet on. She has seen everything, the image crystal clear in front of her. Me sitting vigil at Alex’s bedside, holding her hand, crying. I don’t bother moving away or relinquishing her hand. There is no point. I had forgotten that Erin was the tech last night during Alex’s surgery.
“Hello Erin. Thanks for stopping by.” She takes a seat on the other side of the bed.
“How is she?” I can see Erin’s eyes taking in Alex’s condition. She was there last night, she knows the baseline. She also knows that I cannot legally tell her anything related to Alex’s case or care. “Not much change then. Drainage looks good though.” No questions, just verbal observations and assessment.