Crash

Crash Page 2

by Carolyn Roy-Bornstein

  I followed her into the ER, feeling like a bad mother for following the rules.

  4

  The Other Side of the Stretcher

  When Neil was a sophomore in high school, he played Tybalt in Romeo and Juliet. He had few lines but a formidable stage presence, with his fierce anger and menacing bluster. He learned the complicated fight choreography, expertly clashing sword against sword, first with Mercutio then Romeo. Advancing. Retreating. Slicing. Thrusting. A rhythmic dance. The theater was silent except for the soft shuffle of gliding feet, boots landing on stage in perfect balestra, swords clanking, first high then low.

  And then the death scene. Romeo plunged his dagger deep into Tybalt’s chest. Neil’s chest. My son. He fell to the ground. Juliet dropped to her knees and cried over him.

  “ ‘Tybalt, my cousin! O my brother’s only child!” ’

  “Doesn’t that make me your nephew?” Neil would joke during rehearsals, cracking Juliet up every time. But on opening night he wasn’t joking. And Juliet wasn’t laughing. She was weeping, and so was I.

  His fellow actors came on stage and lifted Neil reverently onto a slab of wood and then covered him with a pure white shroud. They walked slowly, as if marching to a silent dirge. They placed him carefully onto a makeshift bier, two foot-high blocks of wood pushed together at the back of the stage.

  And there he lay for the rest of Act III. Scene after scene played out. Romeo. Friar Lawrence. Lady Capulet. Nurse. Their lines were silent to me, their movements unseen: My eyes were glued to the body at stage rear. Neil’s shroud was made of a gauzy fabric. I could see his facial features beneath its flimsy folds. I tried to detect some movement. A breath. A twitch. But there was none.

  It filled me with sorrow and dread watching my son, dead on stage. The rest of the audience was at a play. But I was at a wake, staring into a coffin and waiting for the victim to rise.

  “I’m sorry my son keeps killing your son,” Hal’s mother joked after the performance. We chuckled together, but for months I could not shake the feeling of doom that enveloped me since Neil’s onstage demise.

  Now, three years later, an ER nurse was taking me to my boy. And there he was again, my son. Behind a curtain. Under a shroud. On a bier. But now the stage was an ER cubicle, and the curtain here was stark white, not velvet red. His shroud was a sheet pulled up to his neck; his bier, a hospital stretcher. His clothes were lying in piles on the floor around him, cut from his body in haste. I tried to detect some movement. A breath. A twitch. His head was wedged between two big Styrofoam blocks secured by thick white adhesive tape to protect his neck. I laid my hand across his forehead and his eyes fluttered open.

  “Hi, Mom.”

  He knew me. I felt a rush of relief. But he drifted immediately back into unconsciousness, and my brief elation gave way to a gathering knot of fear. A doctor came in and gave me the rundown on my son. I did not know this woman. I didn’t know any of the medical personnel here at Anna Jaques Hospital. My admitting privileges were at a different community hospital twenty miles away, Lawrence General.

  “What happened?” I asked her.

  “The police are still trying to piece it together,” she told me. “It looks like a hit-and-run.”

  I tried to follow her message, to stay focused on what she was telling me. But those words—hit-and-run—seemed to take over the part of my brain that paid attention. At first she told me his only injury was a broken leg. I lifted the sheet between my thumb and forefinger and peeked underneath while the doctor continued her update. Neil’s lower leg was badly deformed; his fractured shinbone strained against his skin at an unnatural angle. Dark blood pooled just beneath the surface. My stomach turned in response. Though I have scrubbed in on dozens of strangers’ surgeries over the years and patched together many patients’ gashes and scrapes, I have always been totally squeamish when it came to the slightest wound on one of my own.

  The doctor’s words drifted back to me. “CAT scan . . . Just a precaution . . . Out at the scene.”

  I tried to follow the gist. Neil would be okay. He had a broken leg. They were CT’ing his head as a precaution because he had lost consciousness right after the crash.

  I’ve talked to hundreds of parents in emergency rooms and ICUs. I’ve been the bearer of bad news or at least uncertainty more times than I care to remember. I know people shut down. I know they can only take in so much. I’ve learned to slow my pace, to read the signs in patients’ eyes and faces that this is enough. The well is full and I should stop dumping information into it. And now here I was on the other side of the stretcher, trying to comprehend what was happening. My son recognized me—that was good. But he slept if you let him—that was bad. He was not asking what happened. He was not asking for his father or his girlfriend.

  I could not be alone. I had to reach Saul. But I couldn’t leave Neil alone either. I stepped out into the hall, clinging to the curtain that hung from the ceiling and separated Neil’s cubicle from the bustling corridor as if it were some kind of mooring that anchored me to my son. As if by holding onto the curtain I was protecting myself from being swept away from him. I recognized the fire chief, Steve Cutter, pacing nearby. Our kids played soccer together years ago (a lifetime ago!). His hand rested lightly on his two-way radio.

  “Steve, can you get a message to my husband? He’s playing volleyball at the Salvation Army.”

  “I’ll see what I can do,” he said and strode off, happy to be on a mission.

  I returned to my son’s side. There was no chair in his cubicle so I stood over his stretcher, looking down on his sleeping face. I ran my hand through his long brown waves. His eyes opened sleepily.

  “Hi, Mom,” he said again. But it was as if he were seeing me for the first time. I shivered.

  A nurse entered and deftly released the brakes on Neil’s gurney with her foot while simultaneously swinging the bed around and wheeling him out the door and down the hall. She called to me over her shoulder, “You can follow us to CAT scan.” I fell in line behind the speeding procession.

  We passed Trista’s cubicle, next to Neil’s. It was humming with activity. Monitors beeped. Doctors barked orders. Someone was crying. Mary was wailing in the hall outside her daughter’s room. I kept my focus on my son. The nurse wheeled him into the radiology suite, motioning toward a couple of lonely plastic chairs in the bare hallway. I took a seat and waited.

  A faraway jangling sound drew my attention down the long corridor. A uniformed police officer was striding up the hall, his heavy keys bouncing against his leg as he walked. He was escorting my husband to us. Saul broke away from the officer when he spotted me and I rushed to meet him. My husband is a big man with strong, broad shoulders. He owns his own restaurant supply store, and he is accustomed to moving industrial refrigerators and wrestling two-ton walk-in coolers into place. But as he raced down the hall to me, his arms open to gather me up, his frame was heavy and bent.

  “He’s okay,” I blurted out, more because I could see how panicked Saul was than because I believed it was the truth. We fell into each other’s arms.

  “I thought he was dead, Cal.” Saul’s voice cracked. His face was buried in my neck, muting his words. I tried to console him as best I could.

  “He’s okay. He’s okay,” I repeated, trying to convince myself of the truth of the words as I spoke them. Saul’s shoulders shuddered with small sobs. I had rarely seen my husband cry. I had never seen him this wracked. We held each other. I was relieved to see him. I was glad to have someone to talk to, to be scared with, to hold onto.

  B
ut I realized that no one was going to relieve me of the burden of duty here. I would be the interpreter, the bridge. This was my world: ambulances, hospitals, ERs. If there were medical decisions to be made, I would need to gather all the necessary information and make them. With the facts and on my own. I could not let my guard down. I did not feel strong enough for this.

  As we withdrew from our embrace, I locked eyes with the police officer who had escorted Saul to me. He quickly looked away, perhaps discomfited by the raw display of emotion. He slowly turned and headed down the hall, his mission here over. I tried to fill Saul in on what I knew. The broken leg was a definite, but after that I was on shaky ground. The CAT scan had been presented to me as a mere precaution. Probably overkill—doctors just being thorough. But the more Neil slept and the more he repeated himself every time he saw me, the more I worried about his brain.

  The scanner door opened, and the nurse pushed Neil’s stretcher back down the hall toward his room. Saul bit his lip and touched Neil’s head as they moved.

  “Hi, Dad,” Neil said, monotone, then closed his eyes again. Saul looked at me with a smile and a sigh of relief. My heart cracked. I felt almost nostalgic for that sense of relief that I too had experienced just moments ago when I realized Neil was alive and knew me. But even though Saul was only minutes after me in responding to our son’s accident, I felt like I was light years ahead of him in understanding the magnitude of what was happening. Not just because of my medical training but because Neil was repeating himself. His recognitions were without emotion. He seemed a shell. The blanker he was, the more I worried about damage to his brain.

  Saul and I sat together waiting for the doctors to tell us the results of the scan. Saul caught me up on how he was informed of the accident. A uniformed police officer had walked into the Salvation Army gym and interrupted their volleyball game, asking for Saul by name. There were a couple of jokes among the players.

  “Uh-oh, what’d ya do, Saul?”

  “How many parking tickets do you have anyway?”

  But it soon became clear that something was very wrong.

  “Your daughter’s been in an accident, sir.”

  “He just kept saying it, Cal, over and over. I told him I didn’t have a daughter. Did he mean my son? But he just kept saying, ‘I can’t give you any more information than that, sir.’”

  Saul’s head dropped into his hands again.

  “I thought he was dead,” he said again, his voice a whisper.

  I rubbed his neck, kissed his shoulder. But I knew none of it was a comfort to him. The only thing that would comfort him would be a piece of good news about Neil. Our chairs were close to where a group of scrubs huddled in front of the light box and murmured over someone’s films. I wanted to join them, to render my own interpretation of the images. I strained to hear their words over the ambient bustle. “Brain.” “Fracture.” “Bleed.” I knew they were talking about Neil. When they turned and walked toward us like one organism, I squeezed Saul’s hand hard.

  “Your son has a fractured skull,” one of the scrubs explained. “There’s a tiny bit of bleeding at the site,” another added. “Nothing big really, but we’d like to transfer him to Boston. In case.”

  In case he needs a Richmond bolt, I thought. An intracranial pressure monitor. Anna Jaques was not equipped to do brain surgery on a child. I tried to push visions of Neil’s shaved and bandaged head out of my mind. While I was glad he was being transferred to a tertiary trauma center with the best neurosurgeons in the world, I was terrified that he might actually need one of them. I squeezed Saul’s hand, trying to interpret the situation for him.

  “It’s just a precaution, honey,” I said, hoping this was true.

  They led us back to Neil’s cubicle. He was more agitated now. His leg was hurting him. He thought he was in a gym. After each arousal he fell back into a deep sleep. Saul and I stood over him, our hands on his shoulders, feeling helpless and scared.

  The noise level outside our cubicle rose. I could hear Mary wailing. Police walkie-talkies crackled. Trista’s brother, Bud, was pounding his fist into the arm of a metal chair in the hall, sputtering over and over, “I’ll kill him. I’ll kill him.”

  “I have to go say good-bye,” I told Saul and stepped into the hall. I followed the sounds of Mary’s cries and found her outside Trista’s cubicle. I put my hands around her shoulders, trying to console the inconsolable.

  “Have you seen her?” I asked. I had only seen Mary in the hall outside Trista’s room.

  “I can’t; I can’t,” she sobbed.

  But what if Trista didn’t make it? What if this was Mary’s last chance to see her daughter alive? I had helped countless distraught parents see their intubated and unconscious children for the first time. I had done it as a nurse, a resident, and an attending. I explained the machines, the tubes. I held their hands and answered their questions. I was good at it.

  “C’mon with me. You have to see her.” I gently led this mother, this woman I was just beginning to know, to her daughter’s side. A crowd surrounded Trista’s stretcher. Her head was taped between two Styrofoam blocks, like Neil’s. She was intubated. A respiratory therapist knelt against her, pressing air into her lungs rhythmically with an Ambu bag. A nurse was securing her heart monitor to the stretcher’s side rails with Velcro straps.

  “I can’t,” Mary screamed again and collapsed on the floor next to the stretcher. Mary’s husband, David, lifted her gently, and together they moved into the hall. I stepped closer to Trista. I’m not sure why the local ER crew made room for me. They didn’t know I was a doctor, but maybe they let me in because Trista was stabilized or because they thought of me as a surrogate mother, given Mary’s inability to see her child this way.

  Someone had put ointment into Trista’s eyes to keep them moist. Despite the bright glare of the ER’s fluorescent lights, her pupils yawned widely open. I swallowed hard, knowing what that meant: fixed and dilated. I kissed her forehead.

  “Good-bye, sweetheart,” I whispered. Then the helicopter crew arrived and whisked Trista out the door. I never saw her again.

  5

  Transport

  When I was a resident at the University of Massachusetts Medical Center, one of the most stressful rotations was the neonatal intensive care unit. And in the NICU rotation, one of the most stressful calls we could get was a request to go out on transport. Calls came into our tertiary care center whenever a baby at an outlying community hospital was born prematurely or was too sick for the local hospital to care for.

  Our catchment area spanned a fifty-mile radius, which made for some pretty long rides bouncing around in the back of an exhaust-filled ambulance. Usually a resident, a nurse, and a respiratory therapist made up the transport team. On the way there we checked equipment and reviewed emergency algorithms in our heads. Our biggest side effect then was nausea and motion sickness. On the return trip, with a tiny life hooked up to high technology, every bump in the road threatened to dislodge a hard-won breathing tube or IV line. If one of those lifelines needed to be replaced, our options were to continue our pell-mell journey and risk failure or injury as the moving targets of miniscule veins and vocal cords hurtled down the highway or to stop the ambulance to have a bump-free shot at a do-over, losing precious minutes in the gambit. Either way, it was our call. The driver would forge on full speed ahead or screech to a stop at the side of the road at our request. We were in charge.

  One sunny Sunday morning, after a particularly harrowing transport, I brought my sons out to my parentsâ
€™ house for a visit. I was reliving the drama over coffee with my dad.

  “So I was on this transport the other night, Dad,” I started. My father chewed his English muffin and asked from behind his Telegram & Gazette, “What do you mean, a transport?”

  I poured milk and buttered toast for my sons and answered, “Well, if there’s a sick newborn, we have to go out in the ambulance and pick the baby up.”

  My father lowered his newspaper and stopped chewing.

  “You mean you drive an ambulance?” he asked, clearly impressed.

  “Well no, Dad, actually I’m in the back, working on the baby.”

  My father swallowed a mouthful of coffee, muffin crumbs gathering at the corners of his mouth.

  “Oh, I thought you drove the ambulance,” he said, before disappearing back behind the paper.

  And now here I was in unfamiliar territory, in the cab of an ambulance, thinking of my dad, long since gone. I was peering through a small square of glass into the back, where the action was; where I belonged. An EMT watched over my child; he held Neil’s wrist, checking his pulse, recording the blood pressure on his metal clipboard. He beamed his flashlight into Neil’s eyes and noted their response.

  It was like watching TV with the sound muted. I couldn’t hear anything; I could only watch. Through the tiny glass square I saw the EMT asking Neil questions, recording his answers. I knew the drill. What’s your name? Where are you right now? Who’s the president? Determining if the patient was oriented to person, place, and time. If all three questions were answered appropriately, the patient was proclaimed “oriented times three.”

  Neil certainly wasn’t alert. He slept when not stimulated. When we left the local hospital, he thought he was in a gym. I wondered where he thought he was now.

  I glanced over at the driver of the ambulance. She was a young woman, no more than twenty-five years old, with closely cropped dark brown hair. She was deftly weaving through traffic on Interstate 95, lights flashing, sounding the siren in short, as-needed bursts to get past the occasional oblivious driver. She kept a watchful eye in her rearview mirror, waiting for instructions to either pull over or hit the siren and go full speed. She had my boy’s life in her hands. At that moment I was filled with my father’s love for her.

 

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