Crash

by Carolyn Roy-Bornstein

  6

  “He’s Gonna Be Just Fine”

  Just after we reached the ambulance bay at the Brigham and Women’s emergency room, Neil’s blood pressure dropped and he complained of belly pain. A liver laceration, my doctor mind told me. A ruptured spleen. They yanked his stretcher out of the back, its collapsible legs smashing to the pavement. They pushed him through the glass doors, using his gurney like a battering ram. Neil never opened his eyes. I followed close behind, my own eyes glued to my son the whole time.

  Inside his new city cubicle, a team stripped him of his transport heart monitor leads and replaced them with their own. They got to work with stethoscopes, flashlights, and reflex hammers, poking and prodding, asking questions and recording responses. A resident young enough to be my son asked, “Do you mind stepping out, Mom?” (Mom!) I took my chances.

  “Well actually I do mind. I’m a pediatrician. I’ll stay out of the way.” With that, he laid his hands gently on my shoulders and guided me through the curtain and out into the hall. Apparently it was a rhetorical question.

  I stood there alone and adrift. Back at Anna Jaques, Saul and I had agreed that I would ride in the ambulance with Neil. Saul would stop at the house and pick up a few essentials (my asthma inhaler for one) and then meet us at the Brigham. I hoped he’d get there soon.

  Now a burly bearded doctor in an attending-length white coat strode over and offered me a meaty hand. He pumped it twice, introducing himself as Chuck, or Mitch, or something equally short and informal.

  “I just looked at your boy,” he boomed jovially. “Don’t worry. He’s gonna be just fine.” He then took off down the hall, calling over his shoulder, “They’ll come get you once he’s all settled in.”

  I watched him disappear. Even though he couldn’t have done much more than literally “just look” at Neil, I felt oddly reassured by his words, as if years of experience at this sort of thing made his brief glance as sharp a predictor as any CT scan or thorough neurological evaluation. I imagined him popping into other cubicles, making pronouncements along the way. “Fine.” “Not fine.” “Well.” “Not well.”

  I found the waiting room; capacious yet teeming with patients. Babies crying. Pregnant women carrying plastic containers of urine, trying to disguise the cups by wrapping them in paper towels. (I knew that trick.) A television mounted above the fray flashed silent images. I kept a wary eye on the scrolling headlines at the bottom of the screen. It was almost eleven, just over three hours since the crash. I knew it would be just a matter of time before we would become one of those banners.

  By this time, I had a few things pieced together. One of the first responders was the fire chief and a neighbor of ours. He told us how he had been at home when the call came in. He’d heard it on his police-band radio, always on. A drunk driver, out of control. Some of the nurses at the local hospital had also filled us in. The kids were victims of a hit-and-run accident, but they had caught the driver, drunk, a teenager not so many years older than Neil and Trista. He left the scene in his SUV but flipped it on the Interstate 95 overpass a few hundred feet down the road. He had taken off on foot but was quickly apprehended. He had thirty empties in his car.

  Oh, this would make the news all right.

  As I watched the headlines, Saul came through the waiting room door. Just seeing him, I breathed easier, even before taking a hit of the inhaler he had brought. He carried a paper bag full of the “essentials” I had sent him home for: clothes Neil would never wear, books we would never read, and knitting I would never touch.

  When they finally let us in to see our son, he still lay on the hard plastic board used to transfer patients from stretcher to bed. His head was still pinned between two Styrofoam blocks, but now his wrists were tethered as well. I knew what those straps meant. I had used them as a nurse many times to restrain confused old men or to keep belligerent drunks in the ER from injuring the staff. We used thick leather ones with metal buckles for the occasional inmate we treated, a security officer planted next to him. Then there were the thin cloth varieties padded with soft lamb’s wool to gently remind the elderly woman not to get up to use the bathroom alone. Neil’s were white Velcro straps slipped around each wrist and lashed to the side rails. The ends were tucked under his mattress, a maneuver I knew was to discourage escape.

  My heart broke seeing my boy’s fingers picking at the sheets and testing the limits of his restraints with short jerks. Those fingers had petted gerbils, iced cupcakes, moved chess pieces, turned book pages, tuned guitar strings, and played Beethoven. Those hands had never hurt anyone and did not need to be restrained.

  I gently removed the straps and shoved them under the mattress. Neil’s eyes opened.

  “Hi, Mom,” he whispered then drifted back to sleep, his fingers still working the sheets in constant motion, a frenetic Braille known only to him. I tried holding his hand, but it continued worming in mine.

  He was shivering under his one thin sheet. Saul and I took off our coats and laid them over our son. He woke to complain about his head being trapped and the hardness of the backboard. I tried to explain that both would be gone once his spinal films have been cleared, but he wasn’t comprehending. He was agitated, irritated. He thought he was in a gym. He yelled for us to bring him things that didn’t make sense, and when we tried to clarify what he wanted, it only made him worse.

  I tried to think about Chuck/Mitch and his reassuring words about my son. But this was a trauma center, and I was slowly realizing that by “He’s gonna be just fine” the doctor really meant Neil’s going to survive, to walk out of the hospital alive. And I wanted so much more for my boy. I was worried about his IQ and his personality. Would he still be smart? Would he still be Neil? I glanced over at my husband, who was looking uncharacteristically helpless.

  “But honey, he’s alive,” he told me, as if reading my thoughts. It’s no wonder Saul reacted so differently to our son’s accident. Unlike Saul, I had found out about the crash gradually, with time at first to deny reality, to disbelieve:

  “Where are the kids?”

  “They should have gotten to your house by now.”

  “Two kids were hit on Ferry Road.”

  I had had time, running through the freezing cold, to postulate alternative scenarios. Two other kids were hit. Not our kids. Not Neil.

  For Saul the news came all at once, with stomach-churning clarity.

  “Your daughter’s been in an accident, sir. I can’t give you any more information than that.”

  And he was alive. And I was grateful. I thought of Mary somewhere else in the city, about Trista’s unseeing eyes and how they were probably having a very different conversation with their doctors—and I felt guilty for my thoughts. I swallowed my grief and stroked my boy’s hair. There was no dried blood, no broken glass, no evidence of the trauma he’d just been through. I thought, How can he have brain damage when he doesn’t even have dirt in his hair? He opened his eyes.

  “Hi, Mom.”

  7

  “There Was a Crooked Man Who Had a Crooked Smile”

  It was after midnight when the doctors came in to update us on Neil’s condition. His CAT scan was unchanged from the one back home. The bleed in his brain was still small. They had CT’ed his belly too. No lacerations of the liver or spleen. My husband and I squeezed hands at each piece of good news. He did have a fractured shinbone that would need an operation to repair; the orthopods would tell us more about that in the morning. His C-spines had been cleared. They’d be taking him out of his collar soon.

  E
ventually they took us up to the trauma ICU and deposited us in the waiting room. They showed us the phone on the wall and told us they’d call when Neil was settled in and we could see him. I protested briefly, but my husband led me over to the couch and sat down next to me to wait.

  “This isn’t right,” I grumbled. “They’ve got it backwards. He’s our kid. We should be giving them permission to see him. Not the other way around.”

  “We’re going to need to start calling people,” Saul commented, perhaps trying to distract me from my irritation. I thought of Saul’s elderly mother. I wanted to get to her before the TV news did. We’d managed to avoid the eleven o’clock broadcast, but it was just a matter of time. We also didn’t want to wake her with scary news at this time of night. Our oldest son, Dan, was studying Spanish in Mexico. But the only number we had for Dan was the Study Abroad Coordinator at Goucher College. That would also have to wait until morning. There were other calls to make as well. Friends, family, work. I was employed at a large community health center and had patients scheduled. Someone else would have to see them. Saul ran his own business, and his staff would have to be told that the boss wouldn’t be in. But we decided all the phone calls would have to wait until morning. Right now we just needed to be with our son. Besides, maybe we would have more information by dawn.

  Finally the phone on the wall rang and we were granted permission to come inside the ICU and see our son. The nurse brought in an office chair on wheels for me, and I sat down and lowered the side rail on Neil’s bed to be closer to my boy. When Saul asked for a chair for himself, the nurse told him we couldn’t “just camp out here” and left him standing. He went back to the waiting room to sleep on the couch. We made a plan to switch places every few hours, but I found I couldn’t leave Neil’s side. I was afraid that if I walked through those glass doors, the nurses would never let me back in. They’d tell me visiting hours were over and keep me from my son. I laid my head on Neil’s belly, but I couldn’t close my eyes. I was afraid if I were caught sleeping, they’d send me away. I didn’t even go to the bathroom, afraid I wouldn’t get buzzed back in.

  The hours ticked by. Neil’s blood pressure was low. I pressed my hand into my son’s belly and squeezed his thighs, searching all the places where blood could hide. It was discomfiting for me. Neil is modest by nature. He closes his bedroom door just to change his shirt. I felt I was somehow violating him now, but I needed to know he wasn’t bleeding out. I needed an answer to his low blood pressure. The nurse kept calling the resident with the numbers, and he kept ordering fluid boluses. But it didn’t make sense. Neil’s pulse was rock stable, and plenty of clear urine filled the bag hooked to the side of his bed. Bleeding just wasn’t the cause of his pressure drop. Perhaps it was the whopping dose of antiseizure medicine he had been given in the ER.

  I was trying hard to stay awake. The ICU was a surreal setting, hallucinogenic at times. At one point I thought I saw Neil’s eyes open wide, but when I rubbed my own and looked again, he was sleeping peacefully. Later, the numbers on a wall calendar seemed to wriggle off the page and dance along the ceiling. But once I shook my head, the numbers had marched back into their orderly 2-D row.

  A neurosurgeon came in the middle of the night. He took a tiny penlight out of the breast pocket of his white coat, pinned Neil’s eyelids open with his fingertips like they were butterfly wings, and shined his light in them one at a time. PERRL: Pupils equal round and reactive to light. A good sign. He put Neil through all the moves. Squeeze my fingers. Raise your eyebrows. Smile. Wait. Smile again. I looked over the neurosurgeon’s shoulder as he asked Neil to smile over and over. Something was wrong. The doctor didn’t like the asymmetry he saw in Neil’s face.

  I thought of the nursery rhyme:

  There was a crooked man.

  He had a crooked smile.

  How did the rest of that go?

  Over and over my son contorted his face into an expression normally linked to cheer. But for Neil it was just a ticket back to sleep. It was a mask that said “Leave me alone.” More snarl than smile. When I was a nurse on the eleven-to-seven shift in the pediatric intensive care unit, I often had to do hourly neuro checks on my patients. I knew how difficult it could be. After the sixth time of answering questions like “Where are you?” and “Who’s the president?” folks get cranky. They want to go to sleep. They grunt and don’t answer. Then it was up to us nurses to determine if this was a diminishing level of consciousness or just grouchiness. When do you call the resident?

  Now the neurosurgeon was asking me if Neil’s smile normally looked like that. I thought back to a case I had recently of a little boy with headaches and a positive Lyme titer. On exam one of his pupils was bigger than the other. We were trying to figure out if this anisocoria was a result of the Lyme disease, which would be very unusual. The mom swore it was new; otherwise she would have noticed it long ago. We asked her to bring in pictures of him as a baby and toddler so we could sort it all out. When she brought in the photos, sure enough, his pupils had been asymmetric right along. Could I be like that mother? Could I not have noticed all of my son’s life that he smiled like Ellen Barkin? I flipped through a mental photo album. Neil at Horseneck Beach. Neil dressed as an alien for Halloween. Neil with his head in the stockades at Old Sturbridge Village.

  “No,” I answered. “This is new.”

  Another member of the neuro team tested Neil’s hearing. I knew then that they were thinking he might have a basilar skull fracture. The resident rubbed several of Neil’s hairs together between his fingers just in front of Neil’s ears.

  “What do you hear?” he asked gently.

  “Beating off,” Neil replied, eyes closed. We all looked at each other.

  “What’d he say?” the team asked one another.

  “Beating off,” Neil asserted, more loudly. I searched my son’s face for signs that he was making a joke. His sense of humor was notoriously dry. But I knew this was no joke. Though he had passed the bedside hearing test, my modest son’s immodest response was one more sign of his injured brain, his usual inhibitions temporarily off duty.

  The ICU attending ordered another CT scan for the morning to check for evidence of the fracture Neil’s asymmetric smile suggested.

  I thought again of those reassuring words. “He’s gonna be just fine. Don’t worry.” I looked down at my boy and worried.

  8

  Pre-Op

  Inside an ICU cubicle, there are no windows. There is no clock. Time is measured not by the sun or any timepiece but by subtler changes in routine and personnel.

  At the Brigham, the residents rounded early, moving from bed to bed like a many-legged organism. Clipboards in hand, their ranking was given away by the length of their white coats. Medical students wore short jackets. Residents’ coats reached to their knees. Attendings could be distinguished by their names stitched in red cursive above their white breast pockets. Later the residents would be in scrubs of green and blue. But for morning rounds, they were all in their best civvies. The men sported pressed shirts and neat ties. The women wore skirts and blouses, nylons and pumps. Shifts changed. Seven-to-three nurses replaced their eleven-to-seven counterparts. Then there were the people who only worked the day shift: housekeeping, dietary services, social workers, ward secretaries. Lights at the nurses’ station that were dimmed for the night shift now gleamed brightly in all their white fluorescence. The long dark hours of my nighttime vigil gradually gave way to morning’s bustling routine.

  A nurse came in and cranked the head of Neil’s bed so that he was sitting more
or less straight up. She handed him a glass of water and a toothbrush and laid a kidney-shaped emesis basin on his bedside table to spit in. He looked at them. I waited. Finally he took a sip of water and began to brush his teeth. I exhaled; Thank God. He knew what to do with a toothbrush. At that moment I was again sadly aware of the terrible burden of knowing too much as a physician. What other mother would sigh with relief when her son put his toothbrush in his mouth? He doesn’t have apraxia! Yay!

  The nurse and I continued getting Neil ready for the OR. We took turns wrestling with his long curls: combing, brushing, detangling. When the rounding team walked in, we gave up, stuffing the unruly mop under his paper operating room cap.

  The doctors on the team included an orthopedic surgeon, an anesthesiologist, and a neurologist. Each came with several fellows, residents and medical students. Each team had its own list of risks they needed to warn us about in the name of informed consent. The orthopod’s plan was to insert a titanium rod into Neil’s lower leg and hold it all together with plates and screws. He warned us of the possibility of bleeding or infection. The anesthesiologist talked about the possibility of more invasive monitoring. Neil was going to the operating room with just a simple intravenous but may need an arterial line or a central venous pressure line, a CVP. The neurologist had his own worst-case scenarios to describe: intracranial pressure monitoring, a Richmond bolt. I listened to them all, understanding the lingo even as I had trouble acknowledging that the body they would be working on was my own son’s. But I was waiting to hear from the trauma surgeon, the ICU attending, who had ordered one more CAT scan, which Neil had had around 4:00 a.m. He wanted to be sure the asymmetry he had seen in Neil’s face hadn’t been a harbinger of a basilar skull fracture. The results of that scan would determine if he should be having surgery on his leg or his head. So when they handed me the consent form to sign, I did something very much against my nature: I refused.