by Tessa McWatt
I expect that I will die if my wife does not survive.
By now she has been given the optimal dose of anaesthetic, and her breathing has slowed, her heart rate has dropped. Her brain stays awake; only her mind sleeps. This is the paradox of anaesthesia. Anna is now unconscious but her brain is still able to keep the rest of her body alive as her head is placed in a three-pin skull fixation device. The clamp will hold her head in place while Dr. Gottlieb makes a zigzag incision at the top of the skull.
The clip-clop of my heart becomes a zoom.
I look around me at the stringy, sticky people, and no one else seems to be alarmed. One group, a Punjabi family, stands out. Two young women in silk caftans to their calves, over-wide, patterned trousers, scarves slung around the front of their necks and flowing down their backs, hover around a table where an older woman in more traditional dress, her head covered by her scarf, sits. Next to her, an older man—the grandfather? uncle?—in Sikh turban and with a beard almost as white as his garments, is hunched over, looking miserable. Is it his wife they are visiting? Or his son? Where is the mature woman’s husband? She unpacks food from a hamper, unwrapping dish after dish. Wisely, they have brought their own supplies, and I regret my own poor preparation.
When my father died before I met Anna—a sudden heart attack, with one day in the ER, another day in the morgue—I remember wondering if I’d ever have a son to mourn me. I stare at the young women of the family, perhaps the daughters; their placid faces give nothing away.
What will happen to my wife’s mind? Over the past month there has been no past between us. All Anna and I have is each moment of now. And in the now I have done nothing wrong. In the now I am exonerated.
“Dad,” Charlotte says. Startled, I snap my plastic spoon in two and spill coffee on the table. I see a sliver of blood surface on my thumb. I look up. Charlotte and Sasha are sitting across from me. I wonder how long they have been there.
“Where were you?” Charlotte says, all chippy and choppy, and I wonder if she means just now or all along?
“We were upstairs looking for you,” Sasha says. “Have you had anything to eat? Do you want lunch?”
“I’m starving,” Charlotte says. “But the food here is complete crap. I may have to settle for a donut. For the first time in about ten years.”
When she is gone, I’m alone with Sasha and relieved. But Sasha is scrutinizing my face. “Mom’s stronger than she seems sometimes,” she says.
“Who would know that better than I do?” I say. “But they’re ruining her right now.”
“What?”
“Right now,” I say, and look at my watch and determine it is around this moment that Dr. Gottlieb will be making a skin incision to expose Anna’s skull. The skin and muscles are being lifted off the bone and folded back. A drill will bore holes into the skull that will allow the craniotome, a special saw, an entry to cut through bone. “The aneurysm has shown her off. Maybe that’s really her.”
Sasha’s face betrays the fear of a daughter whose father as well as mother is now potentially lost to her.
“I just mean that maybe interference is unnatural.”
Sasha looks at me with horror.
“I mean … her mind … she’s less articulate, but maybe more lucid …” I mumble, but I know that I’ve lost her now. I didn’t mean to frighten her. “Aren’t you going to eat something? We have a while yet.”
“I’m fine,” she says.
“This place is gross,” Charlotte says as she comes back to our table. “Let’s go out for a bite. We have a couple more hours before we’ll hear anything.”
“No, no. I’m staying here,” I say, adamantly.
“Me too,” says Sasha.
“But, guys, we—”
“Right about now your mother has a jigsaw in her skull carving out the bone like it’s a pop-out window!” My voice is much louder and harsher than I had intended.
“Come on, Sash,” Charlotte says, as she grabs her sister by the sleeve, pulling her up from the table. They walk out of the cafeteria with Charlotte’s arm draped protectively over Sasha’s shoulder.
I leave the cafeteria, dropping crumpled sheets of paper into the garbage can on the way out. I avoid the elevator and instead take the stairs to the third floor. A young man in his twenties, with brown hair and strong arms, shoots up ahead of me, taking the stairs two at a time. He seems happy and my guess is that he has just had a baby. I try to keep up with him, but it’s no use. He exits the stairwell at the second floor: maternity. I care little that I guessed right. I slow down, trying not to distress myself with the image of someone in the operating room finding the drawing I slipped under Anna’s sheet and laughing right now.
And then I wonder if I should call Anna’s brother in Florida.
By the time I reach the third floor and push open the doors into the neurology ward, I am out of breath. I need to see Anna.
The ward seems busier than a few hours ago; it’s foolish for me to be here so early. I retreat to the post-op waiting room, with hours still to massacre. But there are people in here. I’ve entered the room too purposefully to then turn around and leave without appearing rude, so I sit down in one of the available steel-blue vinyl armchairs.
“Be still,” a Chinese woman says to her daughter who is restlessly flopping about on the arm of her chair.
“I’ve never seen anything like it,” says a woman with red hair, dressed in baggy pants and a tank top, her arms freckled and firm. She snuggles into the arm of the woman beside her who is of similar age but has cropped dark hair. The dark-haired woman brushes the redhead’s arm in consolation. From their conversation I garner that their friend had an epileptic fit and has been transferred to neurology to see a specialist. They caress one another for comfort, and I wonder if they are lovers or if they have simply been thrown together by events. I slouch down in my chair, trying not to stare at them.
A sporty man enters and sits down beside the Chinese woman and her squirming daughter. They say nothing, and my guess is that their son has been in a bicycle accident. I don’t know why this seems the most likely scenario, but it does. The potential for drama is as obvious as a soap opera.
I try to picture Gottlieb now, wielding the jigsaw and then removing a small section of the bone from my wife’s skull. But I have difficulty with this.
“You can’t go the whole distance,” Christine once said to me on a night out when we were celebrating something, I can’t remember what. I know for certain it was while she was still on the pill. It might have been a celebration of a new client contract or perhaps the first anniversary of our affair. She had been referring, as I later discovered, to my designs, not to our relationship, but the undertones of the comment had touched a nerve.
“What the fuck is that supposed to mean?” I asked, and took a sip from my wine, wanting to go home to Anna.
“Hey …” Christine said, hurt. She slumped back in her chair, and I leaned forward, shunted my chair closer to the table, and took her hand, which she immediately snatched away. We had been discussing a design I’d done for an insurance company—a graphic whose umbrella image I was proud of.
“I’m sorry, but I don’t understand,” I said, reaching across the table for her hand.
She sulked, but I stroked her hand until she softened.
“All I meant was, I thought maybe you were holding something back. And you do. There’s always something you hold back.”
“There are commercial constraints, you know that,” I said.
“But that’s not what I mean. I don’t know how else to say it. You hold back,” she said, and sipped her expensive Barolo with what felt like resentment. I was convinced that she wanted more, that she hated me for not leaving Anna, and that she was punishing me. After dinner I made love to her in her kitchen and made a point of not holding back in any sense. But what I think she really was pointing to is what I’m sensing for myself in this waiting room, what I’ve been experiencing over the
past month. I’m not capable of going the whole distance even now, with my wife; instead, I’ve been obsessed about my conscience, my confession. In case she lives? In case she dies? Either way, who would that serve? Only me.
I think of the bone flap being cut from Anna’s head and being slid like a snug puzzle piece out of its place in her skull. The dura mater, the membrane that protects her brain, is now exposed. I wonder what they will do with the bone, where they will place it so as not to damage it or lose it.
“You’re such a coward, Mike,” Anna had said to me when we had returned from the hospital after spending the night at Sasha’s side. By morning my daughter’s dehydration was in check. The Egyptian desert was still in Anna’s hair, still on my skin.
“What?”
Anna threw down her handbag and walked to the back door and pushed it open. The fresh April air cleared the stale winter from our house.
“What?” I repeated.
She turned back to me and I could see her skin go mottled with approaching tears: “Coward.”
“What are you talking about?” I couldn’t stop thinking about Hamada and the sounds outside our tent.
“When Sasha asked you if you were angry with her,” she said. I was taken aback. Sasha had wept when she woke up and saw us there, and had begged for forgiveness.
“She’s alive,” I said harshly, incensed by the idea that I should have disciplined my daughter in those circumstances.
“But she was asking you, for once, directly, to be angry with her, to show her you had emotion of some kind in you,” Anna said, as I felt the rawness turn in my throat. “She wanted you to be angry with her. Don’t you get it?”
I didn’t get it.
It was a few weeks later that I met Christine.
I strain to feel time passing. Objects appear in the room as though I’ve drawn them myself. I am stalled in so much rawness that I am all blood and veins and muscle, a sinewy flank of uncooked meat.
I touch the pocket of my shirt and am relieved that I still have my Staedtler. I look around for something to draw on. All I find is the discarded business section of today’s Globe and Mail. It will have to do.
“Interesting … What is it?”
Fred has come up behind me and is looking over my shoulder. I quickly cover the sketch and wonder how long he has been standing there. The Chinese family has gone; the two women are both reading magazines.
“Another international sign, eh, Dad?” he says through a grin that slices off a sliver of laughter. “Have you been sitting here the whole time?” he asks.
I look at my watch. “There’s only another hour or so,” I say, surprised at how time has passed.
“They’ll probably finish early. That’s why I came now.”
He is so believing, so trusting of how things function in the world.
“This hospital has had some of the lowest MRSA rates in the province,” he says, imagining he’s reassuring me.
I think about the tiny endoscope that Gottlieb is navigating past the protective layers of brain tissue, steady-steady-hands-that-will-not-slip-and-cut, as he separates the two lobes of Anna’s brain on his way towards the arteries and the ultimate goal.
“Wake up, Fred,” I say.
“Excuse me?”
And I know that I’ve pricked the little boy who doesn’t like to be challenged in any way, the boy who, on his first solo flight down the high slide in the playground told his mother that she was the one who was frightened and that he would never be.
Did he really think they’d finish early? Fred might be the most fragile of us all, I realize.
We sit in silence. The yellow paint on the wall is cracked and blistering like our failed imaginations.
“Seeing anyone these days?” I ask with as gentle a tone as I can muster.
He looks at me, suspicious, before he nods.
“Nothing like a good distraction,” I say, nudging him with my elbow like some pathetic teammate. He shakes his head and looks away, his shoulder edging me out slightly.
I am sorry for what I’ve done. The image of my mother in her coffin—the tiny head, the shrunken chest cavity, the shock of the stroke still clear on her twisted face despite the mortician’s careful work—leads me to take my son’s hand.
I breathe in deeply again. Dr. Gottlieb will be trying to secure control of the blood flow in and out of the aneurysm. He knows how easily it can rupture. He is preparing it for clipping.
“Fred,” I say, squeezing his hand. He turns towards me.
“Fred,” I repeat.
“What’s so special about you, then?” he asks.
I let go of his hand.
“It’s not like you’ve ever done anything—” He stops himself and shakes his head. He checks his watch and looks around, craning his neck to see out into the corridor.
I take another deep breath.
“Do you ever fantasize about things, Fred?” He looks at me as though I might be perverted. “I mean, do you ever dream of things you want, like a job, a house, a car, a lover … I don’t know, anything. Do you fantasize about having them, imagine yourself with them, and get some sort of private joy from that?” He still looks confounded. “I used to lie in bed at night, before I met your mother, and I used to picture myself in the future—sometimes just the near future, like the next weekend and the perfect woman I’d meet; or two years on when I’d be having a gallery show of my work. I used to pretend that I was being interviewed by a magazine journalist about a particular commission I’d just done, or about winning awards and giving speeches, thanking my parents for making David the banker and me the creative one.”
Fred’s reaction is still impossible to discern. He looks like me at that age. But if he shifts his lips towards a smile, he instantly becomes Anna. I want him to smile, to react somehow, to stop me.
“But I don’t fantasize about the things I want anymore. Do you?”
“Yes, I do,” he says, but still doesn’t smile.
“Like what?”
“Like fantasizing that if and when Mom wakes up she’ll be completely fine,” he says. “I’m going to check with Rosie.” He rises abruptly and walks out.
I close my eyes and try to picture a year from now with Anna; she is well and we are on a trip somewhere—the Caribbean, or Italy, or even Indonesia. When did I actually stop this little game? When did fantasies become so proven never to come true that it hurt to have them?
I see us now, in this yellow-grey corridor of illness with death’s door ajar, creaking on its hinge.
The dome of the aneurysm in Anna’s brain has likely now been punctured with a needle and carefully drained to ensure that blood doesn’t continue to fill it up. Once the clip is in place, the retractors holding the brain lobes apart are removed and the tissue gently unfolds towards the centre, disturbed but intact.
But where is the bone flap? Lost? Hidden amongst soiled swabs and discarded tongs?
No, it is there, placed gently in sterilized gauze, safely on the tray. Now it’s being unwrapped and levered into its crook. Titanium plates cover the fissures and, here, the screws that will secure them to the skull are put in place. The needle that sutures the muscles and skin back together is tough but thin as it pierces through the fabric of my wife’s head. I see the ribbon of gauze dressing that the nurse is slowly unravelling over the wound; she will wrap it once, twice, many more times around Anna’s head, and my wife will resemble a turbaned Egyptian nomad.
TWELVE
“You’re an asshole!”
Charlotte’s face is nearly mauve with anger. I don’t understand all that has just happened, what it is exactly that we have been told. I don’t think I can feel anything as I watch my children react to the news. But my bottom lip is the Geiger counter of the distress that is no doubt taking hold of me, ticking in millisecond beats.
“I realize you’re upset,” Fred says to Charlotte calmly, in his doctor’s voice.
“Go back to your own patients—you’re
probably more compassionate with them!” Charlotte shouts.
“Stop it, stop it!” Sasha mumbles, also trembling, her tears more timid than Charlotte’s. I can do or say nothing to help these three. Gottlieb has spoken a series of words. I have followed their trail to these children, who are reacting for me. One of the words was “complication.” Complication during the surgery. I have followed that word to Charlotte’s distraught face, and I slowly realize what is happening. Charlotte has comprehended immediately what the rest of us have not yet clocked. She believes that the complication experienced in surgery might well result in her mother becoming a vegetable.
“The bone flap.”
Dr. Gottlieb pronounced it mechanically, as he stood in his surgery greens in his small consulting room. The Hunt and Hess assessment before the surgery determined that Anna did not have subarachnoid hemorrhage, and her symptoms pointed to a low risk. In normal circumstances, the bone flap is replaced during the craniotomy. Dr. Gottlieb had fully expected to be able to do so in this case as well. But during Anna’s surgery, he detected larger swelling in the area than they had anticipated, and the possibility of infection. Gottlieb’s other key words were “pressure” and “damage.” I slowly began to understand that normal procedure could have caused increased pressure on the brain, resulting in damage that could be as severe as a stroke.
“The bone flap was not replaced,” said Dr. Gottlieb to the four of us standing stone-faced in his office. And now that my senses are returning, I can remember his words in their precise order: “But we expect to do so within seven days, after the swelling has been reduced. It’s a precaution.”