by Abby Maslin
I can’t explain the desperation that has suddenly taken over. It topples logic. I begin hitting my forehead against the concrete of the hospital wall, when my sister quickly grabs my shoulders and pulls me into her lap. “You don’t know that, Abby. It’s only been a few minutes. You’re just tired, I promise. Please just keep breathing.”
I want to believe her, but I can’t stave off this feeling of dread. We are living a waking nightmare, and I am trying to get through each hour the best I can, desperate for any small opportunity to crack the weight of it. To laugh or even smile. But then I am hit with a moment like this, one in which reality hits swiftly and crushingly. And then I am drowning once more, asphyxiated by the terror of imagining a life without TC.
I wrap my arms around Bethany’s neck and follow her instructions to breathe as we sit there hugging. After a few minutes, I feel my chest expand and a wave of oxygen returns to my brain. The double doors swing open, and a nurse emerges.
“You can go back now,” she says.
TC’s room is quiet again. The doctors are continuing their rounds on the unit in the room next door, and Klu, once again TC’s night nurse, has resumed her position behind the laptop outside his door. “Everything’s fine, honey,” she assures me, pressing down on my heaving shoulders.
I feel like an idiot as I sit down and try to recover from my nervous breakdown. I can’t keep losing my mind every five minutes like this. I search through my bag until I find the bottle of donated Xanax, then break one in half and wash it down with a sip of cold coffee. The drug is new to me, and its effects are immediate. My muscles unclench, and I sink deeper into the chair. Just ten minutes of sleep and I can keep fighting. I just need ten minutes.
CHAPTER 8
The next morning the fog begins to lift. Seventy-two hours is what Dr. Kalhorn has promised. And after exactly seventy-two hours, we receive what feels to me like a small miracle. I am seated at TC’s bedside as the respiratory team monitors his oxygen levels when TC’s right eye flutters open.
“TC, TC!” I shout, thrilled and eager for a repeat performance. I wait a few minutes more, but even though I don’t get one, I’m still elated.
I rush out to inform our family in the waiting room. After days of complications, we are all in need of some good news. Some sign that we are headed in a better direction.
“TC’s still not making a lot of progress breathing on his own,” I am told during morning rounds.
“Has anyone mentioned the possibility that he aspirated?” one resident asks me.
I shake my head no, although it’s entirely possible I’ve forgotten this piece of information.
“It simply means he vomited at one point after his assault and that he swallowed that bile. It’s why he seems to have developed a bad case of pneumonia,” he continues. “We’re going to need to perform a tracheostomy since we can’t wean him off the ventilator.”
The pneumonia is bad news, but so is most everything else, and I don’t know what medical concern is chief anymore: the breathing or the brain injury. I try to picture TC with a permanent hole in his throat, but the surgeon assures me it’s not what I’m imagining.
“The hole will close on its own as it heals,” he insists. “It’s not forever.”
Beyond the single eye flutter, nothing else magical occurs once we’ve passed the seventy-two-hour mark. No confetti drops from the ceiling. No doctor makes a grand or sweeping declaration.
Another three days pass before Mladen enters the ICU waiting room, accompanied by a tall man in a white coat. The man’s face is grim, and he addresses the group of families convened here. “I’m looking for the family of Thomas Maslin.”
“That’s us,” I say, standing up with a cup of coffee in hand. Why does he look so serious? The gentleman’s expression makes me uneasy, and I prepare myself for another round of shock.
“Hi,” he says briskly, then looks around at the other waiting families. “Would you mind excusing us?”
With the exception of my parents, Sean, and my in-laws, everyone begins to move toward the hallway, hauling their personal effects with them. Mladen stays in the room, getting a nod of approval that his presence is permissible. My stomach drops. Shit. I know what’s about to happen. This is how it goes when doctors are about to deliver the worst news. I’ve seen it at least three times over the past few days. Everyone gets ushered out of the waiting room, and a moment later the wailing begins. As strangers we try to keep our distance, cognizant of those who have just fallen into a dizzying well of grief. When the crying subsides, we approach them gently, offering a simple “I’m so sorry.” What else can you say to someone whose world has just collapsed?
We sit back down, and the doctor takes a seat on the coffee table in the middle of the room. He introduces himself. “I’m Dr. St. Andre. I see you know Mladen.”
I nod weakly. “Yes, he’s a friend. What’s going on?”
The doctor launches into a lengthy update about TC’s status. First, the craniotomy to clean up what wasn’t fixed by the craniectomy. Then the tracheostomy to address the pneumonia. Then a surgery to remove a large clot pushing up against the optic nerve of his left eye. Then, of course, a PEG line, a long-term feeding tube. Every hour, there is a new part of TC’s body I must throw my mental energy into understanding, and I quickly forget the reason we are here in the first place. Not because of an accident—but because of some intentional act.
At some point during Dr. St. Andre’s long-winded explanation, I realize I’ve stopped breathing. I’m doing the same thing I did with Dr. Kalhorn after the first surgery, just waiting on a single piece of information.
“If I had to guess,” Dr. St. Andre continues, “I’d say TC is going to survive this.”
I inhale deeply and manage a grin. Sighs of relief and a series of thank Gods fall quietly off the lips of our parents.
He continues. “But as Mladen might have warned you, this is not going to be a quick recovery. It could take months, more likely years. And TC may not be the same person. I’ve seen people with brain injuries emerge with totally different personalities. Sometimes they’re aggressive. Sometimes they don’t remember things about their lives before. You need to prepare yourself to deal with a totally different person.”
This is the first conversation we’ve had with a doctor that involves a long-term prognosis. And the picture Dr. St. Andre paints for us now is a somber one, although not unexpectedly so. My expectations for TC’s recovery are decidedly low. I understand that after all he’s survived, he’s unlikely to live a life identical to the one he had.
Plus, I simply don’t have the luxury of focusing on all the what-ifs. What if TC’s permanently physically disabled? What if he can never speak again? What if he can speak, but he behaves like a monster?
Even if one of those scenarios comes to fruition, it doesn’t change the course of action we’ll take today. The only thing to do is to keep pushing toward the tiny milestones. Another eye flutter. A wriggle of the toes.
Dr. St. Andre continues describing the long list of side effects TC will likely experience as he awakes from his coma, and I nearly giggle when he mentions diarrhea.
“Well, we all have a little of that right now,” I joke, attempting to defuse the tension in the room.
Dr. St. Andre looks surprised by my unexpected lightheartedness but can’t contain a half grin. Everyone laughs, temporarily distracted from shaking nerves. We can do this, I think. But it’s not so much a self–pep talk as it is a matter of fact. I have to do this.
This is my invitation from the universe, or perhaps my command. “You enter the forest at the darkest point, where there is no path,” Joseph Campbell wrote.
This may very well be my hero’s journey: the opportunity to discover what I’m made of. The true depth of my love. The search for courage in a forest illuminated only by uncertainty.
* * *
Mladen has become a wonderful friend over the past few days, not to mention my real-life Siri for answering my many medical questions. When he’s not busy attending to patients in his unit of the ICU, he comes to check on TC, walking me through the notes in TC’s chart and even offering me the key to the on-call room so I can steal a few minutes of rest. Nobody in the ICU touches TC without Mladen knowing about it first.
I trust Mladen in part because he is so similar to the man I married: hard-nosed, analytical, practical. With every decision I make, I try to conjure TC’s even-keeled voice in my head and let him guide me. Talking with Mladen is the next best substitute I have for my husband at the moment. After Dr. St. Andre departs, we stand outside the ICU doors, arms crossed, leaning on the wall.
“Mladen, if Dr. St. Andre is right and TC survives this, what’s he going to be like afterward?” I ask.
He meets my question with an audible exhale. Mladen is not one to sugarcoat the truth. His frank communication style is the result of a childhood spent in war-torn Serbia, followed by an emotionally stressful career as an emergency-room doctor. “Well, you know, Abby, this is going to be a long, long road. It’s going to be a marathon, not a sprint.”
I nod. It’s not the first time I’ve heard this analogy. Although, as a non-runner, I’m not fully certain I appreciate its implications. However, I will commit myself to this ICU for as long as necessary—three weeks, three months, three years—whatever it takes. I won’t tire easily. “Yeah, I figured that much. I understand. But I’m worried about what kind of person he’ll be. Will he have serious brain damage?”
“It’s hard to say what he’s going to be like,” Mladen admits. “He could be the same TC, or he could be just a fraction of the person he was before. He could have a totally different personality. I wish I could tell you, but it’s impossible to know.”
He runs his hand through his dark hair and looks deep in thought. “One thing you do need to consider is that TC has very serious trauma to the left side of his brain. That’s the part that usually controls speech and language. Hard to say how much of it will be intact when he wakes up, but it’s pretty unlikely he’ll be able to speak or communicate.”
This answer does not surprise me either. During the hours I’ve spent kicked out of the waiting room or sitting next to TC’s bedside watching him sleep, I’ve been scouring the internet for information about the brain. Each part, its function, and the skills affected. TC was hit in the frontal temporal lobe—the area of the brain that, for most people, houses the two primary language centers: Wernicke’s area, which is involved in the comprehension of written and spoken language, and its partner, Broca’s area, which controls the production of language.
Put together, this region not only helps us understand language; it helps us make it.
Everyone and their mother is trying to keep me off WebMD these days, but arming myself with these basic neurological principles feels like one small thing I can do to try to take control of the situation.
Denial is the other small gift I can give myself.
“Well, as you know, TC’s left-handed,” I point out to anyone who will listen. “I’ve read left-handed people can have language centers on both sides of the brain.”
“Maybe.” Mladen shrugs, reminding me again that it’s impossible to predict how this injury might play out for TC. The blunt-force trauma may be isolated to one specific area of his brain, but the bleeding it caused spread throughout, affecting nearly every other part as well. I guess I can understand why Dr. St. Andre is hesitant to be overly predictive.
The one hope Mladen does offer me is that of neuroplasticity—the ability of the brain to rewire itself.
“TC can’t grow new parts of the brain. The parts that are damaged are damaged forever. But he can strengthen the parts that are still healthy.”
A later Google search confirms Mladen’s assessment, but I also learn that some neuroscientists have even begun to challenge the idea of permanent brain damage. Clearly, there is still so much to be discovered about the brain. Ever the optimist, I cling to the idea of neuroplasticity right away. From all accounts I’ve read online, the most significant period of recovery takes place within six months of a brain injury. This is the time when neuroplasticity is at its peak—the period during which TC is likely to do the bulk of his healing.
I think of Dr. St. Andre’s other warning: that TC’s personality might be impacted. But this is one outcome I struggle to wrap my mind around. When TC is fully awake, I am certain that he’ll spring into action, that his recovery will be as critical to him as it is to me. After all, this is the National Honor Society member, varsity soccer player, straight A student I married. I’m certain we’ll work together as a team to move forward. To imagine anything else would defeat me before we even get to the starting line. There is no other TC beyond my TC, the gentle introvert, the rational mind. Jack’s father.
I think of the doctors I’ve met throughout my dad’s illness and the many times I’ve asked a pointed question and been offered “We’ll just have to wait and see” in return. I can ask anything in the world, but neither Mladen nor anybody else at this hospital can give me the assurance I’m looking for. Brain injury, it seems, is as gray a condition as exists in the medical world. If he lives, TC will not heal as if he had a broken arm, a lacerated bladder, or even a new liver. With extraordinary luck, he could be everything he was before. Or, perhaps, none of it at all. The world of possibilities is the size of an ocean.
* * *
In the meantime, there are practical decisions to be made. If TC continues to stabilize, as Dr. St. Andre has predicted, he will need a full-time caregiver. With a very heavy heart, I reluctantly inform my principal he should start looking for a replacement. My class of new students is due to arrive in just three days. My colleagues deserve as much notice as they can to put together a plan for my absence.
Next, I craft a carefully worded message to TC’s employer, trying to make the situation sound a little less dire than it is. It’s no secret TC is gravely hurt—anyone who’s turned on the local news knows as much—but I’m afraid of saying too much, of having him cut out of the professional world with so much still unknown. I think of all the work TC’s put into his life and career, and my anxiety skyrockets. I cannot let him lose it all.
There is so much to plan for, so many things to take care of to ensure we don’t end up bankrupt or homeless a few months from now. Sitting at TC’s bedside with my laptop, I am now running a one-woman office—trying to put together a power of attorney agreement and spending several frustrating hours guessing at TC’s online passwords so I can pay the bills on time. There are e-mails to answer and media requests to sort out and more questions to answer from detectives about the night TC was injured.
The two things I don’t do are sleep and eat. TC’s office graciously sends over a catered lunch every day, which feeds all our family and friends in the waiting room, plus the nursing staff, but I cannot stomach the thought of food. Food is an unwelcome and undeniable reminder that we must nourish ourselves if life is to go on. I am not yet ready to accept that fact. My life has stopped. I cannot think about the world that still spins outside these hospital walls.
Most hours of the day I keep myself parked at TC’s side like his personal bodyguard. I don’t want to run the risk of missing a single update from doctors, who are notorious for stopping by at inopportune times. I’m also hopeful that if I stay close enough nearby, my presence will stir TC. His neuro checks continue every few hours, a test for increased responsiveness. Doctors stand beside his bed and talk to him in a loud voice, commanding a series of movements such as open your eyes or raise your right arm. Tasks that, until now, TC has been unable to hear or perform.
The nurses are insistent that he’s more likely to respond to my voice than theirs, so I take a shot at it the next time Klu is on duty, leaning in close to TC’s face.
&nb
sp; “Honey, if you can hear me, squeeze my hand,” I ask. But there is no immediate response.
I’m starting on the right, hoping to elicit movement from the side of his body that has been most severely impacted. The cross-wiring of the brain means that TC’s right limbs are the ones affected by his left-sided injury. Each day when the team performs these checks, they test the strength of TC’s limbs on both sides. The left side gets marked down as “strong” while the right side is considered “flaccid.” It’s a condition explained to me as hemiparesis, or weakness on one half of the body. It’s commonly known as an outcome of strokes.
Now I move over to the other side of his bed and grab TC’s left hand, the side I know he’s more likely to respond to. “TC, I know you can hear me. Please just squeeze my hand, honey.”
I’m about to let go when I feel it: the faintest pressure as his fingers begin to clench my own. And then he does it again. My face flies up in bewilderment; my eyes open wide in Klu’s direction.
“Did he do something?” she asks.
“He squeezed my hand!” I exclaim.
“Keep going, dear,” she encourages excitedly.
“OK,” I answer nervously. “TC, can you wriggle your toes for me?” I find myself shouting for emphasis. His left toes move slightly, and then without warning, his left leg jerks to the side.
“Oh my God.” I take a huge breath and then grin. I’m ready to kiss Klu. I love everything about this wise, delicate woman and the caring way she calls me dear. For every hopeless look I’ve received from a doctor, I love that Klu has stayed calm and given me a reason to stay hopeful. “Did you see that? Did you see that!?” I cry giddily.
“He’s coming back to you, my dear.” Klu smiles knowingly. “You just have to be patient.”