Crossings

by Jon Kerstetter

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  During the rest of that flight, I wondered what kind of complications we all might have. And I noted how tired I had become in my tours as a military doctor, especially during my last deployment. I had learned to distance myself from the casualties I had seen, but now I was one of them. Clinical distance had always helped me face the challenges of war, but it couldn’t help me face my own injuries. How could I distance myself from myself? There was a final thing: I had become a patient, one of the many numbers of soldiers who thought injuries were for others but not for them. I didn’t realize that my injuries would change my life so abruptly, and I began to understand how war and its consequences extended far beyond a theater of combat.

  The first thing I saw was the light. Blue. White. Intense. It reminded me of the light I had seen from an Alaskan glacier as shoulders of ice fractured and slid into the ocean. My family and I watched from a boat off a glacial bay. I responded with awe at the depth of the blue-white color and the massive icy waves. The crests of those waves moved outward toward a horizon that seemed dreamlike, ethereal, as if they were beckoning me to drift with them wherever they decided to go.

  A strange partial gravity embraced my body. I closed my eyes and drifted….

  I heard the voices of Collin and each of my children. Their words traveled above the surface of those icy waves, strong as the blue of glaciers, soft as the weight of dust. They called my name. They sounded far away, like a distant wave breaking on the face of a rock.

  My right leg tried to move—nothing. Bend it, shake it, kick it—nothing. My toes blundered about near the bottom of the bed. I couldn’t sense exactly where they were or in which direction they were pointed. I lifted my head to see them. I saw a foot and a leg, all real yet unreal—attached yet unattached. The skin of my right arm tingled in spots and felt dead in others. My right hand flopped at my side. Its fingers poked without finesse and groped at the doughy consistency of my thigh. A large black hole obscured the right side of everything I looked at. I blinked repeatedly. The hole remained.

  I recognized Collin and the kids but I couldn’t say their names. I wanted to call to them. They were saying things I didn’t understand, to each other and to me. They gathered near and touched my arm and my head. Their touch felt fuzzy, like anesthesia.

  Something was off, but nothing specific came to mind. I focused on my right leg and skin. I remembered that I was a doctor, so I tried to sit up and diagnose myself. I managed to flail about with my left arm. A nurse tucked it back under the sheet. I furrowed my brow as if I were growling at her. Collin stroked my arm and I was able to turn my head toward her. As I turned, I saw the light again; its glacial blue saturated the room. A cool puff of air hit my face. It smelled like plastic. Something on my nose made me stir. I opened my eyes and saw a hand trying to smother me with a mask. I tried to yell but nothing came out. A nurse said to take some deep breaths. I did, then drifted.

  I was watching an old silent movie with jittery frames that flashed and disappeared before I had time to catch their meaning. I drifted toward a hospital tent in Baghdad. A young Army doctor called my name as he shook my arm and asked me to wiggle my toes. I recognized his voice but his face belonged to somebody else. He called me “Mister” instead of “Sir” or “Doctor.” I mumbled some unintelligible mush. He interrupted. Told me surgery went just fine. His words conveyed nothing useful, tangible, or real. He tapped my leg, then turned and walked away. I wanted to call him back, say a terse word, maybe two, but the words just circled my tongue and fell to the sides of my mouth. They clung to the inside edges of my teeth, where they hunkered down, entrenched and irretrievable. My thoughts teetered and fell like a drunken soldier on weekend leave. I wanted to speak, yearned to speak, just a single small word—but nothing.

  Drifting in Iraq, I felt the buffeting of a helicopter. Something jolted me. My wife stood by my bedside, speaking. I heard her voice but not her words. A nurse positioned a pillow under my legs. She asked me to wiggle my toes. My toes had become detached. I faded…recovered…faded. I drove through Baghdad in a Humvee. Mortars exploded in the distance. The smell of medicinal alcohol hit me. A field hospital appeared. I awoke. Collin said, “…home.”

  I tried to speak again—nothing. I looked at my leg that was not a leg and closed my eyes, afraid without knowing why. My mind wandered back to Iraq. The walls of my tent flapped back and forth in a desert storm and the dust choked me. I heard a nurse say “Breathe.” My not-leg leg, my drifting toes, and my dough-like skin all coalesced into a single amorphous appendage. Muscle dissolved into bone, bone into skin, skin into air. My right buttock flipped itself inside out and rested, concave, on the bed. My ankle became a knee, my knee a toe. My knee-toe wanted to wiggle but had no mind to wiggle. My calf pretended to be a thigh and my thigh wanted to try its skill at bending, right in the middle where it had no joint. My right hand and fingers flailed against my thigh, touching without touching. My left hand reached across my trunk and rubbed my chest, face, and arm. My right shoulder was missing, as was the right half of my face. The hair on my head separated itself, real on the left, fake on the right. I looked at Darren and Justin. They were missing parts of their faces. That bothered me more than anything. I closed my eyes for a moment, then opened them. Their half faces remained.

  My mouth seemed to be fighting a mapless war. I ordered my tongue and lips to speak, but they formed only broken approximations of speech. Words crawled along the length of their neurons, unconcerned that they should find my mouth. Unlike my crazy leg, my words did not coalesce. They scattered and hid. They ran from my brain. I started to get pissed, then drifted back to sleep and back to my war. Each time I awoke, I gained a little more sense of where and who I was. Collin looked more real. Justin, Darren, and Katelyn all smiled and spoke, one at a time, and I could tell they loved me by the way their words sounded and by the way they touched my arm or leg. I began to ask myself questions, but the doctor inside me would not answer. He had no diagnosis for failing skin and floating toes and fractured thoughts. My brain flowed toward a horizon that jumped back and forth from Iowa to Iraq. My thoughts all abandoned me. They were traitors. I was neither soldier nor doctor, alive nor dead. I was something, someone in between—an object drifting.

  In a haze, I searched frantically for a medevac helicopter—for a weapon—for my medics. Where are my medics? Let’s move! I wanted to send a distress signal. I tried to form a word, but my mouth locked in defiance. I tried again, once more, and then finally managed to force a word to the back of my teeth, where I pressed it firmly until it slid from the corner of my mouth. Collin bent over to hear me. I puffed my lips and made only a low-pitched hum. She stroked my right arm: nothing. I needed her skin, our skin. I needed to say a word, to gather my wits, and legs, and arms and lift myself to the edge of the bed. Instead, I floated and twisted. I drifted seamlessly from hospital to war, from patient to soldier. The bloody smells of the wounded alarmed me. The sterile smells of my room confused me. I lost partial control of my bladder, but I did not feel the warmth.

  I maneuvered through the streets of Baghdad. I smelled the medicinal smells of hospitals. I felt the percussion of an RPG. My body shook as I pushed against the heavy door of a damaged Humvee. A soldier moaned garbled words in a combat hospital. Surgical lights filled my room. I opened one eye…closed it…opened it. The doctor I saw was strangely familiar. He told me the anesthesia would wear off soon, that the numbness would go away, that I needed to rest. Collin stroked my arm. I watched her smile as I drifted back to war.

  A fire in my helicopter burned my skin. I tried to scream but could not scream. I felt the thud of metal, a missile hitting the aircraft: the doctor dropped my bedrail. Bullets pinged and pierced the aluminum skin. Several hit my legs: a nurse tapped my leg repeatedly. Shrapnel hit a soldier next to me. I moved to his side, but a safety harness pushed me back: Collin’s hands trying to calm me. A helicopter warning signal blared: an intravenous monitor alarm sounded. The helicop
ter spun toward the ground. Soldiers screamed. One jumped from an open door. I struggled to free myself from my harness, but was slammed to my right, hard against the ground. I startled and opened my eyes. Collin stood near with my children. Justin said, “Dad.” I stared at them and mumbled to Collin, “I’m hurt. My leg…numb. Something’s wrong.”

  Two weeks after my medevac flight from Landstuhl, a surgeon from the orthopedic department at the University of Iowa Hospital in Iowa City outlined my treatment plan. The Army had transferred me from Fort Bliss to the Rock Island Arsenal in Illinois, where a Wounded Warrior Project case management team contracted with university and private hospitals throughout the Midwest. In response to the overwhelming numbers of soldiers returning from Iraq and Afghanistan with injuries, the Army decided the transfers would expedite the medical care of soldiers.

  A series of operations was scheduled on my left shoulder, left hand, right ankle, and right leg. Surgery would be followed by the appropriate months of physical therapy. I was also scheduled for maxillofacial surgery to repair some upper jaw damage from an infection. The surgeries began in March 2006. During the following year, I had eight operations; five involved my leg, shoulder, and hand and three involved my upper jaw and sinus. Doctors in each specialized field took turns. Following each surgery, physical therapists spent months working my joints to help me regain strength and range of motion. Each surgery went as planned. No surprises. But with each successive surgery, I had a progressively longer recovery. There was more pain than I expected and longer periods of post-op physical therapy.

  The second week of May 2007, I woke up one morning with severe nausea and vertigo. I had to crawl to the bathroom, because I couldn’t stand without losing my balance. I had no history of vertigo, so I went through a mental checklist of diagnoses: Ménière’s disease, labyrinthitis, infection, brain tumor, brain stem stroke, intracranial bleeding. None of them made sense, but I felt I should see a doctor and at least get a shot or some medication. I asked Jordan, who had been home for a month preparing for her wedding in June, to drive me to the University of Iowa Hospital. I told the emergency doctor that I just needed a shot, but he insisted on a full workup, a brain CT, and a neurology consult. It was standard medical practice, but I wanted to avoid going down that path and discovering a serious diagnosis right before Jordan’s wedding. If my symptoms didn’t resolve, I would get the full workup after the wedding. When I tried to sit up for the exam, a flood of nausea hit me and the room spun around. My eyes jerked back and forth in rhythmic saccades that made everything appear jittery. I grabbed the sides of the bed to keep my balance.

  The workup revealed an aneurysm at the base of my brain. The ER doctor gave me the diagnosis with a serious look that to me conveyed the sense that I was in trouble. One thing came to mind: bleeding. I had treated several patients in my career with ruptured brain aneurysms, and the resulting hemorrhages always pushed them toward death. The quick shot of medicine I wanted might alleviate my symptoms, but it would not cure an aneurysm. In disbelief, I simply responded, “You serious?”

  The consulting neurologist reviewed the CT scan and concurred with the diagnosis, but he thought my symptoms unusual for an aneurysm. He did further testing to determine if I had central vertigo from brain pathology or positional vertigo related to an inner ear or vestibular nerve problem. He diagnosed an inner ear problem as the cause of the vertigo and concluded that the aneurysm was incidental. I had seen similar cases where, in the process of making a primary diagnosis, other secondary and incidental findings often revealed themselves in lab work or imaging studies. Sometimes the secondary findings became more significant for the patient than the primary diagnosis. After he gave me a shot and performed a maneuver that repositioned the small otoliths in the vestibular system of my inner ear, my symptoms resolved almost immediately. He ordered a brain MRI and a neurosurgical referral for the following week.

  After several hours, Jordan came to get me from the waiting room. She wanted to know all the details.

  “So what did they find?” she asked me.

  I deliberately chose not to mention the aneurysm. “I had an inner ear problem and the neurologist gave me a shot and fixed some rocks in my head. Maybe a virus. We don’t know for sure, but I’m better now and we can go home.”

  “I always knew you had rocks in your head, but all that for an ear infection?” We both laughed.

  “It’s slightly more complicated than that,” I said. “The rocks are needed for balance. I can show you in an anatomy book at home if you want.”

  “That’s okay, Papa,” she said, rolling her eyes.

  And with that, we left the ER and drove home. On the way, I decided not to say anything to Collin either. The word “aneurysm” was sure to set off alarm bells. I still had an MRI and neurosurgical referral and I wanted to make sure of the diagnosis. I told Jordan and Collin about my follow-up appointment but said the neurologist needed to evaluate the underlying cause of vertigo, which was in fact partially true, but also partially false, for which I felt a tinge of guilt.

  The MRI and neurosurgical appointment confirmed the diagnosis. The neurosurgeon said the aneurysm’s location at the base of my brain complicated the surgical approach. He recommended endovascular surgery and the placement of a small titanium coil by an interventional neuroradiologist. The procedure, he explained, was much like a cardiac catheterization for a coronary stent or a balloon angioplasty, except they would thread a vascular catheter up through my carotid artery and into my brain, where they would release a coil into the aneurysm, preventing it from expanding or rupturing. This was the safest surgical option.

  A neuroradiologist visited with me after the neurosurgeon. He reviewed the MRI and walked me through the procedure again. “Should be less than two hours and you go home the same day,” he said slightly rushed. “All you need to do is schedule it. Any questions?”

  “You’re sure I need this procedure?” I asked.

  “The size of the aneurysm is at the minimum for treatment, but if we do nothing there is always the risk of expansion and rupture. You have a history of high blood pressure, which adds to the risk.” He sounded the way I sounded when explaining a medical risk to patients—precise and with a bit of warning.

  “I know about the risks, but it all comes as such a surprise. I have no symptoms.”

  “Small aneurysms rarely produce symptoms.”

  “I know. But I don’t particularly want somebody digging around in my brain. You’ve done this before, I know, but I just want to make sure you know what you’re doing.” I thought he might become defensive at my comments, but he answered with a brief and professional explanation.

  “No, it’s a perfectly legitimate concern. Patients ask it all the time. We’ve done hundreds of coils and most have no complications,” he assured me. “You know there are risks of bleeding and stroke and infection, but those are rare—not nonexistent, but rare.”

  “I know, but I just never expected to have brain surgery.”

  “Nobody ever does,” he said dryly.

  There was always a difference between providing clinical facts and clinical assurances, and the more risky the procedure, the harder that difference was to bridge. The doctor had given me reasonable assurances, but I still walked out of his office with the heavy truth of needing brain surgery. As I left, I felt a sense of near-betrayal by my profession, as if it were shunning me. I asked myself how it was possible that I needed brain surgery. I wondered how, as a doctor, I could have known all the things that conspired to hurt other people without understanding how the same things conspired to hurt me. I had given my life to medicine. How could it turn on me?

  I decided to continue keeping the diagnosis secret from my family, at least until I made it past Jordan’s wedding. I wondered what Jordan and my other kids would think—their dad keeping secrets about things they deserved to know. And I wondered what Collin might think—a husband who decided to keep her at a distance. I wanted to let them all
know, but in my own time.

  The week before Jordan’s wedding stressed our family, as weddings tend to do. I tried to remain calm but couldn’t help thinking about my aneurysm and pending surgery. When I ran around doing last-minute details for the wedding, I worried my aneurysm might explode. I imagined standing next to an IED in Iraq, afraid to move for fear of triggering it.

  I needed to let somebody know, so I pulled the pastor aside before the rehearsal dinner. “If anything happens to me, it’s because of a brain aneurysm. Call 911 and tell them to get me to neurosurgery,” I said. I briefly told him about my diagnosis and pending surgery.

  “I understand,” he said. “How is Collin coping?”

  “I haven’t told her yet.”

  He gave me one of those pastor stares that blended concern and blame. “Are you sure you don’t need to tell Collin? I had a sister die of a ruptured brain aneurysm.”

  “No, I just want to get through the wedding before I tell her. Just keep this between us.”

  I felt an urge to warn Collin so she wouldn’t get blindsided by a medical emergency, but I didn’t want to risk putting a spoiler on the wedding. It was Jordan’s time and I wanted it to remain special and untarnished by a family medical drama.

  On Sunday, the first week of June, I walked Jordan down the aisle. As we entered the church sanctuary, I turned to her and told her how much I loved her. It was one of those father-daughter moments when the world stops turning and the only thing that matters is the love between a father and his daughter. That precise moment held all the joy of fatherhood wrapped tight like a seed ready to take flight in a summer breeze. As I said “I love you,” my words had a double meaning for me. One meaning conveyed that father-daughter bond that looms when daughters get married and leave home, the other held a sub rosa connotation of last rites: “I love you” meaning I might also be leaving home, but not for beginnings, rather for endings, and I will never see you again. I am sorry that you will grieve, but I will grieve too. And even when I am dead, I will always love you.