Crossings

by Jon Kerstetter

  At the wedding reception, we danced and ate and laughed. I toasted the newlyweds and danced the traditional father-and-daughter dance. The dance got to me. If I wasn’t going to die of a ruptured aneurysm, I might have died from a broken heart. Jordan was my first daughter. When she was a child she had undergone heart surgery to correct a congenital aortic defect. In her first junior high year she had scoliosis surgery. The surgeries and the rehab drew us close as a father and daughter, so when she announced she was getting married, I wanted to hold on just a little longer and a little tighter, which I did during the dance. And when the music was over, I kissed her on the forehead and let her go, and like my words “I love you,” the kiss had a double meaning too.

  The day after the wedding, I asked Collin to go for a walk. She figured something was up, because a casual stroll was out of character for me. As we walked around the block, I mentioned how my leg and shoulder had really been improving since my operations.

  “So what’s going on?” she asked. “I know you didn’t bring me out here to talk about your operations.”

  “Well, I need to go over something with you and it’s kinda tricky. It’s nothing about the kids, or us or another tour. And it’s not necessarily a bad thing.”

  Collin stopped walking and faced me. “You’re scaring me.”

  “No. No. I don’t want you to be scared or to worry.”

  “I’m already worried.”

  “I know, but don’t be. Everything will work out. It’s not that bad, really. I just need to have a small surgical procedure.”

  “A procedure? What kind of procedure?” Her question wasn’t so much a question as it was an alarm.

  “Well…I kinda need brain surgery.”

  Collin froze mid-stride. She turned to look at me and I couldn’t tell if she hadn’t heard me and didn’t understand or if she had heard me and understood. She blurted a puzzled “What?” I had never seen her turn suddenly pale in our forty years of marriage—not through childbirth or the broken bones of our children or even after my post-deployment surgeries, when I looked like a zombie and my leg swelled to twice its normal size. Her face looked more the color of the sidewalk than the color of skin. I understood how revealing such diagnoses always caused a sort of emotional shock wave, but I didn’t expect Collins’s visceral reaction, and as we talked I wished I could have broken the news differently. She had carried the weight of deployments and extended tours and the uncertainties of war, just as I had, and now she would have to bear the impact of this new diagnosis. It seemed so unfair.

  “It’s not a brain tumor or cancer or anything like that. I have an aneurysm at the base of my brain. It’s small right now, but I need surgery to keep it from breaking and causing problems.”

  She pressed for more detail. “Is that what they found in the ER?”

  “Yes, but I didn’t want to say anything until after the wedding. I didn’t want everybody worrying about it. It’s not that big a deal.”

  “It sounds like a big deal to me. You should have told me.” She wasn’t angry, but she did look disappointed. Whenever I tried to minimize the impact of bad news, she tended to see through my words right to the heart of the issue.

  “No…I didn’t want to upset anybody, especially you. The important thing now is I need some further evaluations and then we need to schedule surgery. I just need you to be aware of what’s going on.”

  “Ya think?” she replied. She took my hand as we continued around the block. I tried to answer her questions, but there was a flood of unknowns for her and for me. We both questioned what would happen if. And the answers were vague and complicated. We decided to take things one step at a time.

  I had to report my diagnosis and get a deployability assessment from Colonel Danny Smith at the Wounded Warrior office at the Rock Island Arsenal. Danny was an affable and seasoned military physician and personal friend whom I had served with in the Iowa National Guard for nearly fifteen years. He had been overseeing my post-deployment care and recovery since my transfer from Fort Bliss. When we discussed my diagnosis, he ruled out any further deployments until surgery and recovery were complete. We considered a medical transfer to the Bethesda Naval Hospital in Maryland, but rather than deal with the logistics and the family upheaval, I opted to stay in Iowa for the surgery.

  Brain imaging and visits with University of Iowa physicians occupied the entire following week. At the conclusion of all the testing and consultations, we scheduled surgery for the third week in July. I talked to Jordan and Justin on the phone and explained the details as best I could without trying to alarm them. Darren and Katelyn were still home from the wedding, so I discussed the surgery with them individually and tried to answer all their questions. Justin decided to come home for the day of surgery. Jordan had just relocated to Washington, D.C., so I insisted she didn’t need to come back home. The whole business of telling my children about my brain surgery reminded me of the times I told patients they needed to call their families. That meant surgery was serious, as it always was, but calling a family together held its own kind of subliminal message. I tried, as my own doctors had tried for me, to assure my children that the procedure carried minimal risks and was one of those things in medicine that caused lots of unfounded fear and worry. I told them that the words “brain surgery,” like “cancer,” whipped up all kinds of crazy emotions, when in fact I had better surgical options than most patients needing brain surgery. We all believed that reasoning because it made intuitive sense and offered hope. Still, there was that lingering, gnawing understanding that brain surgery still harbored the potential for significant complications.

  In the remaining days before surgery, Collin and I were rushed and weary. Over dinner at home we wondered together if we were ready. We decided we were not but that we had to keep moving forward anyway. We talked only tangentially about the procedure itself, without dwelling on it.

  “This is one of those procedures that usually works just fine,” I said. “But if there are any complications, at least we’re prepared.”

  “I understand,” she said calmly as she pushed her food aside. “I just never imagined.”

  “I never imagined it either,” I said quietly

  The doctors had explained all the risks of the surgery and mentioned death as a rare complication. That got our attention, and although we knew on paper that the risk fell below 1 percent, even a remote possibility of death by surgical complication was more foreboding than the risk of death by combat. I had signed on for combat. Collin understood that risk from her own father’s military career and from mine. But neither of us signed on for neurosurgery and its possible untoward outcomes, no matter how rare. More significant than death, at least for me, was the potential for a brain hemorrhage or a stroke.

  We had both stopped eating and just sat and talked at the kitchen table. At first we talked about some legal issues. “The wills are up-to-date, the insurance policies are paid, and I have a list of financial details in a file. The lawyer has a copy just in case.”

  “Thanks for getting all that stuff in order,” she said.

  After a while, we had nothing left to say about the paperwork and we just sat quietly. I finally blurted, “If I have a bleed or a stroke it will change everything, but doing nothing is not an option. If the aneurysm were to break, I could die.”

  “I understand,” Collin said. “It’s so scary though, especially for the kids. Everybody hears stories about brain surgery. If you need it, it’s not good.”

  “I know. It’s scary for me too. I’ll try to answer their questions, but I don’t want them to be all stressed-out, so we have to be calm about this.”

  “Calm. When have our lives ever been calm?” she asked.

  I chuckled just a bit. “I always promised that you would never be bored if you married me.”

  Collin grinned at that. “Boredom might be good for a while.”

  —

  The morning of the surgery, we all packed into two cars like a s
quad of soldiers on a mission. It was quiet in our car. No last-minute questions. No small talk. At the hospital we said our goodbyes and hugged each other in the pre-op waiting room. I told Collin and the kids how much I loved them and they said the same to me. A surgical tech came to get me for surgery. We all said another round of goodbyes and Collin blew me a kiss as I rolled out the door.

  In the operating room, nurses slid me from the gurney to the operating table and hooked me up to monitors. The medical residents verified my name and repeated information about the procedure and the risks.

  “We’re going to place a coil in your aneurysm using a vascular catheter,” said one of the residents.

  “Yes, I know. I’m a doctor. Just don’t break anything,” I half joked. Nobody else laughed.

  “Don’t worry. We’re very careful and we’ve done hundreds of these procedures. We should be done in an hour or so. You’ll wake up in post-op recovery.”

  “Yes, I know the drill,” I said, as if I really did. Truth was, I didn’t know the drill. Everything done to me since the initial diagnosis was out of my area of expertise and I had to depend on the knowledge and experience of other physicians. That was both comforting and discomforting, a sort of emotional balancing act of trust versus control.

  The anesthesiologist said we were ready to get started. “Okay, Dr. Kerstetter, I’m going to give you some sedation. You should feel a little tingling in your lips and begin to drift off to sleep.”

  The voices in the room quickly became fuzzy and distant. I noticed the promised tingling in my lips. A nurse started to prep my groin for the catheter puncture. The antiseptic solution felt cold on my skin. I heard the busy surgical talk of physicians and nurses. Large computerized monitors linked to a fluoroscope were crowded in among the dozens of intravenous bags of saline. I caught a single image of my brain. It all took me back to my time as a medical student when the operating rooms at Mayo were the greatest of all possible places in the world. The anesthesiologist leaned over his station at the head of the bed and asked me to take some deep breaths. I took two deep breaths as I watched a surgeon position the operating room lights. They were blue and white—like the light of a glacier. The lights stayed there, fixed, intense; then they faded.

  The recovery room was quiet. Collin had sent our children home sometime after I was wheeled in from surgery. They had all taken turns near my bedside before they left. As I lay in my bed, half sleeping, half waking, a doctor came into the room and asked me to move my legs. The right one didn’t move. I looked at the doctor and Collin. I said my leg felt numb. “The anesthesia will wear off soon,” the doctor said. He explained that surgery was complicated because my aneurysm turned out to be an infundibulum that wouldn’t hold a coil. I stayed alert long enough to hear the explanation, then fell back to sleep.

  After noon, a different doctor came to examine me briefly before my discharge home. He checked my leg where the catheter had entered and then listened to my heart and lungs. I said that my leg was numb and something was wrong. He examined me more thoroughly, then assured us I could go home after the discharge paperwork was done. Within an hour, Collin and a nurse helped me get dressed and into a wheelchair. Discharge papers in hand and a plastic urinal in a hospital bag, off we went. The halls seemed foreign, as if I had never seen them before.

  When we got home, it was about three o’clock. The kids were out. Collin decided to park in the driveway to give her more room to maneuver in getting me out of the car.

  “Stay put,” she said.

  “I feel sick,” I responded “I’m going to vomit.”

  “Take some deep breaths.”

  “Hurry up,” I pleaded. “Get me in the house.”

  Collin ran around the car to my door and held it open for me. We didn’t have a wheelchair. We didn’t expect to need one.

  I swung my feet out, put my hands on Collin’s shoulders, and pushed off the front seat. Up on my feet, I felt like I was riding ten-foot seas in a rowboat.

  “Sit back down!” Collin shouted.

  That wasn’t difficult. My butt hit the car seat as my legs flailed between Collin’s feet.

  I mumbled. “You’ll have to hold me up.”

  Collin weighed maybe 110 pounds in a winter snowsuit. I hit the scales at a solid 200.

  “We can’t do this,” Collin said. “I’m calling Bev to help us.”

  Beverly was a retired nurse and a friend from church. She lived only a few miles from us and within five or so minutes was at our house. Bev and Collin tried to get me up and walking, but I wobbled too much to make it more than a few steps at a time. They finally decided to get a chair from Collin’s computer room and use it to roll me into the house. Once inside, they got me into my recliner near the fireplace. I felt like I had run the Army Ten-Miler. I fell asleep with a large bucket at my side in case my nausea gave way.

  The next morning my leg and my arm still felt numb, but I could move them a bit more. Collin helped me to the bathroom and I shuffled the twenty feet, feeling dizzy. I said something was off, that everything felt weird and hazy. She had to hold me up in the bathroom and help me with my pants and with washing my hands. I kept dropping my toothbrush with my right hand and we both thought that was unusual. I was tired, more tired than I expected, and we thought that might be a post-op effect. Collin got me back to the recliner and repositioned my leg. “Maybe we should call the doctor,” she said.

  “No, let’s give it some time. Let’s see how I am tomorrow,” I replied. I slept for most of the day.

  The second day home I was more alert, but I couldn’t remember many of the pre-surgical or surgery details. I struggled to put sentences together. My words came out, but they were out of order and some made no sense. My right arm and leg remained numb. Small patches of skin on my arm tingled when I touched them. I had a vague premonition of something gone wrong, something more serious than numbness. And I felt a nudge of fear about surgery and my brain. When I tried to test my fine motor coordination, I couldn’t tap my fingers and toes or pinch with the thumb of my right hand. When I stood near the recliner, I wobbled like a bobblehead doll mounted on a dashboard. I recognized the living room, the kitchen, and the bathroom, but my collection of Native American art seemed nothing more than a collection of meaningless color and lines. I flipped through a book. The words seemed distant and meaningless; sentences were invisible in the upper right corners of the pages. I skipped around the pages but that gave me a headache, so I quit. I decided the anesthesia was still in my system, that I would be fine in another day.

  Darren was there to help and he and Collin took turns with meds and toileting and feeding me juice and crackers. I mostly slept, and when I needed anything I rang a tiny brass bell on the end table. By post-op day three, the pain in my groin incision had mostly subsided. I still wobbled when I stood, my attention drifted, and my memory was erratic and dull. I was aware of my off-centeredness but assigned it to the lingering effects of surgery. Collin was concerned and wanted to take me back to the hospital. I thought she was being a bit too cautious and told her we could wait until the follow-up appointment.

  Months prior to my surgery, Collin had made plans to visit her cousins for their annual cousins’ caucus. When I announced that I needed brain surgery, she called the airlines and wanted to cancel her nonrefundable tickets for medical reasons. They balked at a refund, but agreed to give her an open ticket to use later. After breakfast, I asked Collin if she could get me some things at the grocery store. While she was gone, I decided that she needed a break and should go on her trip. Darren said he could help me at home and drive me around if necessary. When she came home, I told her I was feeling so much better and she should go to her cousins’ caucus.

  “You have an appointment in a week,” she said. “I need to be here to watch you.”

  She insisted on staying. I insisted she leave.

  “You have the tickets,” I pointed out firmly. “You’ve been counting on this for a year. There’s nothi
ng you need to do that Darren can’t do. He has a phone and a car. If I need a doctor, they’re only two miles away. I’m fine. Now, get packed and go.”

  Collin had always been one of those people who wanted all the loose ends tied before she went anywhere. But in her striving to make things smooth and uneventful for everybody else, she often shouldered the burden and stress of all the extraneous crap that surfaced when things didn’t work as planned. I told her she needed to let go and trust us. Darren and I could manage. Reluctantly, she agreed but only after making detailed lists: medication, emergency phone numbers, schedules for feeding me, and instructions for feeding the cat.

  “Mom, we’ll be fine,” Darren said. “Just go.”

  “I don’t know about this.” She hesitated. “I’m going to call Bev to let her know.”

  I was edging toward frustration. “Collin, we’ll be okay,” I said. “We have a phone. Darren knows what to do. Go. I love you. Go.”

  Still cautious, she left in the late afternoon.

  On the fourth post-op day, I woke about 8:00 a.m. Darren was downstairs in his bedroom. I needed to go to the bathroom and wanted to try it without help, so I didn’t ring my bell. As I stood up from my recliner, I planted my feet wider than shoulder width. I experimented with my stance by moving my feet closer and then wider apart. Feet close, a bobblehead ornament. Feet wide, a shuffling passenger on an ocean cruise. An ultra-wide stance worked best for balance. I shuffled toward the bathroom with a gait that may have suggested I was carrying a load in my underwear. In the bathroom, I balanced myself like a camera tripod with my legs spread wide and my left hand against the wall over the toilet.

  On the way back to my recliner, I tried to walk without holding on to the wall. As I moved down the hall, arms out to the sides, I teetered as if I were walking a tightrope in a circus. I can do this, I said to myself. One step at a time. When I reached the sofa I didn’t grab hold but let my leg press against it, which felt like a violation of some mythical rule of gait and balance. Confident that I could negotiate the remaining ten or twelve feet, I took a firm, wide step with my left leg. I made a good strong step forward away from the sofa. My head and upper body followed. My right leg stayed fixed. I started to fall and tried to compensate by twisting my trunk. The twist rotated my hips and my arms began to flail. I made one stumble step forward and launched myself into a fall. Before I hit the floor, I managed a crude effort at grabbing the back of the sofa with my right hand. My arm more or less dragged across the top of the sofa as I fell forward.