Crossings

by Jon Kerstetter

  The torque and the pressure were enough to rip my shoulder. The thud on the floor and my yelp brought Darren bounding up the stairs.

  “Dad!” he yelled. “What happened? What are you doing?”

  “I tried to make it to the bathroom and back. I hurt my shoulder.”

  “You’re supposed to ring the bell for help.”

  “I didn’t want to bother you. I figured I could make it. Just help me back to my chair. I’m fine. Don’t call your mom.”

  Darren helped me back to the recliner, where I rested and tried to make sense of what had happened. He brought me a pain pill and some water and put a pillow under my leg. My left hip and right shoulder throbbed. I suspected I had broken my right clavicle, but after several minutes I realized it was okay. My shoulder continued to ache and throb.

  As I recovered, I knew something was terribly wrong. The natural movement of my right leg had failed; my hand lacked the strength and coordination to grab hold. I began to think and focus on causes of falls and reasons for failed balance. There was nothing about lingering balance issues or leg and arm numbness or a loss of concentration on the sheet of instructions about post-op care. I thought again about the fall. I tried to think clinically, diagnostically. I told myself I could figure it out. Nothing clicked.

  Later in the day, after lunch, Darren helped me to the bathroom. As we walked toward the hallway, I paused to look at a painting hanging on the living room wall. It was an impressionist oil done by a Native American artist. It depicted a warrior on horseback thundering toward a campfire in the foreground. Standing close, I could see only scattered colors and the broken lines of a larger image. The intersections of reds and blues caught my attention, as did the energetic lines and splashes of paint. The brushstrokes portrayed an explosive energy and a defiance of normal lines. As I stared at the art, it dawned on me that my thinking matched the broken lines and scattered blotches of color. I had no linearity of thought, no immediate connection of lines or logic. My thoughts were like the wild brushstrokes of an impressionist artist. The painting struck me as odd and beautiful at the same time. Odd because it defied the usual realism of many Native artists. Beautiful because its impressionism released color and form like I had never seen before. As I looked at the warrior painting, something clicked. The scattering of lines, the brokenness of the whole, the patterns of oil and texture, and the wild, almost incoherent brushstrokes began to make visual sense. The thought “brushstroke” lingered. “Brush” and “stroke.” Two words. Two meanings. The realization hit me. I caught the meaning of “stroke” in the context of art, and then I caught it in the context of medicine. Stroke. Everything fit. Surgery, post-op numbness and weakness, imbalance, my mind and its wanderings. How could I not have seen it?

  “Darren,” I said spontaneously while staring at the painting. “I think I’ve had a stroke.”

  He didn’t know exactly what that meant, so I tried to explain.

  “There might be some damage from the surgery,” I said. “I need to go to the doctor.”

  —

  The exam room smelled like a hospital. The chairs were worn, the floor tile was dated. The clock on the wall ticked and the second hand seemed stuck. I sat and waited with Beverly, who sat in a chair next to me. Darren had already arranged to meet with some friends that afternoon, so I told him to go ahead and I would call Beverly to take me. He balked at first, but I assured him it would be okay.

  After thirty minutes or so, a young doctor entered the room. I vaguely remembered him from before the surgery. He was doing his fellowship training and worked with the staff neuroradiologist, who, he explained, had left town for a meeting. The doctor told me he was looking at my MRI—that he had some concerns. That word “concerns” bothered me. I used it in my own medical practice. I knew what it meant.

  “Let’s take a look on the monitor,” he said, directing me to bring my chair closer. I struggled with the chair and Bev helped me. An MRI flashed on a computer screen. My name appeared on the upper right corner of the images. It was the first time I’d seen my brain since a month before surgery. The images looked like a cross-sectional atlas of human neuroanatomy; the details showed everything. The numbered frames revealed the intricate details of my grayscale anatomy. I recognized cortex and ventricles, cerebellum and midbrain. The brainstem, of course, looked like a stem. The medulla and pons bulged slightly from their stalk. I saw white matter, which on an MRI was not really white but a shade of gray. In a brain MRI, white could indicate an abnormal finding. I remembered that much from my training. I saw no white in my brain.

  The doctor pressed a computer key and the screen advanced twelve frames at a time. Miniature brains appeared as fast as he pressed a button. “You’re going too fast,” I said. I couldn’t get a feel for what I saw.

  “We can slow down a bit.” He clicked through all the images for an overview, still faster than I could comprehend; then he flipped back to the first frames. I saw no abnormal white. He paused on a frame in the middle of the first screen of my brains. He enlarged it and tapped it with his finger. “Here,” he said definitively. “There’s a spot here.”

  I saw the white where he pointed. I paused…tapped my right leg: nothing. I looked away from the images and then to Bev. She pursed her lips, said nothing, and gave me a slight tilt of her head. I looked back at the brains. The spot remained.

  The doctor said, “Okay, then.” His voice was flat.

  He flipped through the images as if scanning the pages of a book. “Here’s another,” he said. “This one hit the pons, this one hit the caudate nucleus, this one’s in the cortex, this one’s occipital. There’s a large defect in the brainstem.” He told me they were real, not artifacts. He used the words “embolic” and “infarction” to refer to the spots. I knew the senses of the words, but I did not know their exact meanings. They were words I had used in my medical practice. I saw the spots as he pointed to them. At first there was just one, but then another, and then more, scattered from cortex to brainstem. I counted: five, six, seven—more. I tried to say the medical words for “brain pathology.” I could not. I called them “spots.”

  “I see them. That’s not a good sign,” I said, sounding as detached as I could.

  “No,” he replied, equally detached as I had sounded.

  I looked at Beverly. “I’ve got spots on my brain.” As I said the words, I felt my sphincter loosen.

  The doctor adjusted the frames of the MRI. Again I saw my name on each screen. Those brains have stolen my name. The images enlarged; the white spots came into focus. I decided that the brains belonged to some other patient. “Are you sure this is my MRI?” I asked suspiciously.

  The doctor persisted. He nodded his head and said, “Yes.”

  I thought he was confused. He’s an asshole. He pointed to the shaggy white of pathology. He gave them special names. Cortical and occipital and brainstem infarcts. Again I asked if they were my scans, insisting they belonged to some other patient. He said they were unfortunately mine and that they were real. Arrogant prick. More than thirty images, sectioned into millimeter slices, projected the same white spots from different angles and different depths. The images cannot be my brain. Doctors make mistakes.

  He asked if he could examine me. I wondered why. “For what?” I blurted.

  “We need to correlate your exam with the MRI findings.”

  I didn’t want him to touch me, but I said, “Sure, go ahead. But remember, I’m a doctor, so I’ll be grading you.” I chuckled just a bit. He didn’t respond. Beverly helped me onto the exam table, and when I got situated, the doctor took my shoes and socks off and rolled up my pant legs. I couldn’t feel my right leg and foot and I knew he would discover the same thing on his exam.

  He pricked me with a pin, made me tap my fingers, and told me to flip my hands back and forth, faster and faster. He peppered me with questions that I could not answer. I knew I was in a hospital, but I didn’t know the date or recall the words he asked me to
remember—just three small words. I grunted to force them out of my brain. I guessed one word was “apple”; it was “ball.” An apple is a kind of ball. Three plus five became thirteen. I counted backward by sevens. One hundred minus seven…The numbers dissolved before they hit my mouth. I wobbled when I stood. My body shook in a rhythmic ataxic stance when he made me bring my feet close together. I failed to walk a straight line on the floor—a drunk test. I felt drunk. I listed to the right. I began to fall. He and Beverly caught me. The doctor told me the MRI spots correlated with the exam, that the spots were real. He’s a bastard.

  He explained to me that a piece of atherosclerosis from my aorta might have broken off during the procedure and caused an embolic stroke or that it was possibly air bubbles that inadvertently entered the catheter system and blocked the flow of blood in several arteries feeding different areas of my brain. And he explained how, during surgery, the procedure revealed that my aneurysm was really an infundibulum, an aberrant widening that couldn’t hold a coil. “Either way,” he said rather bluntly, “you have a multifocal stroke.”

  “In other words, surgery didn’t go so well,” I responded, still distant and rather clinical. “Beverly,” I said, “this can’t be good.”

  The doctor interjected. “This was part of the risk we talked about before surgery. These complications can happen.”

  “I know, but this isn’t supposed to happen. Are you absolutely sure the MRI is mine?”

  “Yes. I’m sorry. It’s your brain.”

  I sat silently for a moment. Nobody said anything. The room was too warm. I needed fresh air. I defied the truth of the images, the doctor, and the fact that complications were real. I asked to look at the MRI one more time.

  For the sake of argument, I agreed. Yes, the brains were mine. They were a set of images that showed my brain had been damaged and that I was in deep trouble, or at least in need of a good neurologist. The doctor reviewed each image again. I studied the frames one by one as if studying for a board exam. I put my finger on the spots and nudged the computer screen to erase them. Nothing changed. We looked at each brain again; the white spots remained. I finally said the word “infarct,” then “multiple,” then “embolic.” The doctor reaffirmed my diagnosis and told me once more about the normal risks of surgery. The words “normal” and “risk” seemed to float in the air like my right leg and foot, insensate and unreal. They made the room feel hot and dry like the desert in Iraq. I said nothing. I wondered how Collin and our kids might react, and I didn’t want them to find out. The doctor finally said the stroke could interfere with my medicine practice for a while, but that he would refer me to neurology for further testing. I didn’t know what that meant, “further testing.” Hadn’t I already been tested enough times?

  I sat back in my chair and looked around the room. Silence…a crack in the universe, the pure space of nothing. Then a heartbeat, then a breath, then a single isolated thought—stroke. I saw the spots of pathology and I finally understood their meaning and the meaning of the doctor when he spoke of my career. The spots were real; the pixels did not lie. I saw my life diminish as I vanished into the darkness of nothing.

  Beverly drove me home from the hospital and helped me back into the house. I sat in the recliner—thinking, not thinking. I didn’t phone Collin to tell her what happened. Three hours later, I got up to go to the bathroom. I held on to the sofa and used the hallway walls to balance. I stared at myself in the bathroom mirror. I asked the mirror what I was going to do. No answer. I fumbled with my pants, pissed, looked in the mirror again. I saw a stranger. Back in my recliner, I rested and reread my post-op instructions. The part about sudden headaches was circled in red. I had not had a headache. I wanted a headache, something to feel inside my head. Instead, I felt nothing except perhaps the weight of a diagnosis.

  Darren came home late, and when he asked me how the appointment went, I told him I was right about the stroke.

  “What does that mean?” he asked.

  “I’m not sure yet,” I answered. “I have to see a neurologist this week. It probably means my walking will be off for a while.”

  “Did you call Mom?”

  “No, I’ll call her tomorrow.”

  I didn’t call her. She called me—in a panic. Somebody from church found out about my stroke and the pastor put me on an e-mail prayer chain to the general congregation: “Pray for Jon Kerstetter. He has had a stroke.” At her cousins’ caucus in California, Collin checked her e-mail about noon and got the news. She called home immediately. I answered.

  “What’s going on? I just got an e-mail saying you had a stroke.” When Collin was anxious she became more direct and shortened her sentences.

  “I didn’t send any e-mails.”

  “I don’t understand. Are you okay, then?”

  I hesitated. There was no way to hide what had happened. “Well, not exactly. I had to go to the doctor and he said I had a stroke during the operation. It was either a blood clot from my aorta or air bubbles.”

  “Why aren’t you in the hospital?” Her short reply wasn’t a question; it was a scolding wrapped in disbelief.

  As with telling her about my brain surgery, I wanted to minimize the impact of what I was saying, but she was already seeing through me. “I’m not bleeding and there is nothing that can be done now. I have to see a neurologist and Internal Medicine in the next few days.”

  “I’m coming home today.”

  “No, there is nothing you can do. The doctors repeated an MRI and there’s no emergency. It’s not like I need another operation. I can wait until you come home to see Neurology. It’s only a few days extra.”

  “I don’t care. I’m coming home now,” she insisted.

  “Don’t be upset. There’s nothing you can do.”

  “I’m not upset. Why didn’t you call me when you went to the hospital?”

  “I don’t know. I didn’t want to upset you.”

  “I’m not upset.”

  For a flicker of a second, I saw the irony in our back and forth. Having a stroke deserved some upset, maybe even demanded it. Yet we both tried to check our emotions.

  I had several follow-up appointments with my internist and a neurologist. My internist, Dr. Leslie, saw me first after my stroke diagnosis. She performed a complete neurological and mental status exam. I flunked both. Dr. Leslie was tall, fit, and persistently kind. She had worked in an Internal Medicine practice in Dubuque during the same time I worked at the Finley Hospital there. She was one of the rare internists who didn’t complain and moan when called to come to the ER for consults or patient admissions. Instead, she displayed an uplifting manner with her patients as well as her professional colleagues.

  She tapped my knees with her percussion hammer and tested the sensation on my skin with a cotton swab and a pin.

  “Close your eyes and tell me if you feel anything,” she said, her voice conveying a doctor’s clinical objectivity.

  “I feel soft on the left. I feel sharp on the left. I feel something on my right shoulder. It’s not the same as my left,” I said. I didn’t feel the cotton or the pin on my right arm and leg.

  “Squeeze my finger,” she instructed. I did. And I could tell my right hand was weak.

  She walked me down the clinic hallway with a nurse at my side. My ataxic gait had not changed from my initial stroke diagnosis just a few days prior. “I walk like I’m drunk,” I said.

  Back in the exam room, Dr. Leslie continued with a cognitive exam. “Let’s have you count backward from one hundred by sevens. I’m going to give you three words to remember for later. Do you know who the president is? Can you tell me where you are, and the date?”

  I knew who I was, at least my name, and I knew I was in Iowa City, that she was my doctor and a colleague that I had worked with at the Finley Hospital in Dubuque, Iowa. I had chosen her as my internist because she had trained at the Mayo Clinic and had a reputation of excellence and thoroughness, and her patients loved her. Beyond all
her medical acumen, she was a doctor who made patients feel confident that, under her care, they received the best practices in medicine. I felt the same confidence, but I also felt loss as she examined me. With each tap of the hammer, each touch of a pin and movement of a muscle or joint, I added up the deficits and felt the impact of the words the interventional radiologist had said as we looked at my MRI: “This may affect your practice of medicine.” When he said that, I decided he was at best mistaken, at worst a liar. Nothing short of death could ever keep me from being a doctor. Not war or disease or accidents or life—nothing. Period. So, to hear a young doctor still in training tell me that an untoward surgical outcome could potentially damage my abilities as a doctor was simply unacceptable. But as Dr. Leslie completed her exam and discussed the findings with me, I had to consider her diagnosis to be grounded in truth, because I knew she would not tell me otherwise. When she said the word “stroke,” I knew the diagnosis was real.

  “Well, Dr. Kerstetter,” she said calmly, “your exam is consistent with your diagnosis. I’ve already seen your MRI and talked with Neurology. You’re going to need stroke rehab and I’m working on setting that up for you.”