Crossings

by Jon Kerstetter

  I hesitated. Therapists are a sneaky crowd. You have to watch them carefully.

  “Okay, I got it,” I said. I wanted to move on, change directions.

  Cher continued. “And can you tell me the name of the patient on the computer screen?”

  Silence. Silence for a long while. I looked at the plastic brains on her shelves. I wanted to hide from that name on the screen. Instead, I swallowed hard and faced her.

  “I need you to read the name on the MRI for me,” she said quietly.

  “It’s me. Jon Kerstetter. They left off ‘MD.’ ”

  “Dr. Kerstetter, you’re right. You’re still a doctor, but you have a brain injury just like some of the soldiers you treated. Only this time you’re the patient and you have to run with that. That’s what we have to work with, and it’s going to take all your cooperation to get this patient better.”

  “I still don’t think it’s me. I mean, I know it’s me on the screen and I know it’s me when I try to walk and read. But I keep thinking tomorrow I’ll wake up and find that everybody was mistaken or that I’m caught in some crazy dream.”

  “Would you like to talk with the surgeon or the neurologist to verify the findings?”

  “No. I know where this is coming from. I’m the one who treats other soldiers. I’m a doctor. I’m supposed to give medical care, not get it. Army doctors don’t get hurt. They can’t get hurt. Everything is backward. I’m not supposed to be the patient.”

  “But you are the patient. That’s your brain we see. What do you want to do?”

  I paused and looked at the MRI on her computer screen. The images were real; she was real; therapy was real. I tapped my leg and felt nothing.

  “Can I start over?”

  —

  For my next book I choose Ayn Rand, Atlas Shrugged. Same problem as string theory but without the math. We had the same discussion in therapy again, only Cher pulled a plastic life-size model of the human brain down from her bookcase and asked me to name the various color-coded parts. The model split down the middle in a sagittal plane that showed the left and right hemispheres. I struggled but was able to name about a third of them. I felt so smug and so smart. Then she pulled up my MRI on her computer and asked me to find my injuries and point them out on the plastic brain. I used a pointer to show her the spots on the model that corresponded to the spots on the MRI. I’m so damned smart. I could be a neuroscientist. My mind wandered to stroke patients I had treated in the emergency room.

  “Focus,” she said. She told me to pretend she was a patient with that kind of brain injury and then asked me to explain the things she might experience and what prognosis she might expect. I did so, but with a bit more struggling. Again I knew what she was up to.

  Sure enough, she asked me to explain what to expect in terms of the time it would take for healing and recovery. I told her how slowly brain function tended to recover, and that she might see little progress at first, but that it was important to keep trying and to not give up and to trust her therapist. I choked and stammered a bit because I knew it was a role-playing exercise and I was really not talking to her but to myself. But I wanted to be honest with her, as if she were my patient, and so I told her the facts as gently as I could.

  “Cher,” I said, my voice sincere and starting to break. “There’s no question about the significance of your stroke. That, you can’t change. But what you can change is how you do your therapy. That will impact your recovery more than anything else.”

  She sat attentively as if she were a real patient and she nodded her head in agreement. “You’re absolutely right,” she said. I continued by telling her the importance of working together with her therapist; then we concluded the role-play.

  She was genuinely moved. “I could sense by the way you talked to me that you are an excellent and caring physician. If you were really my doctor, I would have been confident with your approach. It’s obvious that you care for your patients,” she said.

  I had to breathe slowly as I considered what she said. I did care and I wanted nothing more than to continue caring.

  “I have a question for you,” she asked me gently. “Can you give yourself the same care and concern as you gave your own patients?” When she asked, her eyes welled up just a bit, and I sensed that she touched the heart of my struggle. I needed to care for myself the same way I had cared for my patients. It was that “permission to heal” that Peggy had mentioned. And when I realized that she had exposed my weakness, I wanted to yield to the power of therapy. I wanted her to see inside my brain, into the parts that held my fear and pain and confusion, into the spots that were broken and into the areas left undamaged. I wanted her to see all the things I had done in war and to understand all the crossings I had made in becoming the person I was. I wanted her to know how much I needed my soldier and doctor identities, because I was dying inside without them.

  Spontaneously I said, “My brain hurts.” But I really meant to say, “My soul hurts,” that my innermost being was lost not knowing who I was, what I was, or if I would continue as a doctor and a soldier or as a patient forever. I said nothing more. Cher said she understood. I believed her.

  She assigned me a book of short stories for my next appointment. As I listened to her instructions and looked at the plastic brains, then back at her, I understood that I was a patient whose life was redefined as much by stroke as it was by war. I saw myself as a boy and a doctor, a soldier and a survivor, and finally as a patient with a stroke. And in that compound glimpse of myself, I sensed the polar ambiguities that had come to define my life, and I knew I faced both limitation and possibility.

  —

  Reading continued to challenge me over the many months that followed. It was a struggle of distractions, the deletion of words, the substitution of words, the incomprehension of meanings, and the inability to discern plot and story development. I could generally understand only three- to four-page stories; anything longer gave me difficulty. I wrote notes about the characters and the meaning of individual paragraphs. Literary imagery and metaphors often took me off into different directions that the story never intended, some of the directions triggered by words that brought back memories of war in Iraq. I didn’t know then that my reading would recover so slowly, that it would take more than two years to read the entire 1,600-page anthology of short fiction compiled by Ann Charters, The Story and Its Writer. I read classic stories by Chekhov, Hawthorne, Poe, and Conrad, and more recent stories by Sandra Cisneros and Sherman Alexie. I read them every day. I underlined sentences I didn’t understand, which in the beginning were most. I read some sentences and paragraphs four or five times, some even more. And when they made no sense, I closed the book and went for a walk with my cane. Sometimes I imagined my boyhood and the mountains where I hiked. Life was simpler then, or so it seemed. In high school I read books like The Catcher in the Rye, Franny and Zooey, The Pearl, Nineteen Eighty-four, and Animal Farm. I used to thrive on literature that challenged my intellect and the norms of society and culture. Reading was so enticing, enriching, and natural, a skill as essential as walking. When I compared the kind of reader I had been in medical school with the kind I had become after a stroke, I felt like Charlie in Flowers for Algernon: a man rendered childlike by a developmental brain disorder, then treated by scientists whose experiments held out a chance at recovery, only to eventually fail. In the end, despite a period of hope and improvement, Charlie regressed to his childlike world.

  I never thought my life would regress. I saw myself as a person who would always move forward to challenge new boundaries. I was educated, smart, and self-confident. I was a thinker and reader and explorer. I believed in the substance of human will and the science of the universe. Electrons always spun in molecules, planets stayed in their orbits, medicine cured disease—and none of it wavered, not even one ripple. But then there was a complete reordering of my ordered universe and, instantly, simple words that had served me so well in transforming my life evaded a
ny effort at comprehension. My brain could only quiver at words and their meanings, and the damaging effects of a stroke loomed larger than any cosmic storm.

  I continued making efforts to read. I made slow, visible progress despite my stumbling comprehension. Many of the stories in the Charters anthology were simply too complex, but I muddled through. The good stories, the ones I understood and could retain and retell, I read several times, only to forget them within a few days. A new story displaced one read just days before. If I didn’t read a story in one sitting, I had to start over because I had no context for a mid-story paragraph. But the literary energy and the human connection and the ingenious insight of the stories were enough to keep me going. And on those days when comprehension evaded me, I went to the city library and walked among the stacks. I picked out books, fanned the pages, and smelled the ink and the paper. I lingered on pictures and reminisced about my first school-age library trip. When I finished with the fiction or nonfiction section, I perused the children’s shelves and checked out Charlotte’s Web and The Prince and the Pauper and other similar titles. Sometimes I read them there in the library at a secluded table, embarrassed that I might be seen mouthing words and reading at a child’s level. Other times I took them home and read them secretly while Collin was at work. I laughed in the places where I was supposed to laugh and was serious or sad when appropriate. The stories moved right along in a linear plot. They pulled me into their niches of time and consequence, just as they had when I read them as a child. That was fine with me and far more insightful than string theory. And I knew if I could read a children’s book, well, at least that was a start.

  In the mix of specialists taking care of me, Psychiatry got involved in my case because there was a concern about depression. I was told over forty percent of stroke patients developed depression. I didn’t feel depressed in the clinical sense—loss, yes; clinical depression, no. In my first appointment with Psychiatry, the resident psychiatrist asked me the usual questions about suicide and mood and feelings and libido. My answers must have been too terse, because he asked if I was upset that I had had a stroke.

  I responded abruptly. “Wouldn’t you be upset if you had a stroke?”

  “Yes, I would,” he said. “That’s why you’re here, to make sure your mood and reactions don’t interfere with your ability for recovery. We are part of your therapy team.”

  “Okay, but I’m not depressed. And my libido is fine.”

  I didn’t want to talk about my mood or my feelings. I knew how I felt; I knew the pain of a stroke, every emotional and physical thread. Stirring it up only risked more pain. As an alternative, the psychiatrist offered a low-dose antidepressant, citing an academic study of stroke patients on low-dose therapy as recovering better than patients receiving a placebo. I consented to the treatment because the benefits seemed real enough, but I still resisted the monthly follow-up appointments and the persistent efforts to peel back the layers of feelings about my stroke.

  In November, Colonel Smith and the medical command at Rock Island Arsenal requested an assessment regarding my prognosis and likely timeframe for return to duty. My therapists, Dr. Leslie, and the neuropsychologist were asked to respond with a written summary. They visited with me about their assessments and it became clear that they considered me non-deployable for military service. The neuropsychologist summed up their position.

  “Dr. Kerstetter, what is your level of confidence that you could return to duty as a military doctor right now?” he asked. He was probing, infiltrating.

  “Well, none. I know I’m not ready yet,” I said.

  “And we don’t think you are ready either. It’s too early in your recovery. Colonel Smith has a sense about that, but we need to document your prognosis for the Army.”

  “Yes, I know,” I responded coldly.

  “Your clinical findings are already documented in the chart, but in summary I am going to recommend that you not practice medicine or be deployed until you have recovered enough cognitive and physical ability. Do you understand the reasoning?”

  I responded with a stare and a pointed question. “You’re concerned about me practicing medicine?”

  “Yes, but do you know why?” That was a clinical trick to make patients own a decision—throw it back on them, get them to voice the hard logic of a difficult outcome. “Well, I suppose you think I can’t remember how. I know I’m not ready to return to medical practice or active duty. I know that. Colonel Smith knows that and if you document that in the chart, the license board will know it. They could suspend my license.”

  “I’m not saying you cannot return to active duty eventually, but not right now and not in the immediate future—not until you have some significant recovery of function.”

  I wanted to curse but decided against it. “I get it. I need more progress.”

  “More function,” he responded.

  I wasn’t sure I knew the difference. His semantics were bullshit to me. I knew exactly what I needed. Time. I finally said I agreed and left it at that. And I judged him as a bastard, because he gave the Army the idea I wasn’t fit for duty, and he told me I wasn’t fit to practice medicine, and goddamn him and the therapists and the psychiatrist who said I might be depressed. What the hell did they know? Wouldn’t they be depressed if they were me? Hell yes, I knew my brain was injured, but how about some time? Give me time to heal and I would do the work. All I needed was time.

  —

  Throughout December I wrestled with the notion of non-deployability and with a possible hold on my medical career. My right shoulder degenerated and it gave me persistent pain. The fall I had taken the first week of my stroke had torn my right shoulder rotator cuff, and my orthopedic surgeon advised surgery. We scheduled it for the first week of January 2008. It would be my tenth surgery in twenty-four months since returning from Iraq.

  Our children came home for Christmas and we had a wonderful family celebration. They all put their money together and bought me a motorized recliner with the standard wooden lever on the side replaced by buttons to press for raising my legs up or down. They were all supportive and concerned about my surgery. I didn’t want us to dwell on my health, but rather on our family Christmas.

  The January surgery did go well, except for a temporary setback in my balance, which, if I had the sense to think it through, should have been expected. I stayed an extra day in the hospital and was discharged in the afternoon of day three. The orthopedic surgeon was satisfied with the surgical repair and arranged for physical therapy to start in the following six weeks. I had the usual incisional pain and post-op pain that kept me down for a week or so. I slept in my new recliner and Collin watched after me and gave me meds on schedule. I wore a shoulder immobilizer that secured my arm to my chest to aid in healing.

  On post-op day four, my second day home from surgery, I felt good, with only moderate pain. Collin helped me to the bathroom and had to pull down my pants and hold me up while I pissed. I told her I could handle it, but she insisted I might fall. I was weaving from my pain meds and stroke and that concerned me a bit. I slept off and on throughout the day. Collin woke me about 8:00 to get me ready for bed. After helping me in the bathroom she got me settled back in my recliner and covered me with a blanket. She started the gas fireplace and gave me a pain pill and my little brass bell with stern instructions to ring it if I needed help. She left the hallway light on and promised to wake me at midnight for another dose of medication. A kiss, a gentle hug, the tight snug of my blanket, and I lay back to sleep.

  —

  I dreamt about the helicopter crash of my second tour in Iraq.

  An Apache and a Black Hawk collide in the desert in northern Iraq. The survivors huddle in a desert ravine, dark of night, fifty miles from their base. All are injured. Four soldiers from the Black Hawk maintain a defensive position. They have limited ammunition. The commander orders a security and medic team to respond. The teams move immediately to the crash site to recover the injured sold
iers. I command the medical team.

  The response team is a flight of three aircraft, two Black Hawks and one Apache gunship. The soldiers load into the helicopters and begin the flight to the crash site. The flight proceeds in a flurry of movement. The medics buckle in. Engines start. We fly off into the night. The pilot makes a radio announcement: “We are five minutes out. There is intermittent small-arms fire at the site. Expect a hot LZ.” He starts another string of updates, then abruptly chops his radio transmission. The aircraft jinks hard left. Several of us slam our arms and heads against the sides of the aircraft. I anticipate a warning light or a fire. Nothing happens. I expect to lose altitude, but our Black Hawk continues to fly. I catch a glimpse of red tracers on my side of the aircraft. Fear mounts.

  Time to LZ: 30 seconds. Focus. Clear the landing zone. Initiate medical intervention. Recover the dead. The aircraft attitude pitches upward to slow the helicopter. The pilot hovers just above the ground, then finally touches down. We run straight out of the doors to our 9:00 and 3:00 positions.

  As we move out, my feet sense a new kind of threat—rocks. Rocks scattered in icy mud. Rocks that break soldiers’ legs and ankles. They lie in wait for the exact moment when they can break some unsuspecting bones. They can wait for years. Rocks wait for soldiers in just that way; then they strike and they never give much warning. My mind snaps back to the mission.

  The medic team is two hundred yards from the crash site. I move slower than I want. I curse the rocks and the mud. I feel a sense of panic and a need to pick up the pace. Don’t panic. Stay calm. Lead the mission. The team humps the first fifty yards without incident. Sweat now runs down my forehead and neck. I am hot. The cold desert air hits my skin and chills me. My legs feel heavy and tire too quickly. I keep pushing forward until I step on a rock and twist to my right. I slow the pace of the team and signal them to advance with caution. I look back toward our insertion point and forward toward the objective.