by Chris Licht
In the days ahead, as I lay in my hospital bed, I would get short e-mails from him that said nothing more than Call me if you get bored or We miss you very much. They were good enough to keep, and I have.
During these first hours I wasn’t worried about Jenny, Andrew, or the future. There were no ruminations about how and why this event had happened. That would come later. By swooping in and taking charge, Mika and Joe had freed me to focus on the present task, which was fixing the problem. How do we do that? How do I get out of this? Who do we call, what doctor do I need? It was as self-centered as I had ever been.
Mika and Joe were aware that until now I had been the beneficiary of good fortune all my life. Not enough emotional pain had been inflicted, they sensed, to bequeath perspective and serenity as I went about my job. I was too young and too lucky to carry scars. Now change was coming. A transformation had begun in the backseat of the Escalade, and accelerated in C2B. A driven, focused, charmed man had been knocked to the floor by something no one saw coming.
“Usually, bad experiences, if you can survive them, are the best things that can happen to you,” Mika says.
If you can survive them.
Joe, at my bedside, had an idea. He turned to Mika.
“Hey, do you have Joe’s phone number on your cell?”
Joe Biden’s, that is.
chapter seven
The Doctor
On the morning of my event, as we’ll call it, Dr. Vivek Deshmukh, one of the most skilled neurosurgeons in the country, had yet to assume his current top medical post in Portland, Oregon. That wouldn’t happen for four months. So as I lay on my bed in C2B, Dr. Deshmukh was across the street in a clinic affiliated with George Washington, in a closed consultation room where he was seeing a patient. An assistant interrupted to announce a phone call. She was insistent. Dr. Deshmukh excused himself and stepped out to one of the clinic’s workstations.
“Hello, Doctor. Vice President Biden would like to speak to you.”
He had never met Biden. He had never spoken with him. He did recognize Biden’s voice, however, and was understandably amazed to find himself chatting with the second most powerful man on the planet on an otherwise mundane Wednesday.
“I know you’re real busy,” the vice president began. “I don’t want to take up too much of your time because, unlike me, you’re doing consequential things.”
Dr. Deshmukh was impressed by the self-deprecating humor.
“I have a good friend in your ER,” Biden went on, “and could you make time to see him? I’ve called around and asked many people who should be taking care of him, and everyone I’ve talked to has said you’re the best doctor to take care of it.”
The friend had bleeding in his brain, Biden said. He gave my name.
Not only did Dr. Deshmukh not know Biden personally, I didn’t know Biden personally. He was not my friend, though I’d like to think he is now. Mika and Joe, however, knew him well. More relevant, they knew he was an aneurysm survivor.
Twenty-two years earlier, when he was forty-five, Biden had suffered not one but two aneurysms that had to be corrected with surgery, which somehow the politician in Joe Scarborough had remembered as he stood at my bedside in the emergency room. After describing my problem to one of Biden’s aides, Mika had been put through instantly and, fighting through tears, had asked for help.
Biden did not hesitate. He would find the right guy.
The guy turned out to be Vivek Deshmukh, who had finished second in a class of 120 at the University of Florida College of Medicine and done his neurosurgical training at the Barrow Neurological Institute in Arizona, one of the world’s best. That morning, he was director of cerebrovascular and endovascular neurosurgery at George Washington. As I would come to know, he is unflappable and skilled at reducing complexity to easily understood terms in a soft, reassuring voice.
Dr. Deshmukh told Biden he would, of course, help and, after hanging up, turned to the hospital’s computer system to find my CAT scan.
It was ugly. He had seen a thousand like it. But it was ugly. There was a lot of blood loose in my head.
A brain has three linings, and my renegade blood was between the middle and the inner, the space where the brain’s arteries and veins live. The middle lining is the arachnoid, because it looks like a spider’s web, and any bleeding beneath it is thus a “subarachnoid hemorrhage.”
The most common reason for blood to be loose there is blunt-force trauma, the sort of thing that happens in a traffic accident. That wasn’t my problem, obviously. Another common reason is a rupture in an abnormal collection of blood vessels some people are born with. Dr. Deshmukh had in mind something else, the same thing I had raised with Dr. Mayersak. An aneurysm.
Cerebral aneurysms are balloonlike bulges in the walls of arteries, which are the high-pressure freeways that deliver blood from the heart throughout the body, as opposed to veins, which return blood to the heart at lower pressure. Where arteries fork, there’s turbulence in the blood, which can lead to weakness in arterial walls, which can lead to the ballooning. An aneurysm can be as small as an eighth of an inch, as big as an inch and a quarter.
Statistics vary, but several million people have an aneurysm at this moment and do not know it. Most will probably live on in blissful ignorance, because their aneurysm will not cause symptoms or burst.
But each year in the United States, something like twenty-seven thousand aneurysms do rupture. That’s seventy-four a day, three an hour. From looking at my CAT scan, Dr. Deshmukh was pretty certain that today had been Licht rupture day, which, if true, meant my life had moved closer to the abyss’s edge.
If an aneurysm ruptures, there’s no room for the blood that escapes. The skull is not an expandable place. Pressure builds. The blood can irritate tissue. Other arteries can spasm and constrict, blocking themselves, which can lead to a stroke. Tissue can get squeezed against bone. The whole brain might shift. It’s a potential cascade of malfunction.
About 15 percent of those whose aneurysms burst die before reaching a hospital. About 25 percent more die later. Of those who survive, most are permanently disabled by the invasion of blood into places it should not go. In the end, only about a fifth of those Americans whose aneurysms rupture live through the experience undamaged.
None of this did I know. It would be days before I did, not until I got home and surfed the Web and talked with Dad.
Examining my scan, Dr. Deshmukh could not tell how much damage had been done, because no scan can pick up the physical side effects of an aneurysm, like immobility or scrambled speech or blurred vision. He needed to see me in person to get a sense of those things, and he also needed a more detailed look at my brain. He called the neurologist on duty in the emergency room and ordered up a second CAT scan.
After finishing with his patient in the consultation room at the clinic, he scampered across Twenty-third Street to the main building, into the ER, and down to the CAT suite. The second test would be done with contrasting dyes, the better to see my arteries. I had been delivered there before he arrived. It was sometime around noon.
I have no memory of this moment. I apparently have erased it just as I did Dr. Mayersak’s first visit to me. As I lay on a table that would slide inside the CAT machine, Dr. Deshmukh asked me to describe what had happened and how I felt now. He asked if I had any allergies, surgeries, or medical problems.
Now came another variation of the already familiar neurological quiz.
What is your name?
Where are you?
Do you know what year it is?
I knew the answers, knew them all, and that was good at least. Except for the head pain and the initial scan that showed considerable bleeding, the doctor concluded I was an otherwise healthy young man who was aware he was in trouble, but not catatonic or fidgeting or wailing with grief. Stoic, he thought.
Into the machine I went. Into my arm through an IV went the contrast solution. The hunt for my aneurysm was on. The CAT ma
chine began methodically imaging my head in slices 2.5mm wide. Dr. Deshmukh examined the images, one after another.
Nothing. No aneurysm.
Yet there was so much blood. That much almost always means an aneurysm.
Where is it?
A doctor wants to get inside and repair the artery. But he has to find the scene of the microscopic disaster first. Dr. Deshmukh feared he was missing something. If he sent a patient home without finding the aneurysm, it could rupture again, perhaps fatally. Mine should be easy to find, yet there was no evidence of it.
The doctor wanted the next level of test, the gold standard, a cerebral angiogram, a test that makes possible a much higher degree of magnification of the arteries. We were entering a phase of the afternoon I do remember.
I was taken upstairs to the “angio suite,” a chilly, sterile room with multiple monitors and a machine that seemed as big as a Buick. As I was wheeled in, there were people milling about. One pointed down at me on the hospital bed and mouthed to the others a single word, “Biden.”
Joe and Mika had told me they were reaching out to the vice president. Now I was seeing the results. Now I was becoming a celebrity, which wasn’t all that unusual for a hospital in the same neighborhood as the White House, the Capitol, the Supreme Court, the embassies of dozens of nations, and most cabinet-level departments of the government.
I had no problem with the special attention. When your head feels as if someone has put a belt around it and yanked with both hands, when they’ve told you that you might have an aneurysm, when your emotions have careened into unexplored lands, you want special attention. You want somebody to make a call if that somebody knows somebody.
The hospital, in any event, probably would have reacted to my case in precisely the same way even if Biden had never gotten involved. In the emergency room, Dr. Mayersak hadn’t known he would be, yet she had sounded the neurological claxon as soon as she had the proof. Dr. Deshmukh might have been summoned anyway.
In the angio suite, they seemed to be in a good mood, which helped me. The anesthesiologist announced she would be my cocktail waitress. The guy who was going to shave my right leg as part of the procedure noted he was providing a bikini waxing. I was counting on this test. I wanted to be told the bleeding had stopped. I didn’t know anything about aneurysms, but I assumed unchecked bleeding could not be good.
My leak almost certainly had stopped already, though, which Dr. Deshmukh now told me. Ruptures tend to be quick affairs. The aneurysm seals itself. But that might not last. A re-rupture at any time is possible. That’s why it was important to find the spot.
A consent form was put in front of me. I hesitated.
During a cerebral angiogram, an incision is made in the patient’s leg, and a small-diameter catheter is inserted into the femoral artery. Using arteries, it then travels up through the torso and into the neck. Dye is shot through the catheter, erupting at the other end like a fountain, providing excellent contrast in the brain for that big Buick of a machine to snap images.
But to the body, the catheter is an alien disrupter that needs to be attacked. Blood can coagulate on it, and a clot can break away, travel, and stop, blocking an artery and causing a stroke. There is, in other words, a risk to a cerebral angiogram. Not much of one, but a risk.
I did not pause in signing the consent form because I’m a guy who loves control. That trait only involves the control room. It doesn’t extend to reading the fine print on every single document. I paused only because I had come so very far so very fast. I had been doing a show and now I was in a strange room with all these people and the vice president was involved and my brain had blood and nothing was right.
But I knew there was no choice. Small, theoretical risk from a catheter vs. devastating, actual pain in my brain from an unknown cause?
Dr. Deshmukh nudged me along.
“Mr. Licht,” he said, “you’re very, very sick. You need to get this done now. Sign the form.”
I signed the form.
My doctor had done more than two thousand cerebral angiograms. As daring and complicated as it sounds to thread a tube such a long way through a body, from leg to head, he made the journey to the base of my skull in no more than ninety seconds, using a live monitor to watch the catheter’s travels. I could feel it as it went, a very odd sensation, but they had given me some excellent drugs so I wouldn’t squirm at the thought of being threaded like a human needle. The drugs didn’t put me out, because they weren’t intended to. Dr. Deshmukh needed me awake to follow his instructions.
“Take a deep breath in, hold your breath, don’t breathe or move,” he began.
A shot of dye raced through the catheter, into my head. A feeling of warm, suffusing liquid ensued. I wouldn’t recommend it.
“Breathe,” the doctor said.
We did this sequence of hold-your-breath, shoot-the-dye, release-your-breath twenty times or so. Sometimes the dye caused little sparkly lightning bolts in my eyes. For an hour, the machine rotated through all kinds of angles, snapping images that Dr. Deshmukh and the angio team could see on monitors.
“You find anything yet?” I said.
“So far, it’s looking okay.”
He meant that, other than the blood, everything looked normal, which was both good and complicating. Good because there was no aneurysm, complicating because there was no aneurysm. If there is one to be found, the very first cerebral angiogram almost always finds it. Not this time. The doctor peered more closely at the images to make sure he wasn’t missing something. He wasn’t. He was so certain he would see an aneurysm. He was troubled.
What is the source of this blood?
When we finished, they wheeled me upstairs to the intensive care unit, which would be my home as they watched for signs of secondary damage and until they could do more exploration to find out what was going on inside my head. Passing a sign in the ICU that said NO BARE HANDS, I was rolled into Room 284, which had a single bed and a wall that was nothing but windows, looking out on the low-rise skyline of Washington.
Not long after, Jenny walked in.
chapter eight
Jenny
In the early years, Jenny Blanco came to a couple of unequivocal conclusions about me.
“This guy’s a real jerk.”
“I hate him.”
Our relationship began telephonically around 1998, and it was only professional, journalist to journalist. She was the producer of the 11 P.M. news at NBC in San Diego, I was the producer of the 11 P.M. news at NBC in Los Angeles, and sometimes Jenny would call and ask for help covering a breaking story on my turf. Those were reasonable requests, given that our stations were siblings and her show did not have the resources mine did. We had a helicopter. We had four camera crews. We had three reporters.
NBC’s late news in Los Angeles had the biggest audience west of the Mississippi River then, and there I was at its helm, mid-twenties, not long removed from college and even less long removed from my serendipitous start in television as a writer on the O.J. show. As a result, I could be insufferably arrogant. Jenny Blanco? She was that producer on the phone from a much smaller station who made annoying requests of the very busy me. It’s difficult to believe, but somehow she wound up feeling second class.
Then, one day, Jenny came up to L.A. to go to a party I had been invited to as well. At last, like two fated lovers in a fable, the telephone voices came face-to-face for the first time, and Jenny left with a distinct, fresh impression of Mr. Licht.
“He’s an overgrown frat boy.”
She couldn’t believe this creature had seemed intimidating. He was a kid. “I still hated him.” In time, she left Southern California for San Francisco and then a job with MSNBC in New York, not saying good-bye because there was no reason to, because she possessed nothing but antipathy for me. She might have possessed even more antipathy if she had known I had told my station’s executives not to hire her if she ever applied for a job. To be honest, I feared the competi
tion; I could tell she was smart and good.
Years later, years without contact between us, I went to 30 Rock to see network executives, and while strolling through the newsroom of NBC’s local station I came across Jenny, by now producer of the 11 P.M. news in the nation’s biggest market. Wow, I thought, she looks great. We chatted. She immediately wondered if I was being sweet simply because she had attained market acceptability.
She was correct.
Sir Romance.
But professional success is, indeed, an attractive quality, and one of the things most attractive about Jenny to this day is that she’s successful and driven.
Now began the longest pursuit of my dating days, longest in time and longest in distance. I was living in the Bay Area because NBC had bought a station in San Jose and asked me to move from Los Angeles to help oversee its integration into the NBC way of doing things. This meant many trips to New York to talk with management.
With another coming, I e-mailed Jenny to tell her about a job that was open at our station. Perhaps you’d be interested, I noted. Perhaps we should talk. Perhaps we should have a drink. She read this for what it was, a backdoor request for a date, a “total scam,” but she did consent to meet at an Irish pub in Manhattan one night after her 11 P.M. show had ended. She arrived with a “let’s get this over with” air and no makeup. More than three hours later, she says, she left with a “he’s not so bad” feeling. The years had sandpapered a bit of my cockiness.
Though separated by the entire United States of America, we managed to go out a few times, and while I thought Jenny liked me, she regarded each get-together as nothing more than collegial. “We can hang out,” she said, “but it’s not going to go any further than that.” Her argument was we worked for the same company and had similar jobs and those were ingredients that should never be combined with a personal relationship, period.