Waking

by Matthew Sanford

  This scene played over and over. I would become vaguely aware of certain sounds, try to hold my breath, fail, and then float back into the comforting silence—that place just below sleep, which renders action unnecessary. Over time, though, my efforts became a source of panic. I fought to win, to make what was happening a dream. But the more I failed, the more frightened I became, and in turn the harder I fought. My resistance became a problem, so much so that my doctors were forced to medicate me. Without knowing it, I had begun to fight against the respirator, the very machine that was keeping me alive. But still I admire that young boy who struggled to wake from a dream by reclaiming his own breath. He could have gone back to seventh grade, back to playing on three basketball teams, and made a vow not to watch so much television. Instead, he woke up to quite another life.

  “Matt, you gotta make it … you gotta pull through … I don’t know if I can go on without you.” With my brother’s imploring voice, I began to consciously realize that something was very wrong. His words rang through my head as a continuous plea, a relentless invasion of my sleep, though in reality, this wasn’t the case. Intensive care visits were restricted to ten minutes every hour, so he couldn’t have been there that much. Still, for me, his words were a mantra, a guiding beacon leading me through the silence and back into that room. Somehow, I traveled to the sound of his voice.

  Once my eyes adjusted, my mother’s face irreparably broke my protective silence. On the left side, from the corner of her eye to the side of her jaw, was a gruesome bruise—black, muted with purple, yellow, and gray. At that moment, waking life snapped into focus. Up until then, I had remained an observer. My lifeless presence had yet to do anything, had yet to commit me to anything. I was merely a body-ghost. But as the helpless pain in my mother’s eyes washed through the body I could not feel, the first outward signs of living trickled down my cheeks. Something terrible had happened to my family.

  My gaze traveled between their faces, between my mother and brother, between Paula and James. My mother looked pale. Below her curly, strawberry blonde hair, her eyes had always carried a touch of sadness, as if anticipating great suffering. Now that sadness was realized. My brother’s sharp chin and long eyelashes were softened by a mop of dishwater blond hair. Seventeen years had brought him the look of the man before the man, that off-balance, in-between vigor that someday would transform into stabilizing strength. Emanating from both of them, I felt a loving, desperate emptiness.

  The room’s only rhythm was the respirator’s uneven bursts and the synchronous heaving of my chest. Silence lingered between us. Within it hung, just for an instant, images of our previous lives—canoe trips, dinner-table discussions, laughter, long car rides—images of a family now slipping away. But in that moment, just before the present wrenched from us an unconditional surrender, a truth coursed through me—my family needed me to live. I would accept whatever was coming. I knew I had to show them that I was going to be okay, that I would join them in this painfully uncertain future. All this happened before we shared words.

  I tried to speak but could not. When I motioned for a pen and paper, a surprising relief crossed their faces. I had been knocked out, so there had been no way to know the extent of my injuries, and especially if there had been brain damage. My mother and brother had lived with this unknown for three and a half days. At least that concern ended as I wrote Dad and Laura? My mother slowly closed her eyes; my brother looked up to the ceiling.

  “They didn’t make it,” my brother choked. My father and sister dead? Unable to gulp or cry out … into the silence my new life went.

  My next scrawl: What happened?

  My brother’s cracking voice: “We were in a car accident … skidded off a bridge.”

  You two?

  “I jammed my shoulder and mom hit her head pretty hard, but we’re fine.”

  Where are we?

  “Mercy Hospital in Des Moines, Iowa.”

  Me? There was a long pause as they looked at each other. When my brother turned back to me, I saw tears flooding his eyes.

  “You got pretty banged up.”

  My mom broke in, “Matt, you’ve been in a coma. It’s serious.”

  I can’t feel my legs.

  “You’ve broken your back. They think you’re paralyzed.” Time stood still. Disconnected images of walking moved through my mind and into the darkness. “They say you’ll never walk again.”

  I felt numb. The death of my father and sister hardly registered—I took it in as a piece of information, like a report of the day’s weather. Instead, I stayed locked on the feeling that my remaining family needed me to live. I’d like to say there was something heroic in this stance, but there wasn’t. I did not grasp the threat to my continued existence and then rally to beat the odds. Nothing was that conscious, nothing that willful. The invisible strength came from somewhere much deeper. Survival took charge without my choosing.

  My focus also intuitively shifted away from the decimated state of my body. I could not dwell on the extent of my physical damage. In addition to crushing my upper thoracic vertebrae at T4–6, I had broken my neck at the very top—the atlas vertebra—the one that literally holds up the head and protects primary life functions, including breathing. I had also broken both my wrists, filled a lung with fluid, and sustained an internal injury to my pancreas. This last problem knocked my digestive system off-line for what turned out to be months.

  My injuries were beyond my comprehension. I could sense, however, that they threatened more than my physical body. My psyche, my sense of living was also under attack. I was enveloped by a feeling of death. My body was without its own breath, a powerful pointing toward an immediate end. Moreover, through the acute absence of my father and sister, the imprint of death surrounded my bed, so much so that even to this day my mother, brother, and I cannot dismiss the viability of ghosts. Finally, my mother’s and brother’s expressions poured forth the sallow hue of tears, grief, and devastating loss—death as it is absorbed by the living.

  I could not control what was going to happen, but I could control how I perceived my situation. I needed to find a path, a way to keep focused on going forward. So I told myself a story, a healing story: My mother and brother desperately need me to live. It was like whistling in the dark—a way to feel rhythm despite being engulfed in the unknown. This healing story guided my tenuous sense of living through disastrous waters, an unconscious move wrought by the brilliance of survival.

  During the fleeting moments in intensive care when I did feel connected to my body, wow did it hurt. Often, just being rolled from side to side was enough to knock me unconscious. I was in a state beyond my comprehension—too many things were going on, going wrong. My sense of feeling overwhelmed was only heightened by my inability to speak and connect directly with others. I spent five days in Mercy Hospital doing the only things I could—lying flat and listening. Whether I was in a coma or awake, people around me spoke as they saw fit.

  Over time, my brother told me the story of what had happened. I remember none of it—not the accident or any of the day it occurred. I don’t even remember the last meal I ate with my whole family. In fact, I have only sketchy memories of the preceding weekend. My brother has been my witness.

  Ever since I can remember, my family had spent Thanksgiving with my mom’s sister, Aunt Kathy, and her family. This entailed two long, straight-shot drives on I-35 between Duluth, Minnesota, and Kansas City, Missouri. The main constant on these trips was Iowa corn. That year we did even more driving because we detoured to pick up my sister, who was in her junior year at the University of Iowa in Iowa City. The five of us piled into a car built for four and spent cramped, chaotic, but lovely time together as only families can. There were candy wrappers and comic books and gum, games of hangman and packed sandwiches and sleep. All too quickly, Thanksgiving weekend was over and it was time for the long drive home.

  This was a dreary Sunday, overcast and slightly misting. We left a little be
fore eight in the morning. About an hour into the drive, we stopped for gas. Apparently, I bought some gum that came with a superball. (I know this because my brother kept the ball in his pocket throughout my hospital stay.) The five of us packed ourselves back into the car. My father was driving. My brother, having recently gone past six feet tall, had finagled his way into the front passenger seat because he needed extra leg-room. I sat in the back seat behind my father. My sister sat in the middle, and our mother sat behind my brother. None of us backseat passengers wore seat belts. In 1978, the “buckle up” media blitz had yet to occur. The temperature outside was near freezing. Although a snowstorm was forecast for later, it seemed like a harmless day to travel.

  As we approached an overpass just across the Iowa border from Missouri, my father pulled into the left lane to pass another vehicle. Once past the car, we hit a patch of ice—quite a surprise, considering it was only misting. We skidded to the right; my father corrected. Suddenly we hit a dry patch of road, and because the wheel was turned hard left, the car shot sharply in that direction. Our left front wheel got caught over the road’s edge, causing our car to tumble down the embankment. We rolled three times, front to back.

  My brother came awake to the flat rhythm of windshield wipers. He saw that my father sat dead, belted in his seat, his head crushed through the side window by the force of impact. He could hear our mother moving behind him, but my sister and I were nowhere to be seen. He forced his door open and stumbled around the site. Off to the left of the car, he found my sister lying in some tall grass. One look, and he knew she wasn’t going to make it. Her neck was horribly broken, her head impossibly crooked over her left shoulder, her futile gasping for breath obviously short-lived. Still, there was no me. My brother frantically trampled through the grass. Panicked, he fell silent. Imperceptibly at first, then louder and louder, he detected a guttural noise back near the car. As he rushed to the sound, he clearly heard moaning and groaning, and a long run of choice cussing. He told me, “When I heard you swearing to beat the band, I knew you were okay.” He found my body right beside the tilting car, wedged almost underneath it. He saw that I, too, was struggling for breath. He ran up the embankment, flagged down a car, secured help. He then fainted near the scene.

  Amazingly, he had flagged down a nurse and a paramedic, athough there was little they could do. My brother awoke a few moments later to confirmation of what he already knew. There was no hope for our father or for our sister. Although things looked bad for me, I was still alive, so there was a chance. The wait, the wait, the wait. An ambulance had been called, but it had to travel more than thirty miles and took nearly a half-hour to arrive. After saying good-bye to her husband and her only daughter, my mom wandered around aimlessly, gathering up the clothing and personal belongings spewed by the violence. Already she was starting to pick up the pieces. There was no rhyme nor reason to what she was doing. My brother, on the other hand, sat next to me, praying.

  I was turning blue by the time the ambulance appeared. The blue continued to deepen as we approached the county hospital in Leon, Iowa. I needed that respirator; I needed its unnatural rhythm. My time in Leon was short, a little over twenty-four hours.

  The nature of my injuries was somewhat mysterious. At first, there was some hope that I might just wake up and be relatively fine. As I continued to slumber, however, the concern increased proportionally. Obviously something had happened to my ability to breathe, but what? I had no apparent cuts or bruises, and yet my upper thoracic region must have been hammered. My heart was the initial concern. My condition was so critical that nothing could be done but watch, wait, and hope that I might weather the storm. The doctor stayed with me through the night. It wasn’t until the next morning that Dr. Sullivan began to suspect an additional injury. He responded to my mom’s questioning eyes.

  “For what Matt’s been through, he’s doing just fine. The worst is over. I think he’s going to pull through.” He paused. “But something else worries me. The whole night I was with him, Matt never moved his legs. That’s not a good sign. I’m sending him for x-rays, but I suspect a spinal cord injury.”

  “No … how could you have … ?”

  “Missed it? I don’t know … he arrived in such critical condition that I could barely keep up with keeping him alive. I can’t believe I didn’t catch it earlier. I’m so sorry.”

  “Will he be paralyzed?”

  “It’s too soon to be sure. We’ll know more after the x-rays … but it looks as if he already is.”

  The spinal cord injury, coupled with the fracture at the top of my neck, put my case beyond the reach of the county hospital. Although my condition was still critical, and moving me posed a mortal risk, Dr. Sullivan immediately arranged for my transport to Des Moines. The hope was to get me better care. Unfortunately, that turned out not to be the case.

  So began the five-day, behind-the-scenes saga at Mercy Hospital. The waiting room outside the ICU had no windows. The trembling fluorescent lights could muster only an unnatural dimness. Colors lost contrast; reading was nearly impossible, and focus was gained solely by rubbing one’s eyes. The room’s only intended reprieve—a poorly done mural—covered the entire wall directly across from the stark and uncomfortable chairs. Its subject was a dark and ominous wooded scene traveling up a distant hill. Its effect was to enhance the room’s surreal character. My mother and brother struggled for equilibrium.

  Worse, the doctors literally avoided them. The orthopedist and the neurologist made their rounds at five in the morning, making no effort to be available for consultation. So my family waited, waited for something to change, for me to open my eyes, for time to move forward. They were told nothing about my prognosis, about potential treatment or strategy. When I finally awoke, there was still no contact from the doctors. At five the next morning, my mom tracked down one of the attending physicians. He wouldn’t say much but agreed to set up a meeting with the neurologist for the next day.

  In the meantime, my favorite nurse, Marilyn, approached my mom.

  “Mrs. Sanford, I shouldn’t be telling you this, but you need to get Matt out of here.” She looked my mom straight in the eyes. “The care he’s getting … it’s not good enough. His injuries are too severe … the doctors don’t know what they’re doing. We’re turning him from side to side, and he’s only wearing a soft collar brace. His neck is broken, for god’s sake. It’s dangerous … it’s wrong.”

  “We have a meeting with them today.”

  “I know, but I’ve talked to some of the other nurses, and we all agree: No matter what they tell you, get Matt out of here. If he’s going to survive, he needs more-aggressive treatment. It can’t wait any longer.”

  “What should I do?”

  “Demand his release and get him to another hospital. They may tell you that he might not survive the trip. But I can tell you one thing for sure … he won’t survive if he stays here.”

  Mutiny among the caregivers. My mother went to the meeting as planned, hoping that Marilyn was overreacting, hoping that it wasn’t true. The neurologist was an older man, his body tired, his hair completely gray. He was obviously from the “old school” and nearing the end of his career. At first, the meeting was typical of one with a doctor—confusing and evasive. My mom finally brought it to a head.

  “Why aren’t we doing more? Why aren’t we doing something to protect Matt’s neck?” Standing firm, she feigned authority.

  “Your son’s condition is far from stable. We can’t do anything without the risk of making things worse. As far as his neck goes, that’s not his most pressing problem.”

  “What are you saying?”

  “Look, your son has suffered catastrophic injuries. There isn’t one thing we can definitely do to make things better. His case presents a myriad of issues. Although he’s now awake, he can’t breathe on his own. His heart appears to be okay, but it’s not functioning as we would like. There must be some internal injury, because everything in his digesti
ve system has stopped working. Who knows if and when that will ever reverse itself. I’ve never seen anything like this. Quite frankly, his broken bones are not his worst problem. Even if he makes it through this initial crisis, it only gets worse. His spinal cord injury will never go away. It presents complications you don’t even want to imagine right now.”

  “So basically, you’re waiting to see if he might die?”

  “Sometimes it’s better to let your loved one go.”

  “His name is Matt, and we’re not waiting for him to die,” my mom said, stepping forward. “We want him discharged … we’re going someplace else.”

  “I’m sorry. I can’t do that. As a doctor, I cannot take an action that will make my patient’s condition worse. Your son will die if he is moved.”

  Immediately, my mom contacted my sister’s godfather, an orthopedic surgeon. He made the arrangements for my transfer to the Mayo Clinic in Rochester, Minnesota. Then she called my father’s law partner. “Get Matt the hell out of this hospital. They won’t release him!” Bruce drove down from Duluth that afternoon. He made one phone call to the neurologist and said simply, “We won’t sue you if you agree immediately to …” That was that. He then contacted an ambulance service that had a mobile home vehicle that doubled as an intensive care unit. I was off to the Mayo Clinic the next day.

  I remember being taken down the hallway—respirator, at least three IVs, a heart monitor, and who knows what else in tow—toward this huge ambulance. Out of nowhere, a man wearing a big silver belt buckle yelled “Hold it!” and stopped us right on the spot. “You’re telling me that this boy has a broken neck, and no one is holding it steady! Who the hell is in charge here? Scratch that! Whoever it is, you’re done. I’m taking over.” This belt buckle was a nurse-practitioner, the person in charge of my care during transport. Finally, something was happening.