Less than forty-eight hours later, John and I would arrive at her hospital bedside to find her bridge voice quieted. We were there to say goodbye.
Kit met us outside the door to Mama’s ICU room. She prepared me for Mama’s appearance, severely altered from that of the sweet woman who kissed me goodbye at the airport. Mama was tethered to a multitude of machines and monitors, which I had expected. What I was not prepared for was her half-shaven head and the ghastly horseshoe-shaped incision that went from her left earlobe all the way back to the nape of her neck. I half expected Mama to sit up and commiserate: “Isn’t this the most hideous thing? You’d think they could at least put a scarf on my head.”
Kit saw my reaction and gently said, “Honey, it’ll grow back.” I shook my head and fought back tears.
Like all ICU patients, Mama had what I came to call her “mortality team,” the doctors and nurses charged with monitoring her condition, her progress, and assessing her chances for recovery. Clinically, she was in a coma.
“Can she hear us?” I asked her day nurse, according to her name tag, Gretchen G.
“We’re not really sure, but it’s possible. So we talk to Mrs. Carter ask if she hears every word.” And then to Mama, “Don’t we Mrs. Carter?”
Our days with Mama were punctuated by the daily arrival of her attending physician and the team of colleagues in tow. It was then that we, occupying our islands of ignorance, sat in wait for the daily update on our mother.
On the third morning, I happened to meet up with Dr. Ross, a resident on the neurosurgery team. He had observed Mama’s surgery. He was most eager to show me Mama’s pre- and post-op X-rays. He seemed especially pleased with himself. “The patient has shown predictable progress. Her incision is healing nicely and, as you can see, the hematoma is completely contained and shrinking.”
“I see. What can you tell me about her chances for recovery?”
Dr. Ross’ smile dissolved. He looked like I had asked his mother’s bra size. “Well, of course, these recoveries take time. After all, with a ninety-two-year-old subject, we try to maintain realistic expectations. There are, of course, no guarantees.”
I was getting less impressed by the minute and was irritated by his clinical and cold references to the person who was my mother. “What kind of guarantees?”
“Well, we cannot provide guarantees of cognitive recovery, mobility, and, more specifically, what life skills will be regained over time.” Dr. Ross’ satisfied smile returned.
Smiling back, I asked directly, “Is it likely that she will ever walk, talk, know us, be able to brush her hair, play bridge, call me on the telephone? Take your pick, doctor. Any chance of any of those things?” I felt tears burning my eyes.
“These are all questions which cannot be answered. It will take time.”
I returned that night to sit with Mama. Kit and I had been taking turns round the clock, when Mama’s night duty nurse, “Karen N.” according to her name badge, urged us to go home and get some sleep. Karen was a pretty woman, probably no older than thirty, with kind blue eyes and a comforting voice.
“I promise I’ll call you if there is any change. We look in on Mrs. Carter every fifteen minutes. We’re monitoring her vitals. Go home. Get some rest.”
Returning home, my active and worried mind blocked any semblance of sleep. After two unsuccessful hours, I slipped out of bed. Careful not to wake John, I left him a note and drove back to the hospital. I was coming out of the hospital cafeteria with hot coffee when I ran into Karen. “Just can’t stay away from us, can you?” she said, smiling. We made small talk on the way up to the tenth floor, where the only sounds were the rhythmic whir and wheeze of the ventilators and the beep of the life-sign monitors.
I stood next to Mama, looking at her face for any signs of recognition. Karen stood quietly. “Is she getting any better? Her team seems so cheery and optimistic, but won’t or can’t give me any straight answers. I can tell you, Karen, this,” pointing to the ventilator and the tubes, “is not what she wanted. We have the papers. She wanted no heroics.”
Karen leaned over and smoothed a lock of Mama’s remaining hair away from her forehead. “I can’t tell you the answers you want to hear,” she began carefully. “But if Mrs. Carter were my mother, I’d insist on an EEG to determine signs of brain function. If there are no signs, we are required to honor the patient’s wishes.”
“What do you think, Karen? I mean about her chances of making it?” I asked.
“I think, if you haven’t spoken to her about letting go, you might want to.” Karen’s voice was measured. She looked at me with kind eyes. “Sometimes the ones we love need permission. They need to know we’ll be ok and that they can leave knowing they are loved and their job is done.” Karen smiled and put her hand on my shoulder.
“She’s not coming back, is she?”
“No, Mr. Carter. I don’t believe she is.”
“Thank you, Karen, for your honesty and for your advice. Who do I ask about the EEG? I want it done as soon as possible.”
“I’ll leave a note in the chart for Dr. Cummings, her surgeon. And one for Dr. Ellis, her attending. But your best chance is to talk to them in person.” Karen reached into her uniform pocket and retrieved an unopened package of tissues. “Just in case,” she smiled, watching me wipe my eyes on my sleeve.
I stayed all night, alternately napping and reading to Mama from her favorite anthology of American poets. It was the same book she used to introduce Kit and me to her favorites, “Hiawatha” and “Thanatopsis” among them.
I began. “By the shores of Gitchee Goomie. By the shining big sea water, stood the wigwam of Nokomis, Daughter of the moon, Nokomis.” I paused. “Remember, Mama?” I held her hand and watched her face, hoping to will her into any perceptible movement or recognition. “Remember, Mama?”
The respirator whirred quietly.
I nodded off and on in the guest chair, and Karen brought me coffee just before her shift change at 7:00 a.m. “Go home. Get a shower. They won’t be making rounds her until at least nine.”
At nine-forty, Dr. Ellis knocked perfunctorily and entered Mama’s room without breaking stride. Five others followed like chicks behind the mother hen. He introduced them only as “my colleagues.” He was pleasant, but clearly not interested in sharing his teaching moment with one of the family. We exchanged looks: his, inviting me to step out; mine, assuring him I was staying. He began presenting Mama, his case, to his underlings. Seeing my clear distress, however, he warmed by degrees, and referred to my mother by name and with respect.
I was patient and cordial. I listened as he presented the details of Mama’s fall and fielded questions about her history and treatment. When it seemed that everyone else had had their turn, I asked, “Dr. Ellis, the family would like for our mother to have an EEG, this morning if possible. She has very specific wishes regarding prolonged life with heroic efforts. She’s made it clear—legally—that she wants no part of any of this,” I finished, gesturing to the equipment crowding the room. “Especially with no hope of any quality of life.”
Dr. Ellis seemed to be gathering his thoughts, and his young charges waited with curious looks. He started to go down the “we need to give things time” road, and I interrupted. “Dr. Ellis, forgive me, but I’m tired and I’ve waited all morning for you and I need you to answer a few simple questions. Now.”
Dr. Ellis, not used to being interrupted, lost his teaching face, and said, “What would you like to know?”
“First, does my mother have any measurable brain activity and has she had an EEG since her surgery so we might even know that answer?”
“No. According to her chart, there are no orders for an EEG.”
“Then, please make it happen, today. We are tired of not knowing.”
“I will talk to her team.”
“This morning.”
“All right then, this morning.”
“Next, and I know you’re not a psychic, but, in your professional opinion, say my mother wakes up. What kind of quality of life can she expect?”
“Well, as you’ve said, I’m not a psychic.”
“I won’t hold you to your answer. But dammit, Dr. Ellis, I want an answer.”
“Look, Mr. Carter, I know this is a difficult time.”
“And you, Dr. Ellis, are in a position to make it less difficult. Please. Tell me the truth.” At this point, John arrived with two cups of fresh coffee and a bag of breakfast sandwiches. He sensed the tension in the air. “I can come back if you want.”
“No, I’m really glad you’re here. Dr. Ellis was about to very kindly talk with us about Mama.”
Dr. Ellis fumbled a bit and, despite what appeared to be a genuine effort to help, couldn’t get out of the way of his own medical jargon. He looked uncharacteristically perplexed. Afraid I would lose patience again, I threw him a bone.
“Dr. Ellis. Just answer me this: if she regains consciousness—and I know that’s a big ‘if’—will she be able to sit up and feed herself?”
“We can’t say for sure, but with time, possibly.”
“How about brushing her teeth, reading a newspaper?”
“Again, possibly, but we don’t know.”
“Will she ever walk again?”
“If she regains these capabilities, it will likely require a long rehabilitation.”
“How long?”
“Many months of hard work. Possibly years.”
“And you realize, of course, my mother is ninety-two years old?” Dr. Ellis’ face softened, and he nodded.
I turned to him and his young colleagues who offered no questions of their own. Knowing that Mama couldn’t speak, I felt she needed someone to advocate for her, to express the wishes that she had shared with Kit and me so many times. For good measure, she had put them in a legal document. But no one seemed to be honoring this. So I began.
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