By Aich Kay
His young wife rolled him in to the clinic room on a motorized wheelchair. Review of records indicated that he was here for a follow up after a prolonged hospitalization for cardiac arrest. I may have missed looking at his age in the pages and pages worth of documentation because it came as a complete shock to me that he wasn’t a geriatric patient. He was young, his skin clear, his dark hair full, his body lean and muscular. But that’s where the illusion of health ended. His strong limbs were contracted in odd positions, his eyes vacant, his face expressionless. Foam pads kept his nails from digging into his palms, padded braces and Velcro restraints kept his feet positioned on the footrests. I had seen the MRI brain prior to his visit: “diffuse axonal injury,” the report had said. In other words, the parts of the brain that make a person who they are, were all damaged irreparably. My heart bled for him and his family. I reached out to touch his wife’s hand, and her eyes welled up with tears. What happened, I wanted to ask, but afraid that it might be misconstrued as curiosity, not as an effort at sympathy, I left the words unsaid. But she read those unspoken words in my eyes anyway and told me. And as she spoke my mind filled in all the details in her story.
It was an otherwise normal day. She was parked behind 20 other cars waiting to pick up the kids from school. Early next morning they were going to be on a flight to Barbados to visit family. It was a special trip: Grandma was turning 100 and family members were gathering to celebrate. Kayla who hadn’t seen her family in two years couldn’t wait and the butterflies in her stomach were fluttering wildly in anticipation. She checked off things on her mental checklist. Laundry: done. Tickets and IDs: packed in her purse, electronic boarding passes saved on her phone. This evening’s meal stood on the stove, still warm, its aroma wafting through their small house. Their suitcases stood in a line next to the entrance, packed and ready for departure. And the cat: Sheila from next door had agreed to keep her for the week they were to be gone. She was glad she had taken a day off from work today to get things ready. There was no way all this could have been done in the evening.
Her phone rang briefly then got cut off. She glanced at the screen quickly. It was John. He could wait. She wasn’t about to pick up the phone while merging on the highway. Home was five mins away anyway. He might have been looking for something and then likely hung up because he had found it. She smiled, her heart swelling with love for John. What would he do without her, she wondered, if he couldn’t locate things in his own house? Anyway, she was glad he had canceled his night shift tonight. She was glad he was home. The kids chattered non-stop and she heaved a sigh of relief as she took the turn into her street. It had been a long day.
“We’re home, John,” she announced as she ushered the kids inside.
School bags and shoes were dumped in the mud room, the squeals of delight and the patter of little bare feet echoing in the small space.
“Use the bathroom and wash your hands first!” she told six-year-old Elijah who was reaching to grab a snack from the pantry.
“Aww Mommy!” He complained but headed to the bathroom.
Four-year-old Kevin simply followed his big brother like he always did. Kayla looked at them for a moment, her hand on her chest, her heart full.
She could see the top of John’s head as he sat on the sofa, the TV blaring loudly in the background. She started getting the dishes out, then turned the stove on to warm the food again.
“John!” she said, “come on, help me. Don’t just sit there watching TV!”
But John didn’t come. She looked over her shoulder through the little wall cut out between the kitchen and the living room. He was still sitting there. Surely he had heard her.
Perhaps her heart got to the truth before her brain had had time to process. She felt a tremendous jolt and panic rose rapidly like bile hitting the back of her throat. Something was wrong. She ran towards the living room, but it was as though everything unfolded in slow motion even though she knew her hands and her feet were working as fast as they could. She shook him, trying to get him to respond, but he slid sideways on to the sofa, still unresponsive. His hands were cold, like death. She couldn’t find his pulse. She ran to pick up her phone, her hands shaking as she tried to call 911, wondering who was screaming, not realizing that the animal sound came from her own throat.
They told her he wouldn’t make it. They wanted to let him go. Big medical words that didn’t make sense floated towards her in the family meeting. They told her neurosurgery wouldn’t operate. Why wouldn’t they? Why couldn’t they save John. No, she wanted everything done. He was there, her John, still with her. They just needed to do everything to keep him here. No, she didn’t want comfort care, she didn’t want to let him go just like that! No! She begged them to leave her alone. Her boys clung to her legs, confused, scared. She drew them to her, her body shaking with sobs that wouldn’t stop.
It was she who had failed him, not them. She should have called him back when she was on the highway. She should have kissed him on his forehead when she came in, like she always did. They told her he had been down for too long. She had seen them working on him, pumping his heart with their hands, pushing air into his lungs through the mask, the defibrillator sending shocks through his body, lifting it up briefly and then letting it crash again. As she watched him, she remembered thinking absent mindedly that the floor was hard, almost as though she was disconnected from the scene before her. They will hurt him, maybe they already had. Why wasn’t he waking up? Nine minutes till they got his pulse back, they said. But still he lay there, a tube down his throat, unresponsive.
“I can see he knows it’s me, I can see he understands,” she tells me at the clinic appointment. I see the unstated plea in her eyes and stop myself just in time from responding to the statement with logic and cold, hard facts.
“He knows his boys, too,” she says, and turning to him, runs her hand through his hair, “don’t you, John?”
John doesn’t say anything. His eyes are open but barely just. They hold no expression, no answer. But I don’t know him like she does. Maybe his eyes tell her something different. Maybe he does respond in some way even though I can’t see it on the surface, a flicker of the finger, a turning of the head, a shift of his gaze. His wife’s life had changed overnight. Perhaps this was her way to deal with her new reality. It’s a busy clinic but I settle down in my seat and prepare myself to answer some tough questions.
Aich Kay is the non de plume of a physician at UAMS who wishes to remain anonymous.