The Unspeakable (26 page)

“What is your religious affiliation, if any?” the nurse asked.

“What are my choices?” I tried to say this in a tone that suggested I was being funny, making an ironic little joke. The truth was that I need some prompting.

“Adventist, Baptist, Buddhist, Catholic, Christian, Eastern Orthodox, Episcopalian, Hindu, Jewish, Lutheran, Mormon, Muslim, Presbyterian—”

“Presbyterian,” I said. That wasn't true but for some reason I said it anyway. As a teenager, I'd sung in a Presbyterian church choir. My mother had been raised Presbyterian but we did not belong to the church. Later I would see Presbyterian on my chart and think it must be someone else's chart.

And then I got to the part that always seems like the beginning. The part that somehow remains in the present tense even as the whole incident recedes further into the past.

October 27, 2010

4:04 p.m.

“How many fingers am I holding up?” the doctor asks.

I can answer that. That one's easy. Still, there are things that I know and things that I don't. What I know is that I've never felt sicker in my life. Moreover, I've never felt this
kind
of sickness. It's as if my life is draining out of me and pooling at my feet. What I don't know is the degree to which that is indeed an accurate impression. Technically, I am dying. I don't know that a normal platelet count is between 150,000 and 400,000 per microliter and that mine has dropped to 15,000 per microliter. I don't know that my liver and kidneys are seriously compromised and that my BUN, or blood urea nitrogen level, is 35 milligrams per deciliter, far above the normal range of 6 to 20 milligrams per deciliter. I don't know that the doctor is at this moment writing things in my chart such as “scleral icterus,” which means that the whites of my eyes are yellow (which I knew earlier but forgot).

Now the doctor is touching my feet and looking at my toes. My toenails are painted a light greenish blue.

“Would you call that cerulean?” he asks.

“I guess you could say that!” I say, too loudly and at too high a pitch. I can't modulate my voice. The harder I try to sound normal, the weirder I sound.

I tell him that I was recently bitten repeatedly in my sleep by a mosquito that was trapped in a New York City apartment I was staying in and still have several welts on my back. I suggest that maybe I have West Nile virus.

The doctor examines my back, peering at the welts like a jeweler peering through a loupe.

“Amazing that you managed to get mosquito bites in New York City in October,” he says.

People are always saying this kind of thing to me. I try to explain to the doctor that I'm constantly getting bitten by bugs. It's just something about my body chemistry, not a big deal. I mentioned West Nile more for the purposes of making conversation than out of genuine concern. As a child living in Texas, and even later in New Jersey, I was chronically pocked with mosquito bites that leave scars even now. Once in a motel room in Galveston, a spider bit my eyelid and it was swollen shut for days. These days when I hike in the Sierras, even at high altitudes, I've been known to be singled out by swarms of blackflies so smitten with me that my traveling companions ask if I'm wearing perfume. More recently, a few weeks before the New York trip, I woke up with fleabites all over my ankles, a casualty of letting the dog sleep on the bed. It's not the bites, I tell the doctor. It's hepatitis. I have what Pamela Anderson has.

But I barely have enough energy to pry my lips apart to speak.

The doctor has a rumpled, intellectual air about him, like he could be a graduate student in English. He has a hospital ID and stethoscope around his neck but he is not wearing a lab coat, just a plaid shirt and jeans. He has told me he is an infectious-disease specialist. He is not old but not young. He is maybe in his late forties. I think to myself that he is just the right time for a doctor. What I mean is “just the right age” but “age” does not come to me. Words are floating past me but I cannot grab them. They are slimy fish. They are concepts with letters attached, but the letters are out of order and fading away as if on a screen. I don't want to let on, though. I don't want to embarrass myself in front of the doctor.

Cerulean
. I think of color strips from the paint store. I had a cerulean wall once, in a living room somewhere. I painted it myself and it contrasted beautifully with the white wainscoting. This house was a lifetime ago, though it's possible I still live there.

The doctor says he'll order tests and come back later.

RECOMMENDATIONS:

  1. Blood cultures will be obtained.

  2. CBC, CMT, PT, PTT, chest x-ray, and right upper quadrant ultrasound will be ordered.

  3. The patient will be placed on empiric doxycycline and Rocephin.

  4. Hepatitis serology, a Mono spot test, and Epstein-Barr virus panel will be ordered.

  5. West Nile virus IgM and IgG will be ordered.

  6. Weil-Felix antibodies will be obtained.

  7. Rickettsial typhi IgM and IgG will be obtained.

  8. HIV PCR testing will be ordered.

  9. Leptospira antibody will be ordered.

10. As part of comprehensive workup, a lumbar puncture might be helpful, but in this patient the platelet count is currently too low to safely permit this.

October 27, 2010

10:00 p.m.

I am both asleep and not asleep. You know that state where you're not dreaming but, rather, circling semiconsciously around an idea? It's like your mind has been assigned a theme that splits off into a dozen variations as you lie there stuck in hypnagogia. This is the state I am in. The theme I'm working with concerns a friend who is somehow in trouble. I wasn't aware of it before but suddenly I am seized with the knowledge that she is in a very bad way and I have left her to her own devices long enough and now need to tell someone. I've been trying to sleep but the more I lie here, the more I think about her situation and the more it seems like something very bad will happen if I don't get her help now. Also, I am so thirsty that I want to convert my body into a sponge and dunk myself into a vat of water and never come up.

“Hello?” I call. This isn't really the word I mean. “Hello? Hello?”

My husband is here. I think it's maybe the middle of the night, but I'm not sure. I need to tell him about my friend. I had dinner with her when I was in New York last week, right before the fever came on. She is recently married but I am worried for her, though I can't put my finger on why. Like me, she is a freelance writer. I'm not sure if my concern has to do with her career or her personal life. It feels like it's probably both. The word that comes out is
shackles.
Except my words are slurred. It sounds more like “shales” or “shells.”

“Sara is in shackles,” I say again and again. The slimy fish have turned into oysters in my mouth. They are multiplying. My tongue has shut off its communication receptors and is flopping around in my mouth with the oysters.

My husband says he doesn't know what I'm talking about. I'm making faces and waving my hands around as if we're playing charades.

“What is going on with you?” my husband says. “Do you know where you are right now?”

*   *   *

My husband is talking to someone in the background. Time has gone by. Maybe minutes. Maybe an hour.

“You have to understand, this is not normal,” I hear him say. “She uses words for a living. Something is very wrong here.”

What I know in real life but have forgotten now is that my husband writes about science and medicine. He almost went to medical school himself. But he went to Africa instead and reported on the Rwandan genocide. Our one-year wedding anniversary was two days ago.

“I think we should call your dad,” my husband says.

“Really? What for?” I ask.

October 28, 2010

3:00 a.m.

Dr. Plaid Shirt is back, though he's wearing a different shirt now. I don't know it but it's the middle of the night and my husband has insisted that the doctor be called at home and ordered to come in.

The doctor covers up his ID and asks, “Who am I?”

“Steve,” I say. This is not how he introduced himself earlier but this is what I have to work with. It comes out as “Shteve.”

“Fair enough,” he says. “What kind of doctor am I?”

I've totally got this. What's more, it's going to impress the hell out of him.

“Epidemiologist,” I say. Again with a lisp.

I am under the misimpression that an epidemiologist and an infectious-disease specialist are the same thing. What I mean is that even in my normal, nonconfused state I believe this to be true.

“Okay,” the doctor says. He's writing a lot of stuff down. I am worried that he's getting a bad impression of me. He maybe leaves or doesn't leave. Probably he leaves.

Suddenly my toes hurt. Or maybe it's not sudden. Maybe more time has gone by. In any case they hurt a lot. Like they're being frozen off my feet. I still have the nail polish on. I'm kicking my feet and yelling. I'm trying to warm my toes with my hands, except my arm is attached to an IV.

“We have to remove the polish,” I hear someone say.

My husband and a nurse are removing the polish. The cerulean is rubbing off onto acetone-soaked cotton balls. The scene fades for me right here, maybe because they give me something to calm me down or maybe because I stop remembering due to natural causes, like falling asleep or passing out. In the ensuing hours, I am transferred to another floor so I can be watched more carefully. I do not know this, though. I am getting closer and closer to not knowing anything at all.

October 28, 2010

Patient transferred to Direct Observation Unit at 5:20 a.m.

 

9:00 a.m.

TYPE OF CONSULTATION: Neurology

 

REASON FOR CONSULTATION: Altered Mental Status

40-year-old female patient was admitted yesterday to the hospital. Her husband as well as a friend are at her bedside and indicate that yesterday they began to notice she was having deterioration in her speech. In fact, she was telling them “I know what I want to say” but having difficulty getting the words out. She states that she is in the hospital, however she cannot name the hospital. She cannot name the president. She is unable to state the date. She is quite confused.

 

IMPRESSION:

1. Aphasia with increased deep tendon reflexes in right lower extremity, suspicious for central nervous system lesion, rule out ischemic event such as septic emboli versus encephalitis.

October 28, 2010

2:00 p.m.

I don't know where I am in time or space but I know my husband's close friend is here. She is the woman who married us a year ago. She got certified on the Internet and officiated at our ceremony in Central Park, where we stood under a chuppah even though I am Presbyterian. Now she is saying that the person at the hospital reception desk told her that only family members were allowed in but she that said she was my “clergy person” so they let her in. She is saying she'll go to our house later and feed the dog and bring him to another friend, who will watch him for a few days. She asks if there's anything I need her to do in the house.

I picture the house. It's not really ours but a place we're renting while we look for a real house to buy. It's a little shabby and the yard is overgrown and layered with several seasons of leaves, but we rented it because the landlady allowed dogs. I think about what our friend might do for me in the house and I see a stack of laundry on the dryer. Not a stack but a pile. Some socks probably fell on the floor. I need her to pick the socks up and put them back in the pile. Or maybe in the drawer. The socks need to go from the pile to the drawer, though maybe not back to the pile. Maybe the pile can be skipped.

I try to explain this. The laundry is floating in front of me. Shirt sleeves blowing in the breeze like in a laundry commercial. Underwear folded neatly. Maybe what I want her to do is take stuff out of the dryer. Or actually out of the washer. That's what it is. I want her to take most of the stuff that's in the washer and put in the dryer. Except there are a few things that need to be hung up to dry. One of those things starts with a letter in the alphabet.

“You know the thing I mean,” I say. Not only is my speech slurred by now but my voice has melted into a flaccid monotone. I sound like a hobbit in a smial. I sound exactly like my mother sounded when she was dying.

My husband's friend is smiling and nodding as if everything is fine and casual. I don't notice that her face is contorted in fear.

“I understand,” she says. “I'll take care of it.”

October 28, 2010

6:00 p.m.

Patient moved to ICU after signs of deterioration. Propofol sedation.

Currently, decreased reflexes. Presence of nuchal (neck) rigidity.

Meningioencephalitis, clearly worse than this a.m., discussed at length with husband and brother. Despite DIC/thrombocytopenia I feel potential benefit from lumbar puncture outweighs risks given the clinical deterioration and despite abx and acoclyovir.

 

Patient to be intubated for airway protection/safety and L/P will hopefully be done later if platelets/coagulants can be improved. Patient's husband understands risks/benefits. Informed consent was obtained for L/P and blood/blood product transfusions. Patient will receive right and left wrist restraints due to agitation/combative behavior.

What I will learn later is that I have been placed in what is essentially a medically induced coma. I will learn that I was thrashing around so much that they had to tie me to the bed with wrist restraints. Then, for sedation and “control of stress responses,” they placed me under propofol, the drug Michael Jackson used when he wanted to take naps and that eventually killed him. I am breathing on a ventilator for “airway protection” and I have a feeding tube. The MRI has shown that I have meningoencephalitis, a swelling of the brain and the lining around the brain due to infection. They think the infection is viral, for instance, some kind of massive herpes infection, but the insect bites also raise the possibility that I have West Nile or
Rickettsia typhi
, better known as murine typhus, which is caused by fleas not just biting you but then also defecating on your skin and spreading bacteria through your bloodstream when you scratch.