Crash (3 page)

Someone had put ointment into Trista’s eyes to keep them moist. Despite the bright glare of the ER’s fluorescent lights, her pupils yawned widely open. I swallowed hard, knowing what that meant: fixed and dilated. I kissed her forehead.

“Good-bye, sweetheart,” I whispered. Then the helicopter crew arrived and whisked Trista out the door. I never saw her again.

5

Transport

When I was a resident at the University of Massachusetts Medical Center, one of the most stressful rotations was the neonatal intensive care unit. And in the NICU rotation, one of the most stressful calls we could get was a request to go out on transport. Calls came into our tertiary care center whenever a baby at an outlying community hospital was born prematurely or was too sick for the local hospital to care for.

Our catchment area spanned a fifty-mile radius, which made for some pretty long rides bouncing around in the back of an exhaust-filled ambulance. Usually a resident, a nurse, and a respiratory therapist made up the transport team. On the way there we checked equipment and reviewed emergency algorithms in our heads. Our biggest side effect then was nausea and motion sickness. On the return trip, with a tiny life hooked up to high technology, every bump in the road threatened to dislodge a hard-won breathing tube or IV line. If one of those lifelines needed to be replaced, our options were to continue our pell-mell journey and risk failure or injury as the moving targets of miniscule veins and vocal cords hurtled down the highway or to stop the ambulance to have a bump-free shot at a do-over, losing precious minutes in the gambit. Either way, it was our call. The driver would forge on full speed ahead or screech to a stop at the side of the road at our request. We were in charge.

One sunny Sunday morning, after a particularly harrowing transport, I brought my sons out to my parents’ house for a visit. I was reliving the drama over coffee with my dad.

“So I was on this transport the other night, Dad,” I started. My father chewed his English muffin and asked from behind his
Telegram & Gazette
, “What do you mean, a transport?”

I poured milk and buttered toast for my sons and answered, “Well, if there’s a sick newborn, we have to go out in the ambulance and pick the baby up.”

My father lowered his newspaper and stopped chewing.

“You mean
you
drive an ambulance?” he asked, clearly impressed.

“Well no, Dad, actually I’m in the back, working on the baby.”

My father swallowed a mouthful of coffee, muffin crumbs gathering at the corners of his mouth.

“Oh, I thought you
drove
the ambulance,” he said, before disappearing back behind the paper.

And now here I was in unfamiliar territory, in the cab of an ambulance, thinking of my dad, long since gone. I was peering through a small square of glass into the back, where the action was; where I belonged. An EMT watched over my child; he held Neil’s wrist, checking his pulse, recording the blood pressure on his metal clipboard. He beamed his flashlight into Neil’s eyes and noted their response.

It was like watching TV with the sound muted. I couldn’t hear anything; I could only watch. Through the tiny glass square I saw the EMT asking Neil questions, recording his answers. I knew the drill. What’s your name? Where are you right now? Who’s the president? Determining if the patient was oriented to person, place, and time. If all three questions were answered appropriately, the patient was proclaimed “oriented times three.”

Neil certainly wasn’t alert. He slept when not stimulated. When we left the local hospital, he thought he was in a gym. I wondered where he thought he was now.

I glanced over at the driver of the ambulance. She was a young woman, no more than twenty-five years old, with closely cropped dark brown hair. She was deftly weaving through traffic on Interstate 95, lights flashing, sounding the siren in short, as-needed bursts to get past the occasional oblivious driver. She kept a watchful eye in her rearview mirror, waiting for instructions to either pull over or hit the siren and go full speed. She had my boy’s life in her hands. At that moment I was filled with my father’s love for her.

6

“He’s Gonna Be Just Fine”

Just after we reached the ambulance bay at the Brigham and Women’s emergency room, Neil’s blood pressure dropped and he complained of belly pain. A liver laceration, my doctor mind told me. A ruptured spleen. They yanked his stretcher out of the back, its collapsible legs smashing to the pavement. They pushed him through the glass doors, using his gurney like a battering ram. Neil never opened his eyes. I followed close behind, my own eyes glued to my son the whole time.

Inside his new city cubicle, a team stripped him of his transport heart monitor leads and replaced them with their own. They got to work with stethoscopes, flashlights, and reflex hammers, poking and prodding, asking questions and recording responses. A resident young enough to be my son asked, “Do you mind stepping out, Mom?”
(Mom!)
I took my chances.

“Well actually I do mind. I’m a pediatrician. I’ll stay out of the way.” With that, he laid his hands gently on my shoulders and guided me through the curtain and out into the hall. Apparently it was a rhetorical question.

I stood there alone and adrift. Back at Anna Jaques, Saul and I had agreed that I would ride in the ambulance with Neil. Saul would stop at the house and pick up a few essentials (my asthma inhaler for one) and then meet us at the Brigham. I hoped he’d get there soon.

Now a burly bearded doctor in an attending-length white coat strode over and offered me a meaty hand. He pumped it twice, introducing himself as Chuck, or Mitch, or something equally short and informal.

“I just looked at your boy,” he boomed jovially. “Don’t worry. He’s gonna be just fine.” He then took off down the hall, calling over his shoulder, “They’ll come get you once he’s all settled in.”

I watched him disappear. Even though he couldn’t have done much more than literally “just look” at Neil, I felt oddly reassured by his words, as if years of experience at this sort of thing made his brief glance as sharp a predictor as any CT scan or thorough neurological evaluation. I imagined him popping into other cubicles, making pronouncements along the way. “Fine.” “Not fine.” “Well.” “Not well.”

I found the waiting room; capacious yet teeming with patients. Babies crying. Pregnant women carrying plastic containers of urine, trying to disguise the cups by wrapping them in paper towels. (I knew that trick.) A television mounted above the fray flashed silent images. I kept a wary eye on the scrolling headlines at the bottom of the screen. It was almost eleven, just over three hours since the crash. I knew it would be just a matter of time before we would become one of those banners.

By this time, I had a few things pieced together. One of the first responders was the fire chief and a neighbor of ours. He told us how he had been at home when the call came in. He’d heard it on his police-band radio, always on. A drunk driver, out of control. Some of the nurses at the local hospital had also filled us in. The kids were victims of a hit-and-run accident, but they had caught the driver, drunk, a teenager not so many years older than Neil and Trista. He left the scene in his SUV but flipped it on the Interstate 95 overpass a few hundred feet down the road. He had taken off on foot but was quickly apprehended. He had thirty empties in his car.

Oh, this would make the news all right.

As I watched the headlines, Saul came through the waiting room door. Just seeing him, I breathed easier, even before taking a hit of the inhaler he had brought. He carried a paper bag full of the “essentials” I had sent him home for: clothes Neil would never wear, books we would never read, and knitting I would never touch.

When they finally let us in to see our son, he still lay on the hard plastic board used to transfer patients from stretcher to bed. His head was still pinned between two Styrofoam blocks, but now his wrists were tethered as well. I knew what those straps meant. I had used them as a nurse many times to restrain confused old men or to keep belligerent drunks in the ER from injuring the staff. We used thick leather ones with metal buckles for the occasional inmate we treated, a security officer planted next to him. Then there were the thin cloth varieties padded with soft lamb’s wool to gently remind the elderly woman not to get up to use the bathroom alone. Neil’s were white Velcro straps slipped around each wrist and lashed to the side rails. The ends were tucked under his mattress, a maneuver I knew was to discourage escape.

My heart broke seeing my boy’s fingers picking at the sheets and testing the limits of his restraints with short jerks. Those fingers had petted gerbils, iced cupcakes, moved chess pieces, turned book pages, tuned guitar strings, and played Beethoven. Those hands had never hurt anyone and did not need to be restrained.

I gently removed the straps and shoved them under the mattress. Neil’s eyes opened.

“Hi, Mom,” he whispered then drifted back to sleep, his fingers still working the sheets in constant motion, a frenetic Braille known only to him. I tried holding his hand, but it continued worming in mine.

He was shivering under his one thin sheet. Saul and I took off our coats and laid them over our son. He woke to complain about his head being trapped and the hardness of the backboard. I tried to explain that both would be gone once his spinal films have been cleared, but he wasn’t comprehending. He was agitated, irritated. He thought he was in a gym. He yelled for us to bring him things that didn’t make sense, and when we tried to clarify what he wanted, it only made him worse.

I tried to think about Chuck/Mitch and his reassuring words about my son. But this was a trauma center, and I was slowly realizing that by “He’s gonna be just fine” the doctor really meant Neil’s going to survive, to walk out of the hospital alive. And I wanted so much more for my boy. I was worried about his IQ and his personality. Would he still be smart? Would he still be Neil? I glanced over at my husband, who was looking uncharacteristically helpless.

“But honey, he’s alive,” he told me, as if reading my thoughts. It’s no wonder Saul reacted so differently to our son’s accident. Unlike Saul, I had found out about the crash gradually, with time at first to deny reality, to disbelieve:

“Where are the kids?”

“They should have gotten to your house by now.”

“Two kids were hit on Ferry Road.”

I had had time, running through the freezing cold, to postulate alternative scenarios. Two other kids were hit. Not our kids. Not Neil.

For Saul the news came all at once, with stomach-churning clarity.

“Your daughter’s been in an accident, sir. I can’t give you any more information than that.”

And he was alive. And I was grateful. I thought of Mary somewhere else in the city, about Trista’s unseeing eyes and how they were probably having a very different conversation with their doctors—and I felt guilty for my thoughts. I swallowed my grief and stroked my boy’s hair. There was no dried blood, no broken glass, no evidence of the trauma he’d just been through. I thought,
How can he have brain damage when he doesn’t even have dirt in his hair?
He opened his eyes.

“Hi, Mom.”

7

“There Was a Crooked Man Who Had a Crooked Smile”

It was after midnight when the doctors came in to update us on Neil’s condition. His CAT scan was unchanged from the one back home. The bleed in his brain was still small. They had CT’ed his belly too. No lacerations of the liver or spleen. My husband and I squeezed hands at each piece of good news. He did have a fractured shinbone that would need an operation to repair; the orthopods would tell us more about that in the morning. His C-spines had been cleared. They’d be taking him out of his collar soon.

Eventually they took us up to the trauma ICU and deposited us in the waiting room. They showed us the phone on the wall and told us they’d call when Neil was settled in and we could see him. I protested briefly, but my husband led me over to the couch and sat down next to me to wait.

“This isn’t right,” I grumbled. “They’ve got it backwards. He’s
our
kid.
We
should be giving
them
permission to see him. Not the other way around.”

“We’re going to need to start calling people,” Saul commented, perhaps trying to distract me from my irritation. I thought of Saul’s elderly mother. I wanted to get to her before the TV news did. We’d managed to avoid the eleven o’clock broadcast, but it was just a matter of time. We also didn’t want to wake her with scary news at this time of night. Our oldest son, Dan, was studying Spanish in Mexico. But the only number we had for Dan was the Study Abroad Coordinator at Goucher College. That would also have to wait until morning. There were other calls to make as well. Friends, family, work. I was employed at a large community health center and had patients scheduled. Someone else would have to see them. Saul ran his own business, and his staff would have to be told that the boss wouldn’t be in. But we decided all the phone calls would have to wait until morning. Right now we just needed to be with our son. Besides, maybe we would have more information by dawn.

Finally the phone on the wall rang and we were granted permission to come inside the ICU and see our son. The nurse brought in an office chair on wheels for me, and I sat down and lowered the side rail on Neil’s bed to be closer to my boy. When Saul asked for a chair for himself, the nurse told him we couldn’t “just camp out here” and left him standing. He went back to the waiting room to sleep on the couch. We made a plan to switch places every few hours, but I found I couldn’t leave Neil’s side. I was afraid that if I walked through those glass doors, the nurses would never let me back in. They’d tell me visiting hours were over and keep me from my son. I laid my head on Neil’s belly, but I couldn’t close my eyes. I was afraid if I were caught sleeping, they’d send me away. I didn’t even go to the bathroom, afraid I wouldn’t get buzzed back in.

The hours ticked by. Neil’s blood pressure was low. I pressed my hand into my son’s belly and squeezed his thighs, searching all the places where blood could hide. It was discomfiting for me. Neil is modest by nature. He closes his bedroom door just to change his shirt. I felt I was somehow violating him now, but I needed to know he wasn’t bleeding out. I needed an answer to his low blood pressure. The nurse kept calling the resident with the numbers, and he kept ordering fluid boluses. But it didn’t make sense. Neil’s pulse was rock stable, and plenty of clear urine filled the bag hooked to the side of his bed. Bleeding just wasn’t the cause of his pressure drop. Perhaps it was the whopping dose of antiseizure medicine he had been given in the ER.

I was trying hard to stay awake. The ICU was a surreal setting, hallucinogenic at times. At one point I thought I saw Neil’s eyes open wide, but when I rubbed my own and looked again, he was sleeping peacefully. Later, the numbers on a wall calendar seemed to wriggle off the page and dance along the ceiling. But once I shook my head, the numbers had marched back into their orderly 2-D row.

A neurosurgeon came in the middle of the night. He took a tiny penlight out of the breast pocket of his white coat, pinned Neil’s eyelids open with his fingertips like they were butterfly wings, and shined his light in them one at a time. PERRL: Pupils equal round and reactive to light. A good sign. He put Neil through all the moves. Squeeze my fingers. Raise your eyebrows. Smile. Wait. Smile again. I looked over the neurosurgeon’s shoulder as he asked Neil to smile over and over. Something was wrong. The doctor didn’t like the asymmetry he saw in Neil’s face.

I thought of the nursery rhyme:

There was a crooked man.

He had a crooked smile.

How did the rest of that go?

Over and over my son contorted his face into an expression normally linked to cheer. But for Neil it was just a ticket back to sleep. It was a mask that said “Leave me alone.” More snarl than smile. When I was a nurse on the eleven-to-seven shift in the pediatric intensive care unit, I often had to do hourly neuro checks on my patients. I knew how difficult it could be. After the sixth time of answering questions like “Where are you?” and “Who’s the president?” folks get cranky. They want to go to sleep. They grunt and don’t answer. Then it was up to us nurses to determine if this was a diminishing level of consciousness or just grouchiness. When do you call the resident?

Now the neurosurgeon was asking me if Neil’s smile normally looked like that. I thought back to a case I had recently of a little boy with headaches and a positive Lyme titer. On exam one of his pupils was bigger than the other. We were trying to figure out if this anisocoria was a result of the Lyme disease, which would be very unusual. The mom swore it was new; otherwise she would have noticed it long ago. We asked her to bring in pictures of him as a baby and toddler so we could sort it all out. When she brought in the photos, sure enough, his pupils had been asymmetric right along. Could I be like that mother? Could I not have noticed all of my son’s life that he smiled like Ellen Barkin? I flipped through a mental photo album. Neil at Horseneck Beach. Neil dressed as an alien for Halloween. Neil with his head in the stockades at Old Sturbridge Village.

“No,” I answered. “This is new.”

Another member of the neuro team tested Neil’s hearing. I knew then that they were thinking he might have a basilar skull fracture. The resident rubbed several of Neil’s hairs together between his fingers just in front of Neil’s ears.

“What do you hear?” he asked gently.

“Beating off,” Neil replied, eyes closed. We all looked at each other.

“What’d he say?” the team asked one another.

“Beating off,” Neil asserted, more loudly. I searched my son’s face for signs that he was making a joke. His sense of humor was notoriously dry. But I knew this was no joke. Though he had passed the bedside hearing test, my modest son’s immodest response was one more sign of his injured brain, his usual inhibitions temporarily off duty.

The ICU attending ordered another CT scan for the morning to check for evidence of the fracture Neil’s asymmetric smile suggested.

I thought again of those reassuring words. “He’s gonna be just fine. Don’t worry.” I looked down at my boy and worried.