Trapped (25 page)

Chapter Forty-Six

Phoebe drove over the wet Berkeley Hills streets through the morning ground fog to Brier Hospital.

“Maybe it’s not such a good idea for you to be taking care of Mike so much,” Beth Byrnes, the head nurse of the ICU, said, as Phoebe pulled off her coat in the nurse’s lounge.

“You don’t want to have that conversation with me, Beth. I promised Lisa. If you see the slightest sign that my relationship with Mik
e or Lisa affects my work, I’ll bow out—maybe not gracefully, but bow out, I will.”

After receiving report from the night nurse, Phoebe moved to Mike’s bedside. Each time she looked at his inert body, she struggled with the image of what
he was then, and what he is now.

If it’s this tough for me
, thought Phoebe,
imagine how it must be for Lisa.

She performed her assessment
, which revealed a questionably enlarged abdomen and a small amount of mucous diarrhea. As Phoebe did each time she came on duty, she shook Mike, and, in a loud voice, said, “Wake up, Mike. Wake up. It’s Phoebe. Wake up.”

She exposed his chest
and examined the two round red areas, the first degree burns, from the shock of the defibrillator paddles. She picked a clear area, placed the knuckles of her hand against his chest, and ground them, trying to use pain to arouse him. Nothing. Phoebe pulled the tape off Mike’s lids, and then shined her penlight into his eyes to check his pupils. They constricted normally. She instilled artificial tears, and replaced the tape.

What’s that? Thought Mike, awakening.

I feel that ripping sensation on my eyelids
, and then blurry light—red, I think.

My chest still aches from whatever happened before. When
? Why? Where?—I don’t have the slightest. A distant voice is shouting something—what is it?

I try again to move something
, but nothing happens.

What is this?

What’s wrong with me?

Things are happening around me
—I know it—I’m alive, but never so alone.

At noon, Phoebe pulled off Mike’s sheet, and gasped. The abdominal swelling had markedly increased to the size of a near-term pregnancy, and Mike’s temperature had increased to 101.6 degrees. His pulse raced at 140/minute, but his blood pressure was stable.

“Page Dr. Byrnes, stat,” Phoebe said to the ward clerk. “I need him to see Dr. Cooper right away.”

Phoebe took the phone from the clerk
. It was Jack. “I’m in a meeting, Phoebe. What’s up?”

She repeated her findings and concerns, and he rattled off a series of blood tests. “Call radiology and have them do abdominal films
, stat. I’ll take a look at them, and be up in about twenty minutes.”

After his meeting, Jack Byrnes went to the x-ray department and studied the digital images. He entered the radiology reading room, and switched the screen to Mike’s images for Bernie Meyers, Brier’s best radiologist.

Bernie magnified the image.
“You’ve got big problems, buddy. What’s the story?”

“It’s Mike Cooper. He’s been in ICU for months with one problem after the next. He hasn’t come out of coma
, yet, and now this.”

Bernie
use the image measuring tool and and placed it across a large dilated segment of what could only be Mike’s transverse colon, the part of the large intestine that crosses in the upper abdomen.

“It’s fifteen centimeters, Jack. Greater than six is enough for the diagnosis.”

“Shit,” Jack said.

“An appropriate expletive.” He pointed to several other features, including the presence within the colon of soft tissue masses. “It all fits with antibiotic
-induced inflammation of the colon that’s progressing to toxic megacolon. It’s going to rupture if you don’t do something, and soon.”

Jack rushed back to the ICU. He quickly examined Mike, put his stomach tube on suction
, and ordered intravenous antibiotics specifically to control this toxic bacterial overgrowth in his colon.

He called surgery. “Tell Julie Kramer
that I need her in ICU as soon as she finishes her procedure.”

Jack signaled for Phoebe to join him at the nursing station.

“It’s toxic megacolon. It’s caused by infection in his colon, which we commonly see after antibiotics. Usually, it’s simple to treat, but this extreme form is dangerous.”

Phoebe paled. “I must talk with Lisa. She’s at home on bed rest due to bleeding. I don’t know how much more of this she can take.”

“I’ll see her,” Jack said.

“Let me do it. She’s going to freak
, and it’s better if the bad news comes from me.”

When Sandy answered the door, it surprised her to see Phoebe. “Oh, Phoebe, we didn’t expect you.”

“I must talk with Lisa. It’s important.”

“What is it?” When Phoebe didn’t answer, Sandy said, “She’s in bed. Go in.”

When Phoebe entered the room, Lisa bolted upright. “What’s wrong? Why are you here? Mike
—is he okay?”

“I want you to stay calm. Mike’s having some problems
, but it won’t do anyone any good if you compromise your own health.”

“Phoebe!”

Phoebe paraphrased everything that Jack had told her about toxic megacolon, while Lisa listened in silence.

When she finished, Lisa said, “I’m going in to be with Mike. Don’t try to stop me.”

“You’re not going anywhere,” Phoebe said. “Use your head. There’s nothing you can do for him that we can’t deal with over the phone.”

“
‘Over the phone.’ Don’t be ridiculous, Phoebe. I need to be with him. He needs me—I can’t leave him alone this way—I won’t do it.”

“Lisa…
”

“Don’t ‘Lisa’ me. I’m going, with or without your help. I want to be there when Julie comes.”

Phoebe shook her head. “Let me help you get dressed. I’m putting you in the wheelchair, and there you’ll stay, or I’m taking you back home. Deal?”

“Deal.”

When they arrived at Brier, Julie Kramer had completed her pre-op assessment. She bent over to kiss Lisa
, and said, “I’m so sorry. You two deserve so much more than this.”

“I don’t want your condolences. I just want Mike
—I want him back. He’s got to live to see his baby.”

Julie pulled up a chair
, and sat by Lisa. She grasped her hands. “Here’s my plan; if we don’t see improvement within the next seventy-two hours, I’m operating. If he ruptures his colon, I’m going in.”

“I know, but what does that mean?” Lisa
asked.

“If circumstances force me to operate, I’m going to remove Mike’s colon.”

“His whole large intestine?”

“All of it.”

Chapter Forty-Seven
(Week 26)

Phoebe dragged Lisa away from Mike’s bedside at ten p.m.

Lisa slept poorly
, and called the ICU several times. Although the cramps had tapered off, she continued to bleed, saturating three pads before morning.

Just as Sandy brought in her large mug of coffee, the phone rang.

“How was your night, Lisa?” Harvey asked.

“I’m still bleeding, but no cramps.”

“What’s happening with Mike?”

“God, Harvey, it’s awful, just awful. He’s so sick. On top of everything
, he developed toxic megacolon.”

“He’s a tough guy. If anyone can make it, it’ll be Mike.”

“I’ve got to be with him—I know this isn’t what you want, but Harvey…”

“Let’s use some common sense, at least. The bleeding doesn’t surprise me, and it’s good that the cramping is gone. If everything stays the same, let me see you in two days. I’ll tell my staff to get you in
, and we’ll repeat the ultrasound.”

“What going to happen?” she whispered, turning away from Sandy.

“I don’t know, Lisa, but the odds are still in your favor. Some pregnancies continue threatening until the baby’s old enough to deliver or you go into labor.”

“I don’t think I could spend the next few months in bed, Harvey. I must deal with Mike’s situation
, and I know confinement will kill me, or I’d wind up murdering my mother. Can I take my baby to jail with me?”

“Well, at least you haven’t lost your sense of humor.”

“Oh, you think I’m kidding,” she said in a monotone.

Harvey laughed, “See you Wednesday
—and please be sure to bring your mother with you so I know she’s still alive.” Harvey paused, and then said, “I’m going to drop by to see Mike. If nothing else, I can provide moral support.”

As Lisa set the phone down, it rang again.

“It’s Lilly. How are you feeling?”

“I’m still bleeding, but no cramps. Dr. Russo says that’s a good sign.”

“Is there anything I can do? I can only imagine how difficult this is for you.”

“I’m okay. Sandy’s here, and Phoebe—she’s a miracle.”

“I’ll be over to see Mike tonight. Will you be there?”

“I can’t. I’m confined to bed, but I’m planning a jailbreak.”

“Don’t do anything…”

“I won’t.”

“I don’t like being in the middle
, again, but Nora wants to know if it’s okay for her to visit Michael?”

“That’s exactly the kind of crap I don’t need now. I have real problems
, not the bullshit, daytime soap opera kind that Nora concocts. I’d never interfere with her, or anyone who cares about Mike, from visiting. What I can’t stand is her negativity, her pessimism, and, if you’ll excuse me, her moral superiority. It’s destructive, and I won’t tolerate it.”

“Tell me
what’s going on, then, so I can work with her. She’s not easy, you know.”

“This problem with Mike’s colon is dangerous. The next two or three days are critical.” Lisa began crying
, and then after a minute, she took a deep breath, and blew her nose. “He could need major surgery again. My God, that’s the last thing he needs. They might have to remove his colon. I don’t know how much more he can take.”

“Don’t take this the wrong way, Lisa…”

“Please, Lilly, not you, too.”

“We’re worried about his brain. How much damage
is intact? Will he go on this way? We need some frame of reference to help us through this.”

“I spend every day asking the same questions. Here’s what I know
, something is keeping him in a coma, yet we can’t find anything to suggest permanent brain damage, or even a persistent vegetative state. If you superimpose the fact that Mike’s kind of brain injury, trauma, has the best prognosis for recovery, and that improvement can occur up to, and possibly beyond a year, we have reason to hope.”

“I know you’re hopeful, Lisa, but are you being realistic?”

“I’ve had my moments. I’m human, after all, and it’s difficult to resist being drawn into the shadow of sorrow.” She paused. “And other people’s negativity. You may think I’m crazy, but I believe that hope is a self-fulfilling prophesy. I embrace it, and reject anyone or anything that interferes.”

Chapter Forty-Eight

Lisa’s mind was everywhere but on her driving. She jerked away at the last second to avoid a collision as a car pulled into her path when the lanes into the Caldecott Tunnel converged from four to two.

What else can go wrong?
She thought.

When she arrived at Mike’s bedside, Phoebe was measuring his abdomen. “
It’s forty-two inches,” she said, “slightly more swollen.”

“Has Julie been in this morning?”

“Julie and Jack were here. Julie’s in surgery. They’ll both be back at noon to confer. So far, a minor or no change—maybe that’s a good sign.”

“We could use some good news
, for a change.”

Lisa, Phoebe, Jack Byrnes, Julie Kramer, and Carter Reynolds, the neurosurgeon, sat around the table in the nurse’s lounge.

“I’m disappointed,” Julie
said. “I’d hoped that some of the swelling of his colon would have abated. The longer it persists, the more danger of perforation and compromise of the colon’s blood supply.”

“Isn’t there any way of relieving the pressure?” Lisa
asked.

“We’ve seen a few reports of decompr
ession of the colon through colonoscopy,” Julie said. “It’s not the standard of practice, and, because the colon is already compromised, it’s dangerous.”

“Jack?” Lisa
asked.

“I don’t know,” Jack
said. “We can try it, but we could wind up with a perforation and generalized peritonitis. I’m not sure he could survive both peritonitis and removal of his colon.”

“Could we wait longer
?” Lisa asked. “And, if medical treatment doesn’t work, then try colonoscopy?”

“No,” Julie
said. “If we try that approach, I’d say do it now before the colon weakens and is more vulnerable.”

“I’m trying to think what Mike would want,” Lisa
said. “I can’t stand the thought of him losing his entire colon.”

“It sounds worse than it really is,” Julie
said. “People do well, and it’s a hell of a lot better than a perforation and peritonitis.”

“I think you should try the colonoscopy, Julie,” Lisa
said, “but let’s not force the issue of decompressing his colon. If it happens, great, but if not, then he’s none the worse for the effort.”

They moved Mike to the gastroenterology suite, where the technician had the equipment ready. When Julie inserted the black fiberoptic tube into Mike’s anus, the TV monitor showed the red, inflamed lining of the rectum. It was covered with white patches.

“We call these patches pseudo-membranes
,” Julie said. “They’re typical of inflammation of the colon due to antibiotics.”

They watched as the scope moved up the colon. Large
, angry patches were everywhere. When Julie reached a narrowed segment of colon, she said, “That’s as far as I go. I’m not pushing through that area, and I’m sure not going to try to get through by adding air. I’m done.”

“I’m sorry, Lisa,” Julie said afterward. “There’s no question about the diagnosis, but I couldn’t get through safely to decompress Mike’s bowel. We’re back to watching and waiting. I don’t think I want to go beyond another twenty-four hours before I remove his colon.”

Nora came after seven that night. She nodded to Lisa, and then kissed and embraced her son.

“I feel helpless,” Nora
said.

“We all do,
” Lisa said.

Lisa paraphrased the events of the day, the colonoscopy
, and Julie’s plans for surgery within twenty-four hours, if Mike didn’t improve.

Tears streaked down Nora’s cheek as she stared at Lisa. “What will you do if he codes now
, during, or after surgery?”

“What kind of question is that?” Lisa
asked, flashing with anger.

“I mean that this is the end of the line. Mike wouldn’t want to
be kept alive like this. He’d insist on a DNR.”

“You’re out of your fucking mind, Nora. He’s not ready
, and neither am I. What’s wrong with you?”

“Don’t you dare to talk to me that way,” Nora said, blanching. “How can you watch him like this? How can you continue when there’s no chance? I don’t
want my son to live this way, and he wouldn’t want it, either.”

“Don’t tell me what he’d like. Mike wants to live. He wants to be with me
, and he wants to see our baby. I don’t care how poor the odds. If there’s any possibility of getting through this, he deserves the chance.”

Just then, Mike’s sisters entered his room.

Lisa turned to Lilly. “Get her out of here. I don’t want her anywhere near Mike.”

“Lisa…” started Lilly.

“Get her out.”

After they left, Lisa was alone
, again. She grasped her hands, looked around the room, and cried.