Viral Voyage: Circumstances, Choices, Carelessness & Care
My surgery was scheduled for 2 p.m. the day after I was brought out of the coma. A nurse explained I would be given propofol, fentanyl and a paralytic drug prior to the tracheotomy. Just before “going under,” I glimpsed the surgeon. I’d been his patient before. He is one of the best trauma surgeons in our area, perhaps the best. Slight of build and unassuming, he radiates an Olympic confidence. I was in excellent hands — literally.
The propofol wore off before the surgery was finished. Fentanyl kept pain at bay. I heard the doctor and nurses talking. They moved and spoke above me in modulated tones. I wanted to tell them the propofol had worn off so they would know I was awake. I don’t know why I didn’t open my eyes. I may not have been able to, due to the paralytic drug. Before I figured out how to communicate, they walked out. The silence they left behind was total, seamless, heavy.
I moved my eyes to the right and glimpsed the bustling recovery room next door through tinted glass; to the left, a wall with a high window. The paralytic drug wore off enough, I could move my hands and forearms. Patting my hands to right and left, I searched for a call button. There was none. Two electrodes were attached to my body, making me think I was connected to monitors. Those would sound alarms if disconnected. With effort, my weak, shaky fingers peeled away the electrode patches that held the cords connecting me to the monitors. I expected to hear that sound like a siren on a large toy fire truck, but there was just more silence. I could only guess that the nurse turned them off before leaving and left the patches holding the electrodes in place. I knew my heart rate was erratic from earlier exams; I was at high risk for blood clots; if the ventilator malfunctioned, then what? A person’s decisions made in just a few moments had now put me inside hours of the classic nightmare: can’t talk; can’t move; people there, and no one sees or hears me.
My thoughts dart unpredictably when I’m under extreme physical stress. The distraction helps me. In that moment’s mental mix: Sartre and Camus, fathers of existentialism. What I remembered most from their work was the insistence that a person could always make a choice. Even when not free to make decisions about our circumstances, even if facing execution the next day (Le Mur by Sartre), something within remains alive and capable of choosing, no matter how narrow or irrational the range of choice might be.
I chose not to feel fear. I don’t know if I could do this a second time.
I simply knew that I could not allow fear into my mind while I was bound to that table. Time wore on. The light coming through a high window to my left grew darker by shades of gray. I would not feel fear. It helped to let my mind observe more darting thoughts.
“You are you and your circumstances,” wrote Spanish philosopher José Ortega y Gasset. Damn these circumstances. I hadn’t caused them, couldn’t change them. I was a prisoner. Just beyond the wall, the world of recovery and human help waited. Blood clots and heart attacks are silent; so is the end of breathing. Would someone please come in this room?
I made one more choice: to believe God was in the space with me. I could choose to feel utterly alone or utterly alone with God. If there had been a hand to hold, I would have chosen it over the presence of God. Yet when the human help I want most is denied, I’m given the presence of the Divine Source. This is not an answer, not a solution; it is the presence. It almost sounds like settling for a lesser good. I would have turned away from the presence for a helping human hand. Yet in the absence of all human accompaniment, God hastens to the lone soul in blinding darkness or icy silence. How many times have I prayed for fixes and answers? How many times have I prayed not to be alone? That last prayer, I believe, is continually answered. Often not in the human medium I want, but always in the spiritual one. “Bidden or not bidden, God is present.”
Time continued to drag until, in an instant, the door swung open. An African American respiratory therapist with light hazel eyes came in and checked the various equipment attached to me. I used my hands to signal that the monitors were not connected to me. She looked concerned, then swiftly rolled my bed into the recovery room. She talked to me about my new circumstances in a melodious voice. She handed me a mirror to look at the tracheotomy. I looked only that one time. I wanted no permanent visual memory of the hole in my neck, about the size of a quarter. As she guided my hands, I learned the exact position of the tracheotomy, could feel the aqua tube inserted into the hold. I felt uneasy, yet relieved. The mechanical is not natural, even though in Covid cases, it’s the equipment that has saved so many of us. Being connected to the ventilator sent precious air through that tube. I could breathe. I would live.
Out of the blue, an earthquake-cough erupted. My torso twisted, subjected to the spasm moving through the muscles along the sides of the rib cage. My legs pulled up, knees first. If there’s something to cough up, you’re in luck. Get it out, and the cough should stop quickly. Apologies to the sensitive: if something is stuck in or blocking an airway, the blockage can be a mucus plug, blood, or simply thickened mucus. Coughing can also start from that irritation we euphemistically call “a tickle,” which keeps egging the coughing on. Coughing can lead to choking. Just as I felt I might choke, my respiratory therapist appeared. Skillfully and swiftly, she removed the ventilator tube. She inserted a tiny tube into the hole and pulled out what I couldn’t cough “up.” Then, the blessed subsiding. I was reconnected to the ventilator. The spasm stopped, and the cough disappeared — but not for long.
In about half an hour, the next big cough started. I asked a young nurse nearby for help. “Take care of it yourself!” she snapped. The nurse knew I’d just come from surgery, yet spoke to me as though I’d violated some rule or were simply stupid. “You ought to know how to do that,” she said and walked away. Even if I’d had some practice to helped myself, I could just barely make my hands work normally, and my forearms felt leaden. The kind respiratory therapist came back. With skill and reassurance, she put me right. I asked her to wait a moment by the bed so I could text her that she had beautiful eyes. She smiled.
It amazes me how sharp and clear emotionally painful memories can be: the tone in the nurse’s voice; the way she looked down at me; her perfect posture as she turned her back. It’s equal to, if not greater than, the memory of the physical ordeal. Spasms end. The physical memory dissipates. I can recall it, but I can’t re-feel it. Yet a year later, I can relive her disdain in my being, hear her voice, see her turn away. Time again to make a choice not to feel. This time, it’s not fear, but shame I choose not to feel. I felt ashamed that I couldn’t adjust the ventilator tube, stop the coughing and keep myself from choking. Thank goodness for the kind therapist, who reassured the shame away in that moment.
After the shift changed to the night staff, Nurse Melissa came in.
Melissa means honey.
Knowing I’d been in a coma for three weeks, Melissa had gone to the local Walmart and bought bath gel and a hair-washing cap for me. It was an indescribable relief to feel clean again. Gentleness repairs so much. She helped me gain distance from the icy despair I’d felt, alone in the O.R. She talked to me about lots of things. I nodded and used hand gestures in response. She seemed to read my wandering thoughts, from the summer heat to how to survive with a ventilator. Though I was mute and immobile, she “got” me. She asked perceptive questions about things that had nothing to do with hospitals. “One day, you and I are going out for a drink!” she said, smiling. That’s something I almost never do. And, Covid continues to limit drinking-out options. Still, I nodded with enthusiasm and gave her a thumbs up. As she gathered the clean-me-up supplies, she said: “Yes, one day, you and I are going to have a drink… and we’ll talk!” Those words sounded full of hope and promise to my silenced self: “We’ll talk.”
The next morning, I felt safe again; clean and breathing with no struggle. I looked forward to seeing Melissa when she returned that night, but it was not to be. In the afternoon, two ambulance techs arrived and announced they were moving me to a rehab hospital. I felt a sick pulling sensation in the pit of my stomach. I wanted one more night in this familiar hospital. I didn’t get to say goodbye to Melissa, or say thank you.
The ambulance drove a few blocks and backed up to a large door. The techs wheeled me in the wheeled bed, and I stayed connected to all the necessary devices, including the ventilator. Staff members scurried in, walking silently in rubber-soled shoes. They lifted me from the ambulance bed into a shockingly uncomfortable hospital bed. The mattress curled up at the foot of the bed, reminding me of a huge Moroccan slipper.
Everyone left. I didn’t know the name of the place I was in or where it was. If someone had told me, the information hadn’t remained in my clouded mind. A young tree filled the room’s window. Afternoon light filtered through its branches and danced in windswept patterns on the floor and walls. Just as I was about to feel a bit of calm, the coughing began again, stronger than the day before. I pressed the call button and tried to suppress the earthquake within while I waited.
A male nurse appeared. “Hang on, love,” he said. It was strange to hear that typically English phrase in a Texas accent. I was about to learn many phrases, though. The first one, awkward now, but music to my ears then: “I’m going to suction you.” Once I heard those words, I knew the coughing, the spasms, and the nauseous gagging would come to an end. It wasn’t always fast, but the awful concert of symptoms would always resolve.
The nurse assigned to me for the night walked in. Tall, blue-eyed, and energetic, the first thing he did was hold crossed fingers in the air and say, “Remember, not this.” Then he pressed his palms together, as in prayer, and said, “This is what we do with our fingers instead of crossing them.” He smiled and stood patiently by the bed as I texted him one question after another on my phone. Then he said: “The most important thing is, don’t be afraid. Your stats look good. I’ll help you get off this ventilator as soon as possible.” And he did. I graduated from a ventilator to a trach collar in less than a week. The ventilator pushes humidified oxygen / air through the lungs at a set pace. A trach collar is lightweight, goes around the neck like a (dare I say it?) choker-necklace, while the patient stays on a humidified oxygen supply. It allows a person to breathe at their own rhythm and helps the lungs to inhale, not simply be inflated by a machine. My lungs and I were soon making progress.
When I can, I ask writers I admire for advice on how to improve my craft. When I asked writer and professor Albert DiBartolomeo for advice, he answered, “The key is to take care.”
Care with monitors. Care with kindness. Care with words. Take care.
If we take care — and the time to take care — we’ll be the ones to open the door on darkness, reassure the frightened, or brush a life with love as we pass by. We can be the person someone remembers as the honey in their lives.
Her name was Melissa. God willing, she is still well. I will find her, and we will have that drink. But first, I’ll take a moment to hold her hand — no plastic gloves this time — and hoping to hold back any tears, I’ll say, “Thank you, thank you. You took such good care.”