Time on Fire: My Comedy of Terrors (26 page)

“Are you trying to tell me how to do my job?”

“No,” I said, lying.  “I’m just trying to get you to clean the ports before you push the needle through.  I don’t want to get an infection in there.”

“Listen, baby, I been doing this a long time.  If you gonna get a infection in there, it won’t be because of me.”  And the blood lab technician at Sloan-Kettering jabbed the needle through the rubber, after giving a cursory, glancing swipe with an alcohol pad.

At Johns Hopkins the blood lab technicians would scrub the ports of my catheter, first with alcohol, and then again with Betadine.  The activity was done as if it were part of the serious task at hand, not an insignificant impediment to it.

“You better watch out, honey,” I was told back in New York.  “Some people don’t like being pestered while they’re working like that.”  The fact that her place of work happened to be on and inside my body seemed of no importance to her at all.

Within two weeks, I was in the hospital with a fever.  The diagnosis: a gram-positive staph infection in one of the tubes of my Broviac catheter.  This was the first infection I’d had in it since it was implanted nine months before.  I was put on heavy intravenous antibiotics to see if the infection could be cleared.

As if this news wasn’t dreary enough, I was told upon admission that there were no beds available on any “medical” floors, meaning floors where the staff is experienced in giving the type of care needed for nonsurgical patients.  I would have to be sent, at least until a bed became available, to one of the “surgical” floors.  In spite of all my experience up to this point, none of this struck me as anything to get too concerned about.  I was well acquainted with inconvenience and figured that, by now, I could handle just about any situation thrown my way.  I was assigned a room on the ninth floor, which specialized in neurological cases, and I headed up to do my time.

The seething madness swirling around inside Memorial Sloan-Kettering Cancer Center is invisible to most people passing on the street.  The exterior of the building – the facade, if you will – gives no indication of extraordinary events within.  Similarly, on a medical floor, while the suffering and deterioration of the patients is sometimes on display, their disease can frequently be concealed by the unblemished exterior of their bodies.  Not so on a surgical floor.  On a surgical floor, everyone’s trouble has an image, and these images come in every shape.  The shapes are formed not so much by what you see in front of you, but by what you know was once there and that now is gone.

The amputees.  Human beings whose limbs have been expertly, scientifically, lopped off.  They stagger through the halls, trying to teach their bodies to accept what their minds can barely grasp.  Their losses are most obvious.

The add-ons.  Their missing parts are signified by the devices that now adorn their existence.  The urine receptacle; the colostomy bag.  The hand held electronic tool through which someone will learn to speak.  Each piece of masterfully designed hardware acts as a confession.  The indisputable evidence that at least a pound of flesh, once hidden deep inside, has been taken away.

And then there are the neurologics.  The reconstructed contours of their misshapen heads are often the most graphic portraits of the human ability to wound in the pursuit of making well.  Nowhere else on the body, even with the missing limb, is alteration from the expected form more startling.  The graceful curve of a skull that now drops off like a cliff, as if some giant creature had taken a hefty bite.  The luminous symmetry of forehead, one side of which has become sunken, like an apple left too long on the ground beneath the tree.  These people, even if their brain functions remain intact, are branded with a physical imbalance.  The precision of our bodies, which we depend on to reassure us that all is well planned and taken care of, has been removed, and what is left is something lopsided.  An unwelcome reminder of the randomness that threatens us all.

On the ninth floor of Sloan-Kettering I was informed that there was a problem with the plumbing.  There was no hot water available, and the cold water came out of the tap nearly black.  Since extra-vigilant hygiene practices were of utmost importance in my precarious condition, this made for an inauspicious beginning.  Brushing my teeth and bathing several times a day was looking like an overwhelming proposition.

Since the nurses were unfamiliar with most of the drugs I was prescribed, I had to maintain an extra level of watchfulness over their administration.  Some of the antibiotics, when combined with other  drugs, would coagulate in the clear plastic tubing that led toward my veins.  The two colorless liquids would, if brought into contact with each other, form a curdled, cottage cheese-like substance that was rendered useless, not to mention disgusting, by the transformation.  Each time a nurse came to hang one of these medications on my IV pole, I had to remind them to change the tubing if the other fluid had been run through it previously.  Many of the staff were unappreciative of my “interference,” but if I kept quiet, or if I was asleep, often times a mistake was made, which set back everyone’s already overcrowded schedule.  As was the case with anyone in the hospital who upset the routine by making unusual demands on an overburdened staff, I was not the ninth floor’s most popular patient.

My first night there, I woke up suddenly to the sound of liquid being suctioned through a vacuum hose.  Like the sound of the plastic straw a dentist hooks over your teeth and under your tongue to suck up your spittle while he drills away.  There was the muffled gurgling of a human voice, like an animal being strangled.  I heard other voices, clear of congestion, hushed but intense, and there was a light on in the other half of the room.  Not knowing how to escape or where I might hide, next I heard the sound of my mother cutting up a whole chicken into pieces for frying.  The decisive grinding crunch of metal on bone, then the more extended tearing, snapping sound, as the leg is separated from the thigh, the wing wrenched away from the breast.  I saw the larger-than-life-size shadows of two gowned figures, instruments in hand, hunched over a bed frame, displayed on the pale blue curtain that hung between them and me.  I hid under the covers, afraid that this was a standard ninth-floor strategy.  Afraid my turn might be next.

I had seen enough, I decided.  My eyes could tolerate no more visions of horror, and my ears could accept no more sounds of suffering.  I wasn’t ready to die.  I had no intention of giving up my life.  Yet I felt I could not endure another moment of that existence, and so I concluded the time had come for me to lose my mind.  If I could just get my brain to let go, I thought, then I could let all the agony around me fade away by loosening whatever screws bolted my awareness to the reality of my circumstances.  I lay quietly in that bed, with my eyes closed,
and – as the giant shadows chopped up the body on the other side of the
curtain – I tried with all my might to go mad.

What I learned that night was that there were limits to my ability to manipulate my mental state.  Although I tried, I prayed, I begged, and I cried, my mind simply would not let go.  It was as if my connection to rational thought was an unbreakable bond.  It was as if there was no bond at all, but that my mind and pragmatic thinking were of the same substance.  I exhausted myself first with the effort, and then with my disappointment over my inability to sever my connection to the state of consciousness.  In the morning, the head that lay attached to the body in the other bed was mummified in bright white bandages.  It was two days more before I was transferred to another floor.  I never saw it move, and I never heard it speak again.

* * *

In his classic novel Joseph Heller writes, “There was just one catch…and that was Catch-22.”  The predicament I found myself in next would have to be classified as a Catch-33, maybe Catch-44.  Many of the drugs used to combat infections, whether bacterial, fungal, or viral, are also toxic to the bone marrow.  Since the reason I had an infection was that my bone marrow was not producing enough effective infection-fighting cells, the necessity of taking those drugs only increased the asperity of my problems.  As I was put first on intravenous antibiotics for the staph infection, then on intravenous acyclovir, an antiviral drug, for the herpes zoster (shingles) infection that cropped up, my blood counts plummeted to nearly nothing at all, leaving me, once again, neutrapoenic, and utterly defenseless.  But, thinking I had checked myself into the hospital for just that reason, to be protected against that which I was threatened by, I expected to hear the gears click in and see the life-saving machinery go to work.  Not exactly.

Day after day the Broviac catheter continued to culture positive for gram-positive staph.  It was quickly determined that the infection was not being cleared by the antibiotics and that the device should be removed from my body as soon as possible.  Otherwise, the infection was likely to spread, leading to a systemic sepsis that very often results in death.  The only difficulty here was that “as soon as possible” was taking an awfully long time to come around.

Twenty-four hours passed after the decision to pull the catheter was made.  No surgeon appeared in my room.  Forty-eight hours passed.  No surgeon.  Seventy-two hours passed, and I lay in bed, sick with fever, with infected rubber tubing resting in one of the chambers of my heart, and still no sign of a surgeon to pull the poisonous serpent out of my body.  I was ready to explode.

Each day Dr. Melman made a visit to my bedside.  She assured me that the surgeons were aware of the situation, and that, eventually, one of them would come up to the room and remove the infected catheter.  She stated that I was in no danger from waiting “a couple of days,” and she told me that the surgeons were very busy people who performed this procedure only when they found the free time after or between their operating room activities.  Whenever Jesselyn Melman left my room, she was immediately replaced, like air rushing back into a just-opened canister of tennis balls, by several nurses who were checking to make sure that the tubing had finally been removed.  When these nurses saw the two reptilian rubber heads still poking through my flesh, their faces tautened like actors pretending to be generals convening in a war room.  They looked at me, and then each other, with expressions that I had seen before only in movies, as the portly gentlemen waited tensely to see if the errant missiles heading toward enemy territory could be called back.  Olivia was often there.  Gisella, too.  And, of course, there was Karen.  These were nurses who came to check on my condition even though I was no longer their patient.  They stopped in from other floors on their way home or before beginning their shift in the outpatient clinic.  The three or four nurses who, over the years, had proven to be unafraid of criticizing, or even crossing, the hospital when it was failing to provide the necessary assistance to their cavalric crusade.

Late on the second day of no surgeon I was in my room, surrounded by my coterie of professional advisers.  By this time I had come to trust Karen to a degree beyond any of the other nurses.  While some of them had aided and abetted my schemes to bypass the crowds in the outpatient clinic, and several of them had listened sympathetically to my complaints about some of the more egregious offenses committed during my internments, Karen had remained the only nurse whose honesty outstripped even her compassion.  I knew that Karen would sooner scare me to death than let a lack of information kill me.  When she spoke, it wasn’t that she delivered any different facts from the others, but rather, she sent a message along with her data.

“Evan,” Karen said firmly.  She held my eyes with hers.  “That thing should come out.  Now.”

I didn’t need to be told any more.  With Karen’s tone of voice illuminating her choice of words, I knew that I was being told that whatever I wanted from this world, it was up to me to make it happen.  I waited for Jesselyn Melman to show her face again, and, although convinced I was in it already myself , I prepared to raise a little bit of Hell.

“Evan,” Dr. Melman said to me, exasperated.  “There is nothing more I can do.”  Our interactions with each other had deteriorated drastically as of my return from Baltimore.  I hid from her none of my disdain for the lackadaisical practices of the New York hospital, and my attempts to disguise my abhorrence of her unwillingness to assist me in circumventing them were unsuccessful.  I complained bitterly to Dr. Melman about the fact that it had been three full days since a decision was made that it was medically necessary to remove an infected catheter from my chest, and yet the catheter still remained.  I wasn’t dangerously ill at this point, but there was an active infection in the tubing, which was not being eradicated by antibiotics.  The risk of the infection spreading and raging out of control was constant.  Why was it still in my body? I demanded to know.  And how long would I have to wait, how sick would I have to get, before it came out?

“The surgeons will come when they can,” was all that I was told.

“Well, what if my infection gets worse and I die before they find the time?” I asked.

“It is my opinion,” Dr. Melman said, “that you are in no immediate danger.  Your condition is stable, and I see no reason to expect it to deteriorate.”

“But certainly,” I countered, “you have seen patients die from infected catheters.”

“Yes.  Yes, I certainly have.”

“And you wouldn’t argue that, in terms of risk reduction, the sooner the catheter is removed, the less chance of deterioration there would be?”

“Yes, I would agree with that.”

“Then how can I accept just sitting here, waiting, while the odds of my situation are slipping steadily out of my favor?”

Dr. Melman became angry.  I had seen her annoyed before.  I had seen her lose her patience.  But this was the closest I ever saw her come to losing her temper.  She snapped at me.

“Evan, the surgeons are on their feet twelve hours a day in the operating room.  I have told them to come when they can, and when they can, they will.  I know you don’t think the care you’re getting is very good, but I believe that you are getting adequate care, and I can’t very well drag a six-foot three-inch surgeon up here against his will.”