Trapped (18 page)

Chapter Thirty-Three

Lisa jerked awake as the first rays of the rising sun streamed through the windows of the ICU waiting room. Phoebe’s head lay on the sofa’s armrest, her legs curled to her chest. Nora and Mike’s sisters had left shortly after two a.m.

When Lisa pushed open
the door to the ICU, the clicks and the raspy movement of air through Mike’s respirator sent chills down her spine. She moved to his bedside, looked him over, and then checked the cardiac, blood pressure, and intracerebral pressure monitors. She lifted the sheet, and looked at the multiple drains from Mike’s chest and abdomen. She checked the drains from his head, and then collapsed in physical and emotional exhaustion into the easy chair the night nurse had placed by his bed.

Carla Watts, Mike’s day nurse, had received report from the night shift
, and came to the bedside to do her assessment. “Have you been here all night?”

“Yes,” Lisa
said. “I must have nodded off somewhere after three. How’s he doing?”

“His pressures are stable
, although we had to increase his ventilation when his brain pressure rose last night. We gave more Mannitol to bring it down. The lab drew this morning’s blood, x-ray is on its way, and in the next ninety minutes we’ll have a deluge of docs.”

“Is it all right if I watch?”

“Of course.”

Carla started at his head, checking the drains, the dressings
, and the pressure monitor. Although it was early in his course, she leaned over to smell the bandages for signs of infection. “Just dried blood and Betadyne antiseptic,” she said.

She moved downward to check the IV lines, cardiac monitoring
, and pressure lines, and the chest tube, squeezing it to insure its patency. She moved to the abdomen, and then down to his lower extremities where she checked the adjustment on the traction device that immobilized his left thigh, the site of his fractured femur.

“It’s overwhelming,” Lisa
said.

“Tell me about it,” Carla said with a subtle smile. “I know how bad it looks. It always looks this way at the beginning, but I’ve been at this long enough now to see the recovery ahead.”

Carla recorded her findings, made her nurse’s notes, and then stood with her hands on her hips. “Look at this guy—he’s a huge and powerful man. That’s really going to help.”

“I’d like to wait until the docs come through this morning, then I’d better get home for the dog
, and to get some sleep.”

“Can I give you a small piece of advice, Lisa?”

“Sure.”

“We’re in for a long haul
, here. These are devastating injuries, and it’s going to take some time before we know how he’s doing. If you want to help Mike, you must protect yourself first. It won’t do either of you any good for you to wind up sick, too.”

“I know. We see it all the time in the NICU
. Parents exhaust themselves trying to be with their babies 24/7. I understand it more now than ever. It’s visceral—almost as if stepping away puts Mike in jeopardy. I know it’s ridiculous, but that’s how I feel.”

“Be smart, Lisa. This will be a marathon, not a sprint.”

When Lisa arrived home after Mike’s first full ICU day, she was exhausted. Daisy went through her greeting ritual of tail
-wagging and wet kisses, but she kept returning to the front door, looking for Mike. Lisa fed the dog, and then they walked for an hour, but instead of pushing ahead as usual, Daisy stopped often, looking back expectantly.

Lisa made her final call on Mike’s condition
, and then crawled into bed with Daisy by her side.

She slept fitfully, waking every hour or so, finally catching three or four hours in the late morning.

Lisa drove in commuter traffic toward Berkeley in bright sunshine. She exited the Caldecott T
unnel into heavy fog, and continued to Brier and parked in the garage.

When she reached Mike’s bedside, Carla had completed changing the scalp dressings.

Lisa bent over Mike, grasped his hand, and placed a kiss on his flaccid lips; lips so unlike the ones she remembered. “How’s he doing?”

“No change. I’m still waiting for his morning lab results.”

Jack Byrnes came over to join them, squeezed Lisa’s hand, and said, “So far, so good.”

“What does the neurosurgeon say?”

“Carter says it’s too early to know much. Mike has some abnormal reflexes, but we expect that with the severity of his brain injury. He did an electroencephalogram (EEG) to get a grasp on his brain wave activity.”

“You don’t think…
” cried Lisa.

“No,” Jack
said. “We need one for a point of reference, a baseline reading for future tracings.”

Jack pulled back the sheet to examine Mike’s swollen abdomen. He checked the incisions
, and the multiple drains, and again noted the extensive black and blue marking of blood that had seeped into his tissue. “It looks about the same to me.”

Lisa scanned Mike’s body
, and then shook her head. “I don’t think so, Jack. Look at the space between the upper part of the incision, and the drain below his right ribs. Last night it wasn’t more than an inch and a half, now it more than two inches.”

Jack looked at Carla. “Did anyone measure his girth last night?”

Carla flipped through the nursing notes. “Here it is. Just above his navel, they measured thirty-eight inches.”

Jack took the tape measure,
and passed it under Mike’s back. He drew the end of the tape across the black marking, and said, “I’d better do this again.” When the repeat measurement showed forty-one inches, he said, “Shit—something’s going on in there. We’d better get Julie Kramer up here, ASAP.”

“What is it?” Lisa
cried.

“I don’t know. It could be fluid accumulation from all the
injuries, or he could be bleeding internally. I’d like to put a needle in there to see, but it’s too dangerous.”

Suddenly, the cardiac monitor beeps increased as Mike’s heart rate reached 160 beats per minute.

“His blood pressure’s down to 90/50, Jack,” Carla said. “There’s fresh blood at his incision line.”

Jack checked Mike’s monitor reading. “He’s got to be bleeding. Get me two units of fresh blood, Carla, and make sure the blood bank has six units available at all times.”

Julie Kramer arrived as they completed the infusion of the second unit. Mike’s pressure had increased to 109/60. When Julie placed her hand on his abdomen, she said, “I’m calling surgery. We must go back in.”

Julie studied
Lisa’s ashen face. “I’m sorry, but I can’t say this is unexpected. It could be anything from his damaged liver to bleeders that we missed.”

“How much of this can he take?” Lisa
asked.

“Let’s hope it’s something simple, Lisa, so we can get in and out quickly.”

“Is he ready?” Julie
asked.

“Go ahead,” said Mickey Katz, the anesthesiologist.

When Julie cut the abdominal sutures, the midline incision burst open, expelling dark clots, and a mixture of dark and bright red blood. She handed two large retractors to her assistant, and then cleared the large amount of blood with a large vacuum suction and surgical pads.

After she removed the blood-soaked pads, Julie peered into Mike’s abdominal cavity. “It’s part of the left lobe of his liver
.  Shit—I should have removed it yesterday.”

“Sure,” Mickey
said, “we’re all geniuses in retrospect.”

“How’s he doing?” Julie
asked.

“So far, okay. If we can keep up with his blood loss
, and we don’t run into blood clotting problems, he should do okay. Are you going to remove that part of his liver?”

“Don’t have a choice.”

Julie began the delicate process of removing the damaged lobe of the liver, tying off numerous blood vessels and bile ducts. The electrocautery sizzled against the bleeding points with billows of smoke rising and filling the room with the smell of burning meat. After two hours, she placed clean white towels into the abdomen, waited for several minutes, and then removed them. They showed only mild blood staining and no sign of active bleeding.

“Let’s finish,” she said, repositioning the drains
, and beginning to close using thick, stainless retention sutures.

Lisa and Phoebe were sitting and holding hands in the surgery waiting room when Julie entered.

Lisa tried to rise, but Julie sat her back down.

“How is…?” Lisa asked.

“He’s okay. I had to remove part of the left lobe of his liver. That’s wh
ere he was bleeding. I should have removed it yesterday and spared him a second operation.”

“Can we see him?”
             

“Of course.”

As they stood by the surgical gurney, Lisa said, “What will it mean for Mike to lose part of his liver?”

“The problem isn’t the resection,” Julie
said. “He’ll grow new liver over time. It’s the amount of injury caused by the accident, and now a second surgery.” Julie removed the green surgical cap and used it to wipe her sweat-soaked forehead. She stared at Lisa, and said, “I think he’ll get through this. His EEG shows the characteristics of a patient in a coma. It’s his brain injury that worries me the most. Thinking about it keeps me awake at night.”

Chapter Thirty-Four

Lisa boarded the emotion
al roller coaster, moving from intolerable pain to lifeless lassitude, from flashes of hope to devastating despair, and from the warm communion of friends and loved ones to the arctic agony of her isolation. Her stony face reflected emotional exhaustion. She listened to the words of condolence, hope, support, and expressed memories of times shared by close friends and relatives, but absorbed little of it.

Lisa remained alone.

“Don’t go on this way,” Phoebe
said.

Lisa looked up. “What way?”

“Please, don’t do this to yourself.”

“What are you talking about Phoebe? Look at me. Look at my life. I don’t understand any of this. What kind of a fucking world do we live in? What did I do to deserve this? Haven’t I suffered enough?”

Lisa reddened.
What am I saying?
She thought—
It’s me—me—always m
e.

“Don’t expect meta
physical explanations from me, sweetie. I’m Miss pragmatic—I go with what works.”

“They say things happen for a reason
—what a load of crap that is. This is a sick, meaningless, and cruel world. We’d better get used to it.”

“I know it looks that way, but we know better. I don’t know how to say this without sounding like a Hallmark card or regurgitating platitudes.” Phoebe
caressed Lisa’s hair, and then continued, “Life, especially a quality life, says enjoy our world of love and kindness while you can; carpe diem. Someday, it’s going to end.”

“I can’t believe you’re talking this way
. He’s not dead, you know. I’d like to believe we can live that way, but we don’t. The difference between the neurotic or the depressed and
normal,
is our ability to deny the disaster demons. Obviously,” Lisa said, pointing to Mike’s bed, “for me, that’s not possible.”

“As long as I’m alive, you’ll never be alone.”

“What’s going to happen to me? What am I going to do? I so wanted Mike’s baby—I couldn’t even get that one right.”

“Be kind to yourself. You’re stronger than you think. You need that strength now more than ever.”

When Jack Byrnes came in for morning rounds on the third day, Lisa said, “When I was at Chico nursing school
, we had a presentation from the U.K. on coma arousal. It’s a program designed to stimulate the brain of comatose patients. They had some promising results. What do you think?”

“I know the studies and the theory behind the techniques,” Jack
said. “We’ve done some of it informally by reading and playing music to patients, but these programs demand much more. I’m not sure if it’s worth it, especially; if it takes away resources we need for routine care and diverts our attention away from his medical problems.”

“I’d never let that happen, and I’ll provide the woman power. The only thing I request is that you ask
the nurses to talk to him while they’re at the bedside, and that they be vigorous with Mike’s personal care, you know, washing and massaging. That, with physical therapy and range-of-motion exercises, should give him plenty of tactile stimulation.”

Daisy continued to mourn. When Lisa got home each day, Daisy was waiting sad-eyed on the sofa for Mike. After a few moments, Daisy would come to Lisa, placing her head in her lap. At first, the dog’s grief upset Lisa even more, but soon she came to see it as the purest and most honest expression of loss by one being for another. “It’s you and me, Daisy—for now.”

Daisy became more attentive to Lisa. Each time Lisa returned from the hospital, she’d follow her around the house. At first, Lisa thought this was a sign of the dog’s anxiety, but Daisy was more relaxed
, and happier than normal. As Lisa lay on the sofa watching television, Daisy would lie next to her, lift her head to look for Mike, and then return to Lisa’s lap.

Phoebe stood at Mike’s bedside the next morning. She fought with the ICU nursing care coordinator to be Mike’s nurse for the shift. She usually got what she wanted.

She studied Lisa
, and shook her head. “You look exhausted.”

“I’m sleeping well, but I’m tired all the time.
I’ve been going to bed early, and I wake up refreshed, but soon I’m beat. I’ve missed my period, but that’s stress.”

When Lisa became nauseated each morning and when she felt the increased sensitivity
in her breasts, she rushed to the pharmacy.

“Phoebe,” Lisa
said, getting her friend on the phone, “you won’t believe it.”

“Believe what?”

“I think I’m pregnant.”