Tuesday, March 25, 2008


Another excerpt from my novel-in-progress, Ginny Bates. If you are already a familiar reader, begin below. The action in the story resumes immediately after my post two days ago. If you need background, check the links in the sidebar on the right, fifth item down, to get caught up.

February 2007

When they all got up, no one would eat anything, out of solidarity for Myra who had to be empty for her surgery. Ginny did persuade milky honey-sweetened tea into the kids. It was still dark out, the streets slick and almost empty, when they drove to the hospital.

All too soon, Allie and the kids were peeled away and left behind in a waiting room. Myra was having trouble getting warm until she was placed on a gurney and confided her fear to the nurse anesthetist. A warmed blanket was brought for her and she huddled under it, her hand out one side to hold Ginny's hand. Until they pushed her away.

When Ginny went back to the waiting room, Allie was not there. Margie said "Chris called and they talked for a while. Allie went out to the car to do a visualization, I think. She said she's going to stay linked with Mom until the surgery's over."

Ginny thought this must be what Chris would be doing if she were here, and she approved. She coaxed the kids to the cafeteria, where they ate overdone eggs and old fruit salad.

Nancy called as they were walking back to the waiting room to say she was meditating, and she felt nothing but positive energy from her entities. She was leaving for Hawaii at noon, but they had her cell phone number. When Ginny passed this on to her kids, she saw them both brighten a little.

After two hours, Margie was pacing and Ginny had stopped reminding Gillam to not pick at his face. When Ginny saw Allie walking down the hall toward them, she stood up, frightened, and said "What happened? Did you hear something?"

"No" said Allie, "I was wondering if the surgery was over early."

"Nobody's come to tell us anything" said Ginny.

"I was -- I think I was in touch with her" said Allie in a soft voice. She looked like she'd rather not spill this to the kids, but they were crowded in close, of course. "It was deeply cold, and I kept seeing flashes of light at the edge of my vision. You know, I'm not good at this sort of thing" she said apologetically.

"How was she?" demanded Ginny.

"Fine. Like -- some part of her recognized me. There were -- I think there were others there, too. A man, and a woman." Allie stopped. "I can't describe them, it wasn't -- visual. But I knew they were looking after her. It was -- like being at the sweat, only cold, cold."

"Then why are you here?" said Ginny.

"It -- the connection ended. Blip, just like that. I mean, if it was a real connection. I tried for 15 minutes to get it back, and I couldn't, so I thought maybe you'd know more" said Allie. She and Ginny both turned and looked toward the double doors where Myra had been wheeled away.

Ginny wanted to lie down on the floor and scream. But the kids were watching her intently. She forced a ghastly smile and said "There's a lot of reasons why you might have lost signal. Maybe they started up the MRI machine nearby and it crashed your bars."

Allie forced herself to laugh. They sat down again, and when Margie stood up five minutes later to resume pacing, Allie went with her.

Gillam asked Ginny hoarsely, "Do you think it matters to god when somebody is -- when there's so many of us who can't do without her?"

Ginny looked at him. He was too old for her to lie. "You mean, does your Mama have a Clarence somewhere in this hospital right now? I don't know, Gillam. What I do believe, know absolutely, is that when you live a good life, you create a web of connection around you that makes you safer. Binds you here. And your Mama has the strongest ropes I've ever seen."

Half an hour later, Dr. Desai came through the double doors. She had on a clean yellow overblouse, and she was smiling. That smile enabled Ginny to get to her feet. She said Myra was already starting to wake up, but the length of this surgery meant her recovery from anesthesia might be much longer. She said there had been no visible tumors outside the uterus; her ovaries had been studded with polyps but they all looked ordinary; there was no ascites and nothing unusual anywhere. She'd taken several biopies.

She said the only worry was the size of Myra's incision, because of her fatness. She was going to have to be less active than most hysterectomy patients until the staples came out and her incision was reliably closed. Because of that, she was going to put Myra on Lovenox, a drug to prevent blood clots from inactivity, and also call in physical therapy to help her regain function without stressing her incision. She walked with them to Myra's hospital room.

Myra looked blank and bewildered, as she had right after the D&C. She held tight to Ginny's hand and lifted her face for everyone to kiss her. The IV was already running and Dr. Desai said she had been given some morphine to deal with the pain. The catheter would remain in until she could sit up to pee the next day. Ginny leaned her hips on the bed, laying her face next to Myra, and let relief scour through her. Dr. Desai then left, reminding them her fill-in, Dr. Maxwell, would do her rounds later in the day and until she returned on Saturday. They wished her a happy vacation.

Allie tried to josh with Myra a bit, but Myra wasn't talking much yet. She kept closing her eyes, though she was not completely asleep because her grip on Ginny's hand did not release. A tall black nurse with white hair was in and out of the room. After a few minutes, a tech came in with blue booties that he slipped onto Myra's feet. They were attached to an electronic device that created pneumatic pressure at random intervals. This was also to prevent clots in her legs, forcing blood up from her feet.

Myra hated them instantly, tried to slip them off her feet as soon as the tech left. When she dislodged them, a beep would start sounding. The nurse came in and repositioned them. Ginny said "Myra, you can't mess with these, you have to leave them alone." But Myra kept slyly trying to get out of the socks. Ginny began readjusting them every time the beep started. The nurse thanked her and said they would only be on part of the day and night.

Ginny looked at her watch and told the kids they needed to eat lunch. She handed them money and asked for maybe a baked potato or some yogurt for herself. Allie went with them. Ginny slipped off her shoes, let down one of the railings, and lay on the edge of the bed, next to Myra. Myra gave a sigh and seemed to go to sleep then.

After a couple of minutes, Ginny remembered all the other people who would be worried and waiting for word. She returned to the bedside chair and pulled out her cell, calling Chris (where she had to leave a message because they were surely at the funeral or sitting shiva right now), Patty's machine, then her father. She changed the outgoing message on their own machine, put her cell away and got back into bed with Myra.

When the tall black nurse came back in, Ginny didn't budge and the nurse didn't look upset after she made sure Ginny wasn't encroaching on Myra's lines or space. She said her name was Velda. Ginny gave her name and, stealing the idea from Edwina, identified herself as Myra's wife. Which also did not surprise the nurse.

Allie and the kids returned with a baked potato topped by broccoli and cheese. Ginny returned to a chair to eat. Allie sat down on the edge of Myra's bed and said "I brought you something special from home." From her pocket she pulled a small Ripley action figure, putting it into Myra's hand and saying "Your role model." Myra smiled at it and said "Thank you." She then handed it to Margie to put on the bedside table. A while later, Velda was changing Myra's IV and saw the Ripley figure. She pointed to it and asked Myra kindly "Now who is that?" Myra said "I have no idea." Ginny grinned, waiting for the joke, but that was it. She looked around to see if Allie had noticed; Allie, however, was talking with Margie.

Ginny finished her lunch and stashed her trash, returning to Myra's bed. Myra looked at her and said "Something's wrong."

"What's wrong, honey?" asked Ginny. The kids and Allie turned to listen.

Myra looked intently at Ginny, expressionless, and didn't speak. Ginny said "Myra, you had surgery this morning. You had a hysterectomy. Do you remember that?"

After a couple of seconds, Myra shook her head. Ginny said "You had a big operation, and you've still got anesthesia in your system. It'll be better by tomorrow morning. We're taking care of you, you're okay."

Myra closed her eyes. At 4:00, Velda left, to be replaced by a moon-faced white woman with long blonde hair showing black roots at her part. The new nurse was named Francine. She was swamped, but nice to Myra, asking her if she'd passed flatus yet. Gillam giggled as Ginny answered "Yeah, she's passed gas a couple of times." Shortly after, Edwina arrived. Occasionally Ginny or Myra's cell would ring, and Ginny always gave it to one of the kids to answer. When it was Chris, Allie took it and walked out in the hall for a long chat.

At 5:00, Francine brought in a tray for Myra, a bowl of minestrone-looking soup and some jello. Myra sat up with a wince and took a spoonful of the soup. She immediately began gagging. Ginny yelled at Francine, on her way out the door, and Francine pulled a small basin from the cabinet. Myra said "There's something wrong with this soup." She took a sip of her water, and vomited onto the tray. It wasn't much, but enough to send her into her usual cycle of reactive puking if she looked at it.

However, she didn't heave again, though she stared at the tray. Francine cleaned up the mess, while Ginny washed Myra's face. Francine brought in another container of jello, which Ginny opened and offered a bite to Myra. Myra spit it back out instantly, saying "It tastes awful." Ginny tried it and found nothing wrong with it. Francine said sometimes folks had strange reactions post anesthesia; they'd keep her on an IV and try again in the morning.

Myra was not very conversational. Mostly she lay with her eyes closed. When asked a question, she would respond, but she didn't laugh at Gillam's jokes. Ginny hoped to talk with Dr. Maxwell, but he didn't show up. She finally asked Francine about him, and she said he had come by and read the chart, posted orders, but said he didn't need to see the patient.

At 8:00, Francine reminded them visiting hours were over. Ginny said she intended to spend the night, and Francine nodded. Ginny made a list of things for Margie to bring after school the next day -- she insisted both kids go to school, despite Gillam trying to argue with her. Allie had to leave at dawn again, to drive to Vancouver, and although she offered twice to sleep at the house with the kids, Ginny refused. She fixed her tired gaze on Margie and said "You're in charge. You'll make sure the alarms are set and everything's safe, right?" Margie squared her shoulders and promised she would.

Allie sat down on the bed to give Myra a long hug and remind her she'd see her again on the weekend. "You're doing great, pal, keep it up" said Allie. Myra said "There's something wrong." Allie's expression turned grave. She took Myra's hand and said "What is it? What's going on? When Myra didn't answer, Ginny said "This one is a lot harder on her. I wish she could drink water, flush out her system faster." Allie talked to Myra a while longer, with Myra just nodding occasionally. Finally she left with Edwina and the kids. Ginny washed her face, brushed her teeth with the corner of a washcloth, and slid onto her side next to Myra.

Even with the lights down and the door almost shut, noise was an issue, as were regular intrusions by Francine, then another nurse, to check IV, catheter, or adjust the pneumatic booties which had been put back on Myra's feet. Ginny slept no more than half an hour at a stretch. She couldn't tell if Myra was sleeping or not. She was still and quiet, but she'd been that way all day.

Myra was brought a breakfast tray at 6:00. Ginny gave her milk first. Myra immediately vomited. Francine had a frown, and said it wasn't good for her to be emptying out like this. They tried one more item, a sip of cranberry juice which Myra spit out, complaining it tasted "like sewage". Ginny drank the rest of the juice and decided not to go for her own breakfast until Dr. Maxwell arrived.

Francine also wore a frown when she changed Myra's catheter bag. It did not look like much urine to Ginny, and the color was mustardy. Ginny called her kids at 7:00 and talked with each of them. They seemed to be okay. Dr. Maxwell finally showed up at 8:00, a fussy man with red curls and no inclination to make eye contact. Ginny was determined to get information from him.

"Are you going to keep her on the IV? Will she be able to get better on that?"

"We can maintain her a while on different kinds of intravenous feeds" he said. "But we are concerned about her renal function. Her kidneys seem to be sluggish. We have to monitor intake until we get that resolved."

He lifted the sheets, pulled up Myra's gown and peeled back the bandage on her abdomen. Ginny did not look away; instead, she moved in for a closer view, taking in the staples and the pucker where it looked like underlying tissue had been excavated out. "Is that how it's supposed to look?" she asked Dr. Maxwell. He nodded and replaced the bandage.

As he was writing things on the chart, which Ginny was later unable to read, he said "There's no cause for concern. Her metabolism will kick back in. Try to impress upon her the need to eat. We can't release her until she's eating normally and has a bowel movement. I'll check back in later." He left after having been in the room less than five minutes.

Myra still only speaking when spoken to, until the early afternoon when she tried to shift position slightly and said to Ginny, "It hurts." Ginny rubbed her hand and said "Yes, sweetheart, the incision is large." When the new nurse came in, not Velda, Ginny said "She's complaining of pain." The nurse looked at the orders, then at the IV. "She's got a dose of morphine on board, she shouldn't be experiencing pain. But patients on morphine frequently hallucinate." She left again. They were very busy on the floor that day.

Myra was still gagging when she tasted anything, even water, and would progress to vomiting if she tried to swallow. One nurse got Myra to open her mouth and inspected her throat so deep that Myra gagged then, too, but the nurse said there was no obstruction. When the kids arrived after school, Ginny handed Gillam a handful of change and told him to go buy a Coke and Myra's favorite candy bar, they'd see if she could keep that down. He was too rattled to get anything for himself.

He held a Hershey bar in front of Myra's face with an eager expression. She said "I am so hungry" and reached for it, then stopped herself and said "It hurts". Gillam peeled back the foil for her and broke off a square. She popped it into her mouth, bit down, and three seconds later vomited down her front. This brought the nurse in, who said Myra could not afford to be retching because it might tear her incision, and they should not bring her anything to eat that wasn't cleared with a nurse or doctor.

"Well, I'm not happy with how she's progressing" said Ginny. "I don't think the morphine is working for her pain, and I'm worried that's was causing her inability to eat." The nurse said she would pass it on.

Ginny told Margie and Gillam she, too, had not eaten all day. Gillam immediately jumped to his feet and offered to get her anything, anywhere. She sent him to the cafeteria with a list, for a meal then and something she could save for later. Margie handed an overnight bag to Ginny, and Ginny went into the bathroom to clean up, brush her teeth with a real brush, and change clothes. After she ate, she felt merely exhausted but no longer lightheaded.

Both the kids had homework. Ginny gave them the arm chairs, lowered Myra's tray table so they could share it, and had them start on it. Ginny sat carefully next to Myra, who repeated "It hurts" if there was any motion. Edwina arrived a while later, and Ginny talked over her concerns with her, choosing her words carefully because Margie and Gillam were openly listening.

"I don't know anything about morphine" said Edwina. "I wish Allie or Chris were here. Listen, why don't you call Davonn, he was a drug user as well as alcohol?"

Ginny grabbed her phone and managed to get through to him. After she hung up, she said "He thinks I might be right, he says lots of people have really negative reactions to morphine. The hospitals use it first because it's cheap." She walked out of the room toward the nurse's station. When she came back, her face was pale with anger.

"That fucker Maxwell came by but didn't bother to check on us directly. He's changed her morphine to Demerol, and they're bringing in a shot now" she said. The nurse who slid a needle into Myra's IV line also reapplied the hated booties, with Myra resisting between complaints of "It hurts". Gillam was becoming agitated, cracking his knuckles and unable to read his text.

Ginny waited for the new drug to kick in. Myra began dozing after fifteen minutes, even with the booties on, and Ginny leaned back against the wall in a near paroxysm of relief. At dinner time, she refused to leave the room, and Margie said "Then I'm not either." They ordered Chinese food delivered, and Edwina walked downstairs to meet the driver. Ginny offered Myra some rice. Myra took a single grain in her mouth, managed to swallow it despite heaving, but shook her head at any more. She repeated "It hurts" every time she moved. The rest of them ate wthout pleasure.

Shortly before 8:00, Ginny told her children "I don't feel okay about leaving her alone overnight. Not the way things are. But I'm concerned about you spending too much time on your own." Edwina said "I'm going home with them tonight. We'll keep each other company, I won't have to face an empty apartment without Allie." Ginny hugged her gratefully. After they left, she tried to call Chris and Sima but had to leave a message.

The night shift nurse was another new face. Every time Myra woke up, she said "It hurts". Ginny tried to find out if the Demerol dose was adequate, but the nurse couldn't explain pharmacology or therapeutic levels, she was young and inexperienced. She promised to have Dr. Maxwell talk to Ginny the next day.

Ginny pushed the two chairs together and slept upright, her feet in the second chair, so as to not disturb Myra. When Myra complained of pain, Ginny stopped reassuring her, refusing to lie any more. Instead she said "I know it hurts, I believe you" and gave her a kiss. Her sleep was ragged.

The nurse who came in at 5 a.m. was Velda again, and Ginny felt a rush of hope when she saw her. She checked Myra's catheter bag, which was still very low, though the urine was not as dark, Ginny thought. Velda was taking her temperature and pulse. With every minute motion she made, Myra was now yelling in pain. She kept saying to Ginny "It hurts, Ginny, it really hurts." Then she said "I can't believe you are letting them to this to me. If you really loved me, you'd stop the hurting."

Ginny stood up beside the bed. She looked at Velda and said "Something's wrong. You don't know this woman, but I know her inside out. She's not a complainer. She's tough. Something's wrong."

Velda said, "I think maybe you're right." She lifted Myra's bandage and looked at the incision, touching around it with her fingers. It was healing rapidly, dry, not swollen. When she pushed gently with her fingers near the incision, she said "Ms. Josong, is this what is hurting you?" Myra looked at her blankly. "Is this what hurts?" Finally Myra shook her head.

Velda pulled down the covers and inspected Myra's legs, bending the knees slightly, checking the toes. She pulled Myra's thighs apart and looked at her groin. Replacing the sheet, she went to the head of the bed and got Myra to lift her head from the pillow. Myra moaned as she did so. Velda untied Myra's gown and pulled it down, exposing her chest and arms. She inspected them thoroughly.

"We need to get her to sit up" she said to Ginny. "You take her arm on that side and let's do all the work for her, pull her just to upright, not further." On Velda's signal, Ginny pulled. Myra yelled again briefly. Velda leaned behind her to look at Myra's back.

Ginny saw it at the same time as Velda. On Myra's low back, just above her buttocks, was a red line about five inches long. The skin was not broken, but when Velda put her hand gently onto the line, Myra shrieked. Velda looked at the bed where Myra had been lying, unmoving, for over two days. A small bulge under the sheet, a wrinkle in the mattress pad, matched the size and angle of the red line exactly.

Velda made a sound of anger. She told Ginny "Keep holding her upright. We're going to have to change this bed, get her to stand up. I need help." She left the room and came back with a young nurse and a bedside commode. "As long as we got her up, let's see if she can have a b.m." Velda pointed out the mark on Myra's back to the new nurse, who shook her head.

"What is that?" said Ginny.

"The beginning of a decubitus" said Velda. "A pressure sore. If we hadn't caught it, there would be skin breakdown. I think we're in time to treat it."

"Is that what's been hurting?" said Ginny.

Velda looked at her. "The pain is exquisite. It's like a severe burn."

Ginny felt faint. They had Myra up on the side of the bed. Now that nothing was pressing against her back, she had stopped moaning and did not appear to be in pain from her incision. She was weak and seemed to have trouble understanding their instructions without repetition. They were trying to hold her weight as she stood up, but also managing the IV line and the catheter snaking down her leg. Ginny came over to that side of the bed and took charge of the tubes running into Myra. They got her safely on the toilet.

"Don't strain, Ms. Josong" said Velda. "But see if you can pass anything."

The toilet chair was open over Myra's low back, so she could lean back in it without pressure. The other nurse left and Velda began stripping the bed swiftly. After a minute, a horrible odor came from the toilet chair. As Velda walked out with the linen, she said to Ginny "Don't let her get up."

She returned with fresh sheets and a mattress pad. She took meticulous care in tightening and smoothing each item that went on the bed. When she was done with that, she heated up some wet towel-like cloths sealed in a bag, then pulled off Myra's gown and gave her a thorough wash. Myra began moaning again, this time from relief. With a final rag, Velda leaned Myra forward and wiped her ass.

"Why does it smell so vile?" asked Ginny.

"Happens after anesthesia" said Velda. "Plus it's been cooking in there a while."

Velda put a clean gown on Myra and walked her over to the chair. Myra was walking a little easier. "Sit here but don't lean back" said Velda. She took the bucket from the commode chair and went into the bathroom. There was a long sound of running water. After the washing was done, Velda dressed the line on Myra's back using a skin-like substance that she peeled off a paper. Ginny helped lead Myra back to the bed, then Velda placed a series of pillows down Myra's back so even if she leaned all the way onto the bed, her lumbar area would not be touching the mattress. Myra sighed once she was prone, and went straight to sleep. Even when Velda gave her the Lovenox injection into her abdomen, Myra did not wake up.

Ginny said "Why couldn't she tell us before this something was hurting on her back?"

"Maybe the morphine" Velda looked at the chart. "But she's been on Demerol for twelve hours now." Velda pursed her lips. "Be sure to talk to Dr. Maxwell about how she's not being herself."

Myra refused breakfast. Ginny didn't push her. Not any more. She ate Myra's breakfast for her. When Edwina called to reassure her about the kids making it to school, Ginny told her what had happened. Edwina said "Allie's cell is not working, I don't think -- I've left her a couple of messages. I'm going to leave a message for her at her hotel."

At noon, Margie walked in the door. "Don't yell, but I can't stay away, I turned in my assignments and told them I was leaving, I can afford to miss the classes this afternoon." Ginny said "All right. I'm glad to have you. Leave a message on Gillam's cell about where you are."

"I already did" said Margie. She turned to Myra, who had woken up, and said "Mom, you've got a lot of calls on the voice mail at home, people who love you sending you their best. Would you like to listen to them?" Myra paused, then nodded. She didn't reach for the phone, so Margie picked it up and put it her hand. Myra looked at the dial and carefully pressed the 7 button four times in a row, then placed the receiver up to her ear.

Margie looked at Ginny, who stepped over and took the phone gently from Myra. "You have to dial our access number, honey. Here, let me do it for you". She dialed the phone, then handed it back to Myra. "When the outgoing message ends, push 686 and you'll get the first saved message." Myra looked at the dial again, then pressed 7 twice before placing the phone to her ear.

Ginny took the phone away again. "How about if we do this a little later?" she said very gently. Myra nodded and closed her eyes.

"Mom" breathed Margie. "I know" said Ginny. "My god."

Ginny tried the hotel where Chris and Sima were staying and talked to the desk clerk, who had no information about their whereabouts. She left a message for them to call her instantly. She called Edwina back and talked to her for a minute, asking Edwina to have Allie leave for home as soon as she could. She left a message on Nancy's cell phone; she didn't have the number where Nancy was in Hawaii. She called Dr. Desai's service and asked if she could get through to Dr. Desai directly, and was deflected to Dr. Maxwell. Ginny hung up, feeling increasingly desperate.

"What about Dr. Bratcher?" asked Margie. This was Ginny's family practice physician, whom both kids had begun seeing once they outgrew their pediatrician.

"Myra's only seen her once, years ago for a bout of bronchitis. She's mostly only gone to Aradia, and since they closed down, she's -- she doesn't have a doctor who knows her" said Ginny.

Velda came back into the room and Ginny said "If Maxwell shows, tell him there's been a change in her condition, it's urgent that he examine her." Velda looked startled and Ginny told her what had happened, then asked if they could get another doctor on the floor or from the ER to come look at Myra. Velda, obviously torn, said "It doesn't -- they won't agree it's an emergency, not enough to disrupt the process. Dr. Maxwell is supposed to make rounds this afternoon, we have to wait on him."

After Velda left, Ginny stood for a minute, watching Myra. She took Myra's hand and said "Honey, do you remember coming to the hospital for your surgery?"

Myra nodded slowly. "Those beets" she said, not smiling.

"Not that surgery" said Ginny. "Your hysterectomy, the big surgery you just had." Myra looked confused and stayed silent.

"Last weekend, we went to Bloedel" said Ginny. "You remember the red-winged blackbird you saw, how beautiful it was?"

Myra shook her head blankly. "How about last shabbos, where we had two kinds of meatloaf and Sima's kiwi tart?" persisted Ginny. Myra's face changed a little then. "The potatoes went too long but nobody minded, we like the brown bits" said Myra.

"That's right" breathed Ginny. "Okay, so that's the last you remember?" After a long pause, Myra nodded. Ginny wanted her face to show expression, anything, even fear, but it was smooth.

She said to Margie "Stay here with her. Guard her. I'll be in the hall, I have to make a call." She left the room.

When she came back in, Margie looked even more upset: "I asked her if she wanted to watch TV. I turned it on, and one of the channels was showing a rerun of Northern Exposure. You know how much she loves that show. Chris in the Morning was talking, and after a bit, Mama turned to me and said 'Could we find a channel that's in English?' But it was in English."

Myra's eyes were closed again. Ginny said "Myra? I called Jules Lefkowitz. She's the only really good doctor I know. She's one of the best. Do you remember who Jules is?"

Myra paused, then shook her head. "Well, she's coming by at 3:00 to look at you. She's going to help us."

Ginny sat down suddenly, refusing to cry. Myra closed her eyes again.

Margie said "I don't know this person, do I?"

Ginny shook her head, then said reluctantly "She's one of my exes. We haven't seen each other since before you were born. She wasn't thrilled to hear from me, but I begged her....She's one hell of a doctor. And the thing is -- Myra's always been crazy jealous of her."

Margie looked at Myra's blank face. "Oh, god."

When Jules wasn't there by 3:00, Ginny was having trouble thinking at all. Margie's cell rang and she answered, saying it was Gillam. She talked to him briefly and said "He needs a ride from home."

"Go ahead" said Ginny. Five minutes after she left, Jules walked in carrying Myra's chart. Her blonde hair was now streaked with grey and long, down to her shoulders. She had on a tailored women's suit underneath her white coat. Ginny wondered what on earth she'd ever seen in her.

"Hello, Ginny" she said, using a cool tone to counteract the awkwardness.

"Jules, I can't thank you enough. I really can't."

Jules was looking through the chart. She got very still after a while, looked around for a chair, sat down, and kept reading. Edwina walked in before she was done. Finally, Jules closed the chart and looked at Ginny. Ginny forgot to introduce Edwina, staring at Jules urgently.

"I'll cover everything, because I'm not sure what you know" began Jules "She's in renal failure."

Edwina sucked in air. Ginny said "That means her kidneys, right? Are her kidneys failed?"

"No, not completely. It could come completely back, and this morning's labs aren't in here so I can't tell if she's responding. The ins and outs are off kilter. I'm worried about her glycemic state, but so are they, seem to be on top of it. The switch in pain medication hasn't made any difference, as far as I can determine. There is no sign of any other organ damage or failure. Her saturations are good, her telemetry is fine -- her heart and lungs are fine -- and there's no sign of overt neurological deficit, but no formal testing has been done." She paused. Here it comes, thought Ginny. "There was an episode during her surgery. It doesn't show up on the dictated op report, but it's there in the anesthesiologist's notes. Her pulse oximetry showed a precipitous drop for a period of two minutes. Her sats went down into the 50s. They adjusted her flow and other things, and it came back to normal after two minutes. But to me it looks like she had anoxia during the surgery."

"I don't know what anoxia is" said Ginny, having to clear her throat to get it out.

"Loss of blood supply to the brain. It was brief, if it really occurred. Brief enough to cause only partial damage. I suspect that's the source of her renal failure, not the morphine. And it could be temporary."

"You're talking about brain damage. She may have brain damage." Ginny was looking at Myra, who seemed to still be asleep.

"Possible. And possibly reversible. You need a neurologist to check her out."

At this point, Velda came back in. Jules stood up and said "I'm Julia Lefkowitz. I'm doing a consult on this patient at her family's request." She didn't offer to shake Velda's hand. Velda said "Are you going to assume care?"

"No, Dr. Maxwell is the attending. I'll call him when I leave here. In case I can't reach him, I'm leaving him a note about my impression. I am requesting a neurological consult for -- " she paused, glanced down at the chart -- "Ms. Josong. I have privileges here and don't advise waiting for Dr. Maxwell, whom I'm certain will sign off on this, so I'm going to ask Dr. Hilary Reading to do an emergency neuro assessment as soon as possible. She's also on the staff list for this facility. I'll dictate my note into the chart this afternoon, but for now, I'm adding fall and aspiration precautions to this patient's orders."

Velda nodded.

"Do you know if Dr. Maxwell has requested a nephrology consult?"

"Not yet, he's waiting on today's BUN and creatinine."

"All right, I'll leave that to him."

Jules turned to Ginny. "Hilary Reading is a superb neurologist. She's probably going to want to do a brain scan and run other tests. She'll find out what there is to find out. I can't stay on this case, but if you need a follow-up consult, feel free to call me." She shook Ginny's hand, then Edwina's, then left with the chart for the nurse's station.

Velda began putting the pneumatic booties onto Myra's feet. Myra woke up and protested. Ginny lowered the bed rail, scooted in next to Myra, and said "Here, focus on me. Put your arm around me and try to match my breathing rate." Myra pulled Ginny in tight and closed her eyes again. Ginny could feel a faint tremor in Myra's arm. Ginny said to Velda, "Be sure to tell Dr. Maxwell he has to speak with us when he gets here."

Velda said, "Oh, he'll be paying attention to you now". She added, "Can I get you all anything else?"

"No. Velda -- god bless you."

At that moment, Gillam and Margie came in. Gillam was carrying one of Myra's spinach lasagnas, heated through in the microwave at home, and a loaf of challah on top. Margie had a bag containing wine, glasses, candlesticks and candles. Ginny stayed entwined with Myra but pulled her children in close and told them what she'd just found out.

Gillam stood protectively beside Myra and whispered "What are we going to do?"

Before Ginny could answer, Jules walked back in. She hesitated at the sight of Ginny draped around Myra and the two teenagers. Ginny said "These are our children. Margie and Gillam. Kids, this is Dr. Jules Lefkowitz."

Jules looked at them appraisingly, lingering on Margie's face, and said drily "The very image of you." She went on "I just thought of something, and checked in the PDR out there to be sure. Lovenox, in less than 5% of cases, has a side reaction of causing a disruption in the --- the taste buds, to make it simple. Patients report that anything placed in the mouth tastes extremely caustic. I'm leaving a recommendation for Dr. Maxwell that he switch her to another anticoagulant. If that's what's causing her inability to eat, it will take a few days to completely clear her system, but her normal function will return. If you can get across to her what's happening and can persuade her to eat and drink, it will make a serious difference in her recovery."

"Thank you, Jules. Thank you for helping our family."

Jules hesitated again. "Good luck, Ginny." She left with a brisk stride.

© 2008 Maggie Jochild.

Afterword: I want to take the opportunity here to thank Kathy Plakovic, a precious friend and a gifted healer, for her editing and suggestions with regard to this section around Myra's surgery. Her revisions have made it much, much better (and any errors remaining are all mine). If you need a Nurse Practitioner in the Austin area, you won't do better than Kathy.

I first wrote this section of the novel over a year ago, out of sequence, early in the process. I knew this episode was going to play a major role in the story, and I got 30 pages of it down. It's been fascinating to me how extensive my recent rewrite has had to be. This is not just because of the goofs and inconsistencies Kathy caught, but also because my relationship to the characters has altered, and the story has had to change to match.

What happened to Myra in this section more or less happened to me with my knee surgery. Except (and this is a big exception) I had no Ginny, no Allie or Chris or Nancy. I had no one who saw what was occurring, no doctor who diagnosed me, no help at all with what turned out to be brain damage. I did have some wonderful friends who showed up and did what they could, given their understanding (I couldn't express what was happening for a long time), and I'll never forget their kindnesses: Heather Burmeister, Ginger Webb, the Deagans, Donna Hoffman, Nancy Crossthwaite, Ixchel Rosal, Dawn Surratt, Jamila Tharp, Kathy Plakovic, and my little brother Bill immediately come to mind.

Of the three people in whom I placed my deepest trust (plus power of attorney), one was persistently misled by impatient, arrogant physicians to ignore what I was trying to tell them. I forgave her for her error right away. The other two, old friends, betrayed me in egregious ways and, eventually, I ended those relationships, in no small part to how they failed to stand by me when I was in my most terrible trouble.

Get powers of attorney, living wills, and clear instructions in place for yourselves, no matter your circumstances. Think about the unthinkable and make sure you are your own best advocate in advance.

And my eternal gratitude to Dr. Reading who, almost three years after my nightmare, listened to me well enough to piece together what had occurred and help me make sense of it all. Answers, and reassurance, are never too late to bestow.

1 comment:

letsdance said...

what a blessing it is when we have friends/family who listen and who advocate for us. what a blessing to have doctors and nurses who listen and search for answers.

it was frightening when Myra was complaining and no one knew what was wrong.

you are a phenomenal woman and writer, Maggie!