I Don’t Know What ‘Cardiac Arrest’ Means Anymore
For our 13th anniversary
A master document of medical records has sat open on my laptop for the past few weeks. In total, it consists of 2,119 pages. 2,119 pages of physician reports, blood tests, radiology assessments, social worker interactions with family, intake forms, consent forms, allergy forms, history forms, release forms, pre-transplant pharmacology consultations, post-op analyses, EKG analyses, ECHO analyses, administered medications, miscellaneous notes, and an infinitely more overwhelming deluge of language that cannot be simulated in simply a sentence. It is a disorienting, nonsensical mess to parse through. 2,119 pages of unintelligible medical slop. 2,119 pages of sterile, righteous glossolalia—read through what is said and notice the doctor’s head bent in prayer; notice as he recites in tongues from the devil’s book, preserving life through intellectual inflection as he exorcises the soul. Snap your head back and allow his magic to work. June 27th, 2012 was the day I died. Here is the first passage, of 2,119 pages, that revived me, presented to you precisely how it’s written:
“Patient is 11yo male no PMH who was running at botanical gardens when he had a witnessed syncopal event, and subsequently found to be pulseless. CPR was provided by physician bystander and pulse was regained. He was brought to Kings County Hospital where he was found to be groggy and thought to be post ictal, he received antiepileptics. His MS waned, was hypotensive and desaturating and was intubated. Echo found EF to be 15%. Also found to be in Vtach which required shocking and pressors. He was transferred to CHONY for ECMO consultation and was started on VA ECMO via 15fr L fem artery catheter, and 11fr fem vein catheter. Because of the caliber of the retrograde arterial catheter there is concern for limited perfusion of LLE. Vascular is consulted for insertion of peripheral perfusion catheter. At the time of the consult patient undergoing atrial septostomy to unload poorly function LV.”
Patient
You do not understand yet, and that is okay. Let me break the line down for you: by “patient” they mean me, Lucas. You will notice my name is absent from most of the documents, but it has been truncated in full to the convenient “patient.” Sometimes you can see it shorthanded to “pt,” for even further efficiency.
is 11yo male
By “11yo male” they refer to my age and genitalia. It’s still 2012, so we are not quite yet in the practice of asking pronouns, and thus leaving everyone uncertain on the other’s gender. Obama will be comfortably voted back into office in just a few months, but right now the national media still thinks it’s a toss-up between him and Mitt Romney. Who can blame them? The Middle East has been a disaster, Obamacare is going to be a disaster, and the gays are trying to kill god or something. All on Barack’s watch, if you listen to the drone of Fox News, playing from the waiting room’s corner TV. “How can we be sure he’s not a Taliban plant?” Greg Gutfeld is saying seriously. He places his $15.95 officially branded Gutfeld! mug down on the mahogany table and leans forward, towards the blonde woman sitting across. Somehow, she says something about Michelle’s penis and hilarity ensues. The cast of Fox & Friends finds themselves rolling around, laughing so hard they are in tears. A black man who unironically calls affirmative action reverse racism suggests Barack is a bottom and Gutfeld is punching his own chest. Perhaps his lung has collapsed—no he’s just doing a bit. It appears Gutfeld thought the black man’s joke was funny. He takes a break from not breathing to introduce the next segment: a real-deal, journalistic transvestigation of Michelle Obama. The TV will carry on like this for a while. Conversations of Michelle being the real man, blatant queerphobia, the nationally televised reinforcement racism of gender-swapping black men and black women will serenade my mother for hours. She sits upright and motionless in the hard, plastic chair. Staring straight ahead, she does not even process the crimes of Fox News. Usually she’d fly off at the white man on the screen—how can this be the thing you’re criticizing Obama for, Greg Dickfeld, when he’s been bombing children across the Arabian peninsula his whole term? But words like that are nowhere to be found. She’s busy, you see. She’s trying to forget the sight of my blue, bloodied lips while still remembering the look of my face. It’s a delicate, dissociative process that requires her full concentration to maintain my skin’s tender pink. When she slips up, when the blue invades thoughts of pink, she is back in that ambulance, back to holding my lifeless hand in hers. She can’t do that. So she sits and she stares. And she remembers me healthy. She remembers me pink. He’s healthy. He’s pink. He’s healthy. He’s pink. She does this for as long as she can before blueness and death threaten her vision. Then she checks the time. Only ten minutes have gone by since the last she looked. Afraid of her fear, she goes back to sitting and staring. Healthy and pink. Healthy and pink. In three weeks, I will wake from a coma with suspected brain damage. A doctor will come to the bed to test my cognizance. He asks me, “who is the current president of the united states?” I will respond, “don’t you know my mother cried with joy when he won?”
no PMH
According to the Mississippi Department of Human Services, "no PMH" means I'm something of a newbie. “No past medical history” indicates we are operating with a certain kind of history here. A language explicitly medical, a story kept only during bodily emergency. In a way, this line indicates a privilege. The dad in me, you could say. He is just getting to the hospital now, hopping out of the cab, and running into CHONY; this time at the right ER after just missing the ambulance’s last stop at Kings County. It is the first time he has stepped into the emergency room with an actual emergency and he’s no idea what to do. The stress is overpowering. He’s smoked three cigarettes in the last half hour alone. He can’t stop pacing, he can’t stop moving. Fucking christ someone needs to tell him if his son is going to be okay. He won’t stand for it. He cannot allow this disrespect and—notice—he’s riling himself up to be combative. Anger instead of fear, that’s the manly way and my father performs man. Notice too how he fails to fight the forces he wants to. He wants to beat the shit out of being scared, so he calls himself angry. He wants to shake the doctors violently for doing nothing right, so he is quiet, pulling his phone out to play games when they march up to him and my mother. Always having so many more question, those pesky doctors, he broods. They should just do their job. He doesn’t know that family histories can be such a hard thing to gather, as the intern interviewing my parents is nerve-rackingly proving. The freshly divorced pair of polar opposites perfectly practice their art of collective nonsense. Their issues, in confluence, create a harmonious projection of discomfort. The intern gulps. If you’re already squirming, you were never built for it in the first place. Don’t ask them about before because it won’t matter if you’re not going to record what it’s like to be between my mother’s panic and my father’s rage. What use is that sort of history to you? There are no medical abbreviations that can describe a history as incomprehensible complexity, as an unseen and looked past web of pain. Why ask the kid’s dad if his son has ever experienced chest pain before? He would’ve just told the kid to stop faking. Why ask the kid’s mom if her son should have surgery or not? She’s just going to get insecure about her confusion and tell you to make that decision instead. But, alas, the poor intern keeps on asking about before June 27th, 2012. What are you fucking doing man? What use are strep throat diagnoses or chicken pox vaccines for the doctor treating the sickest patient in the hospital? What medical history do you need to see when it is the listening that will help you? Turn to the kid’s mom and let her tell you, “he’s allergic to penicillin.” Do not ask her, sit there, and listen. The woman can’t stomach having any piece of information somehow useful stuck in that crazy brain of hers. Just shut up. Let her talk and now let’s be cordial, shall we? My mother rattles off every stray fact she can find in her hoarder’s head while an intern wildly tries to keep up with her unmitigated adrenaline. “Oh and he’s allergic to penicillin!” my mother says unprompted. Not following directions, the intern asks her, “what happens when he takes penicillin?” Incredulous, she will respond, “do you not fucking believe me?”
who was running at botanical gardens
Every year, the cherry blossoms bloom in Brooklyn. Children under 12 are allowed free entry to the botanical gardens all year round, but freeness is only offered to adults during the winter, so my memories are colored by images of barren branches. Impressions of cold, tranquil walks with mom meddlesome to my recreations of that dead summer day. Faintly, a pink pollenates the dry sticks. I swear the picture of the trees in their full, regal, and coral attire live somewhere in my brain. I wonder if I’ve blocked out elementary school field trips to assuage the fear that I’ve always loved the flowers this much. Weirdly entrenched in my toxic masculinity, cherub pistils watch an old friend walk through the garden gates. Today is their coming out party—the annual cherry blossom festival—and they wouldn’t have had me miss it for anything. They oversee from the sky, as me and Ysa and our closest friends play a frenzied game of tag. Running, laughing, the trees lovingly admire their flower boy’s joy. Suddenly, I must stop. Pain in my chest. Difficulty with my breathing. I sit on a rock to catch the air. I imagine it was breezy in that calming, early summer sort of way. Wind kissed face lolling lazily towards the grass as I plummet from the rocky seat. Petals settle gently—a caressed cheek to show they care. My best friend’s mother encounters my lifeless body. There should be screams. There should be a park full of sobbing onlookers, thousands of pollen tears. Lara is crying for a doctor, anyone at all who can help. And cherry blossom trees, now possessed by protectiveness, will call out and ask, “do you think he’s ever going to be the same?”
when he had a witnessed syncopal event
According to the Cleveland Clinic, “syncope is also known as fainting.” This is only a temporary loss of consciousness. Pt. will recover shortly. If you are reading, there is no need to worry. A nurse placed there by happenstance is performing chest compressions while a parks department employee runs up with the defibrillator. “I don’t know how to use this fucking thing,” she tells him. So he pulls out the manual and reads her the instructions out loud.
and subsequently found pulseless.
By this, they mean I really beefed it. Heart went out like the lights and now I’ve gotten everyone who cares about me up in arms about it. Look at them running around like that chicken from Sleepy Hollow. How shameful it is of them, for not knowing what to do when the emotion overwhelms you. My father gets quiet. When I was little, I once ran too far in the dog park. Free from the plodding trod of our border-collie-mix Abby, I sprinted down the steep hill of sandstone concrete with my father’s permission. Sparing patches of grass whizzing by are what qualified the measly park an official responsibility of the New York Parks Department. (To me, there was no place any better in the world.) Black chain link fence stooped over the Prospect Expressway in gargoyle fashion; fading chitters from the always-locked community garden’s weeds, taunting—these things pushed me further. I ran with the cars, feeling the rush under my outstretched arms, laughing, elated with the speed I was traveling. Coming to a screeching halt at the entrance to 6th Avenue, I turned back towards my father and Abby. It was only then when I remembered I was supposed to stop halfway down. Fear froze me in indecision: to walk up and profusely apologize or to wait and face his wrath. My legs made the choice for me. Feet planted firmly beneath, I wished for my father to ask, “do you know what you did to scare me?” Instead he walked past in silent disdain to presumably lead me home. In a few days, mute dad will still be ignoring me. I ask my mom why he hates me. She doesn’t know. She just tells me I have to believe the hate means he loves me.
CPR was provided by physician bystander
My sister has stretched out lazily on the couch, only half paying attention to our show. Summer is past its boiling point and the air conditioner remains off despite our earnest negotiations. Mother won’t have it. Think of the electric bill, she says, and so we do. Television remains the most vital use of our utilities budget. Being home alone as we are, the companionship of TV character, the togetherness of mutual involvement, outdoes the comfort of cool air. Faint TikTok sounds from Ysa’s direction meld with the hyperactive Youtube gamer voice playing through my headphones while Steve Carrell’s character on The Office is singing Gloria Gaynor’s “I Will Survive.” He’s doing the CPR too slow, which is the joke of course, but a shot of disquiet cuts through our trauma-induced overstimulation when I imagine myself as the plastic doll on screen. What if the nurse had timed her compressions to the wrong song? A shiver in the heavy heat. Chortles rise from me anyway and Ysa joins in, the dissociation too ingrained to realize itself in genuine feeling. Neither of us need to look up to witness the scene. The number of rewatch, now standing in for the day or hour. Time has dissolved. I can’t tell you when we are. There goes Dwight cutting the face from the mannequin. There goes Stanley grabbing at his chest. We know it shot for shot. Eventually Netflix will pause and ask if either of us are still watching. Ysa and I make eye contact for the first time in hours and only now realize our past silence. “Do you want to keep going?” she asks, in charge of the remote. I will respond, “Let me turn on the A/C first.” We zip deviled smiles to each other, bond in our self-care mutiny, and I bound over to turn the thing on. Basking in our riches, we let the next episode begin. We evaporate into time. Separate into our most frayed selves. Somehow, we are together still. Held there by our shared peace and quiet revolts.
and pulse was regained.
It was a miracle she was even there. Normally on call at the Brooklyn Methodist Hospital emergency room, a resident nurse is spending one of her lone days off at the Brooklyn Botanical Gardens to have a picnic with her family. Blanket spread out, sun blazing overhead, an assortment of snacks lay ready for them all to consume. Beholding the feast, she sighs, satisfied. It’s just perfect. Her wife, feeling differently, bemoans the overwhelming crowd: “Can’t they go somewhere else?” The nurse leans in and swipes slices of bread and cheese, “It’s a beautiful day isn’t it? I imagine a lot of them here are running from work too.” She settles down next to her partner and the two sink into each other, annoyance seeping away. Together, they hum the tune of the Bee Gees’ “Staying Alive.” Perhaps it is their song. Perhaps they are aware of their function as characters and sense its upcoming usefulness. A cherry petal flutters past the couple. It rests on the checkered blanket, signaling the entrance of reality. The right song having been sung. Fiction is disrupted. Conceited authorly myths become undone. Then the cry rings out and she is on call once again.
He was brought to Kings County Hospital where he was found
In 2008, a woman collapsed to the floor in the Kings County ER waiting room. I remember the news reports that day, which always accompanied our morning routine when I was growing up. NY1 anchors, Pat Kiernan and Jamie Stelter, are incensed in a liberally neutral way, unbelieving that such a thing could happen. My mother is letting their voices play to me while getting Ysa ready. She is a flurry, always on the anxious edge of fury. My breakfast is already wrapped in a paper towel for later. If I eat too early, I will throw up. The woman, 49-year-old Esmin Green, died on that waiting room floor. On security camera footage released to the press, Esmin can be seen collapsing suddenly. She lies motionless for over an hour. Doctors, nurses, security guards, and other patients filter in and out of the grainy video. They all pay her no mind. A red circle has been edited in by NY1 to really highlight how noticeable Esmin was. I mean she was smack dab in the middle of the room, Pat Kiernan is saying, how does no one even check on her? I don’t know Pat, Jamie Stelter lies. Tasked with upholding the status quo, Jamie Stelter is not allowed to say that Esmin Green died because she is a woman. She is not allowed to point out Esmin’s psychosis diagnosis, or how the assignment of crazy makes people think they can kill crazy women. She is not allowed to call Esmin Green a Jamaican immigrant, or to suggest we kill black women, will sacrifice so many black feminine lives before we discuss the injustice, before the killing of whites makes the thought of justice rise. My mother takes a moment to step away from the stress of morning, taking note of the news segment that has me so enraptured. I sit there and wonder if she identifies with Esmin Green. I want so badly for her to know I want to identify with my mother’s identifying. I want to be her. I want her to know I understand. But I don’t. All I know is that, according to the American Heart Association, men are 1.23 times more likely to receive bystander CPR in public, that their chance of survival is 23 percent higher than it is for women, that even this statistic no doubt disadvantages the race disparity. I know that before Esmin Green received CPR for her complex heart failure, someone kicked her, to test if she was faking. Violence coming too late. She’d been dead the whole time. Sat cross-legged on the living room floor, I try to cry for Esmin. It will not be for many years, when my urge to die is much more strongly felt, until white guilt is enough to incite a sufficient sadness. But today, that day—whatever fucking time it is—I do not cry. Eyes dry, I pray Esmin forgives me for surviving.
to be groggy and thought to be post ictal,
I don’t remember a sliver of the day I died. Everything I’ve told you is a reconstruction based on stories told to me or tidbits repurposed that are really from an actually aware time of my life. But “groggy” implies presence. A hint of it, sure, but a ‘being still around somewhere in there.’ My mom is working from home today. Perhaps her vertigo is real bad and a train ride feels like too much. Maybe she wanted to be around for my last day of fifth grade, be there to at least pick me up. Regardless of the reason, she’s gotten caught up in her laptop. John Finn’s being an asshole again, I’m sure, and she can’t leave right now I’m sorry sweetie. Flashes of her face in the walls of the ambulance confuse me. You didn’t come with us, I want to say, you told me you were staying home. I don’t need you to see me like this mom, how did you even get here? Specks of their stories constitute into groggy thought. Synthetic coma dreams serving as sort of remembered commas, lucid breaths between seizures engendering empty. I make my mom tell me she made it just in time. She says a cherry blossom dancing in the window made her shut down the computer. She knew I needed her, she says, and she takes my hand, squeezing tight. Patient is in postictal state, a hypothetical doctor says in narration. He is experiencing a temporary, altered brain state and he is not quite himself yet. He wants to squeeze his mother’s hand back. He wants to ask her what’s going on. He can’t. Patient is seizing again. Push 2mg Ativan and get the mom’s hand out of there, he needs to be turned on his side. The boy’s body complies. Our narrator nods approvingly and makes a note on the report: “patient thought to be post ictal,” the typo purposeful. Compassionate formal space opens up, and the doctor hopes patient will be able to find himself in the extra between left behind. Someday, he says, what you imagine will be as real as what is.
he received antiepileptics.
We’ve talked about this Lucas. You need to let us do what we need to do. Don’t whine to me about “oh it hurts so much,” it’s not relevant. Don’t tell me about how much you want to go home, because it doesn’t fucking matter does it? You’re here. You’re in our care. We need you to be strong for us. Your family needs you to be strong for them so they can take you back to that home you miss so desperately. I can see your hands shaking, yes. That’s because of the withdrawal, I’ve already told you that. You’ve been loaded up on a lot of drugs Lucas. Sedatives, pain killers, anti-convulsants—that’s some high-grade addictive shit. There’s bound to be some side effects while we ween you off. No, nothing long-term don’t worry. Now please, can you just let me draw your blood. No it doesn’t matter that your arm is shaking Lucas, I’m good at my job I promise. Lucas. Lucas, please. Okay now you’re just acting like a child. Do you want me to call the nurse in so we can hold you down? No? Okay fine. Then hold your arm out like this and make a fist. Take a deep breath, this might sting.
His MS waned,
The medical abbreviation “MS” apparently does double duty because I’ve always understood it to mean multiple sclerosis. My mom has MS, an autoimmune disease that attacks the nerves. Lesions in her brain light up on the MRI like buckshot. Scars that prove her internal damage. Scars that explain her difficulty with memory, the losing of her balance, her lapses in focus. Her lack of executive functioning (EF). MS symptoms appear to be doing double duty as well, because I’ve always understood them to be indicative of PTSD. I’ve eaten only one thing today: a tuna fish sandwich at around 4:00pm. It has been seven hours since then, but I just can’t stop what I’m doing. My mother is the same way. We can go the whole day without food if sustained by distraction. An essay to write? Well surely I can’t eat until it’s done. A plane to catch? Well surely she has to make it there before getting sidetracked by hunger. This is the way it is. Lacerations of past attacks re-realizing themselves in our bodies. I cannot resist my rigidity, my refusing to switch states at risk of losing everything I am. A man who writes is no longer a writer when he takes a break to cook. He’s now a man cooking himself food. Will he ever be able to become the man who writes again? Will he ever be anything but the man eating, the man passing out from exhaustion, the man responding to his every bodily need? She too cannot risk a change. What is a woman in movement to be when at rest? Just a woman at rest? What if her fingers start to tingle? What if she begins to feel on the verge of collapse, what if her body overpowers the needs of the mind? And so we are together stuck. Stuck in the mud of central nervous system injury. Mine/her thoughts fray. I/she is not sure where she/i/we are. The plot is lost, we’ve/she’s/i’ve got nothing left to give. Your/my form is gone. This essay/writing/lie/lie/story doesn’t mean shit anymore. This is just the shouting into voids between thems/mothers/sons until past/present/they/we are one. We are plunging from a PTSD/MS onset vertigo. i am my mother lying on the hospital floor. She is me snoring soundly from the bed. My/her frenetic, frigid glances search wildly for the call button, dangling precipitously above. Arms weak, we reach for it and fail. Head spinning, we come to our knees and falter. She’s/i’m back on the ground and now we’re/she’s/i’m holding my/her/our breath, trying to not make a sound. The boy needs his sleep. He needs us to figure this out. Eleven doctors high stomped their way in at 6:00am this morning to prod and poke. A whole team of surgeons and residents and interns and fellows turning over the boy who lives under their microscopes. Let him rest, we’re saying to ourselves. Gritting teeth and digging nails into palm, we use the pain to rise. The room lurches as she/i/we inch quietly to the door. We do not wake him. He doesn’t need to see this. He doesn’t need to feel responsible. He can’t save us so let’s not ask him to. Take it and bear it, i/we/she says, stumbling ever forward. Wavering under nausea, persisting against the threat of re-concussion, tingling digits touch down on the cool handle. We pull the door slowly, silently. One tuna fish sandwich sits in our stomach as the hallway opens up before us. Salvation. The end of journey. As we step towards help our body gives out and spills to the ground once again. Nurses come running over to drag us away, and she/i/we leave the boy behind.
was hypotensive
It was really hard for him when Dave and I got divorced. It was probably harder before—when David’s alcoholism was most prevalently in our home—but all the anger that was lying latent in him came bubbling to the surface after our separation. I still remember the night we found out. Used to David’s bar-hopping tendencies, I told him to call his father before bed. We would do this often. Previously, there’d been days I forgot, only to have that forgetting turned against me in stumbling, drunk-sounding tirades in the wee hours of morning. It’s your fault, he’d say, if I had heard the sound of my children’s voices I would’ve come home sooner. I trained the habit into myself, obsessively crystallizing the line ‘call your dad’ in my head through the entirety of the day. And every night, when I’d text Dave if he’d be coming home tonight, when he didn’t respond, I’d say that line. Kids, call your dad. Our communal habit, more present than the man it was in reference to. Sometimes he wouldn’t pick up. Sometimes he’d say two words (goodnight kiddo). Every time, he’d stay out past 4:00am. “Hypo” is the Greek word for under. To be hypotensive is to be under pressure, usually used in the context of blood, this time I use it in the context of him. David was our force of pressure and us other three—my daughter, my son, and I—we were to be under. On this particular night, the night we found out, he called his dad. As he always did. I remember him coming up to me, using one tiny hand to tug at my clothes and the other to hand me my cellphone. At first, I assumed he was once again trying to get out of talking. He’d grown tired of the nightly calls, the unintentionality, a dad who couldn’t even dad through the phone. I try to tell him he needs to say goodnight, but he continues to insist I take it on instead. So I acquiesce. Take the phone, put it to my ear, and say hello. He responds, but not to me. David appears to be talking to a woman, perhaps mistakenly picking up when meaning to decline, and slipping the Blackberry back into his pocket. Their conversation filters through the cloth into microphone. A mumbled mess I can just make out my name in. The word “wrong” ominous. The word “affair” colonizing. All the pain living in me emerges at once. Lashings of inferiority ravage brain. My whole world is crumbling. I am crumbling. He’s staring at me with his tiny, hazel eyes, expecting my analysis. Curious as to if he’s done the right thing. I can’t bear it. I can’t dare to be perceived. I run downstairs, away from the children, legs giving out on the living room floor. Hide, is all I can think so I bury my head in my hands. Crying. I realize I’m crying and suddenly the cries are full-throated screams. The harpies’ shrieks tear out of me, the feeling of betrayal in truly worded form. There’s no telling how long this goes on for and when I finally muster the strength to return to light, I spot his tiny, hazel eyes staring down on me. Head peeking through the banister, they sparkle with a familiar grit of responsibility. He thinks this is all his fault, as he always does. He’s searching for how to make it right, how to make us all feel better, and looking back into him breaks my heart. He’s already trying to explain it, reason it out, say the thing that fixes what he feels he’s broken. He doesn’t even know it yet, but that’s his look. That feeling he has is what makes him. World on his shoulders, sister at his side, he peers down with hope. With the hope he can make it all better. That look will return in a few years, first briefly, then all at once. Lost in confusion, his brightness will somehow momentarily return. Clutching his beloved stuffy Puppy, he looks at me in the same grown-up way. Eyes on. Discerning. Without asking any questions, face hardening with empathy and hopeful scheming, he will say, “don’t worry mom, when i’m all better i’m gonna tell everyone a story.”
and
and there’s nothing left to write and i’m too tired
and i’m sorry and i’m sorry there’s no story and i’m still so sorry
and i’m
desaturating
and we believe in you lucas
and
and and and and and I
was intubated.
There’s an urge to write about a familiar story. Thought of tube down throat incites a violent bracing of body, resisting best it can against the onslaught of memory. Intubation means technologizing the act of violating consent. It is autonomy loss made most material. A literal theft of lung. The human act of breathing, stolen by machine. Suddenly the mechanisms of flesh appear so apparent before me. Flashes of the many times the structures of my carapace have failed feel freshly held, newly discovered. Consider sickness the body’s internalization of victim blaming. Now, the heart failure is a skimpy skirt. The state of lunacy is simply me asking for it. ICU induced psychosis is the technical term for walking alone in the dark. LED lights blare endlessly in the hospital’s crisis wing and her comatose patients cannot differentiate between night or day. Nerves behind lidded eyes suffer the full wrath of sun, evolutionary instincts insisting on wakefulness. The mind doesn’t rest. I’m in a coma for two weeks, but my mind is alight the whole way through. Severe sleep deprivation perverts my miraculous arousal. When I am brought back, the world makes no sense. Spiders have spun their webs around me and scurry around the room. I am for some reason being drowned with buckets of soapy water, sponged down by beetles dressed in blue scrubs. Adele’s “Chasing Pavements” plays endlessly in the ever-repeating memory of our fifth-grade dance while blank, skinned-over phantoms frown towards me with pity. Why do my friends have no faces? It makes no sense. I’m crying and kicking and screaming. Hell has captured me well and truly, the fighting makes no difference. Mazes lead me along corridors of hopelessness. Why do those rollie-pollies laugh at me? It stinks. I’m feeling sick, or at the very least my head doesn’t feel screwed on straight. A doctor materializes human-looking without warning. He shares the ghosts’ look of pity. I shrink further from his fully realized gaze. Abilify, he tells me, a laundry list of side effects scrolling across my hallucination as the doctor’s voice prattles from the advertisement’s script living somewhere in my subconscious. Eventually the world comes more into focus. My mother is no longer the anxious wolf spider, my father no longer the deadly brown recluse. High dosage Abilify, doc says again, this time his peepers suspiciously buggy and beady. I’m sorry Lucas, I’m afraid it’s necessary—these symptoms are to be called steps in your recovery. Despite how much anger rises in my throat, the vocal chords stay paralyzed. I cannot curse his name like he does to mine. For two weeks I’m in that coma, for two more I’m unable to speak a word. Finally lucid, finally alive again—the anti-psychotic threatens to really break me. My mother leans forward and whispers so only I can hear: “Lucas are you in there?” Our system of wall-knocking referenced—the secret code I’d sign to her during the nights, when feeling unfathered and scared. Twice for yes. Once for no. I blink one.
And then two.
Echo found EF to be 15%.
I was a weak child. Always getting ill with something; overly sensitive to the sand under my feet and to the deaths of book characters; a poor performer in anything athletic save for being fast. This objective fact was often ignored by my parents, the ideal of what I could accomplish standing in for what it was that I wanted to do. During their divorce, wanting to spoil Ysa and I, my mother and father suspended ongoing military operations to splurge. They sent me to one week of fencing summer camp, for which I was horribly suited, and sent Ysa to two weeks of horse camp in return. A natural-born Disney princess fan, my sister was well-practiced in speaking to animals. I, in my borrowed, ill-fitting, sweat-soaked uniform practiced losing. My limp fencing foil was batted away with ease as my quivering grip was trained up into a barely solid wrist throughout the week of exhibition bouts. That Saturday, the camp held an open tournament. Quite tragic: compulsory participation on the most valuable of days off. The first match begins, and immediately a touch on the left shoulder. One point for my opponent, and so quickly too. The second round starts up and I manage to pull off a deflection, stall just a tad. Then a touch right on my chest, the opponent’s sword spearing me softly through the heart. Game. I try to hide my tears of embarrassment under the caged mask as I showcase the week’s most workshopped skill for me: humility. My mother tells me she’s proud of me, and that you were so good sunshine. The evidence of my weakness, however, is overwhelming. EF is the medical abbreviation of “ejection fraction.” It is a measurement, expressed as a percentage, of how much blood the left ventricle pumps out with each cardiac contraction. Somehow mistaking me for the winner of my match, the tournament organizers move me along the bracket to face their second-best fighter. You’re wrong, I lost, I say. It doesn’t matter, none of them believe me. I am shuttled into the arena, stray cat being dragged in so she can be fed to the dog. Before the match kicks off I run up to the kid who bested me. He looks like he’s about to cry. I tell him: “I’m going to win it for you.” (I was a romantic, kill me.) “Sure you will,” he responds. The fight is nearly over before it begins. Not even a second goes by and the sword is on my chest, now morphing into a sonogram wand trained directly onto my left ventricle. Another touch and I am peering up from the Echo to search for my mom’s still proud smile in the midst of my loss. Instead, she can be seen talking with muted seriousness to a white-robed figure. The normal ejection fraction is between 55 and 70 percent, the surgeon can be made out saying, your son’s is 15. My mom takes a moment to gasp. Her son’s heart so weak, it is essentially dead, she will ask, “what can we do?” The third and final touch comes suddenly, blade goring uniform as her pen touches down on eerily pale paper. I have dissipated completely, my breast now the consent forms. A last-ditch resort in the case of full-blown fatality. “Lucas is going to be placed at the top of the transplant list. He’s our highest priority,” the surgeon assures my mother. He doesn’t tell her I’ll never need a new heart. He doesn’t tell her I’m already okay. He says what he says: “He’s in good hands.” And waits for a response. She only nods her head and retreats to her seat. The waiting room now home base, now the new estate, my family gathers around their matriarch. The only option left, together they set up to pray. Guilt-ridden hail marys fly out, carrying the wish for someone else’s child to die on their wings.
Also found to be in Vtach
Ventricular tachycardia is an arrhythmic acceleration. The heart’s lower chambers beat faster and out of time. Sometimes it gets so bad a patient gets sent into complex cardiac arrest—percussive discord so bad you’d rather shoot yourself in the head than listen to these hacks play their drums any longer. But at this point, you understand what is happening. “We get it Lucas, you had incredible heart failure, and have medical trauma out the wazoo.” Do I really need to bore you with metaphor anymore? Let me give the kicker to you plainly: In this line of the document, I am dead. Not sick, not dying. Dead. Gone from the world completely. Heart stopped. Brain off. Fucking shit.
which required shocking and pressors.
Hey everybody, Ann here. Celeste’s not doing so great today, so I’m back with another update. It was a bad night for Lucas. He was up all-night agonizing over writing this essay. The doctors say he can’t remember what it feels like to be okay and that his body must restimulate the conditions of crisis in order to access this part of him. Celeste had to watch her son claw his way back from the brink of oblivion all those years ago. Sat by his side while his heart repeatedly failed, while he seized and while his lungs collapsed, while his chest filled from massive internal bleeding, while his foot rotted and withered away, while he thrashed in protest against the mountains of sedatives running through his veins, pulling tube after tube out mid-coma. The doctors say it’s because he wanted to die, that pt. is only making himself worse and that it’s on purpose but Celeste says she knows it’s because Lucas is fighting to go home. The fact that he’s still sticking around is a testament to Lucas’ fire, so I’m inclined to agree with mom (don’t you know that mother’s always right mr. doctor?). But still, it was a rough night. Celeste had to go through all that and tonight she had to know that Lucas was mean to himself again. He didn’t eat again to know what his body felt like when he ripped out that feeding tube again. He didn’t sleep and got high again to get closer to that feeling of utter delirium again. He smoked too many cigarettes again just to be chemically reanimated by the fear of clotting, to exalt in the hypervigilant counting, measuring, metronoming of his own heartbeat again. The doctors say he has no sense of self-preservation, that someone who survived against those kinds of odds should be on their knees, grateful for god’s mercy. They say grateful people do not practice unhealthiness, that grateful people get better the right way, the regimented way, that grateful people do not treat their body this way. They say Celeste should be ashamed of him, that a mother of such a failure should leave him to waste. The doctors say he’s a lost cause, a deadbeat son, but when I talk to Celeste, all she can say is that she’s forever proud of Lucas. That she loves him. Still, it was a hard night for him. He had to cry the whole way through writing this.
He was transferred to CHONY
They sense the ambulance barreling up the FDR. None of the boy’s companions has any idea what is wrong with him, but the scent of pollen causes them all to throw snouts back in mournful howls. Bring him back, the song crooning on the wind snarls. EMTs not trained in community integration continue onwards, weaving through the peak of New York City rush hour from Kings County to NewYork-Presbytwrian Children’s Hospital. Blaring sirens call attention and they can make out the distant din of heart-based squalor. Perked-up ears, pupils trained for disaster, boy is spotted. His furry crew sets out a rescue. There goes Abby, the best of them. She goes bounding by the Hudson with dog-park freedom. Skirting over the water she flies from Brooklyn to meet him. In her mouth she carries a lone cherry blossom flower. A gift for when she gets there, and she gets there before they lose sight of him. She rests atop the supersonic vehicle, barely panting. They send memories of heat through her—warm tongues, cozy cuddlings. from above his makeshift casket, Abby advises the boy come closer. She feels his soul reaching. So weakly. So impossibly. She gives a wail of yearning. He responds, leaping, grabbing hold of the petals sitting delicately in her grizzled maw. He surrenders to her embrace, held by Abby and her siblings. Protecting him from harm in the world unseen, the one spirited not made. The animals urge you to be calm now. It is time to be relief. He is safe now. They will hold him ‘till he’s back. Until then, they all lay sleeping.
for ECMO consultation
Hi there, it’s Heidi this time. Just wanted to give everybody a quick Ysa update! Dave and Celeste have obviously been super busy so Ysa’s been bouncing around to various family members and friends. The social worker says she’s a tough kid and that she’ll be okay but Ysa can’t say anything. She’s so buried under the avalanche of it all. Her brother takes up all the space in everyone’s minds and she has been forced to make herself so small. At this point, she is nearly invisible. The social worker says this is normal, that the whole situation is fucked and while she will survive this, she’ll also be justified in feeling how she feels after the storm has passed. Her brother’s death has been natural disaster, a foundationally destructive tornado-hurricane-earthquake combo. There will be many messes to clean up when it is finally done. But when I ask Ysa how she herself feels, all she says is Lucas is awesome. She somehow puts him first too. And I, Ysa’s aunt Heidi, can’t help but wish she could be angry at anyone, at anything. If I could, I would tell her that he’d want her to be important again. That he’d want her to feel entitled to feel. I’d tell her: “Ysa, Lucas loves you.” I’d tell her that I only hope he gets better, so he can tell you he loves you himself.
and was started on VA ECMO
Kiddo, it’s been awhile since we last talked, huh? I know we aren’t on the best of terms right now, so I’ll be brief, but I’ve been having a memory replay in my head and I just wouldn’t feel right if I didn’t trauma dump on you a little bit. Sorry bad joke. Anyway, do you remember that first heart-bypass thing-a-ma-jig they put in you? The one that went through your legs? ELMO or ELVIS or something right? No no that’s it! ECMO! Now that’s the right one! Wish you were around Lucas, you were always better at this remembering stuff, keeping track of things stuff than me. Hope you’re doing well. Um, anyway. Well I was thinking about that time when you were rushed into the Columbia Presbyterian emergency room and I was racing over from work as fast as I could to try and meet you and your mom there. And, um, well I got there almost a second too late because when I burst through those doors they were just rolling you out to go to an operating room or something. They were gonna put that ECMO thing in you I think. And anyway, I bust in just in time to see them take you away and I remember I got one last final look at you before you disappeared behind those weighted doors they used to section off the operating rooms—you remember those? And I see your face and your eyes and I see your head flop to the side as they spin your gurney around a corner. And I remember the gravity tugging at your eyelids, pulling them open and I remember the lifeless look you shot towards me. There was absolutely nothing behind your eyes. It was like a creature had replaced my son. It was terrifying. And just when I thought it couldn’t get worse—at the moment exactly before those weighted doors slammed shut—a bubble of blood as big as my beer belly formed from your nostril and popped. And I just remember feeling so sick. So lost. I was so scared. And in that moment, all I wanted was to be able to tell you that I’m sorry. That I might’ve done so, but I never ever wanted to hurt you. And I just hope you can hear me saying that, wherever you are. And I’m sorry I didn’t say it sooner.
via 15fr L fem artery catheter, and 11fr fem vein catheter.
Lucas, my love, I’m writing you from the adult emergency wing of the same hospital you’re in. It hurts so much to be so close and still somehow kept in opposite ends of a world—you in the pediatric ward, me in the adult one. I’m very sorry you had to wake up without me there. I can’t imagine how scared you must’ve been. How hard it must be to be alone in this place. The hospital is just awful isn’t it? I hate it here, that’s for sure, and I wanted to let you know that I’m working as hard as I can to get back to you. I’ll be there as soon as possible, I promise. Your dad told me last night was really hard. It’s crazy that after all this heart stuff you got to sleep through, there was the hell of your leg waiting for you upon waking. I’m really sorry it happened this way. Every second of my life has now become thanking those doctors for saving your life. It’s different for me though. For you, the things they had to do ruined you. They saved me. Sometimes though I’m bad. I will wonder what it would’ve been like if they had gone straight to the BIVAD instead of starting out with the ECMO. Would the clot have still been thrown? If they hadn’t put those catheters in your legs, would your foot still be alive? I know it’s useless to speculate like this. There’s no changing what happened, but god Lucas, I so strongly wish the best for you, even if I have to find that best in my imagination. Because the alternative is finding your best in this reality and that just feels rude. How does it feel when we say things like that? When we tell you you’re so lucky? When we work so hard to find the bright side in your darkness? How awful would it be if I even tried to try suggesting there is something good to be found in the hours of pain you went through last night? How could you ever look at me the same? Sorry for overloading you with all these questions, it’s unfair of me. I don’t want you to feel like you’re responsible for parenting yourself. Really the answering of these questions is my job. I am, however, curious as to how you’re doing. Would you mind writing me back about what it was like last night? I know we can’t be together right now, but maybe it’d help me understand if you tell me the story yourself. If not, that’s totally okay, I’ll be seeing and talking to you very soon. But I love you and want to know more about you, so I’ll keep an eye out for a letter. Until then, know I’m on my way. Know that I miss you. Please give a kiss to Puppy for me and thank her for looking after you for me. I’ll give her a proper thank you of my own in a few days.
Because of the caliber of retrograde arterial catheter
There were two of them. A man and a woman. He was an anesthesiologist, young but tenured. She was some denomination of surgical fellow. They came to visit me in hell. I often rely on hell as metaphor because it is effective. To go back to these memories is to pour gasoline into cranium, to flick a lit match through ear canal, and to surrender to the blaze. Around and around I go, lost in the confounding confines of raging, trauma spirals. There were two of them. An anesthesiologist and a surgical fellow. He was nice, but obnoxious. She was quiet and focused. Walking into the room, they are a mismatched pair. The anesthesiologist can’t stop talking. He introduces his counterpart, quickly, then launches into what can be described only as superfan behavior. While the man prattles off survival odds and grovels before me, the surgical fellow pulls out her tools. He is grateful to meet me, and she wants to do her job. I find myself more partial to the fellow, my patience already stretched to its limit, the anesthesiologist is risking a few choice words from his idol. I will be transferring from CHONY to the Rusk Rehabilitation Center very soon, so the doctors are here to clean up my leg. It got caught in the crossfire. A casualty of the war between me and my heart. When I woke from the coma, three of the toes on my left foot were soot black and a gash scored either side of my calf. It’s called a fasciotomy, the anesthesiologist can be heard saying in an attempt to sound knowledgeable. As the surgical fellow is preoccupied with laying out rolls of gauze and pairs of forceps, it is becoming more and more evident how useless her partner is for anything but yapping. We’ve had the vacuum on for the past few days in order to remove the excess fluid in the wounds, the resident chatterer is continuing, and tonight we’ll take it out so they can close it up in surgery tomorrow. He beams at me, happy to talk outside of his discipline. I am not receptive. Dull annoyance emanates from me and I respond to his nervous overcompensation with a look that says, yeah I know. The anesthesiologist clears his throat and fidgets. Luckily, the surgical fellow is done with her set up. She motions for her colleague to join her at my side. His job is to hold her garbage. The first sheath of plastic is undone and the vacuum’s tube splutters to the floor. Turn that off will you, she says absentmindedly while her eyes remain trained on the fasciotomy. Anesthesiologist rushes to do his task and she begins to pull out the crusty sponge inside the open gashes. Ripe with blood turned brown by the days, the refuse from the inner side of my calf is expelled quickly. Seamlessly. The anesthesiologist is back just in time, to collect the biohazard sponges and deposit them elsewhere. She moves to the other side, to the outer gash. Again, the plastic is removed. This time there is no rush of air from the tube that was being held underneath. Vacuum already off, the surgical fellow slides this piece of trash in his general direction and gets ready to pick at the sponges again. We’re almost done, she says to me, and then we’ll wrap your leg up and you’ll be all ready for the surgery tomorrow. Of course I already know this. I already know exactly what’s going to happen, they don’t have to remind me. I assure you, someone has already told me fifteen times before and if they hadn’t, well I’ve already looked through my chart at the end of the bed and read your notes so if we could just get this over with, that’d be fucking great thank you. She picks at the first sponge and I am set alight. Arching my back, I roar. Lucas she barely even touched you, the dumb one says, then turning to her suggests, maybe you just scraped a sensitive part. She goes in again, a different entry point, aiming to avoid skin. All I feel is red. Hot plated, tortuous pain. Lucifer’s destiny now mine. I lay in the bed and let god’s angels punish me.
there is concern
Neither of them know what has gone wrong. The surgical fellow stops her picking and the pain subsides. Questions. Where does it hurt? How much? Everywhere. The most it’s ever hurt in my entire life. They are confused. She says, Lucas I haven’t even taken anything out yet, just tugged a little to unseat the sponges—are you sure it hurts that bad? As if on cue, a spare gust from the hospital A/C grazes the exposed incision, igniting another round of screams. This isn’t normal, the anesthesiologist says, maybe we should wrap him up and wait to do this in the OR. No, she responds. We need to do this now, give him something for the pain won’t you. He rushes over. I can see his syringe-holding hands shaking. I taste the saline wash in my mouth as it floods the ever-present IV. Then morphine flushes my face with warmth. There, that should help, he says. This stuff works fast. I am for the first time grateful he’s around, as I slump into blissful relief, saved. She starts up again. I’m going to try pulling a piece of the sponge out, okay Lucas? Tell me how it feels. Her forceps go in. More monstrous wails come out.
for limited perfusion of LLE.
The pain is no better. It cuts through the morphine like flesh, making my burning felt anew and she has only a few strands of sponge in her tweezers, to show for our trouble. For a moment, we all don’t know what to do. I can’t give him anymore morphine, the anesthesiologist tells her, if you’re going to keep going then you just have to do it. The surgical fellow looks up, sadly. She says, “i’m sorry Lucas, it’s okay if you hate me.” I will respond, “do what you have to, just get me out of here, please whatever it takes.” So she nods and resigns herself to the role of torturer. She spends the next three hours harvesting the sponge. It has become so crusted over with pus that it’s impossible to take the whole thing out at once. She goes piece by piece, line by line—the whole-time blood-curdling screams tearing out of me. It will not be until the next day, when it is confirmed the nerves in my leg have turned hyper-sensitive, that we have an answer for the pain. Before then, however, us three sit in the fear. The anesthesiologist, the surgical fellow, and the boy they torture cry together into the night. When it is finally done, when we are finally through it, the doctors leave my room. There are two of them. An anesthesiologist and a surgical fellow, both holding mounds of medical debris. They stop at my bedside, hands full, and smile gently. They say, “have a goodnight Lucas, we’re sorry that was so awful.” My throat is too raw to respond, but I recognize in their eyes the same shell-shocked look of terror, the empty stare from seeing into the void. And as the door shuts behind them, I wonder about the physicians who have scolded me to stop my whining, who have witnessed me in agony and coldly told me to shut up and endure it. I wonder if it comes from this. If they tell me to be strong because every minute they have to tell themselves the same. I wonder how painful it is just to hear the screams. Because, at first there were two of them. And then that look made us three. An anesthesiologist, a surgical fellow, and me.
Vascular is consulted for insertion of peripheral perfusion catheter.
I miss you mom. I hope you can come back soon. And I’m sorry if the story was hard to hear or didn’t make much sense. I tried to do my best and yeah, it sucked so I’m sorry that happened. If it makes you feel any better, Puppy was with me the whole time. I don’t know if I could’ve made it through without her to hold on to, but I wish you were here too. I love you.
At the time of the consult
Oh baby, you don’t need to be sorry at all. There are so many people who have held this pain with you, and none of us for one second thought the pain was your fault. After you’re out, we’ll have a big party and everyone is going to come tell you how much they love you. I’m doing a lot better from all these IV fluids, so I’ll be there by tomorrow and then I’ll be there until the end. They’re releasing me from the ER sometime today. I’m going to stop at home for some clothes and I’ll make sure to give Ysa and Abby a kiss for you. We can’t wait for you to be back. You should see the backyard. Our family and friends and your old teachers and your old classmates all got together and planted a whole garden back there. From the living room, you can see clouds of hydrangeas, dollops of blues and whites and purples through the window. There are tulips and peonies and daffodils and lilies; carnations, lavender, and chrysanthemums. A huge stalk of sunflower towers in the middle and it is ringed by dozens of bleeding hearts. And none of that compares to the most miraculous stem of the masterpiece: a grand cherry blossom tree in full bloom. A symphony of pink. You’re going to love it. We’re all waiting for you and we’ll wait for as long as it takes. The flowers will be here when it’s time to come home. I’ll see you very soon Lucas. We love you.
patient undergoing atrial septostomy to unload poorly function LV.
Patient is 11yo male with extensive PMH and little else to him. Gaunt, worn, broken—take your pick of adjective, the boy embodies anything that might indicate exhaustion. If I were to tell the truth, he is nearly gone, though at this point you should consider him saved. The soul remains intact, the brain miraculously still sane. No tubes stick out of him any longer, patient now projects to return home safely and, in some cultures, completely. But right now, not much Lucas is in the patient. He is comprised mostly of medical jargon, of a story at best pieced together. Please don’t worry, he’s doing all the things he should be. Pt. attends the daily sermons, listens devoutly to the doctor’s atheistic spiel, bows his head in gratitude for the opportunity to still be here. It will take many years for the reverence to wear off and for the anger to rise. It will be quite some time until the patient’s memories have painted over theirs, until the story is really his and no one else’s. Right now, he has to be of them and right now, he is only sickness. Still the body thrashes. At every opportunity, despite needing his rest, patient begs to be wheeled down to the gardens. Some part of him aches to see the trees, the fauna, the vibrant displays of summer. Hot, humid air begets the tiniest inkling of being, a validation achieved in the sweat, in the peace of quiet and ruinous ruminations. Surrounded by leaves doing much the same thing, patient droops in his chair. He is allowing himself the rare indulgence of private wallowing—private because weakness is reserved for the unblessed. Those who have been touched with miracle are to be strong, or at least this is the practice that Lucas has been brought up in. Beneath the green, the walls come down. Lucas feels the threat of tears, even if he is not yet strong enough to surrender to them. Even this is progress, the dissolving blankness of avoidance more cathartic than his learned ignorance. Limp petals float down, lying themselves on the boy’s motionless solitude. They spark an awareness of his sadness and suddenly Lucas must now fight to stave off the sobs. I don’t want it to be like this, he says, I want it to all be the same. As if in response, a whole blossom plops into his hands staring up with cherry eyes, inviting. Her pinkish blush smirks and though they share not a word, it is as if Lucas can hear the flower’s motherly voice saying, “foolish boy, do you really think you’re always going to feel this lonely?” The dam breaks. The boy begins to cry. Yet for once, he has no pain.