The World of the Wounded

It occurred to me today, sitting in Mark’s hospital room, that I may have crossed some strange threshold to where I am feeling more at home with the wounded than the well. Mark was in a double neuro unit room, and we sat silently listening to the chaos in the bay next to us. A young man. Traumatic brain injury, broken pelvis, trach, feeding tube. When the nurse stepped out, he’d managed to get his legs over the bed railing and tumble onto the floor. He’d been at the hospital for three weeks. He wanted out, they said. He knows what’s going on, they said, of the silent young man. The bay filled with hospital staff working together to get him up into bed, restrain him, hustle him off to get a CT scan to check for new injuries. With the bay empty, I studied the objects that remained. A phalanx of happy balloons. A picture of the young man and a buck. Stuffed animals. Cards.

We’ve been there. Some version of there. We’re not there now. Mark can talk and walk. He had not been able to coordinate his legs, for unknown reasons, on Tuesday evening and had fallen on his face. Then he couldn’t answer my questions. Then I called the ambulance. “Have you been here before?” I queried the cop who came, the EMS. It’s a lot to explain to new people, and I prefer shortcuts at this point if I can.

At the ER, all the tests showed nothing new happening. The fall was a mystery. A seizure? Sudden blood pressure drop? They decided to keep him overnight for observation, but there was no bed available yet in the neuro unit. Over 22 hours between Tuesday night and Wednesday night, Mark and I lay side-by-side in an ER room bed, the lights off, the door cracked for air flow. We kept the TV off, and I missed even one ounce of election coverage. I didn’t need that kind of stress. Instead, I listened to the cases going on outside the door. The patient who kept asking for more and more layers of dermabond for a tiny cut on her leg. “Ma’m, I think I’ve gone above and beyond what anyone would consider reasonable,” the young doctor said calmly. “You have a nasty attitude,” she said calmly back. “I want to see another doctor.” The young doctor paused, walked away, walked back. Got the dermabond back out. “Where else would you like some?” he said, and applied another layer, following her directions. There were several traumas that came in by helicopter. Teams of doctors and nurses materialized and waited in the hallway, stationed from elevator to trauma bay. A motorcycle v. car pelvic break that was rushed to the OR. A bloody trauma-based coding. A person with a pulse but not blood pressure.

Mark had his arm around me, sleeping. His cognition was getting better. He went from not being able to say where we were to being able to say we were at a hospital. He went from saying he was “fine” to finally admitting his wrist hurt, leg hurt, lip hurt. He did not remember falling. He didn’t remember most of the evening. I dozed on and off. We waited for a unit bed to open up.

Mark had been having more cognition problems in the past week. A CT scan had not shown enough detail. I was thankful Mark and I had voted early as we headed back to the hospital for a day of appointments on Tuesday. MRI with contrast, appointments with neurosurgery and ENT surgery. The news was not great. The MRI showed that Mark has swelling in his prefrontal cortex. A spot of necrotic tissue, damage from radiation. A graft that is healing slower than they anticipated.

There could be various reasons for the swelling. To rule out infection, they did a spinal tap. “It’s a newie!” I said to Mark, echoing the unfailingly positive spirit of my dad. The nurse and I made small talk with Mark to distract him while the doctor poked into his back. Mark took it as he takes most things medical, with silence and a small wince. To rule out the graft failing, the ENT surgeon stuck the scope back up Mark’s nose, the laser light making the area between his eyes glow red beneath the skin. Mark sat silently as the surgeon poked at the graft, which currently looks like a perfectly roasted marshmallow. The surgeon noted Mark’s brain pulsing underneath. “We’d rather this looked pink by now,” he said, “It’s taking a long time to heal.” He pulled off some of the “crust,” as he calls it, leaving spots of gooey white fat from the graft open to heal. He found some edges of vascularized tissue below. He was cautiously optimistic that the graft was healing from the inside out, rather than what it might have done which is heal from the outside in. “It’s not black,” he said, “so that’s good.”

Mark had a neuropsych exam done a few weeks ago, and the results came back last week. It read like a lot of gobbelty-gook to the layperson — individual tests and results — all the way up to this one crisp, clear sentence: “He is unlikely to recover to a significant degree though important and meaningful compensatory strategies may be learned.” I’m vacillating between trying to understand that one sentence and all its implications, with learning about brain edema and radiation necrosis, with reading a novel about Typhoid Mary and watching episodes of Comedians in Cars Getting Coffee on Netflix. As one does with their leisure time.

Maybe it’s not a bad thing to be comfortable in the world of the wounded. We all gain wounds in some way or another over time. Physical scars, emotional scars. We get injured and we heal and it happens again and we heal some more. Pain makes our world contract and expand, over and over, like a reversible shrinky-dink whose image morphs over time. Like a kid trying to cross the monkey bars, you gotta get some rhythm to your swing and find the next bar. Your hands may blister up but with intention and effort you can get across. Even when you aren’t sure where you will land.

Today we walked out of the hospital into a bright, perfect day, wincing at the sunlight. When we got home this afternoon, Mark pulled off his hospital wristband and gave it to the Pandemic Puppy to play with. I took the loveseat, Mark took the couch, and we flew off into sleep.