The Doctor and Mr. Dylan (22 page)

I ground my teeth. I turned away from her and said, “Give me a few minutes to review your medical records.” She’d arrived at the Emergency Room with abdominal pain at 1 a.m., and an ultrasound had confirmed that her appendix was inflamed. Other than an elevated white blood cell count, all her laboratory results were normal. She already had an intravenous line in place, and she’d received 4 milligrams of morphine in the Emergency Room. 

Dr. Perpich entered the room and offered me his usual professional handshake. “Thanks a lot for coming in, Nico. Are we almost ready to begin?”

“I still need to talk with Alexandra,” I said.

“I’ll be waiting in the lounge,” he said. “Gina, call me when the patient is prepped and ready.” He left, and I stood alone with my wife.

“Are you in pain?” I said.

Her eyes were dull, narcotized—pinpoint pupils under drooping lids. “I like the morphine,” she said. “Please give me more.”

I looked at the clock. It was 7:30 a.m. The door opened, and Johnny entered the operating room. He hadn’t seen his mother since the night before, prior to her illness. It seemed wrong, this family reunion under the surgical lights, but I didn’t have the heart to tell him to leave.

“Hi, Mom,” he said, his face and his emotions hidden behind a scrub mask. Alexandra reached out her hand toward him. Johnny’s fingers became tangled in the IV tubing that coursed from her left wrist. He pushed the tubing aside and massaged the skin of her arm.

“It’s good to see you, John-John,” she said with a giggle. “Mommy’s a little sick. Daddy’s giving me some real good drugs, and I’m floating high above the bed right now.”

“You’ll do fine, Mom. You have the best anesthesiologist in Minnesota.”

She slurred her words. “He’s the best anesthesiologist in the whole wide world.”

I rolled my eyes. Alexandra had no aversion to mind-altering drugs. The door opened again, and Echo entered the room. She took a spot beside Johnny, and rubbed my son’s back as he massaged his mother’s arm. I was surprised to see Echo in the operating room. She was the last person I’d expect to see at my wife’s bedside.

Echo whispered something into Johnny’s ear. He stepped aside and said, “Mom, Echo is here, and she has something to say to you.”

Echo stepped up and covered Johnny’s hands where he caressed his mother’s wrist. “Mrs. Antone?” she said.

Alexandra blinked back at her. “Yes, dear?”

“I love your son.”

“Good God, girl. Don’t start talking to me about love. Not now. You and Johnny are babies yourselves.”

“I love your son,” Echo repeated.

“I can’t listen to that right now. Please leave me alone.”

I turned my back on all three of them. I was having a hard time enduring the mawkish drama of the Johnny/Echo/Alexandra sideshow. I stood at the anesthesia workstation and reviewed my checklist. The anesthesia machine, monitors, airway equipment, and necessary drugs were all set up and ready to go. I filled a 20 cc syringe with the sedative propofol and a second syringe with 40 mg of the paralyzing drug rocuronium. I turned back to the three of them and said, “Johnny, I need to start the anesthetic. You and Echo need to leave now.”

I watched him stroke Alexandra’s arm one more time. His girlfriend whispered something into Johnny’s ear, and my son shook his head no. “Sleep well, Mom,” he said. He leaned in and gave his mother a hug. He and Echo shuffled backwards, never turning their backs on Alexandra. Johnny clasped Echo’s hand, and they exited together.

“I’m going to let you breathe some oxygen now,” I said as I lowered the anesthesia mask over Alexandra’s face.

She said, “Remember, no matter how much you might hate me, Nico, I’m still the mother of your child.”

I took a deep breath, exhaled slowly, and injected the anesthetic into her intravenous line. The milky whiteness of the propofol disappeared into the vein of her arm, and Alexandra went to sleep. I opened her mouth, inserted a metal laryngoscope past her tongue, and slid an endotracheal tube into her windpipe. It seemed bizarre to connect the motionless body of my wife to an anesthesia machine. I listened to her lungs to confirm she was being ventilated. The metal disc of my stethoscope pressed against her left breast, a part of her anatomy I hadn’t seen or touched for two years.

I felt dirty just being there. I couldn’t wait to get this over with and move on with my life. I watched Gina prep the abdomen with antiseptic soap. Dr. Perpich reentered the room, his scrubbed hands held high in front of his face. The surgical tech was dressed in sterile gown and gloves, and she dressed Dr. Perpich in the gown and gloves he’d wear for the surgery. Together they draped the abdomen in sterile blue towels. Alexandra’s midriff disappeared from view, reduced to a 15-inch by 15-inch square of exposed abdominal skin.

Michael Perpich operated with a calm precision and a lack of intensity, as if solving an easy crossword puzzle for the thousandth time. He inserted a hollow metal trocar through Alexandra’s belly button, and insufflated carbon dioxide through it to convert her abdomen into a gas-filled balloon. Dr. Perpich inserted a camera lens through a second small incision, and a two-dimensional image of Alexandra’s intestines appeared on the video screen. He inserted two additional long-handled surgical instruments through the abdominal wall, and spent the next twenty minutes dissecting the appendix from the surrounding tissue.

I managed the anesthetic as I always did, using standard combinations of narcotics, muscle relaxants, and anesthetic vapors. The surgery flashed by. Dr. Perpich closed the skin a mere 37 minutes after his initial incision. I turned off the anesthetics and ventilated 100% oxygen through the breathing tube. My patients usually opened their eyes within 5 to 10 minutes from the time the anesthetics were discontinued.

Five minutes passed, and Alexandra did not stir. Ten minutes passed, and she did not wake. I inserted a suction catheter into her mouth to stimulate her, but Alexandra slept on.

I double-checked my systems. No anesthetics were running, either through the IV or through the breathing system. I touched the twin leads of a nerve stimulator near the facial nerve lateral to her eyebrow. Her facial muscles contracted in a strong twitch, confirming her muscles were not paralyzed.

“Is everything all right?” Dr. Perpich said, as he watched and waited.

“She’s waking up slowly, that’s all,” I said. “Let’s be patient.”

I opened an ampoule of Narcan, a narcotic antagonist that reverses the effects of morphine. I injected the Narcan into Alexandra’s IV, and waited. Narcan was effective within two or three minutes. Two minutes passed, then three, then five. Nothing changed. Alexandra still didn’t wake up.

Dr. Perpich asked again, “Is everything all right?”

I tried to act like I wasn’t concerned. It was obvious to everyone that something was wrong. I said, “Let’s go ahead and bring her to the recovery room. We’ll let her wake up there.”

Thirty minutes later in the recovery room, Alexandra lay motionless without spontaneous movement or eye opening. I stood as a vigilant soldier at her side, maintaining an outward calm as I pondered the grim reality in front of me. My wife was inert, senseless, and dependent on a breathing machine. I’d been the last person to speak to her before robbing her of consciousness. I could hear the nursing staff whispering in distant corners of the recovery room, no doubt discussing the damning happenstance of a man anesthetizing his estranged wife, and her not waking up afterwards.

Dr. Perpich stood watch with me, his arms crossed over his chest and a grim look across his face. “I’m concerned, Nico,” he said. “I’m going to call our best neurologist to come in and take a look at her.”

“I agree,” I said. “It was a routine case in every way. I have no idea why she’s still unconscious.”

Perpich’s face was blanched white, drained of all blood flow. He wasn’t looking me in the eye, and his annoyance was apparent. Surgeons expect two things from their anesthesia providers: that the patients do not move during surgery, and that the patients wake up afterwards. I’d failed on the latter, and he wasn’t happy about it.

The neurologist, Dr. Preston Mattson, was a three-hundred-pound giant with a ZZ Top beard and a shaved head. His attire of blue jeans, red plaid flannel shirt, and a white coat belied his “best neurologist” status. After Dr. Perpich and I recounted the clinical history, Dr. Mattson turned his back on us and began to assess Alexandra’s condition. He manipulated her flaccid limbs and murmured, “No spontaneous movement.” Mattson inflicted painful stimuli in the form of pinches and twists of the skin, and said, “No response to pain.” He focused a flashlight into her eyes, and said, “Pupils unreactive to light.”

His beard bobbed and his right cheek billowed as he chewed on something, either gum or a plug of tobacco. As the exam progressed, the bobbing and chewing accelerated. After fifteen minutes of deliberation, the neurologist turned to us and said, “I’m going to order a CT scan of her head to rule out brain injury. We should have the result within the hour. I’m also ordering a full panel of laboratory tests to rule out a metabolic cause for her coma.”

Coma. It was the first time anyone had used the word. Instead of a delayed awakening from general anesthesia, my wife’s diagnosis now turned on one horrific word.

Coma.

CHAPTER 18

INTO THE SUNSET

Alexandra was unresponsive after her surgery and no one knew why. The minutes following the horror of that discovery blended into my next problem. I had to tell our son what had happened to his mother.

Johnny was sitting in the staff lunchroom when I found him after Alexandra’s surgery. “How’s Mom doing?” he said without looking up from his phone.

“The surgery went well. She had acute appendicitis, just as diagnosed, and they took the appendix out.”

“Can I see her yet, or is it too early?”

“It’s a bit early. She’s still pretty sleepy.” Whatever was going on, Johnny didn’t need to know about it yet.

Roberta Selvo walked up to our table and said, “Johnny, we need two orderlies to transport a patient down to the CT scanner.”

The hair on the back of my neck bristled. This wasn’t right. Johnny couldn’t push his comatose mother down the hallway to a brain scan. “Can I talk to you?” I said to Roberta. I pulled her across the room. “This is a no go. The patient is Johnny’s mother. He can’t see her like this. He doesn’t even know about her condition.”

Roberta stared back. “Of course you’re right. I’m so sorry. I’ll have Echo take your wife down to the scanner.”

“I’m going with Echo,” I said. “Alexandra is still on the ventilator. I need to watch over her.”

“Very well.”

I returned to Johnny in the lunchroom. ”When can I see Mom?” he said.

“Not yet. I’ll let you know.”

“Will she go home tonight?”

“No. She’ll spend the night here.” Beads of sweat coated my forehead and betrayed my fear. Johnny didn’t bother to look up from his phone, so he didn’t notice. I felt very protective of him. I needed to evade him for now. “I’ve got to go back to work.”

“Let me know when I can see her, all right?”

“I will.” I returned to the recovery room, where Echo Johnson waited at the foot of Alexandra’s bed. She’d removed her mask. Her cheeks were blanched and her lips were pressed together in a thin line. Echo gripped the railings of the bed as if they were the top rungs of a ladder descending to hell. She knew the score. Echo was only a high school kid, but she’d worked at Hibbing General for two years. She’d transported patients to their hospital rooms after appendectomies. Transporting a comatose patient to the CT scanner after an appendectomy was an extraordinary event.

Echo kept her gaze focused on blankets that covered Alexandra’s legs. I took the cue that conversation was off limits for now. I attached a ventilation bag to Alexandra’s breathing tube, and squeezed the bag twice, pumping oxygen into and out of her lungs. “Let’s go,” I said. Echo’s movements were robotic and zombie-like as we wheeled the bed toward the scanner.

We exited the recovery room and approached the elevators for our trip to the scanner one floor below. To my alarm, Johnny popped out of the locker room and stood wide-eyed and hopeful between us and the elevator. He flashed Echo his teenager-in-love smile.

Echo said, “Johnny, I’ll meet you in the lounge when I get back from the scanner, OK?” Her eyes shifted from him toward the horizontal figure lying on the bed. Johnny followed her cue, and looked down at the patient. His eyes widened at the spectacle: his mother lay motionless and dormant before him, a plastic hose coursing between her perfect teeth.

“Mom?” he said, grabbing her by the shoulders. When she didn’t respond, he turned to me. “What’s wrong with Mom?”

“I was going to tell you.”

“You told me she was still sleepy! What’s going on?”

“We don’t know. The neurologist ordered a brain scan. That’s where we’re headed now.”

Johnny leaned over Alexandra’s body and touched the blanched marshmallow of her cheek. “Mom!” he screamed into her ear. “Mom?” He steeled his jaw and turned to me again. “Can she hear me?”

“I don’t know. We’ll know more after the neurologist runs some tests.”