Fallen: A Trauma, a Marriage, and the Transformative Power of Music (3 page)

“I love your mother, but she is driving me crazy,” Simon railed. “She expects too much. It’s not fair to you.”

Simon was protective of me, and I appreciated that, but his anger didn’t help. My mother had a potentially life-threatening illness. It was important to make, and keep, things right between us. Also, I suspected his motives. When he said that what she expected wasn’t fair to me, he was also saying it wasn’t fair to
him
. And he had a point.

He was tired. It’s a difficult working life being a musician. The time dedicated to developing one’s craft both as a player and as a performer is generally not reimbursed. As hard as I worked at my various writing projects, Simon worked even harder. A typical Monday-to-Friday work week for him meant getting up at 6:30 to do forty-five minutes of sight reading and scales on the guitar and then, after a quick piece of toast and a cup of coffee, working a full day, eight to five, of construction finishing work: hanging fir doors, laying oak floors, putting up beveled cedar siding on million-dollar homes. After dinner, from seven to eleven, he would either be rehearsing, with a band or on his own, or recording at the studio. On Friday and Saturday nights he played gigs, which kept him out until one or two in morning, and twice a month he worked the Sunday-afternoon jam at the Garden Bay Pub. Saturdays during the day, Simon watched Eli play soccer, and Sunday evenings he crashed in front of the
TV
and caught up on sports news, usually falling asleep on the couch. Monday morning, he’d start all over again. It was a demanding schedule, and while Simon tackled it with a seemingly endless reserve of energy that I both admired and was envious of, he was growing a little weary. That winter, in addition to being the primary parent while I was in Powell River, he had also finished up work on a major recording project, a
CD
by his band, The Precious Littles, entitled
Sometimes You Win
. A few weeks before, he had received the final mixed and mastered copy, the
CD
artwork was completed, and the unofficial debut was set for July 26 at the Islands Folk Festival, the gig I prayed he wouldn’t miss.

Sometimes it’s coming up roses
Sometimes dandelion wine
You take your chances and honey
Just jump right in
Sometimes you lose
But sometimes you win

Joe Stanton was the songwriter who penned these lyrics. Simon was the electric guitar player and co-producer, along with StraitSound studio owner Ray Fulber. Joe, Simon, and Ray had worked with the rest of the Precious Littles for over two years to bring the project to fruition.

The stress of creating a
CD
was over. Now the stress of releasing and promoting was to begin.
Sometimes You Win,
we’d say, as if it were a promise. A lot rode on the
CD
’s success for everyone in the band. Like Simon, the rest of the Precious Littles were journeyman musicians, highly competent craftsmen who, in order to afford life on the Sunshine Coast, had to work a day job to support their musical career. A little radio airplay, some national exposure, increased
CD
sales: “winning” didn’t mean striking it rich—it meant being able to support yourself and your family modestly by playing music.

Simon had started working full-time at construction five years earlier, when I returned to school, commuting to
UBC
to earn my
MFA
in Creative Writing. Now, with my thesis work nearly finished, it was Simon’s turn to focus on music. He was brainstorming how to promote the new album, and he had lined up two new projects producing full-length
CD
s of original music, work that was to start in August. We didn’t anticipate that he could give up carpentry altogether, but it seemed reasonable to think that his current work ratio could be reversed: in September, 70 percent of his work time would be devoted to music, the other 30 to various carpentry projects. These were big changes. When the mixed and mastered version of
Sometimes You Win
arrived, it was almost more nerve-wracking than exciting.

Still... the completed
CD
? It was something to celebrate. And so we drove into town together, bought a bottle of wine, and walked to Claytons, the local grocery store, to buy takeout picnic food from the deli counter. We were midway down the junk food aisle discussing the specific ways, come September, Simon could phase out carpentry work when he stopped beside the shelves of Perrier and tonic water, put his hand on the cart, and leaned toward me, off balance.

“I have such a weird feeling,” he said. “Destabilized. Like everything in my life is about to change. Totally change, like on a molecular level. Like my very atoms are shifting.”

“Yeah?” I said. “That’s a good thing, right?”

“It’s weird,” he repeated and shrugged. He wasn’t prone to weird feelings, much less to belaboring them, and although it was obvious that the sensation was an uncomfortable one, it seemed inconceivable that a premonition of change could bode anything but good. Simon had worked so hard for so many years, and he was so skilled at what he did. This was his time.

VANCOUVER GENERAL HOSPITAL
is monstrous, a labyrinth of parking lots and entranceways and long halls, designed, it appears, to keep me from finding Simon. The panic, held at bay for so long, burbles over as Ryan and I try to find a parking spot, then an entrance to the hospital, and finally where the hell we are supposed to go. We hurtle down various corridors, and for the first time, I am rendered incoherent with panic. I want to stop dead and call Simon’s name until he comes to retrieve me and explain what the fuck is going on. Rounding a corner, we meet up with Lou and Dave, the same look of unsuppressed panic on their faces. Then we see Simon’s uncle Jerry and his aunt Barb stepping out of an elevator.

Jer is a judge, recently retired but still possessing both the ease and weight of authority his title conferred, an authority that is easily matched, if not exceeded, by that of Barb, his wife of forty years. It is a relief to see them. They are parents, and I have never felt more like a child lost at the mall. It is also frightening: Lorna and Marc have called in the reserves. Jer and Barb’s presence means something is really, truly, terribly wrong.

Together we all enter the elevator, which Barb and Jer have just exited in confusion. The door closes, but none of us thinks to push a button. We stand in the motionless elevator for a solid minute trying to construct a plan when someone—Jer? Dave?—finally remembers to choose a floor. We navigate the route to the emergency room, where, upon seeing a lineup at admissions, I move decisively to the back of the queue. This is something I can do: wait in line. As if my visit to the hospital is no more critical than checking on the status of a patient who, say, needed a few stitches or a tetanus shot.

Lou walks past me, past the red stripe that the queued line is not supposed to cross, and through the doors into the ER. A moment later he returns, takes my arm, and leads me back to a nurse and a social worker. I am the daughter of a social worker, and I know what her presence means: this is more than just serious. She explains that Simon is still in surgery. She says he is very sick. His condition deteriorated in-flight: when he arrived at the hospital, he had high blood pressure and a low heart rate and was unable to breathe on his own. His left pupil was blown. (
Blown.
This word catches me, traps me:
blown,
suggesting leaves or cherry blossoms, colored glass transformed into pretty, light-catching baubles, kites, or candles on a birthday cake. It is an inexplicable word in the context of Simon’s eyes, which are a pale, jade green with a thin amber filigree around the iris and which, most notably, are, and have always been, steady and wide open.) After having a seizure, Simon’s body contracted into the stiff contortions of a decerebrate posture. Before being taken into surgery, he was rated multiple times by the trauma doctor as having a Glasgow Coma Scale score of 3, 3 being the lowest possible score and indicating the lowest level of consciousness. The nurse continues to speak, but the words blur into a smudgy, gray tangle in my mind: Catastrophic. Devastating. Life-threatening.

“I’ll take you to the surgical waiting room,” she says. “You can wait there.”

GUIDO IS SITTING
in a chair facing the door of the waiting room. He sits with the kind of effortless posture instilled through years of practicing the Alexander technique of efficient body alignment, a posture that evokes both grace and vulnerability. He is our inner circle, our closest friend since the early days in Montreal, and, for both Simon and me, like a brother. He is Eli’s godfather, part of our family. He stands and holds me and I allow myself to exhale a long-held breath.

“Okay?” he says.

“Okay.” As I inhale, my breath rasps down my throat, strange and shallow. The air, in this closed room, under the fluorescent lights, is all wrong. It vibrates and hums with an eerie dissonance. I sit beside Guido, woozy with a nightmare lightness. The social worker has already spoken to him, and there is no other news. Simon is still in surgery. And so we wait, time trembling to a standstill, a still life. The seven of us seated, silent. No words, nothing to say.

And we wait.

SIMON IS IN
a decerebrate posture when he arrives at the hospital: arms and legs straight and rigid and his head and neck arching backward. The zombie posture. A decerebrate posture is associated with a very poor prognosis, indicating that massive brain damage extends from the higher portions of the brain into the brain stem. A decerebrate posture means that internal pressure has caused brain tissue to be moved or pressed away from its usual position inside the skull. In Simon’s case, the pressure from the buildup of blood in his left hemisphere caused the top section of the brain stem to shift down and to the right—a transtentorial herniation—so that the brain stem’s fragile tissue bulged out from the narrow confines of the tentorial notch, the triangular opening through which the brain stem extends. The preservation of the brain stem’s integrity is critical to a body’s survival, as the brain stem controls our most basic functions—breathing, heart rate, blood pressure. And Simon’s brain stem has been compromised.

The Glasgow Coma Scale (
GCS
) was developed by Graham Teasdale and Bryan J. Jennett at the University of Glasgow in 1974 to objectively evaluate the degree to which a person is conscious or comatose. The scale measures three responses: eye opening response, verbal response, and motor response. Each receives a score from 1 to 5, for a maximum score of 15, which indicates a normal level of consciousness. The lowest score is 3, which means there is no response in any category. Anyone scoring 8 or under is considered to be comatose. The general rule is that the longer someone scores 8 or less, the worse the prognosis is for meaningful recovery. Within the first thirty-six minutes of Simon’s arrival at the hospital, the Emergency department records his
GCS
five times. The first three times Simon scores a 3—no response on all accounts—but the fourth time, after he is intubated and during his
CT
scan, he scores a 5 in motor response, for an overall score of 7, meaning that although he is neither speaking nor opening his eyes, he is responding to localized pain. He is sedated then, and six minutes later returns to being completely unresponsive and is taken to the operating room for a
STAT
craniectomy, “
STAT
” indicating that immediate, urgent medical intervention is required.

Here, a neurosurgeon named Dr. Haw removes a large portion of the left side of Simon’s skull. Dr. Haw then cuts into the dura, the first of the protective layers that surround the brain, and begins the delicate search through Simon’s left temporal lobe for the ruptured artery that is pulsing blood into the precious neural tissue of his brain.

He describes this process in an excerpt from his postoperative report:

The dura was incised in the temporal region with #15 blade and immediately liquid hematoma came out under high pressure. Further bone was removed to carry out a temporal decompression. The dura was then further opened in a large curvilinear flap and the hematoma was removed fairly easily using suction and irrigation. The underlying brain appeared to be in good condition. However, there was active arterial bleeding arising from the temporal lobe inferiorly. There was an evident temporal contusion, which was removed using suction and irrigation. The source of the bleeding was controlled using bipolar cautery and ultimately this gave good hemostasis [the process by which bleeding is stopped, which is the first stage in the healing of a wound]. The patient received frozen plasma. The brain was now gently swelling out through the dural opening. The dura was expanded and the bone flap was left out and sent to the bone bank for storage. The soft tissues were closed in multiple layers using staples for the skin.

A craniectomy differs from a craniotomy in that the bone that is removed to perform the surgical procedure is not replaced after the procedure is complete, as it is after a craniotomy. The skull bone is stored either in a deep freeze or, in an attempt to minimize the risk of infection, in a patient’s abdomen or thigh, to be replaced, hopefully, at a later time. Both procedures have their historical roots in trepanation, the ancient surgical practice of drilling holes in the skull. Prehistoric skulls with holes that vary in size from a few centimeters to half the skull have been found in several countries across Europe. Trepanation was also common in Peru, where more than ten thousand trepanned skulls have been found, some dating back to the first millennium before Christ. Although surgical tools used to perform these surgeries were rudimentary—say, a piece of sharp obsidian, bronze, or copper attached to a carved wooden handle—there is evidence that many individuals survived the procedure and even lived for several years after.

That trepanation was performed, and often, indicates that early humans had some notion of the brain’s central role in the body’s functioning. Before Aristotle argued that the heart, not the brain, was the primary organ of rational thought; before Galen, surgeon to Ancient Roman gladiators, dissected the nervous system of oxen and coined the word
autopsy
; before René Descartes stated “I think, therefore I am” and attempted to separate the machine of a material body from his immaterial and immortal soul—before all this, ancient man was opening the skull for an array of medical, spiritual, and mythical reasons. Evidence suggests that trepanation was performed in an attempt to treat a range of conditions: depressed skull fractures, headaches, convulsions, and possession by evil spirits. Trepanation may also have played, for some cultures, a fundamental role in important rituals, informing both superstition and belief. Those strong enough, or lucky enough, to survive the dangerous procedure may have been honored as being blessed with special power.