Fallen: A Trauma, a Marriage, and the Transformative Power of Music (9 page)

“Appear to understand” is the key phrase. Dr. Griesdale’s explanation for the spinal surgery is essentially that there is, neurologically, a lull before the storm. It will be in Simon’s best interest to stabilize him now. I remain uncertain, but the combined expertise of the Neurosurgical, Spinal, and Intensive Care teams is enough to convince me to agree to the surgery. Dr. Griesdale reiterates that the central issue is still whether Simon will survive. They want to proceed with the spine surgery although he might not survive it; even without the surgery, he might not survive the next hour, the next night, the next week. The outcome of his injury is still to be determined, Dr. Griesdale says. Yes, we collectively agree, and then ask a barrage of questions based on the premise that of course he will survive.

“How long might he be in hospital?” I ask.

“If he survives,” Dr. Griesdale says, “a rough time frame might be three months in critical care, three months in the hospital, six months in rehab. Or, possibly, an indefinite amount of time in a long-term care facility.”

“How long might he be in a coma?” Emily asks.

“If he survives... it is hard to say. Depending on how stable he is, we will begin to lighten the sedation in anywhere from seven to fourteen days. It is important he wakes up slowly, but you need to understand he might not wake up on his own.”

“Will he,” Lorna asks, a barely contained desperation straining her voice, “will he be able to play music?”

“Again,” Dr. Griesdale says, “right now it is still a question of whether he will survive—”

I can’t listen to any more. Emily, who has worked as a medical transcriptionist to support her PhD studies, is taking notes. I can trust she won’t miss anything important. I have to get out of the confined space of the conference room. I stand up abruptly, apologize, and leave. Sassafras is quiet after a busy day of visitors. Sully, alone, sits in one of the cafeteria’s central tables. I crawl onto a chair and lean into his flannel shoulder as a howling storm catches up to me. I shake and sob and he holds on until the tidal wave of grief recedes enough for me to catch my breath.

A NERVE CELL,
or neuron, is composed of three distinct parts: the cell body, the dendrites, and the axon. Neurons respond to a stimulus with a nerve impulse, an electrical signal that travels rapidly throughout the body. Dendrites receive nerve impulses from other neurons and are usually short and highly branched, like little trees extending from the cell body. The axon is a single, taillike nerve fiber that carries impulses to the dendrites of other neurons and can vary in length from less than a millimeter to over a meter long. The dendrites and cell bodies of neurons constitute the so-called gray matter of the brain and spinal cord, while the axons, insulated in a milky white lipid and protein covering called the myelin sheath, constitute the white matter.

The brain has four main structural components: the brain stem, the cerebellum, the diencephalon, and the cerebrum. The brain stem is continuous with the spinal cord, and it enters (and exits) the cranial cavity through the foramen magnum (Latin for “great hole”), the large opening at the base of the skull. Nestled behind the brain stem is the cerebellum, or “little brain,” and immediately above the brain stem is the diencephalon, the mid- or through brain. Extending anteriorly from the base of the diencephalon and the brain stem is the cerebrum, the largest portion of the brain. Divided into left and right hemispheres, the cerebrum is internally connected by the corpus callosum, a broad band of white matter containing axons that communicate between the two hemispheres.

Inside the brain are four narrow cavities called ventricles: one in each hemisphere of the cerebrum, one in the midbrain, and one that lies between the brain stem and the cerebellum. It is in the ventricles that cerebrospinal fluid is produced and circulated, cushioning the brain’s delicate tissues against the bony ridges of the cranial cavity and providing an optimal chemical environment for neurons to communicate in. The doctors have placed a vent, called an external ventricular drain, into Simon’s ventricular system, by drilling a hole through the bone on the right side of his forehead. Through this vent the doctors and nurses are able to drain the pooling cerebrospinal fluid, relieving the buildup of pressure inside his skull. It was also here, in the ventricular system, that early physicians and philosophers named the locus for our humanity, the feature that most notably separates us from the beasts. They believed that the key to our uniquely human mental faculties lay not in the flesh and blood tissue of the brain but rather in the fluid tides of this inner space. For centuries, this was the dominant theory of the human brain throughout Europe and the Middle East.

Galen, the preeminent physician of the Roman Empire, believed that vital spirits were produced in the left ventricle of the heart and were carried upward in the carotid arteries. Once delivered to the ventricles of the brain, these spirits were transformed into animal spirits, the highest of spirits. Galen maintained that these animal spirits formed the “instrument of the soul” and, when needed, passed into hollow nerve cells to provide sensation or muscular movement. St. Augustine suggested that sensation belonged to the ventricles in the cerebrum, that memory belonged to the third or middle ventricle, and motion to the fourth, posterior, ventricle. Da Vinci injected molten wax into the ventricular cavities of cattle, cutting away the brain after the wax hardened in order to get a proper anatomical understanding. Although he challenged previous anatomical drawings with his work, he too unquestioningly accepted that the human faculties of imagination, memory, and intellect were located in the cavities of the ventricles. This basic belief—that animal spirits animate and elevate human thought by traversing the ventricular system—did not alter much until the eighteenth century.

Seated beside Simon, I am unaware of the historical importance of the ventricular system. Barely able to recall the basic macroanatomy of the brain and the microanatomy of a neuron that I gleaned in grade 12 biology, the brain and the infinite wonders of its gray and white matter are as mysterious to me as the dark matter in the deep space of our universe. Yet I need no history or biology lesson in neuroanatomy to understand this basic fact: as the cerebrospinal fluid is drained from Simon’s ventricles, some vital life force is being lost. Here, now, the gradual dissolution of self from body that we all must eventually face is sped up to a frantic pace. Each time the drain is open, Simon leaks a little farther away from his broken body.

MARC’S BROTHER JERRY
and his wife, Barb, have opened their home, in North Vancouver, to Marc and Lorna, and tonight Emily makes the trip there for dinner. I read to Simon until she returns and takes my place beside his bed. I eat a bowl of soup and a piece of buttered bread at the tea shop across from the hotel and then lie down and sleep, finally, for almost four hours. I return to the
ICU
a little more grounded, a little stronger. Emily has drifted off to sleep in the chair but wakes when I arrive and we sit for a few moments, silent, both of us staring at the numbers flashing on the machine behind Simon’s bed, staring as if we expect to see something more than a representation of an ascending or descending heart rate or spiking blood or intracranial pressure, staring as if we expect some deeper truth or future outcome to suddenly be made apparent. Emily sighs and stands up, a mild scent of rose hand lotion sweetening the antiseptic air. She kisses the top of my head and says, “I’ll see you in the morning.”

As I sit in the glass room at Simon’s bedside, I recall the description Jill Bolte Taylor gave in her
TED
talk of the effects of the bleed in her left cerebral hemisphere, the ecstasy she felt, the simultaneous agony, and the difficult decision she made to fight to remain with her body. When I hold my hands on or near Simon’s face, I can feel a kind of jumbled, roiling heat pulsing off his skin. I think I can actually sense the battle being waged at the peripheries of his physical self.
Please, please, please,
I have been praying, begging, pleading.
Please, please, please,
the supplication of a greedy and undisciplined child. But is my request fair? Would Simon want to stay, in this new, possibly profoundly damaged body? The thought that Simon might awaken from the coma to live a barely conscious life, seems, in this moment, more cruel than death. He would reject that. And so I revise my prayer and make him a new promise, which I scribble down in my notebook:

3:30 A.M., JULY 25, DAY 4

Hey, babe, I’m here. As usual, it’s taking a little extra time for me to catch up with you. These last few days I’ve been locked in a back-and-forth struggle between absolute despair and blind hope. But no more. The reality is that this time is critical for you. Your injury is extremely severe but you are alive. And I am here with you as best as I possibly can. I’m here with you for as long as I possibly can.

Behind me, buoying me up, are all the many people who love you. It’s huge. There is so much love and strength building around us, making sure that Eli is safe and I am able to be here, completely, with you. I am holding you strong, Beau, in my heart, my mind, my gut. Let me be your anchor. I know you might have to journey to a place where I cannot follow but I’m here, now. I promise I’ll stay with you as long as I can.

AT FOUR IN
the morning, Lorna calls the
ICU
. She is still on Eastern time and is wide awake at Jer and Barb’s hushed and sleeping household. She is distraught. She and Marc remained in the
ICU
after the family meeting and spoke with another doctor, a young woman from Quebec, whose predictions for Simon’s outcome were even more pessimistic than Dr. Griesdale’s. The young doctor explained that Simon’s injuries were global and diffuse, and if he survived, it was impossible to predict what areas might be affected. All of them, possibly. The bleeding in his brain was extensive, and blood was toxic to neurons; wherever there has been blood, neurons have died off.

“When I asked her about what the other doctor said to you, that the underlying tissue looked good, she said, no. She said his brain was soaked in blood. Blood soaked down to the ventricles.” Lorna is weeping. “She said his brain was like soup with neurons swimming in it.”

Her distress is operatic, grief and regret pounding over her in waves, words stuttering out, breathless and drowned. The swells of her emotion make me feel absent, misplaced from my own body. I am sitting at a desk adjacent to the nurses’ station, illuminated by the strident fluorescent glow of a desk lamp; within its halo of brightness so lucent and heartsick, I am emptied of words. Finally, grasping, I say:

“You cut your hair. I’ve been meaning to say it looks great. It’s really beautiful.”

Since the last time I saw Lorna, her long, wavy salt-and-pepper hair has been shaped into a stylish silvery bob. “Simon will love it.” It is all I have to offer, and I hang up, leaving her weeping at the other end of the line.

When I return to Simon’s bedside, his
ICP
levels are spiking up. Cerebrospinal fluid is drained from the external ventricular drain, and now, instead of its usual clear color, it is pink with blood.

I try to regain my earlier resolve. An image of a canoe comes to mind. It is a visual prompt given by my yoga instructor in certain difficult positions: Imagine that the back of your body is shaped like a canoe, your ribs the canoe’s ribs, your inhale breath expanding and defining the shape of the boat. Exhale and relax your chest, your heart, into the boat’s curved embrace. And so I imagine my body a canoe on a dark, cavernous river, wet walls of dark rock rising high on either side, eddies of water swirling in fast, confusing currents. Inside the body of the canoe is Simon, lying still to prevent further swelling, and in this way we float and bob toward morning, together.

DESPITE THE DIFFICULT
night, the surgery on Simon’s spinal column proceeds as scheduled, and we all reconvene at Sassafras. Guido brings a yoga mat, unrolls it in an uncluttered corner, and instructs me to lie down. His wife, Sari, and his cute-as-a-pumpkin daughter, Nadia, circle around us. Nadia, her round face framed by dark feathery curls, rolls pebbles off of cushions and crawls between chair legs, discovering discarded bits of food. At two years old, she is as willing to make a playground of a hospital cafeteria as she is Stanley Park.

“There’s not much I can do,” Guido says. “But a little Alexander technique? Maybe we can help your back make it through this.”

Guido is a newly certified Alexander instructor, and over the last few years of his training, Simon and I have been willing guinea pigs. The exact mechanism of the technique is still mysterious to me, consisting mostly of Guido giving gentle physical cues designed to relax or realign areas where tension is chronically held in the body, but however it works, the results are undeniable: after a session with Guido I always feel taller and lighter inside my skin. An Alexander session is not like a massage; I am meant to be attentive to the process, a student of the technique not a recipient of a treatment, but now I lie passively, allowing Guido to readjust my shoulders and neck. My back is sore, and I’m sure Guido has noted how stiffly I’m moving.