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CHAPTER 1

It Was Supposed to Be Two

I WINCED AS THE NURSE-PRACTITIONER, SNIPPING AND tugging at my stitches, caught some hair. She apologized as she worked on another stitch.

I smiled. "No worries — nothing can bring me down now. I get to go home tomorrow."

After two brain surgeries and a week of intensive and much-needed rehab, I was more than ready to be discharged.

As she collected the debris from my stitches, I mentioned that, starting that morning, I'd been hearing an echo whenever I talked. It was an odd sensation.

She glanced sharply at me. "Have you been swallowing a lot?"

I nodded.

"What does it taste like?"

I swallowed. "Salty."

"Do you have a cold? Or allergies?"

I sniffed experimentally, swallowed again, and shook my head.

"Try tilting your head forward. Now back. Is there more to swallow?"

I did have much more fluid going down the back of my throat; I did need to swallow more.

"Try it again."

The same thing happened.

"It's a CSF — cerebral spinal fluid — leak, probably from the site of the second brain surgery," she said. "They usually heal themselves."

*
Something is very wrong.

A wave of overwhelming fatigue washes over me. I fight to keep my eyes open. Am I about to have a seizure? I need help. Where is the call button? I don't see the button. All I see is its cord.

My arm feels impossibly heavy. I stretch out my hand, grasp the cord, and pull on it. It won't budge. I pull harder. It still won't move.

I call out to my roommate and her visiting daughter.

My voice is too small. They are both caught up in the litany of complaints pouring out of my roommate's mouth.

I roll onto my stomach. My head and arm dangle over the side of the bed. The call-button cord is caught on something. I stretch out my arm. I lean. I lean farther, and farther again, another fraction of an inch, and ... I grab the cord and pull it free.

I press the button, collapse onto the bed, and wait. Nothing happens. I press the call button again. Nothing.

I struggle to think. I have to get help. I have to get a nurse. I have to get to the nurses' station. I have to get up.

I roll to a sitting position. I pause to gather the energy for my next move. I launch myself toward the wall. When I reach it, I lean heavily on it. I pause to steady myself. I take a deep breath, press my shoulder against the wall, and slide my way along the wall toward the door, propping myself up with my shoulder.

I rest right in front of the wide gap in the curtains drawn around my roommate's bed, hoping they'll notice me.

But they don't.

Giving up, I move on. I pause when I reach the door. I hear voices coming from the nurses' station.

The hallway is empty.

Grabbing the doorframe, I heave myself across the doorway.

I eyeball the distance to the nurses' station.

I slide along the wall, focusing on each step. Pick the right foot up, move it forward, plant it on the ground. Pick the left foot up, move it forward, plant it on the ground.

My shoulder runs up against something. I look up — I am a doorframe away from my goal. The nurses have their backs to me. They are still chatting. I try to call, but all that comes out is a soft, halting murmur.

I don't have enough energy to lurch across another open doorway. When I focus to measure the chasm with my eyes, I realize that I'm in luck — the door is closed.

I maneuver past the protruding doorframe, inch by inch, ridge by ridge. When I reach the door, I shuffle across it, no longer able to pick up my feet. I work my way past the frame on the other side. I glance up. Two nurses are sitting six feet away from me, the closest one with his back to me. I can see the other nurse's profile. I breathe a sigh of relief. She'll see me.

She doesn't.

I slide along the last stretch of wall, energy almost depleted. I'm barely within arm's reach of the male nurse, but I am invisible.

Leaning heavily against the wall, I slide toward the nurse and tap his shoulder. I whisper, "I don't feel ..." He whirls around, leaps from his chair, and shoves it under me as I collapse.

*
It seems awfully bright in the room. My eyes are closed. I try to open them.

I can't.

I sense a lot of people in the room with me. I feel the air move as they move.

I recognize the anguished voice of a nurse I chatted with earlier. "But I don't understand. I was talking to her this morning; she was fine."

I want to reassure her. I want to tell her that I was fine when I talked to her. I don't want her to feel guilty; it's not her fault.

But I can't.

I hear a piercing beeping, followed by a tinny voice announcing over and over again something about a code. Oh, there's some sort of medical emergency going on.

Why is the light so bright? Am I in surgery?

"She's going into convulsions!"

Who's going into convulsions? I feel a hand on my leg. Oh, I'm going into convulsions. I hear the sound of someone moaning. Is that me? Maybe I'm the medical emergency.

*
The light is brighter, though no longer blinding, no longer harsh. It's pure white light, far above me, filling my field of vision.

I want to know it. I want to be one with it. I'm floating toward it, lying horizontally, facing upward.

I'm content. Peace surrounds me, from without and within.

I am.

I am suspended in time. Time is meaningless. I can keep drifting toward the light forever. It feels right.

I continue to float, but ... the light is no longer drawing me in.

I don't understand. Did I forget something? Is something missing? But ... I don't ... I want ...

My eyes open to a darkened room.

Where is the light? Why is everything so dark? Where are all the people? Even my obnoxious roommate is gone.

Nurses and doctors swarm into the room. Someone says, "You're going to the ICU."

*
This was not how I imagined my life.

I was an academic, a successful professor of mathematics at a prestigious university. I was multi-lingual, thanks to my international upbringing. I loved to travel, especially to developing countries where I could explore traditional textile work, enriching my own abilities as a weaver. I was the married mother of two young teenagers; we lived a comfortable life in the suburbs. I was young, barely in my forties, and healthy, with a healthy lifestyle. I'd had no car accident, concussion, or stroke. A year ago, no one would have considered me at high-risk for brain injury.

I was not supposed to be here.

*
I am in bed on my side, with wires and tubes attached to me. One tube protrudes from the small of my back.

Without warning, the universe explodes.

I cannot see. I cannot hear. My entire world has become pain. The pain has no orientation — it has no location, it has no direction, it has no measure. It defies words.

I am pain.

Another explosion, and the pain intensifies. Now there is orientation, location: it is in my head, and it is beyond excruciating.

The level of my CSF has dropped too low, again.

At the ICU, the doctors agreed that I did indeed have a CSF leak, and they were concerned. If the fluid has a way of leaking out, bacteria have a way of getting in.

They needed to test the CSF for bacteria, for meningitis. That meant a lumbar puncture: lying curled on my side in a fetal position to create a gap between two vertebrae in the small of my back, through which the doctor would insert a needle and draw out spinal fluid for testing.

When we were kids, my older brother, Jonathan, got very sick. I watched him lying on his side in bed, curled up, with the doctor and Dad bending over him. Mum satisfied my curiosity by naming the procedure: lumbar puncture.

Jonathan was diagnosed with meningitis. Simon and I weren't allowed anywhere near him. I was relieved that I didn't have to kiss him — meningitis wasn't like chicken pox.

The next time I heard of meningitis was when I was in the third grade. During the summer, Galit, a classmate of mine, died. I hadn't seen her since the end of the previous school year, and she wasn't there when classes resumed in the fall. I hadn't noticed her absence until the teacher explained it. My classmates and I stared at each other wide-eyed for a couple of seconds, and then it was time to take attendance — back to business as usual.

As an adult, I was aware that meningitis could be fatal, and I realized that a lumbar puncture was a major procedure. But I retained my childhood perspective on the matter, a curious sort of naiveté — no fear, no worries, nothing. I viewed the whole event completely objectively. It was simply an interesting experience.

I was preoccupied by my disappointment at not being discharged and by my distress over the fact that my kids would see me in a hospital setting; they'd seen me in the hospital far too much over the past few months.

As I curled on my side into the fetal position, I felt as if my body were not my own; everything was happening to someone else, to a stranger.

I knew I wasn't going to die. The lumbar puncture was merely another unnecessary medical test among many. It was a nuisance, an inconvenience, a waste of time and resources.

The test was negative; I was free of infection. I felt like telling the doctors, "I told you so." I wanted to know if I could please go home now.

The doctors did not share my optimism. Since the needle was already in place, they decided to attach a catheter to it — a lumbar drain.

A lumbar drain operates essentially like an IV in reverse: the drain siphons fluid out of the spinal column into a drainage bag. Before it reaches the bag, the fluid flows through a tube, called a buretrol, which measures the volume of liquid passing through it. A spigot controls the rate and amount of drainage.

The surgeons wanted to remove enough CSF to relieve pressure from the site of the leak to increase the probability that it would repair itself. If it didn't work, we were looking at a third brain surgery.

I believed that the doctors were fussing over nothing. There was some sort of disconnect in my mind: on the one hand, I knew that a third surgery wasn't in the cards, and on the other hand, I was sure that the lumbar drain wouldn't work. But I missed the connection between the two — it did not occur to me that if the lumbar drain didn't solve the problem, I would have to undergo another surgery.

Anyway, none of it really mattered. I was more interested in the potential discomfort involved in having a tube sticking out of my back.

Would I have to lie on my side the whole time? Would I be allowed to switch sides? Would the various tubes and wires get tangled? How often would the nurses change the dressing? Would they constantly obsess about infections?

One inconvenience that I did not anticipate was the balancing act involved.

The CSF's purpose is to act as a shock absorber, cushioning the brain against injury caused by movement. When the level is too low, it cannot perform its function effectively. If the level drops too far, the brain sets off alarms — seizures, brutal headaches.

The doctors wanted to remove enough CSF to promote self-healing, without lowering the level too much. The fact that the body continually replenishes CSF complicated things. Instead of merely removing a certain amount by draining the fluid in a single step, they had to remove fluid at an appropriate rate, which meant that the balancing act would be ongoing for the duration of the healing process.

The plan was to first remove sufficient CSF by draining it at a faster pace than the rate at which it was produced — but not too fast. Once the fluid was at the optimal level, they would adjust the flow rate to match the rate at which my body produced it, thus maintaining the optimal level. Sustaining such a delicate balance requires careful management, and there's more than one way to do it.

After the doctor inserted the lumbar drain, he supervised the initial CSF drainage until he deemed the level optimal. He demonstrated to the ICU nursing staff how far to turn the spigot in order to maintain an appropriate drainage rate. He instructed the nurses on how to monitor the rate of the flow by tracking the volume passing through the buretrol, and suggested checking it periodically in case minor adjustments were needed.

The nurses followed his instructions for several hours, but then the routine changed. Instead of adjusting the flow every so often, the nurses kept turning the spigot on and off. If the level of the fluid was too high, they turned the spigot off, and when a sufficient amount drained into the bag, they started the CSF flowing yet again. Apparently, they were now following another doctor's orders.

Later, when the original doctor made his rounds, he criticized the nurse for using the intermittent-flow method. He patiently explained that there was a greater danger of letting out too much CSF with the intermittent method, for example, if a nurse was delayed.

He adjusted the rate and repeated his earlier orders.

The nurse nodded and proceeded to follow his instructions. Throughout her shift, she wandered in and out to check the flow rate and fiddle with the spigot to make minute adjustments.

The second doctor came into my room several hours later. He questioned the nurse on the drainage procedure she was using. When she described the first doctor's method, the second doctor reprimanded her. He patiently explained that if the CSF is drained continuously, the flow rate must be just right. It was much easier to determine the correct amount than the perfect rate. The nurse was to drain a certain amount at certain intervals. The nurse merely nodded and followed his instructions, until the second doctor's shift was over.

Neither method was infallible. The CSF level dropped too low several times during each of the doctors' shifts, swamping my world in pain.

*
I was sufficiently cognizant to realize that I needed painkillers, and that I needed them fast. I was aware of the procedure I needed to follow to procure the medication. I was not too far gone to realize that I needed to take action, not merely theorize on it.

The fact that I was able to breathe and that my heart continued to beat seems miraculous now. The fact that I managed pick up the call-button device, find the button, and then press it is still mind-boggling. I cannot begin to understand how I was capable of speech, let alone of explaining the issue over the intercom.

I croaked, "I have a bad headache. I need pain meds."

A cheery voice answered, "We'll be right with you."

Then it was time to wait. A mere couple of minutes seemed like a lifetime. When the nurse finally arrived, her voice was gentle. "Here you go."

She held out a little paper cup with the painkillers in it: two white pills. Raising my hand to take the cup was no easy task. Every motion added to the pain, making me wince, which intensified the pain further. Trying to minimize additional agony, I worked hard to keep my motions fluid.

Once I held the cup of pills in my hand, I brought it up to my lips and tilted it toward my mouth until the pills tumbled onto my tongue. I handed the little cup back to the nurse, reached for the cup of water that she held out to me, lifted it to my lips, tilted my head back, took a mouthful of water and swallowed it with the pills, handed the water cup back, lowered my hand onto the bed, and let my head sink into the pillow.

By the time I laid my head down, I was completely drained of energy. I held myself as still as possible, all my muscles tense, my eyes tightly shut, my brow furrowed, my breathing shallow, engulfed in pain.

And I waited for the miracle to occur. I waited and waited, an eternity.

A glimmer of a thought entered my mind: relax.

I worked to ease the tension in my muscles, but every movement, however slight, increased the pain, causing a sharp intake of breath, which intensified the pain, causing my entire body to tense up again. I had to focus on breathing slowly and evenly. But concentrating, focusing my mind, also exacerbated the pain, tightening my muscles further.

Relax.

I lay with my eyes closed. I carefully eased the tension one muscle at a time, my toes, then feet, then legs, all the way up to my neck, facial muscles, and brow. I tried to relax mentally. I envisioned gentle waves washing through me, one chasing the other, each wave carrying more of the pain along with it, cleansing me of it.

My mind drifted back and forth with the undulating waves, floating, worlds away from my hospital room. Then, slowly, the hospital setting eased into my awareness. I lay in bed feeling the worn, soft cotton sheets between my fingers, seeing the green lights flickering on the monitor, hearing a distant hum from the hallway. It occurred to me that I had left the pain behind somewhere.

(Continues…)

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Excerpted from "But My Brain Had Other Ideas"
by .
Copyright © 2017 Deb Brandon.
Excerpted by permission of She Writes Press.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

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