I waited through supper. Then we watched some somnolent golf on the sports channel and Charlie dozed off to the polite patter applause of spectators on a course in Georgia or Florida. I kept my eye on the clock, digital numbers changing one red stripe at a time: a five morphing into a six, a six squaring into a seven, a seven into an eight, an eight to a nine. In the no-time of permanent lights and the round-the-clock nature of illnesses and broken bodies, clocks were the clearest way to mark the passage of day into night and of night’s slow creep into dawn.
It was late by the time I left the hospital and found a motel. Then I read for a while until I was sure I was tired enough to sleep. But as soon as I shut off the light and closed my eyes, the vision of Charlie’s accident returned, so I switched on the light and stared at the ceiling. The Snake River ran past my room near here. I could hear it racing west contained by banks of concrete. At last I got up, dressed, let myself out of the room, and walked along the river, watching streetlights bounce off the oily water on either side of the place where it had been abruptly broken by the imitation waterfall.
Early the next morning, I did an interview with a journalist from Colorado for my new book. My editor had offered to cancel any publicity until things settled down again, but I welcomed the distraction of work, the chance to talk about writing—this was my everyday world and the ordinariness of it comforted me. While the journalist and I were talking, another call came through. I looked at my phone and said, “I’m sorry I have to cut this short. I think that’s my husband on the other line. He’s in the hospital.”
“Nothing serious, I hope,” the journalist said.
“Oh no,” I said. “He’s going to be fine. A horse accident is all.”
But when I returned Charlie’s call he said he felt confused. “I can’t get my . . .” He paused. “My brain is . . .” There was another pause. “Can you come?”
I hurried to the hospital. Charlie looked baffled and fretful. “I’m mixed up . . .” He pressed his lips together in an effort. “My head . . . I can’t remember how to . . .” I called for the nurse and she called the doctor and he administered tests of the sort commonly depicted on afternoon soaps when someone comes out of a conveniently amnesic coma and has to prove their identity. Could Charlie say his name? What year was this? Who was the president? Did he know what had happened to him and where he was? Could he hold his thumbs and little fingers together? Could he touch his nose with first one forefinger and then the other?
Charlie answered all the questions correctly and managed all the physical tests, but he seemed uncharacteristically irritable and he was having trouble telling us what was going on in his brain. “What I want . . . ,” he said, but he couldn’t tell us what he wanted. “There are . . . ,” he said. “Oh, I’m brain broken . . .” His hands went into the air and he conducted his remaining, unspoken words in the ensuing silence.
I pulled the physician into the corridor outside Charlie’s room. “What’s happening?”
The doctor was calm. “He’s on some pretty strong medication. It’s scrambling things a little, that’s all.” He smiled at me conspiratorially, as if Charlie were on a magical, drug-induced trip that we would all be so lucky to experience. Then he looked at his watch. “We’ll keep an eye on him,” he assured me, and then he hurried away. I phoned Charlie’s doctor in Wyoming and he reiterated that pain and painkillers might cause confusion; it was nothing to worry about. I called another doctor, a friend of Charlie’s. She said, “Are there any recreational drugs he might be withdrawing from?”
I felt as if I alone were watching an accident unfold in slow motion, Charlie falling silently off a cliff, his body plummeting through the sky. I felt as if I alone was shouting in alarm, “Look! Fetch a safety net!” But it seemed as if everyone else was purposefully ignoring him, admiring the blueness of the sky, the steepness of the cliffs, the incidental brightness of a bird flapping past Charlie’s tumbling body. And I was an annoyance to them, a meddlesome woman saying the same things over and over, distracting them from an otherwise pleasantly normal day.
By early afternoon, there was no denying the severity of Charlie’s condition. He understood what was expected of him—a horror of frustrated effort burned from his eyes—but when the doctor asked him to repeat certain phrases, he managed only exhausted, preemptive moans. And when the doctor asked him to touch his nose, or lift a foot, his movements were hard-won and approximate. The doctor ordered more tests, summoned a neurologist, agreed with me that things were worrisome.
While Charlie was being taken down for an MRI, I phoned his brother, a psychologist in New York. He has the soothing, unhurried delivery of one accustomed to dealing with the seriously unhinged. “Please, you’ve got to come out here,” I said. But I couldn’t bring myself to say what I really thought, which was that in a few hours Charlie might not be here anymore. Or that if he was here, he would be so far removed from a familiar version of himself that he would be unrecognizable. Charlie, as we had known him, was dying. A body remained that resembled Charlie’s, but it had none of Charlie’s acuity and power. Charlie’s mind—that predictable thing so certain and in control two days ago—had slipped its coils and was now beyond the bounds of ordinary reach.
I called Bryan. “Things are getting weird,” I said.
I could hear Bryan measuring my words. He said, “Are you okay? Have you slept yet? Or eaten?”
“Well, yeah,” I said.
“Your voice just went up an octave,” Bryan said. “Where do I fly into?”
At three o’clock the neurologist—a visiting physician from out of town, avuncular and undismayed—confirmed that Charlie had suffered a shower of strokes, for no really good reason that he could tell. Then he said he would order a course of intravenous blood thinners right away and that we shouldn’t worry: rehabilitation would take care of Charlie’s failed faculties; people had strokes all the time; Charlie was relatively young and very fit. So Charlie was hooked up to more medication, and then the nurses and doctors filtered out of the room and we were left alone in the surreal new reality of that word, strokes. I kissed Charlie’s sagging cheek and pressed his inert hand. “Please hang on,” I told him. And then I lied for the first time since the accident: “Everything’s going to be okay.”
Five hours later—seventy-six hours after the accident—the threads that were holding Charlie to his life were snapping fast. He had lost words and the use of his limbs, he was unable to hold his lips firmly against his teeth, his eyelids were sagging and his jaw was becoming slack. The doctor and nurses began to speak of him in the third person and I could tell it wouldn’t be too much of a jump for them to begin referring to him in the past tense. But I knew Charlie was in there. I knew he could hear us. And I assumed that he would want me to fight for his life, harder than I would want him to fight for mine if the circumstances were reversed.
I had always told Charlie and the kids, “Pull the plug on me for anything worse than a bad head cold or a stubbed toe.” I didn’t think I could take the indignities, the beyond-ten-on-the-smiley-face-scale pain, the pools of bodily fluids, and the bags of excrement. That kind of fighting, that kind of life seems as if it takes courage and a depth of resources I’m certain I don’t have. But I knew Charlie had those qualities in spades. I knew he was tolerant of pain, that he would take physical anguish over emotional turmoil any day, and that he valued life differently—not better or worse—but differently than I did.
In the back of my mind, I also knew there was a good chance I could end up fighting too hard, that I could fight beyond what was reasonable and not allow Charlie the dignity of a simple death. I knew that Charlie in a permanently vegetative state was not something he wanted. But there’s a lot of room between vegetative and the way-he-was, or the way he could tolerate being. Too late, I needed to ask him, “Show me how hard you want me to fight.” Too late, I needed to know what an acceptable life might mean to him
. Too late, I needed to understand what a good death might look like.
“You always take things too far,” Charlie repeatedly told me in one version of our frequent arguments. But there seemed to be nothing for it. If I didn’t risk taking things too far, Charlie would die. Of that I was certain. So I pushed, and made calls and pushed harder, and when the neurologist could not be found, nor could he be made to answer his cell phone, I insisted we move Charlie to Salt Lake City, to a proper hospital, to a place with a neurological ICU.
“It’s very risky to move him,” the doctor said.
“It’s very risky to keep him here,” I replied, and I felt not angry, but something akin to that emotion that allowed me to speak in clear, whole sentences, paragraphs of persuasive, quiet outrage.
Then everything suddenly started to move quickly, time taking on a shocked, jumping quality. I signed papers authorizing Charlie’s removal from this hospital and his transfer on a life flight to the next. The nurses began to prepare Charlie for an ambulance ride to the airport, attaching his monitors, IV bags, and medical equipment to mobile units, moving him onto a gurney. He was breathing, but beyond that, he had stopped existing in any way I could recognize. I kissed him. “Hang in there,” I told him.
Our medevac airplane took off from Idaho Falls at midnight. The darkened cabin contained Charlie, two nurses at his head, and me on a small jump seat at his feet. In the dark, I strained against my harness and wrapped my hand around the high arch of Charlie’s left foot, the only piece of him I could reach. “I love you. I’m sorry. Forgive me,” I thought, over and over. “I love you. I love you. I love you. I’m sorry. Forgive me.”
Charlie and I had let the sun set on our anger too many nights, too many months, too many years in a row. We had brought each other our defenses, not our vulnerabilities; we had attacked one another with our strengths instead of shoring one another up with them; we had been disloyal to one another and to ourselves. We had allowed old, unrelated wounds to become the battle scars of our marriage. We had been so careless, so arrogant, so heartless, always assuming there would be another day, another chance, another way to fix ourselves, to forgive one another, to see and be seen. “One of the most widespread adult illusions,” John Berger wrote in his 1967 biography of a country doctor, A Fortunate Man, “is the belief in second chances.” Charlie and I had used up all our illusory second chances, and now we were here.
BROKEN
As soon as the ambulance deposited us at the doors of the hospital in Salt Lake City, Charlie was taken away for scans and tests. Meanwhile, a brain surgeon put the images I had brought from Idaho Falls on a screen. He pointed to two dark places on the monitor where Charlie’s neck connected to his head. “These are bilateral dissected carotid arteries,” he said. He went on to explain that carotid artery dissection was not an uncommon injury associated with severe whiplash but that it was very rare for both arteries to be dissected. It was even more rare for someone to survive this eventuality. The surgeon didn’t look at me. “There’s not enough blood getting to his brain to support normal life,” he said. Then he excused himself and hurried away into the rest of the dark hospital.
The definition of hell has been the same forever, or at least since Dante’s Inferno. The beginning of pain, the moment at which it is instinctive to flinch away, is simply that. It’s the beginning, it’s not where we get to stay, in mediocre discomfort: “But the stars that marked our starting fall away. We must go deeper into greater pain, for it is not permitted that we stay.” The ICU was an eerily static place, pale fluorescent lights whirring into echoing spaces. There were beds taken up with bodies collided into silence by strokes, vehicle accidents, and system collapse. Monitors beeped from one room to the next like electronic insect-creatures trying to locate one another in the humming, weird, no-night hospital. It seemed a terrible place to have come to, the sort of place you don’t come back from.
Charlie’s room was still empty; a tiled floor held the space into which his gurney would be wheeled. I propped myself up in the corner of the room where the walls could support my shoulders. I dug my phone out of my bag and called a friend with medical training. He was someone I could trust to tell me the truth. Then I phoned Vanessa in Zambia. I told her I needed to speak to Mum and Dad. I said, “There’s been an accident. I think Charlie’s dying.”
Vanessa said, “Oh Al, I’ll get Rich.”
Richard came on the line and told me the name of a hotel in Paris. He said he thought my parents were staying there and gave me a number. When Dad answered the phone, I started to cry. I told him everything: the ambulances and helicopter, the airplane ride, the strokes. There was a pause, then Dad said, “That’s a lot of roaring about.” And I could see him weighing up the cost of all that fuel against the odds of Charlie’s ultimate survival and I was suddenly furious with the people who had raised me. Their crazy courage no longer seemed charming and life-affirming and more or less innocent, it felt deliberately distancing and brutal.
“I can’t do this alone,” I said. I was trying not to shout, and surges of resentment I didn’t even know I harbored came flooding up. Why could no one from my family be with me now? What calamity could shift them?
Dad was saying, “It doesn’t sound like I can get there in time, Bobo.”
“Please, Dad.”
“What can an old madala do, that you can’t?”
I imagined Dad in an inexpensive little hotel near the Sacré-Coeur, sitting on the edge of a small single bed with the phone against his ear, his pipe cupped in the palm of his hand, fingers pressed against his chin, a cloud of tobacco smoke around his head. I imagined Mum on the other bed, her feet up, an open book next to her. I knew she had been rereading George Orwell’s Down and Out in Paris and London in preparation for this trip: “It is a feeling of relief, almost of pleasure, at knowing yourself at last genuinely down and out. You have talked so often of going to the dogs—and well, here are the dogs, and you have reached them, and you can stand it. It takes off a lot of anxiety.”
“I’m so frightened,” I said.
There was a long pause, and then Dad said, “You already know everything there is to know, Bobo. You’ve been here before.”
I hung up and hugged my knees and the ways in which loneliness surrounded me became its own weather system. Dad never apologized for not being there, but months afterward he said to me, “Sometimes you can give a person just enough help to sink them.” And I thought back to those days of Charlie’s accident and how it felt a lot like being alone on a crowded boat and that if anyone from either of our families had swooped down and made my loneliness feel less profound, I might have been able to carry on as we had been, and everything might have been worse in the long run. “Letting other people row their own boat to shore,” Dad said. “That’s the tricky bit.”
About an hour passed. At last Charlie was brought back to the room and he was hooked up to monitors, and IVs, and a catheter. The nurse said, “Does your husband have a living will?” And then I noticed that the pupil in one of Charlie’s eyes had frozen into a wide black dilation. I knew there was a name for this: fixed dilated pupil. And because of this, I knew too that Charlie’s condition had plummeted from extremely critical to whatever came next. I squeezed Charlie’s hand and he squeezed back. “The company of six is reduced to two,” Dante wrote. “By another way the wise guide leads me, out from the quiet, into the air that trembles, and I come into a region where is nothing that can give light.”
The surgeon returned and said there was nothing more they could do for Charlie in this hospital. He seemed matter-of-fact in his delivery of this bad news. What else could he be? I knew he was just doing his job, grinding away through another shift, paying the mortgage or a car payment or for his family’s vacation. To him, Charlie was a body making its way through their system. But to me he was Charlie Ross, father of my children, my dream-relinquished spouse. “Then we’ll move him t
o a hospital that can,” I said. I kept touching Charlie’s arm, so he would know I was near.
The doctor shrugged. I asked him to make the necessary phone calls now, I didn’t care that it was three in the morning. I knew that every minute we waited, every minute no matter what, Charlie was sinking further and further beyond the reach of any help. I could only imagine his torment, to be mentally alive and alert and aware, but trapped inside a dying body. It was Jean-Dominique Bauby’s short but beautiful memoir after his stroke: “Paralyzed from head to toe, the patient, his mind intact, is imprisoned inside his own body, unable to speak or move.”10 It was Michel de Montaigne’s reminisce after his near-fatal riding accident: “I can think of no state more horrifying or more intolerable for me than to have my Soul alive and afflicted but with no means of expressing herself. I would say the same of those who are sent to be executed with their tongues cut out.”11
At first light Charlie was wheeled out to a tiny translucent-bellied helicopter on the tarmac outside the hospital. I kissed his forehead. “I love you,” I told him. His eyes were open, his mouth slack, as if agog with horror. “Hang in there,” I told him. “Please hang in there.” The sun appeared suddenly, unapologetically bright behind the Wasatch Range. The sky raged pink with dawn. “Look, the sunrise,” I said, as if that was something that might give Charlie hope. Wasn’t there a statistic that most people died before dawn, not after? If he’d made it this far, he could make it for the rest of the day and all he needed was this day, today, now. The orderlies loaded Charlie onto the helicopter, and two nurses climbed in next to him. Those of us left on the ground ducked and turned our backs against the turbulence of the blades as the helicopter lifted into the perfect June morning.