At St. Joseph’s Hospital’s ICU
About a year after the first recurrence of the melanoma it came back again. I took a heavy casserole out of the oven and felt something pop in my back. I ignored it for a while but finally had to go to the doctor, who took x-rays and scolded me for waiting. Turned out that it was a compression fracture of a vertebrae, broken because it was full of tumor, not strong bone. The surgery was lengthy and complicated, but good surgeons got the tumor out and put some metal where the vertebrae would be, and put me all back together and I woke up in ICU a few hours later. Scarred and hurting, but awake. And scared. Everything was spreading, and I was scared. This was the kind of time that rearranges priorities and engages the spirit and the soul.
Peg will tell you this part of my story, too. I tried to tell it, and couldn’t. She was there, she was more awake and alert than I was at that time, and she remembered what happened and how things looked and felt. From the first part of the story to the last, she was there. She understands it, and she’ll tell you all about it.
She came into the therapy room early in April after a blood draw looking tired. Sat down as if she’d walked a hundred miles, and tried to smile. .
“Peg, when your back hurts, everything hurts!” Carolyn leaned back in the chair and closed her eyes. .
It was empty in the therapy unit, early in the morning. Tracy was over at the hospital doing the morning ‘run’ for supplies. I poured a mug of coffee and gave it to Carolyn, and pushed a stool over so she could put her feet up. .
“What happened?” I asked, wanting to know but also not wanting to know. .
“I lifted a heavy casserole out of the oven a couple of weeks ago when I was in a hurry, and wasn’t standing right. I felt a ‘tug’ in my back, and then it really started to hurt. Felt like a flame thrower for a few days and then it calmed down. I finally went to the doctor and had x-rays, and didn’t think much about it except that the tech’s comment bothered me. He mentioned something about a ‘compression fracture” in an offhand way, just making an observation. I thought I was doing fine, handling everything OK, Jack and I. Then when I didn’t hear from the doctor for four days, I started panicking. Maybe the fracture was caused by bone cancer, spreading from the lymph nodes? It was funny but not funny, it was definitely a possibility of course. But to immediately assume it was a worst case scenario was nuts. People do it all the time, I know…” she watched me nod in agreement. “…but I have no symptoms, other than the back pain which seemed to get slowly better day by day. My blood results were fine. But I was convinced at one level that I was dying of bone cancer.” She shook her head at the nonsense that people put themselves through, but I knew, and she did, too, that other tests were necessary. .
She sighed and smiled at me. “Dumb, huh? I’ve told many patients and their families not to worry until there is something to worry about.” She squirmed, frowned and put her hand behind her back to brace it against the chair. .
“Take my own good advice, right?” .
“What are they going to do, a bone scan?” My mouth was dry and I felt a little dizzy. This was my buddy’s back and future we were talking about. .
“And an MRI and a bone density test to rule out osteoporosis. I’m turning into a little old lady, Peg. An LOL at my age. What a bummer.” She closed her eyes and leaned back in the chair, tired and flattened. I stood up and did my Brisk Nurse act. “Come on, Fink, you’ve got work to do. Write that book…”.
“Tote that hay, or whatever,” she grinned stood up, wincing. “I’m on my way to see Pam again, I need to see how her husband is doing.” Carolyn had a big jar of spaghetti sauce in her nurse tote, along with the tape recorder. .
“Pasta and patients?” I asked. .
“Jack made it. I can’t stand at the stove or anywhere else for more than 10 minutes before the flame thrower goes into action.” .
She gave me a hug, looked around the room, now dim and empty. “What peace there is, here.,” she murmured. “What a funny place for peace.” .
The phone rang and I waved her out the door. Patients began coming in slowly, looking around them as usual, as if surprised to find themselves here, in this peaceful place. This funny, peaceful place. .
She did have to have surgery because the final tests showed a tumor in the vertebrae, sure enough. So for the second time in eleven months, she went back into the hospital. It was a six hour surgery, very extensive and difficult. We all sat in the waiting room, in and out for the time it took, and waited to hear the news. The surgeon was brisk and to the point. .
“All done, tumor’s out. She’ll be in ICU for several days, but she’s fine. She needs to rest and heal. I’ll see her tomorrow.” .
A couple of days later I walked into the big intensive care unit at St. Joseph’s and waited until I got acclimated to the noise. I was used to the quiet therapy room at the cancer center at UNM, here it was bleeps and noise and bustle and lots of machinery. At almost every door there were computers, inside the rooms were x-ray machines, physical therapy stuff, some respirators. All around the halls like sentinels were machines used to take vital signs, and monitors to check heart rates. I’m used to machinery, but this was wild. It was like walking into a construction site, everything beeping and moving of its own accord. I passed several rooms and poked my nose inside, naturally. All around each patient was the normal ICU stuff, the tubes and the drains and the IV poles, and the monitors. But on the shelf that ran along the wall opposite the bed in each room I saw pictures and cards and little figures, little statuettes or something bright. It reminded me of Honoria’s little figures; people who couldn’t stay with the patient left their love in ceramic and paper to watch over them. They didn’t allow flowers in ICU of course, so all the little figures added color and life to the white walls. .
I found Carolyn in a room, a nice room with a window so at least she wouldn’t get psychotic and not know whether it was day or night. She lay there with a tube coming out of everywhere, trees of intravenous fluids all around the bed, pale, calm, quiet, eyes closed. I stood there for a minute and waited; it was quiet in the room, I couldn’t hear the noise from the hall outside. I wasn’t sure how really asleep she was, so I walked my fingers down her leg like a spider, and she opened her eyes. When she recognized me, she grinned. .
“Ever seen so much damn equipment?” She asked, her voice strained but still her own. .
I shook my head. “What are they doing, trying to make more holes in you? Did they forget any places?” .
She shook her head and sat up a bit. “At least I don’t have a tube going down my nose into my stomach. Look at these collection bottles; it takes three nurses to count all the stuff that comes out.” She lay back in the bed, already tired. “They think I had pneumonia when I came in here.” .
“You did ignore that backache too long, Fink, you kept saying it would get better and it didn’t, so you couldn’t breathe right or eat right…..”.
She opened one eye and grinned again. “Stop that, you sound as bossy as every other head nurse I know. I wasn’t thinking about me at the time, I was thinking about a new daughter in law and two new granddaughters. What was that compared to a little pain in my back?” .
I was quiet then, knowing that she knew as well as anyone what damage she had done to herself and it was useless to go back and rake up that ground, it was done and that was that, and she had to move on. We sat there, quiet, looking out the window at the darkening spring day. .
I had driven to St. Joseph’s from the UNM cancer center at the end of the work day. The sky was a dark, royal blue, the lights from the cars on the freeway were bright with the promise of going home, and the mountains were dark black cutouts against the wide sky. We both had known those mountains for many years, we had gone to work watching them begin to lighten with the sun coming up. Now we looked out the window and wondered what our next days would bring. .
“They walked me, you know, less than 24 hours after the surgery.” She shook her head. “They’re wonders around here, they really are. They never lost me under all those tubes and wires and technology. Never made me feel like they were taking care of machinery instead of a patient. They walked an old lady the other day,. It took five of them, and this old lady had her eyes closed, feet barely moving. But she was up, and moving, kinda sorta.” .
She laughed. “No way anyone stays in bed around here.” She struggled to sit up, and reached for the little plastic inhaler that stood on the table near her bed. I tried to get it for her but she waved me away. “Does me good to move, even that little bit.” She breathed in slowly, watching the indicator on the bottle, and frowned. “Can’t breathe in as much as I want; that little indicator needs to go up to 1000 by tomorrow.” .
I nodded, knowing that competing with herself was good for her, but would she know when to relax and just heal? I hoped they kept her in ICU for a while; she’d be out on the floor checking on people if they let her out of here. I thought of Sybil and Pam and smiled. .
“You’ll get there, just keep at it. You do know that you have to rest, don’t you? You won’t heal unless you rest.” .
“I know that; but it’s hard being so helpless. Awfully hard.” She lay back on the pillow and I saw circles under her eyes. Because of the chest surgery she couldn’t get enough air into her lungs to get all the oxygen that she needed, so she got tired easily. I stood up and moved the table closer to her, and put some more ice and water in the plastic jug. She didn’t complain, didn’t tell me she could do it herself. She just lay there, eyes closed, breathing hard. I looked around her room and saw some great stuff. .
“Is that your granddaughter?” I asked. There was a picture of a little two year old smiling madly for the camera, eyes all squinched shut. Carolyn smiled. .
“That’s Zoey, on her second birthday two weeks ago. Somebody said ‘say cheese’ and she did, in spades.” She looked around at the shelf in her room. “There’s a totem from my friend Kate, and a ceramic flower from my neighbor in Los Lunas.” .
“Looks like everybody does that, here. I passed several rooms and patients have pictures and little figures people have given them. I guess they are totems, like Honoria’s. She brought all kinds of stuff to the cancer center at every treatment, and got them all lined up before we could even start the IV.” I smiled, remembering how serious Honoria was, putting those little things of hers on the Mayo stand. “She said they all meant love, when people couldn’t be there, they sent their love in little figures like that.” .
I told her about the latest gossip from the cancer center, two docs were retiring and one going into private practice. I sat and watched the nurses come and go, and thought about the surgery she had. It was called a ‘transthoracic vertebral resection’ which simply means that they went across her chest from the right side, turned left and took out a vertebra from her spinal column. One of the risks of surgery like that of course is that she could have waked up paralyzed but she had the most competent doctors in the city, or probably the whole region. The nurses told me that the first thing she did when she woke up was wiggle her toes. She figured if she could wiggle her toes she was fine. The whole surgery took six hours, and hopefully the tumor that had been pressing on the spinal cord was gone, and she would heal and go on with life. .
I talked for a few minutes more and knew that she was getting tired. The nurses had given me a high sign when I came in that said ‘this one won’t tell you to leave, so don’t stay too long’ so I made sure she had things close to her, within reach, and gave her a hug and told her hello from her buddies at UNM and watched her turn, sleepily, against the pillow. I stopped at the desk on my way out of the Intensive Care unit and spoke to the nurse. .
“She won’t limit her visitors, so could you, please? Room six, she’s a nurse, and…” I said. .
The young lady smiled and nodded. “We know. We already took the phone out because she’s so short of breath she can’t talk long. We’ll keep an eye on her, don’t worry.” She looked up at me and I knew that she would. I went on down the hall, out of the ICU It seemed longer to walk out than it had coming in, and the road felt darker all the long way home. .
The next time I saw her was two days later, about 10 in the morning. She was up and walking, slowly but surely. Next to her walked a trim Physical Therapist in a dark blue uniform with her hand at Carolyn’s waist holding a belt to make sure she didn’t fall. Carolyn didn’t see me, so I stood and watched and waited. She was talking with her hands like she always did, gesturing and intent. She seemed much better, more awake, less tired. Her short gray hair was sticking up all over her head, and she wore the little hospital gown and a pair of paper slippers. She waved when she saw me, and she and the PT person made their way back to her room, past all the equipment and people in the unit. .
“Hey there, don’t they need you at the Cancer Center any more?” she laughed. .
“Got a reprieve,” I said. “Big meeting let out early so I thought I’d come bother you.” I turned to the therapist and said, “How’s she doing?” .
Kristen grinned. “Better and better. Let’s do the step now.” .
They brought out a platform, and Carolyn stepped up and down, up and down, and started talking and lost her rhythm and stopped, laughing. .
“Can’t walk and talk at the same time; takes too much concentration.” .
We got her back to bed, she was tiring fast and her breathing was labored. .
“I need to stay up, it’s better for my lungs to do some work.” .
“The key word here is ‘some’,” said Kristen, briskly. She smoothed the sheets and winked at me and said she would be back in the afternoon. .
“Twice a day now?” She was getting better if they had changed the schedule that much. .
“Yep, just trying out for the Olympics.” Carolyn drank some water and put her head back on the pillow. “I go to the step-down unit tomorrow and then to the floor and then home on Friday. Dr. Kazu came to see me twice, so the whole team of doctors and nurses is working together.” She closed her eyes. All the tubes were gone, her IV would be taken out soon, she was up and walking and eating regular food, and something was wrong. .
“What’s up, Fink? Something’s bothering you.” .
She opened her eyes. “Wrong? Heavens, what could be wrong? I’ve got a scar from gaggle to zatch, I hurt like hell, and I’m praying that the tumor won’t pop up somewhere in something they can’t take out.” She leaned back, and closed her eyes. “What could be wrong?” .
She was scared, and sarcasm was her way out. She wouldn’t be sarcastic with the staff, and never was with patients, but sometimes with people she knew very well, it came out like venom. I sighed and sat down on the visitor’s chair and thought for a minute. I could ignore the sarcasm, or get her to talk about it, or let her know I understood. That was tricky; sometimes she didn’t want to be understood, just left alone. .
“Sounds reasonable to me. What you need is work, woman. You’ve been idle too long, just lying around. Too much energy wasted on silly things like healing.” I looked her straight in the eye and caught a flash of something in her face, and then she laughed. .
“Right on. I know.” She sighed and looked serious. “I need to write about this,” she waved her hand at the unit beyond her room. “All of this. All the docs and the procedures and the surgery and the nurses, all of it. Only way I can deal with it.” .
“Where’s your journal?” I asked. The last time I had seen her there was a little blue spiral notebook on the table next to her bed. She dug under the covers and found it, and looked at it. She handed it silently to me and closed her eyes. I opened it and read a little, and felt tears pricking behind my eyes. The writing was a scrawl, almost illegible, going up and down the page, not following lines or going in any orderly direction. One page was upside down. But through the scrawly writing and the pages that were sideways, I felt the apprehension and the pain and the attempt to get some measure of control in all the fear. She had described the view from the window, the wonderful picture of her two-year old granddaughter on the shelf, the clock on the wall when she woke up in the middle of the night and couldn’t sleep. She had written about insomnia, and about the odd noises that a nighttime hospital makes. She had written down the names of the nurses and the techs and the physical therapists, to let the hospital know when she went home that there were some special people in their intensive care unit. I sat with the little book in my hands for a minute and then put it back on the bedside table. .
“You’ll use it all, I know you will.” .
“I have to. Only way to stay sane.” Her eyes were closed, and I saw the tears, and patted her hand. “I’ve got to get back, I’ll come and see you again when you go to the floor.” She waved, eyes still closed, hand around the little blue notebook. Writers, I thought. Digging into themselves and using all that pain for stories. Go figure. .
She got out of the hospital, of course, and home, and felt weak and wobbly. Jack and her family took over all the household chores and let her rest. Her friends in Los Lunas arranged to cook several days of meals, a practical and loving way to help. I went to see her one Saturday afternoon, and she told me about her friends, and showed me all the plants and flowers and cards. .
“It makes me feel so proud, to have friends like that,” she said. “They have a prayer group, too.” She shook her head over the wonder of friends. I made some iced tea, and we talked about grandchildren and the future and Jack’s garden. I left her after a while, propped up on the couch, leaving her to scribble in her little blue notebook. .