Awakening

Paul H. Rockey, M.D.
paul.rockey@ama-assn.org

Awakening at 4:30 in the morning, both dogs are asleep beside me, not yet ready for their early morning walk.  I could take the aerobic cure, but the YMCA doesn’t open for another half hour.  Reading the novel at my bedside might distract me.  I could tune in classical music on the radio.  But none of these ploys will quiet my discomfort or soothe my restlessness.

In a few hours, I will make rounds with the residents on my medicine team.  Most of our patients are in the twilight of their lives.  They appreciate our attention and accept our medical ministrations. I look forward, for example, to assisting the 86-year-old woman we admitted the previous night.  What wakens me from a dead sleep before dawn however is a comatose 27-year-old woman in room 874.  My mind comprehends what has happened, but my heart cannot accept it.

Her medical history is simple but inexplicable.  In February, eleven weeks before her admission, she delivered healthy twin boys.  On May 12th she dropped off her sons at her mother’s house and drove with her husband to the movies.  They were celebrating her first Mother’s Day.  She stopped for a red light, turned to her husband and said, “I feel so tired.  Wake me up when the light is green.”  Before the light could turn, her life changed forever.

Suddenly she stiffened, slumped over and lost consciousness.  Her husband summoned help.  A witness in an adjacent car started CPR, and paramedics arrived.  They found her heart in ventricular fibrillation and shocked it into normal sinus rhythm.  Her heart continues its steady beat, but her brain, denied oxygen too long, suffered severe, irreparable damage.

Kelly’s hospital room is filled with the usual medical paraphernalia.  She receives around-the-clock nursing.  She is breathing on her own.  Physicians have weaned her from the respirator.  A tube provides essential nutrients directly into her stomach.  But her body is rigidly trapped in a stiffened posture, her hands and feet hyper-extended like a small child in a temper tantrum.  Her face is in a constant grimace, never relaxing, never smiling.  She cannot speak.  Periodically, nurses and therapists suction her tracheal secretions.  A recent CAT scan shows her brain has become atrophic, like that of a 90-year-old patient.  Those of us involved in her care hope she will regain some mental functions; we tend to her medical needs every day.  But I question whether the twins whose photos are taped to her bed rail will ever know their mother.  Will she ever be able to hold her sons again?  Will she ever read bedtime stories or tell them she loves them?

Kelly’s life, her history, has become important to me.  I need to know who she was before Mother’s Day.  She worked as a paralegal for a prominent trial lawyer.  She had a storybook wedding and honeymoon.  She became pregnant right away and miscarried.  The next time she got pregnant, she was delighted to tell her many friends she was having twins.  Both identical boys were born healthy, and she was a devoted mother.  They were moving their young family into a new house.

It is her eyes staring into mine that disrupts my sleep.  When we enter her room, she responds to my presence with a wide-eyed stare that fixes to my eyes.  Her eyes gaze out from her pretty face while she maintains that ever-present grimace.  What is trapped behind those bright-blue eyes?  The question is enough to awaken my soul from sleep.

I could detach myself from her gaze.  Intellectualize the relationship.  Stay clinically focused.  There are plenty of medical details to deal with each day.  What are her vital signs?  Does she have a fever?  What organisms grew from the cultures of her blood and sputum?  What are the peaks and troughs of the two antibiotics she’s receiving?  What are her liver and renal function tests, electrolytes, and blood counts?  I am good at that drill.  I do it every day.  But concerns about these daily details do not invade my sleep.

Usually, it is a call from the emergency room.  I go into my clinical mode.  I listen to medical details and make professional decisions.  The interruption is routine and the response is intellectual.  I relay the necessary medical decisions and promptly fall asleep.  But this awakening is another matter.  I cannot return to sleep.

At the family’s request, we consult another neurologist.  He repeats an EEG and performs a comprehensive neurological examination.  His verdict: “She is in a persistent coma, a persistent vegetative state, with little likelihood for any meaningful recovery.”  I am uncomfortable with this pronouncement.  It tells me nothing about her as a person.  “Is there a person behind those staring eyes?” I ask.

I know she has a loving family and their loss is unimaginable.  Her parents visit daily.  Her father kisses and nuzzles her and tells her stories. Her mother holds her hands and talks to her.  They play her favorite music.  Her husband arrives each afternoon after work, before picking up the twins at his mother’s.  He reports their progress to her: “The boys slept through the night for the first time!”

With my encouragement, her family brings the babies to visit her on the weekend.  Because there is no stronger bond than mother to child, I hope she will respond to them.  I stay in the room to watch for any reaction.  The boys are healthy, smiling and cooing, each looking exactly like the other.  Her husband lays them on her chest, and I search her eyes for some sign of recognition.  Seeing no response, I leave the family alone while my eyes fill with tears.

While I pray these boys regain their mother, I realize that she is a messenger to me.  Her eyes awaken my spirit and stir my deepest feelings.  They rip away my mask of detachment.  Now, in the quiet gray light of dawn, they compel me to write down my thoughts.  I have kept my true feelings behind a clinical facade too long.  Sitting in my pajamas, I have no white coat or stethoscope to shield me, no medical terms or laboratory details to hide behind.  Tears stream down my face, but I cannot stop writing.  I must confront myself.

Kelly reminds me of life’s fragile embrace.  In January, our daughter-in-law required an emergency cesarean to give birth to our first grandson.  For several frightening minutes, my wife and I were powerless spectators of modern obstetrics.  A beautiful and healthy baby, and quick recovery of his mother, promptly erased our fears.  In May, my mother died just days after we held each other and expressed our love.  At her memorial, I spoke of her artistic creativity, indomitable spirit and indelible imprint.  A few days later, our daughter gave birth to her second daughter.  Our third grandchild is named Zoe, the Greek word for life; and her gentle newborn breath keeps an ancient promise.

I visit Kelly daily.  She is often asleep when I enter her room.  When I move each extremity through its normal range, her eyes open wide, her breathing quickens and occasionally her face grimaces in pain.  When I flex her joints, she looks at me and opens her mouth as if trying to cry.  My physical exam is meant to keep her muscles supple, to gauge her response.  It has become a ritual.  I tell her to wake up, encourage her to talk.  Her eyes beg me to be gentle, to be patient.  When I leave her room to attend to others, I am saddened but renewed, for her eyes remind me to fill the day with purpose and with love.

Published: April 15, 2005