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今天上 Dr.Hirsch 的病理學課，
邊上課邊去查了一下 e-mail，
看到 Dr.Pyle 寄給我們一篇文章，
要我們在明天上課前看完。
是我們學校裡另一個教授的姪子兩個星期前中風過世的經過，
我想也沒想，
就覺得看一下好了，剛好我們這星期在學中風相關的東西....
不看還好，
一看就整個....太投入，
一開始是鼻酸，
後來變成暗自掉眼淚，
最後變成摀著嘴巴哭，還差一點哭出聲音....
看完以後，一想到內容就又哭....
偏偏我還坐第二排而 Dr.Hirsch 又認識我，
他應該覺得我是神經病吧～
好好的上一上課哭個屁ㄚ....
實在是喔....
Dr.Pyle 這個局佈很久了吧～
好好的上課也會被突襲...
這個經過除了：中風 → 全身性細菌感染、
作者的先生 → 哈奇之外，
其他好多情節都驚人的相似。
而作者描述的心路歷程也跟我一樣，
我們都是一開始以為是另外一個不相干的病，
後來變致病的反倒不是最初的病。
也都是必須要一個人面對這個消息還要安撫其他不能趕到的家人，
也是暫時以為好轉了，
檢查之後才反而發現急轉直下。
她先生也是在被宣佈不可能好轉的情形之下，
勉強用維生系統支持著，
等他父母趕來見他最後一面....
我也有那種連續好一陣子守在急診室外面的焦急，
也有那種心碎跟說不出來的傷痛，
反正一切的一切都是太相像了。
最後作者跟她那維生系統被拔掉的先生道別，
就跟我最後趴在哈奇身上等他呼吸停止一樣，
是那種感覺一部分的自己已經隨著他死去了。
我想這樣的生離死別一定天天在各地的醫院裡上演，
所以跟她或跟我一樣有過這種經歷的人不在少數，
人生真的很殘酷，
可能要像文章裡講的腦科醫生一樣吧！
要嘛就是習慣跟看開，
要嘛就是不斷的反覆在哀慟裡打轉....
我真的很不喜歡自己動不動就沉溺在那段回憶裡，
可是這篇真的是毫無預警的出現....
內容有點長，
也不確定別人看不看得懂，
但是還是想貼在網誌裡....
這種文章不是文筆好，而是真情流露。
Marvin came home last Tuesday complaining of stomach pain and headache. We both thought he had food poisoning because he ate some chicken salad that sat out on the counter for more time than I think is acceptable. By Thursday morning however, it was apparent that something more serious was going on and we took a trip to the emergency room. Marvin was hospitalized for two days and the final diagnosis was acute pancreatitis.
He was quite ill the first night in hospital but by the second day, he was bitching at me for fussing over him and complaining he wanted to go home to anyone who would listen. Saturday evening, we were released from the hospital and came home. Marvin was very happy to be out of the hospital and while I was running around picking up his prescriptions, he ran a hot tub and got in for a soak. When I came home, I sat in the bathroom with him for a while and we talked. He was happy because the hot soak in the tub made him the warmest he has been in two days. Marvin always hated to be cold and the hospital was somewhere in between frigid and arctic at all times. He ate a small meal, took his meds and we went to bed. He was snoring away in no time and I was glad for him to sleep. Anyone who has been in the hospital knows that you don't get any rest when you are there. You are being poked and prodded around the clock and I was grateful to hear him snoring peacefully next to me.
I spent two nights sleeping sitting up in a chair next to him at the hospital and I was pretty tired as well. I am a fairly heavy sleeper and did not hear it, but it seems that sometime during the night, he got up and took a pain pill. He has been complaining of a headache along with the abdominal pain but the doctors thought it was related to the pancreatitis and at the time, that seemed reasonable. He must have been OK enough to get out of bed and walk around the house in the middle of the night because I found a glass of water next to the bed the next day that had not been there the previous evening. When, after the incident, we counted the number of pills in the pain med prescription, we noticed two were missing when I had only seen him take one before going to bed so I put it together that he got up sometime in the night and took more pain medication. I did not hear him get up and it would not be in his nature to wake me up - Marvin was always so considerate of my every need that he would not have wanted to wake me just to get him a glass of water and a pill. I surmise that sometime between 10:30 p.m., when we went to bed ,and 6:30 a.m. when I got up, he must have been functioning and fine - though in pain - so he took a pill and came back to bed.
I got up early Sunday morning and went out in the living room to catch up work that had fallen behind while I was caring for Marvin in hospital. I could hear him snoring away in our bedroom and I was glad for him to get his much needed rest. Around 9 a.m., I heard him get up and go into the bathroom. Our dog, Dugmore ("Dug"), who is very close to Marvin, leaped out of his bed in the living room and ran down the hall when Marvin closed the bathroom door. He stood outside the bathroom door whining and I thought this was very odd behavior on Dug's part, so I went down the hall to check on Marvin. When he opened the bathroom door, I asked him if he was OK and when he responded, his speech was very slurred. This frightened me beyond belief so I hustled him into the living room and sat him down in a chair. When I first sat him in the chair, I asked him to look at my face and asked him if he knew who I was. He did and he tried to say my name, though he was having tremendous difficulty speaking.
I told him to stay right there in that chair while I got some clothes on so I could take him back to the emergency room. By the time I threw on a pair of jeans and a tee-shirt and grabbed my shoes, he had started to have some involuntary fluttering arm motions, which really made me start to panic. I was thinking that the combination of medication must be giving him a bad reaction and I had better get him right back to the hospital. Marvin is a tall man and I could not get him into my car by myself, so I ran to get my neighbor Buckley to help me carry him to the car and drive us.
Buckley is right next door to us and within three minutes, he was at my house to help me. When I ran back to the house from Buckley’s, I found Marvin sitting on the floor, not on the chair. He tried to get up even though I told him not to move until I came back and whether or not he hit his head when he fell, I will never know. Buckley and I got him up on the couch and it was now apparent to me that driving him to hospital myself was not an option. I called 911 and the operator stayed on the line while we waited for the paramedics to arrive.
By this time, Marvin no longer knew who I was when I asked him to tell me my name. When the paramedics arrived, they examined him and at first, they also thought it was a bad drug reaction. Then they noticed that he could not lift his right arm at all. They took him to the ambulance and made me sit in the front seat while they examined him. I heard one paramedic say "stroke" and then they came and told me they had called the helicopter from Tallahassee Memorial Hospital. Buckley cleared the horses from the field of our neighbor Kent across the street and the helicopter arrived in minutes to rush Marvin to the emergency room.
Buckley took me to the ER and I raced to Marvin's bedside. The doctor was already working on Marvin when I arrived and after a few minutes of examination, she told me she was ordering an immediate CAT scan and that I was to wait in the room while they rushed him down there. Before they took him, I kissed his face. His last words to me were "Help me" and God knows I tried. By the time they brought him back, he was having difficulty breathing and they informed me that they needed to put him on a ventilator and induce a coma if he was to have any chance of survival. I was in a tail spin of panic and distress and I would have done anything to save his life, so I said yes, do it.
A few minutes later, the neurologist arrived to talk to me. He took me into a cubicle and showed me the scan of Marvin's brain. He explained to me that a very large hemorrhage had erupted on the right side of Marvin's brain and that while there was some hope that the brain could reabsorb the blood and Marvin could experience a limited recovery, the likely outcome would be at minimum, loss of speech and some brain damage. He said that the hemorrhage happened in an area of the brain where they cannot operate and there was no way for them to drain the blood or reduce the swelling with surgical intervention. He said the brain has already shifted 5mm as a result and that IF Marvin survived the next five hours, his chances of continued survival started to improve somewhat but that it was a big IF. I was told that it would take some time to free up a room in the Neurological ICU (NICU) and that we would be in the ER until then. I sat with Marvin in the ER as various doctors and nurses came and went, poking him, prodding him and hooking machines up to him. It was very painful to watch and all I could do is talk to him, hold his hand and call him back to the light, which I must have done a thousand times. The staff at TMH is wonderful and within the hour, they had freed a spot for him upstairs and we transported him to the NICU.
I had called my mother and my sister-in-law Toni while the ambulance was in my driveway. Toni and her husband Scott arrived while we were still in the emergency room and my mother arrived from Tampa several hours later. I could not call his mother and father to come because, having long ago exhausted all the regular vacation spots that most people visit (they LOVE to travel and organized yearly family trips to various exotic locations around the world called the Familia Raulston Expedition (FRE)....), they were vacationing in Croatia, half a world away without any cell reception for American phones. Toni called my other sister-in-law, Susan and she rushed here as quickly as she could. Susan had saved an email from Dad that had the direct phone number for the hotel in Croatia and by some miracle, she and her husband Will were able to get through and tell Marvin Sr. and Helen that they needed to come home at once. Susan's husband is a Delta pilot and he told them if they could just get to a major city, he would call the Chief Pilot and ensure that they had seats on the very next flight home. Will continued to work on getting Marvin's folks here and Susan arrived at the hospital late Sunday afternoon. Our son Zac also arrived from Gainesville that afternoon and we all gathered around Marvin in the ICU, praying and praying that he was improving.
His temperature started to rise soon after we arrived in the ICU and this set into a motion a whole new set of interventions to keep him cool so there would be no further swelling in his brain. Knowing how he hates to be cold, it pained me to see them pack him in ice and all night, we sat vigil with Marvin and prayed for his temperature to drop. Every tenth of a point was a victory and we all held each other as we held him and hoped. He made it past the five hour window, then the ten hour window and this gave us more hope that we could bring him back. He responded to pain stimulus and the nurses told me that this was also a positive sign that might indicate improvement was possible. I sent everyone home to rest when they do the "lights out" time in the ICU between 1 and 4 a.m. and I paced the halls outside the ICU until they let me back in at 4:01 a.m. They informed me that the neurologist had ordered a second scan and it was to be done right away. They took him for the scan around 4:45 a.m. and because it was the wee hours of the morning, it did not take long to get him down there, scan him and bring him back.
I asked the nurse, a wonderful woman named Amy, if she saw the scan. She hemmed and hawed a lot and told me that she did not want to comment because she is not a doctor and it was not her place to make a diagnosis. I started to feel that knot in the pit of my stomach because I knew if the scan had been positive, she probably would have said something vaguely positive and she was just being waffly. At 7 a.m. they kicked me out of his room for a few minutes under the pretense of a staff meeting to discuss patient situations at shift change, which I should not be privy to (HIPPA privacy act and so on, I thought...) so I left and washed my face and tried to get myself together until they let me back in. I figured out later on that they knew that the doctor was going to tell me that Marvin could not survive and they were having a meeting to discuss it and quite naturally did not want me present when they did so.
I continued to sit with Marvin and everyone started arriving back at hospital around 8 a.m. Monday morning. The ICU staff at TMH is marvelous and they let all of us be in there with him all the time, even though they are only supposed to allow two at a time in the room. The ICU rooms are small and cramped and full of machines but they willingly tripped over us and maneuvered around us so that we could all be with Marvin throughout the morning. The compassion and caring of the TMH NICU nursing staff is beyond compare and I did my best to thank each and every person who cared for my husband throughout the long night and into the morning.
We took turns falling apart and being strong and at around 9 a.m., the nurse told me that the neurologist would speak to me within the hour about the results of the scan. I felt sick about what I was about to be told because by now, I was fairly certain it was not going to be good. I could just feel it all around me and it made me physically ill with foreboding. I told my mother I could not bear the waiting and at about 9:30 a.m., the staff called me to a phone in the nurse’s station of the ICU. Thank God that my mother and sisters followed me there, even though the doctor had specifically said he wanted only me to come to the phone. The nurse handed me the phone and the doctor told me that a second hemorrhage that was larger than the first had opened up on the left side of Marvin's brain and that the massive injury to both sides of the brain was not survivable. I threw the phone and threw my glasses and felt the life draining from me as surely as it was draining from my beloved Marvin. I collapsed, screaming, and the horror of that moment is something that will haunt me for the rest of my life. I went into a total meltdown in which the space-time continuum stopped and my heart was forever broken. My mother took the phone and talked to the doctor while the nurses carried me and my sisters away to a private room to absorb the shock.
Helen called Susan's cell phone minutes after the news was delivered. There was no way I was going to tell Helen over the phone while she was thousands of miles away that her son was going to die. I made Susan lie to her mother and tell her that we did not have the results of the CAT scan but that Marvin seemed the same and that we had stabilized his temperature - all of which was mostly the truth, just not the whole truth. I could not believe the crass insensitivity of the neurologist who told me the news - that he would tell me over the phone and not in person that my husband was going to die. I was NOT going to do that to my mother-in-law, whom I love as dearly as my own mother, so Susan told a lie and continued the conversation with them. Marvin Sr had made a marathon effort to get them from Croatia to Frankfurt but flights to America are in the morning only and by the time they got to Frankfurt, there were no flights out until Tuesday morning. By the time they arrived in Atlanta and picked up their car from Will (driving here is faster than flying out to Tallahassee from Atlanta) it was late in the afternoon and they did not arrive in Tallahassee until around 9 p.m. Tuesday evening.
Keeping Marvin alive on the machines for those long hours of Monday night and into Tuesday is the heaviest burden I have ever borne. We had started our Advance Directives after the Terry Schiavo case - as did many Floridians - and I knew for a fact he did not want his life sustained by machines. However, I felt so strongly that his mother and father needed to be able to say goodbye to him that with a heavy heart, I allowed life-sustaining intervention to continue. I hope that none of you ever suffer the heartbreak of watching your loved one being forced to breathe with a ventilator. When you lay your head on their chest, you can hear the forced air as it rushes into their lungs and the sound of it tears the soul from your body. I sent everyone home at the ICU quiet time from 1-4 a.m. and on Monday night, unlike Sunday night, the staff did not make me leave the ICU at all. I sat with him all night and into Tuesday morning and never left his side, save one trip to the bathroom. I kissed his face a thousand times and held his hand, talked, prayed and cried a river of tears a hundred miles wide. I asked his forgiveness for leaving him on the machines but I told him that I just had to ask him to hold on until his parents arrived.
My sisters came early Tuesday morning and insisted that I go get some rest. My mother had arranged for a room nearby for herself and Zac and they took me there while Toni and Sue sat with Marvin into Tuesday afternoon. I knew I had to compose myself for the difficult task of telling his parents the sad news and I did my best to sleep but it just would not come except in a small dose of a few hours. I returned to the hospital in the late afternoon on Tuesday and instructed the ICU staff not to let his folks in until I had met them at the door and told them the news. The staff had cleaned Marvin up and shaved him while I was gone - he was all weekend-scruffy - so that he would look as nice as is possible when his mother and father arrived. I am grateful for all of the care - large and small - that the nursing staff provided to my husband. It was obvious to me that his well-being - and ours - was their utmost concern. His temperature had dropped during the day and my sisters, knowing how stressed and upset I was about him being cold - had been sneaking towels and bed pads onto him when the nurses weren’t looking to cover him up for me. His temperature dropped enough by the early evening that we were able to get the nurses to agree to cover him all the way up with a sheet so he would not be cold.
Marvin Sr. and Helen arrived about 9 p.m. Tuesday night. I took them into a small room where I could break the news to them privately. They already knew in their hearts because Helen is a nurse and she knew that the result of a CAT scan does not take hours. Susan was never a good liar anyway and in their hearts, they knew what I was going to tell them was not good. But, it is one thing to suspect bad news and another thing entirely to hear the news point-blank. It tore my heart from my chest - as one mother to another and as the wife of her beloved baby boy, I told Helen and Marvin Sr that their son was not going to survive this tragedy. That was the saddest moment I have ever experienced and we all collapsed inward on each other in sorrow.
I left Helen and Marvin alone with their son and when they has said their goodbyes, I sent them to a hotel room that my mother had kindly arranged in conjunction with the Marriott, who cancelled reservations and rearranged rooms to put my family together in a group of rooms at the Courtyards on Appalachee Parkway. Marvin and Helen had not slept in 24 hours with the frantic trip to get home and the shock and horror of seeing their baby boy breathing through a tube tore them apart. Before they left, we sat for a time and discussed the final outcome for Marvin. We all agreed that the life support must be stopped and he must be allowed to die with dignity. In the quiet of the night, I asked our ICU nurse Patrick, who is an angel on earth, to disconnect all life support. He called the doctor for the OK and within a half hour, they had removed everything from Marvin and he was on the final leg of his journey. Susan's husband Will and their three sons arrived from various points in Georgia shortly after I removed life support. Will led us in a beautiful prayer for Marvin and they all said their goodbyes to him and left the room around 2:30 a.m. so I could be alone with him.
I climbed into the bed with my beloved husband and kissed his face a thousand times. I held him and stroked his face and told him it was time for him to leave and cross over to the other side. All of his dogs are waiting there, especially his favorite, Nikki and I wanted him to cross the bridge and meet them there. I finally lay down quietly next to him and put my head on his chest and wrapped his arms around me and mine around him and listened as his heart slowed and the time between breaths became longer. At 6:45 a.m. Wednesday morning - just as the soft pink sunlight of the first day of spring started to fill the morning sky - I heard the last beat of my beloved husband's heart and he crossed over to the other side.
I kept my promise to my husband.
To have and to hold
For better and for worse
In sickness and in health
Until death do us part.
I love you, Marvin E. and I will never recover from your loss. Travel safe, my love, and I will see you again and hold you in my arms someday when we are reunited on the other side.
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