I
It’s Thanksgiving week. The Cardiac Intensive Care Unit—the CICU—is decorated with cut-out maple leaves, and spangly signs reminding us to Be Thankful. I spend time at work—and cooking. I can feed twin college-age sons, one girlfriend, and an ex-husband with much left over.
I’ll see them later. Right now, I’m in the CICU—
I didn’t go into adult medicine because the older patients reminded me of who I will become. I chose pediatric medicine without knowing how having my own children would alter me.
I round on my new admission, a teenage boy from South America, seeking asylum. His parents sold their possessions to pay for their one-way passage to the U.S. They’d carried copies of operative notes on yellowing paper from his hospitalizations that began just after birth.
And now he is dying. He needs a new heart. My specialty—transplant medicine, transplant cardiology.
His hair is curly and dark, like my son’s—my Ben. Do I see Ben in him? Do I see myself in his mother? What do I see? A teenage boy whom I can’t help. A situation I can’t control. He needs another family to donate the heart of their dying child so he can live. I can’t control this—the timing, the donor.
His parents got jobs in Florida, established residency, got Medicaid. They fed him before they ate—so he could have the nutrition he needed. The mother and father provided, expecting their efforts would keep him alive.
II
Thanksgiving dinner.
“You’re a wonderful cook,” Ex, the ex-husband, says.
Ex has always said this. Listing what he values, it’s at the top, entrained by, “She’s controlling,” and “She’s only a cardiologist.”
He’s come to value The Only, which provides for our sons and pays his alimony.
Ben says, “Let’s go around and say what we’re thankful for. I’ll start—I’m thankful for my family—and for Monica.”
The girlfriend smiles. “I’m thankful for God. And being here.”
Liam has his fork to his mouth. “Fabulous, Mom. Thankful to you for always making a ton of food. Jesus did it with loaves and fishes.”
“That wasn’t Thanksgiving,” I tell him.
“But they were thankful, right?”
Ben talks about neurotransmitters. “Acetylcholine is most important. But 5-HT is the one that controls mood. That’s the target for treatment of depression.”
Ben looks at me and smiles. I smile—imaging him in the future—
“Med school, Ben?” I say.
“Maybe,” he shrugs. “It’s interesting—drugs and neurotransmitters.”
III
After—the boys returned Monica to Miami and they to their dorm. Ex went back to his home with ample takeaway—an unlikely marriage, Ex and me.
Attachment and love cannot occur without object permanence. Yet nothing is permanent. You cannot step twice into the same stream.
Object permanence. My son goes out with the car to visit his father. A drunkard in a pickup on a cell phone doesn’t stop for a red light.
IV
Despite the seat belt and airbag, Ben hit his head on the windshield.
Liam and I are first to arrive in the ER, then Ex.
Ben is lying unconscious, intubated on a stretcher, waiting to be transported to CT—slices of deep tissue X-ray, like the cut slices of a loaf of bread. Quick and easy.
His forehead has a softball-sized swelling, his eye nearly shut. He has broken ribs and bruises—soft tissue injury—all over.
“I wish it had been you,” I say to Ex.
He nods.
“I shouldn’t have said that. I’m sorry.” I start crying.
“Don’t be,” he whispers.
V
Ben has a coup-contrecoup injury on CT scan. Brain bruising, swelling—but not so bad as yet that he needs a decompressive hemi-craniotomy—a hole in the head to relieve pressure. Like ancient trepanning—holes to release evil spirits trapped inside the skull. Only the hemi- is performed in an OR by a neurosurgeon. I enlist my friend Danny Garcia, to consult on Ben. Garcia advises—close monitoring. Post-injury swelling occurs slowly. We’ll know in five days. Keep his head up. Load him with Keppra to prevent seizures. Let the loss of consciousness, the coma, work itself out.
Go home. Rest.
VI
I sit on the couch, the television off since Liam and I got home. It had been playing all night, since the call.
Liam comes in. He’s had a shower and is in his bathrobe.
“What are you drinking?” he asks.
I hold a curved glass with a blue stem in one hand and a white mug in the other.
“Water and wine. I’m hoping for a miracle.”
We cry. We tell each other, “Be very strong.”
VII
I think in boxes and lists. ICU medicine is boxes and lists: Brain, check. Heart, check. Lungs, check. The order makes me look at all the boxes and understand the whole. Boxes and lists keep me sane.
Every day I sit with Ben. I talk to Ben. I read his chart and look at his labs and brain scans. Do my own brief neurologic exam. But I can’t do anything useful. The Neuro ICU is a strange land with a language I barely understand.
Garcia rounds on Ben daily, more to give me updates in language unveiled from the doctor-to-parent speak.
“Is my boy gonna live?”
“Yes, today he will live.”
Liam sits with Ben. Ex drifts in, never for very long. I let him hold my hand tightly and then he leaves.
Until the next day.
Liam and I will come home.
I will drink water and wine in front of a silent and black TV.
VIII
In the very early morning of the fifth day, Ben’s pupils are sluggish. His heart rate rises acutely for no reason. He’s hurried down to CT. The ICU is slow to call neurosurgery so I call Garcia. He comes in and examines Ben, then reviews the scans. He shows me that the changes are minor. He advises reconsulting neurology. He likely had a seizure.
Neurology comes and orders an EEG. The twenty-five small leads circle his head, covering all segments; their wires extend like a thick, multicolored braid and attach to the machine that records his brain’s electrical waves. Like an EKG—only we use twelve leads across the chest. I can read EKGs. I can’t read EEGs.
I go and sit with Ex. We don’t talk. He clutches his jacket with both hands. It’s always cold in the hospital. Winter inside.
“I can’t take this,” he says. “Let me know.”
I nod as he leaves.
The neurologist calls me that afternoon. The EEG shows diffuse slowing, no epileptiform activity. All expected and normal. Precautionary, but she’s increasing the anti-seizure meds.
Not too much, please. I still want some light to get in, some familiar sound—the cadence of our voices, a word slipped under the door.
IX
After a week I go back to the CICU. The mother of my patient, the teenager waiting for a heart, smiles when I enter, but she is crying.
My patient, her son, is on more intravenous meds than when I left. His liver and kidneys are struggling. So is his brain. He’s restless, irritable. His breath comes in shallow salvos, noisy and desperate. He’s tiring. He needs to be intubated and let the ventilator breathe for him.
The CICU doctor and I discuss a ventricular assist device—a VAD—a machine to keep his heart going. His parents are scared. They need time to learn what it means—to Google their own information and understand the risks: bleeding, stroke, infection. Death.
X
Before and after the CICU, I go to see Ben. He’s had some variability in his heart rate, a good sign. When I enter, when his brother enters, when we speak to him, Ben’s heart rate goes up.
The nurse suggests bringing in some scents he likes. Anything to stimulate his brain to wake up. I bring in his Versace cologne. His heart rate goes up when I waft it under his nose. I kiss Ben’s cheek.
Liam tells him he’s a pain in the ass to put us through this. Ben’s heart rate goes way up.
These tricks don’t work every time. His repeat EEG shows brain activity but it’s still not normal.
“Diffuse slowing, like bradycardia is to the heart,” Garcia tells me. “It’s expected. His conscious state may wax and wane.”
We’re ten days into this. Ben goes for an MRI, imaging that takes longer than a CT scan. The MRI shows each undulating turn of his gyri, his gray matter. There’s less swelling than was seen on the initial scan. There is no bleeding.
“All this is good,” Garcia says. “It’s up to him when he wakes up.”
“Is it possible he won’t?” I ask.
“He’s improving,” Garcia says.
“But will he wake up?” I ask again.
“He should,” Garcia says.
“If he doesn’t—I won’t be strong enough.”
XI
In the CICU my patient gets fifteen minutes of CPR and is shocked out of the pulseless rhythm. He then becomes asystolic. More CPR—twenty-seven minutes—while he’s put on ECMO, like cardiopulmonary bypass at the bedside. I watch the blood going round and round.
The CICU doctor and I speak with the parents. He likely won’t get a heart in time. Maximal anticoagulation means there’s a high potential for stroke.
They ask about the VAD. He has to wake up first, show us that after forty-two minutes of CPR his brain still works. He must do something purposeful and on command—like squeeze his mother’s hand when she tells him to.
XII
In the Neuro ICU, I sit with Ben. His eye is less swollen. I carefully brush his hair. Liam sits by the window, staring at the monitor.
“He doesn’t like that,” he says. “He never liked you brushing his hair. Remember?”
“Yes, I do,” I say.
“Did you see? His heart rate went up by fifteen beats when you came in and said hello,” Liam says.
“You’re good at reading his vital signs,” I say. I put my hand on Liam’s shoulder.
“He’ll wake up, right, Mom?” he asks. “These are all signs he’s going to wake up.”
I nod. “I pray for that.”
“Is there something you’re not telling me?”
“He’s improving,” I say.
“If he isn’t going to wake up, you’d better tell me right now and make this stop. Ben wouldn’t want this.”
I shake my head.
“I’m not strong enough,” I say.
“What does that mean? You have to be strong enough! Is he going to wake up?” Liam’s voice is loud in the quiet room.
Am I strong, enough? If I do this, then God will do that. If I’m a good doctor, a good mother, repent everything—then God will spare my son. But I’m not strong enough to say goodbye. Not to my son. My son—if he progresses to brain death, am I brave or numb enough to donate Ben’s heart? God, please—I pray, but don’t know the words.
I talk to Ben.
“Squeeze my hand, honey. It’s Mommy. Try, baby. Try.”
His hand is warm and alive but not animated.
“I tried that,” Liam says. “Maybe tomorrow.”
XIII
My patient’s mother sits by his bed.
“Aprieta mi mano,” she says, grasping his hand. Her voice is at first pleading, then angry. “Aprieta!”
His hand falls back limply on the bed. He’s on no sedation.
Two days after his resuscitation, we take him for a CT scan. The trip down in the elevator requires a hospital bed, the cardiac pump, monitor, oxygen tank, nurses, and takes longer than the CT.
By the time we’re back in the CICU, the radiologist has read the study. He calls and tells us that there’s a hemispheric brain bleed with midline shift and impending herniation. The protective skull makes this swelling deadly. There’s no room. A hemi- isn’t useful. His brain would explode out of his skull. The evil spirits—cold and indifferent—will never leave my patient.
XIV
Once my patient’s parents understand his brain is damaged irreversibly, they withdraw support. They want the machines turned off and the tubes removed. They make it all stop.
His breath slows and his eyes close—
His death is immediate.
The sadness comes.
I hold his mother. We both cry.
“There, there,” I say. “There, there.”
I help the nurses wash and wrap his body— wrapping his body in clean white sheets. He’s still and pale. His mother sits in the chair by the window.
“There, there,” I tell him. “Rest now.”
The mother knew that he wouldn’t survive, but she had to try. He was sixteen and he wanted more time.
She holds his hands. She kisses his face.
XV
In the Neuro ICU I help the nurse wash Ben’s face and arms and hands. I pull back the sheet to wash below his waist. His hand finds the sheet and he pulls. His heart rate goes up. He moves his index finger round and round as his hand falls back to the bed.
His nurse sees and calls the intensivist.
She checks his pupils, which are briskly reactive. “These are good signs,” she says. “Ben, can you hear me?”
He lifts his shaking finger from the bed.
XVI
Liam and I have dinner with Ex.
“Ben’s better, each day a little better,” Liam tells him.
“You haven’t seen him in days,” I say.
Ex stares into his steak.
“Come on, Dad,” Liam says. “He’ll be happy to hear your voice.”
“He was driving—to see me,” Ex says. He catches the waitress’s eye and taps his wine glass.
Ex doesn’t want us to leave.
I tell him about my patient.
“Well, nature took its course, right? I mean, he was born with a bad heart. It was only a matter of time. He lived a few more years, and now the parents don’t even have a place to go back to. Sad, but—some people—even children— are meant to die.”
“You tried your best, Mom,” says Liam. “Don’t let the bastards get you down. You know what I mean?”
“Death’s the bastard,” I say.
Something I can’t control.
This gets harder as I get older. This gets harder. I examine all I do. Have I done enough?
Am I brave or numb—
XVII
Ex and Liam and I are in the Neuro ICU visiting Ben.
“He keeps moving his finger,” Liam says. “Why’s he doing that?”
I shrug. “I think he wants to wake up,” I say.
“Well, he better just do it,” Ex says. “Ben! Ben!” he shouts. “Open your eyes, Ben!”
Ben’s eyelashes flutter and his face frowns. He raises his index finger and moves it in circles through the air, again and again.
“What’s he doing?” Ex says.
“I don’t know,” I tell him.
“This is going on too long, isn’t it?” Ex says. “I mean, how long are we supposed to wait?”
“As long as it takes,” I tell him.
Ex takes Ben’s hand, quieting his movements. “I love you,” he says.
Ben’s heart rate goes up, and he squeezes his father’s hand.
“Remember,” Ex says. “Remember the deep end.”
XVIII
The boys were just five when we moved to Florida. We rented a house with a pool. Swimming was necessary, like walking. Their father would throw them into the deep end. Liam would laugh and bob up to the surface, doing an inelegant freestyle to the wall. Ben would sink. I dove in to save him—he’d come up sputtering. “Let me try it again.”
Ex threw him in. “Swim,” he yelled.
I watched the trail of bubbles from six feet under.
“Don’t—” Ex ordered me, holding out his arm.
Ben emerged, sputtering, paddled to the edge.
“I almost drowned,” he coughed, and smiled.
“But you didn’t,” Ex said.
Was he as bad a father as I remember?
XIX
Liam and I sit with Ben. I leave to get coffee.
When I return Liam is asking him, “Do you know how long you’ve been here?”
Ben holds a pen and makes marks on the page that look like 14.
“Close,” Liam says. “Nineteen. You’ve been here nineteen days.”
Ben nods. His eyes struggle to remain open. He sees me.
MOM, he scrawls.
Liam turns. “He was writing, in the air. He was writing.”
Liam is half-laughing, half-crying.
DAD, Ben writes.
“He’s been here a lot,” I tell him.
Ben nods and closes his eyes.
XX
Twenty-one days. Ben’s just had physical therapy. He’s sitting in a reclining chair by the window. He’s breathing fast and his face is moist.
Ex watches Ben, not talking. Ben wants his cell phone. He scans the messages.
“Monica called me eighty times,” he says. His voice is raspy and flat, not his own.
His hands shake and he gives the phone to Liam.
“Tell what happened. I’ll—find her—no, call. I’ll call later. Drink.”
I hold a cup of ice water up for Ben. His hand jerks the straw to his mouth.
“Later—when is later?” he says. “Time is different.”
“Later can be in fifteen minutes, an hour, or days,” Liam tells him.
“How many days?” Ben asks, looking at me.
“Nineteen you slept. Now twenty-one.”
“That’s a lot of later,” he says.
“Hey,” I ask. “Do you remember the most important neurotransmitter?”
“Acetyl,” Ben begins. “Acetyl-something—”
I begin speaking but his father stops me.
“Acetyl—choline,” Ben says finally. “Acetylcholine.”
Ex is as close to smiling as he gets.
“Where were you, Ben, when you were—not with us?” he asks.
“I—don’t know,” Ben says.
“Do you remember anything?” Liam asks.
“Dark. Wet. Black-water sky—stars, planes. Liam. Mom. Dad—I was drowning. Dad said swim.”
XXI
There’s a reassurance in saying, “I did that. I supported and raised my sons. I toiled and sacrificed.”
But I worry—that I’m not a good mother, that I’m not a good doctor, that I don’t live a good life, that I don’t pray. Will my sons be taken from me?
If I live a good life, if I pray—then they will be safe. I have control.
“It doesn’t work that way,” Garcia tells me. “I don’t believe in much, but if there is a God, I don’t think She operates on a quid pro quo.”
“That’s the basis of religion,” I tell him. “Think about the Golden Rule. Not that I don’t believe—I do. But I can’t pray anymore. I don’t know how. It’s all surrogate control.”
“The older I get,” Garcia says, “the more I see we don’t control anything. And the more I am surprised. Ben’s injuries were bad, his coma was—dense. But he woke up and he’s intact. Whatever bargain you made seems to have worked. What’s your payback?”
Whatever bargain I made—in that cold room in the Neuro ICU, holding the warm hand of my son—was the same as that made by the mother of my teenage patient. Just as desperate, just as vital.
I turn back to Ben’s room and see my sons talking together. They’re laughing.
About the Author:
Maryanne Chrisant, MD, has been published in 34th Parallel Magazine, Apricity Magazine, Connecticut River Review, Freshwater, JONAHmagazine, Open Ceilings, Pennsylvania English, Platform Review, Shark Reef, Sand Hills Literary Journal, Spotlong Review, and on the podcast Anamnesis: Medical Storytellers. She has attended writing workshops with Jericho Writers, The New School, Tufts University, and in Shaker Square, Ohio. She studied poetry with Galway Kinnell and Denise Levertov. Her short story “Dia de los Muertos” is nominated for a 2024 Pushcart Prize. Maryanne is a physician and has held leadership roles at many prominent health-care institutions in the U.S. An advocate for children’s health, she’s currently a medical director at Joe DiMaggio Children’s Hospital in South Florida. Maryanne is still raising her teen-age twin sons, who are now in college. She enjoys biking, weight training and traveling, and frequently returns to her New York roots. https://maryannechrisant.com/ & maryanne@chrisant.org
*Feature image by yayang art from Pixabay
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