Joan Didion - The Year of Magical Thinking

I remember trying and failing to understand the phrase “leave the table.” Did they mean alive? Had they said “alive” and Gerry could not say it? Whatever happens, I remember thinking, she will without question “ leave the table. ”

It was then maybe four-thirty in Los Angeles, seven-thirty in New York. I was not sure how long at that point the surgery had been in progress. I see now, since according to the CT report the scan had taken place at “15:06,” six minutes past three in Los Angeles, that she had probably been in surgery only about half an hour. I got out an OAG guide to see who would still be flying that night to Los Angeles. Delta had a 9:40 p.m. out of Kennedy. I was about to call Delta when Tony said that he did not think that being in flight during the surgery was a good idea.

I remember a silence.

I remember setting aside the OAG.

I called Tim Rutten in Los Angeles, and asked him to go to the hospital to wait with Gerry. I called our accountant in Los Angeles, Gil Frank, whose own daughter had undergone emergency neurosurgery at UCLA a few months before, and he too said that he would go to the hospital.

That was as close as I could get to being there.

I set the table in the kitchen and Tony and I picked at coq au vin left from the dinner for the family after St. John the Divine. Rosemary arrived. We sat at the kitchen table and tried to develop what we referred to as a “plan.” We used phrases like “the contingencies,” delicately, as if one of the three of us might not know what “the contingencies” were. I remember calling Earl McGrath to see if I could use his house in Los Angeles. I remember using the words “if I need to,” another delicate construction. I remember him cutting directly through this: he was flying to Los Angeles the next day on a friend’s plane, I would go with them. Around midnight Gerry called and said that the surgery was finished. They would now do another CT scan to see if there was additional bleeding they had missed. If there was bleeding they would operate again. If there was not they would do a further procedure, the placement of a screen in the vena cava to prevent clots from entering the heart. About four a.m. New York time he called again, to say that the CT scan had shown no bleeding and they had placed the screen. He told me what the surgeons had told him about the operation itself. I made notes:

“Arterial bleed, artery gushing blood, like a geyser, blood all over the room, no clotting factor.”

“Brain pushed to the left side.”

When I got back to New York from Los Angeles late on the evening of April 30 I found these notes on a grocery list by the kitchen phone. I now know that the technical term for “brain pushed to the left side” is “midline shift,” a significant predictive factor for poor outcome, but even then I knew that it was not good. What I had thought I needed on that March day five weeks before were Evian splits, molasses, chicken broth, and flaxseed meal.

R ead, learn, work it up, go to the literature.

Information is control.

On the morning after the surgery, before I went to Teterboro to get on the plane, I looked on the Internet for “fixed and dilated pupils.” I found that they were called “FDPs.” I read the abstract of a study done by researchers in the Department of Neurosurgery at the University Clinic in Bonn. The study followed ninety-nine patients who had either presented with or developed one or two FDPs. The overall mortality rate was 75 percent. Of the 25 percent who were still alive twenty-four months later, 15 percent had what the Glasgow Outcome Scale defined as an “unfavorable outcome” and 10 percent a “favorable outcome.” I translated the percentages: of the ninety-nine patients, seventy-four died. Of the surviving twenty-five, at the end of two years, five were vegetative, ten were severely disabled, eight were independent, and two had made a full recovery. I also learned that fixed and dilated pupils indicated injury or compression of the third cranial nerve and the upper brainstem. “Third nerve” and “brainstem” were words that I would hear more often than I wanted to during the weeks to come.

Y ou’re safe, I remember whispering to Quintana when I first saw her in the ICU at UCLA. I’m here. You’re going to be all right. Half of her skull had been shaved for the surgery. I could see the long cut and the metal staples that held it closed. She was again breathing only through an endotracheal tube. I’m here. Everything’s fine.

“When do you have to leave,” she asked me on the day when she could finally speak. She said the words with difficulty, her face tensed.

I said I would not leave until we could leave together.

Her face relaxed. She went back to sleep.

It occurred to me during those weeks that this had been, since the day we brought her home from St. John’s Hospital in Santa Monica, my basic promise to her. I would not leave. I would take care of her. She would be all right. It also occurred to me that this was a promise I could not keep. I could not always take care of her. I could not never leave her. She was no longer a child. She was an adult. Things happened in life that mothers could not prevent or fix. Unless one of those things killed her prematurely, as one had almost done at Beth Israel and another could still do at UCLA, I would die before she did. I remembered discussions in lawyers’ offices during which I had become distressed by the word “predecease.” The word could not possibly apply. After each of these discussions I would see the words “mutual disaster” in a new and favorable light. Yet once on a rough flight between Honolulu and Los Angeles I had imagined such a mutual disaster and rejected it. The plane would go down. Miraculously, she and I would survive the crash, adrift in the Pacific, clinging to the debris. The dilemma was this: I would need, because I was menstruating and the blood would attract sharks, to abandon her, swim away, leave her alone.

Could I do this?

Did all parents feel this?

When my mother was near death at age ninety she told me that she was ready to die but could not. “You and Jim need me,” she said. My brother and I were by then in our sixties.

You’re safe.

I’m here.

One thing I noticed during the course of those weeks at UCLA was that many people I knew, whether in New York or in California or in other places, shared a habit of mind usually credited to the very successful. They believed absolutely in their own management skills. They believed absolutely in the power of the telephone numbers they had at their fingertips, the right doctor, the major donor, the person who could facilitate a favor at State or Justice. The management skills of these people were in fact prodigious. The power of their telephone numbers was in fact unmatched. I had myself for most of my life shared the same core belief in my ability to control events. If my mother was suddenly hospitalized in Tunis I could arrange for the American consul to bring her English-language newspapers and get her onto an Air France flight to meet my brother in Paris. If Quintana was suddenly stranded in the Nice airport I could arrange with someone at British Airways to get her onto a BA flight to meet her cousin in London. Yet I had always at some level apprehended, because I was born fearful, that some events in life would remain beyond my ability to control or manage them. Some events would just happen. This was one of those events. You sit down to dinner and life as you know it ends.

Many people to whom I spoke in those first days while Quintana lay unconscious at UCLA seemed free of this apprehension. Their initial instinct was that this event could be managed. In order to manage it they needed only information. They needed only to know how this had happened. They needed answers. They needed “the prognosis.”