Everything can change in an instant.
On July 4th, 2009, the last day of my daughter’s and my beach vacation in Duck, N.C., I went alone for a late afternoon swim. All week the water had been calm, and I had been swimming, often by myself early in the morning. I love the ocean, and often feel more at home in water than on land. I noticed that evening that there were more surfboarders out, and that the ocean was choppier, but these were tangential thoughts--my real thoughts were on the Elizabeth Bowen novel I was reading. For me it was the thirties in London, tulips arranged in a glass vase and Lady Charlotte snooping into everyone's business.
I waded into the water, surprised by the strength of the roiling waves. I hesitated, an instinctual part of me wondering if I should go on, but that small voice was overruled. “You need your exercise, girl,” my super ego bellowed. I struggled gamely in the water—it could hardly be called swimming--until I was exhausted. As I tried to make my way back to the beach, the waves that had earlier in the week shoved me gently to shore, now crashed around me. I couldn't get my footing. The undertow was vicious. So I decided to body-surf to shore.
I’ve body-surfed since I was a kid, and I had always been as confident of my body-surfing as I was of my swimming. I stood to catch the right wave, looking over my shoulder at the seething waters--the incoming waves battering me, and the outgoing water sucking at my legs. I was exhausted. A huge wave loomed—12-14 feet, and I dove to catch it, but my timing was off. I knew it with a sickening foreboding, and a split second later I felt as if a giant hand slammed me head first into the ocean floor. My body followed, and as I tumbled I heard a distinct snap and felt my felt my neck and back give way. I was spun head over heels several times, then landed, half reclining, the water up to my armpits. The surf surged around me. Afraid I was paralyzed, I was overjoyed to feel and move my arms and legs. Yet as I tried to push myself off the sand to stand, I was struck by the most intense pain of my life. It felt as if there was a boulder on my ribcage. I tried to push up again, realizing instantly that I could not move and in that same instant, that I would drown if no one saw me. Terrorized, I slowly and painfully raised my arm.
It was close to dusk. I saw two golden retrievers catching Frisbees on the beach, saw families enjoying their July 4th. I looked at the tiny teenage lifeguard bopping her head to the music piped through her ear buds. I waved to the people on the shore, but no one saw me. I tried to cry out "help" but I could barely breathe. If no one saw me, the sea would drag me back in, and I would be helpless to stay afloat. The light was fading, and so were my chances at survival.
At last, a middle-aged woman walking with her mother turned and seemed to see me. At first she started to wave back, as if I might be someone she knew, but then she must have seen the look of panic on my face. She and her mother came running into the water. "Don't leave me," I cried through the pain, gripping her arms, when they reached me. Because what I had come to know when I was alone in the water was that it was not death I was afraid of, but being cut off from the human family. "I won't leave you," she said. She shouted for the lifeguard and held onto me for countless minutes until the lifeguard and firefighters arrived. The whole time I looked into her eyes, whimpering, 'don't leave me.' It was exactly like my experience of childbirth, where one nurse, a stranger until that moment, becomes the most important person in your life. And she didn't leave me; she was there, crying, when they put me in the ambulance.
In the ambulance, I couldn't stop crying. I had never felt so alone, so out-of-control, so vulnerable. I said to the EMT, "I'm afraid I'll be paralyzed." I had trouble breathing, and every wave of panic made it worse. The EMT, her name was Amanda, kept reassuring me that my grip was good, my vitals good, and the prognosis good. She also said she knew how painful it was; she was recovering from back surgery. She did not make me feel ashamed for my tears, for my moans of pain. I hung on her every word; she was my lifeline, my oxygen. She held my hand and looked into my eyes. When I was finally delivered to the emergency room, she came to say good bye and wish me luck. There were tears in her eyes.
It turned out I had ten broken thoracic vertebrae.
I had told my daughter to take my car and drive back to D.C. She had a job to go to, and I didn’t want her traumatized by my accident. On a morphine drip, I was taken by ambulance to a trauma center in Norfolk, Virginia. I woke up alone in the emergency room. Panic overcame me. I heard someone emptying trash and called out, but no one answered. It sounded like a party was going on somewhere. I cried out again, and passed out. When I woke up, there was a young woman. "We are waiting to put you in a room," she said. I said, "But you left me alone." "We'll get you there soon," she said, and took my hand.
It was in the trauma clinic that I experienced both the best of medical care, and the worst.
I was in the hospital for a little over four days. The doctors were terrific—smart and communicative. The nurses were on two day twelve hour shifts. Many of the nurses were students. For the most part, they did not touch or interact with me, but simply asked questions, typing away on their kiosks. I was often alone, sinking into the bed because my back was a sack of broken bones, waving to get their attention. When I asked to be cleaned, a young nurse threw a wet washcloth at me. Literally. I was scolded for spilling urine from the bedpan on the pad. The sheets were never changed.
Emily, however, was different. A black woman in her fifties, she had an incandescent smile. She straightened my bed, listened to my lungs, and wasn't afraid to lay a hand on my head, to look me in the eyes. She wasn’t afraid to companion me in my pain. I thanked her for everything, saying I knew it was hard to be a nurse these days. Her eyes filled, "I can’t nurse the way I want to," she said.
But it wasn’t the physical neglect that was the hardest part of this experience. What was the hardest was the expectation that I have no feelings around what was happening to me. For example, on the third night of my stay in the Trauma Clinic, I'd been weaned off the morphine that had kept the worst pain of my shattered torso at bay, and I had been told that I would leave the clinic the next day or the following day, as soon as my body brace had been made. My brother, who had stayed with me the first two days, had to leave. My husband and son were Arizona, trying to drive back East and find a way to get me home to Georgia. All evening there had been calls back and forth trying to figure out how to get me home. I was still reeling from the accident, from the pain, and now from the stress of trying to figure out the next step. I lay in the sand I'd brought in with me, sweaty and filthy, and I wept. Not sobbing or groaning, just silently weeping.
At 1 am, there was a light knock on the door and a resident entered. Young, sandy haired and with a sprinkling of freckles, he stood over me. "Why are you crying?" he asked, and there was an edge of irritation in his voice. I looked up at him. "I hurt. I'm being thrown out of the hospital. I don't know how to get home." He began with the same spiel the social worker had unleashed on me earlier: "Do you know how lucky you are? Do you know that same night another man died and another came in, paralyzed?" I put up my hand to stop him, but did not stop weeping. "I have thanked God with every breath in my body since I was dragged from that ocean," I told him, "but I am in pain." I did not stop weeping, and I looked him straight in the eye. There was a long pause as he seemed to cast around for the right response. Then, suddenly, his whole body seemed to soften, and he leaned towards me, "Oh, I understand," he said, "you've got a broken back, you are in pain, and now you have to deal with the logistics to get home." I nodded. "Thank you, Doctor. That's all I needed from you," I said. What I needed, more desperately than anything else, was someone to simply listen and accept me, in all my pain, at that moment, and by doing so relieve the frightening isolation that attends being so broken, especially in a strange place.
The weeping had begun earlier, and curiously I had not felt ashamed of it. It had seemed true, real, not gratuitous or manipulative, but simply what my body was doing in response to what I had been through. The social worker had come earlier and also questioned my weeping, suggesting that I might need anti-depressants. "Are you kidding? " I said to her, "I don't need to be drugged. I've just been through a trauma. I'm in a trauma clinic." She chewed on this a while, "Well, I guess if you were happy that would mean you were in denial," she agreed. I looked at her, incredulous. What happened to the sense you were born with? I wanted to ask her.
When the doctors had come to tell me I would be leaving the next or following day, I was again incredulous. As unaccommodating as the experience of being in the hospital had been, I was overwhelmed at the thought of getting into a body brace and flying 500 miles alone. Oliver Sacks writes of a similar reaction to the news of his release from the hospital after a traumatic injury to his leg. He said he was "dead scared of leaving." So was I.
Yet the attitude and tone of the staff was to hew to the heroic model. When I took my first faltering steps in the brace, I was praised. To smile through your tears, that was being a good patient. To cry or question, however, was frowned upon. Only Emily, my beloved nurse, dared to question the party line, flying into a fury when she heard that they were going to discharge me so early. "You are not ready, this is crazy," she said, and I could see a few tears of her own. When I confronted the PA about the fact that I had not had any PT or OT, that I was still in tremendous pain, she read me the criteria for "no medical necessity": pain under control and you walked 120 steps. (I had been held up by two large orderlies). We both knew this was the formula dictated by the insurance company. "That," I told her, "is magical thinking." It was an uncomfortable moment, but not for me. There was almost nothing about this situation I could control, but I could refuse the script of the good patient. I could stay centered in my experience, and not tailor it to make others more comfortable.
Discharge me they did. When I was wheeled up in my wheelchair to the Air Tran desk sporting my new body brace, the agent, an Indian woman of about sixty, stared at me with wide eyes. "You don't look in any shape to travel," she said. "I'm not," I said, "but that is the system." "A cold system," she said. On the plane, I was the object of an almost overwhelming amount of sympathy. Besides the body brace, I was covered in bruises and scratches. Businessmen in expensive suits teared up when they saw me. No one asked me to be heroic.
The story has a good ending: I arrived home, was welcomed by a loving family and community, and healed. But I recount it here for several reasons. It is my story, and by telling it, I am able to find my voice and my humanity in a system that pressures a patient to give up her voice. I share it also as an example of how modern medicine limits its concept of responsibility, and in doing so, abandons, sometimes, its human reality. The formulas, in this case, revolve around the guiding principles set down by insurance companies and hospitals regarding the ideal patient. The commonsense world and its duties--the comprehensive needs of an individual patient, in this case--are sacrificed to those principles.
In this experience, many people went beyond what many would consider their responsibilities to not only come to my aid physically, but to meet me in my terror and vulnerability, to not shame me for it, and to companion me through the darkness. They entered into what Martin Buber called a relationship of "I and Thou." Arthur Frank in The Wounded Storyteller, says "Living for others is not an act of exemplary goodness. Persons live for others because their own lives as humans require living that way. The self is understood as coming to be human in relation to others, and the self can only continue to be human by living for the Other.”
Why are you crying?
Why are you asking?