by Linda Chase
He was Henry Hudson, navigating the mighty river, heading north. He loved this river. His river. The sheer power of it, the expanse. The night was coal black. A thick darkness cloaked the banks that rose on either side, steep as cliffs. He felt them breathing like living things. He could not see the way forward but he felt his hand steady on the helm. He must stay the course. The land was a force, and the night was a force, but the force of the river was stronger. Wilder, deeper. Fathoms deep that could not be fathomed. The sails snapped taut in the brisk wind. He felt the speed like a pulse, his heart beating at one with the motion. Steady ahead, moving swiftly, the strong river current driving them on, urging them north toward Albany. He could feel its lulling cadence beneath him. True north, true north, true north. But no. A worry flickered like a hazy, indistinct constellation. It was now, it was then. He was lying on his back. He was the captain of the ship. Now was then. Then was now. He was Henry Hudson on a great voyage up the mighty river: he was lying on his back, the ambulance tires thrumming beneath him. Where was the North Star? Something nagged, something about the current. Didn’t the current run south? Thoughts traveled light years through the synapses of his brain, dying stars that were gone before they arrived. Where was true north? How would he know when he had found it?
It had seemed a normal day. Tom was in his studio in the barn, putting in long hours as he always did, working on the final painting for his upcoming New York show. I had gone to town in the late afternoon to buy groceries, and he came in while I was unpacking the bags. He must have been listening for the car, I think when I see him, because he is usually oblivious to the outside world when he’s painting. I often tease him that someone could back a truck up to the front door and load up all the furniture and he wouldn’t even notice, but as I glance at him now, he doesn’t look in the mood for teasing. Something strange happened while I was gone, he tells me. A stock broker called, of all things. He could hear the man on the other end of the line but he couldn’t answer. He knew what he wanted to say but his mouth wouldn’t form the words. “If the guy knew how little we have to invest, he wouldn’t have been wasting his time,” he says, forcing a laugh, trying to make light of it. “Anyway, I feel fine now. I felt fine then. I just couldn’t talk. It was weird.”
He is speaking perfectly clearly as he says this. We stare at each other for a couple of minutes, not knowing what to think. I have bought a cooked chicken and some coleslaw so we set the table and sit down to eat. We know we should take this episode seriously, whatever it is, but we don’t want to panic. Could he be having a stroke or something? We have a general idea of what a stroke is but have never paid much attention to the symptoms. It is one of those things that didn’t seem to have anything to do with us. This is before we have come to know all the signs of stroke by heart, before we have read or even noticed those posters in every hospital corridor and doctor’s waiting room. The ones that tell you to Call 911 immediately if you experience any of the following symptoms—sudden trouble speaking, we know now, is high on the list. We are young, or at least we still think of ourselves that way, and have hardly given stroke a thought. Besides, Tom is a runner who does four miles almost every day. At sixty-one he has the blood pressure and cholesterol of a man in his forties. And if it was a stroke, how could he be so lucid now? These are the things we tell each other, attempts at reassurance, so maybe we know more about strokes than we think we do. Just not enough.
Still, I do call the doctor, getting the machine because it is after office hours. I leave a message, thinking all the while that I am probably being alarmist. So we sit down to eat, a little worried, sure, but not worried enough to consider rushing off to the emergency room. Not as worried as we should be. And then Tom drops his fork. He is raising it to his mouth about to take a bite, and it just slips from his hand. It lands on the plate with a clang that makes us both jump—literally lift off our seats like cartoon characters. Our eyes catch. We know this is bad. He picks the fork up again but can’t make his fingers hold on to it. “I don’t think we should wait for Dr. Collins to call back,” I say, but just then the phone rings. “Call an ambulance right away,” she says when I describe what is happening.
We are sitting at the round table in the bay window; the phone is above the kitchen counter by the door. I turn back to Tom and see him starting to tilt sideways off the chair. There is the barest hesitation, and then his body starts toppling, rigid as a tree being felled. I drop the phone and rush over to break the fall. He has suddenly become a dead weight, so heavy that I can barely keep him propped up. But I have to make the 911 call. I stretch out my arms and am just able to keep one hand supporting him while I reach for the phone with the other. It isn’t a cordless but at least the numbers are on the handset so that’s a help. Once I have it in my hand I can just pull it out far enough from the wall to dial while I lean against Tom to keep him up. It’s a weird balancing act. If I drop the phone I will not be able to get it again without letting him go.
We live in a very remote rural area. The hospital is at least nine miles away. Our house is on an obscure winding road, notoriously difficult to find. My friend Dorothy lives halfway between us and the hospital, and the ambulance will have to drive right by her house, so I hang onto the phone and call and tell her what happened and get her to watch for it and flag it down and make sure it gets here. My hands free now, I put both my arms around Tom and lean against him so he won’t collapse to the floor. “It’s okay, the ambulance is coming,” I tell him. The kind of meaningless soothing words you say to a child—to yourself. He can’t speak, and I don’t know if he hears or understands me. He seems lost somehow but there is flicker of fear in his eyes that I want to assuage. At least his eyes don’t look completely blank, I think, telling myself that this is a good sign.
It’s another half hour at least before the ambulance arrives. The paramedics quickly wheel a gurney into the kitchen, place Tom on it, and wheel him out. Despite what you see on all those shows on TV, they won’t let me ride with him, so I squeeze his hand and tell him again it will be alright, still not sure what of all this he comprehends. It all seems far too unreal to even begin to imagine what alright might mean.
The next hours are a blur of anxiety. The small local hospital is not equipped to deal with stroke patients but has to process him into the system anyway. He needs to be airlifted to Albany, they say, and so we wait for the helicopter that ultimately can’t land due to heavy fog, and then for another ambulance that is licensed to take him the two hours to Albany General. I have no idea, as I get into Dorothy’s car, that time is in any way crucial. While ignorance in this case is certainly not bliss, it is at least a blessing, since I am helpless to make any of this move faster. We can’t follow the ambulance because, after all this waiting, it takes off too fast. We naturally assume they will get to the hospital ahead of us, but when we arrive the admissions nurse tells us she has no record of Tom or of any patient arriving by ambulance. “But you are expecting him, right?” I say. “The hospital in Margaretville said they called ahead so the doctors would be ready.” She has no record of such a patient or any such call, she insists. We should have a seat and wait.
We sit down but I get up almost instantly. The ambulance definitely should have gotten here by now, and I don’t understand why there is no record of the other hospital’s call. Dorothy follows me outside to watch for its arrival. More waiting and pacing, and I am truly getting frantic. I go back inside and ask the nurse behind her protective glass to check again, and she repeats her assertion that there is no such patient listed, her annoyance palpable. There is a pair of double swinging doors next to this admitting office, and I can glimpse the treatment area through their small square glass panes. Whether it’s intuition or just frustration that impels me, I push the doors open and, against the nurse’s protest, rush inside. It seems to be just one large room with several rows of gurneys, most of them unoccupied, and then I see Tom on a stretcher being pushed through another set of doors around the corner by a burly man in green scrubs.
“I’ve been going crazy waiting. Why didn’t anyone tell me he was here?” I say to one of the nurses standing nearby.
“Are you the wife, then?” she asks, without any hint of apology. “Well it’s a good thing you got here. He’s been to radiology and they’ll be wanting to move him up to a room upstairs soon, and I need you to fill out some paperwork.” So he has been here awhile, although no one thought to let the emergency room admitting office know. I want to scream in anger and frustration, but I don’t want to upset Tom. I’m not much good at screaming anyway, so I go over and stand next to him and stroke his arm. He looks calm. His eyes rest on me with seeming recognition but without any apparent sense of relief, so I guess he has not been frightened or worried about where I was. At least that is something, but it is also scary. If he doesn’t know the trouble he is in, what does that say about his brain function? Is he in some kind of coma, or just zoned out? There is definitely a disconnect. Maybe it is just some self-protective mechanism the brain has. Some kind of automatic shut-down, like a computer that freezes when it gets too much conflicting input. I suddenly get a vision of the “Fatal Error” message that would flash on the screen of my old IBM when I hit some mysterious combination of keys that forced it to crash—a drastic and startling message even in reference to a machine. I don’t have time to dwell on this, however, because the man who was pushing Tom’s stretcher comes striding up.
“You are wife?” he demands. His face, aggressively close to mine, is ruddy, and his hair, the color and texture of wet straw, juts wildly around his ears.
“Massive stroke,” he says when I nod. “We look at picture. CAT scan.”
At least I think that is what he says. His accent, clearly Russian, is so thick I can barely make out the words. I think he is saying something about the parts of the brain but I can’t be sure. “What?” I say. “I don’t understand.”
He presses even closer, his whole body hovering belligerently. “Massive stroke,” he says again, waving his arm dismissively over Tom’s inert form. “Massive.” That part is very clear.
I look around and see the nurse I had spoken to before standing off to the side. “Can you explain what he’s saying? I can’t understand him. His accent’s too heavy.” I am trying to speak quietly, but he has apparently been listening for the complaint and has homed in on my voice like a radio scanner tracking a frequency. He is immediately beside us, on top of us, waving his arms. “What do you mean? Why do you say that? You want I should be fired? I speak well. You are problem.” With his red scrunched-up face, heavy accent, and childish grammar he is like a Robin Williams caricature of a Russian doctor. If this were a movie I would be laughing.
I don’t want to risk Tom’s care by alienating this doctor—if that’s what he is—any further, so I mutter an apology and go back to stand next to Tom. Fortunately, Tom seems not to have noticed any of this. “Paralyzed. Not move. Very bad,” the Russian pronounces from across the room, and with another dramatic wave of his arms he pushes through the double doors. In the calm that follows I lean down and speak quietly in Tom’s ear. “You know you have had a stroke,” I say. I’m not sure if telling him is the right thing to do. I only know that if it were me I would want to know. If there is any part of his brain that is aware enough to be confused about what happened to him, then he is be better off knowing at least that much.
Now I am sitting by Tom’s bed where he lies asleep. He is hooked up to an IV pole, and the metal bed railings are up so he won’t roll over and fall out. There is no possibility of lying next to him and holding him or even sitting next to him on the bed, so I reach through the bars and hold his hand. It is impossible to know what will happen next. The first twenty-four to forty-eight hours are the most critical, the admitting intern has advised me. There could be another stroke, or the damage to the brain could continue. There is nothing to do but watch and wait. If we had gotten to a hospital with the right facilities soon enough, they might have been able to give him blood thinners, which could have reduced the severity of the damage, but the window of opportunity for that kind of treatment is only three hours. Any intervention now would be too risky. If he has another stroke there is nothing they can do to stop it.
I have sent Dorothy home. She will come back tomorrow and bring whatever I need. I have no intention of leaving Tom alone. There is a hard, plastic-covered reclining chair next to the bed. One of the night nurses has brought me a pillow and a blanket, and I lean it back as far as it goes and try to sleep. Exhaustion fights with fear. I doze and wake, doze and wake, twisting on the harsh scratchy surface. Every few minutes I sit up and look over at Tom, searching for the rise and fall of his breathing.
What if this is it? What if he doesn’t recover at all? I am terrified for him but so grateful he is alive, and I hope I am not being selfish. He is still here; that is the consolation I am holding onto through this terrible night, and I have to believe it will be a consolation to him too. Yet I know if Tom could speak to me now, he would say unequivocally that he would rather be dead than alive and totally paralyzed for the rest of his life, that for him a life of helplessness, a life in which he couldn’t paint, would be no life at all. It is way too soon for such thoughts, I tell myself. Too soon for fear, too soon for hope. Too soon for denial, too soon for acceptance.
I hold in my mind the Tom I know, the Tom who has always had so much energy—energy for work and love, and nervous energy too. So much nervous energy that he could barely sit still, tapping his foot unnervingly on the gas pedal when he drove, and incessantly drumming his fingers on whatever hard surface was around, rhythmically tapping out streams of words in the Morse Code he had learned during his stint in the Navy, his speed at the keys making him a crack radio operator. I look at him now and, physically at least, it is like looking at a different person. It isn’t just that his arms lie limply on the stiff sheets, drained not only of energy but seemingly of life itself. They seem to have actually shrunk, withered. He looks like someone who has been lying immobile in a hospital bed for weeks or months not merely hours. How can such a transformation happen so quickly? Can it really be that it is only the electrical impulses from the brain that keep the muscles taut? Or is it some kind of reaction of the body to the trauma of the stroke? In its own way this diminishing is as shocking as his inability to move or speak.
It is after ten the next morning when Dr. Abramowitz, the neurologist, arrives. A tall man with a small goatee and thinning dark hair combed back from his forehead, he looks like a nineteenth-century European intellectual, but he exudes a twentieth-century fit, compact energy. Blessedly, he speaks perfect English and seems reassuringly sane, even kindly. He asks Tom to lift each hand and each leg in turn, although it is immediately clear that Tom cannot comply. Then he approaches the bed and gently lifts each hand and lets it drop back down. After this, he takes a pin and pricks Tom’s finger. “Do you feel that?” Tom shakes his head, a small movement but enough to indicate a no. He doesn’t feel any of the pin pricks, but he can move his head, and there is no doubt he understands what the doctor is asking. “Do you know where you are?” the doctor asks next. Tom nods this time and looks like he would like to answer but doesn’t try to speak. “Do you know what year it is?” The same nod. There is no point going on with this series of questions, a series we will soon come to learn so well, designed to test the patient’s orientation to time and place. He picks up Tom’s chart from its place at the end of the bed and reads it. Blood pressure: 110 over 70. Resting heart rate: 60. “You’re in better shape than I am,” he says with a straight face but clearly aware of the irony.
Tom has had an ischemic stroke, he explains, as opposed to a hemorrhagic stroke that would involve a bleed in the brain. The right carotid artery appears to be completely blocked, cutting off blood flow to the right side of his brain. As we just saw, he is almost completely paralyzed and has no feeling in his hands or feet. Since the stroke was on the right side of his brain, it will primarily affect the left side of his body. If he lives, there is a good chance he will regain some, or possibly all, use of his right side. It is too soon to know if the speech areas of the brain have been permanently affected or if he will regain any functionality on his left side. The good news: he is still young and obviously in good shape, and that should help his recovery. “I don’t want to mislead you. The CAT scan showed extensive damage to the brain. When the blood supply to the brain is cut off, the brain dies. Cells that have died are gone; they do not regenerate. Sometimes the brain can learn to compensate for some of this loss. It’s too soon to know the true extent of the damage much less how much recovery is possible.” He isn’t ruling anything out, the doctor says, but he doesn’t want me to expect too much. Those words “massive stroke” keep replaying in my head.
“If he’s in such good shape, why did this happen?” I can’t help asking, but the doctor has no answer to that.
Tom has been watching us through all this but it is unclear how much he has heard or understood. His arms are still lying lifeless outside the covers, and I am thinking about what the doctor has just said about his condition, and then I suddenly see the index finger of his right hand lift off the sheet.
“He raised his finger,” I call out to the doctor. “I saw it.”
Dr. Abramowitz comes back in and stands behind the bed. “Do it again, Tom,” I say. “Do what you just did. Move your finger.”
It takes a few seconds. You can see the concentration in his face as the thought gets routed from his brain to his finger, but then there it is, the slight but unmistakable movement. Then he does it again, lifting it a little higher the second time.
“This is really excellent,” the doctor says. “Any improvement in the first forty-eight hours is a good sign. And this isn’t even twenty-four. We still don’t know what the outcome will be, but as a general rule the stroke patients who show improvement in the early stages have the best recovery outcomes. I don’t want to mislead you, but this is a good sign. Really encouraging.”
It’s strange how some moments impress themselves so vividly on your consciousness while others just as crucial seem to slip by. I can picture the exact motion of Tom’s finger as he lifted it a half inch off the starched white sheet of that hospital bed, but I can’t recall the exact moment when he started to speak again, even though that would seem an even more momentous occurrence. Perhaps this is because the ability to move at all was the first sign of hope; the fact that he repeated it for Dr. Abramowitz proved beyond question that he both heard and understood us. Maybe the leap from understanding to speaking didn’t seem so amazing. Or maybe I was suffering some combination of shock and exhaustion that prevented me from registering his first attempts at speech. Maybe I had asked him, as I did so many times, if he was in pain. Or maybe I asked if he understood what had happened, if he knew he’d had a stroke, and maybe instead of nodding he mouthed the word yes.
Maybe I wipe his first words out of my mind even as Tom speaks them because they are so painful to watch. As he starts to gain movement on his right side throughout the day, his left side remains completely paralyzed. The left side of his face droops, flaccid and immobile. His first attempts at speech are garbled and barely comprehensible, and worse than the sight of his drooping face is the distress in his eyes as he struggles to get the words out. More than the paralysis, his difficulty speaking brings home to him the truth of his condition; it is the first evidence that his brain cannot ignore.
By the time Dr. Abramowitz makes his morning rounds the second day, Tom is managing to speak well enough to try to answer the classic roster of questions. “Do you know what year it is?”
It’s something of a tongue twister but he gets it out: “Nineteen ninety-nine.”
The doctor is obviously pleased. You can see it in his eyes, though he keeps a straight face. “Do you know where you are?” Tom nods. “Wish I didn’t,” he mouths, managing a hint of a lopsided smile. “Okay, but where is it?” I’m surprised and delighted by this flash of humor but the doctor wants to be sure Tom knows the right answer. It is unclear if he even thinks of the humor as a good sign. We will soon learn that no matter how many times these same questions are asked, the doctors want them to be answered correctly so the answers can be checked off on the chart. “Albany Hospital,” Tom manages, chastened. “Good,” the doctor pronounces, though I can’t tell if he is as impressed as I am that Tom does really know exactly where he is.
It is another day before they get Tom into a wheelchair and allow me to wheel him out into the hall. There is a small seating area next to a large window. We are on the twelfth floor, higher than most of the buildings in the medical complex, so the view is mostly blue sky. In his two-bed room, Tom was in the bed nearest the door, and with the other patient’s curtain pulled closed it was impossible to even see the window. We could barely tell if it was day or night, not that it seemed to matter. But now the glimpse of the outside seems to perk Tom up. “Henry Hudson,” he says. His speech is still difficult to decipher, slow and slurred as if his tongue is too thick, so he has to say it a couple of times before I understand the meaning. “I was Henry Hudson.”
“You mean you were dreaming?”
He shakes his head. “I was him.” I don’t know if it is seeing the sky, or sitting up for the first time, or just the fact that enough time has elapsed for his brain to begin to grasp where he is and what he has been through, but suddenly he wants to explain it. Despite his struggles with forming the words and frustration that he can’t get it all out fast enough, he is in a hurry to share it with me. “We were sailing up the Hudson,” he states, as emphatically as his speech deficits allow. Then he must pick up on my distress and confusion, my fear that his brain is not working right after all, because he looks me in the eyes and adds, “I know I was in the ambulance, but I was him, sailing north.” He is so pleased with himself—so pleased that he has been able describe his experience, and so pleased with the memory. “It was amazing.”
He will tell this story over and over again in the days that follow. Clarifying it, reiterating the sense of reality it had, wanting me to know how detailed and elaborate his concept was. He wasn’t just sailing up the Hudson, he was the captain of the ship, concerned about his men. They were counting on him. He knew he needed to navigate by the stars, but it was too dark. Dr. Abramowitz has tried to prepare us both for the future. He has told Tom he may never walk again, and that it is unlikely he will ever be able to paint again. But fortunately Tom hasn’t been listening to any of that yet. He is still on the ship navigating the mighty river.
I have no idea what to make of this fantasy, and I don’t know if it is good to encourage it, but he clearly enjoys remembering it and talking about it, and it’s wonderful that he is talking at all. I try to be logical about it, to think where the idea would have come from. The New York Thruway does run north along the Hudson, and we know that was the route the ambulance took, but how could Tom possibly have known that given the condition he was in? He was flat on his back hooked up to monitors, so he couldn’t see out the window. And even if he could have, even sitting up in a car, there is no place you can actually see the river from the thruway. He is something of a history buff, but as far as I know he hadn’t been reading any books about Henry Hudson or the river or the history of New York State. I can’t remember a movie or PBS special that might have triggered it. We do drive over the river occasionally, taking the Rhinecliff Bridge to dinner in Rhinebeck or driving to visit my brother in Connecticut, commenting on how beautiful and majestic it is, but we haven’t even done that in months.
It is easy to assume that the ship Tom was captain of was his own body, that his inability to navigate and his fear of leading the ship aground are perfect metaphors for his condition. But that seems too pat. There is something deeper in the poetry of his vision. I was so afraid that he was afraid as I rode in the car, making my own trip north that night. I was afraid he was feeling lost and alone and abandoned and maybe in pain. But he was in a better world. He was Henry Hudson, sailing up the mighty river, scanning the heavens, searching the celestial hemisphere of his brain for the bright pinprick of light that would be his North Star.