Help?–the smile test and the agony next door

“I’d like you to take a drink of water,” the nurse says. “From a straw.” I’m in the ER at West Bloomfield Henry Ford Health System. She hands me a styrofoam cup with a lid on it, a straw poking out. I’m good at this. I take a little sip, nod and smile.  “Not a sip,” she says.  “A swallow.” I do as I’m told. “Again,” she says.  “Three swallows total.”  

It’s a test. I pass with flying colors. Even showing off a little. She taps on her computer keys, recording the results.

“Okay, now three swallows from the cup. One at a time. No straw.” 

It’s the old Toronto Bedside Swallowing Screening Test, for dysphagia. Impaired swallowing that can result from a stroke. I came in thirty minutes ago, a little before noon, after the feeling in my right hand faded and the dexterity in my fingers fizzled. I was in the kitchen. When I trilled my fingers, my ring and pinky fingers on that hand didn’t participate. I took an aspirin and discovered I couldn’t screw the lid back on the aspirin bottle with my right hand. Before we left for the hospital, I slid my feet into flipflops, confident I would not be able to tie my shoes.  Some confidence. Here in the ER, when I take the swallow test, if I dribble or drool, that could mean I’ve had a stroke. I picture one of my grandsons, when he was maybe a year old, the look on his face the first time I raised a water glass to his mouth and invited him to take a drink. The water went in his mouth, then he smiled and it all poured out. 

I drink, I swallow. I don’t dribble. It’s not even close. And I don’t talk funny or drag a foot when I walk. And I already have my right hand back in working condition, all my appendages doing what they are supposed to do. I pass a smile test, three times; touch a neurologist’s fingertips, then my nose, a dozen times. It would appear my neurons are firing.

“Do you smoke, Mr. Bailey?”

“No, I do not.”

“Do you drink alcohol?”

“Yes, I do.”

“Approximately how much?”

Just enough, I start to say. Then decide against it. “One glass of wine a day.” I think about explaining my “rule of one,”  which is moderation in all things, especially alcohol, when I see my wife’s face. “Okay,” I say. “sometimes two. Put me down for one-ish.” 

“Do you ever have six drinks a day?”

This seems like a preposterous question. Six? Really? Why six? Why not five, or seven? In the interest of truth in testimony I answer yes, once or twice a year I have six drinks, over a 4-6 hour period, usually when I’m in our friends’ swimming pool, and I always regret those drinks the next day. 

At the end of my orals, when they ask, I say Yes I know where I am.  Do I know the month and year? It’s not a trick question, but I pause. Just a minute. Damn, I think, don’t pause and think about it, you idiot.  

December 2022.  I’m 70 years old. How the hell did this happen?

#

My father was 89 when he died. It was the chicken pox that got him. Not shingles. Chicken pox, the kid’s disease. His condition baffled doctors. He presented with hearing loss, total. Then he was unable to swallow properly. There was a sore in his throat. The ENT guy could see something back there. He just didn’t know what it was. When they admitted him to the hospital, they didn’t trust him to take water from either a straw or glass, for fear water would trickle down into his lungs. To keep him hydrated they asked him to drink a sludgy, chalky, not quite liquid mix that was trickle-proof. He hated it. 

Every new white coat that came to the door would ask him how he was feeling. 

I’d say, “He can’t hear you.” 

“How are you, Mr. Bailey? Were you able to drink the water substitute? 

“He hates it,” I’d say.

My father would look at me. “What did he say?” 

“He asked how you are,” I’d yell.

“I’m doing just peachy,” he would say, smiling at the doctor. 

There was a lot of other stuff going on, some pox-related, some not, none of it good. Outside in the hall, I was asked if we had a do-not-resuscitate order on file. I said we did. They asked me to please bring in a fresh copy.

Later, when they moved him to ICU, the same request. Do you have a do-not-resuscitate order? I said that we did, that it was in their files. They asked me to please bring in a fresh copy.

I’m admitted for observation, which is okay with me. Observation is like a clearing house. If you’re okay they clear you out of the hospital. If you’re a problem, they move you to a place in the hospital where they can fix you. 

In Observation I get my own room, which is also okay. A couple more doctors stop by. I show my teeth, squeeze their fingers, hold out my arms in front of me as if I’m sleepwalking or preparing to take a dive. I explain I had a TIA, a transient ischemic attack, on three occasions twenty years ago. This event felt just like that. But, really, since then, I’ve been good. They run down a list of tests they’ve ordered. Within thirty minutes I’m wheeled to the CT scan room. During the test, they inject me with iodine. The tech says, “You’re going to feel like you peed your pants. Don’t worry. You didn’t.” Let’s hope not. The machine revs up. A few minutes later there’s a rush of cold up my arm, then a flush of heat inside me. My butt starts to feel warm, then hot. I wouldn’t say damp. I can’t feel my brain. It must be hot too.

I try to imagine what they see, what they look for. A shadow? A spot? A smudge? I picture my brain as a Christmas tree, all lit up, and a TIA as one tiny little light burning out. We have eight strings of lights on our Christmas tree at home. With that many lights, hundreds of them, you hardly notice a dead bulb on one string. But then another goes dark, then another. One more and the whole string goes black. I’d like to avoid that, both on the tree and in my brain.

“You want your door closed?” a nurse asks me when I get back from CT.

“Well, now that you mention it, sure.”

One door over there’s a vocal patient, an elderly woman, judging by the sound of her voice. Is there coffee? she says. Is there coffee?  It’s her only question, and it’s urgent.

“Sorry about the noise,” the nurse says. “We get a lot of traffic through here.”

“Will there be coffee?” I ask. I smile, to say it’s okay, the old lady doesn’t bother me that much.  That much.

Is there coffee? Even with the door closed, I hear her pleading. She takes a breath, then yells again Will you please make some coffee? Will there be coffee? For an hour that’s all she says. Then she’s quiet. Moved out of Observation, I suspect, to somewhere else in the hospital. Next to the coffee shop, I hope.

Later that night I go for an MRI. When I get back to my room there’s a new patient in the room next to mine. He’s in pain. This is not moaning pain. These are  exhalations of agony. Every breath sounds like a step toward death. It’s awful. The tech who comes to take my blood pressure apologizes. “That’s deep pain,” she says. “Hard pain. They need to get someone up here.” 

#

I don’t do well with the sound of pain, mine or anyone’s. 

For a few years I was on the ski patrol at a local resort. There was a lengthy first aid course that preceded your induction into the patrol. We learned rudiments of on-the-hill care: mainly bandages and splints, c-collars and backboards. We practiced taking blood pressures, checking for dilated pupils, sniffing for the fruity scent of diabetic breath. The end of my first day on the hill, one of the veteran patrollers asked if I’d had a taste of blood yet. Before I could answer, he told me on his first day, a beginner had skied out of control and collided with one of the steel chairlift stanchions. “He was knocked out  cold,” he said. “He had blood coming out of his ears.” He must have seen me turn a little pale. “But hey,” he said, “that’s once in a lifetime. Don’t worry about that.”

I liked skiing around in the uniform. It felt like public relations. Nice day, I’d say to skiers. Try the back hills today. Good snow. I drove the snowmobile once in a while. 

“Are you okay?” I would ask a fallen skier who’d been on the ground for a while.  “Do you need help?” Thinking, but not saying: I certainly hope not. 

“The worst,” one of the older patrollers said one time, “are the shoulder separations. You ski up to this guy and he’s screaming. And you’re supposed to tie his hand to his head or put his arm in a sling, and he’s just screaming in pain.”  

Sometimes when my radio squawked, I flinched. Then one day it was my turn. “Skier down. Top of the River Cabin chair.  Anyone in the vicinity?”

“Me,” I said. And gulped.

“Possible femur fraction. Please check it out.”

At the top of the lift, a boy lay on his back, his arms out. Beside him looking on were two men. His name was Teddy.

“What happened here, Teddy?”

“I fell.” 

“Okay,” I said, “let’s have a look.” 

In training, in the case of a femur fracture we were told muscle cramping was possible. Cramping meant pain. Intense pain. To alleviate it, we learned to take the patient’s ski boot at the end of the fracture in both hands and gently pull, applying traction until the splint arrived. I guessed I was going to have to do this. “Teddy,” I said, “I’m going to hold your boot and gently pull. . . ” Saying this, I met the gaze of one of the gentlemen at Teddy’s side. He gave me a barely perceptible, very definitive  shake of his head. Don’t do that. I later learned he was an orthopedic surgeon. 

I was dangerous. I could hurt the kid worse.

Just then I heard the whine of the snowmobile pulling a sled up the hill, driven by a more seasoned patroller.  I pulled back from Teddy, relieved, content to wait for someone who knew more than I did. In training we were reminded to do no harm. Fix them. Get them off the hill. But do no harm. I took that seriously. For me do no harm meant don’t screw things up. Don’t hurt people worse. 

#

After a few hours, the agony next door was moved out of Observation, toward relief, I hoped; toward more life.  The next morning I had an echocardiogram. They took hourly blood pressures. Teams of doctors and their apprentices came to my room.

I was probably okay. TIA’s came and went.

These evaluations, echoed by each team, continued through the morning. Feeling optimistic, I put my pants on and found my flipflops. Then waited. The neurologist and her associate said they didn’t think it was a TIA. Then what was it? I wondered. They were going to treat it as a TIA, she said.  At minimum I ought to take a statin. 

Then I waited some more. To get out of there, I considered begging for coffee.

#

After two days in ICU, my father died in the middle of the night, of cardiac arrest. My brother called me. He was on his way to the hospital. 

“This is it,” he said. “It’s sounds like they’re trying to bring him back.” 

“What?”I said. “Why?”

“They called a few minutes ago,” he said, “and told me to get here fast. They might be able to keep him alive.”

“What about the order?” I said. “He was do-not-resuscitate. We said so. We gave them the papers, repeatedly.”

“It’s what they do,” he said. “They’re saving him for us.”

I had seen him that afternoon. He was in great spirits. We yelled a little small talk at each other across the bed. He talked about being called home. My mother had died two months prior. Now it was his turn.  He said that he’d had a good life, that we were going to be all right. He was ready to go. Before I left he started to sing. “Oh, the Lord is good to me…”

It was 2:00 a.m. I drove a little faster, picturing that determined team of doctors and nurses pounding on my father’s chest, determined to do no harm.