This ICU Family Waiting Room has all the charm of a 1970 Greyhound station. Doesn’t the hospital realize that distraught families might appreciate a few creature comforts? Not scattered mismatched furniture and a few random magazines looking like they’re from that same era. It’s only 8:30 in the morning. I still need my first cup of coffee. A quick scan around the waiting room reveals that I am out of luck.
Fox & Friends bleats from a television hung from the ceiling about the upcoming Congressional testimony of fired FBI Director Jim Comey. No remote control to be found. No control at all.
I sit here. Waiting.
On the other side of the big double doors to the intensive care unit, the doctor is giving my husband intravenous medication to sedate him. Only fifteen minutes ago, Rich and I had agreed to an urgent medical procedure to insert a breathing tube into his throat. Once the tube is in place, Rich will be connected to a mechanical ventilator that will breathe for him − at least for the next few days, the doctor says. The mystery inflammation that has swept his lungs like a forest fire is sucking all the oxygen from him. His heart and lungs are nearing exhaustion and desperately need a break, while massive doses of steroids can eventually heal him.
I’ve stepped inside this scene before, at the bedsides of countless patients whose vital organs had failed them. I was the young but trusted Head Nurse, called to coolly assess a patient whose vital signs were suddenly tanking. Perhaps a patient had vomited bright red blood and was now himself as blanched as his pillow case. Or maybe a patient who struggled just to breathe. Now Rich is that patient.
Rich and I are here in Northern California, winding down on a lovely vacation along the idyllic Central Coast with my brother Terry and sister-in-law DiAnn. Wine tasting. Fresh oysters at an ocean-side fish shack. Games and pizza nights with other family who had joined us for a long Memorial Day weekend.
Then two days ago, Rich’s alarming sleepiness and increasing shortness of breath prompted us to postpone our return flight to Chicago. DiAnn and I took him to the Emergency Department of the local hospital, where he was admitted to a medical and cardiac unit. Once on oxygen and antibiotics, he seemed to turn a corner and improve. At first.
Yesterday his breathing had become more labored, despite being on high flow oxygen delivered through a face mask. The hospital doctor suggested a transfer to intensive care so that his medical situation could be closely monitored for a day or two. To my relief, last evening he was comfortable enough to sit up in bed and enjoy the Tony Award ceremony on television with me.
Okay, it seems as though we’ll be headed home to Chicago soon.
But this morning promises no Broadway extravaganza. No Bette Midler. No song and dance.
My iPhone jangles in my hand while I skim the day’s headlines in the New York Times. I see it’s the area code for Roseville, the suburb near Sacramento where Rich is now in the hospital.
“Hello, this is Anne Rooney.”
“Good morning. This is Dr. Bellucci from Sutter Roseville ICU, calling about your husband, Richard.”
I jump to high alert.
The doctor continues. “Right now, he’s working too hard to breathe, even on 100% oxygen. It’s not sustainable. I’d like to intubate him, but he insists that you be here to give the okay. We can wait 30-45 minutes.”
Intubate?! I know what this means – that without having a ventilator to breathe for him, Rich might stop breathing.
“I understand. I’ll be there in 20.”
I run down the hallway to Terry and DiAnn’s bedroom and pound on the door.
“Hey guys, wake up! The ICU doc just called. He wants to intubate Rich. I need to get there right away – can you drive me?”
Five minutes later, DiAnn (also a nurse) and I are in the car, heading to the hospital ten miles away. My brain whirrs, thinking of whom I should call. My sister Mimi and I had already talked briefly. My step-daughter Annika is next. I know how serious this development is. It doesn’t seem right to wait to see how it all turns out before I let loved ones know. He may not even realize it, but at this moment, Rich is fighting for his life.
From the car on the way to the hospital, I reach Annika, back home in Oak Park. I keep my voice calm and measured. “Hi, sweetie. I just wanted to let you know that Dad’s breathing is somewhat worse this morning. The ICU doctor wants to put in a breathing tube to rest his lungs for awhile. I think it’s the right thing to do.”
“Is this normal? Is Dad going to be okay?”
“Well, it happens like this sometimes, but the doctors are trying to keep it from getting worse. They just need to relieve the work of breathing for a few days. It’s putting too much stress on his heart,” I said.
“It sounds serious, but I think I understand. But what about you? Are you doing okay?”
“Not really.” My voice trembles. “This is really serious, but I also think they can turn things around.”
“Should I come out?”
“Not yet. Let’s see how things go in the next 24 hours. I’ll keep you posted.”
“Love you, too. Will you let the rest of the family know?”
When I arrive to the ICU, I hurry to the nurse’s station to speak with Dr. Bellucci, a 30-something critical care specialist who is Rich’s doctor today. His candor, calm demeanor, and personal warmth immediately impress me.
“We need to rest Richard’s lungs, in order to let high dose steroids kick in and reduce the inflammation. We may never know what caused this kind of pneumonia. It could have been a toxin or something else that triggered it. It doesn’t seem infectious.”
I tell him right away that I’m a nurse, counting on that for him to give me the full picture. It works. We talk a few minutes about Rich’s underlying diagnosis and planned treatment. He explains the meaning of the unusual “ground glass” appearance to his lungs that showed on last night’s CT scan. Not good.
“I’m thinking three or four days of mechanical ventilation, then we’ll begin to wean him off. This condition is a rare one, but the odds are good that he’ll make a full recovery.”
“Thank God. I agree with your plan, but give me a few minutes to talk to Rich.”
I collect my thoughts outside the door to his glass room. As I have done before in stressful situations, I float a mental prayer to my late parents: Okay you guys, I really need you. Help me find the strength to handle this, to be here for him.
I remember Mombo’s reassuring voice when I woke up from a difficult abdominal surgery in my 20s, when my doctors suspected (as it turned out, incorrectly) that I had a malignant tumor: “Honey, everything is all right.”
That comforting blanket of a love that I have known my whole life envelops me now. I can do this.
Rich sits upright in bed, his nose and mouth completely covered by a high-flow oxygen mask. His face is flushed and glistening with beads of sweat. I lean in to kiss his forehead and hold his hand in mine.
“Good morning, Bunny Love. I just talked to Dr. Bellucci and he explained why he thinks you need extra help breathing for awhile.”
Rich looks at me intently and croaks through his mask. “Isn’t that different from what the other doctor told us last night?”
“Yes, but things can change hour by hour. Right now you’re working too hard to keep the right level of oxygen in your blood. We just need to send your lungs on sabbatical for a few days.”
I squeeze his hand tightly.
“Okay then.” Rich’s voice is muffled but firm. “Let’s do it.”
“You’ll be in a very deep sleep while the ventilator breathes for you and the medicine heals your lungs.”
I kiss his moist forehead again. “I love you, sweetheart. I’ll be right here keeping tabs on everything. I’ll be holding your hand when you wake up. Who knows − if we’re lucky, maybe while you’re asleep the Articles of Impeachment will be filed.”
Rich chuckles from inside his face mask. “I love you, Blondie Girl,” he wheezes.
DiAnn arrives to his room after parking the car and explains to Rich that as a former surgical nurse, she has assisted with thousands of successful intubations. “This is what they do right before you go to surgery – first they’ll give you a sedative medication through your IV and then the doctor will tip back your head and insert the tube into your throat. You won’t remember a thing.” DiAnn’s calm explanation reassures us both. Rich nods in understanding.
Dr. Bellucci and the team appear, and one of the nurses ushers DiAnn and me to the Greyhound-style family room next door. While I wait, DiAnn fetches coffee for us.
After about 45 minutes, the ICU charge nurse appears at the door. “You can come back in and see him now.”
For the first time in days, Rich’s breathing is peaceful. He is in a deep sleep. I squeeze his hand, but this time he doesn’t squeeze back.
He looks so vulnerable. He is completely dependent on this machine next to him. His life is in the hands of this doctor that I just met an hour ago, these nurses, this hospital. We must depend on them now – just as once my patients depended on me.
When DiAnn returns, she also comments on how peaceful he looks. We agree that it is a relief to see him so comfortable, not fighting for breath.
That night I fall asleep in one of his soft white undershirts, but tussle in the sheets from a restless anxiety. I dream of our vacation in Kauai, standing knee high in the waters off the NaPali coast while Rich lazes in the sun on the sandy beach. A strong wave crashes to shore and knocks me over when it retreats. I struggle to regain my balance and keep from being pulled out to sea. The waves keep coming.
This can’t be when and where our story ends. We’re on vacation. I can’t go home without him. I’m not ready.
Every day that week, I arrive at the ICU before 10 o’clock so that I can join the daily medical briefing with his team of doctors, nurses, pharmacists, therapists, and students – a team I quickly assess as both highly skilled and compassionate. I feel safe in their expert hands. Although I now understand Rich’s clinical condition, it still startles me to hear the doctor begin the morning update with his diagnosis: “Respiratory Failure.”
Even though Dr. Bellucci says the odds for a full recovery are good, failure has a scent of permanence. The levees in Hurricane Katrina. Lehman Brothers. The O-rings on Challenger.
By Day 5, his clinical medical team grows more concerned. Anytime they try to give Rich what is euphemistically called a “sedation holiday,” he tenses up, shakes his head side to side, and tries to dislodge the breathing tube in his throat. He still cannot breathe on his own.
If he does not show significant improvement in the next 3 days, Dr. Bellucci says he will call in a thoracic surgeon. A tracheostomy – a surgical hole in his throat – may be necessary, so they can reduce the sedation to avoid long-term neurological or muscular damage. The breathing tube in his throat will be removed and the ventilator hooked up to the tracheostomy.
I think back more than 40 years, to my Senior Nursing rotation on the Head and Neck ward at the University of Iowa, where I cared for patients with tracheostomies. Many were elderly farmers who had smoked or chewed tobacco − and then developed cancer. In order to speak, they needed to put a plug in the hole or to hold a mechanical voice box up to their neck. Some used an Etch-a-Sketch at the bedside.
But Rich is a trial lawyer. He needs his voice. I love that deep voice.
This is what it must feel like to be sailing in a squall, tossed around in an ocean with no horizon. Keep calm. Focus on getting us safely to port. Don’t be pulled to a dark place. Rich needs my strength at the helm.
Each night when I get home from the hospital, Terry and DiAnn wrap me in a soothing cocoon of support and normalcy. Before I fall asleep, I write an email update to family and friends and post the day’s news on Facebook. I am immediately buoyed by messages of love and support. Mimi serves as my Optimist-in-Chief and affirms any small progress made that day. My friend Connie in Ireland sends a beautiful poem by the late poet and priest John O’Donohue. I cling to its images:
….When the canvas frays
In the currach of thought
And a stain of ocean
Blackens beneath you,
May there come across the waters
A path of yellow moonlight
To bring you safely home.
Every night, I wear Rich’s t-shirt to bed and fall asleep to comforting memories of our life together. In Huey P. Newton, our black panther of a convertible, on our Route 66 road trip. Summer Sunday afternoons reading the New York Times and listening to jazz on our front porch. Waking in our little stone inn in northern Italy, the time Rich told me to close my eyes as he opened the shutters to the sunrise over Lake Como. Swimming off the raft in Eagle Lake. In Selma together for the 50th anniversary of the original march for voting rights for African-Americans.
I want this life − this adventure − to go on.
The night of Day 5, I decide to stay overnight at his bedside. His previous night had been restless and difficult − every time the nurses lessen his intravenous sedation, Rich bears down on his abdominal and respiratory muscles so strongly that his lungs have no room to expand. Any progress now seems stalled. I hope that my voice and touch will calm him during the night.
“I’m right here with you, my love,” I whisper in Rich’s ear. “I’m going to play Benny Goodman’s “Moonglow” for you. I want you to breathe deep and slow, just like Benny did. Try not to fight the machine.”
I stroke his forehead and the top of his swollen hand, held in place with a soft restraint so that he won’t pull out his breathing tube.
C’mon, Bunny Love. We’ve gotta turn this around.
In the recliner next to his bed, I doze off and on and hold his hand throughout the night. His night nurse Suzy sneaks in with a flashlight for hourly rounds. His sleep is peaceful. No restlessness. No fighting the ventilator. At 5 am, I decide to go home to sleep in a real bed.
As I drive north on I-65, the faint streaks of pink daylight emerge over the Sierra Nevadas to the east. In the sky to the west, an enormous full moon glows.
Can this be my path of yellow moonlight?
Exhausted, I crawl into bed and savor a memory of the time Rich and I slow-danced to Benny Goodman in the moonlight streaming into our cottage in the Wisconsin woods.
Six hours later when I awake, surprised to have slept so long, I immediately call the nurse’s station to check on Rich.
“You’re not going to believe it,” the nurse replies. “He woke up about an hour ago and is now nodding and following commands.”
“What?! You’re kidding! That’s fantastic!”
“You’ll be very happy when you see him.”
When I arrive to the ICU nurse’s station a half hour later, his nurse tells me that they had found the right combination of ventilator settings and sedation level so that at least some of Rich’s breaths are now on his own. The steroids are also kicking in and decreasing the inflammation. I rush to his bedside. His eyes are open. He is groggy but alert.
“Hi sweetheart, I’m here now. I’m so happy that you’re awake! Do you know how much I love you?”
Rich nods his head. More than once.
“Can you squeeze my hand?”
Even with the hand restraint, his swollen fingers give mine a palpable squeeze. He wiggles his toes when I ask him to.
“You need less oxygen, which is a good thing, but you still need to keep the breathing tube until you can breathe completely on your own. Try not to push it out or shake your head. It won’t be much longer.”
We listen to jazz and to his all-time favorite singer, Bonnie Koloc. He raises his eyebrows to show me that he loves the music. I update him on the Jim Comey testimony to the Senate Intelligence Committee. No Articles of Impeachment to report. I hold the phone up to his ear so that he can hear the support and love from family back in Chicago.
We read messages and cards from friends and family. “You’ll love this − Cory says that the Patriarch of Oak Park Cinema needs to get back to his place at the head of the table. Ha!”
Rich smiles with his eyes.
That night Terry, DiAnn, and I go out for tandoori chicken and toast Rich with a Kingfisher beer. I sleep for 12 hours.
So does Rich. The sea is finally calm. The storm has passed. The tube comes out.
After another grueling month of rehabilitation in the hospital, Rich is finally cleared for travel home − with oxygen and by train back to Chicago. Exactly four weeks after my pre-dawn drive up I-65, another full moon silhouettes the Nevada desert landscape out the window of our sleeping car on the California Zephyr.
Our path of yellow moonlight is finally leading us home.