Five Years Later: Part 3

“Can you wiggle your toes?” a nurse asks. Mom moves the right side of her body on command, but there is no movement on her left side.

The nurses in the critical care unit check Mom’s neurological status every hour, shining a small flashlight in her pupils, pressing on her fingers and toes, and asking her to follow commands. But as the morning advances, Mom no longer responds.

At noon, when the nurse shines the flashlight in Mom’s eyes, she leaves immediately.

“We’re losing her, aren’t we?” Dad questions the nurse in the hallway.

“Her pupils are uneven. I’m calling the doctor.”

Within minutes, the neurologist arrives with a neurosurgeon. The neurosurgeon is tall, with a boyish face—big brown eyes and dark hair. He wears a knee-length white coat that has “Brain & Spine Institute” stitched on the left breast pocket.

“You have to decide,” the neurosurgeon says. “You don’t have time to call anyone. You’ve got to tell us now. If we don’t operate immediately, she’s going to be brain dead in a few hours.”

When the brain is injured, like any part of the body, it swells—a condition called cerebral edema. Injury to the brain results not only from the infarction itself, but also from the resulting cerebral edema, which peaks 2-5 days after the stroke. Because the brain has little room to swell, as cerebral edema increases, so does intercranial pressure (ICP). The optic nerve is located close to the brain stem, so pupillary changes can indicate that ICP is at a deadly level, compressing the brain stem, which controls all vital functions including heart rate, blood pressure, and breathing.

The doctors explain that Mom’s cerebral edema is causing the damaged right side of her brain to shift over and compress the healthy left side and the brain stem. The neurosurgeon wants to perform a craniotomy. He will remove a large portion of her skull and remove the infarcted brain, to make room for swelling and to relieve pressure. Her skull will be stored in a sterile bone bank until it can be reattached.

“We have to give her every chance,” Dad says, looking at me. “Don’t you think?”

I imagine the neurosurgeon drilling open her skull and cutting out her dead brain. I want to scream. With all of our medical advancements, it seems so invasive, even primitive, that life-threatening cerebral edema can only be treated by drilling open Mom’s skull and cutting out part of her brain.

I know what we need to do. I just hope it’s what she would do.

Dad signs the consent forms. They take her to surgery. In the waiting room, someone hands me a small plastic container containing Mom’s diamond earrings. Grandma tells me her friend has been dreaming that “Josie lost her jewelry.” We realize we don’t know where Mom’s wedding ring is. We panic. We wait. Trying to make sense of things. Someone tells me about a 26-year-old girl who stepped off a curb the wrong way and broke her ankle. Two weeks later she died of a pulmonary embolism—a blood clot in the lungs. I wish I had heard the story sooner.