the emperor’s not wearing any clothes—or in my case, that the role of dutiful son has been woefully miscast.
I try humor. “If you missed me, you know, you didn’t have to go to this extreme. You could have just invited me home for Thanksgiving.”
But neither of us finds this funny.
The door opens again, and Dr. Saint-Clare enters. “How’s he doing?”
“Aren’t you supposed to be able to tell me that?” I ask.
“Well, we’re still monitoring his condition, which appears to be unchanged.”
Unchanged, I remind myself, must be good. “You know this from injecting water in his ear?”
“Actually, yes,” the doctor says. “What we’re looking for in the ice-water caloric test is a vestibulo-ocular reflex. If both eyes deviate toward the ear with the water in it, the brain stem is functioning normally and consciousness is mildly impaired. Likewise, nystagmus away from the water suggests consciousness. But your father’s eyes didn’t move at all, which suggests severe dysfunction of the pons and the midbrain.”
Suddenly I am tired of the medical jargon, of the parade of experts who come in to do tests on my father, who doesn’t respond. Get the hell out of bed and open the damn door. “Just say it,” I mutter.
“I’m sorry?”
I force myself to meet Dr. Saint-Clare’s eyes. “He isn’t going to wake up, is he?”
“Well.” The neurologist sits down in a chair across from me. “Consciousness has two components,” he explains. “There’s wakefulness, and there’s awareness. You and I are both awake and aware. Someone in a coma is neither. After a few days in a coma, a patient might go one of several routes. He might lose all brain function, and become what we call brain-dead. It’s quite rare, but he might develop locked-in syndrome, which would mean he has both wakefulness and awareness . . . but is unable to move or speak. Or he might evolve into a vegetative state—which would mean there’s wakefulness . . . but no awareness of himself or where he is. In other words, his eyes may open and he will have sleep cycles, but he won’t respond to stimuli. From there, a patient might either improve into a minimally conscious state, in which there’s wakefulness and brief interludes of awareness, and eventually regain fullconsciousness. Alternately, he might remain in what we call a permanent vegetative state, never regaining awareness.”
“So you’re saying my father might wake up . . .”
“. . . but the chances of him regaining awareness are extremely slim.”
A vegetative state. “How do you know?”
“The odds are against him. In patients who’ve suffered traumatic brain stem injury, like your father, the outcome isn’t good.”
I wait for these words to hit me with the force of a bullet: he is talking about my father. But it’s been so long since I let myself feel anything for my dad that, actually, I’m numb. I listen to Dr. Saint-Clare speak, I acknowledge that I was expecting to hear this news from him, I accept it as fact. Ironically, I realize, this does make me the best person to keep the bedside vigil for him. “So what happens?” I ask. “Do we wait?”
“For a bit. We keep testing him to see if there’s any change.”
“If he doesn’t ever improve, does he stay here forever?”
“No. There are rehab centers and nursing homes that care for people in vegetative states. Some patients who’ve made their wishes known to discontinue life support will go into hospice and have their feeding tubes removed. Those who want to be organ donors might meet the protocol for DCD, donation after cardiac death.”
It feels like we are talking about a stranger. But then again, I guess we are. I don’t really know my father any better than this neurosurgeon does.
Dr. Saint-Clare stands up. “We’ll keep monitoring him.”
“What should I do in the meantime?”
He puts his hands in the pockets of his white coat. “Get some sleep,” he says. “You look like
I try humor. “If you missed me, you know, you didn’t have to go to this extreme. You could have just invited me home for Thanksgiving.”
But neither of us finds this funny.
The door opens again, and Dr. Saint-Clare enters. “How’s he doing?”
“Aren’t you supposed to be able to tell me that?” I ask.
“Well, we’re still monitoring his condition, which appears to be unchanged.”
Unchanged, I remind myself, must be good. “You know this from injecting water in his ear?”
“Actually, yes,” the doctor says. “What we’re looking for in the ice-water caloric test is a vestibulo-ocular reflex. If both eyes deviate toward the ear with the water in it, the brain stem is functioning normally and consciousness is mildly impaired. Likewise, nystagmus away from the water suggests consciousness. But your father’s eyes didn’t move at all, which suggests severe dysfunction of the pons and the midbrain.”
Suddenly I am tired of the medical jargon, of the parade of experts who come in to do tests on my father, who doesn’t respond. Get the hell out of bed and open the damn door. “Just say it,” I mutter.
“I’m sorry?”
I force myself to meet Dr. Saint-Clare’s eyes. “He isn’t going to wake up, is he?”
“Well.” The neurologist sits down in a chair across from me. “Consciousness has two components,” he explains. “There’s wakefulness, and there’s awareness. You and I are both awake and aware. Someone in a coma is neither. After a few days in a coma, a patient might go one of several routes. He might lose all brain function, and become what we call brain-dead. It’s quite rare, but he might develop locked-in syndrome, which would mean he has both wakefulness and awareness . . . but is unable to move or speak. Or he might evolve into a vegetative state—which would mean there’s wakefulness . . . but no awareness of himself or where he is. In other words, his eyes may open and he will have sleep cycles, but he won’t respond to stimuli. From there, a patient might either improve into a minimally conscious state, in which there’s wakefulness and brief interludes of awareness, and eventually regain fullconsciousness. Alternately, he might remain in what we call a permanent vegetative state, never regaining awareness.”
“So you’re saying my father might wake up . . .”
“. . . but the chances of him regaining awareness are extremely slim.”
A vegetative state. “How do you know?”
“The odds are against him. In patients who’ve suffered traumatic brain stem injury, like your father, the outcome isn’t good.”
I wait for these words to hit me with the force of a bullet: he is talking about my father. But it’s been so long since I let myself feel anything for my dad that, actually, I’m numb. I listen to Dr. Saint-Clare speak, I acknowledge that I was expecting to hear this news from him, I accept it as fact. Ironically, I realize, this does make me the best person to keep the bedside vigil for him. “So what happens?” I ask. “Do we wait?”
“For a bit. We keep testing him to see if there’s any change.”
“If he doesn’t ever improve, does he stay here forever?”
“No. There are rehab centers and nursing homes that care for people in vegetative states. Some patients who’ve made their wishes known to discontinue life support will go into hospice and have their feeding tubes removed. Those who want to be organ donors might meet the protocol for DCD, donation after cardiac death.”
It feels like we are talking about a stranger. But then again, I guess we are. I don’t really know my father any better than this neurosurgeon does.
Dr. Saint-Clare stands up. “We’ll keep monitoring him.”
“What should I do in the meantime?”
He puts his hands in the pockets of his white coat. “Get some sleep,” he says. “You look like
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