I was picked up at the airport at 9:30am central time by Matt, Lindsey, and Dr. Polites, one of Jake's senior advisors in the E.R. Ordinarily he's Jake's unforgiving boss but right now he's just another concerned friend. After a gregarious and large-hearted midwest welcome, Dr. Polites briefed me on Jake's condition as we drove to the hospital.
Here's what I learned: Jake has been diagnosed with a bacteria called Methicillin-resistant Staphylococcus Aureus (MRSA), which, as you'll discover if you look it up on Wikipedia or search Google, is a grave and nasty thing indeed. The pneumonia that he caught at the beginning of the week had the effect of weakening his immune system and opening the door for the MRSA to take hold in his lungs. MRSA is what's known as a "super-bug". In most respects the bacteria resembles more common forms of Staphylococcus (or Staph) but earns it's ominous moniker because of it's resistance to the antibiotics that make Staph a containable and far less serious infection. Knowing that Jake is infected with MRSA though, is only the initial phase of the diagnostic process. Several strains of MRSA exist, each adapted to resist certain antibodies, but each also, we must hold out hope, susceptible to the right combination of other antibodies. Figuring out which strain of MRSA Jake has and then figuring out which combination of antibiotics can kill it, will be the next steps. That's the big picture.
This morning I walked in from the cold and found my mother sitting tiredly in the ICU waiting room. I had not seen my parents in 8 months. My mom's eyes looked glossy and red, not like she recently had been crying, but instead her eyes told of slow and sleepless nights, of the strain of staring too long at a puzzle and yet still unable to find the piece that fits. She was not nervous, or fidgety, or on-edge, as I had expected. Last night and early this morning were relatively uneventful as Jake's conditioned remained stable, and surely the knowledge that the entire family would soon be together helped re-knit the frays of her beleaguered nerves. As you can imagine, our greeting was emotional. When I left Laos 2 days ago I knew that I should be in St. Louis. After hugging mom I realized that I NEEDED to be here.
Moments later my dad walked into the waiting area after being with Jake in his room. My dad's demeanor was transparent and immediately felt – he looked strong as ever and full of optimism. People who know my father well, know that he has a soft heart. He has no interest in retreating behind the stoic posturing of manhood. When my dad displays emotion, you know that it's genuine. So when he came practically skipping through the hallway, I didn't have to consider that this was some front to protect his true feelings, but could instead let my own fears and doubts get swallowed by his evident hopefulness. Seeing my father's slight smile as we walked toward each other made me briefly forget where I was and the purpose for our being there. We were all together at last, and it felt good.
And I could not have chosen a better time to arrive. My father's good cheer was for a reason. This morning Jake's fever finally dropped below triple digits. Moreover, as my father sat with him awaiting my arrival, Jake opened his eyes for this first time in days and was able to do so without agitating the breathing machine or having muscle spasms. Even better yet, when my dad called his name, Jake was able to briefly open his eyes and nod in acknowledgement. My bro's awareness is a huge step forward for us, and was certainly an auspicious way to begin the morning. Jake's improved condition, coupled with my arrival, had us all in high spirits. As we all got caught up (obviously there's a lot to talk about after traveling the globe for 8 months), sharing jokes, and trading playful insults like we're accustomed to, the mood was marked by a very firm confidence in Jake's eventual recovery, not if but how soon. After spending 40 some odd hours filled with the worst kind of dread and uncertainty, sharing such a light-hearted morning with my family was positively reinvigorating.
Around 10:30am I got the okay to go in and see my brother. After being let through the locked double-doors and into the ICU "staging area", as I'll call it, I was able to see into his room from behind another wall of glass. The wall is covered with indecipherable medical papers, and from the outside the best an observer can do is get incomplete glances of the patient. After waiting for the nurse to complete her round of readings and other regularly scheduled nurse things (Jake is definitely the doctor of this family), I put on a yellow medical gown, some latex gloves, and finally a breathing mask, and walked gingerly into the room. For the last several days I have been envisioning Jake layed up in the hospital bed. I've pictured the tubes disappearing into his throat and up his nose, the I.V.'s stemming from his arms, the computers and monitoring equipment, the sallow skin, the beeping noises (god, the beeping noises), and even that raw smell of decay. But I just wasn't prepared to face head-on what I saw. It's not a word thing. The best I can do is metaphor and that would just be for show anyway. It's instinctual. It's in the gut. All those sights and smells and noises descend on you all at once and you realize that you're not looking at your brother but just some husk of a body that might as well be an old coconut lying on the beach waiting to be taken to sea. Okay, so maybe metaphor helps. But only because the only other way I could let out this feeling is by crying, and blogs don't cry. I just sat there looking at him. I couldn't speak. Nothing. Just tears. The breathing machine sucking in and then back out, like an accordion bag. Jake was completely motionless. And this was a good day!?!?!? Mom came in and joined me. She encouraged me to speak to him. All I could manage was his name. At this his eyes reluctantly came open. All whites. His once fierce hazel irises just kind of sat there half concealed above his eye-lid. It was like a bad actor trying too hard to look stoned. I could detect in his face some recognition that he knew it was me. But more than anything, I saw in his eyes a vague recognition of himself; the disconcertment of being an eye-witness to his own bad dream. As he became more and more aware of our being there, you could see him becoming more and more aware of his own being there. The self-realization of the circumstances finally coming to. All that pain, the severity of the illness, the shock, the fear...all at once, heavy like a brick, or like a bullet coming too fast to evade, the shot hitting you before you hear the crack of the gun. The shock of it. This thing down my throat. These straps tying my arms to the bed. This sharp knife cutting through my chest with each breath. I'm a doctor. I know what this means. Until...
Shortly after we leave, Jake is sedated again for the afternoon. His responses weren't nearly as violent as they were yesterday and the doctors assure us that with each time he gains awareness he'll resist less and less. The parylitic he's been receiving has not just turned off his muscles but his brain also. Jake has to learn about what's happening to him just as we do. And if there is anything that Jake hates, and I mean maybe his greatest horror of all, it's to be the last one to know. He wants to be alert and he wants to be aware of what is going on. It's part of his most fundamental self and I guarantee he will be fighting like a madman to keep awake. This is a good thing.
The see-saw. We come back from lunch and once again Jake is fighting to come out of sedation. His fever is back to 102f. He opens his eyes for the briefest moment. He winces. His forehead furrows. He tries to clench his fist but does not have the strength. He tugs against the ropes that tie his arms to the bed. He turns his foot and lifts his knee in a slow motion jerk. Another battle in a long war. His actions are unmistakable. It's the will of a man overcome by pain and desperation, but fighting anyway. It's resolve. The latest round of culture tests come back inconclusive. Jake then sleeps.
Right now we all sit in the waiting room.
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