Letters to Michael: Guatemala

Dearest Michael I sit here in the emergency room at Centro Medico Hospital, Guatemala City and you are on your way to the intensive care unit.  The treatment room is empty.  I sit in a chair hugging your belongings to my chest.  There isn’t much, just a pair of pants, shirt, shoes, socks and digital watch.  They are contained within a plastic bag and yet, that’s all I have left of you right now.  I am stuck here by myself.  Our hotel room is forty-five minutes away and I don’t want to go there in a taxi by myself.  You normally make sure I am safe and now I have nowhere to go that doesn’t include leaving you.  All I can do is review what has just happened in the past several hours.  I keep looking around the room for evidence that this is just a joke and I am not really here waiting for you to get better.  Since when, after twenty years of taking care of me, is okay for you to leave me here to make decisions on my own?  I keep hoping that if I close my eyes really, really tight, when I open them again I will be back in our hotel room, with you lying beside me in bed. We might be enjoying some silly TV show or talking about the wonderful day we just had.  That was normally how our nights would go during the four months of traveling South and Central America.   Better yet, maybe we would both be fast asleep having gotten up at five thirty in the morning to catch a van to Lake Atitlan, Guatemala.  This tour was just the beginning of our excursions within Guatemala.  And even though we normally avoided getting up early, we were both looking forward to the adventure that we planned.  Instead of sleeping safely in our hotel room, I am in an empty ER reviewing the last six hours of the adrenalin packed portion of “Our Adventure.” 

What is burned into my brain is the picture of you standing outside the tour office waiting for our van, which was late, to arrive.  Intermittently you would find me nearby, give me a van status and then go back to waiting by the wall.  One minute you were asking me if I was finding anything to buy and the next minute, I see you with a funny look on your face, a tell-tale half smile, on the left side of your mouth, and you were staring out into space, or were your eyes just hoping to find me?  One second you were fine.  The next I am yelling, “My husband is having a stroke, call an ambulance, get me a chair.  And then I hear myself telling you, “Honey sit down you are having a stroke.”  You just looked up to me with disbelief in your eyes and sat down.

However, when I open my eyes in the ER I realize that no, I am not dreaming, this is a nightmare, and you are here somewhere in a foreign hospital with a cerebral hemorrhage.  The intern reviewed your CT scan with me while the nurses changed you into the requisite hospital attire, started an IV, and put you on a monitor.  You were still awake and shook your head yes when I asked, “Can you hear me?”  I had hoped for a good, old fashioned, tiny clot-type stroke, called a TIA that could be relieved by that wonderful clot busting medication I used to give patients when I worked at Santa Monica ER.  But we were not so lucky.  When I saw that “glowing” white spot confined to the one area of your left brain I said to myself, “It figures, give a guy the gift of gab and then take out his speech center, nice job!”  I see the size of your brain; contemplate the size of the bleed, which, at the moment, is about three centimeters, and think, “Pretty damn large!”  I couldn’t help but wonder, after worrying you through all the cardiac surgeries, had our luck just run out?   But the neurologist reassured me that you should be fine. There was no treatment other than reducing the swelling, lowering your blood pressure and waiting.  He said, “Your travels for now are over.  You will need to stay here about one week to get him stabilized.  Then you can get a first class ticket home and soon as possible, start physical therapy for his recovery.”  In a matter of seconds I thought, get a first class ticket?  You don’t know my husband.  Never!  Michael would never splurge that way. 

Our hotel was an hour away and I was in the middle of a major attack of inertia; scared to leave for fear you would need me, scared to go back to the hotel alone.  Since it was almost midnight, the nurses took pity on me and found me a bed in on call room to use for the night.  I was told that the intensive care unit had strict visiting hours and I could see you later in the morning.  But with a cot and a sink I could rest and still be somewhat close to you when you needed me.     However, rest never came.  All I could think about was those first several hours of terror when this whole craziness began to unfold.  

There we were at some remote Guatemalan lake and you were having a stroke.    All my nursing instincts kicked in usurping any wifely panic.  I was in control calling the shots and thinking “Is this really happening?”  You kept telling me, “I am fine.”  But I could see you weren’t.  When the ambulance arrived you even walked from the curb to the ambulance and got in just as the right side of your body began to weaken and give away.  I was angry that you were so damn stubborn that you had to do get into the ambulance all on your own.  I guess you were trying to prove to me, and everyone else, that you were fine and could handle this “little” problem just like you handled everything else.  We got oxygen on you right away and then there was the harrowing ride up the hill to the hospital that made me dizzy.   I was holding onto your head partially to steady you and so I would stay steady, trying unsuccessfully not to slide on the ambulance bench, from side to side.   

The little remote hospital ER was more like a clinic than a real hospital.  A blood stained blue cot mattress and bloody dressings decorating the floor, this is the type of hospital horror stories I’d heard stories about. Beware of hospitals in a foreign country.  Now, for us, this horror story was playing out in Technicolor.  They would have put you on that dirty mattress had I not yelled, “Don’t we get a sheet?”  With continued oxygen you seemed to get better.  You could talk a little and your right side regained its strength.  The silly left-sided smile relaxed and you were nearly normal again except for stumbling through your words.  Out of nowhere a representative from embassy arrived. He immediately jumped into make any necessary calls and discuss ways to get you transferred two and a half hours away to a private hospital in Guatemala City.   You kept saying as best as you could, “Go back, go on van, I fine, be fine, go hotel.”  At one point you even put your shoes on and stood up, as if to say, “See, I am fine and I don’t need to go to the hospital!”

As time ticked away, I realized that the golden hours of getting you treated, for what appeared to be a TIA, were coming to an end.  According to research, three hours is all we had and it was 1.5 hours from the beginning of your symptoms. With minutes rapidly ticking by I wondered how many precious brain cells were we losing? I couldn’t sit still, I needed action and you needed to be transferred right now.  Like an episode from Star Trek I thought, “Beam me up Scotty.”  Failing that, please give me wings to carry you to the hospital fast!   You recognized my anxiety and patted the space next to you on the dirty stretcher and said, “Sit.” So I did, feeling defeated and frustrated.  I’m screwed, he’s screwed, we are all screwed.  But those feelings lasted only a minute or so.  I needed to get you to a big hospital fast.  But just as I was suggesting we call for a helicopter, I looked outside and saw the rain began to fall and the fog rolling in.   We are definitely screwed I thought.  No way can we make it in time in an ambulance over winding mountain roads, through fog, and then stuck in big city, Friday night traffic.  But that is just what happened.  It was two and a half hours of hell and you reassuring me by saying, “I am fine” and once asking “How much longer?”

Upon our arrival you were alert but having trouble with your thoughts.  You went from saying, “I’m fine to wondering what was happening and saying “(this is) So strange.”  When we asked you to write your name you did so perfectly. You wrote MIKE and then just letters that had no meaning.  When we asked you to read back what you wrote you hesitated and then rattled off numbers as you pointed to the letters on the page.   I couldn’t help but think, “Wow this is interesting, doesn’t the brain work in mysterious ways.  Then I thought, when I get time I want to look that phenomenon up to see what part of the brain that is coming from.  But then realizing when you recover from this and can’t process, can’t write, can’t think straight, you will be so angry.  I thought of all our plans to rent Page’s condo.  You would swim in the pool, get back to playing golf, watch high school sports and I would shop for the new grandchild that was on the way.  How could any of that happen if your speech center was gone?   At one point the doctor took me aside and said, “This is the part I hate.  We need a money guarantee to treat your husband.”  I said, no problem here take all my credit cards and treat him!  But the clerk kept stating that they needed your passport for a guarantee.  Your passport was an hour away with everything else.  I had no cell phone, no computer, and no address book with family phone numbers.  Everything I needed was an hour away! 

Just when the hospital staff was deciding what to do to make sure the bills would be paid, you complained of slight pain in your head and closed your eyes.   For me it was just like a scene out of the Shirley McLain movie Terms of Endearment with me yelling for someone to help you!  When I asked honey does it hurt a lot?”  You just shook your head no.   Finally I cornered the intern and told him, “Stop asking for credit cards and passports, we have plenty of money just get in here now and treat my husband”  “NOW!”  I found myself yelling, I want an IV, Oxygen, monitors and let’s get him to CT or MRI now!”  “Someone take care of my husband now!”  His condition is changing!”  You could nod your head in response to my questions, but no longer opened your eyes, and stopped trying to talk to me. The wife in me just hoped you needed to rest and the nurse in me knew something devastating was happening.   I wondered how does someone recover if the speech center is gone?  How did this bleed happen anyway? The questions just wouldn’t stop.   And now, as I lay in silence on this narrow stretcher, with you somewhere far away from me, I keep thinking about the minute this stroke started and wondering, what, if anything, I could have done differently.  Get me a time machine; I want to go back to this morning.  There are things I need to change.

To start with I would change that I didn’t sit with you this morning.  Instead I climbed into the seat behind you in the van and put our back pack on the seat next to you, instead of putting me there.  I will never forget what you said, “Aren’t you going to sit with me?”  I expressed an interest in catching some sleep during the two hour trip to the lake and needed my own seat so I could stretching out,  “I just need a little more sleep, I’ll come sit with you in a while,” I rationalized.   I also figured you would want a bit more leg room for that metal left knee!  We have traveled like this before and I thought at the time that it was an odd request; we were close enough that I could reach out and touch you anytime.  It was just a five seat van, not some gigantic Greyhound bus!  Even as I write this I wonder if you had some premonition that your time was no longer indefinite. 

 It wasn’t long before the other passengers began to fill up the van and I moved to an aisle seat next to yours.  By then you had struck up a friendly conversation with some men, sitting in front of you, who split their time between living in Israel and Miami.  It wasn’t long before the conversation got around to politics and the crazy, current American political situation.  It was obvious by the tenor of the conversation that both parties were of the same mindset and you were in your glory talking about one of your favorite subjects-Obama and the conflicts within the Republican Party.   I remember thinking how nice it was for you to have someone, other than me, to share the latest political news. 

Our trip at Lake Atitlan began with enjoying an American breakfast with our guide in a tiny town beside the lake.  Then, along with just two other guests, we got aboard a small outboard motor boat and headed across the lake to visit three small cities that seemed to grow out of the rocky hillsides that surrounded the tranquil lake.  The visit to these different cities runs together in my memory now.  One was known for textiles, one for having wonderful artists, and the third for markets, long haired women, churches and a great restaurant to have our lunch.  You kept telling me to look at one little kid after another.  “Oh Cindy look, there’s another cutie” you’d say.  I couldn’t help but notice that you seemed more exhausted than normal. We had only walked a couple of feet when I stopped to go into to a shop to purchase a scarf for my daughter-in-law.  When I came out to ask you for money you were sitting on a stone ledge.   I thought this was odd but didn’t comment because you were in the middle of a conversation with the guide.  Then, a block later, I turned around to look for you.  I will always remember what I saw like it was yesterday.  You were just a few feet away, up the hill from me and you had stopped again. You looked unusually pale standing there catching your breath. This picture of you is still so vivid.  I wonder now why this particular picture of you is still imbedded in my brain.  Why not the healthy pictures of you that I fear are fading, the ones I need to hold onto? Why do those pictures disappear so quickly? 

Though you stopped a lot over the past two to three months, as we walked the streets of South America, you seemed unusually tired today,  I wondered, why is he so pale?  “Michael, are you okay” I asked?”  And typical of your usual responses to me was, “I am fine.  Doesn’t our guide know you need to stop more often to shop?”  This was code for “I need to rest more often.”   But it wasn’t long before you passed me as we slowly made our final decent down a steep hill and back to the boat. I said “Hey speedy!”  And you shot back something like, “Going downhill, piece of cake.”   I thought, okay he is fine.  He is going downhill faster than I am and chatting with our guide at the same time.  He must be fine.   You even kept looking back up to me and wondering why I was taking so long.  You would turn and say, Watch out for those wet rocks on the road they are slippery, don’t get run over by a tuk- tuk!”  I thought good, he is being his usual protective self.  So I put all my worry aside and began taking in the sights with my camera.  All the shops were so colorful.  And since I didn’t have much room in my suitcase for the beautiful tapestries, I figured that I had plenty of room in my camera to take the colorful sights home.   

At one point I noticed that it was three o’clock and the tour was nearly finished.  I rushed to take in just a few more sights and haggle with someone over a beautiful tapestry that might look great at the end of one of our beds.   You wrapped your arm around me and said, “What do you want to buy now?” Since you and the tour guide looked impatient, I stopped my negotiations and followed you both to the dock.   We just needed to get back across the lake and onto our waiting van for the two hour trip back to Antiqua where our beautiful hotel room and bed waited our return.  On the boat you grabbed a seat beside me as we endured the slow process of crossing the large lake, which had grown choppy with the afternoon wind.  You asked me questions about whether my dad liked musicals.  I thought it was an odd question but told you I had no memory of my dad ever liking musicals the way you did.  This triggered my mind to drift to other questions I should have asked my father who had been dead for fifteen years.  I remember thinking how hard it is to have someone close to you die and wished I could just give him a call and ask, “Michael wants to know if you like musicals.”  Crazy how long someone can be dead and yet you still miss them a lot.  I also caught myself thinking about how many people I’d lost in the past twenty some years. 

First of my family to go, besides elderly grandparents, was my sixty-eight year old mother who died of lung cancer in 1986.  Then, in a quick three month succession, I lost two friends and my cousin’s husband in the fall of 1987.   After a near ten year reprieve, my father died at age 81 in 1996.   In 1997, another good friend of mine died of ovarian cancer, a month after “my” ovarian cancer was detected.  Over the noise from the outboard, Michael asked me what I was thinking and I quickly changed the subject to the choppy water and the beauty surrounding us. It had started to rain just a little but the sun was still shining.   I looked around for a rainbow, but never found one.  Now, here I sit, in a tiny room near the emergency room, reflecting on the day, and I can't help but wonder, was I going to lose you too??