Joyce sat with Dr Martine St Germain in the sitting room of Khira’s suite. She had asked the doctor to tell her all about the patient’s condition, tell her how she, Joyce, was supposed to behave when she finally goes in to see her girlfriend – in case a certain behaviour was harmful or possibly convalescent.
Erik’s words, when they had passed the Lausanne interchange, heading for Vevey-Montreux, continued to ring in her memory. Through sheer luck the family drove to Taita Hills Lodge, and there was that aircraft sitting on the airstrip. Erik had practically forced the pilot to fly him and his traumatised family, accompanied by Dr Derek Mills, in the middle of the pitch black African night, to Mombasa where an ambulance they had radioed from Taita Hills was waiting at the airport with a team of doctors. Khira and Loyana had been first transferred to the Aga Khan Hospital in Mombasa, stabilised so that Khira could be flown to Europe with the least risk. His private jet flew in from Nairobi, complete with Patricia, and four hours later he flew his family, and a handful of specialists from the Aga Khan Hospital, to Montreux, Khira in an ice blanket.
“So your money, as usual, had saved your bloody arse,” Joyce had accused him again as they drove along the glittering sickle moon curve of Lake Geneva boasting sleek motor- and sailboats.
Auntie Nyowuor’s famous mountains were on the opposite side, rising and rolling in ink blue capped with the white. In winter, when the Lindqvists were here for skiing, the ranges must indeed seem all white, cloaked in yards-deep snow. The way she said it left no doubt that his arse, not Khira’s health, had been saved. His butt possibly saved from not being locked up for attempted manslaughter. Beating your wife into a coma was way beyond mere grievous bodily harm, Joyce’s tone of voice and body language indicated.
“You’ll never forgive me…”
“Not until grass turns blue, Erik. That aircraft could have crashed in the middle of the night killing her and her children, for heaven’s sake.”
“Odin, I thought we’d been over this. So what should I have done, huh?”
“Not bloody bash her in the first place!” Her feelings fluctuated. She was furious with him for what he’d done to Khira even as she tried to understand what state he must have been in when he thought his daughter was dead because of what had been secretly done to her by her own mother.
“Yeah, God, I…”
“Shut up. Drive me straight to the hospital. I have to see her before I’m confronted with her poor kids who will ask questions I can’t begin to answer.”
And so here she was in this futuristic Clinique in Glion-sur-Montreux listening to Dr St Germain explain Khira’s health condition to her. It was hard for her not to burst out screaming. Khira’s brain had been injured and the transportation over thousands of miles had possibly aggravated the injury. Luckily the specialists who accompanied her in the jet knew how best to minimise the damage, for example by keeping her in that ice blanket throughout the duration of the transportation until she arrived at the clinic. Selfish fool could have probably flown her even without the specialists just to wrap his selfish self in ACTION, thought Joyce while she nodded to the doctor.
The brain injury was finally controlled before the intracranial pressure, pressure in the head which was also called ICP, could get excessive.
How was that done? Joyce wanted to know.
Control of intracranial pressure, St Germain explained, depends on intensive monitoring and control of every bodily function. It’s an around-the-clock attention. It had been necessary to control Khira’s breathing by a ventilator. She was given strong medications to temporarily paralyse her and even deepen her level of unconsciousness in order to control the breathing, blood pressure and other vital functions. A surgery had been performed to remove small amounts of fluid from around the brain.
“Jupiter and Apollo, you didn’t lobotomise her or something?” She was off her seat with her palms holding either side of her face as if to stop it splitting up.
“Please, Madame. Sit down again. No need to panic. Lobotomy is an archaic procedure abandoned ages ago. We only removed small amounts of fluid from around her brain. The ICP monitor, which is attached to her skull, measures the pressure within the brain. Then we know exactly how to proceed.”
“Jesus.” Joyce sat. “And now? How is she? What’s being done to her?”
Dr St Germain briefly put a gentle hand on Joyce’s arm. “When you see your girlfriend, Madame, don’t be alarmed. She has a number of machines around her, all necessary for keeping her safe and help her get better.”
Joyce nodded: go on.
The machines around the bed monitor the patients’ progress, St Germain went on, and keep those stabilised. The arterial line, for example, was a very thin tube attached to a monitor, then inserted into an artery in her arm. This allowed measurement of the blood pressure and the concentration of oxygen and carbon dioxide in the blood.
Joyce nodded again, wiping her eyes.
The catheter, attached to her last night, was a flexible tube for withdrawing fluids from or introducing fluids into her body in order to drain the urinary bladder. The electrocardiogram, the ECG, monitored the patient’s heart rate and rhythm. As already mentioned, the ICP monitor measured the pressure within the brain and was attached to her skull. Fluids and medications were given to her intravenously. Another tube, called the nasogastric tube, passed through her nose and throat and ended in the stomach. This tube allowed for direct “tube feeding” and removal of stomach acids.
“But this we use only for short term tube feeding, Madame. We hope Mrs Lindqvist will soon be able to take her food orally.”
“Hope.” Joyce blew her nose and grabbed more handfuls of Kleenex from the side table. “Complete with respirator or whatever you call it.”
St Germain nodded. The ventilator did the breathing work for her. It delivered her humidified air with the appropriate percentage of oxygen at the appropriate rate, through an endotracheal tube. “We’re very glad that we do not need to use a tracheotomy. Mrs Lindqvist seems to have a remarkable will to...”
“A trach… what? What the devil would that be for?”
“This would be a tube inserted into a surgical opening at the front of the throat,” St Germain dented a spot on her own throat with a manicured, unpainted finger before the horror on Joyce’s face made her drop her hand. She continued fluidly, though, “to provide access to the trachea and windpipe and assist her in breathing.”
That’s exactly what I’m going to endow Erik with – a tracheotomy. “You won’t need to do that, would you? I mean not now and not…”
“Madame, this is a medical situation. Nothing…”
“…is one hundred percent. You sound like my mother.” She blew her nose.
“Sorry, I didn’t mean that the way it came out. My mother was a nurse.”
St Germain smiled several nods. “Was?”
“She’s alive and kicking and collecting money and medicament and hospital equipment from all the corners of the earth for Kenyan patients.”
Joyce settled back before pitching forward again. “Dr St Germain, how much pain is she suffering? I mean, does she feel anything? Hear any sounds?”
“Certainement. I mean, being in coma is like being under anaesthesia.” St Germain now spoke in the third person. “People in coma may well react to pain by moving, or even groaning, but most often have no memory of pain. But they sometimes show signs that they are able to hear and understand. Often these signs are just simple reflexes such as squeezing a hand, or sucking, in response to a touch. Occasionally they seem to get calm when they hear a familiar voice. Since they almost never remember these events, it is impossible to decide if they actually recognised a voice or understood what was said. However, as a rule, it is good to talk to and about people in coma as though they could hear and understand what was being said.”
“Has she? I mean shown any of these… what, reactions you speak about?”
St Germain leaned in on Joyce. “Madame, your friend suffered injury to the brain stem when the back of her head…”
“When the bastard bashed her, I know. Is there a way to send someone deliberately into a coma? A drug or something?”
“Pardon?” the French way.
Joyce blew her nose, wiped her eyes. “Never mind. Just gibbering. Go on.”
“Bon. The brain stem is the part of the brain that connects the larger portion of the brain with the rest of the body. Here is where many functions are tightly packed and consequently it is quite susceptible to injury. Among other things, the brain stem controls consciousness, breathing, heartbeat, eye movements, pupil reactions, swallowing and facial movements. Alors, all the sensations going to the brain, as well as the signals from the brain to the muscles, must pass through the brain stem. The brain stem is often damaged in severe head injuries, but it is almost never the only part of the brain which is injured. It is…”
“God almighty, don’t tell me she has yet more brain injuries, Doctor!”
“Madame, I’m speaking to you, answering your questions, as a medical doctor. This does not mean that you weigh every single word on a gold scale.”
Joyce nodded, pulled more Kleenex out of the box.
St Germain continued. “Alors. Coma in head injured people almost always results from injury to all parts of the brain, not just the brain stem. In very rare circumstances the major portion of the brain is spared and only the brain stem is injured. This may result in prolonged coma with rapid and nearly complete recovery when the head injured person wakes up. In the vast majority of cases, however, prolonged coma implies diffuse injury to all parts of the brain, including the brain stem, and recovery is slow. Residual effects of brain stem injury may include prolonged difficulty with movements, vision, swallowing and other functions controlled by the brain stem. Residual effects of injury to the other parts of the brain may include problems with movement, memory, attention, speed of thinking, complex thinking, speech and language, and behaviour and personality. But as I said, Madame…”
“Jesus, lady, you must know how much damage her brain has suffered! You talked about all those CTs and MRIs and Glasgow whatever! Will Khira’s…”
St Germain flapped her hand in the air from the wrist. “Madame, Madame,doucement. Doucement maintenant. Alors.“ She took in a breath, smiled, patted Joyce’s arm. “Most people with head injuries have extensive diffuse injury as I mentioned, which involves many parts of the brain. Certain tests such as the CT scan provide some information about the extent of the injury. However, in the final analysis, it is the function of the brain in thinking, speaking and moving which provides the most useful information about the extent of the damage. Since the function of the brain often continues to improve for months or even years after a head injury, measurements of brain function must be repeated several times during the recovery progresses.”
Will there ever be an end to it, thought Joyce rocking back and forth.
St Germain continued with professional aloofness, still talking in the third person. Joyce wondered whether this mode was a deliberate strategy. Was it also the best narrative to use with the kids when they ask her about their Mamma?
Injured brain tissue can recover over a short period of time, St Germain was saying. However, once brain tissue is dead or destroyed, there is no evidence that new brain cells can grow again.
I’m going to brain the bastard, I swear to God I am!
The process of recovery usually continues even though new cells do not grow. It is medically presumed this happens as other parts of the brain take over the function of the destroyed brain tissue. Obviously, the more extensive the damage, the less likely it is that the remaining brain can take over the function of the destroyed areas.
Fantastic. “Dr St Germain, when do you think she’ll get out of the coma? I mean for example, when I go in there and talk to her and she can hear and knows who I am – we go very deep, the two of us, like conjoined twins – when she wakes up, what should I do or not do… I mean what would you do if you were a laywoman very close to her?”
“Madame. Why do you want to know all this? It’s only making you suff…”
“Let that be my business. Just tell me. Answer my questions, Doctor.”
“Alors. The next stage in the recovery from head injury is called post traumatic amnesia. Coming out of coma is not just waking up as people often imagine. Rather, it is most often a gradual process of regaining contact with the world. One of the most amazing things about recovery of consciousness is that it takes so long to begin to restore memory. The kind of memory that is most often affected is the ability to continuously remember the events of the day. When head injured people are awake but unable to recall what happened some few hours or even minutes ago, this state we give the medical term post traumatic amnesia. People who are fully recovered from a head injury usually have no memory at all of this stage of their recovery.”
“Well?” Joyce, this time, was the one who flapped her hand in the air. “Go on!”
The lecturing continued. Rehabilitation is the process of helping a person achieve maximum functional potential. This process begins immediately. Once memory of the events of the day begins to be restored, the rate of recovery often appears to be much more rapid. But many problems may persist for a long time. These may be problems related to movement, memory, attention, slowness of thinking and so on as already mentioned. These problems are dealt with in the rehabilitation of the head injured person.
“The rehabilitation, however, begins much earlier than this. For example even right now as we talk and she is next door in coma. She’s healing.”
Joyce nodded once again. She wasn’t going to get much farther with this doctor who talked in circles. “Thank you very much, Dr St Germain. Thank you.” She got up and swung her handbag over a shoulder. “Let’s go in then.”
St Germain’s hand was on the door handle when Joyce spoke again. She was still thinking of the children and what they’d most likely ask her about Khira.
“Just one other thing, Doctor. Suppose – just suppose – she recovers… as well as possible, would there be some relapse? I mean into another coma or…?
St Germain left her hand on the door handle. She twisted her body to face Joyce. “Madame, you worry a bit too much. It’s not good for…”
“It’s not me worried to death, Doctor. It’s her children, understand me?”
“Bon.” And St Germain answered Joyce.
She bobbed her head in thought for a while. “All right, Doctor. I think I’ll need some diagrams or pamphlets – that sort of thing – of coma patients and the life support stuff with explanations of what each single machine or needle in her does for her. Make it as child-friendly as possible. I don’t think five-year-olds would much care to study some surgeon boring holes in their mother’s throat or slicing off bits of her brain.”
“Oui, Madame. I know what you mean.” She smiled before she finally opened the door to let them both into Khira’s bedroom.