PART VII:  COLLEEN'S ICU INTERLUDE
I didn't see Dr. Tottenham again. Her shift in MICU, I knew, ended at 7 AM. I'm not sure whether Colleen had even met her. I'll have to ask if she remembers. Three days later I caught a glimpse of Dr. Tottenham on the 9th Floor in her white coat, not a shiny dark hair out of place, no expression on her pretty young face, glancing neither left nor right as she passed by, her glacial exterior intact. If she saw me too, she gave no indication.

Beginning at daybreak on Tuesday morning, other doctors, obviously pulmonary, began coming in and out of Colleen's room to check on her. Each time they told her, "We're going to take the tube out today."

I started reading another magazine article to Colleen to pass the time. Although not as frequently as the night before, she continued to ask for pain medication for her hurting throat. The nurses complied, but not as liberally as the night before. "In order to extubate, we need you and your lungs as awake as possible," they said.

Having gotten a few hours sleep at their hotel, Leslie and Pat returned around 9:00. Colleen's daughter Chelsea and son Ben drove down from New Jersey, arriving early afternoon, around 1:00. Now there were five us standing by with Colleen in expectation of the tube coming out. We waited together, one anxious hour after another, talking, not talking, reading aloud Colleen's occasional notes. Her initial scrawls were becoming more legible.

Would the doctors be successful in removing it? Would they need to re-intubate? The prospect of reintubation was unthinkable to us. It had not been presented to Colleen, at all, as a possibility. She deserved full protection from the fear that prospect would have induced.

Leslie and Pat had persuaded me to pop back to the hotel for a hot shower and change of clothes, Leslie driving me there after a mildly frenzied search to find her car in the Hopkins parking garage. It may have been around 2 PM by then. 

I had been inside the hotel only minutes, standing at the front desk getting the key card to my room re-charged, when my cell rang. Pat was calling to say they were going to remove the breathing tube within the hour.

Immediately, I phone Leslie to come back to pick me up. Even though only five minutes or thereabouts had gone by since dropping me off, she'd driven straight down Lombard Street, going she knew not where to pass the time. So it took her a while to navigate back to the hotel, which was located within a maze of one-way streets.

I stood on the corner of Lombard and Calvert, waiting, waiting. How far could she have gone, I worried and wondered. I stare at each and every passing gold-hued SUV thinking it's her. And then, bam, she's stopped directly in front of me, in a silver-hued SUV, vigorously trying to get my attention. We speed off back to Hopkins, two miles away.

Leslie generously drops me off back at the entrance to the parking garage. She'll park and be right behind me, she says. I fast-walk across the street to the Main Entrance of the hospital, take the elevator up to the 10th floor, take an immediate left to the double-doors of 10E, take another immediately left and then a right to Colleen's MICU room. Pat, Ben, and Chelsea are standing outside Colleen's door. They tell me that Colleen asked for everyone to leave the room during the extubation except for the doctors and nurses, who now surrounded her bedside. I tried getting a glimpse of Colleen through the doorway but all the working bodies blocked a view.

How long we waited is uncertain. A half-hour perhaps? Forty-five minutes? Was it like waiting for a baby to be born? Waiting for that first alive cry?

And then it was over. We were allowed in. Colleen smiled at us.

By 4:30 or so, Pat and Leslie, Chelsea and Ben, had left the hospital to drive back to New Jersey. It was just me and Colleen again, sharing the quiet of enormous relief, of being on the other side of danger.

Colleen began urging me to go back to the hotel, take a hot shower, and get some sleep. Eventually, around 7:00, still light outside, I did.

In the morning I woke up to an email from her. Sometime after midnight, she'd been transferred out of MICU back to a room on the 9th Floor, where she'd been prior to the procedure three days before. It felt like three weeks.

THE END

PART VI: COLLEEN'S ICU INTERLUDE
The armless chair next to Col's bedside had a rocking feature of sorts so it was mildly comfortable. Col continued writing me short notes intermittently, gesturing with her right hand for a pen. Sometimes, in spite of the tube, the note would be accompanied with a smile from Colleen. At one point she wrote, "You had a meltdown."  Immediately I started denying it. "I had a meltdown?" I'm thinking, how did she know? Did she hear me all the way in here? So then I offered a weak, "Well..." and let it trail off.

From time to time, I asked Colleen if she was in pain. Mostly she indicated no, but a number of times pointed to her throat. When the nurse then inquired if she wanted more pain medication, Colleen would indicate yes.  

From time to time, I also checked the round clock on the wall, the kind with the second-hand. Leslie and Pat would make it to Baltimore no earlier than 1 AM. In the interim, Dr. Tottenham finally came into the room to tell me that Colleen's blood pressure was doing well. Out of Col's earshot I asked, "Does that mean no new lines have to be put in?" No new lines, she confirmed. We'll let her rest (this is rest?) overnight, she said, and try to extubate in the morning. I thanked her, and even touched her clinical hand. Fear eased its grip another micrometer.

It had taken an hour or so after first seeing Colleen intubated to notice the ventilator equipment located to the right of her bed, and its unmistakable sound. The pump itself looks toy-like, made out of blue and white accordioned plastic, and smaller and less robust than you'd expect for performing such a life-and-death job. From my bedside chair, the ventilator pump, housed in clear plastic, stood directly in my line of sight. I watched it go up and down in an exact, digitally programmed, unvarying rhythm. A relentless mechanical plodder capable of saving lives, of mimicking the expansion and contraction of real lungs. I watched Colleen's chest rise and fall in lockstep. The sound of a ventilator mimics nothing but itself, however, particularly its downward, percussive thunk. As the clock ticked on into the late night, and as I settled in for whatever was to come, the ventilator pump became the dominant, sometimes the only, sound-print in the room.

Sometime after midnight it must have been, one of Colleen's nurses quietly told me that Colleen was  breathing on her own. She delivered the news so softly, it almost didn't register. Instinctively, I looked at Colleen. The breathing tube hadn't gone anywhere. It remained exactly as it was. Breathing on her own? Several perplexed seconds passed before I understood. The tube was still in place, but the ventilator was no longer pumping. Colleen lungs had taken over. She was breathing on her own. Fear's grip eased a millimeter or two.

I told Colleen the good news. 

A little while later, I asked her, "Would you like me to read to you?" She and I were alone in the room then, the lights still soothingly dim. She nodded yes, and then hand-gestured her wish for the pen. "No drama," she wrote.

I had purloined a copy of Vanity Fair magazine from one of the many waiting rooms I'd waited in over the past few days. I asked Col if she'd like me to read a piece about Audrey Hepburn written by her son Luca. She nodded yes. I was mid-sentence, Colleen actively listening to me reading, when Leslie and Pat came quietly into the room. It must have been 1 AM by then. Colleen brightened at seeing them. A few hours earlier, encouraged by Colleen's increasing alertness, I'd called Leslie and Pat en route in the car to let them know things seemed to be trending upward. Now  got to tell them that Colleen was breathing on her own. It was a warm reunion.

The three of us stood around the bed, sat around the bed, took turns reading Colleen's hand-written missives, and told stories. Colleen used her fingers to indicate "LOL" in response to one of them, which made all of us laugh, as Colleen smiled beneath the obnoxious tubing.

Around 3 or 4 AM, Leslie and Pat left for their hotel room--they'd reserved a double in the same hotel as me. I stayed on and kept vigil for the rest of the night, dozing for minutes at a time. I had the sense that Colleen was doing the same. By this time, the nurse had removed Colleen's hand restraints. I marveled that Colleen was able to lay still, to refrain from trying to rip out the breathing tube herself.

When dawn's first light filtered through the windows, I couldn't believe we'd made it through the night.

MONDAY MAY 20 . 10 VILLAGE DRIVE
My sister Camille and I drove the back roads to see Colleen this afternoon, her second full day at the rehab hospital, tonight her third night. She's definitely feeling more comfortable being there. I think tomorrow the rehab center will present its team assessment of Colleen to Medicare. After reviewing this information, Medicare will proclaim how many days of acute rehab for Colleen it will pay for. The maximum coverage is 14 days. 

PART V: COLLEEN'S ICU INTERLUDE
Immediately after inking my approvals, I called Leslie. "I need you to come," I said. I need you here   plus, if they can't remove the tube, someone else needs to be here with her too."

"I'll leave right away," she said. And she did, picking up Colleen's close friend Pat Larkin, who lives nearby, to make the trip with her down to Baltimore.  

Dr. Mathai called. He said he'd wanted to see Colleen after the procedure but, because it didn't finish until after 7:00, he'd had to go home to babysit his three boys. He listened to my distress. He listened to my anger at our not having been told upfront, even days before the procedure, that general anesthesia was Colleen's only option. She may have decided against the surgery if she'd known, I told him. And now she's in danger of extubation failing and, since her wishes are not to be kept alive on a ventilator, she may die. He listened to all of it. I can't remember all that he said but it helped. And he would see her in the morning.

It was now around 10:00 PM on Monday night. Seventeen hours of unknowing remained.

After speaking with Dr. Mathai, I went back to Colleen's bedside and pretty much stayed there until 7 PM Tuesday night. Her eyes continued to be closed. I told her that I'd spoken with Dr. Mathai and relayed to her the message that he would come by in the morning to see her. 

The new lines had yet to be put in. But what about the dopamine? Colleen's dangerously low blood pressure?

Dr. Tottenham came in and said they were encouraged. That Colleen was responding to the single dosage of dopamine she'd been given, well over an hour ago now. Having to do something more invasive might not be necessary after all. But it was still wait-and-see.

Not long afterward, Colleen opened her eyes fully. She looked more alert. I was encouraged. Not long after that she tried to speak, which was impossible. She hen tried communicating with her hands, which were loosely tied down so she wouldn't intentionally or unintentionally tug at the breathing tube. A nurse and tried to guess what she was trying to tell us. Her frustration visibly mounted. The nurse finally guessed it right--Colleen's hands were cold. Scleroderma gave Raynaud's disease to Colleen two decades ago, which causes her hands to turn blue and to feel extremely cold. Her hands were blue now and obviously painfully cold. The nurse quickly fitted a pair of large down mittens over Col's hands. Colleen looked relieved. The nurse asked her if she'd also like additional warmers inside the gloves. Colleen nodded yes.

Not long afterward, realizing that as hard as we were trying, we weren't going to be able to read her mind, Colleen made a writing gesture with her hand. The nurse scurried for pen and paper. I put the pen in her right hand and propped up a blank piece of paper on a piece of cardboard the nurse had also scavenged.

Colleen scrawled, "What happened? Where am I?"

And so, my eyes looking into hers, I told her everything. That she was now in the ICU and why, that they'd had to use general anesthesia after all and had put in a breathing tube. I soft-pedaled in one area only. I told her that they were going to take the breathing tube out in the morning.  Withheld the doubts about whether they would try to take it out in the morning, about whether they could successfully take it out at all. This lack of full disclosure would have been deemed a "sin of omission" when I was growing up Catholic. To me, in this instance, it was none other than the saintly thing to do. To bring to my sister as much peace as possible as she lay  utterly helpless, unable to speak, and in full knowledge of her hazardous state.

She lay still, taking in what I'd said. She then began to write again. "Is the worst over?" Four words that took my breath away in their poignancy--please say "yes"--and their bravery--but tell me the truth. She looked directly at me and waited for my answer.

"Yes, Colleen, I believe the worst is over. Yes." 

SUNDAY PM . 10 VILLAGE DRIVE
My mother and I drove through light rain to Vineland to see Colleen today. By the time we arrived around noon she had had her first meeting with an MD whom she liked and felt understands her medical conditions. Colleen also had had her first "assessment" meeting with an occupational therapist. It was a day of first meetings. While we were there, her case manager Suzanne, the same name as our mother, came into Colleen's room to introduce herself, talk about goals, and brief Colleen on what to expect over the next ten to fourteen days. We left as the first physical therapy assessment began. The gym looks terrific. As does Colleen.

It's going on 5:00. I've crawled into bed under a down comforter. Only thing missing here is Colleen.

SUNDAY AM . 10 VILLAGE DRIVE
I just spoke with Colleen. She's continuing to adjust to her new environment and new carers, but tells me she's "okay" and was able to sleep last night. Her first occupational therapy session and physical therapy session begin today! She is happy about this -- that's why she's there. No time to waste.   No body in idle.

As for me, last night I slept ten hours straight. Time to get up, put my grossly dirty clothes in Colleen's thoroughly modern washer, and then present my somewhat grossly dirty, aching body to a hot shower from Colleen's best-in-the-world showerhead.

9:15 PM . BACK IN THE GARDEN STATE
Colleen in settled into her room at an acute PT rehab center in Vineland, thirty-five miles inland from the Shore. We checked into the center around 4:30 this afternoon, the interstate drive from Baltimore uneventful but smooth-going. Being finally discharged from the hospital today brought a feeling of relief, but Colleen not being able to come directly back to her own home didn't feel so good. I'm already in bed in my room on Village Drive, but it's not the same without Colleen being here. And I know her new non-Hopkins surroundings aren't feeling remotely cozy to her on this her first night. Nothing and no one is familiar. Fortunately, although she's in a double room, she's by herself at the moment, assigned to the bed by the window. From Vineland I caravaned down wooded backroads to the Shore behind Camille, who'd come to meet us at the rehab center. Saw two lithe deer dash to safety across our path.