End Notes
If You Should Wake Up
By David Dvorak, M.D.
If you should wake up, will you remember the moments just before the fall, before everything changed?
Will you remember your precarious perch on the top step of the ladder as you hacked away so determinedly at the ice dams on the second-story roof of your home? Will you remember the winter afternoon sun hanging cold and low in the gray sky, the muffled shrieks of children on the nearby sledding hill? Will you remember reaching over a bit too far and feeling the ladder quiver ever so slightly beneath your feet?
Will you remember the fall, the way gravity pulled you with certainty toward earth, the dull thud of your body hitting the sidewalk below, the crack of your head on the pavement, the definitive snapping of ribs, the piercing pain in your chest? Will you remember crying out for help for the first time in your life?
Will you recall the gathering scream of the sirens, the paramedics crouched at your side in the fading light, the neighbors assembling tentatively at the fringes? Will you remember the silent spinning of red and white lights across their faces and the bricks of your house, like a strangely solemn winter discotheque?
Will you remember the bright lights of the emergency department, my face looking down at yours, asking if you knew where you were, what month it was? Who’s the president? Squeeze my fingers with both hands.
The emergency staff instinctively cut away all your clothes, punctured the skin of your outstretched forearms with steel IV needles, attached patches and wires to your chest. You moaned beneath your oxygen mask.
The chest X-ray showed a collapsed lung, punctured by the sharp edge of a broken rib. I injected lidocaine into the side of your chest, then sliced through with a scalpel and inserted a plastic tube into your chest cavity. (A nurse attached the outer end of the tube to suction and re-inflate your collapsed lung.)
With the passing minutes, I noticed you becoming lethargic. Your right pupil grew larger than your left. I intubated you, and a machine took over your breathing. We whisked you to the CT scanner.
The scan showed an epidural hematoma—active bleeding in the space between your brain and your skull—pressing on the brain, squeezing it. Growing larger by the minute. The neurosurgeon hurried you to the operating room, where he performed what remains one of the most primitive yet dramatic lifesaving procedures in modern medicine—he drilled a hole in the side of your head about the size of a nickel. The blood inside the skull escaped, relieving the pressure on your brain.
Now, the following day, you lie in the intensive care unit, eyes still closed. There are tubes and wires, monitor screens with lighted numbers and oscillating lines.
Your wife clasps your motionless hand as the respirator rhythmically sighs. From time to time you cough in reflexive protest of the breathing tube in your trachea. Sometimes you briefly struggle against the cloth limb restraints.
Speaking to your wife, the neurosurgeon is optimistic but cautious. “Only time will tell how much of the brain injury is fully reversible,” he says, “and how much, if any, is permanent.” Your wife silently downplays the latter part of his statement.
If you should wake up, where will you focus your attention, your energy? Most likely on family and friends. Phone calls. Get-well cards. Flowers. Hugs. Therapy to recover strength in your left arm. Learning to walk again. Prayer. What sort of things that used to concern you greatly will no longer matter? Perhaps that fresh scratch on the side of your car. Urgent deadlines for work projects. Your thinning hair. The Dow Jones Industrial Average. Ice dams. If you should wake up, will you forever look back and divide all of history into your life before the fall and your life after? If so, how will they be different? MM
David Dvorak is an emergency physician at Fairview Southdale and Mercy hospitals in Edina and Coon Rapids.