Coming Home
by Ray Fowler, MD
Copyright Jan 1, 1990

(Time in Space Home)

            The internal peace of this family remained undisturbed for many years. Deaths of family members of some remove created no serious waves to stir the basic commitments of the father, mother, and two teenaged girls. The onslaught of menopause, puberty, cheerleading, promotions for dad, demerits for talking in school for the girls, and other such memories still remained peripheral to the central core of comfort found in this familial nest.

            That is, until the night I saw the father, Bill, after he had wrapped his Chevette around a two-foot diameter pine just west of Six Flags while speeding in the dark to make a traffic light. Bill wasn't wearing his seat belt, and his head destroyed the windshielf just a shadowy moment after his chest demolished the steering wheel. Both knees snapped like slender twigs beneath the dash, ripping open the skin and revealing the fragmented bones within.

            Bill was hardly recognizable as a human. He'd peeled his scalp back like the skin of an orange, and he'd lost several units of blood from the scalp laceration alone. The greater problem, aside from the major extremity fractures and the bruise to his heart from the fractured chest wall, was the intense bleeding onto the surface of his brain, an "acute subdural hematoma" which slowly tried to squeeze his cerebrum out the bottom of his skull.

            He had all the signs. His breathing was rapid and driving, like a runner who had just finished a hard-run half-mile. His pupils were dilated and did not react to light. His extremities were paralyzed and did not react to the pain of a needle prick. His pulse and blood pressure were weak and irregular.

            The walls of Emergency are lined with the spirits of those who've come before, some to live and some to die. Other ghosts live there who, when living, were not injured as badly as Bill. The spirits, I think, hover above us and watch our work se we bend down to these terribly crushed humans who gasp as death envelops them.

            We gritted out teeth and waded through Bill's blood to clamp the bleeders. Rapidly, chest tubes re-inflated his ruptured lungs. Pressure dressings controlled his bleeding legs beneath the inflated Pressure Suit on his abdomen and lower extremities.

            Slowly our team gained ground. Thankfully his heart never stopped. That would have been just too much, a cardiac arrest on top of all of that trauma. Ounce by ounce we replaced his lost blood. At the end of the "golden hour", the first 60 minutes after a serious accident, we had him ready to have his skull drilled open to relieve the blood clot on his brain.

            I last saw Bill before his surgery as I rolled him to the door of the operating theater. He'd never waked, and he was desperately near death.

            My years in emergency medicine have shown me many moments of the heart. My work leads me to the death's door of many strangers. Lately, as I've worked in the land of my birth, these doors have opened to friends and loved ones, closing behind them with a solid thud. I almost feel that many are so near, yet not a word from them do I hear.

            Bill lingered for weeks near death. He later had a cardiac arrest in the Intensive Care Unit, his heart stopping suddenly. The rescue team in the Unit revived him in time. His pupils were still dilated and unreactive to light, his arms and legs lifeless.

            Where is joy in life after the many "special things" have come and gone: Marriage, having children, the first house, starting a business, and so on? Perhaps it is inevitable that almost everybody will latch up with another person with whom he/she can ride life out forever, to find new joys.

            Bill and Julie had done this, and Julie was in Emergency when I told her that Bill could go to be with God at any moment (I happened to know that their faith was strong). She was asleep in Recovery Waiting when, after 14 hours of surgery, Bill was brought at last out of anesthesia, back to coma.

            And, she was there in the ICU, every moment that they would let her in. Her tissue-skinned hand was bruised from clutching Bill's ruddy fingers tightly, day after day. I dressed the blister on her elbow where she rubbed herself raw on the bedsheet, holding his arm hour after hour. I could see she didn't understand the grave significance of the tube in his head, the tubes in his chest, the tube into his bladder, and the plaster on his legs. She only kept saying, over and over, first in a whisper, then as a plea, and later as a prayer, "Oh, please wake up, Bill. Please, come back."

            The drama and the courage of recovery from such destructive trauma is part of my job, now as some years are passing in this business. I slide around the hospital, checking up on the patients that I've seen. I slid into the ICU at a time in the life of Bill and Julie that I had no right to see because it belonged only to them. She had been there the night, in the room in the back, holding his hand and praying. Bill lingered in limbo, soaring in his dreams, unable to land back home on firm ground. His dilated pupils had stared into blankness for weeks, and his hand had returned to Julie no confidence in its grasp.

            And, as I crept up behind to stand in quiet respite, Bill's stare slowly gained focus, leaving infinity and the angels to withdraw into the room around us. And, as an answer to her faith and devotion, he squeezed her hand with all his strength, though she felt but the lightest touch.

            Bill had come home.