In Shock Read online

  “Sure, I’ll grab the machine. Where did you want to do it?” was his only question.

  “Just right here is fine,” I replied, suggesting I could lie on the floor of another friend’s empty office.

  I moved a chair and small table out of the way and lay on the rough gray carpet, lifting my shirt to expose my abdomen. He applied the cold gel that aids visualization and knelt beside me, placing the probe just under my rib cage. I waited quietly as he adjusted the probe, moving it from side to side and searching for the location that afforded the best view.

  “There’s nothing, right?” Some part of me must have thought that a cursory exam by a friend, on the floor of an office, would be unlikely to be revealing. I realized that I was purposefully handicapping myself. I still wasn’t ready to face any bad news.

  “Hmm…” he said.

  “What?” I asked, suddenly nervous.

  He played with the controls, trying to get a clearer view. He stopped and turned the screen toward me. “See this?” he asked.

  “That’s the hematoma, I know … it’s still there,” I hurriedly explained. The blood collection from that first night had been steadily shrinking over the past year. It had gone from a ten-pound bowling ball to being about the size of a tennis ball.

  “Yes, I agree with you. Which is why I am not sure what this second mass is,” he said as he pointed to the screen.

  There it was, an ovoid sphere, about three centimeters across, staring back at me from the screen.

  “You need a formal ultrasound,” he declared, standing up. He added, “I’m putting in the order. I’ll call down and see if they can do it now.”

  I knew he was right. Hours later the ultrasound tech was examining the same area, passing the probe over it again and again, similarly unsure of what she was seeing. She excused herself and left to get the radiologist.

  “Listen,” the radiologist began. I had learned to dislike that introduction. I found it was effectively shorthand for “I’m about to tell you something that is arguably bad news. But, I’d rather you not react like it is bad news. I’d rather you take it stoically and just maintain your composure.”

  “When you see the report, you are going to see that I am going to call what we are seeing a mass,” she continued. So they had found something.

  “It has flow, blood flow going to it that we can see. But just keep in mind, just because it’s a mass, doesn’t mean that it’s necessarily cancer. We’re going to recommend further imaging, probably a CT scan or MRI.”

  I nodded. I understood.

  As I walked out of radiology, I realized awkwardly that I’d gotten myself this far, and none of my doctors or family knew. So I began the process of informing them.

  I called the surgeon first, who reviewed the ultrasound and agreed that a triple-phase CT scan of my liver was the next logical step. He thought the timing of the injection of the dye in the past could have been the reason we had never seen a mass. He placed the order.

  I called Randy, who innocently answered the phone with, “Hey, I was wondering when I’d hear from you. Must be a busy day, huh?”

  Poor Randy hated surprises, and knowing I was safe at work had allowed himself the luxury of believing he could ask me how my day had been and not hear anything he would characterize as bad news.

  “Well, actually, I was having some pain … to be honest, I’d been having pain,” I began.

  “Wait, what kind of pain? Why is this the first I’m hearing about this?” He started to panic.

  “It’s nothing,” I said, which was obviously not true. “Anyway, just listen,” I continued, attempting the tactic of the radiologist. I explained that I had a friend look at my liver with ultrasound and he thought he saw something, and so I went for a formal ultrasound and they think they see something, so now I had to have a CT scan. “And that’s all,” I added, hoping that he wouldn’t have any questions.

  “But what are they seeing?” He asked the obvious question.

  I struggled to think of a word for mass that wasn’t mass or tumor. “It’s like a collection of tissue, sort of a … a ball,” I said, struggling.

  “Like a mass?” he asked.

  “Kind of,” I admitted. Just shoot me, I thought, frustrated by my own attempt to maintain my composure as I gave news I’d only barely adjusted to. Then I remembered, I had an out. I was the patient, not the physician who had to considerately and compassionately give bad news. “I don’t really want to talk about it. I just need to get the CT scan and that’s it. Then we’ll know more,” I declared.

  “OK,” he said, understanding it was probably best not to push. “Are you going to tell your mom?” It was a trick question. He was entitled to ask that, because he needed to know who knew, so as not to out me. It was casually framed as a simple question. But it had the potential to give him far more information than pressing me on the issue ever would have. For example, if I said no, it meant that it was serious and therefore he should be worried. However, if I said yes, then he knew she wouldn’t let me off as easily and would get more details out of me and he would benefit by extension. It was a CIA-level spy tactic.

  “I’m not sure yet,” I answered honestly, yet strategically. In fairness, I didn’t know. It was all moving so fast.

  * * *

  I reported for my CT scan the following day, after completing morning ICU rounds. I took off my white coat and badge and changed into the speckled blue patient gown. I helped the technician identify an amenable vein for an IV, and, once placed, I boosted myself up onto the familiar table.

  “Now your doctor ordered this with contrast, so you are going to feel a warm rush throughout your body when it dispenses. It will feel as if you are wetting yourself, but don’t worry, you aren’t,” she said to prepare me. “Try to lay very still, and when I ask you to hold your breath, be even stiller so we can get good pictures, OK?”

  I nodded. I knew what was expected of me.

  I lay back on the hard metal surface and heard the familiar noise of the table as it clinked and slid me into the doughnut-shaped scanner. I felt the warm flush of contrast as it filled my veins and coursed through my body, making my bladder feel warm and contractile.

  “Now hold still, breathe in and hold,” she instructed through the speaker.

  I marveled that I was able to both lie flat and hold my breath. It was real, tangible progress. To be in the same space a year later, and have those successes, felt like everything. But as the table began to slide me out of the scanner, I felt instead that I was being carried along a conveyor belt, transporting me ever further away from my coat on the wall and from even being a physician. I could see the path ahead clearly; it led down a long, cold hallway. The hallway led to the pre-op area and back into the OR. I sat up and felt an overwhelming urgency to leave the hospital.

  I drove home in silence, without radio or phone calls. I tried to listen to the pain and discern what it was trying to tell me. I let the thoughts that held the possibilities ebb and flow, from worst-case scenarios to the bland, boring nothingness I hoped it would be. I trusted myself to sense which would resonate, which would linger without leaving. In the thirty-minute drive, I couldn’t come up with a single possibility that was not going to be a serious problem. I would quiet my mind, and in a moment This is going to be a problem would float back in. This is a problem. This is a serious problem.

  As I walked through the garage door and into my kitchen, I realized in my rush to leave, I’d left my white coat and badge behind. Perfect, I thought, whatever this is it’s already making me stupid. My cell phone rang. It was Dr. G.

  “Where are you?” was his first question.

  “I just got home,” I answered, unsure why we were bothering with small talk.

  “Can you come downtown?” he asked, with a noticeable edge in his voice.

  “I just left, why would I come back?” I replied, feeling I probably already knew the answer.

  “I just finished reviewing your CT scan im
ages with the transplant surgeons,” he began.

  Transplant? Why were we involving them again? I wondered.

  There are moments when you know that the words that come next will change your life forever. The challenge is realizing that your life had changed already—changed some time ago, in fact—and you are only just now finding out the details. But it was all already true. Not hearing it doesn’t make it not true.

  “Listen, there are two masses in your liver. Tumors. They are called hepatic adenomas. At least we think that’s what they are.” He paused.

  My cognitive brain began riffling through its index, multiple frames per second, in ever-increasing specificity. It located the box labeled TUMORS, then LIVER TUMORS, then more specifically, NON-CANCEROUS LIVER TUMORS THAT AFFECT YOUNG WOMEN. They were embedded within each other like Russian nesting dolls. I pulled up my available knowledge of hepatic adenomas, after discarding the others. I knew they were a very rare form of tumor that had a very rich blood supply and grew in the livers of young women. They grew in response to certain hormones, like estrogen. So pregnancy was a very dangerous time, as they grew and sometimes ruptured. Oh my God. “Wait,” I said at last. “That’s what happened.”

  “Yes, one is probably what ruptured on us last time, we can tell that because the perimeter looks fuzzy, as if all the blood vessels burst. But there is another one.” Another pause. “They were always there. It’s just we couldn’t see them before because of the distortion from the hematoma. But now that the hematoma shrunk…” His voice trailed off.

  My first hospitalization appeared before me in sequence, as if I were flipping through a patient’s chart. The presenting complaint of severe pain, the blood loss, the lab values, the diagnosis of HELLP syndrome. My brain tried to superimpose this new diagnosis of a ruptured hepatic adenoma at each point in my hospital course. That first wave of pain in the restaurant, could that actually have been the moment the mass ruptured? The liver failure. Rather than being the beginning, could my liver have failed later, a secondary result of compression from the large blood collection? Had we missed the diagnosis all along? Had I misdiagnosed myself?

  I realized he was still talking.

  “You need to come downtown right now.”

  “Why now?” I countered, thinking that if they had been there all this past year, why now that we suddenly were aware of their presence did it constitute an emergency? It was always already true. They were always already there. They were the heavy throbbing when I rounded, they were what took my breath away when I tried to walk quickly. They were what pulsed under my ribs at night.

  “Well, one has already ruptured on us once and it was pretty bad,” he offered.

  Yeah, I was there, I kind of remember that.

  “And now there is another. It’s just waiting,” he added.

  “Wait, what do you mean there is another one?” I asked. And then I let myself hear what he had been saying all along. I let myself understand. There were always two tumors. One that had ruptured during my pregnancy and one that was still a threat. A very real and very frightening threat.

  “The way they handle these things is to embolize them. The guys in radiology shoot little plastic beads into them to cut off their blood supply, and that makes the surgery a little less risky,” he said.

  “Surgery.” It was more of an acknowledgment than a question. Of course there would be more surgery.

  “They need to remove the half of your liver with the masses,” he said.

  “Remove half of my liver,” I repeated, as if practicing the words for when I’d have to explain it to others. I tried but couldn’t imagine how scary that news would be to my family.

  “Tomorrow,” I offered. “I’ll come down tomorrow, but not tonight.”

  “You won’t come now?” he had to ask again.

  “No, tomorrow,” I promised.

  “OK, but call me if…” He didn’t have to finish that sentence. He didn’t need to tell me what “if” could mean. We’d been through it all before. “And don’t eat anything, just in case we have to take you in for surgery emergently.”

  “Sure. And I know, call if anything changes. Thank you.” I hung up, not wanting any more words to come through the phone.

  I looked around me and wondered what I should do. I had fifteen minutes until Randy came home, and I’d have to drag him into the abyss with me. I’d inhabited those spaces enough times. Times when I knew of a death or a trauma, and the family was still blithely unaware. I’d seen enough to know there was no benefit to foreshortening the space. No one stood to gain anything if I sped up the truth. I preferred to sit very still and wait. Let him enjoy these last minutes without worry.

  I found sitting still difficult. I tried pacing but it felt purposeless and didn’t soothe me. I walked instead to the freezer and took out a pint of ice cream. I sat at the counter with the carton in front of me, and dug into it with purpose. I harbored the genuine belief that there was a group of surgeons who were just waiting to pull me into an operating room, and my only form of control at the moment involved never having an empty stomach. Surgeons were terribly afraid of stomach contents, prone to being regurgitated during surgery and entering the lungs. I would eat constantly. That was my very poorly formulated plan, to never have a stomach that was empty enough to allow surgery. I was sticking to it.

  It’s difficult to eat ice cream when you are crying. It’s just not sad food. It’s overtly celebratory, always cheerily accompanying cake and summer and birthdays. I put it away and sat at the counter. I took off my wedding ring and turned it in my fingers, an old habit.

  Randy, when faced with the prospect of engraving it, had chosen to have it inscribed with the terribly misguided sentiment BECAUSE YOU’RE PERFECT. What he didn’t anticipate was that in having the ring resized, his assertion would be unceremoniously amended to instead say BECAUSE YOU’R ERFECT. It was more perfect in its imperfection. Not only was the grammar offensive, but the adjective had been decapitated.

  The engraving was set in a time before illness and surgery had left their marks. It was inscribed before my hair fell out, before scars and marks were a permanent feature of my abdominal wall. Perhaps if we had had an expectation of perfection, this all would have been more difficult to handle. Instead I was just slightly deformed, like the truncated adjective that had become an emblem of our life.

  He walked through the door and knew immediately that we had a challenge facing us. He looked at my swollen, sodden face and said, “Whatever it is, we’ve been through worse, and we’ll get through this too. Tell me what they found.”

  I raced through the explanation, which was completely unintelligible through my tears, with Randy waiting patiently for me to loop back to the beginning, hoping he’d catch some of the meaning the second time through, or the third. He held my hand, and as the rate of my breath slowed, he began to piece together the events of the day.

  “The thing is, I just found out that I have to have surgery to remove half my liver because if I don’t I’ll die this time, because there is a tumor that is just like what happened last time, only we didn’t know that’s what it was, and oh my God it could all happen again. Actually, it could have already all happened again, can you imagine?”

  “No, I can’t.” He was incredulous at the thought that we could have reentered the same bloody loop. “There is no way we would have been as lucky the second time.” He clearly believed, as I did, that if the second mass had ruptured, it would have killed me.

  I suddenly felt terribly guilty for ignoring the pain for so long. I couldn’t have imagined what it represented.

  “It’s all just … the news has, I don’t know. It’s just completely unnerved me,” I said to explain my disarray. “It’s like, I feel like I’m starting all over again. I thought I’d gotten somewhere and I’m still at the beginning of everything.”

  “We’ll get through this too. You’ll be well again, you’ll see.” He paused, trying to gauge my willingness to ent
ertain questions. “What’s the next step?” he asked cautiously, not wanting to trigger me.

  “I guess when I go in tomorrow, I’ll find out what the plan is. They wanted me to come down tonight,” I admitted.

  “I think tomorrow will be here soon enough,” he offered.

  I shrugged and gently banged my forehead against his chest, wanting to stop my thoughts.

  “It’s going to be OK,” he said, kissing the top of my head and holding it in place. “Just think, they got you through it before, without the benefit of even knowing what was causing the bleeding. Now that they know, it’s got to be easier if they have more information, doesn’t it?”

  “Suppose so,” I replied in the most unconvincing way possible.

  * * *

  I couldn’t sleep and was back at the hospital before 7:00 a.m. I was scheduled to work and fully planned to round after I saw the scans. I logged into the hospital’s record system to look at my CT images myself. I saw immediately I’d been assigned a room on the surgical floor. Morose planning in case the procedure failed, I guessed. I launched a silent protest, subversively eating my breakfast and drinking my coffee as I scrolled through the images. As promised, two masses greeted me, highlighted by the intravenous contrast against the dark backdrop of my liver. I stared at them, wanting to gauge their intention. The little wreakers of havoc. “I see you,” I whispered to the screen. “And you don’t look so tough.”

  I had imagined they would appear more obviously evil. Treacherous and spiny, rather than round and sunny. They just didn’t look as though they were intending to hurt me. They looked as though they had gotten lost and ended up somewhere they didn’t intend to be. And that they now needed help getting out.