Proof of Heaven Page 3

  3. Out of Nowhere

  Dr. Potter paged Dr. Robert Brennan, one of her associates at Lynchburg General and a specialist in infectious disease. While they waited for more test results to come from the adjacent labs, they considered all of the diagnostic possibilities and therapeutic options.

  Minute by minute, as the test results came back, I continued to groan and squirm beneath the straps on my gurney. An ever more baffling picture was emerging. The Gram’s stain (a chemical test, named after a Danish physician who invented the method, that allows doctors to classify an invading bacteria as either gram-negative or gram-positive) came back indicating gram-negative rods—which was highly unusual.

  Meanwhile a computerized tomography (CT) scan of my head showed that the meningeal lining of my brain was dangerously swollen and inflamed. A breathing tube was put into my trachea, allowing a ventilator to take over the job of breathing for me—twelve breaths a minute, exactly—and a battery of monitors was set up around my bed to record every movement within my body and my now all-but-destroyed brain.

  Of the very few adults who contract spontaneous E. coli bacterial meningitis (that is, without brain surgery or penetrating head trauma) each year, most do so because of some tangible cause, such as a deficiency in their immune system (often caused by HIV or AIDS). But I had no such factor that would have made me susceptible to the disease. Other bacteria might cause meningitis by invading from the adjacent nasal sinuses or middle ear, but not E. coli. The cerebrospinal space is too well sealed off from the rest of the body for that to happen. Unless the spine or skull is punctured (by a contaminated deep brain stimulator or a shunt installed by a neurosurgeon, for example), bacteria like E. coli that usually reside in the gut simply have no access to that area. I had installed hundreds of shunts and stimulators in the brains of patients myself, and had I been able to discuss the matter, I would have agreed with my stumped doctors that, to put it simply, I had a disease that was virtually impossible for me to have.

  Still unable to completely accept the evidence being presented from the test results, the two doctors placed calls to experts in infectious disease at major academic medical centers. Everyone agreed that the results pointed to only one possible diagnosis.

  But contracting a case of severe E. coli bacterial meningitis out of thin air was not the only strange medical feat I performed that first day in the hospital. In the final moments before leaving the emergency room, and after two straight hours of guttural animal wails and groaning, I became quiet. Then, out of nowhere, I shouted three words. They were crystal clear, and heard by all the doctors and nurses present, as well as by Holley, who stood a few paces away, just on the other side of the curtain.

  “God, help me!”

  Everyone rushed over to the stretcher. By the time they got to me, I was completely unresponsive.

  I have no memory of my time in the ER, including those three words I shouted out. But they were the last I would speak for the next seven days.

  4. Eben IV

  Once in Major Bay 1, I continued to decline. The cerebrospinal fluid (CSF) glucose level of a normal healthy person is around 80 milligrams per deciliter. An extremely sick person in imminent danger of dying from bacterial meningitis can have a level as low as 20 mg/dl.

  I had a CSF glucose level of 1. My Glasgow Coma Scale was eight out of fifteen, indicative of a severe brain illness, and declined further over the next few days. My APACHE II score (Acute Physiology and Chronic Health Evaluation) in the ER was 18 out of a possible 71, indicating that the chances of my dying during that hospitalization were about 30 percent. More specifically, given my diagnosis of acute gram-negative bacterial meningitis and rapid neurological decline at the outset, I’d had, at best, only about a 10 percent chance of surviving my illness when I was admitted to the ER. If the antibiotics didn’t kick in, the risk of mortality would rise steadily over the next few days—till it hit a nonnegotiable 100 percent.

  The doctors loaded my body with three powerful intravenous antibiotics before sending me up to my new home: a large private room, number 10, in the Medical Intensive Care Unit, one floor above the ER.

  I’d been in these ICUs many times as a surgeon. They are where the absolute sickest patients, people just inches from death, are placed, so that several medical personnel can work on them simultaneously. A team like that, fighting in complete coordination to keep a patient alive when all the odds are against them, is an awesome sight. I had felt both enormous pride and brutal disappointment in those rooms, depending on whether the patient we were struggling to save either made it or slipped from our fingers.

  Dr. Brennan and the rest of the doctors stayed as upbeat with Holley as they could, given the circumstances. This didn’t allow for their being at all upbeat. The truth was that I was at significant risk of dying, very soon. Even if I didn’t die, the bacteria attacking my brain had probably already devoured enough of my cortex to compromise any higher-brain activity. The longer I stayed in coma, the more likely it became that I would spend the rest of my life in a chronic vegetative state.

  Fortunately, not only the staff of Lynchburg General but other people, too, were already gathering to help. Michael Sullivan, our neighbor and the rector in our Episcopal church, arrived at the ER about an hour after Holley. Just as Holley had run out the door to follow the ambulance, her cell phone had buzzed. It was her longtime friend Sylvia White. Sylvia always had an uncanny way of reaching out precisely when important things were happening. Holley was convinced she was psychic. (I had opted for the safer and more sensible explanation that she was just a very good guesser.) Holley briefed Sylvia on what was happening, and between them they made calls to my immediate family: my younger sister, Betsy, who lived nearby, my sister Phyllis, at forty-eight the youngest of us, who was living in Boston, and Jean, the oldest.

  That Monday morning Jean was driving south through Virginia from her home in Delaware. Fortuitously, she was on her way to help our mother, who lived in Winston-Salem. Jean’s cell phone rang. It was her husband, David.

  “Have you gone through Richmond yet?” he asked.

  “No,” Jean said. “I’m just north of it on I-95.”

  “Get onto route 60 West, then route 24 down to Lynchburg. Holley just called. Eben’s in the emergency room there. He had a seizure this morning and isn’t responding.”

  “Oh, my God! Do they have any idea why?”

  “They’re not sure, but it might be meningitis.”

  Jean made the turn just in time and followed the undulating two-lane blacktop of 60 West through low, scudding clouds, toward Route 24 and Lynchburg.

  It was Phyllis who, at three o’clock that first afternoon of the emergency, called Eben IV at his apartment at the University of Delaware. Eben was outside on his porch doing some science homework (my own dad had been a neurosurgeon, and Eben was interested in that career now as well) when his phone rang. Phyllis gave him a quick rundown of the situation and told him not to worry—that the doctors had everything under control.

  “Do they have any idea what it might be?” Eben asked.

  “Well, they did mention gram-negative bacteria and meningitis.”

  “I have two exams in the next few days, so I’m going to leave some quick messages with my teachers,” said Eben.

  Eben later told me that, initially, he was hesitant to believe that I was in as grave danger as Phyllis had indicated, since she and Holley always “blew things out of proportion”—and I never got sick. But when Michael Sullivan called him on the phone an hour later, he realized that he needed to make the drive down—immediately.

  As Eben drove toward Virginia, an icy pelting rain started up. Phyllis had left Boston at six o’clock, and as Eben headed toward the I-495 bridge over the Potomac River into Virginia, she was passing through the clouds overhead. She landed at Richmond, rented a car, and got onto Route 60 herself.

  When he was just a few miles outside Lynchburg, Eben called Holley.

  “How’s Bon
d?” he asked.

  “Asleep,” Holley said.

  “I’m going to go straight to the hospital then,” Eben said.

  “You sure you don’t want to come home first?”

  “No,” Eben said. “I just want to see Dad.”

  Eben pulled up at the Medical Intensive Care Unit at 11:15 P.M. The walkway into the hospital was starting to ice over, and when he came into the bright lights of the reception area he saw only a night reception nurse. She led him to my ICU bed.

  By that point, everyone who had been there earlier had finally gone home. The only sounds in the large, dimly lit room were the quiet beeps and hisses of the machines keeping my body going.

  Eben froze in the doorway when he saw me. In his twenty years, he’d never seen me with more than a cold. Now, in spite of all the machines doing their best to make it seem otherwise, he was looking at what he knew was, essentially, a corpse. My physical body was there in front of him, but the dad he knew was gone.

  Or perhaps a better word to use is: elsewhere.

  5. Underworld

  Darkness, but a visible darkness—like being submerged in mud yet also being able to see through it. Or maybe dirty Jell-O describes it better. Transparent, but in a bleary, blurry, claustrophobic, suffocating kind of way.

  Consciousness, but consciousness without memory or identity—like a dream where you know what’s going on around you, but have no real idea of who, or what, you are.

  Sound, too: a deep, rhythmic pounding, distant yet strong, so that each pulse of it goes right through you. Like a heartbeat? A little, but darker, more mechanical—like the sound of metal against metal, as if a giant, subterranean blacksmith is pounding an anvil somewhere off in the distance: pounding it so hard that the sound vibrates through the earth, or the mud, or wherever it is that you are.

  I didn’t have a body—not one that I was aware of anyway. I was simply… there, in this place of pulsing, pounding darkness. At the time, I might have called it “primordial.” But at the time it was going on, I didn’t know this word. In fact, I didn’t know any words at all. The words used here registered much later, when, back in the world, I was writing down my recollections. Language, emotion, logic: these were all gone, as if I had regressed back to some state of being from the very beginnings of life, as far back, perhaps, as the primitive bacteria that, unbeknownst to me, had taken over my brain and shut it down.

  How long did I reside in this world? I have no idea. When you go to a place where there’s no sense of time as we experience it in the ordinary world, accurately describing the way it feels is next to impossible. When it was happening, when I was there, I felt like I (whatever “I” was) had always been there and would always continue to be.

  Nor, initially at least, did I mind this. Why would I, after all, since this state of being was the only one I’d ever known? Having no memory of anything better, I was not particularly bothered by where I was. I do recall conceptualizing that I might or might not survive, but my indifference as to whether I did or not only gave me a greater feeling of invulnerability. I was clueless as to the rules that governed this world I was in, but I was in no hurry to learn them. After all, why bother?

  I can’t say exactly when it happened, but at a certain point I became aware of some objects around me. They were a little like roots, and a little like blood vessels in a vast, muddy womb. Glowing a dark, dirty red, they reached down from some place far above to some other place equally far below. In retrospect, looking at them was like being a mole or earthworm, buried deep in the ground yet somehow able to see the tangled matrixes of roots and trees surrounding it.

  That’s why, thinking back to this place later, I came to call it the Realm of the Earthworm’s-Eye View. For a long time, I suspected it might have been some kind of memory of what my brain felt like during the period when the bacteria were originally overrunning it.

  But the more I thought about this explanation (and again, this was all much, much later), the less sense it made. Because—hard as this is to picture if you haven’t been to this place yourself—my consciousness wasn’t foggy or distorted when I was there. It was just… limited. I wasn’t human while I was in this place. I wasn’t even animal. I was something before, and below, all that. I was simply a lone point of awareness in a timeless red-brown sea.

  The longer I stayed in this place, the less comfortable I became. At first I was so deeply immersed in it that there was no difference between “me” and the half-creepy, half-familiar element that surrounded me. But gradually this sense of deep, timeless, and boundaryless immersion gave way to something else: a feeling like I wasn’t really part of this subterranean world at all, but trapped in it.

  Grotesque animal faces bubbled out of the muck, groaned or screeched, and then were gone again. I heard an occasional dull roar. Sometimes these roars changed to dim, rhythmic chants, chants that were both terrifying and weirdly familiar—as if at some point I’d known and uttered them all myself.

  As I had no memory of prior existence, my time in this realm stretched way, way out. Months? Years? Eternity? Regardless of the answer, I eventually got to a point where the creepy-crawly feeling totally outweighed the homey, familiar feeling. The more I began to feel like a me—like something separate from the cold and wet and dark around me—the more the faces that bubbled up out of that darkness became ugly and threatening. The rhythmic pounding off in the distance sharpened and intensified as well—became the work-beat for some army of troll-like underground laborers, performing some endless, brutally monotonous task. The movement around me became less visual and more tactile, as if reptilian, wormlike creatures were crowding past, occasionally rubbing up against me with their smooth or spiky skins.

  Then I became aware of a smell: a little like feces, a little like blood, and a little like vomit. A biological smell, in other words, but of biological death, not of biological life. As my awareness sharpened more and more, I edged ever closer to panic. Whoever or whatever I was, I did not belong here. I needed to get out.

  But where would I go?

  Even as I asked that question, something new emerged from the darkness above: something that wasn’t cold, or dead, or dark, but the exact opposite of all those things. If I tried for the rest of my life, I would never be able to do justice to this entity that now approached me… to come anywhere close to describing how beautiful it was.

  But I’m going to try.

  6. An Anchor to Life

  Phyllis pulled into the hospital parking lot just under two hours after Eben IV had, at around 1 A.M. When she got to my ICU room she found Eben IV sitting next to my bed, clutching a hospital pillow in front of him to help him keep awake.

  “Mom’s home with Bond,” Eben said, in a tone that was tired, tense, and happy to see her, all at once.

  Phyllis told Eben he needed to go home, that if he stayed up all night after driving from Delaware he’d be worthless to anyone tomorrow, his dad included. She called Holley and Jean at our house and told them Eben IV would be back soon but that she was staying in my room for the night.

  “Go home to your mom and your aunt and your brother,” she said to Eben IV when she’d hung up. “They need you. Your dad and I will be right here when you get back tomorrow.”

  Eben IV looked over at my body: at the clear plastic breathing tube running through my right nostril down to my trachea; at my thin, already chapping lips; at my closed eyes and sagging facial muscles.

  Phyllis read his thoughts.

  “Go home, Eben. Try not to worry. Your dad’s still with us. And I’m not going to let him go.”

  She walked to my bedside, picked up my hand, and started to massage it. With only the machines and the night nurse who came in to check my stats every hour for company, Phyllis sat through the rest of the night, holding my hand, keeping a connection going that she knew full well was vital if I was going to get through this.

  It’s a cliché to talk about what a big emphasis people in the South put on fam
ily, but like a lot of clichés, it’s also true. When I went to Harvard in 1988, one of the first things I noticed about northerners was the way they were a little shyer about expressing a fact that many in the South take for granted: Your family is who you are.

  Throughout my own life, my relationship with my family—with my parents and sisters, and later with Holley, Eben IV, and Bond—had always been a vital source of strength and stability, but even more so in recent years. Family was where I turned for unquestioning support in a world that—North or South—can all too often be short of this commodity.

  I went to our Episcopal church with Holley and the kids on occasion. But the fact was that for years I’d only been a step above a “C & E’er” (one who only darkens the door of a church at Christmas and Easter). I encouraged our boys to say their prayers at night, but I was no spiritual leader in our home. I’d never escaped my feelings of doubt at how any of it could really be. As much as I’d grown up wanting to believe in God and Heaven and an afterlife, my decades in the rigorous scientific world of academic neurosurgery had profoundly called into question how such things could exist. Modern neuroscience dictates that the brain gives rise to consciousness—to the mind, to the soul, to the spirit, to whatever you choose to call that invisible, intangible part of us that truly makes us who we are—and I had little doubt that it was correct.

  Like most health-care workers who deal directly with dying patients and their families, I had heard about—and even seen—some pretty inexplicable events over the years. I filed those occurrences under “unknown” and let them be, figuring a commonsense answer of one kind or another lay at the heart of them all.

  Not that I was opposed to supernatural beliefs. As a doctor who saw incredible physical and emotional suffering on a regular basis, the last thing I would have wanted to do was to deny anyone the comfort and hope that faith provided. In fact, I would have loved to have enjoyed some of it myself.