Twenty-six

IT WAS MID-AFTERNOON WHEN Grace saw the neurosurgeon again.

She was walking back from the rest room when she saw Daniel Coram standing in the corridor.

“Have you got a moment?” she asked him.

“I was just coming to find you,” he told her.

As she entered his office, she found herself wondering how old Coram was, and how many years he had been watching the lives and deaths of people like her daughter. She noticed a waterproof jacket hanging on the peg behind his door; a pair of worn driving gloves on the desk. Next to them, in between the files and folders, were two cardboard models of rainbows: colors drawn onto cardboard and looped over, and stuck down with tape.

“My grandchildren,” he said, when he saw her looking.

“How many do you have?” she asked.

“Five,” he told her. “And you?”

“Just Rachel,” she said.

She gazed for a second more at the colors scribbled on the card, and then turned away. She found it hard to think of Rachel now. She was frightened for her; frightened to know what she would do without a mother. A constriction of grief in her throat silencing her temporarily, she looked in her bag for cigarettes, and shook out an empty pack.

“My dad had a coat just like that,” she said absentmindedly, nodding toward the Barbour. “He wore it for fishing.”

“So do I,” Coram told her. “I go sea-fishing.” He smiled at her. “Rarely catch a thing besides a cold.”

She smiled back. Looking again at the pack, she crumpled it in her hand, and threw it in the wastebasket. “My father fished near Deerfield,” she told him. She sat down in the chair he indicated. “He would go out early,” she murmured. “Dawn. There’s a dam just upstream from where we lived. Sometimes they would let water from the dam, and if you hadn’t listened to the radio, you had to watch the river level. You would see it drift over one stone, then another, rising…”

And this thought of her father, fishing but rarely getting lucky, but being happy to be on the river with her in the first light, and the sweet bright expectation of those days, and the cracked plastic seats of the truck cab, and the sight of the house at the bottom of the hill as they bounced down the rutted drive while the sun burned away the last of the night…

It was too much. She longed for her father now, for his good guiding sense. She wanted to be back in the truck, seeing the house emerge between the trees, and feeling summer heat on her arm at the open window, and her naked toes making patterns in the dust of the truck floor.

She plunged her head in her hands.

Daniel Coram came around the desk, and put a handkerchief in her grasp. Without opening her eyes, she pressed it to her face, and sat soundlessly without sobbing, pressing the material hard against her eyes to blank out the past and the present.

After a minute or so, she sat back, breathing heavily. She opened her eyes and looked at him. He was sitting in a chair by her side.

“Is it bad?” she asked.

“Pretty bad,” he said.

She put the handkerchief in her lap.

“Mr. Garrett was here this morning,” he said. “I spoke to him.”

She didn’t look up. “I phoned him,” she murmured.

“What did he tell you?”

“Nothing,” she said.

“I don’t know that he understood me,” Coram told her. “He seemed to have made up his mind.”

“To what?” she asked.

“To Anna’s death.”

She gasped, and pressed her back to the chair, as if this would help her move away from him.

He raised his hand. “That’s not what’s happening,” he said.

“Her death…”

“It’s not what’s happening,” he repeated. “Grace, do you hear me?”

Stripes of light and shade confused her; the room was rippling. She blinked. He emerged as before, solid and still, looking hard at her. “Yes, I hear you,” she said.

“Let me get you a drink,” he said. He got up, and poured her a glass of water. She took it and drank in sips; he took it back, and put it within her reach on his desk.

“Anna had a seizure this morning,” he said.

“The nurses said so…”

“I know that this sounds strange,” he said. “But it’s a good sign.”

“It is?” she asked.

Coram put his fingers to his lips for a second, apparently deciding how to phrase the next sentence. “When a patient’s in a coma,” he told her eventually, “one of the questions we ask ourselves is if the brain is functioning, if there is brain stem activity. A patient can be on a ventilator, apparently breathing, but there is actually no activity in the brain stem, and without the ventilator, they would cease to breathe.”

“Anna is on a ventilator,” Grace whispered.

“But we have some motor response to stimuli,” he said. “And a seizure rules out the diagnosis of brain death.”

“Then why did James think the opposite?” she asked.

“There was no response following the seizure,” Coram said.

“You mean, what? What kind of response?”

“Eye opening, verbal responses, reaction to pain.”

“She didn’t react to pain?” Grace echoed.

Coram leaned forward, elbows on knees, hands clasped. “Anna is responding now,” he said. “She was vocal this morning, before you came. After Mr. Garrett had left. And she flexed when we tested.”

“Vocal?” Grace said.

“She gasped a little.”

“Did she move?”

“No.”

“But this…all this is good?”

“It’s not good,” he said. “But it’s not bad. It’s not the end. I wanted you to be clear on that.”

“OK,” she said. And it sounded childish to her, the thin and expressionless way she had said OK like that. “I’m clear,” she added, forcing her voice up.

He sat back, looking at her kindly. “You have Mr. Mortimer with you now,” he said. “I notice he’s talking to Anna.”

“Yes,” she said. “He knew her in college. They once talked about writing and illustrating a book about China. So he had this idea…”

“That he would talk to her about the book?”

“About China, yes. About certain journeys…”

“It’s a good idea,” Coram said.

“You think so?”

“I know so,” Coram replied. “Coma may look like an unresponsive state, but coma patients often report having been able to hear what was going on around them.” He smiled. “I see Rachel is helping him.”

“He thought they would do it together,” Grace murmured. “Draw a map, make the journey…”

She stopped. Rachel was so intent on the drawing. They had bought a long scroll of paper, and a roll of masking tape, and they had been allowed to tape it to the wall opposite the bed. Rachel was creating her rivers, just as she had done when she was five and six, across the wall in the apartment.

David had sat down next to Anna, and begun to speak in a low, soft tone. Occasionally, he would glance at Rachel and watch her as she leaned against the wall, head at an angle, eyes fixed on the pencil point. Grace had sat silently between them, seeing, in the depths of her concentration, how Rachel’s speed dipped at times. There was no obvious indication that Rachel was listening to David, other than this fleeting slowness at certain points. When David reached the Wa Shan summit, Rachel actually paused. She redrew the curve of the coastline several times, like a failing printer copying over a line it had already typed.

“Is Mr. Mortimer related to Rachel?” Coram asked.

“He’s her father,” Grace told him. “They had never met before this happened. He never knew about her until now.”

Coram took this information in with a bemused expression. “That is quite some news for them both,” he said, eventually.

“Yes,” Grace agreed. “It’s been a newsy kind of week.”

He stopped, trying to figure her out. Then laughed softly, sympathetically. “Newsy,” he repeated. “OK. That’s one way to put it, I guess.”

Grace shrugged helplessly.

“And you are alone yourself?” Coram asked.

“Yes.”

“Anna is your only child.”

“Yes.” She looked hard at Coram. “Do you think Anna will recover?” she asked.

“Do you want my opinion, or the statistics?” Coram asked.

“Both.”

Coram nodded. “OK,” he said. “Let’s see what the odds are here. At any one moment in this country, there are ten thousand people in a coma…”

“Ten thousand?” Grace echoed. “Ten thousand…? My God. No.”

“We used to think that in cases like Anna’s, all the damage was done to the brain right at the point of impact,” he told her. “In Anna’s case, that would be the moment that she hit the dashboard of the car. But now we think that probably isn’t true. The damage is done afterward, when the brain can’t get enough blood or oxygen.”

He crossed his arms, looking at the floor momentarily. “There are two types of coma,” he said. “One, from head or spinal trauma. Here, you’ll see labored breathing, limbs extended. You might see a clenched jaw. When we do a lumbar puncture, we find blood in the spinal fluid. The blood pressure goes up, the pulse goes down.”

Grace continued to stare at him, silent.

“Then there’s the second kind of coma,” Coram continued. “The breathing is bad, the pupils are always pinpoint…and that’s caused by damage to the brain stem. When you see a case like that, the prognosis is grim.”

“And Anna…”

“Anna doesn’t have damage to the brain stem,” Coram said. “But she’s sustained a lot of injury. She has some primitive responses, a gag reflex, response to pain. She has opened her eyes a little once or twice. But she hasn’t spoken, and she hasn’t interacted with anyone…recognized your voice, turned toward it, squeezed a hand…”

“No,” Grace agreed. She felt sick, drained. She noticed that the very tips of her fingers, clasped over the handkerchief, were blue. She curled them into a fist, and hid them.

“Do you want me to go on?” Coram asked.

“Yes,” she murmured.

“Are you sure?”

“Yes,” she said.

“OK,” he answered. He watched her closely. “Between five and ten percent of coma patients aren’t capable of conscious behavior,” he said. “They end up like this for life. For what remains of their life.”

“They never get any better?”

“No.”

“But the others,” Grace said. “The ones who start to react…they do get better. They improve, they get well…”

“Even those without brain stem damage,” Coram said, “may never get further than the immobile state in which you see Anna now.”

She raised her hand to her face. “Never get further?” she repeated. “What do you mean?”

“They might make facial grimaces sometimes,” he said. “Or swallow, or open or close their eyes. But there’s no evidence that they’re aware of anyone or anything.”

“And this goes on…”

“Maybe for weeks. Maybe for years.”

Grace had leaned forward in her chair. “I’ve heard of this,” she whispered. “It’s when you turn the machines off. When you talk about the machines.”

“We’re not talking about switching off any machines right now,” Coram replied.

She took this in, her own breath shallow. “But you will,” she said. “If she doesn’t improve. If she doesn’t respond…”

“That’s a long way down the line,” Coram said.

There was a silence.

“You asked me for the truth,” Coram reminded her.

She glanced at him; she had been staring, without knowing it, at the paper rainbows on his desk. “Yes, I did,” she acknowledged.

“And I’ve told you the absolute worst,” Coram added. “You understand, Grace? That’s the worst. The worst that can possibly happen to Anna.”

“All right,” she said.

She closed her eyes, and saw Rachel’s hand fisted around the pencil, and the relentless, concentrated scribbling. She saw Rachel and Anna, posed on a bridge, a bridge with a fathomless drop on either side. And Rachel sitting, the habitual preoccupied look on her face, sitting down at Anna’s feet, and carefully unknotting the strands of the cables, unraveling the steel as if it were cotton, meticulously unthreading each line. And Anna, strand by strand, dropping away, little by little.

There was nothing practical that this child could do to hold her mother, Grace thought. She was making shapes at the edge of Anna’s consciousness, unable to talk to her, unable to hold her. And with each silence, the silence of distracted, misplaced concentration, Anna fell further away from them.

“God,” she breathed. “God.”

Coram had gotten up. He stood uncertainly at her side for a second, then put his hand on her shoulder. “Let’s be positive here,” he said. “The odds are in Anna’s favor. She’s a young woman with no prior health problems. She has every motivation to get well. She has a daughter, a mother, a partner, and a friend in David.” He paused. “What does she do?” he asked. “Does she have a job?”

“She’s an artist,” Grace said. “That’s why we brought the map for Rachel to draw. We thought, even the atmosphere in the room, the sound…”

“Yes,” he said. “I see.”

“It’s not much.”

“But it would mean something to Anna,” he said. “People say music and familiar sounds are useful. There are tapes of the ocean, or birdsong. Or people sometimes record the everyday noises of a house, or a city…”

“OK,” she said, trying to remember. “Tapes…”

“The things that meant most to her,” he suggested. “You could bring in paint for Rachel. The smell of paint or ink? Or whatever she worked with.”

“OK,” she repeated. She looked again in her handbag, this time for a pen and paper. She found her checkbook, and wrote on the back: paint, ink, tapes, sounds.

And she thought of the sounds of Anna’s life: the landscape of sound she would make if asked to describe her by note and vibration alone. The changing conversation of the wind in the Appalachian trees; the murmur of the ocean; her grandparents’ voices; the feel and sound of wrapping paper from parcels that she used to hoard as a child; the barking of the neighbors’ dogs on the other side of the hill. Ogunquit in high season, with the sound of the trams slowing at their stops, the hum of crowds on the beaches; and everything that was Rachel—her cry as a baby, her TV tapes, over and over the same songs. Rachel on the piano. Somewhere in her house, Grace had the first recording she had made of Rachel trying piano scales. And she had others: a Chopin piece, a polka, and Debussy.

There was so much else. Anna’s favorite old Motown on the radio; and the small, touchstone details of the house in Jamaica Plain: the doorbell, the screen door, the squeak of the kitchen door to the garden; the silence of the studio, the intimate proximity of brush on paper. The store on the corner with its wire mesh gate by the register, and WXKS always playing in the back; and the sound of kids playing tennis across the road in the municipal courts, and of Jen’s children; the sound of a ball kicked against concrete; the gentle plash of leaves against leaves in a summer night, when all the windows were open.

And even less consequential things. The sound of coins in her pocket. The acceleration of traffic, the grinding sound of the old Chrysler engine; the click of light switches, the rattle of curtain-hooks as curtains were drawn; the ticking of clocks. The turning page of a book or newspaper. The hush of the Beacon Hill apartment, and the echo on its stairs, and the muted voices of the city below the hill. The splash of water, and the soft rustling settling of sheets, and the whisper of her own voice.

Anna had none of those with her. Not one of those things.

Her life was rolling back, like a tide ebbing the sounds of the world away. It was amazing how a life was made, and what was carried with us, Grace considered. And to bring the sounds to Anna’s bedside would be like walking into her memories. Which memory would turn her head toward a sound? Which memory would turn her away?

She looked up at Coram. “Will she get back,” she asked, “to where she was before?”

Coram gave her a smile. He held out his hand, and helped her to her feet. “If she wants to,” he said.