Things in the brain move around like prizes in a Jell-O salad. This is the analogy that the surgeon gives Janet, Warner, Elizabeth, Louise, Tom, and Michael as he explains the difficulties of the upcoming operation. It is the day before the surgery, and they are all crammed in an examination room at the Mayo Clinic in Minnesota. The surgeon draws diagrams on a notepad that illustrate how he is planning on entering the base of Louise’s skull. He circles an area. “Here is the prize,” the surgeon says. Louise is cheerfully watching the surgeon scribble. She is wearing her eye patch and holding her cane. Janet watches her.
Everyone but Janet oohs and aahs and narrows their eyes in concentration as the surgeon speaks. Janet cannot engage. She cannot think of her daughter’s brain as Jell-O salad, which belongs in the grocery store next to the hummus and cheese. It is rainbow colored and comes in a clear plastic mold. It’s the fruit-flavored stuff at picnics that nobody eats. Janet never made it for her children. She made cookies sometimes, and brown birthday cakes. She made crisps and cobblers.
Janet doesn’t like the idea of food prizes, either. She has heard of marriage proposals that happen at restaurants where the ring is in the center of a crème brûlée, or at the bottom of a bubbling champagne glass. But Janet always thinks of what could go wrong in situations like that. The ring could break someone’s tooth, or be swallowed. If the woman finds the ring in her dessert it will be covered with sticky goo. It will have to be rinsed off and cleaned before it is put on the finger. Janet cannot see the fun in that.
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Janet is getting tired of hearing from the doctors that Louise’s cavernous angioma is in the worst possible place it could be, in the pons, which is attached to the brain stem. This is not helpful, she thinks. They are already scared enough. They already walk around the hallways in a daze, confused by doctors who carry sandwiches in plastic baggies and doors that open into gilded chapels. Too many times Janet has gotten off the elevator looking for an ATM and ended up in an unlabeled corridor, clueless about how she got there or how to get back. The cavernous angioma is causing them to buy things like travel pillows so they can sleep in chairs. It has brought them here, to a world-famous clinic with a brain surgeon who says he will try to get it out of Louise’s brain so that no one will ever have to worry about it bleeding again.
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Claude is not here, and Janet hates Claude for this. Her own boyfriend isn’t here and she hates him, too. She broke up with him after he told her he couldn’t come, right there in the hospital lounge. There had been no unkind words or crying. She feels like she is able to do things now, easily, cleanly, and induce no pain on herself whatsoever. She is like a janitor at the clinic who sweeps up a pile of dirt and tosses it into the garbage. It had taken place in a matter of seconds.
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The morning of the surgery, Janet, Louise, and the rest of the family get up when it is still dark and walk across the street from the hotel to the clinic. It is a commanding place, a huge block of red brick. They carry water bottles and books. Louise uses her cane.
Janet had spent a lot of time in the hotel bathroom that morning, staring at the mini soaps and shampoos in the shower. She thought about how Louise had been getting better, able to bathe without help, bracing herself against the sides of the stall. Louise will be in bad shape for a while after the operation. The surgeon has told them this. There are no guarantees that the operation will work at all. For instance, removing the cavernous angioma might damage the neurons that control the function of swallowing. That would mean that she would have to be fed through a tube. Forever. And if the nerve connectors are damaged, she will have to be hooked up to a machine that will push the breath in and out. It will be plugged into an electrical outlet. She will have to stay in a bed, or a chair, connected by a cord that comes out of a wall. It won’t be like now, how she can go up and down stairs. How she can hold a knife to cut cheese. How she can shake crackers out of a bag.
The surgeon assures them that all of this is unlikely. It is almost certain that swallowing will not be a problem, his assistants say. Or breathing. They say the operation will be worth it.
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It takes three elevators to get to the small, steel room where a woman has them sign life and death papers. Should something go horribly wrong, who would decide whether or not to keep the patient alive? Louise just sits there.
Janet helps Louise into a hospital gown. They forgot to bring an extra bag, so Janet stuffs Louise’s regular clothes into her purse. Janet covers Louise’s feet with nonskid socks. She helps Louise into a hairnet. Louise says nothing, does nothing, lets Janet do it all.
In pre-op, the nurse leads Louise to a gurney and helps her lie down. The room is large and white and Janet stands close by. Louise stares at the ceiling squares, eyes wide. There are many others lying here, too, probably fifty of them with blankets covering their legs, waiting to be wheeled off to surgery. Nurses quietly ask questions and consult clipboards. The surgeon comes by. He has on red fleece socks and leather sandals that buckle. A mask covers his mouth. He writes on Louise’s forehead with a Sharpie: craniotomy.
When he leaves, Janet bends over and hugs her daughter. She kisses the word, covers it with her cheek.
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The surgeon and his assistants shave a back strip of Louise’s head and use a saw to open a bone flap in Louise’s skull. This is a “suboccipital craniotomy.” They want to find the cavernous angioma and cut it out, and then they want to seal the veins together again so there is no more bleeding. But they can’t find it. They take a tiny camera inside and see only healthy brain. All they see is Jell-O. No prize.
They sew her head back up. They will have to wait another day before they can go back in again.