Here is the fourth chapter of Dreaming Out Loud, the book about my mother’s stroke.

Chapter 4

Thirty-six minutes after the triage nurse orders a gurney and leaves us sitting in chairs near the partition, two nurses’ aides appear and roll mom’s wheelchair into an examination room. Once inside, they change her into a blue gown, the kind with an open back to provide convenient access to the fanny, and hoist her onto a gurney — no mean feat given her girth. They stuff her clothes and shoes into a plastic bag and deposit it with us for safe-keeping.

While we stand watch, nurses come and go, constantly monitoring machinery and consulting paperwork with impressive professionalism. Their perambulations remind me of a line from “The Love Song of J. Alfred Prufrock”: In the room the women come and go/Talking of Michelangelo.

Of course, these ladies of medicine do not talk. They jot hurried notes onto a clipboard, all the while wearing serious expressions plastered on their faces.

Eventually, after another 25 minutes passes, the aides wheel mom’s gurney down the hall and disappear through a set of double doors. They return an hour later and park her next to the water fountain. I recall the hysterical woman in the lobby worried about her mother’s heart attack.

Paula sighs. “They’re taking their sweet time.”

I nod my agreement.

We amble over to the gurney. Paula brushes the hair from mom’s face. “How are you feeling, Laura?” She straightens mom’s eyeglasses, which have been knocked askew.

Mom is groggy, but she mutters something under her breath.

“What’s that?”

She holds up her left wrist and we see that someone has attached a plastic bracelet. “Sleep.”

Paula leans over and examines the band. “That identifies you so the doctor knows who he’s treating and why.”

Mom nods and closes her eyes. Her breathing is heavy, labored.

“I’m gonna call Gail again,” Paula says as she holds the cell phone to her ear and marches down the hall. I nod and return to my seat.

A few minutes later, Paula sits down next to me. “She said she will make some calls.”

The time ticks by with glacial speed. Paula and I trade tales about our respective days and activities, but soon fatigue catches up with us, and we dwell in the land of stupor. Paula tries to curl up in a row of chairs using mom’s clothes bag and windbreaker as a pillow, but she cannot find a comfortable position. After a few minutes, she joins me in leafing through old copies of Reader’s Digest. I spot-read a story appealingly titled “I Am Joe’s Liver.” I triple my knowledge of the liver in only a few easy minutes of reading.

Gail eventually calls back. Mom has been examined by several nurses, and the information has been conveyed to the physician on call, a Dr. Rollins. Gail does not know Dr. Rollins personally, but she promises to stay on top of things and let us know if she finds out anything new. Paula gushes our appreciation into the cell phone.

A short while after Paula finishes talking with Gail, a white-haired woman wearing a lab coat appears with a clipboard in her hand. Paula and I have been slouching in our chairs, existing in a semi-daze. This is the first purposeful movement we have seen in many minutes, so we sit up at full attention.

Looking around, the woman acknowledges our presence. “I’m Dr. Rollins, the attending physician. Are you the family?”

“Yes.” We speak in unison.

I lean forward and gaze at mom’s face. She is sound asleep. Her heavy breathing alerts me she is still alive. Her mouth hangs open on one side, and drool slides down the corner of her chin.

Dr. Rollins frowns at the chart as she rifles through the pages. “A sixty-four-year old overweight woman, who smokes, is hypertensive, with a carotid artery aneurysm.” Yanking a stethoscope from around her neck, she moves to the head of the gurney and slides part of the gown from mom’s shoulders.

Paula stands at the doctor’s shoulder. “Is it a stroke?” Of course it is a stroke — what else can it be? We need to hear it said, though. We need official confirmation of what we already know.

Dr. Rollins ignores the question so she can finish listening through the stethoscope. Toward the end of the examination, mom’s eyes flutter open.

The doctor smiles. “Ah, Ms. Martinez. You’re awake. Do you know where you are?”

Mom nods. She tries to speak, but her voice cracks.

“Sounds like you could use some water or ice chips.”

Mom nods again.

“We’ll get you some water in a minute.” Turning, Dr. Rollins points at me. “Do you know who this gentleman is?”

Mom cuts her eyes at me and I see a flicker of recognition. Again, she nods.

“Who is he?”

“San.”

Dr. Rollins nods. “And this lady?” She points at Paula.

“Sleep san.”

Dr. Rollins acts as if mom’s comments make complete sense. “Ms. Martinez, do you know what happened to you?”

Mom sighs. “Stroking out.”

Paula and I exchange glances. It is the most intelligible thing she has said in hours.

Dr. Rollins smiles as she drapes the stethoscope around her neck. “Well, that’s one way to put it.” She holds up a slice of transparency film and, squinting, reads it with help from the ceiling light. “Yes, it does appear you have suffered an ischemic stroke, which occurs when there is an obstruction of a vessel in the brain. In fact, from what we can tell from the scan, it’s ongoing.”

“Ongoing?” I suddenly feel weak in the knees.

The doctor turns and examines me as though I am a science project gone horribly awry for reasons she cannot fathom. “Many people do not realize that a stroke can occur over a period of hours — or longer. Unless we can treat it immediately — within the first few hours — with an experimental drug called a Tissue Plasminogen Activator, or TPA — a blood clot buster — we have to let it run its course.”

I slide my hand through my hair. “Run its course.”

Paula takes the lead. “How long will that take?”

“It’s difficult to tell. The scan shows us the extent of the damage so far, but it doesn’t tell us how much of the brain will be affected.” She leans over the gurney and addresses mom directly. “Ms. Martinez, we’re going to admit you to the hospital and I’ll page Neurology.”

Mom’s eyes grow wide.

Dr. Rollins nods and touches her on the arm. “I understand.” Standing, she points toward the far end of the room with her head, as if to say, join me over here.

Paula and I follow the doctor away from the gurney.

Dr. Rollins’s face is grave. “This is a severe stroke, I am afraid. Not that any stroke is good, mind you, but this one has already done a great deal of damage. I’m very concerned.”

“Is she going to die?” I finally give voice to a gnawing fear that has burrowed into my guts.

“I’m paging Neurology. They can tell you a lot more about what to expect.”

I feel a huge mass lodge in my throat, blocking the power of speech. I nod and look down at the floor.

Dr. Rollins cannot ignore the effect her words have on me. “I’m not a neurologist, but if it’s any consolation, she’s made it this far. There are so many variables involved we cannot say anything for certain until we see what happens. The next few hours are critical.”

It is not much consolation, but it is better than nothing. Again, I nod.

“The question now is how much damage it will do before it runs its course. She still has the power of speech, although it is garbled, and her motor skills are relatively intact. That’s encouraging. Still, the size of the affected area is worrisome.”

Paula leans forward. “Her speech has gotten worse since we’ve been here. She could still speak fairly well a few hours ago. She’s gone downhill since then. At first, it was nonsense words strung together, and now they don’t seem to make sense at all — except for ‘stroking out.’”

Paula’s insight triggers an insight of my own. “She’s been speaking formally all afternoon. No contractions — not at all like she usually talks. It’s weird.”

“Formally?” Paula frowns.

“Very stilted, formal. And sometimes she knows my name; sometimes she doesn’t.”

Dr. Rollins nods. “As the stroke progresses, it affects different parts of the brain differently. Her speech function has dissolved as the stroke has spread.”

I gulp. “Will she get it back — the power to speak?”

“Until we know which parts of the brain are affected, we won’t be able to say for sure.”

I am reeling. “What happens next?”

“Well, let’s get Ms. Martinez upstairs into a room. Then we’ll get Neurology to assess her condition and they’ll take it from there.”

I shake her hand. “Thank you, doctor.”

“Do you mind if I have my friend Gail Smith — she’s a local pediatrician — speak to you? Just so we can get all the facts doctor to doctor? She’s a family friend.”

Dr. Rollins shrugs. “Not at all.” She fishes inside her lab coat and produces a business card. “She can call me anytime at that second number. It’s my cell.”

Paula pockets the card. “Thank you.”

“Good luck.” Dr. Rollins taps me on the forearm and is gone.

We watch as she marches over to the nurses’ station to start the ball rolling on admission and a Neurology page. From our position, we see the doctor talking to a nurse, handing her some papers, and then leaning over the gurney and talking with mom. Dr. Rollins lifts the back of mom’s head and helps her drink water from a foam cup. That is supposed to be my job, but I need a moment to regroup before we resume our bedside vigil.

We eventually return to the gurney. Mom is staring off into space as though she is deep in thought. I hate to spoil her contemplative mood. Paula and I stand silently.

Two burly hospital attendants materialize seemingly out of nowhere to interrupt our unspoken lamentations. For the first time that day, the hospital staff moves with admirable speed. One man consults mom’s chart. After scribbling something on the top page, he and his partner take charge of the gurney and head for a bank of elevators with Paula and me in tow. No one says a word.

The elevator transports us deep into the bowels of the gigantic hospital. Up we rise, up ever higher, up past floor upon floor of personnel and equipment, up beyond the highest levels of the multi-tiered parking deck, up to the heights of medical Valhalla. We journey with predictable and hypnotic rhythm. My ears pop, and I emit an artificial yawn in a vain attempt to restore equilibrium.

The taller attendant smiles at me. “Yeah, it always does that.” He smacks his chewing gum. “You get used to it.”

The doors spring opened to reveal the bright lights and bustling activity of a modern hospital, alive and teeming with antiseptic sterility. Everything looks white, clean, impersonal. It reminds me of a science fiction movie where the protagonist runs down a long hallway under gleaming white fluorescent bulbs in an eerie dreamlike sequence where he can never quite elude the monsters in hot pursuit.

I must have been in a trance, because soon I am conscious of Paula looking into my eyes with a worried expression plastered on her face. “Everything okay?”

“I’m just a little tired.”

“Yeah. Your eyes are bloodshot.”

Our trek concludes when the attendants wheel mom into a hospital room at the end of the hall. Standing across from each other, they lift her bulk from the gurney and slide her into a hospital bed. The men also lift the railing on each side and lock them into place. Finally, one man, the shorter of the two, presses a hand-held call button clipped to the pillow and alerts the nurse’s station to our presence. Without another word, the attendants push the gurney from the room and disappear.

Mom had been half-asleep during the ride. After she is safely tucked into bed, though, her eyes flutter open. She mutters something unintelligible and falls silent. I inch closer and ask her to repeat the comment, but she is far away, nonresponsive.

For 10 anxious minutes, I hover over her and chart the progress of her fitful breathing. With each passing second, she seems more peaceful and relaxed. I do not know whether I should feel thankful or worried.

Paula collapses into a chair near the window. I wander over next to her. “How’s your back?”

“It’s been better, but I’m all right.”

“You think she’s gonna die?”

“You heard the doctor.” She gazes out the window at the inky blackness that envelopes the parking lot. “Let’s see what Neurology says.”

“She seems to be growing weaker.”

Paula wisely does not respond. She must sense how close I am to becoming hysterical. The best course of action is to wait for medical personnel to take charge.

As if on cue, a nurse glides into the room. She is a portly older woman. Her air of confidence and competence is immediately reassuring. She does not hesitate as she heads for the side of the bed and checks the bag of fluids that someone has fastened to mom’s arm. Kneeling, the lady fiddles with a knob and the drip inside the bag increases.

I watch her face, marveling at the contours of her features. They are so strong and well-defined they might be chiseled in granite. The amorphous, babyish look of youth long ago has fled the scene, never to return. In its wake, her face is left with a series of crevices that tell a weary tale of heartache and experience. This woman has seen it all during her decades-long nursing career, and nothing surprises her these days. She refuses to give in to hysteria, a decidedly admirable and acquired trait — one I have yet to master.

Paula and I stand at full alert, poised for some message of hope or at least a concrete assessment of the situation. As we look on, the woman leafs through a stack of papers for perhaps 45 seconds before she speaks. During the interim, Paula and I regard her hopefully. I admire her immaculate uniform with everything tucked into place as though she is a career military officer decked out in dress blues and full regalia.

“Good evening.” The formerly stern expression dissolves into a slight smile that softens her features considerably. “I’m Lydia Jones, the nursing coordinator for the night shift. Are you the Martinez family?”

“Yes, ma’am.”

“Neurology will be up shortly to talk with you about options. In the meantime, I will try to make her as comfortable as possible.”

Something about the phrase “as comfortable as possible” bothers me. “What happens now? Is she in danger?”

Ms. Jones obviously has acquired long experience handling families of the stricken and the dead. She handles us with a deftness I would find remarkable if I were in a more contemplative frame of mind.

“Well, sir. We will administer fluids to keep her hydrated. We will monitor her blood pressure for signs of major changes. We will keep Neurology informed of her progress while we wait for the consult.”

I nod. It sounds reasonable, all so reasonable. “So the danger has passed? We’re out of the proverbial woods?”

I appreciate the way the woman does not sugarcoat the truth, but at the same time she is gentle with me. “Ms. Martinez has suffered a stroke, which is always serious. I would be lying if I said I know what will happen. Nothing is certain when trauma to the brain occurs. That’s a question for Neurology to assess.”

Another huge lump lodges in my windpipe, and I try to clear it away with a series of throat-clearing noises.

The nurse places her hand on my forearm. “She’s in good hands. The doctors here are the best.”

I nod as Nurse Jones sweeps past me to check the bag of fluid again. Kneeling, she adjusts the drip and watches its progress. When she is satisfied with what she sees, she stands, pats down her uniform, and heads for the door. “Please excuse me.”

Paula sighs. “I guess all we can do is wait and see.”

“Let me try something.” I whip my cell phone from my pocket and step into the hallway. Behind me, Paula hovers over mom’s bed, watching the steady rise and fall of the old lady’s chest beneath the blanket.

My cousin, Phil Mead, is an emergency room doctor in a Philadelphia hospital. He can tell me the unvarnished truth if anyone can. I punch in his telephone number and wait while it rings. After a few seconds, his answering machine instructs me to leave a message. I cannot bear to blurt out news of mom’s stroke to a machine, so I hang up without a word.

Paula looks up when I slip back into the room. “From what I can see, she seems stable. I suppose that’s good. Did you call Philip?”

“Yeah. He’s not home, but I’ll try him again later.”

Paula nods. We slide into adjoining chairs to settle in for a long night of waiting.