Don't Shoot the Messenger

28 - the test

1036   words 

*edited 

Macello POV

I sit by her still form and feel paralyzed myself. Everything depends on the next few minutes ...and I can do nothing. I am not a patient man by nature, but have trained the skill and learned when and how to wait. I have had to face crises before in which the correct action was to wait for the right moment to act. In my adult life I have rarely felt truly helpless -until her. How many times have I felt helpless in the face of her danger?

Her heart is beating, and in a few moments she will prove whether she can breathe on her own... My eyes are full of her. Small details catch at my attention. I notice the way the stitches pull at her scalp, and her bottom lip seems a little chapped. Every sense seems heightened... My palms are damp and my Madre has a tight grip on my shoulder. Cousin Vincento is with us as well, his face a tense mask. Not premature grief but sadness in his eyes. No matter the outcome today, there is no easy path ahead. He avoids looking at me.

There is no pillow cushioning her. A brace holds her neck steady. Her head is already positioned to keep her airway unobstructed. The ventilator tube is attached to the endotracheal tube. Her Dr. places his hand on the connection and looks to me for permission before continuing. We have talked about this during the long cold hours. 

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The Dr. reminded me that her wishes would override the power of medical attny. once she was awake and able to speak for herself. "You need to think about what she would want. We can either wake her for the breathing test or keep her sedated."  

"It is ... possible that she may be able to breathe on her own while she is awake, but not without thinking about it. We could keep her alive then by forcing air into her lungs while she is sleeping. We could track her during the day with sensors and alarms when she grows inattentive. Breathing assistance can be available if she faints or dozes off. It does not take much focus or attention to control her breathing, but to stay conscious of it ... "

"This discounts the side effects of forced ventilation. The most common side effects include the possibility of her lungs bleeding... Infection or irritation of the throat and lungs, are not uncommon. There is also the possibility of lung tissue damage from oxygen pressure." He adds clinically.  "You know her better than I do. Would she want to live tethered to machinery? What would it be like for her?"   I knew the answer; we both did. 

"She may not be able to breathe without help at all. In that case she would struggle for breath and fail. If she is conscious for that... Her last few minutes will not be pleasant."  He warns.

"The sedative will not affect her ability to breathe on her own, if she can. We can turn off the ventilator and remove the tube, make her as comfortable as possible. If the test fails, you know her last memories were good ones. She would slip away in her sleep."  I...I can't. I'm shaking my head.   I am shaking. 

"There is another option as well. We could leave the tube in place during the test. If the test fails, we can reconnect the ventilation and wake her after. She can decide whether to disconnect the machinery. " His voice becomes as gentle as possible... "You would have a chance to say goodbye." 

"First, you have to decide whether to have her awake for the test. Then, should we wake her after... or let her go if the test fails?" He left me alone in his office with papers I did not want to touch. I stared at the pages, the signature lines on each. It felt as if I was signing her death sentence. I couldn't... The test could go well. I could not let her die. I could not let her die terrified and...

I pictured an alternative. How would she feel to wake up -to this...? What would she choose? My hands were weighted and my fingers thick as I marked the pages. 

............

The decision is made, but it is impossibly hard. The machine has been breathing for her, forcing air into her lungs for hours. If she is capable of controlling her breathing, then her lungs will be strong enough to continue alone. If the brain stem was damaged during surgery, nothing will fix that. If ...if ...if... If she breathes. I reach for her hand and hold it with delicate gentleness though I want to cling to her fiercely. I know it would not help, and cannot bear to bruise her if these are our last moments together. My own breath stutters with emotion.

The seal is broken; the wide tube is disconnected. Soft mechanical sounds, the faint hiss and dull thump of the compressor, come to rest at the flick of a switch. The Dr. eases the curved plastic of a narrow tube from her mouth and upper throat. 

  I hold my breath waiting... everyone does. We listen for the softest sound of an unforced breath. I see her silent struggle and clench my fist. Hope fought silence in the room. ...Finally, we heard it. Breath. She was breathing.   

It was still hours before she would wake. What would she remember, or forget? Was there brain damage from the time she was... from the time... I had told them continue the surgery even if something went wrong. We all knew it was a risk. If they stopped and tried to finish the surgery later... there might be no later.  

.................

She drifted in and out of awareness. Her soft eyes opened. Before anyone could do more than offer a few quiet words of encouragement, they closed again. It was less than reassuring to those watching that her gaze was so unfocused... and her consciousness- such as it may be- was brief.

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