“I can’t think about that right now.” Victoria told them, but offered no further explanation.
“Victoria, why not? You can’t put this off.” Paul countered wisely.
“Paul, I have my reasons.” Vicki answered tightly.
“Such as?” Paul pushed.
“Damn it, Paul, my father’s in the hospital! He’s had a heart attack and a stroke, the doctors still don’t know what happened, and they still don’t know what’s going to happen, they still won’t give us anything as far as his prognosis goes. He could die; I don’t have time for these petty little games right now!” Victoria exploded, fed up and completely exhausted.
With an exhausted sigh, she all but whispered, “I’m sorry; I shouldn’t be taking this out on you. Just please do what I’m asking and get the taps put in my phones. I don’t want to wait any longer, frankly, I can’t afford to.”
With that, she stood and started walking out of the apartment. She didn’t get very far when she faltered and had to grip a nearby shelf or risk collapsing.
“Victoria, are you alright?” Christine asked as Paul led her back to the couch and helped her sit down.
“Yeah, I’m fine.”Victoria murmured as the room spun.
“You need to eat something.” Paul told her before walking into the kitchen.
“What I need is to get back to the hospital. My mom needs me.” Victoria told them stubbornly as she tried to get up.
“Victoria, sit down, you need to eat. You’re not going to do your mother or your father any good if you collapse from starvation.” Christine told her gently, yet firmly.
“Fine.” Victoria said as she closed her eyes and sat back on the couch with her head resting on a cushion.
After eating the sandwich and drinking the orange juice Paul had brought her, Victoria told them, “Thanks, I didn’t come here so you could feed me. Nobody can know about this visit, nobody. I don’t want this getting back to my parents.”
“Nobody, Christine.” Victoria told her firmly.
“Fine, we won’t say anything for now,” Paul told her pointedly as she walked out of their apartment.
As she waited for the elevator, Victoria vowed, “This isn’t over, I’ll see them both dead before I let either one of those two monsters lay a hand on my parents or any other member of my family!”
“I know I read it somewhere, I know I read that a stroke in the brain stem can mean challenges with paralysis, but where is it?” Nikki said, becoming frustrated as she sat in Victor’s hospital room completely unaware of the dark turn, the turmoil that had become her daughter’s life. “There it is. ‘If someone has a stroke in the brain stem, he or she can have challenges with: breathing and heart function, body temperature control, balance and coordination, weakness or paralysis of the arms and legs on both sides of the body, chewing, swallowing and speaking.’”
True to form, after having slept soundly for several hours, Nikki went right back to her research. “So, is the damage in the brain stem causing his speech problems, or is it damage somewhere else that’s causing it?” She wondered before continuing. “The left side of your brain controls your ability to read, talk and do math. …In addition, the right side of the brain controls creativity, ability to enjoy music and art and ability to recognize people and objects.” Stopping for a moment to consider what she’d just read, Nikki wondered, “So, damage to the right side of the brain could be the reason for Victor’s inability to recognize Victoria-then again, why would he recognize me if he couldn’t recognize her? Why would it be so selective?”
Shaking her head, Nikki went on with the research. “The brain stem connects the brain to the spinal cord so that other nerves in the body, particularly the spinal cord nerves can get messages from and give messages to the brain.”
As she reread the information on the pons, Nikki wondered, “Since it acts like a telegraph station or transmitter, making sure nerve impulses coming from the eyes, ears and touch receptors are sent to the cerebellum, could that be the reason for the paralysis? What about his breathing? Could that be because of damage to that part of the brain?”
“The pons appears to serve as a relay station carrying signals from many parts of the cerebral cortex to the cerebellum. Nerve impulses coming from the eyes, ears, and touch receptors are sent on cerebellum. The pons also plays a part in reflexes regulating breathing.”
With a sigh, Nikki said to herself, “I feel like I’m back in high school biology, with much more advanced material. I didn’t understand a word of it then and I don’t now, so why am I doing this? Why am I pushing so damn hard?” ‘Because your husband is lying in a hospital bed fighting for his life and you may be his only hope of surviving this.’ A little voice inside her reasoned rationally, ‘because whether or not you’re ready or willing to admit it, if you don’t find some kind of answer to this you may very well end up losing the man you’ve loved for most of your adult life, you may very well end up losing the love of your life.’ Wishing that weren’t true, that it weren’t the case, Nikki sighed, exhausted and frustrated before digging down deep within her to continue.“Since the cerebellum’s most clearly understood job is coordinating body movements, could the stroke have affected that part of the brain causing the paralysis? Probably not, since it also says that people whose cerebellums are damaged can perceive the world like before and have the ability to contract their muscles, but their motions are jerky and uncoordinated.” Nikki thought aloud with a shake of her head. “It says this part of the brain regulates and coordinates movement, posture and balance and that it’s involved in learning movement and that it controls posture and coordination. Does that mean that, if that part of Victor’s brain were damaged, he’d have to relearn how to walk?”She gave a small shudder at the thought. “He’d hate that; he’d feel like a child again, in the worst possible way.”
“According to this, the cerebellum coordinates voluntary movement, balance and equilibrium and it has some memory for reflex motor acts. Observed problems with an injured cerebellum include loss of ability to coordinate fine motor movements-I think that’s things like doing up buttons, zippers, snaps and holding pencils, writing, things like that, but I’m not sure.-” Nikki made a mental note to check with the doctor before continuing, “Inability to walk-which could account for the paralysis!” she exclaimed, thinking, perhaps she had at least one answer. “It also includes an inability to reach out and grab objects, tremors, dizziness or vertigo, slurred speech, also known as scanning speech and an inability to make rapid movements. It also says the cerebellum controls motor activity and helps people maintain posture and balance, along with enabling them to perform rapid and repetitive movements like running. Injury to the cerebellum causes dizziness, mobility problems or paralysis.-I knew it! That must be why Victor can’t move his legs!”Trying to do what she could to keep the hope inside her from withering away, she continued. “…The cerebellum coordinates sensory input from the inner ear and the muscles to give accurate control of position and movement.”
“It’s probably Nicholas.” Nikki said as she reached for her phone once again.
“Hi, Nikki, it’s me, Hope. Is there any change? Has there been any change in Victor’s condition?” she asked hopefully while trying desperately trying to keep the worry plaguing her from ringing out in her voice.
“Victoria told me that Victor was in the hospital when I called earlier.”
“Oh.” It was a feeble response, Nikki knew, but it was the best she could muster under the circumstances. ‘Why am I so exhausted? I just woke up, so why can’t I stay focused on anything, why am I so exhausted?’ Nikki thought to herself frustrated.
“How is he? How bad is it?” Hope asked, as delicately as possible.
“It’s bad, Hope, it’s really bad. Victor needs a heart transplant.”
“What? What happened?” Hope asked shocked.
“He had a heart attack and a stroke. Hope, I found him on the floor of his office barely breathing. By the time the paramedics came he was almost gone. They lost him once on the way here but, thank God, they were able to revive him. Then, while he was in the operating room, he had a massive stroke. We’re still waiting for tests to find out what exactly happened. I…I’m sorry, I don’t…”her voice trailed off as tears smothered it once again.
“Oh my God! We’ll be there as soon as we can!”
“Hope, wait!” Nikki exclaimed, hoping to catch her before she hung up.
“Yes?” Hope said wondering what more there was to say, what could be more important than her and her son getting to Victor before it was too late.
“I’m sending the jet.” Nikki said simply.
Touched, as tears started to fall, Hope whispered, “Thank you.”
Overcome by her own emotions, Nikki said nothing as she hung up the phone.
Deciding it was better to try and block out, to try and numb the pain of what was going on around her, Nikki went back to her research.“Language comprehension’s found in Wernicke’s area and speaking ability’s in Broca’s area. Damage to Broca’s area causes speech impairment but not impairment of language comprehension. Lesions in Wernicke’s area impair the survivor’s ability to understand written and spoken words but not speech. The remaining portions of the cortex are linked to higher thought processes, planning, memory, personality and other human activities.
“Would damage to the reticular formation cause the paralysis? Could that be it? It does say that it gets input, whatever that means, from higher centres in the brain and relays it to motor neurons.” Nikki wondered as Casey came in.
“Don’t you ever sleep?”She asked pointedly.
“When I need to,” Nikki answered calmly, but just as pointedly.
“What are you doing here?”
“Victor had a stroke, remember? I’m not going anywhere until we get to the bottom of this!”
“At least eat something!”Casey exclaimed setting down the fruit salad, yogurt and carton of milk in front of her.
“Casey, what is all this?”
“Breakfast, start eating!” Casey snapped.
“When did you become such a slave driver?”
“About the same time you developed your stubborn streak.”Casey replied as she sat beside Nikki.
“I suppose you’re going to stay right there until I’m done breakfast.”
Scowling, Nikki began to eat.
Satisfied Nikki was listening to her, for once; Casey smirked a little and asked, “Learned anything?”
“Not really, it’s just given me more questions really.”
“You know, you could just wait for the doctors to get the test results back.”
“Casey, you know I can’t do that!”
“Why? Because you don’t have the patience for that, or is there something else?” Casey asked trying very hard to stay calm, despite Nikki’s best attempts at making her lose her temper.
“Casey, I’m not going to just sit here wringing my hands! Don’t you get it? I’m not going to do that! Those days are long gone so deal with it!”
“I can deal with that, what I can’t deal with is seeing you get yourself all worked up when it’s out of your hands!”
Recognizing the battle light in her sister’s eyes, Casey carefully continued. “Listen, I understand that you’re worried, I get that, and believe me I understand why you want to help.”
“Then why are you telling me to stop?” Nikki bit out, her temper and frustration on a very short leash!
“Because, I don’t want to walk into work one day and hear that you’ve been admitted! The best way to help Victor is to take care of yourself!”
“And I’ve been doing that Casey, I’ve been doing that!”
“Just promise me something.” Casey reluctantly relented, determined to make one final point.
“What?” Nikki asked impatiently.
“That you’ll keep taking care of yourself, I meant what I said, I don’t want you ending up here too.”
“I’ll be fine Casey.”
“Okay, I promise I’ll take care of myself and Victor.”
Satisfied that she’d gotten through to her sister, Casey gave her a quick hug and left.
Sipping her tea and wishing it was good strong coffee, Nikki began reading again. “Since the cerebral cortex is responsible for thought process, perception and memory and serves as the seat of advanced function, social abilities, language and problem solving. It controls expressive language, assigns meaning to words we choose and involves word associations. It stores memory for habits and motor activities. Observed problems from injuries to this part of the brain include loss of simple movement of various body parts (paralysis) and inability to express language (Broca’s Aphasia), along with problems with sequencing, lack of attention and mood changes. It also says that part of the brain is responsible for reasoning, judging, planning, voluntary movement, and overall behaviour. Injury to the area can impair judgment, cause dramatic changes in personality and produce challenges with attention and focus. The cerebral cortex is also responsible for thinking and language. Could the damage have been to that area and that’s what’s causing the speech and memory problems, along with the paralysis? It says that it controls voluntary movement, so does that mean it’s been damaged and that’s why Victor can’t move his legs?”
“Then again, maybe it’s the hippocampus that was damaged? It is critical in forming long-term memories. Its primary role is in forming memories, classifying information and storing new and temporary memories for long-term storage. And it’s involved in interpreting incoming nerve signals and spatial relationships, along with being involved in learning. So, maybe damage to this part of the brain brought about the paralysis. It’s also important for converting short term memory to more permanent memory, as well as for recalling spatial relationships in the world around us.”Nikki tried to ignore the frustration raging within her, though it was becoming increasingly difficult.
“The brain stem keeps up important functions like breathing swallowing, digestion, eye movement and heartbeat.-So maybe that could be causing the heart problems and not the heart attack, either way, is there a treatment for it?”Nikki asked as she continued, “-Many times, strokes in the brain stem are fatal” she tried her best to ignore the sick feeling in the pit of her stomach as she finished, “however, when they’re not they can affect many of these functions.” Despite the multitude of horrifying images that sprang to mind, Nikki banished each one and went on.
“Since the cerebrum is where muscles are controlled and where written and spoken language is organized, could that be why he’s paralyzed and can’t talk? Or, is because the frontal lobe was damaged? It is responsible for movement and motor functions. It’s responsible for memory too.—The question is how big a role it plays in each and what does it do? It says it’s concerned with emotions, reasoning, planning, movement and parts of speech, along with being involved with purposeful acts like creativity, judgment, problem solving, and planning.—So could damage to that part of the brain account for Victor’s speech problems?”Setting the binder of research aside, Nikki began to pace the small hospital room, the humming and beeping of machines the only noise that could be heard.
Looking at the binders that lay beside her on the table, Nikki briefly considered shredding everything that was in them. ‘What good will that do? That won’t help Victor.’ She thought to herself as she tried to keep her temper in check.
It was the footsteps behind her that caught her attention. “Dr. Cornwell, what are you doing here?”
“I came to check on Victor and see how you’re doing. I talked to Dr. Hoffman and Dr. Throton and we decided it was best if I come and see you.”
“Yeah, that probably is best.” Nikki agreed and silently added, ‘If I see Hoffman right now, there’s no telling what I might do! I still can’t believe his audacity, suggesting I take Victor off life-support!’ “I’m fine,” Nikki lied, “What I really want to know, what I’m really concerned about is how Victor is. How is he really? Surely you must know something by now.”
“We’re getting more answers as more test results come in.”
“Good, then you can tell me what’s going on. You know what’s going on with Victor and how we’re going to fix it.”
“The test results we have so far are giving us a lot of good information and pointing us in a very definitive direction, but I don’t want to speculate at this point. It’s pointless.”
“That’s all I’ve been doing!”
“Nikki, I know it’s hard, but you need to hold on.”
“I am, I am holding on. But, honestly, I don’t know how much longer I can keep this up. I don’t know how much longer I can keep going without any answers.”
“We’re doing everything we can to get you the answers you need, we’re just waiting on a few more test results to be sure and we’ll come and talk to you. Okay?”
“To be sure, what do you need to be sure of?”
“Okay, fine, don’t tell me, just don’t let this go! Don’t let this go!”
“We’re not. There’s no way we’re letting this go without finding out exactly what’s going on with Victor! You can count on that!”
“Good, I want to ask you something.”Nikki replied relieved and determined to get whatever information she could out of Dr. Cornwell.
“Go ahead, what is it?” Dr. Cornwell asked cautiously.
“Are the breathing problems Victor’s been having, the trouble with his heart rate because of the heart attack? Or is it the stroke that caused them? Are they because of damage to the brain stem?”
“We’re not a hundred percent sure yet. We’re still waiting on a few of the MRI and CT scans that we had done on Victor, as well as two tests we did on his heart.” Dr. Cornwell told her honestly.
‘Meaning you still don’t have a clue what’s going on with Victor! Despite all the tests you’ve done, you still don’t have a clue what’s going on with my husband, much less how to fix it!’ Nikki thought to herself, half hoping the fury she felt bubbling inside her wasn’t showing.
The sympathy Nikki saw in the doctor’s eyes infuriated her to no end.
“Thank you.” Nikki replied politely, although one look at her, one look in her eyes told Dr. Cornwell, as it would have anybody else that Nikki was quickly reaching the end of her rope and exhausting her patience.
“Just hang in there a little longer, okay.” Dr. Cornwell told her softly, sympathetically as she left the room.
“What choice do I have? My husband needs me and I won’t let him down. I can’t!” Nikki told her frankly, unable to keep the exhaustion or fear from her voice.
Looking around the room, Nikki spotted her laptop and printer sitting on the table not far from where Victor lay sleeping. “It’s worth a shot,” she murmured as she started her computer and began her search.
After only a few minutes, Nikki’s frustration began to get the best of her. “Come on, come on, why can’t I find anything? Why can’t I find anything that will help Victor?” It wasn’t long before she found exactly what she was looking for. “This is more like it. Now, let’s see… search heart attacks and strokes. I hope this works!” Nikki exclaimed, saying a silent prayer that she’d finally get the answers she’d so desperately been searching for. “This is it! This is it! This is exactly what I’ve been searching for!” Nikki exclaimed, seeing the first real ray of hope she’d seen in so long. “The question is; why didn’t Dr. Hoffman say anything? This trial is just for people like Victor, one’s who’ve had major strokes and whose prognoses aren’t good! Why the hell didn’t he say anything? What kind of game is he playing? What kind of game is he playing with my husband’s life?” Nikki asked incensed!
Shaking her head, she told herself, “I’ll deal with that later. Now I’ve got to read this to see if it’s what I think it is and then make a decision about whether or not to go to the doctors with it!”
It was only a short while before Nikki had her answer. Dropping the stack of papers she’d printed out on the table in front of her, she bolted out the door and to the front desk. “Excuse me, nurse.”
“Yes, Mrs. Newman.”
“Could you please page Dr. Hoffman, I need to speak with him, it’s urgent.”
“Of course. Nothing’s happened to Mr. Newman, has it?” the nurse asked worried.
“No, no, he’s resting. I just need to ask Dr. Hoffman something.” With that, Nikki returned to Victor’s room to wait.
Relieved Victor was still sleeping, Nikki waited impatiently for the doctor and read what she’d found.
A few minutes later, doctors Cornwell, Throton and Hoffman entered the room.
“Mrs. Newman, what can we do for you?” Dr. Thorton asked graciously.
“I want to know why nobody told me about this!” Nikki snapped; thrusting the small stack of papers she’d been holding towards them.
“Mrs. Newman, there’s a simple explanation for this.” Dr. Hoffman began.
“So? Let me hear it! Why wasn’t I told about this? Why wasn’t I told about the trials that were going, the trials that are going on, at your hospital, Dr. Hoffman?” Nikki snapped pointedly, her anger reaching new heights with each passing moment!
“Mrs. Newman, dyasatriamethazone is only in its infant stages. Clinical trials are just beginning and they’ve been largely inconclusive.”Dr. Hoffman tried to explain. “I didn’t bring it up because, frankly, at this point I don’t think it will help your husband. It’s a waste of time and maybe even dangerous, potentially even fatal to even try it. Half of those who participated in the trial who were in the same condition as your husband either had another stroke or heart attack, further weakening them and eventually killing them. Think about it, Mrs. Newman, half of the people who were in your husband’s position and tried this medication are dead. Do you really want that for him?”
“How dare you? How dare you ask me such a thing? You have no idea what I’m going through so don’t presume to insinuate that I somehow want my husband to die! Don’t you dare! According to you I’m supposed to do what exactly? What, I’m just supposed to sit here like a good little wife and let my husband slip away? Is that it? Is that what you expect me to do?” Nikki asked infuriated, indignantly.
“Nikki, of course that’s not what we want you to do. But, from what little I know, from what Dr. Hoffman’s told me about the drug, it may very well kill him if we administer it.”Dr. Cornwell tried to calm her down, all the while thinking ‘Thorton, you’ve got a hell of a lot to learn about how to deal with your patients and their families! You’re just making things worse! I ought to remove you from this case!’
“So what’s the alternative? What do the tests say? How long can we afford to wait before I lose my husband?” Nikki pressed, ignoring Dr. Cornwell’s attempt to pacify her and determined to make her point.
“We’ve reviewed the tests and we found that there was major damage to several areas; the brain stem, the speech centre, specifically Broca’s area and the motor cortex. The hippocampus was also damaged.”
“The damage to the brain stem explains the paralysis and the breathing problems; it also explains him being cold sometimes. I was right, he does have expressive aphasia. At least I know now that he does understand what I’m saying. The damage to his hippocampus explains the memory loss.” Nikki said half to herself, forgetting for a moment that the doctors were still in the room.
Then, shaking back to reality, she told them. “I want to hear more about this drug.”
“Very well, it’s true the medication is successful with some patients.” Dr. Hoffman told her pointedly.
“Only some? What happens with the other people who’ve tried the medication? Why hasn’t it worked?” Nikki asked, knowing she wasn’t giving any of the doctors any breathing room and hardly any room to explain anything, but she didn’t care. ‘I need answers damn it! I need answers now!’
“If administered to the wrong person, it can cause massive heart attacks and strokes.” Dr. Hoffman told her frankly, too frankly for Dr. Cornwell’s taste.
“You still haven’t answered my question. How long can we afford to wait for the transplant before I lose my husband?” Nikki pressed, determined to get the truth from them.
After exchanging concerned, even worried glances with her colleagues, Dr. Cornwell answered. “A few days, maybe a week if we push things, but, honestly Nikki, I wouldn’t recommend it. I’m sorry; I wish I had better news for you.”
“Then why are we wasting time? Why are we waiting around? Is he on the list? Is my husband on the transplant list?”Nikki snapped, unwilling to accept the silence that hung in the air as an answer to any of her questions.
“Yes, he’s on the list but-”Dr. Thorton answered, struggling to find the words to tell Nikki she needed to accept the only thing no wife ever wants to accept, the only thing no wife is ever ready to accept or should have to accept-the impending death of her husband.
“But what?” Nikki asked, sensing she didn’t like the answer she was about to get.
“It’s doubtful Mr. Newman will make it long enough to get a heart. It’s doubtful they’ll be able to get to him in time.” Dr. Hoffman answered, again all too frankly for his colleagues’ tastes.
Choosing to ignore the implications of his curt answer and seemingly aloof attitude towards her and everything she was going through, Nikki said nothing. Instead she walked straight to Victor’s bedside. “Victor. Victor, it’s me, it’s Nikki. Wake up; okay I’ve got news, good news.”
“Mrs. Newman, this medication could very well kill him! He shouldn’t be on it at all! It’s too risky!” Dr. Hoffman tried fruitlessly to convince her.
“Let my husband decide that for himself! He deserves that much! He deserves that much, damn it!”
Disoriented, Victor slowly awoke, his vision blurred in his weakened and exhausted state, he struggled to focus on his wife.
“Victor, I did some research. I did some digging and there’s a clinical trial going on for a medication that might help you get well. There are some side effects though. But I really think it could work.” She told him softly, hoping she’d given him a reason to fight. Treading carefully, she softly asked, “Do you want to hear more?”
With a deep breath and a grimace, Victor nodded.
Concerned, Nikki asked, “Are you in pain?”
With a small and he hoped reassuring smile, Victor shook his head.
“The floor is yours.” Nikki said simply as she turned her attention to the three doctors.
“Mrs. Newman, this isn’t a good idea, it’s not what your husband needs right now.”
“Let him decide that, Dr. Hoffman!” Nikki all but yelled at him, making Victor’s eyes widen.
“Very well,” Dr. Hoffman reluctantly relented and began to tell Victor about the drug trial that John’s Hopkins was currently conducting. When he was done, he asked carefully, hoping he’d been able to convince Victor not to enrol in the trial, “do you have any questions?”
Satisfied with what he’d heard, Victor shook his head.
Hesitantly, carefully, Dr. Cornwell asked, “Do you want to participate in the trial?”
Victor nodded vehemently.
“Are you sure?” Dr. Thorton asked uneasy with the whole situation.
Glaring at her, Victor once again nodded vehemently.
“And you understand the risks and are willing to accept them as I’ve explained them to you?” Dr. Hoffman asked, pressing the issue.
Again glaring, Victor nodded.
“Okay, we’ll draw up the papers for you to sign.” Dr. Cornwell said turning to Nikki before she and her colleagues walked out.
Just outside the door, she turned to Dr. Hoffman and demanded, “Meet me in my office! We need to get a few things straight.”
“You mean I need to get a few things straight.” He answered her angrily, arrogantly.
“Your words, not mine.”