AT THE FURROW’S END

Babylon in all its desolation is a sight not so awful as that of the human mind in ruins—Scrope Berdmore Davies

Heavy double doors banged shut behind me. Like a jolt of electricity, anxiety surged through my body. I quickly located bed 21 and the unidentified woman who was responsible for my stat page to the medical intensive care unit. I placed my black bag on the small table alongside her hospital bed. A quick glance at the bed revealed a small body virtually eclipsed by monitors, a wheezing ventilator, and a virtual spaghetti bowl of wires and catheters.

I hastily scanned the labels of the intravenous bottles that hung at her bedside. The nearby table displayed printouts of her abnormal vital signs. All revealed worrisome numbers, causing me still greater apprehension.

Somewhere across the intensive care unit, a ventilator alarm shrieked, a telephone jingled, and infusion pumps thrummed. Nurses with intent facial expressions scurried about the unit on rubber-soled shoes, providing care for these, the very sickest of the hospital’s sick.

It was late evening in March of 1995. I was the neurologist on call for the hospital. Unseasonable sleet was falling outside, as if Mother Nature had not quite finished punishing the denizens of the Texas South Plains. I was barely aware of the inclement weather, however, as by then my mind had focused on my task at hand. Already I had dismissed thoughts of my wife’s home- cooked meal and of proud recitations by my children of their school activities.

I paged through the painfully thin hospital chart that lay on the bedside table. The “unknown woman” had collapsed in a large Lubbock discount store. An ambulance had been summoned, and she had been transported by EMS to the emergency room. The chart provided no additional information about the unfortunate patient.

I hurriedly examined her. Her left arm and leg were as limp as a Raggedy Ann doll. They were paralyzed. I called loudly to her. “Please open your eyes.” She made no response. “Squeeze my fingers,” I pleaded. I felt no contraction of her thin, cool, arthritic fingers. Ominously, her right pupil was enlarged (“blown,” in the medical vernacular), and failed to constrict to the light from a strong flashlight. I thought if the eye is the window to the soul, then this portal had been tightly shuttered, with her awareness sucked deep into the black abyss of coma.

Her tiny body appeared to weigh less than eighty-five pounds. She seemed childlike and swallowed up by the large mechanical bed. The woman’s hooked nose dominated other facial features, and her thin hair bore an unhealthy yellowish tinge. Sallow skin showed deep, craggy wrinkles much like the bark of an ancient olive tree. I was certain of one thing; time had been most unkind to this old woman.
Dirt beneath fingernails, arthritic knuckles, callused hands, and leathery skin suggested she had led an outdoor, physical existence. I wondered what labor this woman had performed to bring about such physical changes.

I located a folder of her X-rays. The film showing her head CT scan screamed out a dire message. A large blood clot lay buried within her right hemisphere, looking like a coiled serpent. The sanguineous, snakelike figure had shoved her brain violently leftward into her pitiless and unforgiving skull and looked likely to expand still further over the coming days. If that happened, it would crush the vital centers necessary for life itself.

After completing my examination and review of lab and X-ray studies, I wrote medical orders, dictated my consultation, and prescribed a drug that would combat the brain swelling that was sure to come. The deep location of the blood clot made it inaccessible to a scalpel, preventing a surgical option. Her moribund condition and our limited possibilities for treatment left me thoroughly disheartened. My earlier adrenaline rush slowly ebbed away. I sighed heavily and stood for several minutes, searching my mind for other treatment options that because of fatigue might have escaped me.

Finally, I turned to leave, but my pace was less hurried than it was on arrival. An astringent smell filled my nostrils. The incessant beeps and whirs of the equipment soon faded behind me as I departed the unit. I was mindful that the unknown woman’s chance of surviving the night was poor.

To my surprise, the next morning I found her still clinging tenaciously to life. While her examination had improved minimally, she remained deeply comatose and gravely ill. I noticed a name had been posted at the end of her bed, a name that in this narrative we shall call Maggie Croft…

In order not to spoil the ending, let me merely add a dramatic transformation occurs in the story following a moving testimonial from Maggie’s husband in which he describes their hardscrabble life together.