The lotus position

In the Lotus Position, her visage on the cover of this month’s hospital throwaway magazine greets them.  She is young; she is lithe; she is quite attractive.  The magazine is another idea pressed upon The Sisters of Charity by the PR agency they invoked when St. Ann’s became a Level II Trauma Center, the only hospital of that rank on the Western Slope of Colorado.  Now the hospital was truly a medical center to be contended with by the hospitals on the other side of the state, those along the Front Range.  Dr. McBride, the woman in the photo, practices Yoga when she isn’t performing neurology, specializing in seizure disorders.  She will be his attending physician while he is in the hospital, with its new ten-story addition that cost ten million dollars, with a floor procured specifically to neurology patients.  And that is what he is, a neurology patient.  It is Saturday and the emergency department is busy.

Only that Wednesday, while he puttered around simple one-bedroom house he’d retired to on the slopes of the Grand Mesa, Chase Covington suddenly collapsed to the floor suffering a generalized epileptic fit that lasted at most a couple of minutes.  He was conscious throughout the seizure; he was conscious of searing pain as his muscles tensed and contracted.  He feels as though he has been hit by a bolt of lightning.  During the seizure, he has lost control of his nervous and musculoskeletal systems, his jaw clenching so much that later they’d discover he fractured his jaw.  When the seizure releases him, he is entirely exhausted.  Crawling off to bed – where he sleeps for ten hours – he forgets to let his rescue mutt out for before he retires.  He is alone.  He has no one to tell.

Thursday, he gathers himself and wonders what to do.  His jaw on the left side aches horribly.  In Paonia, there are no doctors, just a nearly-retired physician assistant whom he does not trust.  He drinks tea and wonders whom to call.  But he calls no one.  The seizure does not return.  While in high school, he dabbled with drugs, and he realized that some of them could have caused the seizure, he hasn’t turned to them since his twenties.  In Paonia, on the tail end of the West Elk Mountains, he walks his dog down the street.  He can only go a block.  Soon he has to return: his legs just feel too weak to go farther.

On Friday, he calls an old friend from high school, a semi-retired doctor in Riverton.  “What should I do?” he poses to Bill O’Brien after explaining the episode.

“Hell, Chase, you need to go to the nearest emergency room and have them do a head CT.”

“Like now?”

“Like right now.  Can you drive?”

“Yeah,” he says slowly.  “I can drive.  I’ll go tomorrow.  Thanks.”  With that, he hangs up.

The following day, he drives his van down to Delta, a town smaller than Riverton, but one with a hospital with a CT Scanner.  The ER doctor pensively listens to his story, then examines him as if he is a shipwrecked sailor washed up in the frothing sea.  Obtaining an X-ray of his jaw, before he gets the cranial CT, he sees the dark crook of a line that reveals the fracture along the jawline.  Then they perform the cranial CT, which spins and spins around his head, cutting it with invisible X-rays as precise as a butcher’s circular saw.  Among the whorls that appear to be galaxies on the CT scan, there is one star that shouldn’t be there.  He shows it to Chase, but doesn’t want to speculate.  Down to St. Ann’s in Riverton he ships him for further evaluation.  He sends him by ambulance.

In the emergency department of St. Ann’s Hospital, he is sequestered in a private bay with sliding glass doors.  His own chrysalis.  The family that he has still living in Riverton, come to see him, his mother and two brothers.  The brothers leave to pick up his van that he has left in the parking lot of the hospital in Delta and to check on his mongrel bitch.  They are not there when a lanky ER doctor with curly hair tells him that this stellar apparition represents metastatic cancer.  He makes the pronouncement like a proud schoolboy who has just found crystals form in his science experiment jar.  He says all this before he even has time to examine him.  He quickly exits saying he will get the hospitalist to admit him to the hospital.  Once he is a patient, he will be lucky: Dr. McBride will be the neurologist taking care of him.  The ER doctor orders a MRI of the head, a tool much more sensitive for looking at tumors in the brain.  When he arrives, the hospitalist repeats the requiem refrain that he has cancer that has spread to the brain.

When Chase finally sees McBride the following morning, she tells him that she has good news.  The stellate cloud on the CT and MRI scans appear to be a cavernous hemangioma, a benign tumor that usually causes no further problems.  On the MRI, the star-like lesion has formed a tightly grouped constellation.  She has reviewed the scans with the radiologist on that weekend.  And he concurs.  To be on the safe side, they will repeat the MRI in three months and make sure that it has not grown.

And so Chase retreats to his mountainside retreat, the diminutive retirement home he owns in Paonia.  While he waits for the second MRI, he walks his dog, he reads, he watches TV, and he takes Keppra to prevent a second seizure.

Time passes.

He undergoes his second MRI.  Following the head scan, he reports to the steel and brick state-of-the-art medical pavilion where McBride has her office.  When McBride enters, she holds a sheet of paper she hands him.  On the top of the article, is the word: Astrocytoma.  Chase scans the rest of the article, and it points out the various types of astrocytomas, all of them malignant.  Chase shows the least amount of anxiety, pressing his hands hard down on the fabric of his jeans as if to smooth them.  She sits down beside him, and says, “The lesion has grown.  It was six millimeters, now it is nine.  He brushes his lanky and curly grey hair back from his brow.  I think you have a glioblastoma multiforme, the most lethal of the astrocytomas.  He starts to say something, but bites back on it.  “I can tell you are upset,” she says.  “Try taking a deep breath.”  She places a hand on his knee.  Breathe in deeply…Hold it…Breathe out slowly.”  After a few minutes she adds, “I am sending you directly over to Dr. Merrion’s office.  He’s a good neurosurgeon.  He’ll take good care of you.”

A nurse escorts him from McBride’s office to Merrion’s.  When Merrion arrives, he pulls up the two MRIs on his television monitor.  “Yeah, that’s a tumor!” says Merrion matter-of-factly.

“You can tell that from the first MRI?”

“Oh, yeah.  We just needed to go in and get a piece of it for a proper diagnosis.  The problem of astrocytomas is that they send out roots, just like a tree.  It is impossible to completely resect them.  What we need to do is schedule you for surgery and prepare for radiation and chemotherapy.”

“Is it fatal.”

“We need to go through the treatment.  Then you need to enjoy what days you have left.”

Chase undergoes the procedure.  Merrion clips out some of the tumor for a diagnosis and removes what he can of the tumor. its roots extending deep into the core of the brain.  It is what McBride and Merrion say it is.  He puzzles over the fact that they couldn’t have picked it out in the first place.  He undergoes radiation therapy, followed by chemotherapy.

He does well for approximately ten months.

Then one day in the middle of the week, he suddenly has his second seizure, despite being on anti-seizure medication.  When he awakes, it is dark.  Again, his muscles ache.  But this time, they are weak.  Too weak for him to stand.  He can’t even move.  Lying on the floor for two days due to the weakness, his dog stares at him as if he were a creature she didn’t know.  Finally, there is the strength to crawl to the phone.  But the battery is dead.  He crawls on and grabs the fob key to his van.  He presses the button to blare the horn.  After honking his horn for about two hours, his neighbors grow suspicious and go to check on him.

When he reaches me next, he has been in a long-term care center for a few days.  “I think I’ve turned the corner.”

 

 

By Joseph Dylan