VERY HIGHBROW

For most of the time now, grandmother sleeps, in a body that she hardly seems to recognize. Her mouth is filled with canker sores. The scab on her upper lip, a result of her fall nearly three weeks ago, still has not healed – a paradoxical side effect of the oxygen mask she needs to keep her alive. She has lost weight and I was startled last night to feel how thin her calves had become, how loose the skin. But still, I repeated loudly what the nurses had said to me two weeks ago, “Grandma, all the nurses say you have excellent firm skin for someone your age.” We think she is sleeping, but we know too, that when you sleep all day, it is always a half sleep, never deep.

Before, when she still had energy to speak she lifted the oxygen mask just long enough to look at my mother and say, “How did it come to this?” 

It seems like half a year ago that the doctor deemed her well enough to commence physical therapy, but in truth it was just last week, when she showed signs of improvement and when her body was still hers. When we visited that week, we found two towels stuffed into the sides of her bed. We pondered these towels until evening after dinner she grabbed one between both hands, held it shoulder width apart, and began to twist and twirl them through the air in a choppy figure eight. It was an oddly elegant motion, and my grandmother performed it with a similar albeit shaky elegance, eyes closed and lips pursed. At times it appeared as though she were chanting. Even this tiny movement caused her to wheeze and I wondered about its effectiveness. My grandmother’s arms are strong, much more so than her legs which have undoubtedly been weakened further after two weeks of bed rest, but I suppose at this point you strengthen what you have and pray the rest will follow.

At the very least, the exercise helped pass the time. If you are a bed-ridden patient in the hospital, there is plenty of time. Twenty-four hours a day for fifteen days and counting, every hour blends seamlessly with the rest because in the hospital room with its darkened windows, one really cannot rely on the sun. My aunt, uncles and mother, my grandmother’s four children, take turns spending the night with her, given a break only occasionally by me, the unemployed grandchild with nothing but time and a stack of unread magazines. When the lights go out and my grandmother tries to sleep (though it is rare that she sleeps for an hour straight), I take out my CD player (a relic, nowadays) and listen to an audiobook. My aunt often asks me not to go – I am too young, I need my rest, etc. etc. but I stare at her sixty-year old face and say, “Yi-Mah, I’m twenty-six, it’s nothing to me.” And of course a few all nighters here and there are nothing, but she and I both know that if my grandma’s status were to suddenly take a turn for the worst, it had better be one of her own children than me, a grandchild with hardly any history. In the grand scheme of things, my life is but a tender, green branch, near the top of a towering oak tree.

Morning arrives and my grandmother stirs in her monstrous mechanical bed, not because she is well rested but because she is exhausted and tossing and turning is the only thing she can do to pass the night. I look at the clock; it is 6AM and neither of us has had any sleep. Between the beeping of her oxygen monitor and other patients’ IV drips and nurses who, so accustomed to their nocturnal lifestyles, forget to lower their voices in the hallway and the hourly visits of the Respiratory Therapist and the Nurse’s Assistant and the Nurse to administer one or two of my grandmother’s dozen steroid-based medications via the painful IV in the thin skin of her hand (re-positioned every two days to prevent infection) or the respirator or through the mouth, rest is clearly the only thing not administered to a patient in a hospital bed.

But still, the sun is just beginning to show itself and despite my brain crying for sleep and the danger of driving home in this exhausted state, I find myself striding out of the hospital’s sliding glass doors, slamming my car door and weaving in and out of traffic, racing home to my own bedroom which is free of other patients, free of fluorescent lights and free of commodes and bedpans and IVs. Anything but the confines of that small, dim space, to which my grandma is chained both by the oxygen tube that keeps her alive and by the weakness of her legs. Anything but that dim space in which she will remain until God or Zithromax and her seemingly impotent cocktail of corticosteroids are finally able to oust the stubborn phlegm in her lungs, though today it is clear that God is waiting because the drugs have failed.

To call myself a prisoner when I am free to leave at any time is to rub my grandmother’s present eternity in her face. But in truth I am trying to contrast a portrait of youth, myself, who knows nothing of patience and the most patient of patients, the etymology of which I am only beginning to grasp.

Firstly, thank you to those who have sent kind words and thoughts to my family. They are greatly appreciated.

As I write this, my grandmother’s lungs slowly fill with water. She has now been in the hospital for fifteen days, mostly lying down in a bed that is more flexible than she. To move her up or down for meals, we move the bed with the push of buttons conveniently labeled with enormous arrows. And while her arms are still quite strong, it is getting harder for her to push herself up. Occasionally she will sit up with a sudden, startling swing of her legs to the left side of the bed and point at the bedside commode*.

“Move it here,” she will say, “I’d like to sit for a while.”

At first I wondered why she would prefer the hard plastic seat of the commode to the soft mattress, but I thought to my own preferences when dining out, how I prefer chairs to banquets, tables to booths. Squashy seats take away any strength you might employ in your core, the muscles of which enable you to sit up straight and feel dignified, part of regular society. Sometimes she just wants to sit up in bed, but most of the time, if she has made it this far, she wants to sit on the commode. Not use it, just sit on it.

So whomever is at her side will stand behind the commode with arms outstretched in case she falls backwards and wait as she lifts herself up and off the bed, stands for several shaky seconds on her soft legs and turns around inch by inch, the bulk of her weight supported by her strong arms pressing down on the mattress until finally, her bottom is aligned with the top of the commode. With a heroic exhalation, she sits herself down. Panting. This has been for the past two weeks, my grandmother’s main source of exercise and movement, as well as the maximum distance traveled: less than a foot, from bedside to commode.

For all of us with clean, clear lungs and strong, straight legs that can take us from here to there, and even for those of us in physical states similar to hers, my grandmother is a paragon of patience and endurance. A single night in the hospital has me crawling for fresh air, release, sunlight, and did I mention fresh air? The room is like a vault of stale, overused air, far from sterile and filled with the smells of a million different medications, over-boiled hospital food, and of course, other patients plus all that they emit. It is perpetually dim, even near the window, which hospital administration thought necessary to coat with a darkening agent, as though sunlight was the last thing recovering patients needed. As such the interior is brightened only by the  light of two fluorescent bulbs, one deemed “room light” and the other “reading.”

The Improvised Field Hospital     Jean Frederic Bazille, 1865 Oil on Canvas

There is a cheap grey cabinet where patients and family members can store their things, upon the doors of which hang plastic dry erase boards where at every change of shift an energetic nurse comes in with a marker and rigorously erases the last nurses name and writes her own. The board is a bare bones overview of every patient’s “needs,”: the name of the doctor, an elusive man named Hsu; the patient’s diet preferences which in my grandmother’s case is an unappetizing category called “mechanical soft,” and laughably, the “activity for the day,” which is more or less nothing, though hospitals prefer the term “bed rest.” Beneath it all is a row of yellow smiley faces, though not all smiling: they represent a range of emotions: a smile, a grimace, a frown, and a cartoonish scowl meant to signify extreme pain. This is the pain scale – and every patient has a “pain goal,” ranging from 0 to 10, though understandably, a 0 is written on every patient’s board.

To the side, there is a height-adjustable table with difficult wheels, for meals, and a single, vomit-colored chair for visitors. These cramped quarters are meant to accommodate two patients. In the past, before enormous hospital beds and giant breathing machines were invented, this might have been a semi-comfortable set up, but now the machines take up more than seventy percent of the space, forcing nurses and family members to do an awkward dance each time the patient needs something. A dingy yellow curtain divides the room in half, though only by sight, leaving everything else that ought to be blocked (light, sounds, smells) from the other side and the outside, utterly available to torment you and your neighbor. Due to the lack of space, the curtain almost always drapes over something: the vomit colored chair or the commode or the table where your food is placed. You wonder if the hospital ever launders that yellow curtain which is probably as old as the hospital itself and when you arrive at the conclusion, “Probably not,” shake the thought away because it is the wise thing to do.

Most awkward of all, as though privacy and the rest that might result from such privacy were, along with sunlight, unnecessary for full or at least partial recovery, is the fact that even if the room next door is empty, they will always fill the spare bed in your room first before using the empty room next door.

Thus for the past two weeks my grandmother has had a half dozen roommates whose faces she has never seen and some whose voices she has never heard but whose presence and sicknesses can be felt because they are less than three feet away. In years past my grandmother was always the first to leave. She was the one whose health rebounded quickly, astounding doctors and nurses alike. When she left, usually in a wheel chair, they would pat her on the back and say, “Don’t come back,” and she would nod happily, “Of course not.” But now the other patients have come and gone, come and gone, and my grandmother remains.

*For days I called it the “bedpan,” until a frustrated nurse corrected me. “This is the bedpan,” she said, holding up a plastic bedpan, “And this,” she pointed at the aluminum frame that held a plastic toilet seat which sat over a plastic tub for waste, “Is the bedside commode.” I stood there with my GRE textbook and said dumbly, “Thank you.” 

Last Wednesday I volunteered along with my uncle to stay overnight in the ICU, where my grandmother lay under yellow fluorescent lights with a monstrous BiPAP breathing machine strapped to her face like a giant muzzle. A giant muzzle with a blow dryer attached to it. The machine’s function was to push as much oxygen into the patient’s lungs as possible, since the patient’s lungs were most likely resisting their intended purpose, but the machine did not so much help its patients breathe it seemed, as make their last remaining breaths on earth extremely uncomfortable.

For twenty-four hours a day the BiPAP Vision (I have no idea what the “vision” part means) forced air into my grandma’s failing lungs with a horrible, constant whooshing sound, not unlike an industrial strength vacuum cleaner that made the deep, intimidating breaths of Darth Vader’s mask seem like a kitten’s purrs. It cracked her lips and parched her throat, but worse, the pressure of the air forbade her to take any food or water as there was the danger of the air blowing the food down the wrong pipe and causing an infection all over again.

The BiPAP machine should have prevented her from talking, but my grandma has not, for the past ten years (or for the past sixty-eight years that they’ve been married, if you ask grandpa) been one to shut up. The only time she was silent at the hospital was when she had to choose between speaking or breathing, and when that time passed, she was talking again as best she could through the racket of the BiPAP machine.

“Tell her not to talk so much,” my grandpa said over and over again when we visited her in the ICU, “She needs to rest.”

At the time, I had been crying for what seemed like two days straight and was overjoyed to see my grandma well enough to be talking, and I chastised her ornery, often sullen and always stoic husband, “Oh Grandpa, if she wants to talk, let her talk. Someday soon you might not be able to hear her voice at all.”

He looked at me. “What’s that supposed to mean?”

I thought it was obvious, but didn’t respond.

“Oh you mean if she’s dead?”

“Well, yeah,” I said, and my grandpa snorted angrily and walked away.

It was an insensitive thing to say to a man whose wife was hanging on for dear life, but still, I stood my ground. Grandma’s status was far from stabilized and I wanted her to have her say, lest she leave us with wise words unspoken. She never went to college and had little need for books or newspapers, preferring to spend an evening cooking for her progeny, but she’s been around for eight-seven years and it’s not lost on any of us that she raised four filial children, ten adoring grandchildren and maintained a bittersweet marriage to a very difficult man. On top of that she could, as my aunt put it, be the darned community leader of Sunshine Park, where she and my grandpa took their daily morning walks when her lungs still allowed it. I’m sure that for the past twelve days the denizens of their little cul-de-sac have been scratching their heads, wondering where darling talkative Mama Leu is. But word spreads quickly and my grandma’s hospital room has had from the very beginning a nonstop flow of visitors both related and not. People love her. The nurses love her. We love her. There is definitely something to be learned from so much love.

Grandma post ICU and BiPAP, reading about Warfarin.The hair is really something special.

During the first two evenings, when grandma’s vitals were all over the place and when her only hope of leaving the physical world in peace was upon morphine’s calming current, we leaned in close to the mouth cover of the BiPAP machine each time she wanted to speak. If she was at the end of her life, we reasoned, whatever words she spoke would take great effort and we wanted to make sure they were heard.

At first, she cried and we cried and when she spoke her speech waffled back and forth between acceptance of her fate: I’m ready to go, I’m not afraid, don’t be afraid, (I’m rattling them off now but in the moment those are very sad words); and flat out rejection: I’m not ready to go, I don’t want to go, I don’t want to go, I don’t want to go (these are ten thousand time more heart-wrenching and, it turned out, a reflection of her true heart). A few days later when the antibiotics and steroids had taken effect and the infection reduced, she was well enough to inform my grandpa thus: “Don’t listen when someone tells you they’re not afraid of death. Liars, all of them.”

As her condition improved however, thoughts of death and dying floated away and her mind busied itself with other things, namely, hubris and prejudice. That Wednesday night, two days after I’d admonished my grandpa for telling her to shut up, I found awake in the ICU at 2AM, wishing my grandmother would do just that.

Her nurse that evening was a pretty middle-aged black woman with long, curly hair and a perky butt, which according to her, was one reason she was constantly being hit on by reckless young fools in the ER. (“They don’t know I’m old enough to be their mother,” the nurse said smiling to herself). We chatted a bit here and there as she changed my grandmother’s iv, wrote down her vitals, and, occasionally, changed the bedpan – the most unassuming yet menacing reminder of our mortality, if there ever was one. Whenever she clicked her pen to go, I leaned down towards grandma, who even in the deadest hours of the night could not sleep due to the incessant pressure of the Bipap, and asked if she needed anything.

Grandma struggled to unclip her mask and I hurried to help her out of it, worried that she needed more pain medication, “What is it? What do you want me to tell the nurse?”

“Does she know you’re my granddaughter?”

I stared at my darling grandmother. It was two in the morning, she had just come back, it seemed, from death’s door. This was the most pressing question she had?

“What does she need?” the nurse asked kindly.

I chuckled,  aware that my face was, because of the time of night, a sickly yellow pallor, made worse by the unflattering ICU lights, “Oh nothing, my grandma just wants to know if you know that I’m her granddaughter.”

The nurse smiled, “Of course! Your grandma is really proud of her whole family. Earlier I think she was trying to tell me that she had what, twenty grand kids?”

“Ten,” I said. “Ten.”

The nurse nodded towards my uncle who was not quite nodded off, but headed there. He smiled at her.

“And is that your dad?”

“No, that’s my uncle.” 

Grandma tugged at the mask again, this time more hurriedly and I rushed to un-clip it.

“Tell her I’ve got two great-grand kids,” my grandma said, “And two on the way.”

I bit my lip, but the nurse looked at me expectantly. I told her. 

“Wow, that’s such a nice big family you guys have,” she said, “I saw a lot of people gathered around here earlier. She’s lucky to have you all be so close.”

“Yeah,” I said, and looking affectionately towards grandma, I nodded, “She’s pretty special.”

I reached down to clip the mask back on and right before her voice was muffled my grandma asked, “Ask her to guess how old I am.”

I told her to shush and get some sleep. The nurse had other patients in more critical states to attend to.

At four AM, I had all but given up on sleep and instead watched my grandma toss and turn and poke and prod at the plastic mask, one moment scratching the top near the bridge of her nose, at where the mask had dug a fresh red groove, and another scratching the back of her neck, where the Velcro straps no doubt caused a horrendous itch. It was a modern medical torture device and I wanted to rip it off as much as my grandmother did, but if it was removed for more than ten seconds, the blasted machine it was hooked up to would start an incessant beeping and the nurse would come rushing in to admonish us all.

The black nurse came in again to read the machines and a few minutes later a black respiratory therapist entered as well to administer a breathing treatment. They chatted quietly, keeping their voices low so my uncle, who had finally dozed off, could sleep and worked their way around the cramped perimeter of the bed. My grandmother watched them attentively.

The man left, pleased with my grandmother’s oxygen levels and the nurse turned to go to. I glanced at my grandmother to see if she needed anything, and true to form her arm shot out with an alarming urgency for someone supposedly old and tired, though all too lucid.

I unclipped the mask and whispered a little too loudly for the nurse to wait. She turned and said, “Is everything okay? Does Mama need anything?”

Grandma swallowed a couple of times and her eyes fluttered upward. I wondered if the morphine was wearing off. Her mouth opened and closed a couple of times, adjusting to the cooler air and finally, she spoke, “They’re married, aren’t they?”

I was confused for a minute, then realized she was referring to the black nurse and the black respiratory therapist. In her simple deductions of the world at large, the two black people who had by the chance scheduling of their occupations ended up behind the same curtain of the same ICU at the same time, must be married.

I gave my grandma an incredulous look that she ignored and said, “No grandma, they are not.”

“They’re not?” now it was her turn to be incredulous.

“No.” I thought to explain that the nurse was not even from California, that she was a traveling nurse here for 13 weeks, and hailed from Connecticut, but these details, invisible to my grandmother, would mean nothing to her. I could tell she didn’t buy my dissent and rolled her eyes. “They seem married,” she murmured.

“What does mama need?” the nurse said, and I turned to give her an apologetic look. The nurse had been nothing but kind and understanding, and if I’d read her correctly, would merely laugh at my grandmother’s harmless prejudices, but it was four in the morning and I wasn’t about to take any chances.

“She’s fine,” I said, “Doesn’t need anything. She says you guys are great.”

And as if right on cue, grandma waved her IV free hand in both the direction of the Respiratory Therapist that had just gone and then at the nurse. She gave a thumbs up and closed her eyes, attempting to sleep perchance to dream in a world where all black nurses were married to black respiratory therapists, at least those who were in the same room at the same time.

The nurse smiled, “Oh she is just the sweetest thing.” 

When you lose your breath, it can go alarmingly fast.

On Friday, my grandmother fried a fish and made fresh green onion pancakes from scratch for dinner at her house. She kneaded the dough with the same strong strokes she’d always used, a little stronger than usual perhaps, as the pancakes came out tougher than usual. As they fried, she wiped away beads of sweat with a powdery white hand. After dinner she told me not to wash the dishes and slowly cleaned the kitchen in her own methodical way. I had my back to her, eating a Nestle Caramel Sundae and when I turned around to throw the wrapper away saw that the kitchen was sparkling clean. If my grandmother was hampered at all by severe shortness of breath or weak legs, you could not tell by the food she put on the table or by the spotless kitchen she kept. She joined us at the table and shared a Nestle Caramel Sundae with my grandpa. She laughed gleefully when I said her fish was unrivaled.

“As long as I can cook for my grandchildren, I will cook for them. Who else can make their favorite dishes the way I can?”

“They are our favorites because you made them so,” I said.

On Sunday, her steroids stopped working and the oxygen tank, with its efficient little whirring and long clear plastic tubing could not deliver enough air to her lungs, the function of which has deteriorated exponentially, as though racing with her frail legs. Which will fail first? It is a race we hope the lungs will lose.

She breathed deeply, desperately into the oxygen machine, hoping the relief would come, but instead her face grew redder and redder and her mouth gaped and gagged. My grandfather could no longer distinguish between a recent red scar she’d gotten from falling on her face and the rest of her skin. He called my uncles, who drove their suffocating mother to the hospital. They were worried, but the drive, her falling, her troubled breathing, these were all more or less routine for the past two years.

They stayed with her at the hospital through the afternoon and in the evening, bid her goodnight. Not because they wanted to leave, but sometimes, she does want them to leave but won’t say it.

On Monday, my uncles returned to the hospital in the morning and later in the afternoon, my mother joined them. The nurse pulled my uncle and mother aside.

“It doesn’t look good,” she said, “The oxygen we are giving her is not enough, and the steroids don’t seem to be taking effect. You and your family need to discuss the DNR.”

I called my mother shortly after this conversation and she cried into the phone. It was around six in the evening.

“Will you guys sign it?” I asked.

“I don’t know,” she said, I could see her face crumpling, “It’s terrible when they try to resuscitate someone. They cut into the throat…it’s just so violent and terrible and you’re never sure what happens after that. Sometimes they don’t come back and they’re just hooked up to the oxygen machine for years.”

It wasn’t my place or my decision, but a hundred images of other old people hooked onto said machines flashed in my head. I saw a lot of sad, fearful faces looking down at blank staring eyes perched atop freshly fluffed pillows. It’s a touchy subject, I know, but sometimes, sometimes you think about this thing called quality of life and dignity and even though I’m only twenty-six and years away from making a decision like that (knock on wood), I said what I felt: “Sign it.”

“We will wait until we’re all here,” my mom said, “But I think we will sign it.” I heard her face crumple again. We hung up.

At 11PM they reached a consensus. My grandmother was moved to the ICU as her DNR was signed.

It is Monday night and my grandma lies sleeping fitfully in the ICU, unfit to do anything, not even breathe. Last Friday, she was frying a fish and making fresh green onion pancakes.