Fallen: A Trauma, a Marriage, and the Transformative Power of Music Read Online Free Page A

possible score and indicating the lowest level of consciousness. The nurse continues to speak, but the words blur into a smudgy, gray tangle in my mind: Catastrophic. Devastating. Life-threatening.
    “I’ll take you to the surgical waiting room,” she says. “You can wait there.”
    GUIDO IS SITTING in a chair facing the door of the waiting room. He sits with the kind of effortless posture instilled through years of practicing the Alexander technique of efficient body alignment, a posture that evokes both grace and vulnerability. He is our inner circle, our closest friend since the early days in Montreal, and, for both Simon and me, like a brother. He is Eli’s godfather, part of our family. He stands and holds me and I allow myself to exhale a long-held breath.
    “Okay?” he says.
    “Okay.” As I inhale, my breath rasps down my throat, strange and shallow. The air, in this closed room, under the fluorescent lights, is all wrong. It vibrates and hums with an eerie dissonance. I sit beside Guido, woozy with a nightmare lightness. The social worker has already spoken to him, and there is no other news. Simon is still in surgery. And so we wait, time trembling to a standstill, a still life. The seven of us seated, silent. No words, nothing to say.
    And we wait.

{ 4 }
STAT CRANIECTOMY
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    SIMON IS IN a decerebrate posture when he arrives at the hospital: arms and legs straight and rigid and his head and neck arching backward. The zombie posture. A decerebrate posture is associated with a very poor prognosis, indicating that massive brain damage extends from the higher portions of the brain into the brain stem. A decerebrate posture means that internal pressure has caused brain tissue to be moved or pressed away from its usual position inside the skull. In Simon’s case, the pressure from the buildup of blood in his left hemisphere caused the top section of the brain stem to shift down and to the right—a transtentorial herniation—so that the brain stem’s fragile tissue bulged out from the narrow confines of the tentorial notch, the triangular opening through which the brain stem extends. The preservation of the brain stem’s integrity is critical to a body’s survival, as the brain stem controls our most basic functions—breathing, heart rate, blood pressure. And Simon’s brain stem has been compromised.
    The Glasgow Coma Scale ( GCS ) was developed by Graham Teasdale and Bryan J. Jennett at the University of Glasgow in 1974 to objectively evaluate the degree to which a person is conscious or comatose. The scale measures three responses: eye opening response, verbal response, and motor response. Each receives a score from 1 to 5, for a maximum score of 15, which indicates a normal level of consciousness. The lowest score is 3, which means there is no response in any category. Anyone scoring 8 or under is considered to be comatose. The general rule is that the longer someone scores 8 or less, the worse the prognosis is for meaningful recovery. Within the first thirty-six minutes of Simon’s arrival at the hospital, the Emergency department records his GCS five times. The first three times Simon scores a 3—no response on all accounts—but the fourth time, after he is intubated and during his CT scan, he scores a 5 in motor response, for an overall score of 7, meaning that although he is neither speaking nor opening his eyes, he is responding to localized pain. He is sedated then, and six minutes later returns to being completely unresponsive and is taken to the operating room for a STAT craniectomy, “ STAT ” indicating that immediate, urgent medical intervention is required.
    Here, a neurosurgeon named Dr. Haw removes a large portion of the left side of Simon’s skull. Dr. Haw then cuts into the dura, the first of the protective layers that surround the brain, and begins the delicate search through Simon’s left temporal lobe for the ruptured artery that is pulsing blood into the precious neural