Richard H. Schmidt, MD

I attended a continuing education lecture at my hospital early Friday morning. The topic was "Emergency Room Treatment of Serious Head Trauma;" the lecture was a "Grand Rounds" presentation broadcast live via Internet from Primary Children's in Salt Lake. I still work a few shifts in our local ER, so I try to go to these type of things when I can.

I arrived a few minutes late, so it took me a minute to realize why there was something familiar about the speaker. His name was Richard Schmidt, MD, and he is a Professor of Neurosurgery at the University of Utah where I went to medical school.

That's not how I knew of him, though. Dr. Schmidt is the guy who operated on my mom about nine years ago when she had a ruptured arterial aneurysm in her brain. Without question, he saved her life, so of course I have been a fan ever since. I have occasionally run across his name reading medical articles with his name as an author; I have even referred a patient to him since I've been in Rexburg, a young man that I diagnosed with a cerebral arterio-venous malformation a couple years ago.

His lecture was very interesting; I discovered he is not just a great surgeon but an eloquent orator too. I must admit, though, I was having just a little trouble concentrating, as running across him brought back all kinds of memories about that very scary time for us all those years ago. I still remember how apologetic and truly distressed he was when we learned that Mom had lost vision in one eye as a results of his surgical approach. You could tell he felt awful, like he expected better of himself. We feel the same way now as we did then; we're just glad to have her still with us. In fact I, for one, hardly ever remember that she has monocular vision now. Her eyes both look completely normal and she never complains.

At some point after that whole ordeal, I wrote an essay about it called "Subarachnoid Hemorrhage," which I dug up in my old computer files tonight and will post below. If you have a few more minutes and any more interest, keep reading...

"Subarachnoid Hemorrhage"

by Clay Prince, MS3

"Hello? Yeah, hi Dad."

"Oh man, what time is it? I rub my eyes, trying to focus on the clock across the room. 6:30 a.m. It’s early—even for him.

"Wake me? Nah, not me. I’m up."

Yeah, right. I’m right in the middle of my only vacation in months. Three days ago I took step one of the National Board Exams, the most grueling, ruthless test that a medical student has to take. I studied a solid month, fifty hours a week minimum, and now I have a week off before third year clerkships start. It’s Friday morning, the start of the weekend. Yeah, sure I’m up.

"Sorry to bother you so early. I know you’re off from school and everything."

"No problem, Dad, really." The sleepy, sluggish gears of my mind slowly begin to turn as I wonder about the reason behind this early morning call. Fishing. We are supposed to go fishing tonight. He is calling to cancel, calling early so I can make other plans.

"So, uh, how’s it going?" I say, already disappointed. Then, even before he answers, it hits me and jolts me wide awake. Something is wrong.

“Well, not too good, actually.” His voice is strangely quiet, his words slow with the effort of forced calmness.

“What is it, Dad?” In the instant before he speaks again, I frantically search my memory for another time when his voice sounded this way. I want some kind of context, some frame of reference to place myself within to cushion the blow instinct says is coming. There is none. This is something new. In twenty six years of knowing my father, I have not one experience, not one instance in memory to associate him with fear.

I suddenly notice that I am cold. The kitchen tiles feel cold on my feet as I stand in my underwear at the kitchen phone.

“This morning, she got up to make breakfast just like she always does...”

While I listen I somehow notice curiously that I am becoming intensely aware of my surroundings. I hear a bird outside, chirping tentatively, and the absolute silence of the rest of the house penetrates my consciousness.

“A few minutes later, as I was getting out of the shower, she came staggering back into the bedroom...”

Even in the soft light of the early dawn I can see every detail in the room. I feel alert, vigilant, and even as dread washes over me I fleetingly wonder if this feeling I am experiencing is “fight or flight,” a sudden, intense flood of stimulation from my nerves, telling my senses to be ready for anything.

“Now she has a terrible, terrible headache, and she can hardly stand up.”

Subarachnoid hemorrhage. It is the first thing that comes to my mind. Blood, under pressure, spilling into the closed space of the skull, into the brain. Blood, washing over the twisted contours of gyri and sulci like a great flood from a broken dike. Blood, full of caustic chemicals and polluting proteins, coloring the pure clearness of cerebrospinal fluid like crude oil spilling into a pristine lagoon. Blood, upsetting homeostasis, increasing pressure inside the head. Blood, causing pain—extreme pain.
“She’s never felt anything like this before. She says it’s the worst pain she’s ever had.”

‘Worst headache of my life.’ The description learned in those second-year medical school classes is there in an instant, surprising me even as it comes that my memory is so acute: Patients with subarachnoid hemorrhage complain of extreme pain. Words like ‘explode’ and ‘burst’ may be used. The headache is often called by the patient “the worst headache of my life.”

“Since you’re the medical person in the family, well, I guess you were the first person I thought to call. I was just wondering...” There is a pause while he searches for words. “Can you give me some advice here?”

Now, added to the shock of this unfolding event is an incredulousness I feel that my father, the man to whom I have taken every unsolvable problem and been given a solution, the man who I still think knows everything worth knowing, is now asking me what to do. It might be that my father and my lifelong admiration for him are part of why I chose to go to medical school. I mean, who knows? It could be that my feelings while growing up that I could never be as good as him, as smart as him, as utterly competent as him, are what steered me to a profession completely unlike anything he has done. Certainly his high expectations of me and constant reminders that “You can be whatever you want to be if you’ll work for it, son” are what gave me the confidence to try for it and the drive to succeed. Now, for what may be the very first time, my father, my childhood idol, is seeking my advice. Somehow, superimposed on my sense that something terrible is unfolding, I suddenly feel grown up, important—an equal.

“Well, Dad, this could be any one of a hundred things, and most of them aren’t that big of a deal. But I am thinking of one thing in particular it could be, and if it is that, it is very serious.” I realize as I speak that the words are correct, textbook. I try to sound confident, precise, but I can’t help feeling like he sees right through me. I have studied medicine for two solid years, memorized a zillion things, doubled my vocabulary. I just took and passed a standardized national medical exam. I am halfway to being a doctor, and in a terrible instant I realize how pathetically little I know about medicine.

“What do you think I should do?” He tries to ask it casually, as if asking my opinion on whether the fish are biting, but he cannot hide the urgency in his voice, and I realize that my answer right now is very important.

“Well, I think she needs to be seen. She should be seen right away.”

“Where should I take her?” Let’s see. Think. Salt Lake City with its major hospitals is 45 minutes from his house. Park City, Utah, itself a small town, is the closest place with 24-hour medical care. “Probably Park City, Dad. I would take her there just so she can be seen faster. I think they have an Instacare or something.”

“I don’t know where it is.”

“I don’t, either. You’re going to have to look in the phone book.” It is as if I am gaining confidence, becoming more sure as he becomes less. “Call them first, Dad. Let them know you’re coming.”

“Think it will be in the yellow pages?”

“I’m sure it is, Dad. Call them right away.”

“Okay, I’ll do that. Thanks.”

“No problem, Dad. Let me know what happens.” I hang up, drained, and once again I notice the cold. I try to contemplate what has just taken place but instead my mind goes blank. There is too much to process it all just now. I step to the sink and pour a glass of water from the tap and drink, trying to swallow the lump in my throat. All of the calmness, the surety I had maintained while on the phone has evaporated, and all of a sudden I feel naked. I am underdressed for what has happened and I want some clothes or at least a robe with which to cover up.

Feeling helpless, I go to my bookshelf like an alcoholic to the friendly bottle. Pulling out my newly purchased copy of Harrison’s Principles of Internal Medicine, I quickly thumb through the index and open to the page where I find the printed words soothing. I said the right thing. It was all correct. For the first of what is to be many times over the next several days I feel a strange and powerful mixture of emotions, confusing in its intensity. No one close to me has ever been seriously ill. For the first time in my life I have become the 'loved one,' the 'concerned family member.' We have never had a real crisis in our family. We have no experience with family emergencies, and I find this new experience terrifying. Strangely, though, I simultaneously feel electrified and proud somehow, glad with the satisfaction of knowing that after all the constant memorizing, after the seemingly endless process of mental binge and purge of the past two years, I do know something after all.

Medical students are taught to dread ‘the pimp,’ a barrage of questions asked to the student by an attending physician on the hospital wards about a particular patient or condition. These questions are supposed to aid the student in the process of learning, but they are often seen as an attempt to humiliate, or at least to humble, the student, by showing him that he doesn’t really know as much as he thought. The attending physicians take great pleasure in asking these so-called ‘pimp’ questions, and, in turn, the students take great pleasure when, on the rare occasion that they know the answer, they are able to give it correctly. I feel like I just had my first ever pimping, my initiation to clinical medicine, and my father was the attending! How gratifying that I knew it, that I was right—off the top of my head I was right. And how horrible, how terrifying, how unimaginable, that I might actually be right.

A few minutes later he calls back, no longer trying to hide his worry. He can’t get her into the car. She can’t walk. She doesn’t want to go—still in her pajamas, after all, with no make-up. She thinks if she moves she will throw up, or pass out.

“Call 911, Dad.”

“Really? You think so?” He says it as though he is glad someone else was thinking it, too. Neither of us has ever dialed it before, never even considered it. We have never had reason to.

“Hang up and dial 911. I will meet you in Park City.”

I drive surprisingly slowly. By the time I reach the small Instacare I have nearly convinced myself that everything will be fine. She is in the middle of a pretty rough menopause with all of its weird symptoms. She is healthy. She doesn’t smoke. This sort of thing just doesn’t happen in our family. Probably just a migraine headache. My assurance evaporates, though, with my first glimpse of her as I enter the room. She is white, ashen, and the lines of her face are drawn out in an involuntary grimace that makes her look as if ready to panic. She looks fragile, delicate, and very, very ill. I realize that I have never seen her in pajamas past 6:30 am, and then briefly wonder why such a thing would strike me at this moment.

“Hi, Mom.”

“Hi, Clay.” Good, she recognizes me, at least.

“Not feeling very well, huh?” I realize I sound pathetic. I have no idea what to say. I move close, and pat her hand. She seems not to notice, and this disturbs me.

My father and I exchange glances. All of the fear I detected over the phone is visible in his eyes. At that moment, without consultation with the doctor, without tests, without imaging studies, I know without doubt that something is terribly, terribly wrong with my mother. I see the same realization in his eyes, the same confirmation taking place inside him.

“Where’s the doctor?” I ask.

“I don’t know. He came and looked at her. I haven’t seen him for ten minutes or so.”

“What did he do?”

“Nothing. He is trying to decide whether to send us down to Salt Lake.”

“Well, what is he doing?” I look around the large room. There are several other beds, mostly empty. One other patient is resting comfortably nearby.

“I don’t know. Do you think we should go and find him?”

A man enters the room and walks toward us. He looks young, not much older than me. He is short, casually dressed. No white coat. Earring.

“Is that him?”

“Yeah. That’s him.”

We shake hands. He introduces himself, and tries to make small talk.

“Well, what’s the plan, doctor? What’s going on?”

He proceeds to repeat the story my dad told me on the phone, and says he isn’t sure what it is. “It could be a lot of things, and we just need to rule out a few serious things.”

“What about subarachnoid hemorrhage?”

“That’s a possibility. I don’t think it is the most likely thing.”

“Why not?” I do not want to ask these questions. I told myself early on I would never be the cocky, impudent medical student who thinks he knows it all. He is, after all, the doctor. He is the attending physician here. Still, the questions pour out of me, and as they cross my lips they sound like accusations.

“Well, for one thing, she never lost consciousness. People usually lose consciousness briefly at the onset.” I wonder if he had been reading that in Harrison’s just before he came into the room.

“Well, what are her vitals?” This question surprises even me, and even as I ask it I realize I will have no idea what the answer means. The physician is silent, looking at me. Then, he looks at the ambulance workers standing silently nearby, as if to ask for help. His earring gleams in the fluorescent light. When he turns back to me I can see shame, or maybe just irritation, in his countenance. He knows that he should know that one, and he knows that I know he should. I am acutely aware that my mistrust of him now shows plainly on my face.

“Her pressure is 110/50 or so. We are having a hard time getting a diastolic reading,” says one of the emergency medical technicians. “Her pulse is 50.” These guys, volunteers, live in the small community with my parents. One of them drove the ambulance once when I was injured at work and had to ride to the hospital for stitches. They know Mom, and they are worried too. One of them is slowly wringing his hands. “She has been stable and alert the whole time.”

“We are just getting ready to send her to Salt Lake for a CT scan,” the doctor says. “It is the only way to know for sure.”

“Well, let’s get going, then. What are we waiting for?” I can’t believe my own voice.

“I just called the hospital. They will be waiting for you. I think we are ready now.”

I am relieved. I want out of there. I want her back in the ambulance. I want her in Salt Lake City. I leave my car there and ride with Dad, telling myself he needs me to be with him, but knowing it is me that needs to be close to him right now.

Once we arrive, things begin to happen quickly. The ER physician who greets us does not waste any time. “The CT scan is positive, we can see blood in her brain. It is quite an extensive hemorrhage. This is a very serious condition. She needs immediate surgery. We are transferring her to the University of Utah Hospital, where their neurosurgeons are better prepared to handle this problem.”

His abruptness and efficiency are unnerving to my father, who looks dumbfounded, confused. My sister, who arrived moments before with hands shaking, begins to cry, panicked. I find his style reassuring, however. Finally, somebody knows what to do, and knows to do it quickly. Interestingly, I am not surprised much by the confirmation of her condition by the CT scan. I had made up my mind in Park City, so this was not news to me.

At the University Hospital, I feel better. These are familiar surroundings. This is where I have spent the majority of my life for the last two years, attending classes, studying for exams. This is my territory. Nothing too bad could happen as long as we are here. After all, this is the place where I have hung all my hopes and dreams for the future.

Mom has been admitted to Neuro Critical Care, the NCC, a small ward with ten beds or so with locked doors and strict rules. This is the ICU for head injuries. This is where they bring all the broken necks. This is where they bring all the motorcycle wrecks in the middle of the night, all those poor patients with swollen, purple heads, the ones bleeding from their ears. Although I have not yet been inside, I know that this is not a fun place. People do not leave here the same as they came in, if they leave at all, that much I know about the NCC. And now, my mother is in there.

As we wait outside, I remember learning Neurology during my second year of medical school. I remember being fascinated and intrigued at the complexity of the architecture and electrical activity of the brain, being intimidated by the immenseness of the human command center. I remember thinking that there is something about neurology that is different from the rest of medicine. Most physicians heal the patient, at least some of the time. They give a little medicine, cut a little here, sew a little there, and watch the patient be restored to health. The body has a tremendous ability to heal itself, given the right environment.

The work brain doctors do is different. They perform miracles, they save lives. Their surgery is perhaps the most intricate of all the doctors, their knowledge is vast. They are the electrical engineers of medicine, for they know how it is all wired. If doctors are intelligent people, neurologists and neurosurgeons are geniuses. Their work takes them past life and death to the very core of our existence. But, in the end, all they can do is shore up the problem, sandbag it. Brain injury is permanent, unforgiving. It can often be delayed, even stopped, but never reversed.

Not long after we arrive, these troubling thoughts are interrupted as a tall, young man with dark hair and tired-looking eyes introduces himself as the resident who will be working on Mom’s case. He is wearing light blue scrubs with the pants way too short, and despite this and the fact that he seems very young, he carries an air of confidence. “So, as you know, her condition is very serious. In fact, she could very well die as a result of this problem. I only say that so you will know how absolutely essential it is for us to treat her right away.”

“What are her chances, doctor?” Now, my questions sound sincere. I cannot place my finger on it, but there is something about my first impression of this doctor, this resident, that makes me trust him.

“Without surgery to repair the bleeding vessel, there is about a 30% chance that she will die within 3 months. This may be even higher for her, since she has had quite an extensive bleed. Without surgery, almost all of these will hemorrhage again within a year, and a second hemorrhage usually results in death.” I get the feeling that he is trying to convince us about the surgery. I want to tell him not to worry, that we are going to let them do it, that we want them to do it. Yes, do it! Fix it! Give us our mom back! I bite my tongue. “However, if the defect is operable, her chances of survival are excellent.

“So, how do you know if it is operable?” Again, I am surprised at how sincere I sound and feel—such a contrast from just hours before.

“We will be doing some tests, including an MRA, which is a special kind of MRI scan that allows us to look at the vessels inside her head. Based on her CT, we suspect that she has a small ‘balloon’ defect, called a berry aneurysm, in a vessel called the anterior communicating artery. If so, there is a good chance that we can repair it. The surgeon, Dr. Schmidt, has fixed a lot of these, in fact, he is really a world-renowned specialist in this particular problem. Many of these aneurysms are in that location.”

I feel tremendously better. His explanation feels like an organ systems lecture, something I am familiar with, in which medical problems and their solutions are cut and dried. In those lectures, so carefully prepared with facts and statistics, there is always the attitude that, yes, people get sick, but hey, we fix them. Just like that. Lickety split, no problem. I like that. It feels good. This feeling is something that I trust. All of this makes sense to me. They know what they are doing, and I feel my confidence growing. Everything will be alright.

“So, if you will excuse me, I need to get back. We are just finishing up our admission process, and then we can let you come in and see her. Just to warn you, she has been given some medication and is not very alert, so she may not respond to you right now.” He turns to go, and then turns back. “Oh, and one more thing. We will be doing thorough evaluations on her every 10 minutes or so. If her neurological status starts to deteriorate, we may have to take her to surgery emergently, so you will want to stay close by, okay?”

“Yes, of course,” says Dad. “We will be right here.” He forces a half smile. “And, thanks.”

“Don’t worry.” The resident returns the smile, his concern for us evident in his eyes. “Let us do the worrying now. That’s our job.”

By now we are together as a family, those of us in town anyway. My older brother had no idea how serious this was until arriving at the hospital just now. He is dumbfounded, stricken with this news, and he still has not seen Mom. My only sister, the other woman in the family, still sheds tears silently, trying to comprehend, attempting to deny. I look at the time, noticing that it is afternoon already, and then at my father, who bears a look of helplessness. Seeing his expression, I wonder what my own looks like. We all look silently at each other, each wanting to say something, but not knowing what.

It seems like forever before they let us see her, and then we are allowed into the NCC, two at a time. Seeing her offers little comfort, for she is unresponsive, sleeping deeply, and she gained a variety of tubes and wires since we last saw her. The only sounds in the room are from the monitors and IV pumps. After a short visit, we are escorted to the waiting room, and told to make ourselves as comfortable as possible—it will be awhile, they say.

So far, this day has flown by like lightning, each new event happening too quickly for assimilation of the last. Now, however, time seems to nearly stand still as we wait for answers. As time passes my mind begins to wander. I find myself repeatedly fantasizing that someone comes out to tell us that it was all a mistake, that there is really nothing wrong, she is fine. We can go home now. Various scenarios play themselves out through my thoughts as my mind searches for a way out of this, for a way that it can all just go away. Then, although I try to push them out, I have thoughts about never seeing her again. What was the last thing I said to her? What if she survives, but can’t recognize any of us? What would Dad do without her?

“I was just thinking.” It is my older brother. “I can’t think of the last time I talked to her. I mean, what if...”

“Yeah,” I answer. “I know. But you can’t think that way.” I don’t know why I am saying this to him, when he could have taken those words straight from my own thoughts. “She knows we love her.”

“This is just so...out of the blue. You know what I mean, things like this just don’t happen to Mom. I just can’t make myself believe this is all real.”

“Yeah.” He is right. It doesn’t seem real. I wonder to myself if it will ever seem real, if it will ever sink in.

Finally, after hours pass, the resident finds us again. The MRA is done. The aneurysm is in the anterior communicating artery, just as they thought. It is operable. Best of all, they now know that there is only one aneurysm. Once they get this fixed, he says, she will have less chance of having a hemorrhage than the average person. He seems very happy to deliver this news, perhaps even surprised that he does not have something worse to tell us.

“We are just finishing up our preparations, and we hope to take her to surgery within the hour. We are very optimistic that the surgery will be successful.” It is 5:00, nearly 12 hours since this all began. For the first time today I allow myself to feel relief, and I can tell that the others are allowing themselves the same luxury. We are all still very aware that she is not out of the woods, but with this news, with this plan, it is as if a tangible cloud has been lifted.

Later, as she is wheeled silently across the hall to the operating room, my dad places a soft kiss on her cheek and squeezes her hand. A single tear rolls down his cheek and falls. It lingers for a moment as a droplet on her covers before soaking in and disappearing. Seeing this gesture, I am reminded of a daily ritual I witnessed each morning as a child. Mom, in her house coat and slippers, would meet my father at the top of the stairs leading to the front door of our house. There, they would kiss goodbye before he left for work. Often they would kiss more than once, and then, as he descended the stairs, she would ask him if he was planning on coming home for lunch that day. No matter how hectic the morning or what was going on, they did this every workday at 6:55 a.m. It was such a regularity at our house that I grew up thinking everyone’s parents did it.

Now, remembering this, I suddenly want to cry, and for brief moment I am sure that the tears will flow unchecked. They do not, however, and the surge of emotion leaves as quickly as it came, replaced by a strange, hollow feeling not unlike when I used to get homesick during Boy Scout camps. As I watch her disappear through the automatic double doors into the operating room, I wish I had been able to cry, not just for the emotional release it would have provided, but also for the comfort of knowing I am normal, for the reassurance of knowing I am capable of feeling. I wonder if my background as a medical student, my learned objectivity, has hardened me, taken away capacity for normal emotions, and this thought frightens me.

There is a small waiting room just outside Neuro Critical Care, probably ten feet by fifteen, with a few uncomfortable chairs and a television propped up too high to look at. A round plastic clock hangs crooked on the wall, its cord dangling out from behind to an outlet in the wall. The family gathers there now, wondering what to do next. The surgery will take six hours or longer, according to the resident, and it seems like an eternity to wait. If we were at all involved in what was happening before, it is completely out of our hands now. It occurs to me that the operating room is one of the only places in this hospital that I have never been before. I am halfway to being a doctor, and have never in my life seen the inside of a surgery suite, have no idea what goes on behind those doors.

As I sit in that tiny room, my mind is drawn back to many long nights during the past year that I wandered the halls of the hospital, trying to stay awake while studying my notes and review sheets for an exam the next morning. Some of those times I was there all night, cramming desperately in a futile attempt to remember more than I was capable. I passed by this very waiting room several times at all hours during those nights, and, looking up from whatever paper was in my hands, from time to time had caught fleeting glimpses of loved ones waiting, wringing hands as they took their vigils there. I barely noticed them, so intent was I in memorizing the various cytochrome interactions, or whatever other medical details that seemed so important to know.

Thinking of this, I remember that once, thinking no one was there, I stepped inside and turned on the light, wanting to sit for awhile and rest from my pacing. As I flipped the switch, the bright fluorescent lights illuminated the form of a shabbily dressed man with bent glasses, wrapped in a thin hospital blanket, sleeping on the hard floor. He winced at the brightness, but did not awaken, and I remember mumbling a lame apology as I flipped back the switch and continued walking. I had not given that incident a thought since then. Now, sitting there, I wonder which of his loved ones was in there, and why. I wonder if they made it.

Finally, becoming weary of the tiny room and the crooked hands of the clock, someone suggests that we go down to the hospital cafeteria and get something to eat. No sense, after all, in waiting here the whole time. The cafeteria is nearly empty and we take seats near some west-facing windows where the late afternoon sun feels warm and reassuring on the tabletops. From here there is a good view of the valley below, where things are beginning to settle down after the rush hour. The food is greasy and bland, typical, but I am glad to have it. It feels good to eat, not only because this is the first food I have had all day, but also because it gives us all something to do but think about the overwhelming events of this day. Even after we have all finished, no one seems to want to leave, preferring to remain here than return to the closed quarters of the waiting room. After awhile, we are even making small talk, catching up with the siblings that we haven’t seen in awhile.

“Your attention please, your attention please.” The soothing female voice, familiar to me, comes from the hospital intercom. “Will the Prince family please return to Neuro Critical Care.”

I am instantly weak, shaking. It is too soon. All eyes focus on my father, who has paled. Without a word, we stand up, in unison, still staring at each other in disbelief. Then, quickly, we obey the voice. Never before have I felt close to hysteria, but now, striding back down the corridors, back toward the waiting room, I feel as close to crazy, as out of control of my own emotions, as I have ever been. Everything seems surreal, detached, in slow motion, although I remain acutely aware of each step, knowing that before I get there I must brace myself for what has happened. Frantically, I search for some alternative, some other reason they could want us there, but there is none. There is, simply, only one reason they would call us back so soon.

Arriving outside the waiting room, we are met by the resident, who immediately ushers us in to the waiting room, which has been cleared of other occupants, and shuts the door. He moves quickly, as if strangely eager to deliver the awful news.

“I am sorry about paging you like that. We knew it would alarm you, but we needed you back here and didn’t know how else to do it.” The situation does not add up, and I am confused. Then, realization, relief. She isn’t dead! “We have finished the final preparations for surgery, and we are ready to go. Dr. Schmidt, the surgeon, would like to speak with you for a few moments before he proceeds.”

A moment later, he enters the room. He is a skinny man with grey hair, very white skin, and a noticeably erect posture. He is wearing blue surgical scrubs with a cap and blue rubber clogs. His mask is pushed down and he wears it around his neck. There is a certain air with him, a mood, and this is what I notice first, before he even speaks. In a soft, calm voice he apologizes again for alarming us, and explains the surgery in more detail. Everyone has questions for him; he answers each of them patiently, expertly. I get the feeling he has heard them all many times before, yet he considers them each very carefully, thoughtfully. I have great confidence in this man, this surgeon, and wonder why, since this is the first I have ever seen him.

“Now, as you know, brain surgery is serious business. You should know that there is a significant chance that she will not make it through the surgery. The recent reports say there is about a twenty percent chance of or serious complications.” He looks at each of us, making sure we understand. Then, he smiles reassuringly and adds, “But, my own personal success rate is much, much higher than that.” He says it proudly, but he is not bragging. I feel as though he cares about each of us, the waiting loved ones, and wants to give us as much hope as he can. “We will try to have someone let you know how it is going, but don’t expect any news during the operation. With this type of surgery, no news is good news. It could take six or eight hours at least, and don’t worry if it goes longer. I’m not running any races in there. "He pauses to smile thinly, reassuringly.

"Well, then, if there’s nothing else, I would like to get started.”

As he leaves I feel eager. I am ready to get on with it, ready for him to go in there and get it over with, to go in there and fix it. I feel hopeful now, and it feels good to have this confidence. More waiting. The sun finally sets and disappears, bringing an unfriendly darkness and making the hospital seem cold. I try to read a magazine, try to make conversation, but inevitably end up watching the second hand go around and around on the eyed clock. Slowly, the hours go by. Visitors come, relatives, friends who have heard the news. There is nothing to tell them. We won’t know until after the surgery.

Finally, Dr. Schmidt opens the waiting room door. It is very late, and he looks tired but is smiling. As he moves in close to us I notice that there are specks of a white, chalky material clinging to the lenses of his glasses and stuck to the front of his cap, along with a few tiny droplets of blood, and I find this curious as he declares the surgery a success, and announces that he is very, very pleased with the results.

“Of course, she is not out of the woods yet,” he says, “but we were able to find the aneurysm and put a clip tightly on it. She is out of danger for the time being.” He tells us that they are just closing the incision now, and then we can see her. Then, unbelievably, he heads back for the operating room where yet another patient awaits surgery, this time the emergency repair of a man brought in a few hours ago—motorcycle crash. “I will see you in the morning,” he says.

“It is morning,” replies my father, looking at his watch. “Don’t you ever get to sleep?” “Sometimes,” he says, smiling. “Not with all this fun going on, though.”

When she comes to and talks to us, we all cry, even me. They only let us in two at a time, so we take turns going in. It is such a relief to hear her voice, to see her wake up. She doesn’t understand what all the fuss is about. She thinks she is in Hawaii, where she was with Dad a week before. She can’t see out of her left eye. But, she is alive. She recognizes us—she is intact. She has tubes and wires and a room full of monitors and medicines, but she is back.

Weeks later, it is 4:55 am. I walk alone from the parking lot toward the hospital, clad in white coat and stethoscope. I am in the middle of my internal medicine clerkship, and have patients to see and examine before rounds. There is a definite chill in the air, warning that autumn is near. A light fog covers the ground and shimmers in the glow of the still-lit street lamps as the cold dew begins to lift. There is no one else around and all is quiet but my footsteps as I trudge past the medical library toward the back door. Breathing deeply, I savor the quiet and the fresh smell of morning—I love this time of day. As I approach, a smallish, middle-aged man with tired-looking shoulders and erect posture comes out of the hospital and down the back steps, a large stack of manilla folders under one arm.

“Hello, Dr. Schmidt,” I say quietly, almost timidly as he passes by. He seems startled, as if he had been lost in thought and did not know anyone was there. “Good morning.”

He slows down and looks down at me curiously, seeking recognition. It is obvious he doesn’t find it. I don’t expect him to. I do not stop, but smile to myself as I open the door and stride past the cafeteria, under the fluorescent canopy, determined to learn all I can today about how to take good care of my sick patients on the wards.