Landfall… Paisley, Part 3

Drops of White

Paisley was only twelve days old, and no bigger than two upturned palms. She had that scent that belongs only to infants. Pink skin, with tiny newborn speckles on the bridge of her nose.

And she was writhing. Her eyes were rolled up, and she was clutching against a pain strong enough to quench her cries.

The air became leaden as the doctor and nurse, obscured behind their masks, took up positions across the table from each other. Paisley lay between them, and she was rolled to face the nurse and me. The doctor cleaned the insertion point between two vertebral knobs on her lower back. The nurse cupped her body in his two large hands, with one behind her neck and the other grasping her buttocks. As the needle was bared, my wife could watch no more, and she took her trembling and prayerful tears to the hallway. But I stayed.

The nurse curled Paisley into a fetal wad, folding her nearly in half, and more tightly than I thought any baby could survive. The needle went in. But there was no syringe and no IV line. It simply opened at the base like a bare spigot, or a tree tap, and it began to pulse with thick white drops. They clung to the tap for a moment before falling into a small vessel held by the doctor.

The snapshot of that moment will never leave me. As the first drop fell, the doctor’s eyes flashed up, locking gaze with the nurse. I had no grasp of what those white drops signified. But I will never forget her eyes. And I knew. No matter what else was said, I now knew the inning and the score. The doctor had described a range of possible causes for Paisley’s symptoms, from the benign to the lethal. Her life hovered somewhere near the last tick mark on that scale.

The tap throbbed. Not a word was said. And as the doctor had predicted might occur, Paisley began to quiet. Her hands went slack, and she slipped gradually into sleep.

The nurse shuttled the samples away. The doctor disposed of her gloves and mask. “Well, we will run the tests and see what comes back. In the meantime, we will get her started on the antibiotic regimen.” Her cool professionalism was familiar. It mirrored my own feigned detachment to our kids, when we had earlier left the house. And I knew quite well, that the good doctor already knew full well, precisely what was happening.

Friends in Need

Two of our closest friends came to the hospital at about that time, though the exact sequence blurs in such moments. They prayed over Paisley and hugged us.

“She’ll be just fine,” came the reassurance. “Doctors always take extra precautions, but don’t let that worry you. They have to be paranoid these days.”

I was so grateful they had come. But I heard their words as if from some great distance.

Not What We Would Hope

The good doctor returned a short time later. With a deliberate bedside manner, as she had undoubtedly done many times before, she gently informed us that today was the darkest of our lives:

Well, the test results are not what we would hope.

Paisley has meningitis. There are two basic kinds of meningitis – viral and bacterial. Bacterial is usually the more aggressive and dangerous. That is what Paisley has.

Her infection is quite advanced. Her white blood cells are trying to fight the infection, which makes her spinal fluid white. The white blood cell count indicates that she is fighting hard, and that she has been fighting this infection for some time already.

From her words, it was clear that Paisley was losing this battle.  She was indeed hovering at the distal end of that scale. The good doctor continued, in order to lift the veil on what all of this meant.

Time is money with meningitis. The longer the infection lasts, the more damage is caused. But as we talked about, we have already started her on the strongest antibiotic regimen that we have. We don’t know what bacterial strain she has yet, so we may change the type of medication once the cultures come back.

With meningitis, the outcome very much depends on catching it early. But you should know that meningitis is a very serious illness. It can cause loss of hearing, loss of sight, and brain damage. It can lead to septic infections of the limbs. And it can be fatal. Most typically, hearing is the first sense to be affected, and it is hard to know if she has already suffered damage.

Then came the attempted consolation, but one bleakly punctuated:

You did the right thing by bringing her in. There is nothing else you need to do right now. We will have more results back in a few hours. We will bring you some literature on meningitis in time, but for now, we ask that you refrain from looking up medical information on the internet.

She is in the right place, and we’re doing everything that can be done for her. But I want you to understand that much of this will come down to her. It will come down to how quickly she responds to the antibiotic treatment. And how much damage may have already occurred.

It falls somewhat beyond my abilities to convey the inward collapse of that moment. Life condenses to a single fixed point, haloed by grey. Meningitis… Bacterial… Advanced infection… Time is money… Everything we can…

I believe my only response was a soft-muttered question about what Paisley’s chances were, what the odds were for babies her age to survive. The doctor responded kindly, but despite her explanation, it was a question that would go unanswered.

Blur

This was the landfall of the storm. We had been struck blindside, caught in the open without warning. There would be no evacuation. Amid the blinding torrents, we simply clutched and cowered, and hoped for morning.

I cannot recall exactly what happened after that. I know there were tears. I know that family came. I know that we waited. I know that my friends stood by me.

And I know that I prayed. Like my children’s eyes to me, and the doctor’s eyes to the nurse, I somehow realized – this was a day beyond the province of words. The most important things said would not be spoken. It would have been stupidity to explain this crisis to God. And stupidity to ask. We had slipped beyond all of that. I would submit that this is how to discern ritual prayer from soul prayer. In that place, and at that moment, I simply looked heavenward. Through bleary eyes, I wordlessly pleaded, directly from the heart.

Face of the Enemy

Bacterial meningitis is an infection of the meninges that surround the brain and the spinal column. They carry a typically clear fluid, and once infected, this layer swells. The skull forms a rigid container, forcing the swelling to press inward, squeezing the brain. The patient consequently experiences tremendous pain, which causes the seizure-like writhing and eye rolling we saw in Paisley.

A lumbar puncture, colloquially known as a spinal tap, acts as a relief valve that reduces the overpressure. The patient experiences a brief respite from the agony, often falling into exhausted sleep, just as Paisley had.

Like Judas, meningitis often does what damage it will do quickly. It can cause septicemia, shutting down internal organs and killing the victim within a few hours. Sensory loss occurs if the infection attacks the auditory and visual nerves. Irreversible brain damage can take place. Quite often, it is too late by the time a victim is brought to the hospital and is clearly diagnosed. If the battle against meningitis is to be won decisively, it must be won early.

Because like crucifixion, meningitis can also torture its victims slowly. Amputations may follow if septic infection targets the extremities. The taking of limbs can also be serial, leading to the slow butchery of the patient over many days. Then after taking the sight, the hearing, the mind, and the limbs, meningitis can finally grant a terminus. Or not. It can also leave the residual of its tortured and broken prey alive, disabled for a lifetime of mental and sensory darkness.

Meningitis presents a certain unavoidable question: whether you would really want the victim to live no matter the circumstances. Would we want her to live, if she lost her senses and her mind? Would we rather God simply take her? In nearly all people, I believe there is a threshold beyond which our prayers for outcome change direction, and in which one darkly imagines that it would be better for them to depart than to survive. On that day, I learned what it is to pray against such a contingency.

Bacterial meningitis places the unthinkable on the table before you. It is an enemy beyond conscience, pleas, and intimidation. It is an enemy which wages a mindless and merciless campaign of extermination, devouring from within. The enemy is Legion, a countless unseen horde already within the gate.

Thus passed the first two hours in the blitzkrieg to decide Paisley’s fate.

[to be continued…]

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