This happened on december 30, 2003. That may seem a while ago but it won't when it happens to you.
And it will happen to you. The details will be different, but it will happen to you.
That's what I'm here to tell you.
We had come home. "Home" meaning an apartment on the Upper East Side of Manhattan. Early evening, maybe eight o'clock. We discussed whether to go out or eat in. I said we could stay in, I would build a fire.
The fire was the point.
In California we heated our houses by building fires. In Malibu we built fires even on summer evenings, because the fog came in. Fires said we were home, we had drawn the circle, we were safe through the night.
I built the fire. I drew the circle.
I have no memory of what I meant to have for dinner.
Memory stops. The frame freezes. You'll find that's something that happens.
I warned you. I'm telling you what you need to know.
You see me on this stage, you sit next to me on a plane, you run into me at dinner, you know what happened to me.
You don't want to think it could happen to you.
That's why I'm here.
John was in his office. I got him a drink. He sat down by the fire to read. He was reading a bound galley of David Fromkin's Europe's Last Summer: Who Started the Great War in 1914? I set the table in the living room, where we could see the fire.
I must have noticed that later. The name of the book. I eventually read it myself, but found no clues.
Wait. I was telling you what happened.
He wanted a second drink. I got it. He asked if I had used single-malt scotch for the second drink. I said I had used whatever I used for the first drink. "Good," he said. "I don't know why but I don't think you should mix them."
I was at the table, making a salad. He was sitting across from me, talking. Either he was talking about why World War One was the event from which the entire rest of the twentieth century flowed or he was talking about the scotch, I have no idea which.
Then he wasn't. Wasn't talking.
I looked up. I said, "Don't do that." I thought he was making a joke.
Slumping over. Pretending to be dead. You've seen people make that kind of tiresome joke. Maybe you've done it yourself. Meaning "this was a hard day, we got through it, we're having dinner, we've got a fire."
In fact neither of us had yet said out loud how hard that day had been.
My next thought was that he had started to eat and choked. I tried to move him so I could do the Heimlich.
He fell onto the table, then to the floor. There was a dark liquid pooling beneath his face.
Within what I now know to have been exactly five minutes, two ambulances came. The crews worked on the living room floor for what I now know to have been exactly forty-five minutes.
I now know these facts because I obtained the documents. I obtained the Emergency Department Nursing Documentation Sheet. I obtained the Nursing Flow Chart. I obtained the Physician's Record. I obtained the log kept by the doormen in our building."Paramedics arrived at 9:20 PM for Mr. Dunne," the log read."Mr. Dunne was taken to the hospital at 10:05 PM."
The distance from our apartment to the ambulance entrance of New York Cornell is six crosstown blocks. I do not remember traffic. I do not remember sirens. When I got out of the ambulance the gurney was already being pushed inside. Everyone was in scrubs. I noticed one man who was not in scrubs. "Is this the wife," he said to the driver. Then he looked at me. "I'm your social worker."
And I guess that was when I knew.
That's something else to remember. If they give you a social worker, you're in trouble.
Life changes fast.
Life changes in the instant.
You sit down to dinner and life as you know it ends.
The question of self-pity.
Those were the first words I wrote after it happened.
And after that--
I'm a writer--
But after that I didn't write anything for a long while.
For several weeks after it happened I tried different strategies for keeping on the correct track. One that worked for a while was repeating to myself the last two lines of "Rose Aylmer," Walter Savage Landor's 1806 elegy to the memory of a daughter of Lord Aylmer's who had died at age twenty in Calcutta. I had not thought of "Rose Aylmer" since I was at Berkeley, but now I could remember not only the poem but much of what was said about it in whichever class I heard it analyzed. "Ah what avails the sceptred race!" it begins. "Ah what the form divine! When every virtue, every grace, Rose Aylmer, all were thine!" "Rose Aylmer" worked, the lecturer said, because the overblown and therefore meaningless praise in those first lines gets thrown into sudden, even shocking relief by what he called "the hard sweet wisdom" of the last, which suggest that grief has its place but also its limits: "A night of memories and sighs / I consecrate to thee."
"A night of memories and sighs," he repeated. "A night. One night. It might be all night but he doesn't say all night, he says a night, not a matter of a lifetime, a matter of some hours."
Hard sweet wisdom. Clearly, since "Rose Aylmer" remained embedded in my memory, I believed it to offer a lesson for survival.
I told you I knew when I saw the social worker but I didn't really.
Or more correctly--"correctly" is important to me--I knew but I refused to know.
There's a certain kind of personality--my own, maybe yours--that sets great store on seeing it straight. For certain of us this is a big ego point.
You might think you'll see it straight but you won't.
You'll be standing in some ER and at one level you'll have a pretty clear idea of whatever it was that just happened but you'll see it as a kind of first draft.
Notice the evasion there. "Whatever it was that just happened." The actual words will have vanished from your accessible vocabulary. The only words at hand will have to do with how this can be corrected.
If you're a lawyer you're probably thinking she doesn't know what "reversible error" means, but I do.
There was a verdict here. Find the right error and the verdict gets thrown out.
And errors are easy to find.
If you're me.
For example this is the wrong hospital.
This is a perfectly good hospital but it's not "our" hospital. It's New York Presbyterian Cornell. "Our" hospital is New York Presbyterian Columbia, a hundred blocks uptown. So while I stand in line to show the insurance cards--nobody told me to stand in this line but I see it as a constructive step, proof that I'm handling the situation--I tell myself that as soon as he is stabilized I can move him to Columbia.
He will need a bed with telemetry. When I arrange the move I need to specify this.
Notice that only "I" can do this. I do not distrust those in charge here, but I do feel compelled to manage them.
I go further. I see a plan falling into place. Once Quintana is stabilized I can also move her to Columbia.
Maybe I didn't mention this before.
New York Cornell is not our first hospital of the evening.
The first hospital of the evening was Beth Israel North. You know, the one that used to be Doctors' Hospital. Across from Gracie Mansion. Where our daughter has been in an induced coma in the sixth-floor ICU since Christmas night with what began as the flu and is now septic shock.
Another case of the wrong hospital.
From my point of view.
But just try telling a grown child that the easiest emergency room on the Upper East Side doesn't necessarily add up to the right hospital.
Try telling her anything, once they sedate her for the endotracheal tube.
Must you always have the last word, John said when we fought.Which was often. Must you always be right. For once in your life just let it go.
When we saw her tonight in the ICU her hair was damp and matted from the fever. No one seems to have brushed it. I have been trying to brush it since the day after Christmas but cannot. I could always brush her hair. I could brush her hair even in Malibu, when it was long and bleached from the sun and green from the chlorine in swimming pools and she had been in the water all day. She would come up from the beach and John would wrap her in towels on the deck outside his office and I would brush her hair.
"I love you more than even one more day," he said to her tonight in the ICU.
He said that on each of the five nights he saw her there.
On the chance she could hear.
He said it tonight just before we came home and discussed whether to go out for dinner or eat in. Just before I built the fire--
The lights are too bright in this hospital. It's too cold.
If I hold focus I can arrange for both of them to recuperate at Columbia. Adjoining rooms. The McKeen Pavilion. I can go up in the afternoons and have tea with them in the atrium while the volunteer pianist in scrubs plays "Isn't It Romantic." I can stay until eight and the car will be waiting and I'll come downtown and build a fire and make myself a hamburger. I'll think about John and Quintana in their adjoining rooms but I'll still have a fire and I'll still eat the hamburger and I'll still watch Chris Matthews on rerun.
Because I will have arranged for them to be safe. I will have brought in the appropriate specialists. I will have made sure that each of these specialists appreciates the entire picture. I will have managed the situation.
My social worker reappears. He leads me out of the insurance line and into an empty room away from the triage area. He tells me to wait. Part of my mind is thinking that this does not look good and part is trying to remember the words on a pink index card I have in my office.
When he comes back he has a subteen in a white coat with him. He introduces the subteen as "your husband's doctor."
There is a silence.
I hear my own voice. What I hear it saying is this: "He's dead, isn't he."
The doctor looks at the social worker. "It's okay," the social worker says. "She's a pretty cool customer."
They take me to the cubicle where he is. They ask if I want a priest. I say yes. A priest comes. He says the words. I thank him. They give me the silver clip in which John kept his driver's license and credit cards. They give me the cash from his pocket. They give me his watch. They give me his cell phone. They give me a plastic bag in which they say I will find his clothes. I thank them. The social worker asks if he can do anything more for me. I say he can put me in a taxi. He does. I thank him. He asks if I have money for the fare. I say I do, the cool customer.
He uses that word, the "fare."
Wouldn't it have been more colloquial to say the "taxi"? Do you have money for the taxi? Wouldn't that have been less troubling? Less as if I were taking some kind of mystery tour?
When I walk back into the apartment I see John's jacket still lying on the chair where he dropped it. I pick it up. A Patagonia windbreaker, the crew jacket from Up Close & Personal. All pictures have crew jackets, there used to be a joke about a picture so bad the crew won't wear the jacket.
The dark liquid is still pooled on the living room floor. I see now that it is blood.
The EKG electrodes are still on the floor.
The empty syringes are still on the floor.
The pink index card.
I had typed the words on the card because they had to do with a plot point in another picture, one we started and abandoned because we could not figure out how the accidental killer who is also the DA gets the body out of the house. Here are the words, which I had copied from the Merck Manual: "Tissue anoxia for >4-6 minutes can result in irreversible brain damage or death."
I consider irreversible brain damage. I stop.
That isn't exactly what happened.
Something else happened but I can't afford to access the word.
There are people I need to call. I can't call Quintana, Quintana is where we left her, unconscious in the ICU, the IV lines still dripping the medications that are what they mean when they say "We're giving it everything we've got."
"Everything we've got" doesn't do it for me.
I want the names. I wrote them down. I looked them up. There were the antibiotics. Vancomycin. They call it "vanc." By now so do I. Azithromycin. Gentamicin. Clindamycin.
Then there was Xigris.
Xigris is Eli Lilly's drug for septic shock.
Said to improve the survival rate from 56 to 69 percent.
You might want to file that.
For when you're standing by your child's ICU bed and the vanc isn't working and somebody mentions Xigris.
Spelled X-I-G-R-I-S, pronounced ZY-griss.
"This costs twenty thousand dollars," the nurse said tonight when she changed the IV bag.
"We still don't know which way this is going," one of the ICU doctors said.
Did he say that tonight?
Or did he say it last night?
You want to know how this happened.
John asked that question.
A perfectly healthy young woman.
Married five months.
She and Gerry had just had their first Thanksgiving dinner. They pureed turnips, they unpacked their wedding china.
The weekend before Christmas she "felt terrible." She went with a fever of 103 to the Beth Israel emergency room and was diagnosed with the flu. Stay in bed, drink liquids, it's going around. No chest X-ray was taken. Three days later she went back to the emergency room. Her pulse was elevated, 150-plus. Her white count was almost zero. There was pneumonia on one lung. She would go to an ICU overnight for monitoring but it was "nothing, what we used to call walking pneumonia." By morning her fever had passed 104, she was intubated, there was pneumonia on both lungs, her blood pressure was dropping, she had entered septic shock, and they did not know which way this was going.
Copyright © 2007 by Joan Didion. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.