Saturday, September 22, 2012

The Phone Call in the Middle of the Night



Our son's car after a head-on collision 

I am not awakened when the telephone rings at 11:30 on a Saturday night. My husband is and is filled with dread, like he is always filled with dread when the phone rings at that hour. But, he knows that as soon he hears what the caller has to say that everything will be okay. It's always okay. But, this time, everything is not okay. He wakes me gently and in the softest voice says, "Get dressed. James has been in a car accident." That is the only part of the conversation Rich can remember -- "a car accident"-- even though I ask him about it over and over again because I think there must have been even one more word that will tell me my son is safe. He can't remember.

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I tell myself stories on the drive to the hospital about various accident scenarios that could have happened that might be somewhat serious, but not all that serious. I tell myself he had a safe car. It had airbags. It was older, but well maintained. It had good tires. Didn't we just replace the tires? This was an early Saturday night for him so what's the worst thing he could have been doing? He did not drink and drive. Did he? He almost never drove on the freeways. Did he? So, what's the fastest he could have been driving on a side street in this rain-- thirty or forty miles an hour? Is that right? And I pray in that very quiet car, in between the conversation that I'm having with myself in my head, and the questions I ask my husband out-loud about the phone call. But, then we hit the main street just outside of our subdivision that will take us directly to the hospital. It has been under construction for months, but open. Now it's barricaded. Ambulances, police cars and flashing lights are everywhere. And I know. Rich turns the car around. I don't remember the rest of the drive to the hospital.

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Rich drops me off to park the car. I hurry into the Emergency Room entrance and am met at the door by a nun, a couple of nurses and an ER doctor. This frightens me. They shepherd me into a cold waiting room with green walls, blinding florescent lights, vinyl tile floors, and molded-plastic chairs and I say to myself, it's like this because people vomit in here.They say something I don't remember. I sit down opposite the door and am left to wait with the nun, who repeatedly asks me if I'm okay. I say, "I don't know." I notice that she does not touch me. I realize I feel like I'm made of sand, no steel, and think, "that's why she doesn't touch me, she thinks I will fall apart or hurt her." Rich finds me. I tell him I'm waiting on the trauma physician. Our eldest son and his fiance arrive, and Daniel asks, "He'll be okay? Won't he, Mom?" I am the mother and my role is to say that everything will be okay. This time I say, "I don't know." I realize I haven't moved in my chair. I wonder if I've spoken any of the words out loud that I think I have. I close my eyes and pray.

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A police officer appears and seats himself opposite me, and says that our son, heading south bound, and the first of two vehicles traveling north bound, collided, which caused James' car to recoil to the right. When he tried to steer back onto the road, he over-corrected directly into the path of the second north bound car. I think to myself, "He was just going home." The officer tells me it took him an hour to cut James from his car. I remember Rich saying, "Jaws of Life." I think to myself, "So this happened at 10:30 at night?"And I wonder why I didn't know that this was taking place less than a mile from our house? Aren't mothers supposed to sense when something happens to their children? I didn't even have a twinge. I feel crushing guilt. Then I realize that I don't know if I could have lived through the hour it took to free him from his car and I thank God for not knowing. Then I feel ashamed for not wanting to be with my son. There is some talk about the condition of the road: a curve, the road construction, a transition from gravel and blacktop to cement. It is unclear who crossed the line. There was no sign of intoxication. James may have been speeding. I look up and lock eyes with the officer, and he says, "But, that could have been just a matter of perception." I nod. The other two drivers walked away. There were no witnesses. There was no time to break; therefore, no skid marks. The crash will not be investigated. I thank the officer for cutting my son from his car and for not placing blame on him. Whatever the outcome, I don't want James to have to live with the blame.

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The trauma doctor comes in and methodically runs down a long list of possible injuries including brain, neck, and eye damage resulting from the profound impact to the left side of my son's face; his beautiful face. The doctor stops mid-list to look at me because he realizes he has forgotten to tell me that my son is not dying. The only thing I truly understand is that the bones in his face have been shattered. He has swallowed and inhaled a great deal of blood. They are inserting a ventilator to breathe for him, and a tube to drain the blood from his stomach. They will place him in an induced coma. We won't know more until tomorrow after a head-to-toe scan when the specialists are called into assess his condition. They ask us if we want to see him but warn us that we probably do not. Rich does; and emerges from the ER and folds in on himself, sobbing. I feel guilty for not going into console my son.

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Go home and sleep, they say, there is nothing you can do.

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I do go home and take a Valium, which allows me to sleep for a couple of hours. Then I wake. I wonder where I am, what happened and why I feel like someone died. Then I remember. I rise very early and go to see my son in the Surgical ICU.

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This was followed by weeks in the hospital with family and friends, praying with and talking to James while he was in a coma; comforting him when he woke-up sobbing because he thought he was dead; watching him thrash in restraints, while being weaned from the ventilator; trying to console him because his eyes were swollen shut and leaking bloody spinal fluid; preparing him for major surgery to reconstruct his face just five days after the accident; suffering with him while he dealt with the pain after the surgery, which, according to the trauma doctor, "is like the accident all over again," but without the benefit of the coma or the medications they could have administered to him while in it.

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James was very lucky. He suffered no optic nerve or neurological damage. His blood levels returned to normal as his spleen healed. The hole between his nasal passage and brain repaired itself after the 6 hour surgery by a team of 3 maxillofacial surgeons to drop what was left of his nose back in place and reconstruct it, his cheek, and the bones that support his eye socket. All told, the surgery included 2 cranial bone grafts, 10 plates and 60 screws.

The lead surgeon called-in specifically to operate on James' unique set of facial injuries was trained at our "charity hospital system," which is considered to have the best emergency medical training in the country. He told us that he had seen and repaired the most egregious of facial traumas, including those in the days before airbags, and many due to bullet wounds. However, James' injuries were worse. Every time he picked up a bone, there was another broken one to take its place.

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Our "charity hospital system," which has served the poorest of the poor for the last 200 years regardless of ability to pay, is in the process of being dismantled in favor of public-private partnerships. Earl K. Long, our Baton Rouge facility will be shut for good in 2013. Charity in New Orleans, the largest hospital in the system, was destroyed by Katrina and hasn't yet been rebuilt. This year, in the face of staggering Medicaid cuts, it was proposed that an additional 6 hospitals be downsized to 10-bed "shells" and another in Lake Charles that served 78,000 people last year, closed. In 2005, this 10-hospital safety-net served a total of 650,000 individual patients, which is approximately equal to the number of uninsured Louisianians, according to the 2010 Census. Where will people without health insurance get their treatment in the future? Considering that our state has officially decided to opt out of the Medicaid Expansion portion of the Affordable Care Act, I would imagine that our poor (we have the sixth and second highest poverty rate for adults and children in the US, respectively) will seek their care in emergency rooms.

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Otherwise they will go without. They're used to going without.

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James is home now, with boots on two multiply fractured feet, a swollen, asymmetrical face, and a weepy, decidedly smaller, misaligned eye. He'll need more surgeries but they can't start for another 6 to 9 months or until the swelling fully subsides. He has tried to reconstruct the day of the accident but can't remember a thing after two in the afternoon. He was on his way home from visiting his girlfriend-- a waitress at a pizza place. The receipt she retrieved shows he had a pizza and a beer. Photographs reveal an obviously totaled vehicle, with a front-end demolished to the extent that just a sliver of a space remained on the driver's side. We wonder how he fit into it. The engine dropped just like it was designed to do so that it did not crush his legs. All front and side airbags deployed. There was blood, but less than you would think. We don't know why his facial injuries were so severe. We don't know who or exactly what factors caused the accident. The accounts of the other two drivers, traveling together, differ, and James hasn't given a statement because he can't. The police and the car insurance companies have closed their investigations.

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James is trying to accept that he will probably never know what happened.

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We struggled; especially in those early weeks to support him while he grieved over his injuries and the loss of his looks. I enlisted the help of a therapist, because my parenting skills seemed at-best inadequate and at-most inconsistent. I am trying to squelch the anger in my voice, stop looking for instant solutions, and stop saying, "You were so lucky." James has decided to defer his scholarship and sit out fall semester. He retained his room in the rental house he shares with friends, although he has yet to move back in. He doesn't want to go out or socialize. Most of his time is spent in on-line gaming or watching television. He goes to bed late and wakes up late. He says he wants to take an on-line course. I try not to ask if he's registered. His recovery will be at his own pace, not mine.

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We are taking a semester and sometimes a day at a time.

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About six weeks after the accident, I was driving to work when I abruptly veered off to the side of the road and turned off the car. It took me a few minutes to steady my breathing and pry my hands from the steering wheel. It struck me that I had forgotten to make sure that James was still covered under our health insurance policy. He is 21 and I knew that adult children are only covered on their parents' policies until the age of 23 as long as they are enrolled in college full-time. It was too late to revisit the decision about James returning to school. Even if we could enroll him, he just wasn't ready. I had visions of us forcing him to take classes and then trying to make him study for them so that he wouldn't lose his scholarship. How else could we possibly pay for these bills we keep receiving for tens of thousands of dollars, and which, so far, have been paid in-full by our health insurance company? We couldn't buy him an individual policy because his injuries resulting from the accident would be considered pre-existing conditions. No insurance company would have him. Stories about families who had to file for bankruptcy after events like these flooded my mind. I tallied up what we could retain and what the court would take from us. I had just started a new job after being laid off from a healthcare company last year. We were still digging ourselves out of debt. Then I remembered that I did not have to worry about any of that because of the Affordable Care Act (ACA). Adult children up to the age of 26 were now covered under their parents' health insurance policies, period, no filing of school registration materials, no more bureaucracy; I had forgotten that I hadn't had to file school registration materials with our insurer for the last two years. It's almost unbelievable to me that a very short time ago, the ACA had almost been repealed.

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To be honest, when I first heard about the ACA's coverage of adult children, I didn't think much about it; in fact, I thought it was insignificant, sort of a public relations carrot to dangle in front of the masses to appease them while they waited for the substantial provisions to go into effect in 2014. We were professionals with advanced degrees, had always worked, and had always had health insurance. Our eldest son, the one who does have preexisting conditions found work after his MBA and has health insurance. James wouldn't have any problems because there was no doubt that he would be in school and therefore would be covered under our policy; and if he wasn't in school and even if he wasn't employed, we would just buy him an individual policy (I hear they're supposed to be cheap for people his age and that, "the market" takes care of that). He was perfectly healthy -- the one child's insureability I did not have to worry about.

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We are about ready to go to one of James' many doctors' appointments; and despite all that has happened, I feel grateful, or maybe "lucky" is a better word. We were just lucky that James' accident occurred during a period of time when this little piece of the Affordable Care Act was in effect. Due to a complex set of factors, including the timing and outcome of a Supreme Court opinion, we could easily have been on the losing end of this situation. Lucky. So lucky.

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We need to make sure that everyone is just as "lucky."

Let's support our hard won healthcare legislation. Let's help our president to help others to be as "lucky" as we have been.

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