Ashley is still doing well. She had a brief wave of nausea with some emesis, and her headache is still very much present, but she continues to be lucid and to retain new memories. She was able to sit up and take her contacts out, which, to me, is no small feat under normal circumstances (much thanks to our optometrist Todd Mumford for the foresight to suggest bringing her supplies). How many people are lucky enough to get into an accident with a flight surgeon on hand and be visited in the ER by an optometrist? Rag on podunkville Altus all you want. We have awesome and talented friends here.
I thought I would take this opportunity to record the details of today as I remember them (pause to appreciate my intact short-term and long-term memory and the wonder of this 3 pound organ composed over 100 million neurons making over 100 trillion connections - or something like that).
I changed Ashley's flat front tire last night at about 10:00 pm. I gave her my typical overbearing advice to make sure that she checked the tire pressure in case of a slow leak from the patched tire before she left in the morning. I recollect waking up to the sound of her cell phone alarm at 6:00 am or whatever ghastly hour it was. My next recollection is the phone ringing at 7:30 am. Didn't move a muscle. Until I heard the voice of my good friend Micah on the answering machine: "Joey..."
My first thought was, "Somebody's got a flat tire." But then Micah's voice again, "Ashley fell and hit her head." Fear gripped me as I wrenched myself out of bed. He gave me the brief rundown and filled in the details later. They had gone north on Veteran's drive starting at the Altus AFB Jasmine gate. It is a nice, flat, well-paved road that goes on for about 10 miles up to State Route 19. I have ridden it a few times myself, and it is a great road for cycling.
Except for the one spot about 3 1/2 miles north of the base. There is a ranch house on the east side of the street, surrounded by a white metal fence, where lives a large, pale beast. On one of my rides, he had seen me approaching and came roaring out of the yard. The owners were screaming at the canine demon with all their might, threatening all sorts of vile punishments if he did not obey. But to no avail. Then the reassurances: "Go ahead, he won't chase you. Don't worry, he won't attack." Yeah. Sure. I walked my bike for about 100 yards, continually turning around to face the hound from hell and make him back down. Finally, I was able to escape his clutches, but the few times that I have ridden past that house since then I have been alert, watching, waiting, wondering if he were lurking in the bushes, ready to attack again.
When I heard that it was a dog that had assaulted Ashley, I knew exactly where they were. They had passed the house going north and the monster had chased them. On the way back south, it appeared that he was lying in wait to spring his trap. Ashley, Micah, and Lisa road side-by-side, with Ashley on the far right. The dog came running from the front left, crossed the paths of Micah and Lisa, and struck Ashley's front tire. The tire spun instantly to the right, and Ashley's body, feet still clipped in to the pedals, was wrenched to the right. She struck the ground with the back of her helmeted head and slid a few feet. Dr. Bahr reports that in his estimation, had she not been wearing her helmet, she would have shed this mortal coil.
Micah's first thought was her cervical spine, in case there had been any injury that could threaten the spinal cord. She was completely unresponsive and was holding her elbows and wrists in a flexed position (also known as flexural or decorticate posturing). This did not bode well. Her Glascow Coma Scale at the time was 5. The bottom end of the scale is 3. There is no zero. Micah estimates that within 2 minutes she regained consciousness. She began trying to get up, which Micah kept trying to prevent her from doing. It was at this time that he called me.
My instinct was to go. GO GO GO!!! Go get her now! Sometimes that is the wrong instinct. "Reach, throw, row, THEN go," as the lifeguard mantra goes. We should have called 911. I am not blaming Micah or myself. This was a learning experience for us. Next time, I call. Simple as that. That said, I am grateful beyond words that my colleague was there for my best friend and companion.
I woke up the kids and threw them in the car. I went about 95 mph (40+ over the speed limit - another good reason to call 911 rather than let your "go" instinct take over). When I arrived, Ashley was sitting on the ground with the most confused look on her face that I have ever seen. And that, for those of you who know Ashley well, is saying something. I embraced her and asked her a few questions: "Do you know what happened?" "No." "Do you know your name?" "Ashley." "Do you know what year it is?" "No."
That was it. In the car and off to the races again. In the car, the gravity of the situation began to dawn on me. No matter how many times I told Ashley what had happened, she would have no recollection of anything I had just said. I kept talking to her, trying to keep her with me. The kids didn't say much, but Isaac thought it a good time to discuss how the spanking he had received the night before was not an appropriate part of the Merback discipline protocol.
I pulled up in front of the Jackson County ER and helped Ashley out, leaving the kids in the car (yet another good reason...but I digress). I have to admit that I pulled the "I'm Dr. Merback and this is my wife..." bit with the receptionist. She checked us in and had Ashley wait outside for a second while the nurse came out. I used this opportunity to park the car and grab the kids. I came back in to see Ashley vomiting on the floor. We got her into a wheelchair and got her back into the trauma bay. The ED physician was there almost right away. I had worked with him before when patients of mine had been admitted or transferred from the ED. Good guy. Not easily rattled. As an ED doc should be.
Almost immediately, Todd Mumford showed up with his 3 kids in tow to pick up an additional 2 for the day. When I saw my friend and colleague, I broke down for the first time. The adrenaline was wearing off and the fear was setting in.
When Ashley kept vomiting, they fast-tracked our route to the CT scanner. Standing there, alone, watching her confusion and frustration, the fear overwhelmed me. I starting sobbing in the hallway. The radiology techs took pity on me and invited me in to the control room, where I saw a very rapid scroll through her CT scan. White means blood, and I saw no white where it shouldn't have been. The ED doc agreed, but the radiologist's read was pending.
Micah and Lisa came as soon as they could and helped with all of the non-glorious housekeeping. Their concern for Ashley had begun to play tricks on their consciences. What could we have done differently, we feel responsible, etc. Nonsense. I am so glad that you were with her. This could have happened to anyone. I am probably going to execute that dog.
I began the process of repeating the story to Ashley over and over as she would say, "My head hurts," and look at me for an explanation. It was at this point that I became very fearful for her memory. It is one thing to read in a textbook that closed head injury can be associated with transient post-traumatic amnesia. It is quite another thing to be looking into the face of your beloved, hearing her voice, but not being able to find her anywhere in her expressions or words. I would intermittently sob, whereupon Ashley would ask, with the most innocent eyes, "Why are you crying? What's wrong?" Oh, my love, for you to comfort me in those moments was absurdly precious.
Then I realized I was not alone in my love for this woman. I called Nann first and got voicemail. Craig was next, and he picked up. Here I am, the husband and caretaker of his only daughter, and I am telling him how she has almost died and is mentally nonexistent at the present time, all caused by an activity to which I introduced her. Thank you, Craig, for your understanding.
I tried my best to keep it together for her father, as I knew what uncontrollable sobbing would do to his state of mind. But when I called my own mother, I lost it completely. My wife had almost died. I felt an overwhelming urge to confide in Ashley during this horribly frightening experience. There she was, in the same room, yet she was light years away.
The radiologist's reading was not as optimistic as our initial impressions. Small occipital skull fracture, probable blood in the frontal region. The ED doc asked my preference regarding transfer to a neurosurgery service. He was unsure if Lawton would take us on a Saturday, and the only other option would be OKC, 150 miles away. I wanted Lawton. I felt confident that, given how difficult it was to spot the "probable blood," she would much more likely be in for observation rather than an emergent craniotomy. I understand the desire to have your loved one in the best possible facility in the big city. But 50 miles is much more manageable than 150 miles, especially given the low potential for surgery.
Lawton accepted us. Micah and Todd reappeared to administer to Ashley. She kept thanking them for coming and asking if Micah and Lisa were all right. She also kept asking about the dog (the DOG!!!), wondering what had happened to it. They stayed with us until Ashley was loaded into the ambulance at about 10:30 am. My first desire was to go with her (GO!), but that option was not even entertained by the paramedics.
I rushed home and packed. I grabbed a set of clothes for Ashley, but neglected to bring a bra or footwear. Well done, Eagle Scout. (Although, to be fair, they don't teach you about intimate apparel in the Boy Scouts. Footwear is inexcusable.) I didn't anticipate how stepping foot in our home would impact me. Seeing the pictures on the mantle, the rumpled covers on the bed, evidences of her mind at work in the kitchen and TV room (the bike pump on the floor), hit me like a brick. I wept and swore and cried out for the love of my life, who was nowhere to be found at the moment.
I talked to my parents-in-law, my mother, and my brother, Jake, on the drive out. All offered to come immediately to Oklahoma. Nann and Craig were soon on their way. I know that Jake and my mom felt immensely powerless as they confronted this unknown horror from 1,000 miles away. I felt the same frustration from across the room. I very much appreciate their willingness to drop everything for my Ashley.
I arrived at the hospital at around 11:30 am, 4 hours after the incident. I burst into Ashley's room and immediately asked if she remembered why she was in the hospital. Not a hint of recollection. She was still MIA. A medical student followed me in and did the intake H&P. Sharp girl. When I mentioned that Ashley had a coup contrecoup brain injury she gave me a knowing smile. The ED doc came later and informed us that the neurosurgeon was on his way.
As we waited, I spoke with various loved ones and shared the agonizing story. A knock came at the door, but rather than a nurse or neurosurgeon materializing in the hallway, it was Adam Bingham. He put his hand out, but I gave him a Tommy Boy "brothers gotta hug." They just picked up and drove to Lawton (confirming this was the right decision over OKC). And his pregnant wife had just been discharged from the hospital the night before. I'll say it again. You mess with Altus, you mess with my friends.
Ashley recognized Adam instantly, but then became seriously confused as to why he was at her bedside. Adam stayed only briefly, as his pregnant wife was waiting in the, um, waiting room, but he did what bros do. He asked for my food order. His visit was just the right thing to break up the monotony and spark Ashley's slumbering memory.
Dr. Ofori arrived and examined Ashley. He was as relaxed as I was terrified. Not the cool detachment of someone who doesn't know and doesn't care, but the confident breeze of someone who has been there, done that numerous times. When I asked about her post-traumatic amnesia and long-term prognosis, he smiled broadly. She'll be fine, nothing to worry about. The weight began to lift. And the soothsayer from Africa was not to be proven wrong. After returning from speaking with Ashley's brother Bryant (in Singapore, probably 4:00 am his time), a tiny flicker of my Ashley showed itself. "I remember Adam was here..." Oh, the unspeakable joy! I called Nann and Craig right away and posted the hopeful update to my gloomy introduction.
Adam came back with the grub and Shalisa. He bypassed the "one visitor" rule by answering "Yes" when they asked if he was family. Hey, he's my kids' Uncle Bing, he wasn't lying. Ashley was pretty out of it, but was definitely better than she had been all morning. She remembered that Shalisa had been in the hospital, and upon finding herself in a hospital with Shalisa, she naturally assumed that Shalisa was the patient. She kept asking if Shalisa was going to be discharged, which would have been funny had it not been so sad. But that second visit found its way onto the tabula rasa that was her memory. She forgot Adam's first visit, which had served its purpose well, and now locked onto the visit of "Adam AND Shalisa."
I had given Micah an update earlier, and during the conversation he asked if we would be okay with visitors. Yes, yes, absolutely yes. That was all Julie needed. Earlier that morning I had called her trying to find Micah. She knew almost nothing and I unloaded on her, sobbing and fearful. I know that Julie means a lot to Ashley, and now I know that Ashley means as much to Julie (not that I doubted it). She became our second pregnant visitor of the day, having found her way to the hospital through tears and worry. Ashley absolutely lit up for Julie. She held strong to the Gibraltars of her newly-found memory, but asked enough repeat questions and made enough repeat comments to convey the length of journey that remained. When someone who has 5 children, and is pregnant, drops everything on a Saturday, buys flowers and a card, and drives an hour to see you, that is just about all you need to know about that person's heart and character. I owe you a debt of gratitude.
Finally Nann and Craig arrived. Nann had cried all of her makeup off. As horrible as they felt to not be present, I am grateful that they did not arrive until Ashley had turned a major corner. To see her in the fog of amnesia was torture that they did not need. Their timing was perfect, as Ashley's new nurse, Shelly, was coming on shift at the same time. Shelly was confident, decisive, knowledgeable, and full of down-home warmth. I know that Nann and Craig were somewhat concerned about my choosing the close hospital over the big city medical center. But Shelly erased their doubts.
Thus ends the worst day of my life to this point. I am oddly grateful that Ashley will not remember most of it, given that I spent the day begging for her to remember any of it. I am thankful for many things. For the unconditional love of family. For friends who amaze with their selflessness and care. For health care professionals who have worked hard to be good at their job and who make you feel like you are the only patient in the world. For the engineers and physicists who developed X-ray and computed tomography technology. For a culture of safety that inspired the design of light-weight yet shock-absorbent helmets, without which my wife would be dead. For the wireless and satellite infrastructure that makes instant communication possible. For all of the pioneers behind modern hospitals and western medicine. For the progressive human spirit, ceaselessly striving to make this world a better place to live in for everyone. But most of all, I am thankful for my wife, Ashley. Everyday, from now until the end, is a gift.
