Free Fallen: A Trauma, a Marriage, and the Transformative Power of Music by Kara Stanley Page A

called hydrocephalus, which is an accumulation of liquid in the brain. But the two most important acronyms right now are ICP and CPP . Because, a nurse has explained, there is only a limited amount of room inside the cranium, the vertebral canal, and the relatively inelastic dura mater, and when there is an increase in any of the brain matter due to, say, bleeding or swelling, the ICP , or intracranial pressure, rises. When the ICP rises too high, it lowers the CPP , the cerebral perfusion pressure, or blood flow through the brain. No blood flow means no oxygen, and no oxygen means cell death. ICP is measured in millimeters of mercury, and a normal rate for a resting adult is 7 to 15 mmHg. A consistent ICP of over 20 mmHg requires medical intervention, and if it remains over 25 mmHg, the situation quickly becomes critical. I have watched Simon’s ICP levels throughout the night. When they rise above 20, a nurse comes in and opens the EVD and drains out cerebrospinal fluid until the pressure comes down.
    “Simon’s family have arrived,” I tell the doctors. “They have a lot questions. Will we be able to sit down with someone today?”
    There is some hesitation. A few of the huddled group—very young, definitely interns—avoid meeting my gaze. I am told Dr. Haw will answer our questions, but I have yet to meet Dr. Haw, and before a firm Q&A time is established, the doctors dart away, remote and insulated in their cloud of critically important preoccupation. Next to the doctors’ professional detachment, I am achingly raw, feverish with fear and grief and lack of sleep, and I feel defeated by my attempt to communicate with them. I watch as the sun rises, its early-morning heat noticeably raising the temperature in Simon’s room. It has been not quite forty-eight hours since he stood at the foot of our bed, maniac birds chirping outside, and rubbed his sore paw, but it feels like a lifetime ago.
    The hour of shift change for the nurses is 7:30 to 8:30, and I am required to leave. I buy tea and a muffin for Eli and take them back to the hotel, where he and I make a few phone calls to finalize arrangements for his return to the coast. At 8:30 I return to the ICU , where I am greeted by Mike, the nurse from the day before. It is a relief to see a familiar face.
    “I’ve got news,” Mike says, smiling. “They are scheduling Simon for spine surgery later this morning.”
    “Why?” I ask. I don’t understand. Not two hours ago I was told that there was too great a risk that his ICP would rise dangerously high during surgery. Earlier, Dr. Griesdale had told me Simon’s ICP levels would not be stable and would likely rise over the first seven days as his brain reached its maximum amount of swelling. A panic surges through me, similar to the moment when we arrived at the hospital and I didn’t know how to find Simon. “The spine doctor told me the cord was severed; surgery isn’t going to change his chances of walking, right?” I ask.
    “That’s right,” Mike says.
    “But it could risk his brain, right? If his ICP rises? Why would they do that?”
    “Well, if his spine is mobilized, it will be helpful to us in taking care of him,” Mike says.
    “That’s not a good enough reason!” I shout.
    “We’ll get more information for you,” Mike says, “okay?” Since Simon’s family arrived, Mike has been nothing but kind and considerate. While he wasn’t necessarily expecting me to be happy about this news, I don’t think he was expecting this distress. “I’ll talk to a doctor.”
    “I want to talk to a doctor,” I say. “I won’t okay this surgery until a doctor has explained the reasoning to me and the rest of the family.”
    I leave to go find Emily and my mother and to contact Marc and Lorna at Jer and Barb’s house. An hour later, we all return to the ICU . Mike tells us Simon’s surgery has been canceled because of an incoming emergency but was rescheduled for tomorrow. Dr. Griesdale will speak