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First published in the US by Emily Bestler/Atria Books, an imprint of Simon and Schuster in 2016

“The Summer Day” from the volume House of Light by Mary Oliver, published by Beacon Press, Boston. Copyright © 1990 by Mary Oliver, used herewith by permission of the Charlotte Sheedy Literary Agency, Inc.

Excerpts of “Sacred Pause Guided Meditations for Renewing Mind, Body & Soul” used with permission of Karen Sothers, M.Ed.

To Brittany, my sweet pea.

Fly freely in and out of my heart. Always.

Who made the world?

Who made the swan, and the black bear?

Who made the grasshopper?

This grasshopper, I mean—

the one who has flung herself out of the grass,

the one who is eating sugar out of my hand,

who is moving her jaws back and forth instead of up and down—

who is gazing around with her enormous and complicated eyes.

Now she lifts her pale forearms and thoroughly washes her face.

Now she snaps her wings open, and floats away.

I don’t know exactly what a prayer is.

I do know how to pay attention, how to fall down

into the grass, how to kneel down in the grass,

how to be idle and blessed, how to stroll through the fields,

which is what I have been doing all day.

Tell me, what else should I have done?

Doesn’t everything die at last, and too soon?

Tell me, what is it you plan to do

with your one wild and precious life?

—Mary Oliver, “The Summer Day”

Do not judge the bereaved mother. She comes in many forms. She is breathing but she is dying. She may look young but inside she has become ancient. She smiles, but her heart sobs. She is here, but part of her is elsewhere for eternity.

—Author Unknown

Preface

THIS IS A story about ordinary people who accomplished extraordinary things. A story of a family that weathered more than one horrific storm. The last storm was the darkest, leaving in its wake scarred human beings and broken hearts. No one can look into my eyes and miss this. The melancholy is there, even when I smile. I see suffering etched in my husband’s face, as well. We are changed forever by what happened.

Often people ask me, “What did you learn from your journey?” In the early stages of grief I remember thinking, Not only am I supposed to survive, put one foot in front of the other, but I’m supposed to have learned something, too? It was an unspoken rebuke, a visceral reaction to the question. Over time, through the process of grieving, I have begun to understand that the effort put forth in answering this question is valuable, and perhaps even transformative. At least it has been for me.

Shortly after my daughter’s death, I got a tattoo on the instep of my right foot, reminding me not to let pain make me hard or bitter. It says, “Be soft.” Brittany’s birth date is inked below the words.

This book is my “soft.” In it, I’m exposing my underbelly. I’m revealing my daughter’s beautiful spirit, her fury and fearlessness, her resolute determination, our frantic struggle as we staggered toward something that flew in the face of the natural order of things. No mother should bury her child. No child should have to drag her mother, kicking and screaming, out of denial and into ugly reality. My brave Brittany faced the truth sooner than I did. It took me a while, but ultimately I was forced to look death square in the eye. “Death is coming for me, Momma. Don’t you get that?”

More than life itself, for twenty-nine years I loved my daughter. Yet I’ve learned that she doesn’t have to be physically present in order for me to love her. I can love her even after she soared away from me. My heart is open for her to fly in and out of at will.

My daughter did the best she could. I’m rock solid in that truth. She tried so hard to do what was right. This idea sounds simple, but it is not. Look around at those who disappoint you, hurt you. Are they doing the best they can? Are you? Does it make us feel safer to think our best is better than theirs?

Now look at those who are terminally ill. Are they doing their best? How dare we judge them. How dare we tell them how they ought to die. How dare we impose our beliefs on them. How dare we try to manipulate them into fighting when they have no more fight left.

Everyone who walked Brittany toward death was fallible. We were angry, sad, brave, and frightened. We were human. But each of us in the little yellow house in Portland was doing his or her best. That is one of my big lessons, and it gives me great comfort. My daughter knew that she was loved. Even in the worst of it, she knew that, just as I knew she loved me. Love sustained us, then and now.

Our lives are wild and precious, and I’ve promised to try to live mine with those words in my heart; in my laughter; in my plans for living boldly. That’s what Brittany said she wanted for me.

Foreboding

December 31, 2013–January 1, 2014

THE FIRST STEP in leaving the world I formerly inhabited was more like a jarring shove. Not a tiny toe-out-the-door kind of move. Instead, I was cruelly pushed into a new life.

Late New Year’s Eve of 2013, when Brittany should have been dining and dancing, my son-in-law called me from an ambulance. Dan said that Brittany had a very bad headache. They had gone to a hospital, where a CT scan revealed a shadow on her brain. Since the hospital didn’t have an MRI, they were now heading to a larger one that had the proper equipment.

“Should I try to get on a flight tonight? I’m not sure there are any middle-of-the-night flights to Oakland.”

Dan responded that she’d have to do admittance tests and take the MRI, so tomorrow morning would be fine. He put my daughter on the phone.

“Momma, my head hurts so bad,” Britt said, her voice thick and slurred from the effects of pain medication. “They took a CT scan and found a shadow on my brain. It might be a brain tumor.”

My heart dropped as my mind refused to accept this possibility. “Don’t jump there, darling. Don’t draw any premature conclusions. Baby, I’m coming. I’ll see you tomorrow.”

Gary booked my airline ticket as I haphazardly threw clothes into a suitcase. “Follow your own advice,” Gary said. “Don’t jump to any conclusions. I’ll make arrangements for someone to check on your father and stay with the dogs. Then I’ll come up later.” He held me by the shoulders. “Try to get some sleep tonight. You’ll need to arrive rested.”

As I flew to Oakland from San Diego the next morning, I wondered what might have created a shadow on Brittany’s brain. My daughter with a brain tumor? It just wasn’t possible.

Brittany had always been a healthy, active child. Over five feet nine, she positively exuded strength and vigor. As I looked out the plane’s window at the cloudless sky, images clicked through my mind like a silent slide show:

Three years old. Feet up on the dash of her toy ride-on car, screaming in delight. “Faster, Momma, faster!”

Preschool. Curly hair hiding her face, dangling upside down on the monkey bars. “Look at me! Momma, look at me!”

First grade. Bent over homework, Britt printing her letters over and over until she developed a pressure bump from bearing down on her fat beginner pencil.

Elementary school. Green eyes gleaming, Britt as Princess Jasmine sang her solo parts as clear as a bell. Back and forth with the boy playing Aladdin, she fearlessly belted out lyrics about taking a free-spirited flight through a glittering sky. Trilling perfectly on key, she stretched out her arms to the beaming audience. How prophetic this song about seeing amazing sights would be, although Britt would never need an Aladdin to escort her anywhere.

Preteens. Tumbling, cheering, and ice skating her way through middle school, effortlessly excelling at sports.

High school. Alternately crashing and soaring, Britt spiraled into wild rebellion as she fought for autonomy. With almost waist-length honey-brown hair and a smile that knocked the breath out of boys, she skipped school with gleeful abandon, yet somehow always excelled scholastically.

Young adulthood. A trip to Costa Rica to work on a women-owned farm filled Britt with a deep yearning to volunteer, to experience wild places, and to engage in adrenaline-producing activities. It was the first sign of the trekking, bungee-jumping, stranger-befriending young woman that she became.

As I flew toward my sick daughter, I envisioned her startling white smile, muscular legs, and powerful arms as she winged upward and plummeted, freewheeling, through life. I imagined her long tanned legs glistening in the white foam of a waterfall as she rappelled down slippery rock. I pictured my girl in a life vest and helmet, white water almost obscuring the raft, Britt the only occupant who somehow managed to grin impishly at the camera while everyone else grimaced and paddled furiously. I imagined the sound of her laugh—the very best sound I’ve ever heard—as she jogged across a hanging bridge, deliberately setting it in motion to unsettle others in the group.

I could not picture Britt lying still and quiet in a bed. My daughter was definitely more of a magic carpet girl.

Brittany’s mother-in-law, Carmen, picked me up at the airport. We hugged, her compact frame rigid as she squeezed me hard. She drove me to the hospital where my only child slept on crisp white sheets in the Neuroscience ICU.

Carmen told me that they would get a clear MRI today, since the previous hospital only captured a fuzzy image with their CT scan. Her voice was precise, with the charming hint of a Cuban accent that I found endearing. Carmen and her husband, Barry, had bonded with me and Gary at our kids’ engagement lunch. Carmen added that Barry was taking care of Britt and Dan’s dogs, Charley and Bella. I thought of kind, strong Barry and how the dogs immediately calmed down in his presence. The whole family called him the “dog whisperer.”

Carmen and I loved our children fiercely. Dan was Carmen’s pride and joy, just as Brittany was mine.

I didn’t know then that an MRI is the investigative tool of choice for neurological cancers. Carmen and I were silent for a few minutes as she negotiated traffic. “What does a shadow on the brain mean?” I asked.

Carmen replied that she didn’t know, but that Dan would explain when we got there. In the quiet of the van, I prayed silently all the way to the hospital. Brittany had been complaining of headaches for almost a year. Were they migraines? Stress headaches? Sinus headaches? She and I had posed many hypotheses as to what might be triggering the increasingly debilitating pain. Sometimes at night the throbbing of her head was so all-encompassing that all Brittany could think to do was go sit in the shower with warm water pouring down on her neck and head. I had looked online, but there were hundreds of potential reasons.

Brittany tried avoiding wine. She made sure she exercised regularly. She avoided nitrates, and bought farm-fresh, organic foods. Was it our imagination that the headaches seemed to get better when she visited me and Gary in Southern California?

Brittany had bought a Great Dane puppy to join Bella, her needy rescued beagle, soon after marrying Dan in late September of 2012. She said she was lonely living in Northern California, and longed for a puppy to keep her company. Had the teething Charley caused stress?

Soon after her wedding, Brittany saw a neurologist. She chose him because he had training in both Eastern and Western medicine, and he advertised a holistic approach. Although Brittany described the headaches as coming on when she went to bed, severe enough to make her vomit, the doctor told Brittany that she was having “women’s headaches” and that they might get better when she had a baby. Brittany was a bit insulted by this, thinking that he was suggesting that the headaches were potentially a combination of newlywed stress and hormonal imbalance. I didn’t dare say it, but I thought he might be right.

Later, Britt and I discussed the fact that this neurologist hadn’t ordered an MRI and caught her growing tumor. He missed a couple of glaring pieces of information. The headaches grew worse when Britt was lying down. It was at night that the pain caused her to forcefully throw up and to seek the refuge of a warm shower. But we also were told by other neurologists (do they always defend one another?) that a hundred million Americans report bad headaches each year, with 35 million of those experiencing migraine-level headaches. If doctors ordered an MRI for all of these patients, the medical system would go bankrupt. So our anger and desire to write a blistering letter died away with time. There was so much else to deal with—we had to let go and keep moving forward.

The doctor also encouraged her to avoid too much caffeine, red wine, processed meat, MSG-laden foods, and artificial sweeteners, as all of these things can trigger headaches. Brittany became very averse to the use of artificial sweeteners and adamantly opposed my use of sugar-free flavored coffee creamers.

He prescribed subcutaneous injections of pain medication, a selective serotonin receptor antagonist used to narrow blood vessels around the brain. It is a medication used for migraine headaches. Britt would find a place at the top of her thigh, wipe the area with an alcohol pad, and use an auto-injector pen. But the injections hadn’t helped. “Are you going to tell him the medication isn’t helping?” I asked.

“I don’t know. Maybe I need to give them a chance.” Britt changed the subject before I could jump in with more advice. “Mom, why don’t you fly up here? I’m trying to find someone to go shark diving with me.”

“We’d take a boat out to San Francisco’s Farallon Islands, where it’s common to see a great white the size of a car! You could just watch them from the boat. I’ll go down in the great white cage.”

“I would meet you for a few days’ retreat and massages. How about that?”

“You’re such a mom. You’ve gotta break out of this wine and massage thing,” she said, teasing me. “You know what that big galoot, Charley, did now? He ate both of my retainers. That’s $750 dollars of orthodontic products down the hatch.”

I hung up thinking the headaches couldn’t be too big a problem if she wanted to go shark diving.

Now, on January 1, 2014, as I sat next to Carmen in her immaculate van, I wondered what a shadow on the brain might be. Could fluid cause a shadow? Could it be a blood clot? I refused to even think of the word “tumor.”

That was highly unlikely; not even a concern, I told myself. No one would refer to a tumor as a “shadow.” Could it be an infection of some kind? Although I tried to convince myself that we would get to the bottom of the headaches and then take Brittany home, deep inside me a warning sounded. Not a blaring mechanical siren; more like the muffled, mournful tones of a foghorn. This sorrowful pulse of warning stayed with me. I hear it even now, when night falls and I find myself thinking too much.

Carmen pulled into the parking lot of a sprawling, modern glass building, and we hurried to check in at the main desk. On the second floor, we sat in a small waiting room. Since only two visitors were allowed at a time, Dan would escort me back to the ICU while Carmen waited there.

Dan appeared in the doorway. I rushed over and gave him a hug. He reported that there was a large shadow on her brain, that they had scheduled more tests, and that she was awake. His calm demeanor made me feel less agitated.

Dan announced our names into a squawk box, and we were buzzed in. I scanned the glass windows in the rooms we passed, looking for my daughter. The hulking equipment in the rooms overwhelmed me; my eyes were already flooding with tears. Patients were connected to ominous machines that blinked and beeped.

Dan turned to enter a room, and I saw her. A nurse held Brittany’s shoulders up, but her head was lax, elegant long neck arched back, dark hair stark against a crisp white pillowcase. The doctor repeated her name in a loud and urgent tone. “Brittany, wake up! Brittany!” Her eyes were closed, and she didn’t respond. In the background, one of the machines beeped endlessly, flashing a red number that meant nothing to me. The doctor pried Britt’s eyelid open and shone a tiny flashlight in her pupils. She didn’t react.

I hurried to her bedside and touched her hand, but didn’t pick it up as two IV lines were taped to the back. “Brittany, darling. Momma’s here. Wake up.” I spoke loudly, leaning toward her ear. “Wake up, darling! Momma’s here.” Tears streamed down my face. “Sweet Pea, I’m here.” I willed her to recognize my voice and come to.

Dear God, she’s dead, I thought as my knees wobbled. I didn’t get to say goodbye.

What were they saying—something about me? Someone was pulling at my arm. Dan and I were being ordered out. A nurse jostled past us.

In the waiting room, I fell to my knees. “Take me,” I begged. “Take me. Not her, not her!”

My entire face was soaked with tears. A thin sheen of perspiration dampened my hairline. I couldn’t breathe. I felt like something vital had been ripped out of me.

Carmen came near and rubbed my back. I looked through blurry eyes into her troubled face. I felt I was operating on a primordial level, like a mother wolf separated from its pup. The most primitive part of me needed to stand vigil over my child. “I need to call Gary,” I gasped.

Dan slumped on a chair. With a perplexed expression, he said that he’d heard them order Narcan, a drug used with drug addicts who have overdosed.

“Who ordered what?” I stopped whimpering and tried to focus. “The doctor overdosed her?” I asked and began to cry again as Dan strode out of the room on a quest to find out why Britt had been given Narcan.

Carmen held the cell phone against my ear and I heard it ringing. I grasped the phone. Gary’s voice broke my last bit of reserve.

“Come now,” I sobbed into the phone. “Britt’s bad. Very bad. I need you.”

“Honey, slow down. I can’t understand.” Gary’s voice faded as I handed the phone back to Carmen.

I gave in to a guttural noise building from deep within. An animal-like howl erupted as I rocked back and forth on the floor.

My wails had quieted to sobs by the time Dan returned to the waiting room, a smile on his face. Brittany was conscious. The Narcan had worked.

I followed him down the hallway, where someone opened the double doors to let us in again.

The curtain to Britt’s room was drawn, and the room was dimly lit. Machines blinked numbers, but nothing beeped a warning. The nurse said we must follow the brain injury protocol written on the whiteboard. “Dim light. No television. Speak softly.” Brittany sat propped up at an angle.

“This angle must be maintained at all times,” the nurse warned us. “Don’t lower the head of the bed.”

I approached Brittany and softly said, “It’s Momma, Britt. Momma’s here.” I touched her hair.

Britt opened her eyes. Her pupils, tiny pinpoints, focused on me. One eye opened wider than the other. The heavy eyelid fluttered.

“I’m sorry, Momma,” she whispered. “I’m not going to be able to take care of you when you’re old, the way you take care of Grandpa.” Tears welled up and rolled down her face. “I’m not going to live that long.”

Where had this thought come from? Watching me care for my elderly father for the last three years? I touched her flushed cheek. “Hush, sweetness. Just rest. Everything will be all right. I’m here now. Momma’s here.” These words rushed out in a loving whisper, but the mournful warning continued to sound rhythmically inside me. I tucked her tangled hair behind her ear.

“I feel so bad. I want these out.” She tried to reach for the IV lines, but it was as though she couldn’t see where her hand was.

“Let’s leave them in for now.” I stroked her hair as Dan untangled each of the four lines running into Britt. He gently laid them out straight on her bed.

Dan talked to Brittany about keeping the lines in. “What happened?” I whispered to the nurse.

She couldn’t seem to meet my eyes. “Oh my, yes. Well, we’re not sure. She might have had a seizure.”

My hackles rose. “But she was unconscious, not jerking.” I didn’t buy this explanation. “She’s never had a seizure.”

The nurse patted my back. “Well, nevertheless, it was a terrible way to see your daughter when you first arrived. Don’t you worry, all of her stats are fine now.” She busied herself punching buttons on the machines, and then bustled out of the room.

I was trying to determine if the nurse was someone who could be trusted around my child. My daughter was of me, and a great deal like me, but younger, smarter, prettier. She was the hope of my heart. She embodied the grandchildren I eventually hoped to have. She was the promising career, the result of the excellent university education I’d scrimped and saved for. She didn’t owe me these things; she was already all of this, and more. She was my only child—my everything.

Sitting next to her bed, I felt old, even ancient. I felt my youth slipping away, my future sliding away, the rest of my life tumbling into oblivion. Inside my gut, I knew that Brittany, my baby, was going to die. Looking back, I realize that my animal instinct discerned this. However, the thin veneer of my purportedly superior human knowledge denied it. Everything I’d learned in the fifty-seven years of my life—from my parents, schools, and life experiences—told me to keep that mask of human superiority on and deny the warning whimper inside.

Science. Medicine. They would save Brittany. Or perhaps God, through a doctor using science and medicine, would save Brittany. Yes, a combination of faith and science and medicine would be unbeatable. Or so I told myself.

As I watched my daughter sleep, I felt no different, no less awed, than the day the obstetrician held her slippery naked body above me.

“It’s a girl,” the nurse announced, holding what looked like a tiny Martian near my head.

In that instant, I felt a love like nothing else in the world. I would have ruthlessly crushed anyone trying to hurt my baby. My daughter hadn’t been outside my womb five minutes, yet I knew I would die for her if need be. It was as though a switch has been thrown, and from that moment forward I would think constantly about her welfare. I was already fixated on keeping her warm and safe, guarding her against danger.

Later, the nurse rolled a bassinet into the room. Inside was the most beautiful, tiny creature I’d ever laid eyes on. Her head was perfectly shaped, not flattened or pointed by having to pass through the birth canal, since I’d had an emergency C-section. She had dark hair and gorgeous skin, as though she’d been born with a tan. I loved my child with a fierce protectiveness that altered me forever.

Brittany Lauren was the name I chose for my baby in November 1984. I thought it was original; my mother was British, and its Celtic meaning was “from Britain.” In truth, I’d fallen in love with a name that would become one of the most popular girl’s names in the eighties.

A breech baby, Brittany arrived via cesarean because although I was already in labor the hospital classified first-baby breech births as “high risk.” My obstetrician told me I’d have to go to a different hospital if I wanted to try to deliver naturally. Brittany kicked hard and broke my water almost a full month early, avoiding, by one day, a painful procedure whereby the doctors would have tried to turn her manually. She was born with mild dysplasia, a hip click. She looked tan because she had newborn jaundice. She was absolutely perfect.

Now standing beside my adult daughter’s bed, again I felt my body and soul go through extremely powerful reactions, as I had postnatally. Brittany lay there, helpless and in pain. Disease threatened her brain. She was in danger, and just as when she was a newborn, I realized I would die for her.

However, a willingness to die for one’s child was, in this instance, of absolutely no use. There was no such thing as a brain transplant. I sat next to my beautiful girl repeating a useless circular prayer of “Take me, not her. Take me …” This begging, this entreaty, didn’t make any sense; it didn’t make any difference, and didn’t calm me in any way. But I couldn’t stop.

Bad News

January 1–3, 2014

TWO YOUNG MEN came rattling into the ICU room with a gurney. Brittany blinked awake for a moment, one eye droopy, and then disappeared into sleep again. Dan had left the room earlier to do research and make some important phone calls. “What are you doing?” I asked as they slid her limp body onto the gurney.

“The neurologist ordered a functional MRI. It scans the brain while she’s asked to perform various tasks.” He was already rolling the gurney out of the room.

“It’s just an MRI,” I said to Brittany, walking toward the ICU doors. “Nothing to worry about, sweetie!” I called to the gurney as it disappeared.

She was back too soon. I knew that an MRI should take longer. I looked over at Dan, who’d joined me. Something wasn’t right.

“She couldn’t do the MRI,” the guy pushing the gurney said to us. “She was claustrophobic. We’ll need to mildly sedate her and try again.”

“She’s never been anxious or claustrophobic. She’s had MRIs before.” I didn’t want Brittany being drugged anymore; not after finding her unresponsive.

“She was trying to climb out of the machine. She was talking about paradigms.” The guy shrugged and left, passing a doctor entering the room.

“She was most uncooperative, and very vocal about not wanting to do the test.” The doctor raised his eyebrows. “We may need to sedate her.”

I locked eyes with him. “I think she’s too out of it. I don’t think she needs more drugs to make her even more out of it.”

“I suppose we could wait awhile, let the Dilaudid wear off a little, and try again,” he conceded. “She’ll be better able to follow the directions to complete the tasks. I’ll try to reschedule for later today.”

The afternoon ticked by. Dan went in and out of the room, making phone calls and sitting by Britt’s bed. When Britt surfaced, I told her that she’d been a little out of it before, and that they’d thought she was claustrophobic. I explained that they hadn’t been able to complete the test.

“Can you do the MRI without any anti-anxiety meds, baby?” I asked. Dan pulled the curtain aside and slipped into the room.

“Of course I can. I’m not claustrophobic. You are, Momma. That’s your issue.” Brittany sounded incredulous that anyone would think she was claustrophobic. “I want my laptop, Dan. Where is it?” Brittany spoke authoritatively, her heavy eyelid fluttering.

Dan explained that computers were not allowed in her room while Brittany fiddled with her bed, trying to lower the head.

“The nurse said your bed has to stay up at this angle. It’s not supposed to be lowered,” I told her.

“I don’t give a shit what she says. I’m not comfortable like this.” Brittany continued trying to operate the bed. “And my head still hurts.”

“Ready for a ride?” They smiled and chatted with her as they carefully transferred her to the gurney.

“Dan, I want my laptop!” Brittany called, as once again the double doors swished closed.

This time she was gone a good while, so I knew she must be successfully completing the MRI. I flinched at the thought of her poor hurting head, subjected to loud tapping and thumping inside the narrow cylinder of the machine.

“How long do you think we can keep her computer away from her?” I asked Dan, who replied that we should for as long as possible.

I stayed busy by googling what they were doing to her. During a functional MRI, physicians identified regions linked to critical functions such as speaking, moving, sensing, or planning. The goal was to detect correlations between brain activation and the task the subject performed during the scan. This sounded like a logical test. Then I looked up what happened in a Dilaudid overdose. The situation I walked into at the hospital, when Brittany was unresponsive, had lost consciousness, was described as a Dilaudid reaction requiring immediate emergency help. I found out that Dilaudid is eight times more powerful on a milligram basis than morphine. Brittany’s weak pulse, low blood pressure, and pinpoint pupils were all consistent with such an overdose. Finally, I found that the antidote was Narcan, the very medicine the doctor had ordered. Narcan was described as a pure opioid antagonist used to counter the effects of opioid overdose. While I do not know what exactly happened with Brittany, this information did not give me comfort in the care Brittany was receiving. I would need to talk to Gary about this when he arrived.

I mulled over Brittany’s mention of paradigms when they first tried the MRI. Even though she was loaded up on Dilaudid, her reference seemed perfectly coherent to me. Brittany excelled in science. As a science teacher, I had hoped that she would go into the field. At one time she’d expressed interest in studying to be an immunologist.

In the past we’d spoken of paradigm shifts, or great shifts in thinking; and also of paradigm paralysis, the refusal to see beyond current models of thinking. I wouldn’t know until later that my daughter would be leading a good bit of the country’s population toward a huge paradigm shift. My mother’s instinct told me that even on heavy medication, even before results of the MRIs were shared, Brittany was shifting her focus. She was always three steps ahead.

Carmen thoughtfully picked Gary up at the airport and brought him directly to the hospital. He met me in the waiting room.

I must have looked a sight with swollen eyes, smeared makeup, and a panicked expression. I rushed into his arms. He held me and smoothed my hair. “What have the doctors said?”

Later I offered to stay with Brittany in the ICU that night, but I was firmly told that there was a “no overnight visitation” policy. I argued that I didn’t think it was a good idea to leave her alone, but the wall was up.

Gary and I returned to Brittany and Dan’s house with him to catch some sleep, and found a giant pot of fragrant lentil soup simmering on the stove. As I ladled the hearty soup into a bowl, I thought of how kind it had been of Carmen to do this in the midst of running back and forth to the hospital. She was such a good cook. The soup was comfort food, and felt like a giant hug from her.

The three of us sat eating dinner with our glasses of red wine. We were tired, hungry, and quiet. I wanted to cry again. The house was full of Brittany’s Christmas things. Her love of the holidays surrounded me. In fact, their whole house was infused with the very essence of Britt. Her wedding photos and pictures from her trip to Africa livened the family room walls.

Dan insisted on doing the dishes himself, so Gary and I went to bed. Before I turned out the lights, I stood gazing at photos that Brittany had taken at the elephant sanctuary in Thailand where she’d worked for a while. A close-up of a giant elephant eye was my favorite. The elephant’s kind, expressive eye gazed at me as if she knew and understood my fear and sorrow. Brittany had told me mother elephants often became deeply despondent after the death of their calves. She said that a mother would stand over the remains of her baby, touch the body with her sensitive trunk, turn it over, and caress it. There was no greater love in an elephant herd than maternal love.

In the wee hours of the morning, Dan received a phone call from the night nurse. Brittany had pulled all her IVs out and was trying to walk out of the ICU. Could he come help? I slept on, unaware of the call.

Gary and I awakened the next morning to find Dan gone. We drove Brittany’s car to the hospital. A succession of doctors came and went. Over and over, she was asked to sit up and do a series of tasks. The doctor seemed pleased that Brittany was acing these tests. She was asked to stare at his nose, and her peripheral vision was checked. The doctor used a pen-sized light, watched her pupils react, and asked her to follow the light from side to side. He gently tapped just below her kneecaps with a rubber hammer, and they bounced in response just as anyone’s would. She was asked to smile, grimace, and frown. She was asked the name of the president, what day of the week it was, what year it was. I was amazed; I could have easily answered 2013, since it was only January 2. But Brittany answered all questions correctly.

Even when they listed three objects and then asked her to list those objects after more tests, Brittany was on it. She felt the pinpricks, and was able to identify a number traced on her back. She was able to move her finger from the tip of her nose to the physician’s finger. She could identify the stethoscope when asked to feel it with her eyes closed. With each test, my heart swelled with hope and reassurance. She could smoothly rub one heel up and down the opposite shin. My daughter could perform every task with ease. Surely, nothing was seriously wrong. It had to be an eye problem, I thought; just that one drooping eye.

Late in the afternoon of the third day at the community hospital, a doctor we’d seen before entered Brittany’s dimly lit room. He repeated the tests: the light, the hammer, the pushing up and pushing down. Dan, Gary, and I watched as he checked Brittany’s chart, scribbled something on it, and prepared to leave. He was dressed casually, in what looked like a jogging suit, almost as though he planned to take a run after this quick look-see.

He was almost out the door when I heard Brittany’s voice. “Hey, are you my doctor? Don’t leave. I want to talk to you.”

The man hesitated, and then stepped back into the room. “Yes, I’m the neurological surgeon on this case,” he said.

“Have you seen my scans? Can you tell me what’s going on?” Britt’s voice seemed to emanate from the shadows of the room. “I’ve been here for more than forty-eight hours, and no one’s talked to me.”

The doctor shifted his weight. He opened the file in his hand and flipped through some pages, buying time. Those few seconds did not bode well.

“You have a large infiltrating nonenhancing lesion present in the left prefrontal lobe, and it extends posteriorly into the left temporal lobe. It is also crossing into the left hemisphere and pushing on the right ventricle.” The neurosurgeon spoke in a soft but clear voice. He looked up from the file for a moment, and then back down. He moved toward the door.

Stupidly I felt relief. A nonenhancing lesion didn’t sound too bad. He hadn’t said tumor. He hadn’t used the C-word. I’d had a lesion in my mouth after oral surgery; wasn’t that sort of like an ulcer?

“So I have a brain tumor. A big brain tumor?” Brittany’s voice was firm, and much louder than the doctor’s. “Can you elaborate a bit? Infiltrating?” Brit’s eyebrows arched up. “Can you tell me what a ‘large infiltrating lesion’ is? What does that mean?”

I looked at my daughter, who was trying to lock eyes with the doctor. Her green eyes were laserlike. I’d heard the word “infiltrating,” too. I hadn’t liked the sound of it, either, but I hoped Britt was jumping the gun.

The surgeon was clearly uncomfortable. “Based on the MRI, I would say that you have a glioma, a primary brain tumor. This means that the tumor started in your brain. It didn’t metastasize from some other place in your body.” The doctor shifted his weight and glanced around the room, avoiding eye contact. “Based on the scans and your age, I suspect that it is a glial tumor, possibly astrocytic.”

I felt the slap of information, like a sucker punch to the gut. Reeling with the impact of the words “brain tumor,” I frantically dug around in my purse for pen and paper to write down “glial” and “astrocytic,” The doctor was talking fast and using medical terminology I didn’t understand.

“We suspect this tumor has been developing for some time, because of its size and because in the functional MRI we detected that some brain function in the prefrontal lobe and the temporal lobe has relocated. These changes in creating new connections between neurons happen very slowly. The tumor is quite large, and has increased intracranial pressure. We’re giving you steroids intravenously to reduce brain edema.”

The neurologist took a quick breath and continued. “The reason the tumor is described as infiltrating is that as seen on the MRI, it has undefined edges and has invaded quite a bit of the surrounding brain tissue. A biopsy will be needed to be absolutely sure of the diagnosis. We need to collect tissue and do the histology to know what we’re dealing with.”

“So, this thing is going to kill me, right?” Brittany said. In the dim light, her face was a pale dispassionate moon. I’d detangled and braided her hair the day before, and long plaits hung on either side of her face.

“Over time, yes. This tumor presents as a low-grade glial tumor. Historically these tumors evolve into malignant gliomas. I would like to use a stereotactic needle and take a biopsy, collect some cells to have analyzed. That would be the logical next step.”

“How long do you think the tumor has been growing?” Again, Brittany’s clear voice asked hard questions I couldn’t even contemplate.

A ripple of recognition crossed the doctor’s face. It undulated across my brain more slowly. Oregon? Somewhere in an old file in the dark cobwebs of my mind, I had a fuzzy recollection of a controversial law in that state. It had something to do with doctors helping people die. “Why would you ask about Oregon?” Here, the doctor made a strategic error in choosing to play dumb.

“If you don’t know why I’d want to transfer to Oregon, this discussion is over.” Brittany’s voice was filled with disgust.

I shivered. Gary wrapped his arm around my shoulder before quietly asking, “Is the tumor operable?”

“Because the tumor grew out of the brain, it has tentacles, or roots. So no, in my opinion it is not operable.” The surgeon looked around at our stricken faces.

“Are other doctors operating on these types of tumors using new technology, like gamma knife or laser?” Gary asked. My Harvard-educated husband was the first of us, other than Brittany, to form an intelligent question. The engineering company we owned had been involved in the design of similar technology.

“There’s a surgeon over at UCSF who’s really out there doing some crazy …” The surgeon’s hands circled in the air. “I should say, cutting-edge things.” He shrugged his shoulders. “I don’t really agree with his approach, but you could see what he has to say.”

This was how he referred to a colleague? The way he delivered this terminal diagnosis enraged me. Why didn’t he sit down? Why didn’t he go over the MRI images with us? Why was he slowly backing out of the room?

“If Brittany were your sister, Doctor, what would you do then? Would you handle everything here at the community hospital—or would you perhaps consult elsewhere?” I heard the bitterness in my voice.

“I suppose I’d see what the UCSF neurosurgeon had to say, and go from there.”

Yes, I thought, let’s get out of this hellhole. I hate this cold fish of a doctor.

The neurosurgeon started to slip out the door again, his desire to have this meeting over palpable.

“I’d like you to send someone with information about transferring to Oregon,” Brittany called after him.

Gary looked at my face, and took my cold hands in his. He suggested that we might step out for an hour to let Dan and Brittany have some private time.

I bent and kissed Britt’s forehead. From behind a painful lump in my throat, I squeezed out a hoarse whisper. “We’re going to get a second opinion. Don’t give up, darling. I’ll be back soon.”

As unidentifiable sounds bubbled out of me, Gary pulled me into the hall and around the corner. The sounds I was making weren’t controllable, or recognizable. I sputtered and moaned, trying hard not to let go of whatever was dammed up behind the lump in my throat. Gary tried to get me outside the ICU so Brittany wouldn’t hear what was coming.

We stopped at the elevator, and I hit my husband hard in the shoulder. “No,” I said. “No … no … no!” Each “no” was louder than the preceding one.

“Come on. Let’s go outside and get some air.” Gary pulled me into the elevator. I slid down the wall and sat on the floor sobbing uncontrollably. In the reflection of the door, I saw my mouth stretched and contorted, mascara running down my face, snot running from my nose. For a split second, I laughed a pig-snort of a laugh, because the image I saw was what Brittany called “ugly crying.” She hated ugly crying. Brittany always cried in the shower, because she wanted to avoid others witnessing it. My daughter once pronounced Claire Danes one of the best ugly criers in Hollywood. As I rubbed my streaming nose on the sleeve of my sweater, I knew that Claire had nothing on me.

“Deb. Come on, honey.” Gary tugged me up and propelled me out of the elevator. “Hold on. We’re almost there.” Gently he pushed me toward the entrance.

The cool night air hit me. I released a pent-up, god-awful wail. People coming in and out of the hospital walked faster to get away from the ear-piercing noise. I fell to my knees in the planter area before Gary could get me to the car. I got out my phone and flipped furiously through my contacts. My sister Sarah, in Atlanta, knew that I’d flown here. She’d been waiting to hear what was going on with Brittany.

“Deb. Oh my god.” Sarah responded to the hideous noises that I was making. So far, I hadn’t been able to utter anything intelligible.

“What is it?” Sarah paused, then tried again in a wobbly voice. “What’s wrong with Brittany?”

“She has a huge fucking brain tumor!” I managed to scream before I threw my head back and wailed in anguish again. Only this time, I heard someone howling with me.

“Oh God, no!” Sarah cried out. She was screaming “No, no, no!” over and over again. Her husband had come to take the phone away from her. But, even over his calm voice, I could hear my sister howling, just like I was. Gary took the phone from my hand, and I looked up at the moonless sky. It felt right to be screaming together with Sarah.

When I returned to the ICU Brittany was asleep, and a male nurse was on duty at the computer outside. I’d picked at some dinner and attempted to pull myself together.

There was something new written on the whiteboard: “Push Dilaudid slow—3 to 4 minutes to admin. Patient sensitive.”

“Your daughter’s upper body flushes and she gets nauseous when this medicine is given to her too fast. She needs it delivered to her system slowly.” He paused and shook his head. “How long did it take the nurse to push the Dilaudid into the IV line earlier today?” he asked.

“Just a few seconds.” I thought back to when Britt got nauseated. “Less than a minute.”

“That’s wrong. The IV administration should take about four minutes. The push should be very slow. Pushing Dilaudid too fast can be dangerous.”

“Is it in her record that she was unconscious yesterday after this drug was pushed too fast?” I asked.

The nurse established eye contact and held it long enough to confirm that he’d heard the question. His head moved almost imperceptibly up and down. “From now on, ask what they’re giving her. With Dilaudid, point to the note on the board and remind them to administer slowly.” He looked into my bloodshot eyes. “I’m so sorry. I know this has been a hard day.”

At his kind words, tears spilled down my cheeks again. “I think Britt needs someone with her tonight. She’s frightened and anxious. Last night she pulled all of her IVs out. She tried to leave the hospital.” I took a breath. “I brought mindfulness recordings on my iPad. They might help in the middle of the night. It’s a meditation technique.”

“The neurologists always say no. The brain injury protocol strictly restricts visitation and stimulation.” He continued to type into the computer. When he looked up and saw my puffy eyes, his face softened. “To be honest, the literature clearly shows that Intensive Care patients do better with family nearby. All their stats are better. Let me look up who the neurologist is on her case.”

“Believe it or not, he’s the warm and fuzzy one.” The nurse smiled at me, and I tried to smile back.

“I want to be with my daughter. She heard some very frightening news today, and the diagnosis was delivered in a callous and unfeeling way.” My chin quivered. “I can help keep her quiet and calm. Believe me, it will make your job easier.”

“All right, I’ll call the doctor that’s on call. But he’s going to say no.” He picked up the phone. The nurse put up a fight, referencing the research information, recounting last night’s attempted breakout. Finally I heard what sounded like capitulation.

The nurse hung up and gave me a high five. “Let’s try to find a cot for you.”

What they found looked more like a chair you might be electrocuted in. It was a transfer recliner, high-backed, with metal arms and wheels that locked. I was grateful when they showed me that it could lay flat. The good thing was that it was almost the same height as Brittany’s bed. Sheets, a blanket, and a pillow were provided, and I stretched out next to my sleeping daughter.

Brittany hated the puffy devices strapped to her legs that rhythmically filled up with air and applied pressure to her veins, then abruptly released pressure, only to click on again minutes later. She saw this contraption as a torturous sleep interrupter. Its function was to squeeze her legs in a “milking” action, forcing blood and lymph out. Then when the leg sleeves deflated, the veins would replenish with increased blood flow. This was done to avoid deep-vein thrombosis or pulmonary embolism.

After her attempt at leaving the hospital, Brittany was also required to sleep on a sensor pad that alerted the nurse if she tried to get up. “Momma, come here,” Brittany whispered to me. “I have a plan for this stupid antiwandering device.” She pointed at the pressure-sensing pad on her bed. “I want to pee without a nurse in the room, like a normal human being.”

Preface

One

Catastrophe

1

Foreboding

December 31, 2013–January 1, 2014

2

Bad News

January 1–3, 2014