Beyond the High Blue Air. Lu Spinney
the corner into the plaza for a moment I think I have truly lost my senses. Huge white rabbits are dancing in the sunlight to music played by three wizened old men dressed in Tyrolean costume playing squeeze boxes, their short leather trousers, long white socks, and feathered hats making them look like ancient schoolboys. The normally sedate cobbled space is a riot of noise and color, small children racing through stalls laden with elaborate breads and cakes, bright marzipan sweets, painted eggs, colorful wooden toys, and all the while the stout men and women dressed in their rabbit costumes are, I now realize with even more bewilderment, selling loops of giant sausages as they regale the crowd. We wend our way through the surreal scene, smiling politely at the stallholders as they offer their wares and dodging the happy children as they run around us.
Our destination, when we reach it, seems just as surreal. My superstitious hope is irrelevant to Miles as he continues to lie, oblivious, on his high hospital bed.
The senior consultant on the neurosurgery ward is Professor Benir. He introduces himself and explains that he has been in America at a medical conference, which is why we have not met before. His manner is quiet and thoughtful, his dark Middle Eastern features severe against the crisp white of his doctor’s coat. We are standing by Miles’s bed and he looks down at him, studying him silently for some time before he turns back to me.
I would like to know about your son, he says.
And so I tell him about Miles. That he has been a joyful son to have, my firstborn child. That from the beginning he has been quick and bright, an adventurer, a risk-taker. That one of the things that has defined him has been his brain. After academic success throughout school he got a first-class degree from Oxford. He started his own company at twenty-four. At twenty-five he was selected as one of five young people to represent Britain during Giscard d’Estaing’s European Youth Convention. At present he is a management consultant for a large international company based in London but will take his own company further when he has gathered more experience. He is writing a book in his spare time. He likes to keep fit and enjoys white-collar boxing. He skydives, he dives with sharks. He practices qigong. He makes electronic music. He writes poetry. He is funny. He is kind. He loves life, attacks it head on, dangerously, seeking adrenaline, sometimes foolhardy, learning from his flaws while exploring, always, his spiritual resources. He is full-blooded, down to earth, but at the same time he is an intellectual.
I’m boasting about my son. But what seems important is that Professor Benir should know about Miles’s brain, the brain that he and his team are now responsible for. He must know that it is exceptional.
I apologize for boasting, I say to the professor, but what I have told you is true and it is breaking my heart that one of the things defining Miles was that he was an intellectual and now he is brain damaged. I find that the most difficult thing to come to terms with. I wouldn’t mind anything else, his legs, his arms, anything, but not his brain. He used it with such vitality, it was crucial to his enjoyment of life, right down to his particular wit and sense of humor. Can I ask you for the truth, Professor Benir: what form is this brain damage going to take?
He waits some time before answering. Miles lies quite still next to us, only the faintest movement visible as his chest rises and falls with the intake of each breath. Now that the swelling in his brain has subsided, the shunt that was draining off the excess fluid has been removed. There are no longer any tubes coming out of his nose or mouth; the tracheostomy and PEG have taken care of those. Void of expression, his strong, closed face is intimidating in the stillness of its silence.
Professor Benir looks back up from Miles to me. The damage is not to his intellect, he says. That is not the area of the brain that is damaged. But he has suffered a very serious trauma to his brain. What is crucial now is that he begins intensive rehabilitation. We have done our work here, the surgery is complete; the important thing now is for you to arrange the next stage for him. We could move him to our neuro-rehab clinic forty kilometers from Innsbruck but I think it would be best for him to return to England, where you and he will be at home. I would recommend the Acute Brain Injury Unit at Queen Square in London, the National Hospital for Neurology and Neurosurgery, which has an excellent reputation for neuro-rehabilitation. And please, he says, gently laying his hand on my arm, don’t worry about boasting. I asked you to tell me. I wanted to know about him. I am very sorry that this has happened to your son. I wish him, and all your family, very well.
Now we must get Miles home—how, and where to, such obvious and crucial questions that we have deferred facing for the past five weeks. Such a lapse seems extraordinary, though for a time we had talked of staying in Austria until he was well enough to leave. We know better now. And so we get to work, David, Ron, and I researching London hospitals that offer neuro-rehabilitation, contacting anybody we know who might be able to help or advise us. Friends who are doctors are invaluable, generous and patient with their time.
It takes a week of intense negotiation. After a flurry of telephone calls to London hospitals Miles is finally offered a bed in the Intensive Care Unit at University College Hospital, to be reviewed and assessed before being moved to the Acute Brain Injury Unit at Queen Square, the ABIU. Our twin goals have been the ABIU and the rehabilitation ward at the Wellington Hospital, both centers of excellence specialising in neuro-rehabilitation following traumatic brain injury. The Wellington is private, however, and the costs are prohibitive. Receiving the news that Miles is to be admitted to the ABIU feels like winning the lottery.
The logistics of flying home are daunting. To return on a stretcher with a commercial airline would require the space and cost of nine seats, but patients with tracheostomies are not accepted so that is ruled out anyway. There are companies that specialize in repatriation by air ambulance, small jets that have the intensive care equipment to cover every eventuality, but talking to their representatives I get a chilling sense of impersonal service at great cost, that the payment is more important than the patient. Dr. Stizer recommends a friend of his, a doctor who flies a private air ambulance, and the decision is made.
Today Miles and I are flying back to England. On the runway our plane is dwarfed by everything around it. Tiny but purposeful, it looks like a hornet waiting for takeoff, fragile, thread-thin legs and delicate wings outstretched. The airport is closely ringed by high mountains, snow-covered, jagged and implacable, and I cannot imagine how this tiny thing will lift us over them. Once inside the plane you cannot stand upright yet unbelievably there will be six people on board. The pilot, Dr. Stizer’s friend, is a handsome, swashbuckling neurosurgeon who flies for a hobby and often ferries his own or other intensive-care patients. His exuberance makes me realize how brittle I am, how taut and isolated is the space I’ve come to inhabit. His co-pilot looks reassuringly serious, a young man who shows great concern for Miles as he is being lifted into the plane. There is a male nurse from the hospital, and he and I sit belted in with our backs to the pilot and co-pilot, our shoulders almost touching theirs. Relaxed and friendly, the nurse tells me that he is now studying to be a doctor but takes on this work when he can to earn the money and for the ride, and, I can tell, this outing to England will be fun for him. In front of me, almost taking up the body of the plane, Miles lies on his back on a stretcher and I can just about reach across and touch his head to reassure him, or reassure myself. Next to him, at the other end of his stretcher and facing us, sits a young woman doctor; throughout the journey she monitors Miles and fills in the clipboard chart she keeps on her lap. Beside her is a bank of resuscitation equipment and a portable suction machine. Once the plane has taken off we can’t talk, because the noise of the engines is deafening; this air ambulance has no luxury trimmings.
I don’t like flying at the best of times and I especially don’t like flying in small airplanes. This is the most physically frightened I have ever been. I fear the laid-back pilot, the tinny fragility of the plane, the grinding noise of the engines, the low altitude and proximity to the snow-covered mountains below us; above all I fear the effect of the rarefied cabin air pressure on what little oxygen is still being supplied to Miles’s brain. Half an hour into the flight I begin to detect an unmistakeable smell of burning; yes, there is undoubtedly something burning in this airplane. I lean over to the nurse and he leans towards me. I shout in his ear, Can you smell burning? Mmm, he says, and turns to tap the co-pilot on the shoulder. They talk