rachelmankowitz

            I had another oral surgery a couple of weeks age, a second attempt at a skin graft to ameliorate recurring infections around one of the zygomatic implants, after last summer’s attempt failed. I scheduled the surgery for after school was over for the year, so I would have time to rest and recover before having to deal with actual people again. We had to take a car service to the doctor’s office because I was going to be on anesthesia for the procedure and therefore wouldn’t be allowed to drive myself home, but Mom came with me for uneventful-ride-with-a-stranger and when we arrived Mom set herself up in the waiting room with a book to read and a sewing project, and the staff took me over to an exam room to prepare for the procedure.

There were a lot of Elton John songs playing over the speakers that morning, for some reason. Usually there’s a mix of music from the seventies and eighties, and very rarely from the nineties, but there was something comforting about hearing Elton John’s voice over and over, as if he was hanging out in the room with me and keeping me calm as they put the mask over my nose and started the nitrous and then poked my arms, endlessly, in search of a good vein for the anesthesia. I think there were three needle sticks before they finally believed me that the good vein is in my right arm. The last thing I remembered was the doctor saying, “she’s a cheap date,” and I wanted to stand up and tell him that’s not funny, but I was out. I woke up to instructions about where to hold the gauze to staunch the blood, and how to put pressure on the gauze with my tongue, and then I was taken to the recovery room, given a few envelopes of gauze, and the same aftercare sheet I’ve gotten for every procedure in that office, and sent on my way.

            Almost as soon as I got home, though, I realized that I was going through the gauze much faster than I was supposed to. I can’t remember if I’d ever used all of the gauze in the packet before, but this time my mouth was filling up with blood faster than I could change out the gauze, and blood kept pouring onto my shirt before I could fold up new pieces of paper towel to replace the gauze. I couldn’t speak through all of the blood and gauze and paper towel, so Mom called the doctor’s office for advice and they told us to come back in right away to get the wound cauterized. This day was getting expensive, with our third taxi ride in a row, but I had no choice, so I held a pile of paper towels to my face and stared out the window of the car, watching all the same houses pass by for the third time.

            Then I was back in the exam room and they were syphoning away the blood, and rinsing my mouth with salt water, and the doctor was pressing on the wound so hard it felt like his fist was going to push into my brain. My face must have still been numb from the earlier procedure, though, because even though I was uncomfortable and confused, I wasn’t in a lot of pain, and then the bleeding finally stopped and they washed my face, and gave me another sleeve of gauze, and sent me on my way again. One of the nurses offered me apple juice as I was leaving, but I was afraid to dislodge the gauze and start the bleeding all over again, so I promised I would drink something once I got home.

            Mom and I sat in the waiting room for the next ten or fifteen minutes, waiting for the notification that the car had arrived, and then we took the elevator down to the lobby to meet the driver in the parking lot. I felt sort of dizzy and clammy when I stepped out of the elevator, but I thought it was form getting back in touch with the heat of the day after living in the bliss of air-conditioning for hours (it was 80 degrees Fahrenheit in the real world), so I was sure I just needed to rest against the wall for a second and I’d be fine. I took a few breaths and stood back up and made it another few steps towards the glass doors of the vestibule, where I knew I would really start to feel the heat, but I had to find a wall to lean on again, and then I found myself sitting on the floor, which just seemed silly. I laughed at myself and pulled myself up again, feeling like I was getting a full day’s exercise in one go, but I felt really nauseous and found myself on the floor again. From far away, I could hear Mom asking me if I was able to move my arm, because it seemed that my arm was trapped in the doorway and sticking out into the vestibule, and she was worried I would get hurt, or that I would block someone from entering or exiting, I don’t know. I must have been able to move my arm out of the way, and I must have tried to get up again, but the next thing I remember is being flat on my back and hearing the sound of racing footsteps coming down the stairs. Mom had gone back up in the elevator to get the doctor, and it seemed like the whole team had come downstairs with him. I could hear Mom telling them that I’d fainted and hit my head, which was news to me, and I felt a cold compress on my forehead and an oxygen mask over my nose, and one nurse even had a little electric fan that she used to try and cool me off. They put my feet up on a chair at some point and I heard the doctor say that he’d called for an ambulance, and then there were even more people around me, lifting me onto a stretcher (it’s good that she’s wearing jeans, so we can lift her by her belt loops).

Then I was in the ambulance and they were checking my blood pressure and doing more needle sticks (at least three more tries before they found a vein they could use). Every once in a while, I was able to say something, like, that’s the bad arm, the good vein is on the other side, and I could hear the EMTs asking how old I was and saying, no way, she looks twenty-five (which lifted my spirits, I have to say). They put a neck brace on me, because of the fall I couldn’t remember, and I heard Mom tell them that I’d hit my butt first and then my head, so I was probably okay. They brought me to the nearest hospital, which was literally around the corner, and I remember being outside for a moment and then they pushed my stretcher into the emergency room and transferred me to one of the hospital stretchers, which were all sort of floating around the room, with some make-shift screens put up between them to allude to privacy. They checked all of my vitals again, and took the neck brace off, thank God (because at that moment the brace was causing the most pain), and I had to sign a bunch of digital forms, but I can’t tell you what they were, and then the doctor told me her plan: blood tests to see if I needed a transfusion and a CT scan to make sure I didn’t have a concussion.

            The original procedure had been at 11:15 that morning and we’d returned to the doctor’s office around 3:30 in the afternoon, so we probably got to the hospital around 4:30 pm. There was a nice lady in the bed next to me with an amputated leg who seemed to think I was up to making conversation, and then they gave me saline in one of the many holes they’d made in my arms, and I just stayed flat on my back because even lifting my head felt impossible.

            There was something about those few hours, where I could take in most of what was happening to me but couldn’t really make logical decisions, that felt revelatory. I’d forgotten that this state of being even existed, even though it was a very common state from my childhood, because, I realized, I’ve always read more consciousness and choice into my memories than was really there. I always thought I should have been able to understand things, and should have been able to make better choices, but lying there on the hospital stretcher, I realized how silly that was. The whole time I’d been in the lobby of the doctor’s building, falling and standing back up and falling again, I’d been so sure that I would be able to stand up and walk out to the car if I just tried a little bit harder, and each time I was wrong.

            At some point, Mom got a text from the oral surgeon, who had seen some of my early test results and wanted us to know that the reason my blood sugar was slightly elevated was because he’d put a steroid into my anesthesia cocktail, along with the Propofol and Versed, to extend the length of time the pain relief would last. And that was the first time in hours that I even remembered that I’d had surgery that morning and that half my face was still numb. Eventually, the saline started to do its job and they brought me some apple juice to drink and some disgusting orange Jello to try to shovel into my mouth and they tilted the bed so I could sit up like a human again and see what was going on around me.

Next up, they took me for a CT scan on my own personal stretcher, because they didn’t trust me on my feet even long enough to transfer me to a wheelchair, and I found my sense of humor returning, which was good because I could see my reflection in the elevator door and it was a lot. And then I was back in the Emergency Room, waiting for results. I remember thinking about all of the people I should be calling or texting, and just having no energy to even look for my phone. There was a basketball game, or maybe hockey, on the TV screen in the distance, but mostly I just listened to the conversations around me: the woman with the amputated leg really didn’t like her sandwich, and a woman with cancer arrived in so much pain that her not quite adult daughter had to speak for her, and there was a man with back pain who kept trying to stand up against the nurse’s advice, and a woman I couldn’t see who was angry about something I couldn’t understand.

            Once all of the test results finally came back, the doctor told me that the blood loss and the anesthesia, and having two serious procedures in one day, had caused a Vaso-vagal Syncope (AKA I fainted), and it wasn’t an uncommon response (which is what my brother had said a few hours earlier, when Mom texted him). I was discharged from the hospital after 11 PM, once the doctor was convinced that I could walk without falling down, and we called the car service yet again to take us home. I was starting to feel much better, and therefore much more aware that my poor mother had spent the whole day taking care of me, despite the fact that she was walking with a cane and sitting on a hard chair and really really really needed a nap. We both struggled with the walk from the parking lot when we got home, and I had to sit down twice to rest along the walkway. Our downstairs neighbor, a nurse, met us at the front door of our building and insisted on helping me up the stairs, and I don’t know why I kept arguing with her because I really needed the help. We’d called her earlier to ask her to check on Tzippy for us, and it turned out she’d been waiting up for hours just to see how I was doing.

            The left side of my face was still numb, but I dutifully ate a few spoonfuls of chocolate pudding, because it was at the top of my soft foods diet list, and then I made my way to my bedroom and fell asleep.

            I hadn’t really believed in the fainting part of Mom’s story, to be honest, until I woke up the next morning and could feel the sore spot on the back of my head from where I’d hit the floor, and the pain from the actual surgery was starting to kick in as well. I looked over the aftercare sheet from the doctor’s office and took the recommended doses of Tylenol and Ibuprofen and made myself some very well smushed tuna with mayo. The pain in my mouth kept getting worse throughout the day, but I was sure the Tylenol and Ibuprofen should be enough to manage it, since the doctor hadn’t prescribed an opiate this time around, and I really didn’t want to bother anyone.

            I was still very disoriented, and exhausted, so I had a lot of time to think over the next few days and I kept reliving those few moments in the lobby of the doctor’s building, and wondering what would have happened if Mom hadn’t been there with me. I would have been just as helpless, but no one would have been there to fill the gap between what I could do for myself and what needed to be done, and that gap was starting to look really vast. And now that I was remembering all of those times as a kid when I couldn’t help myself, and no one else was around to fill the gap, I realized that instead of feeling the grief and helplessness of those moments, I’d filled the space with self-loathing, as if yelling at myself to try harder would suddenly make me capable of doing the impossible. There’s something so terrifying about that space, where there’s nothing I can do and no one is coming to save me, and my mind chose to deal with it by pretending I was wrong, telling me that if I could just push myself a little bit harder, be smarter, older, stronger, taller, healthier, whatever else I was not, then I would be okay.

            But now, seeing myself over and over on the floor in the lobby of the doctor’s building, and realizing there was nothing I could have done, was an incredible relief; as if I was patting my younger self on the head and saying, see, you didn’t do anything wrong, and here’s the proof: when people knew you were struggling and were able to be of help, they came running. I remember being told as a kid that life isn’t supposed to be fair, and thinking that that was just nonsense, because of course life is supposed to be fair, and therefore if I’m not getting the help I need then I must not deserve it. That makes the world make sense. That makes the math work. But maybe the math doesn’t add up in real life. Maybe, more often than not, the gap between what I need and what I get is left unfilled, not out of intentional malice or because it’s what I deserve, but just by chance. Which is terrifying.

            Anyway, I spent the rest of the week resting and recovering, thinking deep thoughts, eating soft foods, and wondering why the Tylenol and Ibuprofen didn’t seem to be doing very much. And then, exactly a week after the initial surgery, I woke up at three thirty in the morning to the taste of blood in my mouth. I put pressure on the wound right away, just like they’d done in the doctor’s office, and I looked up excessive-bleeding-a-week-after-oral-surgery on my phone and tried to feel reassured when it said that if I kept pressing on the wound and stayed upright, the bleeding would eventually stop. Mom got up to sit with me and after forty-five minutes or so, the paper towels I kept stuffing into my mouth started to be less and less soaked in blood, and I was finally able to take some pain medication, and a few deep breaths. Mom went back to bed, but I stayed on the couch in the living room and kept pressure on the wound, just in case. And then, around six or seven o’clock in the morning the bleeding started again. I went through four rolls of paper towels trying to staunch the blood and I finally texted the doctor’s office and was told me to come in as soon as possible. I woke Mom up again and she called the car service, again, and we made it out to the parking lot somehow and arrived at the office sometime around 8:30 am. But, after getting myself out of the car and thanking the driver and closing the car door, I couldn’t take another step. The nausea and dizziness and this strange weakness in my legs were overwhelming. Mom went inside to get help and I sat down on the sidewalk, trying to scoot along the ground to get a few feet closer to the front door, and then the doctor’s assistant arrived with a tech and a wheelchair, and they brought me inside and up to the exam room.

            The syphoning began again, and it was as if the intervening week hadn’t happened. The doctor was probably in the middle of another surgery when I arrived, so his assistant was in charge of assessing the situation and she gave me fluids through an IV and put me on the nitrous again. Somewhere along the way I heard her telling the doctor, “she’s a faucet,” probably in response to his endless requests for updates while she was busy trying to keep me from drowning in my own blood. Eventually, the doctor decided to cauterize the wound without anesthesia, so he could see where the blood was coming from, he said, and the pain was extraordinary. I was screaming and crying openly and my hands and feet and bottom lip started to go numb, and the doctor said I was hyperventilating and needed to focus on breathing out through the mask more than breathing in and I would have slapped him if I’d had any strength at all. At some point the doctor was standing in front of me and asking if I wanted to go to the hospital and of course, I said no, and then, finally, the anesthesia must have kicked in. I don’t remember losing consciousness but everything became sort of fuzzy. A nurse and a tech stayed with me, changing the gauze religiously until the bleeding had completely stopped, massaging my hands when they went numb again, checking on mom and letting her know I was okay, even bringing her pretzels and coffee in the waiting room.

            Before running to help with the next procedure, the doctor’s assistant told me to stick to a liquid diet for the next few weeks, drinking a lot of Ensure and smoothies to keep my calories up, and I wondered why she was telling me that now, instead of a week earlier. I made a point of asking when I should go back to rinsing with the medicated mouthwash in case the vigorous (recommended) rinsing was also part of the problem, and she said, definitely not today. They transferred me back to the wheel chair and then wheeled me to the waiting room to sit with Mom until the car service could arrive, and then the nurse took me downstairs in the wheelchair and made sure I was safe in the back seat of the taxi before walking away.

            The lesson this time around seemed to be that both me and Mom needed to work on asking for help sooner, and not worrying so much about bothering people, so even before we arrived back home Mom had texted the maintenance man at our co-op to ask if he could bring her rollator down from our apartment (it was actually her sister’s rollator, offered just in case she might need it). I was barely able to stand up long enough to transfer from the car to the rollator, even with help, but it was an incredible relief to find myself sitting on the rollator seat while our maintenance man pushed me all the way around the parking lot and up the walkway (I tried my best to hold my feet up off the ground, so they wouldn’t act as brakes), and we even zoomed along for the last bit, reminding me of childhood visits with Grandpa, driving along in his convertible with the wind in my hair.

And then I was sitting in front of our building, unable to stand, let alone to climb the two steps up to the front door, and forget about the twenty steps up the stairs to the apartment. My downstairs neighbor, the nurse, was home in the middle of the day, fortuitously, and she looked at me and looked at Mom and offered to drive us to the hospital. But I didn’t want to go. I thought, maybe I could just sit there for a few hours until I felt stronger, but my neighbor was dubious and said I’d be safer in the hospital, where they would probably want to give me a transfusion. When I finally accepted that I had no choice – my feet were not walking themselves up those stairs – I also realized that I couldn’t even make my way back down to the parking lot and into my neighbor’s car, so we called for an ambulance.

The maintenance man went to meet the EMTs in the parking lot and brought them to the backyard, where I’d been resettled in the shade, with a bottle of water and a box of tissues (I can’t even tell you how lucky we are in our neighbor and our maintenance man). There were two or three EMTs and they transferred me onto a stretcher and rolled me down to the ambulance, and then the one who looked like a cross between Harry Styles and Harry Potter started the assessment. He couldn’t have been much older than my nephews, and he had tattoos down both arms like Harry Styles, but he had a reassuringly sweet smile and I was pretty sure the bangs on his forehead were covering a lightning shaped scar. He took my vitals, including an EKG, but he didn’t try to put in an IV for fluids this time. My arms were already black and blue from all of the needle sticks the week before, and then again from that morning, so he might just have left it for the nurses to manage later in the ER, when I wasn’t so much of a moving target.

            We went to a different hospital this time, closer to home and with a much bigger emergency room, and the EMT parked me in the entrance hallway and reported my history and vitals to the nurse in charge, and she put two bracelets on my arm, one with my name and birthdate on it, and one in bright neon yellow that said “fall risk.” Pretty quickly they moved me from the assessment hallway to my new parking spot at the end of another hallway, and I started to meet a lot of nurses and techs and doctors. My sense of time was all over the place, but I remember a lot of blood being taken, and I remember drinking apple juice and worrying that the bleeding was going to start all over again.

            The ER doctor asked a cardiologist to consult at some point, and he pulled the skin under my right eye (checking for hidden aliens?) and looked at my blood test results and said I’d probably lost half my blood volume and would need a transfusion. Which meant that the needle sticks had to start again. One nurse even got out the ultrasound wand to try and locate a vein before sticking me three more times, but the pain was excruciating and she still couldn’t find a good vein. Eventually the next nurse, or the one after her, found a usable vein on the back of my right hand, and then she taped the needle in place three times so it wouldn’t move even in an earthquake. By then they had decided to keep me overnight for observation and I sent Mom home to rest (one of the nurses had even brought her a tuna sandwich and some gingerale along the way). More blood was taken (no wonder I needed a transfusion!) and they checked my blood pressure a thousand more times and gave me more apple juice, and I spoke to my brother on the phone and he told me that when they gave me the transfusion, I would be able to hear the memories of the blood’s owner (he reads a lot of sci fi), so I was looking forward to that.

            Mom had reached out to the executive director of our synagogue (one of her favorite people on the planet) so I got a call from one rabbi and texts from the other. I still couldn’t walk, or really stand on my own, but my sense of humor had returned somewhere along the way, and I was taking copious notes in my tiny notebook, and at some point they started the actual transfusion, and then at nine or ten o’clock they transferred me to a semi-private room deep in the ER, where I could watch TV and, to my surprise, was able to fall asleep.

            They woke me up around five or six the next morning and the first thing I noticed was the pain. Whatever anesthesia the oral surgeon had given me in his office the day before was finally starting to wear off, but the nurse needed a doctor’s approval before she could even give me an Ensure, let alone a Tylenol, so it was a few more hours of sitting and waiting in pain while they gave me more fluids through the IV.

            The older rabbi from my synagogue came to visit around ten or eleven that morning, and the younger rabbi texted to check up on me and asked if I’d like to be added to the Mishaberach list, so people could pray for my well-being at Friday night services this week, and I surprised myself by saying yes to that for the first time in my life.

The cardiologist came in to check on me at some point, and had my blood pressure checked in three positions, lying down, sitting and standing up, before ordering more fluids. And, finally, sometime after noon, the cardiologist cleared me to go home. It still took a while before they could remove the IV – which was really well taped in place and therefore hurt like hell when it came out – but Mom was able to get a lift from yet another generous neighbor, and the nurse walked me out of the emergency room for pick up. When I sat down on a bench by the front circle where patients were supposed to be picked up, I realized that I was finally walking on my own power for the first time in twenty-four hours, and then I saw the car and didn’t quite sprint across the parking lot to get into the backseat of the car, and finally, we went home.

            I slept for a long time that afternoon, after filling up on Tylenol and Ibuprofen and Ensure, and when I woke up Mom told me she had called the doctor’s offices asking about pain management, so I guess I must have mentioned the pain to her, but she hadn’t heard back yet, so I took more Tylenol, drank another Ensure, mixed with Fairlife Chocolate Milk to make it more  palatable, and went back to sleep.

            The next morning, the pain was so bad that I couldn’t even drink the Ensure, so I texted the doctor’s assistant and she had the doctor call in a prescription for Percocet and Mom was able to get a lift to CVS to pick it up for me.

            The Percocet did its job, so it was a few days before I realized that I didn’t have my hospital notebook anymore (I was sure it was sitting safely in my pocketbook waiting for me, but I must have lost it among the sheets of the hospital bed at some point), and I felt stupid, because the nurse had specifically asked me if I had left anything behind when I left the ER, and I didn’t think to check for the notebook. But I drank more Ensure and got to work reconstructing events to the best of my ability, though to be honest, everything from the midway point of this essay onward is just a guess.

            As you can imagine, I have some notes for my doctor about what to do differently next time around (on someone else, because I can’t see going through this again, even if this procedure was as unsuccessful as the last one). I still worry that I’m going to wake up with a mouthful of blood in the middle of the night, but so far everything has remained intact.

I’m not sure what lesson to take from all of this, to be honest. I was hoping that writing it all out would give me some clues to bigger life lessons, but for now I’m just grateful that there are so many kind people in my immediate vicinity, willing to go out of their way to help me. Though, I think Tzippy has been taking her own notes on the whole ordeal, so she might be ready to share her life lessons any day now. Fingers crossed.

If you haven’t had a chance yet, please check out my novel, Yeshiva Girl, on Amazon. And if you feel called to write a review of the book, on Amazon, or anywhere else, I’d be honored.

            Yeshiva Girl is about a Jewish teenager on Long Island, named Isabel, though her father calls her Jezebel. Her father has been accused of inappropriate sexual behavior with one of his students, which he denies, but Izzy implicitly believes it’s true. As a result of his problems, her father sends her to a co-ed Orthodox yeshiva for tenth grade, out of the blue, and Izzy and her mother can’t figure out how to prevent it. At Yeshiva, though, Izzy finds that religious people are much more complicated than she had expected. Some, like her father, may use religion as a place to hide, but others search for and find comfort, and community, and even enlightenment. The question is, what will Izzy find?