Beyond the High Blue Air (4 page)

Just before noon the girls and I turn the final corner of our walk and see the hospital once more like a glass fortress at the end of the street. We each feel the same tightening dread as we catch that first glimpse, the dread accompanied by a sudden surge of fearful hope – something may have happened overnight that we don't know about yet. We enter the hospital atrium and cross the light-filled space to the far corner where the lift will take us up to the sixth floor, to Miles.

Yesterday, though, the grief did spill. Marina and I had been out for a walk and passing a small church in a side street we entered it, in the hope that the place might lend us some peace.

After the glare of bright sunshine outside, the dim interior was instantly soothing, the air cool and fragrant with the scent from massed white lilies that gleamed from the chancel. It was empty and as the doors shut behind us a deep silence fell. Marina walked on along the aisle and I sat down in a pew at the back, to succumb to the silence and let the hope and faith of others with which the place was imbued envelop me. But as my eyes accustomed to the pale light coming through the high stained glass windows and I looked across the rows of wooden pews, all I could see was the giant figure looming up above the bank of lilies at the far end. There he was, a beautiful young man, muscular limbs draped in a white cloth, hands and feet nailed through and coated in blood while his face looked down at me with an expression ghastly in its passive suffering. Instead of peace I felt a fury rising, I wanted to rage at the faith that allowed and venerated such a grotesquery. And then I began to hear a sound like the whimpering of an animal in distress, becoming louder and louder until it rose to a crescendo, an anguished howling of pain that reverberated round the once silent space. It was Marina, braced against the altar rail, her clear young face uplifted and fiercely streaming with tears.

We sat for a long time together at the front of the church. There could be no consoling, no words that could change the situation. We had already learnt that comfort came from sharing the pain and waiting until its eruption had passed. When we emerged into the street some time later it was over, and we were just another mother and daughter out on a walk in the beautiful spring sunshine.

I need to write and thank all the friends who have sent letters, cards, flowers to Miles and to us as a family. Grateful as I am, I can't find what it takes to write individual replies. So I compose a one-for-all response.

Thank you for your wonderful supportive letter/card to Miles/me/us. It is a great comfort to know that you are thinking of Miles in the way that you do.

There is so much and nothing to say. Miles is still in a coma and we wait. There is no respite from the anguish of waiting but he looks so strong and beautiful and seems so close that we feel very positive about his recovery. We just can't wait to have him back with us again.

That feels too close to the brink. For safety's sake I need to retreat:

Innsbruck is ridiculously pretty and it snowed right down to the town last night, pure white from mountain tip to cobbled street. I wish Miles were awake to share the strangeness of it. The linguistic delights (kieboschstrasse, crapfencake), the delicate iced cake buildings and jolly Tyrolean men with their feathered hats and lederhosen, the elegant café where a Nazi flag hangs proud above a meeting of bland young people and no one seems to notice (we complained and left, to their surprise), the pride, cleanliness and good manners of everyone, the comfortable conformity. Not one eccentric or homeless person to be seen – everybody looks healthy. Occasionally at night we hear drunken revellers but all they do is sing or yodel happily.

I've retreated behind some kind of glib façade. The truth is, I don't want to share the truth. I'm not ready yet.

I'm worried about the children. Claudia is completing her MA in London, Marina is in her second year at Oxford and Will travels backwards and forwards from London in the midst of trying to set up his design company. Their lives have been disrupted in a catastrophic way, disrupted but now in stasis. No one knows what will happen next, but we all want to be here with Miles when it happens. The future is held in abeyance.

The four children make up a unit. The boys seventeen months apart, first Miles then Will, a gap of five years and then Claudia and Marina, two and a half years apart. Together they are vibrant, warm, humorous, necessary; various, but one. It has been a constant marvel to me to watch them, know them, see how small frictions are resolved, the weight of their different personalities kept in balance. Now the balance has been upended. Miles, a heavyweight, is missing and the remaining three are having to realign the unit while united in their grief and their absolute commitment to him.

It's impossible to say whom it affects most. Will perhaps in the physical sense, because he has suddenly lost his life-long companion. So close in age, attending the same schools one year apart and the same university, sharing many of the same interests and now sharing a flat, they are the best of friends despite their different characters. Miles is defined by his energy, vitality, determination, ambition; he is a natural leader. Will is equally strong-minded, but is happy to follow his own path alone, having no interest in shaping other people's lives. They share a similar intellect, but whereas Miles is a driver of ideas, Will is privately creative.

The girls' loss is different but as profound. Miles has been both their eldest brother, a self-appointed protector, and a friend and advisor, someone to have fun with and confide in. I see him now aged fifteen, an aspiringly tough, cool teenager, awful peroxided hair, standing at the kitchen window waiting nervously for the girls to return. They'd been allowed to walk on their own down to the shops at the bottom of our quiet residential road and Miles is reprimanding me. They're too young, Mum, you shouldn't have let them go down on their own. I'm going to go and find them. No, Miles, you must not, I tell him. You of all people! He laughs with me, acknowledging the double standards of an independent, experimental elder sibling not countenancing it in the younger.

As the girls grew up and the age gap between them and the boys became less pronounced, their relationships consolidated into the unit they have become. Now that all four are in their twenties their interests and many of their friends have converged, but Miles remains a powerful older brother and his absence has made a rift in their lives. Each one is in the middle of a defining process – university, setting up a business – that will suffer from being disrupted. The emotional impact of Miles's accident has been traumatic; we must not allow it to damage them practically as well.

Ron is in Innsbruck for the weekend and we talk about it together and with the children. Decisions are made. Claudia will return to London and ask to have her MA exams deferred from May to September when rewrites are undertaken, so it should be a possibility. I will write to Marina's tutor at Oxford and explain the situation to him; the pastoral care there is excellent, I know. Will's situation is more complex, though in some ways easier; his time is not proscribed by terms and exams but by personal deadlines as his future career begins to take off. His business partner is understanding, but undoubtedly combining his work and being here for Miles is going to be a problem.

Traumatic brain injury is by definition sudden and unexpected. Shock and grief follow in its wake, but it is the unknownness, the complete lack of knowledge that compounds the horror. There is no known trajectory to illuminate the terrible blank thing one faces. Somebody you love is there but no longer there. Lack of consciousness is not comprehensible; the person looks the same and that is all. As a family we are adrift together in our ignorance and our craving for knowledge.

I have been talking to the athletic young neurosurgeon on the ward who is the same age as Miles and who, it transpires, is also a keen snowboarder. He is the one who tells me that he never wears a crash helmet when he snowboards. They may protect the skull, he says, the helmet will take the impact, but the sudden acceleration and deceleration can cause the brain to rotate within the skull. I don't want to hear this.
Rotate
– Miles's brain
rotate
d
? He continues, The medical term is Diffuse Axonal Injury, or DAI for short. If that happens we do not yet know any way of reversing it.

I research DAI. Please let Miles not have suffered DAI. If he has, his brain will have sheared when he fell, or more precisely, the axons will have sheared. I learn that each of the billions of neurons, the nerve cells in the brain, has an axon, a long fibre that acts like a fibre-optic cable transmitting electrical impulses away from it, allowing one neuron to communicate with another. If the axons are broken, the messaging system is broken. Apparently the brain is made up of tissues that vary in density and during that dreadful rotation the different tissues slide over one another, stretching and shearing the axons that connect them; they cascade. The words are surreal, beautiful: rotate, shear, cascade; it is a betrayal of language. The particular cruelty of DAI is that the areas of the brainstem involved with basic life functions, the cardiac and respiratory systems, may remain unaffected; the victim does not die but is left suspended between life and death. I read that
90
per cent of people with DAI remain in a persistent vegetative state. Very few of the
10
per cent who regain consciousness will return to near-normal neurological function, and of those who do, the improvement will have to take place within the first twelve months after injury. If there has been no progress by then the prognosis is bleak. It is only after a year from the time of the accident that a neurologist will be able to make a prognosis and even then it will be approximate; the brain does not yield its secrets easily.

Miles, do you remember my last words to you as you were leaving the house? Please don't do any dangerous jumps, my darling! It was my foolish, ritual request, a kind of game we played. I loved your daring and you enjoyed my mock protectiveness (although it wasn't really mock, I meant it but I had to say it lightly). I remember you hugged me with that crushing bear hug I love so much and you said, Don't worry, Ma, I'm older now. I promise I'll be responsible.

Miles bought his crash helmet that morning just before the jump. He would have died instantly without it. But perhaps without it he wouldn't have gone as fast, perhaps he would have been more cautious, perhaps it disoriented him.

Is it my fault he bought the helmet?

I come across Dr Stizer on the ward one day. He is in his scrubs, seeing his patients in a break from surgery. It's strange, he says, but I have connected with your son in a way I haven't done with a patient before. He could be my son. My greatest hope is that he will return here one day to speak to me himself.

I am profoundly touched by his words and we are both quiet for a moment. Then he says, May I give you some advice? Of course, I say. You saved my son's life! He looks at me quizzically. The first thing, he says, is that you must never reprimand him for doing that jump. It was a brave and wonderful thing to do. He is a young man and young men should all go out and grab life in the way he did. The second thing is that you should never feel guilty. It concerns me, he says, to see that you and your children come every day to visit Miles. I think it may be too much for you. You must not feel guilty if you go away and enjoy yourselves.

This is a surprise. Neither thing has occurred to me; certainly I would not reprimand Miles for doing that jump. As for feeling guilty, what I do feel is more complicated, not guilt but something stranger, whereby all physical and sensual enjoyment – eating, drinking, long hot baths, music, shopping, reading, making love, laughing – is shot through with a new awareness. It can no longer be simple untainted pleasure. Everywhere I go, everything I do, is suffused with, contaminated by, the image of Miles lying unconscious in his hospital room. The incomprehension at his plight has destabilised me; nothing makes its usual sense, nothing at all. Drinking a cup of tea reminds me he can't drink; seeing the sun set over the pale mountain peaks reminds me he can't see it.

Dr Stizer is an unusual man and I am moved by his evident concern for Miles, on a personal level. Miles would like him, they would get on very well – I can imagine their mutual respect and the laughter their shared rumbustious humour would generate. A neurosurgeon who snowboards and plays in an amateur rock band in his spare time – they could have a great time together.

For the first two weeks Miles remained in an induced coma; with a controlled dose of barbiturates his brain had been artificially shut down to the base line of function. By the time he had arrived at the hospital the right side of his face and neck were grotesquely swollen as the cerebral fluid found its only escape route out of the confines of the skull. When a brain is injured it swells and there is no space for it to swell to; the skull protects the brain but now the protector has become the instrument of destruction. As the swollen brain is compressed against the hard, bony helmet of the head, delicate brain tissue is being damaged in the process. If appropriate, the neurosurgeon will perform a craniotomy as they did on Miles, in which a ‘flap' of bone rather like a trap-door is removed to make room for the swollen brain. Then, by inducing a coma, barbiturates will slow down the cerebral blood flow and the metabolic rate of brain tissue and so the blood vessels begin to narrow, allowing the swelling to decrease. The outcome for each person sustaining a brain injury will vary depending on the extent of the original trauma to the brain and, crucially, the time taken to reach a neurosurgeon and therefore the time the brain has to swell unattended. In Miles's case he had to get from where he had fallen,
2000
metres high up on an Alpine mountainside, to a neurosurgery clinic
100
kilometres away. That journey took three hours and even the best efforts of a helicopter rescue team could not prevent secondary cerebral damage. There had been nowhere else his brain could swell to except against the skull or down into his brainstem.