Palm Sunday During Tough Times

I feel like the pall of Covid-19 has shrouded the rhythm of normalcy even as we enter Holy Week. In normal times, we tend to clear our hearts and minds so that we can be present to the Gospel stories of Christ’s journey of the Cross. But this year, many of us are distracted by intense worries, the need to remain isolated, and vast uncertainties. I’m reminded of another Palm Sunday seven years ago. That day, my sister and her family were in the midst of crisis; a deeply personal one. My nephew Conor lay tethered to a ventilator, on life support in the aftermath of a blindsiding accident which left him fighting for life. A week-long bedside vigil became more and more challenging as Conor’s condition deteriorated.

Chicago - March, 2013

It was Palm Sunday morning: one week since Conor’s accident and the start of Holy Week. I was cognizant of the parallels between Christ’s journey of the cross and Conor’s challenge to regain life. This Palm Sunday it felt as if Conor and his family were carrying their own cross. I thought about the connection my sister now had with Mary. A mother’s pain is uniquely intense when privy to her child’s unimaginable trauma. Mary, like Kathy, was challenged with seeking reason and purpose as she witnessed her son’s fate, unaware of the new life to come. The uncertainty of Conor’s outcome was happening in real time, every minute defined by the looming fears. Unlike the Gospel accounts of Christ’s journey, we had no guaranteed resurrection chapter, and nothing more to hold on to than our sheer belief that Conor had to be okay. He just had to. We felt as if Neil owed us this.

Phil and Bridget left Chicago early that morning to return home. Jack had school obligations, and he needed his dad. Bridget had her last round of semester finals at Xavier University, where she was scheduled to graduate in a few short weeks. I remained with Kathy.

Dr. Muro came in early to do his daily rounds. He wore his wool coat and cashmere scarf with iPod earbuds hanging from the inside collar of his coat. His reputation preceded him. You can tell the competency of physicians by the recommendations of the staff members who work beside them. A Northwestern- trained neurosurgeon, Dr. Muro was praised by the SICU nurses who witnessed his skill firsthand.

Dr. Muro stood by Conor’s bed that morning, watching the monitors. We could the see wheels of thought turning through his furrowed brow. Accustomed to multi-daily visits by him to manage Conor’s fluid condition, Kathy had developed a connection with him that surpassed your average physician-patient relationship. My sister didn’t know how to rest at shallowness with anyone, much less the physician in charge of saving her son. As always, she tried to probe him for “something good.” Yet his words were few. His cashmere scarf came off, followed by his coat, which he hung on the metal arm of Conor’s monitor. We sat in silence, wishing not to disrupt his thought process by asking questions, so we waited for some indication of his concern. Why wasn’t he talking? What was he thinking? Dr. Muro appeared so pensive. I honestly thought Conor was doing better. His cranial pressure numbers were lingering in the 20’s. Wasn’t that what they wanted?

After what seemed like an eternity, Dr. Muro looked at my sister told her in a very direct way what needed to be done: Bilateral Decompressive Craniectomy. He then used both his hands and placed them on either side of his head, providing a visualization of where he would perform surgery. Literally, he wanted to remove Conor’s skull.

Taken aback but ever calm, Kathy paused, then asked for explanation and reasoning. Dr. Muro took a seat in the chair next to her. With a pen and the back of a random get-well card envelope, he drew a rough sketch of what the surgical procedure entailed. Two hand-sized bone flaps would be removed from Conor’s head and placed inside the skin layers of his lower abdomen. Storing the cranial plates within Conor’s belly would keep them viable so his body would recognize them as his own when surgically replaced, minimizing the chance for rejection. It would take eight weeks for the swelling in Conor’s brain to fully subside. In the meantime, Conor would wear a protective helmet to guard his unshielded brain. Dr. Muro said Conor’s brain pressure was not trending in the way he wanted, and the risk for irreparable damage was too great. This surgery, he felt, was necessary.

Kathy told him that just months earlier, Conor was excited to learn about this “new procedure” whereby a part of the skull could be removed and stored within the body following severe brain injury. Conor and Kathy marveled about the recovery of Rep. Gabby Giffords, the Congressional Representative from Arizona. Following brain trauma resulting from gun violence in 2011, she had this same surgery, offering the cutting-edge chance for survival. This felt serendipitous to my sister. She recalled how she and Conor used to talk about what would happen if one side of his brain didn’t work for some reason. Jill Bolte Taylor’s book, My Stroke of Insight, was one of Conor’s favorite books as he was fascinated by the story of Taylor’s own stroke and subsequent understandings of how the left and right sides of the brain work in tandem. Conor was fascinated by the brain; yet here he was, the subject of the very same innovative and delicate brain surgery he’d been excited to learn about mere months ago.

Dr. Muro confidently explained the surgery and my sister remained brave within her despair. I witnessed an unspoken connection between them. The intimate scene unfolded between a brilliant neurosurgeon and dedicated mother. As Dr. Muro offered a chance for recovery, Kathy needed to speak to Conor’s promising place in this world. Dr. Muro listened to her, a testament to their mutual admiration. Kathy signed the consent form—a scribbled signature laced with trust. He put his arm around my sister’s slumped shoulders and reassured her. She placed her head on his shoulder, allowing a few tears to flow. Herein rested the cultivated bond of trust between them. If Dr. Muro could allow potential for Conor’s recovery, Kathy could take over with the mission to do whatever was necessary to heal him with love. I was reminded of my mom’s worry for Kathy. As she gave Dr. Muro permission for the surgery, I could only imagine the loneliness and isolation she felt. As much as I knew she needed me next to her, I knew she needed Phil more. All I could do was remain by her side and catch the silences of her worry.

I thought that day, and often since then, of Dr. Muro. What was supposed to be Sunday morning hospital rounds turned into an all-day commitment. During the frequent visits to Conor’s bedside since admission to the SICU, and because of my sister’s engagement, Dr. Muro spoke of his wife, his two young children, and the woes of housetraining two new puppies. This Palm Sunday may very well have included family plans, but his family carried on without him. As the wife of a dedicated physician, I sent a silent wish to his wife and children. I hoped somehow, they knew our appreciation for him also included gratitude for their understanding.

Suddenly, the room held a flurry of anesthesiologists, respiratory therapists, surgical nurses, and countless other hospital personnel preparing Conor for surgery. In the mist of the ordered chaos, my sister fell to her knees at Conor’s bedside. The composure while talking with Dr. Muro gave way to desperation as she cried, buried her cheek against the softness of her son’s hands; kneading his fingers in her frantic need for him to be okay.  

She spoke to him, reminded him of his dreams to visit Dubai, climb Mt. Kilimanjaro, and attend more Dave Matthews Band concerts. She told him Bridget and Jack needed him. She spoke to him with confidence that he could hear her, despite his comatose state. Her longing was palpable. She was willing him and pleading in her attempts to reach the spirit of her son buried deep amidst his brokenness.

The deepest capillaries of my being bled for my sister. I couldn’t believe that in just one week, her ordinary world had been hijacked by this random and senseless accident. Just over a week ago, Kathy and Phil were out to dinner, choosing a nice bottle of wine and dreaming about their eminent days of empty nesting. Brain trauma lived in another world then, but defined their lives now.

There is an eeriness in a surgical waiting room on a Sunday afternoon. Weekdays bring a collection of worried loved ones who gather with coffee and crosswords waiting to hear the report of a successful surgery. The receptionist’s chair is occupied with a hospital volunteer in her yellow smock providing updates to various family members, or directing them to the nearest restroom.

The television blares the high volume of game-show exuberance. On this Sunday afternoon, except for the few of us vested in Conor, the room was darkened. The overhead lights were dim. The television screen was in sleep mode. The empty receptionist’s chair was pushed underneath the paperless desk. It felt unnerving as we gathered to wait amidst such a barren scene.

. . .We spent the afternoon of this Palm Sunday together, the lone group in the surgical waiting area. We laughed and told stories as we huddled together. This was not our first experience with surgical waiting rooms. Memories of Neil, Gerry, Kathy, and me passing time while our mom endured numerous surgeries supported our ability to navigate the worrisome afternoon with usual protocol. Our coping strategies had been in place for years: we laughed, we played “20 questions,” we shared ordinary conversation to keep our anxiety at bay, and we allowed silence to store our angst. Sequential Hail Marys and Our Fathers were recited together, followed by reminiscing with iconic, lighthearted family stories. The heaviness of the surgical reality—Dr. Muro removing Conor’s skull—tempted despair, but the power to resist came from our confidence in him, one another, and the cultivated trust we were compelled to believe in.

The surgery lasted almost six hours. Although our energy was measured for most of this time, we began to get anxious as dusk blanketed the Chicago skies. Just when our impatience piqued, Dr. Muro sauntered through the surgery department’s automatic double doors wearing surgical scrubs. His dark hair was matted from hours of wearing his surgical cap. He plopped down in the waiting room chair across from Kathy, chewing ice from a Styrofoam cup. Slouching with his legs crossed, Dr. Muro exuded a casualness one would never expect after removing a skull and tucking it into someone’s abdomen. I guess it was just another day in the operating room; but for us, it was monumental. It seemed like an eternity before he spoke.

“Well?” Kathy finally said.
Dr. Muro spoke with confidence, simply stating that everything was fine, as if he’d stitched a cut knee. I suppose it is the upshot of brilliance when expertise becomes mundane. His relaxed demeanor (we laughed about it later) indicated he did his job, did it well; and was enjoying his cup of ice. I thought, well, if he’s calm, then we should be too. Dr. Muro gave needed details of the surgery and Kathy expressed appreciation. Her confidence in him so tenderly expressed hours earlier were fruitful. Post-surgery, Conor’s ICP level was 3. That was good news.

This particular Palm Sunday, we did not read the Gospel narratives of Christ’s passion. In fact, we were quite distracted from the ritual of putting ourselves into the company of Christ’s journey. We were engrossed in our own Passion that day, tethering worry with faith. It would take another 48 hours before Conor’s ICP permanently stabilized, but eventually the relief of successful surgery brought an end to the critical state of Conor’s brain pressure. We dared hope for more measured days bringing the possibilities for improvement.