The Water Giver

Joan Ryan
Simon & Schuster
The Water Giver

Prologue

I had not cried in his room. I believed he could hear me, or at least sense what I was feeling. So I chattered at him as if we were around our kitchen table. I told him we would be there when he woke up. That he should rest as long as he needed to heal. That he would be fine.

I believed it, despite everything that had happened. Ryan would be fine because children don’t die and because he was Ryan. I looked at him on the bed in the intensive care unit and saw a strong, broad-shouldered, tanned sixteen-year-old who seemed to be sleeping. My eyes looked past the tube clamped to his mouth to keep him breathing, the hard plastic collar around his neck, the gauze turban, the wires snaking from his arms, chest, and skull into various beeping, blinking machines.

I stood at his bedside and held his hand and kissed his smooth skin. His fingernails still had grease under them from working at Lucky Garage. I wouldn’t let the nurses clean them.

“You can’t do this,” I whispered in my son’s ear. I was crying. “I can handle anything. But I can’t handle losing you, Ryan. I can’t survive that.”

Nine

There was no blood. No obvious injury. When I drove up to the scene, Ryan was already strapped into a stretcher, surrounded by police and para¬medics. Three neighborhood boys had raced to our house on their bikes and knocked on our back door. “Ryan fell off his skateboard,” one said breathlessly. “He’s on Lagunitas Road.” Three blocks away.

Barry and I had been about to leave for the meeting at school to plan the annual fund-raising gala.

I shouted upstairs, where Barry was still dressing.

“Ryan fell off his skateboard,” I said. “I’ll go check it out.”

I drove the three blocks to Lagunitas Road, where a fire truck, an ambulance, and a police cruiser were parked near the stop sign where the road meets Willow Avenue. A small crowd of boys and several adults — residents and passersby — had gathered around Ryan. He was on a stretcher on the ground, straining against the belts pulled tight across his chest, thighs, and forehead. He had an immobilizing collar around his neck. He had been stripped to his boxer shorts. He had a scrape by his left eye and another scrape near the crown of his head. He kept trying to wrest himself free of the straps and grew increasingly irritated that he couldn’t.

One of the boys later told me he saw Ryan on his skateboard gaining speed down a long slope on Lagunitas Road. Ryan be¬gan to wobble — perhaps he hit a rock, perhaps the new bearings on his wheels malfunctioned. He lost control, flying forward off the board. His bare head slammed into the road, then hit several more times as he rolled. He came to rest, face down, near the stop sign at Willow Avenue. The boy ran to Ryan and called 911 as soon as he saw Ryan was crying. He had never seen Ryan cry.

The paramedic crouching over Ryan said he had no broken bones, but because he had hit his head, they were taking him to the hospital to be checked.

“Are you all right, sweetie?” I asked, kneeling next to him.

He said the right side of his head was the only place that really hurt.

“He wasn’t wearing a helmet,” the police officer said. He knew Ryan, as all the officers did, not because Ryan got into trouble but because he always stopped to chat and listen to their stories.

“As soon as he’s fixed up, I’m going to kill him,” I joked.

The officer laughed. “If I don’t get to him first.”

My stomach didn’t lurch. My heart didn’t stop. I didn’t feel what I had always heard you felt in the moment that your life changes.

I wasn’t worried, in part because I knew rescue teams in our little town roar to the scene when old Mr. Pitts steps off the curb too hard while walking his Yorkshire terrier. And I am my mother’s daughter. She wasn’t much for kissing away tears when we fell from trees or bobbed up sputtering from a dive into the deep end. “What were you doing there in the first place?” she’d ask. If we hurt ourselves on the ball field, she didn’t move from her seat in the stands. She figured if the injury was bad enough, someone would summon her.

I raised Ryan similarly, in that I knew the odds were heavily in my favor that he would survive, no matter what stupid stuff he did. I was probably, by today’s standards, an underprotective mom. I believed fear was, generally speaking, a useless expenditure of energy. I knew the newspapers were filled with murders and grisly accidents. But I also knew, because I was a reporter, that these aw¬ful things were out of the norm. That’s why they were in the pa¬per. The odds are always in the favor of nothing bad happening.

The paramedics loaded Ryan into the ambulance and handed me his jeans, T-shirt, and sneakers. I told them my husband and I would meet them at Marin General, less than four miles away. I called Barry on my cell to tell him what was happening and that I would be by in about a minute to pick him up.

“I heard sirens,” he said when he climbed into the car.

“His head hurts, so they’re going to get him checked out,” I said.

Fifteen minutes later, at around 5:45 in the afternoon on a sunny Wednesday, Barry and I pulled into the parking lot of Marin General. Ryan had been there only one other time, for another skateboard mishap. He had fallen going down a hill, ripping the skin from his right arm and leg. That time he was wearing a helmet.

I reached into the backseat and gathered up Ryan’s clothes. He would need them for the ride home. But at the last moment, I tossed them back into the car. If he has a concussion, I thought, they might need to keep him overnight. I could always dash out to the car if he was given the okay to leave.

The waiting room was empty. We filled out paperwork and took seats in front of the aquarium. I wondered if I should call the school to say why we were missing the meeting. Barry and I stared at the fish. Then we stared at the TV mounted on the wall in the corner. There was a news story about Google providing the town of Mountain View with free wireless Internet.

Fifteen minutes passed. Thirty.

The last time Ryan had been there, I was in the treatment room the entire time. I asked the receptionist why we couldn’t go back to see Ryan. He said he’d check. Finally a white-haired doctor appeared from behind the automatic double doors. He said Ryan was still being settled, that someone would come get us soon. Okay. Thanks. I checked my watch. How long does it take to settle one kid?

Another fifteen minutes.

Then a middle-aged woman emerged from the double doors. She asked if we were Ryan’s parents. I looked at the job title on her nametag.

Chaplain.

Ten

The woman walked us out of the waiting room, down a short hallway, and into her office. “What’s going on?” I asked, my heart pounding. “Why are we talking to a chaplain?”

She said a whole team is summoned when there is a “full trauma.” A surgeon,an anesthesiologist, a chaplain. She listed others that I don’t remember now.

“What do you mean a full trauma?” Barry asked.

“He bumped his head,” I said.

The chaplain leaned forward in her chair, her elbows on her knees. She said she wished she had more information for us. A doctor would talk to us soon.

The doctor knocked lightly on the door before entering. It was the same one who had come to the waiting room. He looked shaken. He didn’t sit. He said Ryan had sustained a significant head injury. He had been put into a drug-induced coma.

He led us down the hall into the large ER hub with counters and computers in the center and curtained rooms along the walls.

The doctor pulled back a curtain. Ryan was in a blue hospital gown. His long body filled the bed. His head was wrapped in white gauze. He had a thick tube protruding from his mouth; it was attached to a machine that was helping him breathe. Two IVs snaked from his arms and connected to clear bags of liquid hanging from a metal stand. There was blood on the sheet under Ryan’s right elbow, where, we later learned, he had yanked out one of the IVs. Nurses scurried around him with tubes and needles and sterile things in sealed packets.

Barry and I stood there, mute, trying to take it in.

A drug-induced coma? A ventilator? Ryan had fallen off a skateboard, for God’s sake. He had been conscious and even talking. How could he suddenly be like this?

The doctor explained that during the ambulance ride Ryan had become disoriented and agitated, classic signs of a traumatic brain injury. The EMTs had called the hospital en route to elevate his case to a full-activation trauma. He had been sedated to keep him from injuring his head any further and to allow the staff to treat him.

The ER doc took us to a computer on a counter outside Ryan’s room. On the screen was a CT scan of our son’s brain. The doctor pointed to a white blotch; it looked like a bleed, he said. Ryan probably would need surgery. It was a “significant” injury, he said. The neurosurgeon was on his way. He would be able to tell us more.

We returned to Ryan’s side. We were trying to gather information, absorb what everyone was saying. I listened to the list of medications. Versed. Dilantin. Lidocaine. I knew them. I had spent much of the previous year chronicling the lives of two young soldiers who lost their legs to improvised explosive devices in Iraq. Both had suffered closed head injuries, and both had been given many of these same meds to put them into comas. The two soldiers had emerged from their head injuries pretty much intact — and they had been blown up. All Ryan did was fall off a skateboard on a suburban street.

So while I was worried and nervous, I didn’t panic about seeing him this way. I knew he wasn’t in a real coma. I knew he was sedated to reduce the activity among the neurotransmitters, which could further damage the brain tissue. I knew he could be brought out of the coma whenever the doctors wanted. I understood this was standard head injury protocol. It all seemed familiar to me from my time with the two soldiers.

But the people in the ER seemed to be expecting tears, and neither Barry nor I was complying. They kept offering us water and Kleenex in that awful, pitying tone you hear only in funeral parlors and hospitals.

“This is a significant injury,” the ER doctor said yet again, draw¬ing out his words. He mentioned something called “Cushing’s triad” and “burr hole” and “evacuation and closing.” He paused. He stared at me, as if trying to discern if I understood what he was telling me.

Then he said, “Is there anyone you want to call?”

I began to cry. Okay, I get it. My son might die. The chaplain, hovering in the background, handed me the box of tissues I had declined earlier.

One of the doctors — perhaps the anesthesiologist — lifted his head from adjusting the tubes in Ryan’s arms. He said Ryan’s vitals weren’t looking good. His heart was spiking, then dropping. He said in his opinion Ryan needed surgery right away.

“Do you have other children at home?” he asked.

I looked at him. Do I have other children at home?

“No,” I said.

No, I wanted to scream at him. No, I don’t. This is it. I have no spares at home.

I pulled a small notebook from my purse. The reporter in me kicked in. I flipped the pages and came across a list: “sandwich, snacks, breakfast, water, socks, extra shirt, sunscreen, hat, Aleve.”

They were items my friend Lorna had told me to bring on a seventeen-mile hike we took near Lake Tahoe the previous weekend. Could that have been just five days ago?

I turned the page.

“CT scan,” I wrote. “Hemorrhage. Evacuation. Versed. Induced coma. ‘Do you have other children at home?’ Significant. Substantial. Cushing’s triad. Bur hole. Evacuating and closing.”

The neurosurgeon arrived. Dr. Peter Nguyen looked to be in his forties. He looked at the CT scan, then led us back to the chaplain’s office. Yes, he said, it was a significant injury, but it didn’t require surgery at the moment. He was soft spoken and re¬assuring. They would monitor Ryan closely for any changes.

We bounded out of the office and back to Ryan’s side. I stroked his arm.

“Sweetie, you’re going to be fine,” I said.

Minutes later, Dr. Nguyen reappeared. He needed to talk to us again. We stepped outside. He said he had not seen the full set of X-rays. Ryan’s CT scan was on the screen. He pointed to the same white splotch the ER doc had shown us.

It was a significant bleed. The pool of blood was pressing on Ryan’s brain. Dr. Nguyen explained the specifics. I remember none of them. I remember only that he delivered the diagnosis in a way that left no wiggle room. Ryan needed surgery now to stop the bleeding.

A nurse handed us a clipboard. Barry and I signed the forms.

We went back to Ryan. There was a fluttering of preparation. New IVs being snapped into place. I held Ryan’s still hand. His nails were black from the garage and from putting the new bear¬ings on his skateboard. I traced his eyebrows with my finger. I lifted his hand and kissed it, then Barry did the same.

“You’re going to be fine, Bucko,” he said.

Then they wheeled him away.

I went outside to the parking lot and called my parents in Florida.

CT scan the day of Ryan’s accident, August 16, 2006. The shadow on the left side of scan — which is the right side of Ryan’s head — shows the accumulation of blood in his brain.

“Ryan had a skateboard accident and hit his head,” I said, trying to modulate my voice.

We were not a family that cried. We did our celebrating and fighting at the top of our lungs but our suffering in silence. There was an assumption that life was hard for everybody, and you soldiered on.

“I’m sure he’s going to be all right,” I said. “But he’s in surgery. Say some prayers.”

I said this out of habit. I long ago had stopped believing in prayer. Despite a childhood of Sunday masses and Saturday con¬fessions and long afternoons of catechism classes, I had come to distrust what people called faith. Maybe I had reported on too many exploitive ideologues and fanatics. Religious faith smacked of primitivism and magical thinking. I believed in facts, numbers, source materials. I believed in medical expertise, sophisticated equipment, well-tested pharmaceuticals.

Barry and I sat alone in the surgical waiting room on the second floor. I picked up People magazine. I put it back down. I couldn’t read anything. Neither could Barry. We could barely speak. This was really happening. Our son was in an operating room and a doctor was drilling into his skull.

I fished my phone out of my purse again and called Lorna. I wanted her with me.

Lorna and I had met when Ryan and her daughter, Emma, were in kindergarten together. Unlike most of the mothers waiting outside school at 2:30 every day, she looked as unpolished as I did most days, though she pulled it off better. She had a willowy build with legs like a dancer’s. She rarely bothered to put on makeup or style her hair. She generally wore running shoes, shorts, and a tank top. She usually had come from a run or a hike, or from her art studio, and she still had paint or cement under her fingernails. No tennis skirts. No kitty heels. No scarves. She didn’t try to put up a good front. When Emma wailed and carried on almost every morning of kindergarten, distraught that her mother was leaving, Lorna shrugged and smiled.

“I’m so proud,” she’d joke.

We got to know each other through a Thursday morning hiking group. As a newspaper columnist, my schedule was flexible enough to escape into the hills near my house once or twice a week. Lorna and I would end up talking for two hours straight, barely noticing the other twenty women navigating the trail with us. Lorna was a sculptor who usually had several projects going at once, fitting her work time around her kids’ schedules. She had grown up in Wellesley, Massachusetts, met her husband at Union College in New York, then earned a master’s in fine arts at Columbia. She taught art for years, several in Harlem. She moved to Northern California when her husband, Doug, took a job with an investment banking company in San Francisco.

Lorna and Doug lived a few blocks away from Barry and me, so their family and ours fell into the habit of having dinner together at least once a week, usually twice and sometimes three times. We would run into each other at the corner grocery and end up at one house or the other, grilling chicken and tossing Caesar salads. Doug and Barry were both passionate cooks and went to elaborate lengths to prepare exquisite dinners on the weekends, shopping at the farmers’ market, marinating, chopping, seasoning, braising. At our Christmas Eve gift exchange every year, the two men bought each other cookbooks.

Both men traveled frequently: Doug to visit companies in which he had invested, Barry to sporting events across the coun¬try. The downside to working as a sportscaster was being away from home several nights a week, though Barry’s schedule had improved in recent years. He left ESPN to work for Fox because Fox assigned him to Pac-10 football and basketball, which meant most of his trips were short flights to West Coast cities.

When our husbands were away, Lorna and I and our kids got together for simple, communal meals of store-bought roasted chicken and maybe some cheese and crackers. And always a bottle of wine. Emma and her older brother, Ben, became like cousins to Ryan. Our two families traveled together to Kenya one year, to Tahiti another. Lorna and I took a trip on our own to Ireland to visit a friend whose husband was shooting a movie on location there. Lorna and Doug owned a condo at the edge of the ski resort at Squaw Valley near Lake Tahoe, and the place became some¬thing of a second home for us, too. Barry and I didn’t ski, but Ryan was crazy for snowboarding.

In the surgical waiting room that night, I dialed Lorna’s number.

“I’ll be right there,” she said.

She, Doug, and Emma arrived minutes later. Ben was away at college. Lorna wrapped her arm around my shoulder and I leaned into her. “He’s going to be fine,” she said. Then, in her practical Lorna way, she called a good friend who is a doctor in San Francisco and took notes about what questions to ask the neurosurgeon.

The surgery took about an hour. Dr. Nguyen said he had re¬moved a silver-dollar-sized portion of Ryan’s skull, then suctioned and scraped out the accumulated blood, which was described later to me as like hard Welch’s grape jelly. He reattached the disc of bone with titanium rivets.

He said Ryan had sustained “a right linear skull fracture from frontal to sagittal bone, subdural and epidural hematoma, and right frontal contusion.” I looked this up later in the hospital records; the words were a blur that night.

The doctor took us into a small room where he showed us the post-op CT scan. I pulled Lorna in with us, certain that neither Barry nor I would be focused enough to take in the details. I saw something on the scan I had not seen on the earlier ones.

There was a clear jagged line cutting across Ryan’s skull from the base to the forehead. It’s one thing to see a white spot that is supposed to be blood but looks like a smear of bleach on a photo-negative. But this crack. This was recognizable, undeniable, sickening.

I suddenly felt light-headed and nauseous, as if I might faint. I could barely breathe. Lorna led me to a chair in the hallway, leaving Barry alone to nod his head at the neurosurgeon’s explanations, as if any of this made sense.

The doctor told us there was no reason to spend the night at the hospital. Ryan was in a coma. He was stable. And we lived just six minutes away by car in case anything did happen. We should get some sleep, he told us. We had a long road ahead of us.

We returned home that night to a dark, quiet house. Without Ryan there, the house felt almost creepy, the way abandoned buildings do. There had been only a few nights in Ryan’s sixteen years that he wasn’t with Barry or me. He had never gone away to camp. Barry and I loved to travel, and Ryan went everywhere with us. It sometimes felt as if we were a single unit, three mismatched people who somehow found each other, bound by ties that had nothing to do with blood.

From THE WATER GIVER by Joan Ryan. Copyright © 2009 by Joan Ryan. Reprinted with permission of Simon & Schuster, Inc. www.simonandschuster.com. For more information on Joan Ryan, go to www.joanryanink.com.

Posted on BrainLine October 13, 2009

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