A Hole in the Head

Ann Kathryn Kelly

Word Count 1350

We’d arrived at the ER just after midnight, January 5, 2016—ironically, Mom’s eighty-first birthday. It was a terrible hour to be awake, in an ER, wondering what would come of this snowy night. I was with my brother, Sean, and we’d just been told our mother might get holes drilled through her skull.

Burr holes, they called them.

*

While others walked through life, Mom strode. She was climbing stepladders to paint walls and refinishing antique doors into her seventies. She could roam for hours in flea markets. She maintained six precisely manicured garden beds. But in 2015, Mom—then eighty—threw her first blood clot; a pulmonary embolism. It nearly killed her.

It hit my siblings and me that our vibrant mother, a woman we perpetually saw as the forty-something four-star family general who raised us with boundless energy, had somehow become twice that age. A doctor told us clots can sometimes be an early indicator of cancer. Two months later, she received a breast cancer diagnosis. Although she wasn’t keen on surgery at her age, Mom agreed to a mastectomy. Chemo though, she said, was non-negotiable.

“No,” she told us, shaking her head. “No. You need to know when to say enough is enough. I’m eighty. I’ve had a good life and I’m not about to pull out the stops now and be a hero at this age.”

My three brothers, sister, and I knew better than to push. Mom emerged from her mastectomy free of complications. Her surgeon told her during a follow-up weeks later: “You heal like a woman in her thirties.” Along with hormone therapy, she started on a daily blood thinner: Warfarin.

Warfarin saves our mother’s life each day, but it has turned her blood to water. It has the power to turn an occasional stumble from mere embarrassment into a medical crisis, like her fall that winter night in 2016. I was at the house with her and saw the egg form on her forehead in seconds as a bluish bruise puddled across her eyelid and dripped toward her cheekbone. My stomach somersaulted as I dialed 9-1-1. Within the hour, head scans in hand, an ER doctor at the local hospital introduced us to the term “burr holes.”

“If the bleeding continues,” he said, “burr holes are an option to release cranial pressure.”

“There’s a neurosurgery department here?” I asked. I’d assumed our hospital was too small.

“No, we’d send your mother to Boston.”

Boston is a little over an hour by car from my home in Dover, New Hampshire. Mom had moved in with me a few years earlier. I wondered how long was considered safe to “wait out” a brain bleed? When might they decide whether burr holes were needed? She’d been sedated in the ambulance ride from my house and was several feet from Sean and me, on a gurney, eyes closed.

“Let’s repeat your mother’s scans in an hour,” the ER doctor advised. “We often see that swelling like this starts going down on its own.”

Yes, I thought. Let’s.

For the alternative was chilling. Brain surgery? On our mother? At eighty-one? The scenario was frightening … and all too familiar.

An hour passed and another scan showed the swelling had not subsided. Mom was awake, her eyes bloodshot with a glassiness I didn’t recognize. The doctor was explaining why we should consider burr holes. He didn’t want build-up in blood product between the dura mater and skull to cause dangerous pressure. Burr holes, he said, act as crucial release valves. A drill, he said, would tunnel into the skull and temporary drains would be inserted. The holes, he assured us, would only be the size of dimes.

He looked at Mom. “You’d need just two of them.”

He reviewed potential risks: seizures, infection, blood clots, brain injury, heart attack, stroke. I knew the risk discussion was required, but I haven’t known a situation yet where this part infuses hope or a willingness to go along with whatever is being suggested. He said an ambulance could be ready to transport her to Boston within fifteen minutes.

“Positively not,” Mom interrupted. “Not interested.”

She shifted in the bed to look at Sean and me, and pierced us with a glare. “And don’t you two get into this. This is my decision.” She turned her eyes back to the doctor. “I don’t want any part of what you just described. Besides, I’m on a blood thinner.”

“We’ve already started reversing your blood thinner,” the doctor countered. “If you choose to stay here—certainly, an option—we can keep you comfortable. I want to stress, however, it’s all we can do.”

“I understand,” Mom said. “I do.” She set her jaw. “I’m fine with staying right here. I’ve had a hell of a night, so let’s not discuss it anymore.”

“Mom.” I waited for her to look at me. “You can do this.”

It was what she had said to me six years earlier, when I was the one in the hospital bed. Now looking from the other side, at my mother on the gurney, I needed her to make a similar leap. She pushed back, before finally agreeing. Hours later, Sean and I sat in chrome chairs in the ER of Massachusetts General Hospital, feet from where our mother slipped in and out of sleep. A nurse parted a curtain and stepped into our small partition. She roused Mom with a gentle shake.

“Mrs. Kelly. Do you know where you are?”

Another light shake. She waited for Mom to open her eyes and asked again.

“Boston,” Mom replied.

“That’s right.” The nurse moved down a list of questions and swayed a penlight across Mom’s pupils. Her final question: “Who’s the President?”

“Obama,” Mom answered. She turned to me after the nurse left, groggy, but with a glint in her eye. “Next time I’m going to say Kennedy, just to see how that hits her.”

She settled back against the pillow and closed her eyes. I studied the monitor as lines dipped and climbed across the screen. The sound of it pulled me back to the time when I was the one on the gurney, Sean and Mom on the hospital chairs. Living near each other, it’s we three who usually traverse these medical roads together, keeping out-of-state family apprised. Six years earlier, Sean and Mom had leaned in as I waited for the anesthesiologist, saying they’d see me soon, just as soon as I got out of surgery.

Picturing the possibility of my mother’s brain surgery felt surreal. That it had already happened to me—twelve hours of open-head surgery—was even stranger. Sometimes my surgery felt like it had just happened. At other times, it felt like a lifetime ago. Would my family again need to contend with unknown outcomes and the all-consuming fear of making such a choice?

The following morning brought welcomed news after they monitored Mom hourly throughout that night. Additional scans showed that her body was reabsorbing her brain bleed. Burr holes were no longer needed. She stayed another day and night in the hospital before coming home.

*

Mom will take her blood thinner for the remainder of her life. Now eighty-seven, she’s seven years cancer-free. She had another fall two years ago, but like the cat with nine lives, escaped without injury. She says she’s ready at any point to make a graceful exit, having enjoyed a fulfilling life. She tells me she prays every night she doesn’t have her grandmother’s genes that saw her ring in a ninety-third birthday. I tell her I’d like her to stick around, that ninety is the new seventy.

“The hell it is,” Mom always answers.

She tells me she’ll consider giving me another year, maybe two, of her company. I tell her, thanks, I’ll take it. Then, I privately bombard God with my prayers that she’ll leave her grandmother’s record in the dust.

Ann writes from New Hampshire’s Seacoast region. She’s an editor with Barren Magazine, a columnist with WOW! Women on Writing, and she works in the technology sector. Ann leads writing workshops for a nonprofit that offers therapeutic arts programming to people living with brain injury. Her essays have appeared in a number of literary journals. https://annkkelly.com/