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chapter 13

Excitation, Graduation, Intubation, Revelation

Dallas, Texas

May 2005

It was a beautiful morning in Dallas—sunny, 80 degrees, and early enough that the temperature was still relatively pleasant. It was Friday, May 19, and Carmella was very excited. After almost 5 years, she was finally graduating from Texas Woman’s University with a bachelor’s degree in nursing. It has certainly been a struggle. The two years of commuting from Denton to Dallas for her job at the nursing home had been very stressful, but that got better once her clinicals started and she was able to get an apartment in Dallas. Then there was the event with Gabriel Franklin, which had seemed more than crazy at the time, but in retrospect, had certainly helped her financially, giving her the time and extra money she needed to finish the nursing program. Carmella had no family other than a brother who had been in prison for the last 7 years, so whatever she had was due to her own hard work and initiative. Most of the time it had been difficult for her to envision the end result, just the struggle it was going to be getting there. Today was an exception, however, as the end was here, at least the end of her time at TWU. It seemed like it would never come, but now that the day had finally arrived, she was savoring every moment of it.

Carmella still hadn’t adjusted to the thought of actually being a nurse. After all those years as a nurse’s aide, this was really a big step up for her. She would still have to pass her boards in June, but after that it would be Carmella Brown, RN. It was still hard to imagine! What was even harder to envision was the fact that she would be starting graduate school in the fall. That was a big deal, but even bigger was the location of the school in Portland, Oregon, over two thousand miles away from Texas, a state she had never been out of in her life! Carmella would never have even thought of graduate school had it not been for Norma Reyes, her academic adviser at TWU, who had been almost like a mother to her for the whole time she had been there. Norma had quickly picked up on Carmella’s spirit and determination, and did everything within her sphere of influence to help Carmella reach her potential, which she reckoned to be considerable. Norma had set up a tutor for Carmella, coaching her on grammar, enunciation, writing and oral communication—all skills that she had been notably deficient in due to her rather-rough upbringing. By the first semester of her senior year, she had Carmella ready for the GRE, which she then passed with excellent scores. Ms. Reyes suggested OHSU for Carmella since she herself was a graduate of their master’s program. After considerable deliberation, Carmella had applied to the Family Nurse Practitioner program and had received her acceptance notice just the week before. In addition, Norma had pulled some strings to get her a part-time job, starting in the fall, as an RN at the OHSU hospital, which was very near the nursing school.

Today, however, Carmella just wanted to thoroughly enjoy her first triumph—graduating from TWU! On Monday, she started orientation for a summer job at St. Paul hospital, an 11–7 night shift position as a graduate nurse on a busy medical floor, so she was determined to make the most of her graduation weekend. Three whole days of freedom with no studies, no job, and no worries! She could hardly wait till 2:00 p.m., when the ceremony started!

*****

“Carmella Ronelle Brown, cum laude,” echoed over the PA system at the TWU auditorium. As she walked across the stage to shake Dean Davis’ hand and receive her diploma, Carmella’s pulse quickened with excitement. This moment in time, this very moment, was what she had worked so diligently for the past five years to experience. Now it was here, and she was a bit anxious as she walked toward the dean. Mustn’t trip on the gown, she reminded herself as she had almost reached the podium. Stretch out your hand, Carmella, look confident, grasp the dean’s hand firmly, thank her as you receive your diploma. Good! Well done, perfectly executed!

“Congratulations, Ms. Brown!” Dean Davis smiled as she shook Carmella’s hand and handed her diploma to her. “I know you’ve worked very hard for this achievement, and to graduate with honors is just splendid! We all are very proud of you, and wish you the best in your career and continuing studies. We hope to hear great things about you out there in Portland. Best of luck to you!”

Lots to process in about thirty seconds. Five years pinpointed in that small window of time. Carmella took it in as well as she could. Several of her friends in the audience and in the graduation group clapped and cheered for her in lieu of any family. She was popular with her classmates, who had supported her through the whole ordeal, including the nine months with Demarius! That event had made her kind of a heroine with her friends, to have a baby and still continue in school. None of them asked much about it, as she had simply told them it was a surrogate pregnancy for money to finish school. They just admired her determination to finish, so it was a joyous event when Carmella Brown took that diploma in her hand and waved it over her head in a gesture of triumph. They loved it. “You go, girl!” someone yelled from the audience, while several more whistled and clapped even louder. Carmella took it all in, trying to imprint the moment in her memory, so that it would always be with her.

As she stepped down from the stage and walked in front of the faculty, Norma Reyes stood up with tears streaming down her face and gave her a big hug. “We’ll all miss you, Carmella,” she whispered in her ear, while placing something in her hand. “Several of us got together and wanted you to have this—to help you get to Portland and all,” she smiled through the tears. “You’re a winner, Carmella…I know you’ll always do well,” she added as a queue of graduates formed behind Carmella, forcing her to continue on to her seat.

Carmella sat down in a state of total elation. She was so proud of the diploma she held in her hand that she literally wept for joy. It felt like five long, hard years had just evaporated from her body, leaving her with a lightness and optimism that she couldn’t remember ever feeling before. She literally was not the timid, slightly awkward, completely unsophisticated young girl who had started the nursing program five years ago. As she sat there, she felt confident, more resilient, more articulate, and certainly far more experienced than that starry-eyed country girl who began the program half a decade ago.

Then she saw the folded-up piece of paper in her other hand and began to open it, with the hopeful expectancy of a child on Christmas morning. It was a check, and there was her name on it…Carmella Brown. Next to her name was a 2 and four 0s. Two thousand dollars! That was more money than she had ever seen at one time, with the exception of her surrogate soiree with Gabriel Franklin. She was ecstatic! That would be enough to get her old 1982 Toyota Corolla in good-enough shape to make the 1,600-mile trip to Portland later that summer, and maybe enough left over for a couple of nights’ lodging on the way. With her new job starting on Monday, Carmella now had every reason to feel a bit more secure and optimistic. Life was good, and would be even better once the next two hundred graduates had received their diplomas and she could get out of there.

She and several of her graduating friends had planned a cookout and swimming party at Lake Lewisville, which would be on her way back to Dallas from Denton. The weather was sunny and warm, and she couldn’t wait to get down to the little beach there and just relax by the water’s edge. She wasn’t that big on swimming, since she had never really learned as a child, but one of her friends had a boat and promised to stop by and take them out on the lake for a little ride later that afternoon. Carmella was really looking forward to that—she had never been on a boat before, and was excited at the thought of cruising around the lake in a motorboat.

As her thoughts returned to the graduation ceremony, Carmella soon realized that this was going to take longer than she thought. They were only through the Es, and it was already 3:00 p.m. She had hoped to be on the beach by 4, but the chances of that occurring were diminishing by the second. Will you please hurry up? she thought to herself as she watched the seemingly endless queue lined to hear their name called and receive their diplomas. I’m leaving at 4 regardless, she decided. I’ll just have to make up some excuse as to why I had to leave early, if anyone asks. Yeah, that’s a good plan, she thought. I can surely endure another hour!

*****

As she turned the key in the ignition, Carmella looked down at her watch. It was 4:15. Not too bad, she thought, as the engine engaged. I’ll be at the beach by 4:30 if I hurry. As she made her way south on Bell Avenue over toward Fort Worth Drive, she scanned for police, and pushed the speedometer up to 45 mph. Surely they won’t stop me for being just 5 miles over the speed limit, she rationalized as she made a quick right onto Eagle Drive. Fort Worth Drive was four lanes and just a block away, so she could crank it up a bit once she had turned south onto that road. Then it was just a short ways to 35E, the interstate connecting Denton to Dallas.

As Carmella reached the onramp and merged onto the interstate, she looked down at her watch again—now it was 4:22. That’s ok, she thought. I should still make it close to 4:30 if I do 70 all the way! That was the last thought she remembered, for as she looked up, the eighteen-wheeler in front of her had inexplicably slowed (later she learned, to avoid hitting a dog who had strayed out onto the freeway), and she couldn’t slow down fast enough. As she swerved to try to miss the truck, the end of the trailer struck the passenger side of Carmella’s Toyota, crushing the right door and shattering the windshield. Before she could think or react any further, her head hit the steering wheel. She felt the car spinning out of control and shards of glass striking her face, chest, and right arm. Blood was running into her right eye, but the red quickly faded to black as she lost consciousness.

Fortunately, there was no one immediately behind her car, as it finally spun off the highway and into the grassy median. The entire right side of the Corolla was crushed, with the hood bent grotesquely into the shape of something resembling an eagle’s beak, with the front bent down and the back of the hood thrust up toward the windshield. Carmella’s body was slumped over the wheel, while a four-inch gash on her forehead slowly dripped blood down her cheeks and neck.

It all happened so quickly, but the instant she lost consciousness, Carmella became aware of everything that was happening, but in a very different way than through her usual senses. She was aware of her body lying there in the car, but simultaneously, she was aware of the truck driver’s anxiety as he raced over to render aide. She sensed the uneasy curiosity of several drivers farther behind who had seen the incident from a distance and now pulled off the road to assist. She heard the ambulance sirens in the distance, but somehow was not in her body at all. In fact, she felt above it all, looking down at the wreckage and intense emotions of the onlookers. Her body seemed very insignificant at this point, just lying there, but not housing her consciousness at all. As she looked at the overall scene, Carmella realized that she felt no pain. To her surprise, she felt an unusual lightness and calm peace that was beyond anything she had ever experienced before. It was as if she were a part of the entire scene, sensing a perfect harmony between the sky, the grass, the trees, and even the passersby who had stopped to help. She heard a paramedic yell, “Get the board and a neck brace!” as he pried open the driver’s door. She watched them apply the brace and then place her face up on a rigid board, which was then strapped to a gurney. Carmella felt as if she were floating above the entire scene as an observer. Her body seemed insignificant to her as she watched an EMT check her pulse BP, and pupils. “Pulse, 150 and shallow, BP 100/60. Patient is unresponsive; left pupil is fixed and dilated. Radio St. Paul ER and tell them we’re bringin’ in a head injury. Have ’em get an OR ready and call in the neurosurgeon. Looks like a possible subdural hematoma—can’t tell extent of other injuries. ETA 20 minutes!”

Carmella was calm, peaceful, even serene. She felt no attachment to her body, only an overwhelming sense of peace and love. It was as if her “true essence” had been liberated from her body and was free at last to return to its “natural state.” She was enveloped by an energy, the essence of which was almost beyond her ability to articulate. She was filled with a sense of what could only be described as “utter bliss” in the presence of this force. Nothing else seemed to matter other than experiencing this feeling of magnificence and acceptance. She had no anxiety at all as they placed her motionless body into the ambulance and headed toward Dallas, sirens wailing.

*****

“Dr. Martin to the ER, STAT! Dr. Martin to the ER, STAT!” Dr. Harold Martin looked up at the scrub nurse as he just completed his last scalp suture. “Jesus,” he mumbled, “I think they have a camera in here or something. How does that ER always know when I am just finishing a case? Just once it would be nice if I could even get my gloves off before they page me down there again!”

He was tired and clearly didn’t want any more work for the day. This was his third case, each of which lasted in excess of two hours, so he had been on his feet for over six hours. His eyes were tired of squinting through those microscopic lenses he had to wear too. Besides that, it was Friday afternoon, and he had a fishing trip planned for the weekend. “Why can’t these damn people have their emergencies during regular business hours?” he growled as he ripped off his gloves and pushed through the OR doors. As an afterthought, he held one door open with his foot and yelled back to the nurse, “Mary, just wheel Mrs. Malone over to recovery. Use my standard post-op orders and I’ll be right back to check on her and add anything else she might need.” With that, he let the door slam behind him and headed down to the ER.

Dr. Martin reached the triage desk just as Carmella was being wheeled in through the double doors. She was unconscious, with a 4-inch scalp laceration on her right forehead. The neck brace was still in place, stabilizing her neck. The monitor attached to her showed a heart rate of 140 and BP of 100/60. “Vitals stable?” he questioned one of the paramedics.

“Yes sir,” he replied. “She was unconscious when we arrived. We applied the neck brace before moving her. She sustained a blow to the right side of the head. Her left pupil is dilated and nonreactive.”

Dr. Martin did a quick neuro check of his own, then spoke to the ER staff. “Start a keep-open IV with normal saline, then give her a 25-gram bolus of mannitol over 15 minutes in 100 ml. We need to keep fluids to a minimum to minimize swelling. Follow that with 2 grams of methylprednisone in 100-ml NS over an hour. Get a CT scan of her head and x-ray of her neck on the way to the OR. Call up there and tell them to prep for a possible emergency craniotomy. Have the radiologist call me ASAP with the results. I’m going up to recovery in the meantime. Make sure someone stays with her at all times and call me for any change in vitals or seizures. Ok, let’s move!” he shouted brusquely as he turned to leave.

Carmella, meanwhile, was finding all this most entertaining, almost like watching a soap opera on TV. To the degree that she could, Carmella determined that she was in some sort of higher vibrational frequency than that which was typical of earthly life-forms. Her perception was way beyond the norm, and she was able to be in multiple places at once. Time seemed nonexistent to her, and she was able to move about freely with no physical impediments—through walls, doors, whatever. There continued to be this overwhelming sense of her being loved and cherished, coupled with the realization that she was an eternal spiritual presence, bonded in some unique way with a spirit infinitely greater than herself, yet present within her. There was no verbal communication, really, just an awareness of everything and everyone all at once. It was just too much for her to process at the moment, especially with all that was going on in her body.

She floated along beside her unconscious self as she was wheeled out of the ER to radiology, and watched as the CT scan and neck x-rays were completed. She literally felt the fatigue of the radiologist and his anxiousness to get home. She simultaneously experienced the empathy and concern shown to her by the emergency tech who accompanied her for the tests. It was as if everything and everyone were all connected in some way. She sensed Dr. Martin’s anxiety in the recovery room as he picked up the phone and listened to the radiologist’s report. “Got a pretty good-size pancake in there!” he called up to Dr. Martin. “Looking to be about 11 mm thick with a midline shift of 7 mm. Looks like I’ll be goin’ home way before you!” he joked. “I’ll send up the pics,” he added almost as an afterthought.

“Damn,” muttered Dr. Martin, “I was afraid of that. How about her neck?”

“No problem there. Only apparent injury was to the head.”

“Well, that’s one bit of good luck for her,” Dr. Martin replied with a sigh of relief. “Ok, have the tech get her up here, we’re ready to go.”

“Aye, aye, Cap’n,” the radiologist snickered. “Maybe I’ll catch you at the lake tomorrow!”

“If I’m not too tired!” grumbled Dr. Martin. “Hey, thanks a lot for gettin’ that done so quickly. This girl needs all the help she can get!”

“I’m with you there, man. Take care!” said the radiologist as he hung up the phone.

Wow, thought Carmella, this is way better than nursing school—I can be everywhere at once and know what everybody’s thinking! You guys better do a good job, ’cause Carmella’s got her eye on you, she laughed as she floated along, following her body to the operating room.

*****

Dr. Martin was just finishing his scrub as Carmella’s body was wheeled past and into the OR. “Shave and prep the right side of her head,” he yelled through the doors to the nurse. “I’ll be right in.”

As the body was transferred to the operating table, the nurses began to prepare for the surgery. Her IV was already in, which was good, and she was already unconscious, which was even better. They shaved, cleaned, and prepped her skull, placing the drapes to cover all areas but the operative site. The anesthesiologist meanwhile had intubated her, and was busy connecting all the equipment needed to monitor her condition during the surgery. A mask was placed over her face, and a general anesthetic was administered. At that point, Dr. Martin took over, securing her head with three Mayfield head pins, in order to keep it perfectly still during the operation. The CT scans were on a monitor, showing him the exact location of the bleeding area, and he was ready to begin the incision.

“Mary, scalpel please,” he asked, looking over at his scrub nurse.

“Scalpel,” she repeated, placing the knife in his hand.

With that, Dr. Martin carefully made his incision and reflected the scalp back to expose the area of the skull under which the bleeding had been found. Carmella had a front-row seat as she hovered over the table, taking in all that was happening to her. She gasped as the doctor reached for his air drill to make an initial hole in the skull. I can’t believe I am watching someone drilling into my skull! she exclaimed to herself. Oh my god, it’s just like a carpenter drilling into a piece of wood!

Using an additional attachment, Dr. Martin cut through the skull and opened a flap of bone to reveal the brain beneath. Carmella gasped. I never even imagined what my brain would look like! she squealed, staring down at her exposed brain. I sure hope he knows what he’s doing! she added with a hint of hesitancy, even though she already “knew” that the operation would be a success. In some manner she had already perceived that it was not her time to “cross over” and that soon she would be returning to her body. She only hoped that she would remember her wonderful and amazing out-of-body experience once she dropped back to a lower frequency and re-entered her body. In the meantime, though, she watched as her doctor cut through the dura mater around her brain to reveal the bleeding area beneath it.

Calling for various instruments and tools, Dr. Martin gradually removed a fairly large (at least to her!) blood clot from her brain, and then cauterized a couple of lingering bleeders that were still oozing small amounts of blood. When he was satisfied that he had removed everything, he placed an intracranial pressure monitor, closed the dura, and approximated the skull, using a titanium plate to hold the bone together. He finally sutured the scalp back together in layers, checked with the anesthesiologist regarding her vital signs and level of anesthesia, then told him to go ahead and “bring her back up.”

Carmella knew that her experience in the “other world” would soon come to an end, as her body began to heal itself and it was time for her to return. In a way she wanted to go back, because after all she had seen, she felt there was so much she could do and say to the people there on Earth. In another sense, though, she felt totally at home here, and was overwhelmed with the total joy and love she experienced in that domain. She felt unrestricted in every sense, and totally free to express herself in whatever form she chose. There was no discord, strife, struggle, or any of the other sensations she commonly had felt in her earthly life. She had a sense of being totally supported, and a feeling of already having every possible thing that she could have ever wished for. It was just so harmonious and perfect. There was absolutely no feeling of judgment or disapproval of anything she had ever done, only an indescribable feeling of love and oneness with all of life. There was no separation from anything really. She still had a sense of herself, but at the same time, felt a part of everything and everyone, as if all were connected by this wonderful, loving, and accepting energy field that she struggled to articulate in her own mind. Carmella wondered if she would ever be able to communicate the richness and fullness of all she had experienced to any other person who could possibly understand. I certainly hope so, she thought as the nurse wheeled her into recovery. I certainly hope so!

*****

It was Monday morning at about 8:00 a.m. when Carmella realized that she was back in her body. The sun shining through the hospital window was reflecting into her eyes, causing her to squint and then open them for the first time since the accident. The room looked completely familiar to her because her “spiritual self” had been there for the past twenty-four hours, watching everything that was going on since she was transferred there from the neuro ICU. It felt very odd to be back in her old body again and back to her limited perceptual abilities. No longer could she be multiple places simultaneously. No longer could she feel what other people were feeling. The loving presence of the energy field that had surrounded her was still a vibrant memory, and if she tried hard enough, she still managed to feel its presence even now, although in a bit more limited fashion.

Several things about Carmella’s life would never be the same, however. She no longer had any fear of death or concern with the future. She also felt very comfortable letting that force of love—“God,” or whatever she would choose to call it—express itself through her. She realized that her “job” here on Earth was much easier than she had previously thought. She only had to let the energy flow through her and keep her own ego in check. All her previous notions of God were pretty much shattered, and she realized that they all were just human caricatures of a force far greater in magnitude. She no longer had any compunction to follow any particular creed or religion. Doubt and worry had melted away, leaving her with far more energy than she was accustomed to feeling. She felt more creative than ever before in her life, as if she had now tapped into a power that would allow her small earthly being to bear far greater fruit. Most of all, she felt connected, and no longer separate from anything or anyone. There was a love in her heart for all of creation, and a realization that everything flowed together into a magnificently orchestrated concert, irrespective of what limited human perceptions were sensing. In a strange way, she was glad to be back, as her life had taken on new meaning and significance. She had realized her own spiritual nature and true magnificence in a way that she never could have before. She wanted everyone to understand what life was like “on the other side” so that their own pilgrimages on this planet would be transformed as hers had been. As a nurse, she knew that her role would bring hope and healing into the lives of her patients. It was time to wake up!

Just as Carmella’s eyes were flickering open, Dr. Martin stopped by her room on his morning rounds. He was thrilled to notice her regaining consciousness and spoke quietly to her. “Welcome back, young lady. You had us pretty worried for the past several days! Do you know where you are or what happened to you?”

Carmella thought for a minute before she replied. She really didn’t want to let on that she had been watching the entire event for the past several days. “Ummm…well, the last thing I remember was looking down at my watch and then looking up to see that back end of an eighteen-wheeler right in my face!” she smiled. “I swerved to avoid hitting him square on, but I guess I hit him anyway.”

“Yes, you did a bang-up job on the right side of your head. We had to open your skull to relieve the pressure and evacuate the blood clots. Now you’ve got a nice titanium plate holding your skull together!”

“And thanks to you, I’ve come back to life again,” she grinned, reaching out to touch his hand. “I really appreciate all that you’ve done for me.” I think I’ll have a little fun with him, Carmella thought to herself, and added with a twinkle in her eye, “I’m really sorry about delaying your fishing trip—I know you had wanted to get out of the hospital as early as possible on Friday.”

“My fishing trip? How did you know about that?” Dr. Martin asked with a puzzled look on his face. Still trying to piece things together, he added, “You’ve been completely unconscious the entire time you’ve been here until now. I don’t see how you could have known about my trip!”

“You would be quite surprised at what I know,” she laughed, with that same mysterious twinkle in her eye. “I am very grateful, though. You saved my life! Hope you caught some nice fish too!”

Dr. Martin shook his head in disbelief. “Well, I’m certainly glad you’re back with us,” he conceded, as if he could think of nothing else to say. “I’ll have them send in some breakfast, and I’ll be back to check on you after my surgeries today.”

“Thank you, Doctor,” Carmella smiled. “You gonna use that fancy drill of yours today? That thing is somethin’ else! Why, it goes through a skull faster than a knife through warm butter!” This is fun, she thought, as Dr. Martin’s jaw dropped about a foot.

“Now I KNOW you couldn’t have known about that,” he replied, still not able to find any rational explanation for Carmella’s observations.

“Maybe you do an’ maybe you don’t!” Carmella countered with that same mischievous grin. “You have a nice day now, Doctor, an’ please don’t forget my breakfast. I’m starvin’!”

That accident must have done something totally weird to her brain, Dr. Martin mumbled to himself as he stepped out of Carmella’s room, still shaking his head. My drill? How the hell could she have known about that? Not only was she unconscious from the accident, but she was under general anesthesia as well!

“Go figure that one out!” he said, audibly this time, to the nurse at the desk, who gave him a puzzled look. “Ms. Brown is awake and hungry,” he added quickly, not realizing he was thinking out loud. “Run some breakfast for her, will you? Thanks. I’ll be in surgery all day, but let me know if anything unusual develops with my patient,” he shouted over his shoulder as he stepped into the elevator. As the door shut, he thought, Anything MORE unusual, that is! How could she have known about my drill?...