Proof of Heaven

When bacteria attack, the body goes immediately into defense mode, sending shock troops of white blood cells from their barracks in the spleen and bone marrow to fight off the invaders. They’re the first casualties in the massive cellular war that happens whenever a foreign biological agent invades the body, and Dr. Potter knew that any lack of clarity in my cerebrospinal fluid would be caused by my white blood cells.

Dr. Potter bent over and focused on the manometer, the transparent vertical tube into which the cerebrospinal fluid would emerge. Laura’s first surprise was that the fluid didn’t drip but gushed out—due to dangerously high pressure.

Her second surprise was the fluid’s appearance. The slightest opacity would tell her I was in deep trouble. What shot out into the manometer was viscous and white, with a subtle tinge of green.

My spinal fluid was full of pus.

3. Out of Nowhere

Dr. Potter paged Dr. Robert Brennan, one of her associates at Lynchburg General and a specialist in infectious disease. While they waited for more test results to come from the adjacent labs, they considered all of the diagnostic possibilities and therapeutic options.

Minute by minute, as the test results came back, I continued to groan and squirm beneath the straps on my gurney. An ever more baffling picture was emerging. The Gram’s stain (a chemical test, named after a Danish physician who invented the method, that allows doctors to classify an invading bacteria as either gram-negative or gram-positive) came back indicating gram-negative rods—which was highly unusual.

Meanwhile a computerized tomography (CT) scan of my head showed that the meningeal lining of my brain was dangerously swollen and inflamed. A breathing tube was put into my trachea, allowing a ventilator to take over the job of breathing for me—twelve breaths a minute, exactly—and a battery of monitors was set up around my bed to record every movement within my body and my now all-but-destroyed brain.

Of the very few adults who contract spontaneous E. coli bacterial meningitis (that is, without brain surgery or penetrating head trauma) each year, most do so because of some tangible cause, such as a deficiency in their immune system (often caused by HIV or AIDS). But I had no such factor that would have made me susceptible to the disease. Other bacteria might cause meningitis by invading from the adjacent nasal sinuses or middle ear, but not E. coli. The cerebrospinal space is too well sealed off from the rest of the body for that to happen. Unless the spine or skull is punctured (by a contaminated deep brain stimulator or a shunt installed by a neurosurgeon, for example), bacteria like E. coli that usually reside in the gut simply have no access to that area. I had installed hundreds of shunts and stimulators in the brains of patients myself, and had I been able to discuss the matter, I would have agreed with my stumped doctors that, to put it simply, I had a disease that was virtually impossible for me to have.

Still unable to completely accept the evidence being presented from the test results, the two doctors placed calls to experts in infectious disease at major academic medical centers. Everyone agreed that the results pointed to only one possible diagnosis.

But contracting a case of severe E. coli bacterial meningitis out of thin air was not the only strange medical feat I performed that first day in the hospital. In the final moments before leaving the emergency room, and after two straight hours of guttural animal wails and groaning, I became quiet. Then, out of nowhere, I shouted three words. They were crystal clear, and heard by all the doctors and nurses present, as well as by Holley, who stood a few paces away, just on the other side of the curtain.

“God, help me!”

Everyone rushed over to the stretcher. By the time they got to me, I was completely unresponsive.

I have no memory of my time in the ER, including those three words I shouted out. But they were the last I would speak for the next seven days.

4. Eben IV

Once in Major Bay 1, I continued to decline. The cerebrospinal fluid (CSF) glucose level of a normal healthy person is around 80 milligrams per deciliter. An extremely sick person in imminent danger of dying from bacterial meningitis can have a level as low as 20 mg/dl.

I had a CSF glucose level of 1. My Glasgow Coma Scale was eight out of fifteen, indicative of a severe brain illness, and declined further over the next few days. My APACHE II score (Acute Physiology and Chronic Health Evaluation) in the ER was 18 out of a possible 71, indicating that the chances of my dying during that hospitalization were about 30 percent. More specifically, given my diagnosis of acute gram-negative bacterial meningitis and rapid neurological decline at the outset, I’d had, at best, only about a 10 percent chance of surviving my illness when I was admitted to the ER. If the antibiotics didn’t kick in, the risk of mortality would rise steadily over the next few days—till it hit a nonnegotiable 100 percent.

The doctors loaded my body with three powerful intravenous antibiotics before sending me up to my new home: a large private room, number 10, in the Medical Intensive Care Unit, one floor above the ER.

I’d been in these ICUs many times as a surgeon. They are where the absolute sickest patients, people just inches from death, are placed, so that several medical personnel can work on them simultaneously. A team like that, fighting in complete coordination to keep a patient alive when all the odds are against them, is an awesome sight. I had felt both enormous pride and brutal disappointment in those rooms, depending on whether the patient we were struggling to save either made it or slipped from our fingers.

Dr. Brennan and the rest of the doctors stayed as upbeat with Holley as they could, given the circumstances. This didn’t allow for their being at all upbeat. The truth was that I was at significant risk of dying, very soon. Even if I didn’t die, the bacteria attacking my brain had probably already devoured enough of my cortex to compromise any higher-brain activity. The longer I stayed in coma, the more likely it became that I would spend the rest of my life in a chronic vegetative state.

Fortunately, not only the staff of Lynchburg General but other people, too, were already gathering to help. Michael Sullivan, our neighbor and the rector in our Episcopal church, arrived at the ER about an hour after Holley. Just as Holley had run out the door to follow the ambulance, her cell phone had buzzed. It was her longtime friend Sylvia White. Sylvia always had an uncanny way of reaching out precisely when important things were happening. Holley was convinced she was psychic. (I had opted for the safer and more sensible explanation that she was just a very good guesser.) Holley briefed Sylvia on what was happening, and between them they made calls to my immediate family: my younger sister, Betsy, who lived nearby, my sister Phyllis, at forty-eight the youngest of us, who was living in Boston, and Jean, the oldest.

That Monday morning Jean was driving south through Virginia from her home in Delaware. Fortuitously, she was on her way to help our mother, who lived in Winston-Salem. Jean’s cell phone rang. It was her husband, David.

“Have you gone through Richmond yet?” he asked.

“No,” Jean said. “I’m just north of it on I-95.”

“Get onto route 60 West, then route 24 down to Lynchburg. Holley just called. Eben’s in the emergency room there. He had a seizure this morning and isn’t responding.”

“Oh, my God! Do they have any idea why?”

“They’re not sure, but it might be meningitis.”

Jean made the turn just in time and followed the undulating two-lane blacktop of 60 West through low, scudding clouds, toward Route 24 and Lynchburg.

It was Phyllis who, at three o’clock that first afternoon of the emergency, called Eben IV at his apartment at the University of Delaware. Eben was outside on his porch doing some science homework (my own dad had been a neurosurgeon, and Eben was interested in that career now as well) when his phone rang. Phyllis gave him a quick rundown of the situation and told him not to worry—that the doctors had everything under control.

“Do they have any idea what it might be?” Eben asked.