Here is Chapter 31 of Dreaming Out Loud, the book about my mother’s stroke.

Chapter 31

Three days after we return from the Christmas holidays, Paula, Shelby, and I see a Will Smith movie at the Carmike Cinemas in Snellville. Since Shelby has entered adolescence, she seldom spends time with us if she can avoid it — apart from our holiday trip to Washington, D.C., of course. This is a nice, unexpected treat; no one is arguing, threatening, cajoling, excusing, or lying.

It is a time of relative tranquility before the start of what may be a difficult year. Shelby increasingly is getting into trouble at school, and our family is facing hard choices about her future. At first, Paula and I thought the problem involved the normal, spirited hijinks of a child growing up in a permissive age. She smuggled a water bottle filled with Vodka into school and got caught. It was a stupid move, but hardly the crime of the century. We thought severe punishment was in order, but it was the sort of stupidity we, too, demonstrated at a young age.

I once found a switchblade knife on the grounds of the Williams Junior High School baseball field as I was walking from the bus stop. Because I was 13 years old and did not have good sense, instead of immediately transporting the weapon to the principal’s office, I took it into the boy’s bathroom to show off for my friends. Unfortunately for me, the assistant principal, Mr. Shaw, entered the bathroom just as I displayed the knife’s propensity to flick open with a flip of the wrist.

Shaking his head in disappointment, he held out his hand. “Give me that knife, Mike.” He told me he saw me coming into the bathroom and followed me in to congratulate me for winning the “Spirit of Democracy” speech contest at the VFW the preceding evening. He also told me he was ashamed of my lack of maturity.

Mr. Shaw marched from the bathroom in a huff, and that was the end of the matter. He did not congratulate me during the morning announcements that students read over the intercom at the start of each day, but that was my only punishment. I did not have to sit through detention. It did not get recorded on my permanent record. Despite the lack of institutional punishment, I burned with shame at the thought of the incident. Years later, when I was an adult, I bumped into Mr. Shaw at a convenience store, and I could not bear to look him in the eye as we reminisced about my junior high school experiences. He did not mention my greatest infraction of the rules. In fact, no one, least of all me, ever mentioned the incident again until many years later when, the statute of limitations having expired, I trotted out the anecdote for friends and family.

I lived in a more innocent age. In Shelby’s time, the era of gang-bangers and school shootings, possessing a knife on school property is grounds for immediate expulsion and arrest. Lawyers and judges are involved in such episodes. Counselors are not far behind. Puzzled editorials in the newspapers frame the question: “Where Have Our Youth Gone Wrong?”

I wish I knew.

Fortunately, Shelby has not done anything to merit expulsion or arrest, but we want to keep it that way. Lately, though, her misbehavior has escalated. It mostly involves what the school principal calls “inappropriate behavior.” I will let it go at that. We have engaged a psychologist, but we fear it is too little, too late.

On this pleasant evening, we do not discuss what awaits us after school resumes. We will have occasion to discuss these matters, generally at high volume, but on this night we are relaxed and more or less amicable.

After we return from the movie, Shelby goes up to her room in a self-imposed exile. Paula and I are changing into our night clothes when the telephone rings.

“Who could that be?” I look at the clock on the nightstand. It reads 11:33. I am always apprehensive when someone calls this late in the evening; it is never a good sign. Good news arrives in the daylight; bad news creeps in during the dead of night. It is on a 24-hour cycle, but bad news prefers the darkness.

I pick up the phone and a familiar voice speaks without prelude. “I can tell you the secrets of the children.”

“Hi, mom. Is everything okay?”

“Yes, is everything okay. I mean, no.”

“No? Everything is not okay?”

“No. Everything is not okay. No.”

Thinking of Hortense, I gasp. “Is it Mister Buster? Is he okay?”

“Mister Buster, no. I mean yes, Mister Buster is okay. But no.”

“Do you want me to come down there?”

She sounds excited and relieved at the same time. “Yes. Yes. Yes.”

“Okay. I’ll be right there.” I slam the receiver down on the cradle.

Still brushing her teeth, Paula meanders out of the bathroom. Her mouth is full, so she lifts her eyebrows. The look says, what was that all about?

“That was mom. She wants me to come downstairs.”

Paula glances at the clock before stepping into the bathroom to spit over the sink. “This late? She’s usually asleep by now. What’s wrong?”

“I dunno. Guess I’ll find out.”

Paula rinses her mouth with water and spits again. “I’m coming with you.”

We trundle down the interior stairs leading from our foyer to the basement. It is cold and dark outside, and we are not dressed for outdoor weather. Daisy obediently trails behind in case we partake of food and decide to share.

Mom is propped up in bed with four or five massive pillows stuffed behind her back. The television, as usual, is turned on, although the sound is muted. Mister Buster lies on the bed. He looks up at us sleepily from his perch next to mom’s thigh.

Paula is first through the door. “Hey, Laura. What’s wrong?”

Still holding the portable telephone in her hand, mom uses it as a pointer, sweeping it around the room.

Paula and I exchange glances.

“Did you hear a strange noise, mom? Is that the problem? There’s not another strange dog in here, is there?”

She shakes her head and makes a clicking sound with her tongue. It is the sound of disappointment at my failure to grasp her meaning.

Paula sits on the edge of the bed. “Do you feel bad?”

Mom nods. Yes, she feels bad.

Paula shinnies a little closer, placing her palm on mom’s forehead. “Do you feel sick? Maybe you have a fever.”

“No. No fever.”

Paula looks back at me and confirms mom’s diagnosis. “She doesn’t feel hot.”

I frown. “But you feel bad, right?”

“Yes.”

“Are you nauseated — sick to your stomach?”

She nods and coughs. “Yes. You feel bad, right. Yes. Nauseated, no. Nauseated, no.”

Something in her convoluted answer catches Paula’s attention. The huffing and puffing are more pronounced than they were even a few days earlier. Mom has been exhausted since we returned from Polly and Loren’s house, but the gasping for air is a new symptom.

“Are you short of breath, Laura?”

Mom’s eyes light up. “Yes. Are you short of breath, Laura? Yes, that’s it. You are short of breath.”

Paula is on her feet in an instant. “I’m going to throw on some jeans and get Shelby. We’re going to the ER — Walton Regional this time, not Eastside. Mike, get her robe on, okay?”

“Okay.”

Paula points. “Listen to me, now, Laura. We need to get to the hospital in a hurry. If you can’t breathe, it’s serious. Don’t get dressed. Just put your robe on. Mike will help you.”

For once, mom does not argue. She nods her head. It must be serious if she is not arguing. For the first time tonight, I am scared.

“We need to leave in 10 minutes or less.” Paula turns on her heels and marches back toward the stairs.

I catch her by the arm in the basement after we have walked out of mom’s apartment. Although we are not standing within earshot, I lower my voice so we can’t possibly be overheard. “What’s wrong?”

“She’s seriously short of breath, Mike. Did you hear her cough? It was wet and raspy-sounding. I think she has pneumonia.”

“Pneumonia?”

“Yeah. It’s very serious for someone in Laura’s condition. We need to get her to the ER now.”

“But why not Eastside? You told me Walton Regional is not very good. And why not call an ambulance?”

“Walton Regional is closer. Besides, they couldn’t be any worse than Eastside. Remember how long we sat in chairs when she had the stroke? We can’t wait for hours if she’s having trouble breathing.”

“Yeah, okay.”

“And if we can get on the road in 10 minutes or less, we can make it there before an ambulance could get here.”

“All right.”

I release her arm and Paula takes the stairs two at a time.

Turning, I step back into the basement bedroom. “Okay, mom, let’s get your robe on now.”

Eight minutes later, everyone has thrown on some sort of clothing. I pilot my Taurus onto the road in front of our house. I drive while mom sits next to me. Paula and Shelby sit in the back seat. I am reminded of the first night of our California trip and our concerns as we returned from the Top o’ the Cove restaurant in La Jolla.

“Hey mom: Do you remember this song? ‘California here I come’?”

She looks at me through weary eyes. In a breathless voice, barely above a whisper, she speaks. “Right back where I started from.”

Paula leans up from the back seat. “Mike. Don’t.”

Mom is not breathless, but I see her struggling for air. When she coughs, I hear a raspy sound as well as phlegm stuck in her throat and esophagus. I want to soothe her fears, but singing a song clearly is a poor vehicle to accomplish the goal.

We ride in silence. Everyone except Shelby appears sleepy or depressed.

After a few minutes, I guide the car into the parking lot of the Walton Regional Medical Center and follow the signs to the emergency room entrance. When I have shifted into park and popped the trunk, I hop from my seat to negotiate the wheelchair while Paula and Shelby assist mom in standing up. It is a more difficult task than usual. Mom’s shortness of breath requires them to pull her onto her feet with little assistance from her.

I spot the maneuver as I jog around the trunk with the wheelchair. “Watch your back, Paula.”

“My back’s fine.”

Shelby guides the wheelchair beneath mom’s fanny. “Be careful, Nana. Don’t fall.”

I stop for a moment and stare at this teenage girl, my stepdaughter. Sometimes I grow so angry with her actions, her complete lack of regard for consequences, her thoughtlessness toward friends and family, I have to fight an almost irresistible impulse to slap her face as hard as I can. Yet there are times — and this is one of those times — when she drops the façade of a sullen, brooding, petulant quasi-tyrant and behaves decently. On these occasions, I feel love well up in me as though my throat were filled with water. Maybe I am just getting old and prone to emotional excess, but I am almost grateful for her kindness to my ailing mother.

Shelby knows the score. Nana is not in good shape. In Shelby’s presence, we have never discussed mom’s newly developed brittleness, her frequent exhaustion, her slurred language, or her inexplicably thinning hair, but even a self-absorbed adolescent would have to be blind and stupid not to see telltale signs that mom’s health is deteriorating rapidly.

Automatic doors part as we approach the emergency room. Paula marches toward the registration desk with Shelby at her heels. I push mom and the wheelchair behind them.

The lobby is not deserted, but it is a far cry from the mass of humanity that greeted us at the Emory Eastside Medical Center when the stroke first occurred. Chalk it up to the difference between a small rural clinic and a large suburban hospital.

As I push the wheelchair to the front desk, I see that Paula’s lips are tightly pressed together. Her face is chiseled in granite. I can tell from her steely expression she is no mood to brook dissent. We must be treated with respect and prompt service or there will be hell to pay.

An elderly white lady looks up from the desk. “Hi. Can I help you?”

Quickly, in short, efficient sentences rich in expressive nouns and action verbs but hardly deficient in adverbs and adjectives, Paula outlines our situation. She insists that mom be moved into an examination room and fitted with oxygen. I am astonished at how rapidly the health care professionals snap to it. Paula is impressively authoritative, which no doubt contributes to their alacrity, but they also seem appropriately alarmed at the prospect of an elderly stroke patient expiring in the waiting room because she was not afforded proper medical care.

We follow the intake nurse down a long, narrow hallway that eventually twists and turns into a maze. She pushes a button and a large metal door swings open. Inside, another nurse directs us to an examination area. It cannot legitimately be called a “room.” It is an examination nook. I back mom’s wheelchair into the nook as yet another nurse appears with tubing that she snaps onto a wall apparatus. She fiddles with several knobs before lowering the tubing over mom’s head and sliding two valves into her nostrils.

Mom appears stunned by this sudden movement. “This one smells of butter.”

Not having been clued into mom’s condition, the nurse installing the oxygen tubing frowns. “It smells like butter? But it’s been sterilized.”

Paula, Shelby, and I laugh together. It is a strong, infectious, riotous laugh. It bubbles out of us like crude oil gushing through a pipeline.

The nurse gazes at us as if the entire family is insane. "Did I miss the joke?"

In response to the woman’s alarmed expression, Paula provides a short, “greatest hit” version of mom’s story. As she speaks, the nurse nods. When she is satisfied the tale has ended and the oxygen is working, she beats a hasty retreat, pulling a curtain behind her as she exits.

It is a weird curtain. It hangs from the ceiling and provides privacy from the thighs up. I suppose someone reclining in the hospital bed can remain hidden from sight, but otherwise the curtain transforms the surroundings into a world of pants legs and shoes scurrying every which way.

Paula is still laughing. “You blew her mind, Laura.”

Mom smiles, not quite getting the joke but understanding that joviality is an appropriate response. “You blew her mind, Laura, yes.”

The intake nurse appears at our nook. I mark the arrival of her white shoes before she yanks the curtain open. Looking at Paula and me, she clears her throat. “I need someone to come with me and provide a medical history on the patient.”

I stand and turn to Paula. “I’ll go. I’ve gotten to be an expert at it. I even know mom’s Social Security number by heart.”

The nurse leads the way back through the hospital maze, and I half-walk, half skip to keep up. We enter a cramped office just off the main lobby. She slides into a tiny chair in front of a computer screen while I sit in a metal chair on the other side of a metal desk. The room is so small the sparse furnishings consist only of the desk, chairs, a lamp, and a small file cabinet behind the nurse.

I have brought mom’s driver’s license and insurance cards — these are the prerequisites of any hospital admission, as I have learned through bitter experience — but this time I also have brought a list of her medications and a written chronological narrative of her ailments. Even as the nurse launches into her prefabricated series of questions, I remove several sheets of paper from my back pocket and slide the homemade documentation across the desk.

She looks down at the documents and then up at me. Her face displays a strange expression; I cannot tell if it is uneasiness at my eerie efficiency or admiration at my prescient thoroughness. I do not explain that dealing with mom’s health requires a certain measure of preparedness that is generally absent from the average family’s repertoire.

After the forms are filled out and copies are made of the cards and the list of medications, the nurse leads me back to mom’s examination nook. The patient has been stripped of her clothes and outfitted in a standard hospital dressing gown. The technicians have hoisted her into a hospital bed. She has an IV drip in the vein jutting out from her left hand as well as a plastic ID bracelet on her arm.

I point to the bracelet. “That’s in case you wander off in the middle of the night, mom. Anyone who finds you will know your name is Laura Mellette Martinez and you’re the property of the Walton Regional Medical Center.”

Mom looks at me with her face squinched up as if to say, where the hell did you come up with that dumb idea, Buster? She cuts her eyes at Paula. Can you believe some of the things that come out of this guy’s mouth? What do you see in him, anyway?

Paula laughs. “I know. I know.”

The Walton Regional Medical Center checks us into the system with remarkable punctuality, but afterward we are parked in the examination nook. Time slows to a crawl. As is her wont, Paula pops out of her seat upon occasion and wanders down to the nurse’s station to find out what the hell is taking so long. Otherwise, it is a waiting game.

Mom, now breathing easier thanks to the oxygen, drifts into a semi-daze. Shelby meanders out to the lobby to buy snacks and watch television. I try to read some magazines, but I am too tired to concentrate. At the same time, I am too keyed up to sleep, assuming I could sleep in the grossly uncomfortable hospital chairs, which is impossible.

Aside from her occasional outbursts of anger at the lengthy delay, Paula is quiet, pensive. She seems almost serene when I look at her face.

After about two hours, a technician arrives to wheel mom’s bed down the hall for tests to be administered. He unhooks her oxygen tube from the wall and connects it to a portable tank attached to wheels. Off they go.

Paula calls after her. “Don’t worry, Laura. We’ll be here when you get back.”

I chime in: “If any food arrives, we promise not to eat it!”

As soon as mom is gone, Paula whips her head around and faces me. “Are you okay?”

The question startles me. I consult my watch. It is 2:28 a.m. I am as all right as I can be in the wee hours of the morning while I wait to figure out what is wrong with my ailing, stroke-addled mother.

She sees the battles going on behind my eyes. “Let’s hope for the best, but prepare for the worst.”

Echoing a phrase mom sometimes utters, I nod. “What are you saying to me?”

“I’m just saying….” Her voice trails off. She sweeps her hand in a gesture that says, oh, never mind.

Perplexed by this comment, I let it drop. It goes without saying we should hope for the best but, given the fragile state of mom’s health, prepare for the worst. We have been preparing for the worst since December 29, 2003, when mom suffered the stroke.

The worst is far worse than we could have imagined.

She definitely has pneumonia; that much we guessed. Even I, not the most astute of folk medicine diagnosticians and hardly a discriminating aficionado of WebMD, knew this was the likely diagnosis. What none of us prepared for was the x-ray of mom’s chest.

An on-call physician whose name I do not remember limps into the examination nook, yanks the quasi-curtain closed to afford us a smidgen of privacy, and snaps the x-ray film over a white area on the wall. Mom has returned from her trip to the x-ray room. She is napping when the doctor lurches into the room, but her eyes flutter open when she sees he is carrying something in his hand. Even Shelby has returned from the lobby, apparently bored with the limited fare on non-cable TV at two in the morning. This means the good doctor has our undivided attention.

He points to Shelby. “How old is she?”

Paula speaks up. “Old enough to be here.”

What is the point of shielding Shelby from life’s vicissitudes? Given her increasingly risky behavior, perhaps it is time she learned the dirty little secret of life: Shit happens. It can happen to people you love, and it can happen to you.

This doctor looks older than God. They must have dredged this geezer out of a retirement home to help out on the graveyard shift. His own slow pace of walking rivals my mom’s. If the two of them competed in a foot race down the long, narrow hallway of the medical center, I would be at a loss to say who would take the prize.

“As you know, we found evidence of pneumonia. That we can treat quite effectively. But this was unexpected.”

He leans forward and hovers over the x-ray, apparently searching for a light switch. For a moment, he teeters, and I fear he will topple. After a few seconds, though, he finds what he is looking for and depresses the button. The light blinks on, and even the most uneducated novice can see a dark shape on the x-ray.

Mom’s voice is hoarse, barely a whisper. “This one is this one.” I take it to mean, what the hell is that?

Paula gasps and involuntarily slaps her hand over her mouth.

Shelby is crying.

Obviously, I cannot see my own reaction, but I imagine my face must appear shocked. I believe my mouth has dropped open. A thought, unbidden and uncensored, shoots through my mind before I can stop it: She’s dead.

This octogenarian is old school. He does not believe in sugar-coating the truth. “Folks, that’s a ten centimeter mass. We’ll have to run some more tests to figure out what it is, exactly, but I have my suspicions.”

Paula whispers what we all have been thinking. “Lung cancer.”

Everyone falls silent as we contemplate what this new information means.

Finally, after half a minute, mom speaks. She always has the last word. “Well, for Pete’s sake!”