TIME-TO-SEE-31
Hugo was to arrive at the University Hospital no later than six a.m., which was not a stress on our usual schedule. We were moving by that hour most mornings.
Hugo went to bed right after we returned from mass the night before, and then, that morning, he took his shower and bathed his head, neck and shoulders with some special antibacterial solution the hospital gave him; it was the same betadyne that the hospital used on the boys.
All of us, the boys and me and Hugo, arrived at University Hospital about ten minutes to six.
A hospital staff employee spoke to us, "We have prepared an Observation room where you can watch Mr. Ramirez undergo preparations for his operation."
The boys both threw their arms around Hugo at the same time and squeezed him for dear life. I joined the huddle putting my arms around his shoulders, looking directly into his eyes and showed him my lips as I spoke to him, "I love you, Hugo. I won't leave you, and neither will the boys."
Hugo hugged us all back fiercely. I could tell that he was frightened, but we repeatedly assured him, "We are not going to leave you alone in this place, Hugo," I mouthed the words slowly for him to read on my lips.
The boys and I were politely ushered into an Observation room that was separated from the Prep room by a huge plate glass window-- actually a one-way mirror. We could see in, but Hugo couldn't see out.
They fitted Hugo with one of those stylish hospital gowns, the ones with no backs, but I enjoyed looking at his butt anyhow; so I certainly wasn't offended.
Well, okay, the boys got to see life in the raw; but that trivial butt-sight shouldn't cause a psychological trauma for them, it seemed to me, at least no more than the Janet Jackson Wardrobe Malfunction did.
However, I was saddened, because next the team sheered off the wavy, black hair from Hugo's head. That beautiful, wavy, black hair had assumed a special meaning-- it wasn't merely hair-- it said that here was a kind and loving man who changed his life and committed himself to his mate and to his children.
Just as losing the shaved head marked a turning point in Hugo's life; so too his losing the Black Warrior Cross on his neck publishes his willingness to surrender his anger and attack on God and express his gratitude for the blessings he realized were his, and that we all enjoyed together.
The team continued to gather Hugo's vital signs and draw last minute blood samples. They allowed him to sit for most of their work, but finally he had to lie down on a gurney
Then at a few minutes before 7 o'clock, Dr. Kavanaugh joined the boys and me in the Observation Room.
"Good Morning, Mr. Kramer, Jilder, Nicky, how nice that you could be here while your dad undergoes his operation."
"Good Morning," the boys replied in unison.
"Good Morning, Dr. Kavanaugh. We are so grateful for your being here as well," I said.
Dr. Kavanaugh continued to speak: "Hugo's frame of mind is most important. He has to ALLOW the transplantation process to unfold, and your being here is absolutely the best possible boost that he could receive, to assure that his mood is bright and hopeful and his body is receptive.
I responded, "We love Hugo . He's part of our family, and we're here praying that he'll gain the ability to hear when your work is done."
"Well," Dr. Kavanaugh replied, "We all value Hugo a great deal, and I want to assure you and the boys, personally, that I and my team will do everything humanly possible-- and I do mean EVERYTHING-- to reactivate Hugo's natural ability to hear, just as you or I hear."
"Thank You, Doctor," I said.
The boys sat attentive to our conversation and alert to everything that affected Hugo in the next room.
Through the window a physician signaled Dr. Kavanaugh that he could begin.
"You must excuse me. We're ready to proceed," Dr. Kavanaugh said. And he turned to leave us.
The boys went over to the large window and kept Hugo under their surveillance. A nurse gave Hugo two little white pills and a cup of water.
Both boys looked at each other. They understood first hand what would happen to Hugo in just seconds. And, only they could understand so completely. The boys said, "Sleep good, Dad! We love you."
Of course they knew Hugo wouldn't hear them, but they never failed to express their love, and they continued to express their love for him until Hugo DID recognize their message, either by writing or by touch:
Because: "Love unexpressed is not love at all."
And Hugo was rolled out of the Prep Room on his way to the operating theater.
The boys and I were accompanied by a hospital staff person up to the operating theater, where student doctors and other medical personnel were assembled to watch this history making procedure.
It was almost standing room only, but 3 seats right in the very front row of the theater gallery had been reserved for the boys and me. We took our seats and plugged in the earphones in order to follow the procedure.
They wheeled Hugo in on the gurney. He was unconscious and receiving the anesthesia drip which was moved carefully as his body was shifted onto the operating room table. A tent-like structure was erected around Hugo's head; then he was shifted to his right side as the operating team began their work on his left ear.
A narrator in the ear phones began: "Initial incision will lay open the cochlear structure of the inner ear, from which stem cells will be harvested. Those cells are most compatible with the hair cells that populate the entire region, through which the main aural nerve functions. These particular stem cells thus increase the potential for the transplant cells thriving and functioning fully in the implantation environment."
"Cochlear stem cells will be carried to the laboratory immediately upon harvest from the patient; there they will be treated with nerve growth stimulating enzymes. While in the laboratory, the cells will be threaded into a microscopic growth matrix or structure, tubular in shape, which will eventually dissolve and be absorbed by the patient's body, as the cells incubate and mature over the next 10 to 14 days."
The boys were fixated on the drama unfolding before them in the operating theater. They were both in awe intellectually and profoundly emotionally involved as well. I'm sure that they didn't understand a great deal of the technical explanations to which they were exposed, as I certainly did not understand as well. But they, as I, were attentive to every detail.
The narration went on, "Actual Stem cell harvesting will be accomplished at this time, as the cochlear structure of the right inner ear has been laid opened surgically. Please note how the patient was repositioned for accessibility to both left and right sites of operation. Both surgical sites are active during the entire procedure, and great care is being undertaken to avoid any contamination or damage to one site while the other is being accessed."
"By the time harvesting is completed on the second site, stem cells derived from the first, or left hand site, will have been processed in the laboratory and be ready for implantation."
"Now, the patient has been repositioned yet another time, and implantation at the first site is proceeding. Stem cells just harvested from the second site are undergoing transport to the laboratory for processing, as the first cells did."
"Note. The intricate timing of all activity is aimed at depriving the live stem cells of their natural environment and nurturing by the patient's own body and blood for an absolute minimum of time. There will be perhaps fewer than fifteen minutes of artificial support for harvested cells."
"Our experience indicates that integration of the dendrites from the maturing stem cells will normally make their contact with and attempt to function with the host CNS somewhere after the 10th day of development but before the 14th, post-operative."
We watched as Hugo was effortlessly shifted from side to side, as cells were removed from the second site, and then the first removed and processed cells were returned to the left aural nerve pathway, to splice that broken nerve. Finally he was repositioned yet again to permit implantation at the right, or second site.
Nicky turned to me and whispered, "Dad, the new cells in Hugo's ears will be trying to hear between the 10th and the 14th days after his operation. That's not very long, is it?"
I responded, "You are so right, Nicky. I had in my mind that those cells would take a month to start working."
Jilder heard us talking quietly and he said, "But he'll be in the quiet room for a month, he told me."
"That's right," I said. "I suppose they don't want to disturb anything until they establish that the stem cells are really working and his head is healed."
Nicky said, "Dad! I can hardly wait for the days to pass."
I replied to Nick, "Come on, Nicky. We're not even out of the operating theater. We don't know whether the doctors think that the implant went well, or whether there were any difficulties. We have so many hurtles to clear before we can relax and be sure the operation is a success."
"Oh, I'm hoping God is working with those people down there operating on Hugo," Jilder said.
"Oh, He is, I'm sure," Nicky responded to Jilder.
A murmur of conversation began in the Operating Theater Observation Gallery. That conversation signaled that the implantation had been completed and that the physicians were closing the incisions.
Dr. Kavanaugh left the operating table and some other physicians worked on Hugo. Really, we couldn't see Hugo's face because everything was covered, but we knew our brother, our lover, our dad was down there; and we weren't leaving our seats until they rolled Hugo out of there.
Eventually Hugo was visible, both sides of his face and both of his ears were covered in large white bandages. He looked like he was prepared for a winter snow storm, with big white, fluffy earmuffs.
People covered in masks and gowns rolled Hugo out of the operating theater. We were met by a staff nurse who asked, "Would you consider having lunch right now? Hugo will be in the Recovery Room until he awakens."
"NO!" came emphatically from both boys.
"We want to go to the Recovery Room; so Hugo will see us the minute he comes out of the anesthesia. We promised we would not leave him alone!"
So, there was nothing for our staff guide to do except escort us to the clean room through which all persons entering the recovery area must process.
Visitors like us could not go into the Recovery Room until they were dressed in gowns to cover street clothes and masks to prevent contamination and infection; we had to wash our hands and wear gloves too.
We would be sworn to absolute silence, even if we were able to touch Hugo's hand or arm. The critical period commenced with Hugo's removal from the operating theater.
If past experience served us, the boys and I knew that Hugo would pop out of anesthesia unexpectedly. One moment he'd be asleep. The next he would be conscious.
Jilder took up waiting on the left side of Hugo's bed, and Nicky took his position on the right side. They were sitting so that when his eyes opened, the first thing he would see was them. And I pulled up a chair near the foot of his bed. Again, the damned thing was too low for the patient to see, just as it was in the hospital with Jilder and Nicky, but I sat on the arm of the chair, which allowed me to look upon Hugo's closed eyes.
We had been there perhaps twenty minutes when Hugo's eyes fluttered open and he attempted to focus. The boys were holding his hands, avoiding the digital lines that gathered vital signs and relayed them to recording and display equipment.
The boys had been briefed that they were not to say a word to Hugo. They could squeeze his hand and show him signs they'd written, but NO sounds!
Nicky held up the sign that he had prepared that said, "Dad. I'm here just like I promised."
And Jilder squeezed Hugo's hand and held up his sign, "I didn't leave you, Hugo. Do you feel like you wanna puke?" With an un-happy face showing stuff flying out of its mouth...
Hugo's eyes closed, and the boys looked at one another with panicked expressions.
I gestured for the boys to follow me.
Once outside of the recovery room I said:
"Hugo's alright, boys," then I spoke softly. "The anesthesia left him in a process of becoming conscious that will take a couple of minutes. You remember that happening to you... He's dipping in and out of his sleep state. He's okay. He knows that you are here, and he'll see you each time he wakes back up, until one time he'll be totally awake, and he'll want to stay awake.
We went back to Hugo's bed. Sure enough, moments later Hugo opened his eyes again. He didn't move his head, only his eyes. He looked at Nicky's sign and squeezed Nicky's hand.
Nicky was so delighted I thought he was going to yell out loud, but, you know, he kept his cool and stayed completely silent. He leaned over and kissed Hugo lightly on the forehead.
Then Hugo saw Jilder's sign, a broad smile broke out across Hugo's face. (Only Jilder would press on to the nitty-gritty details so fast.)
Hugo didn't move or become agitated. He squeezed Jilder's hand too, and Jilder kissed Hugo's hand and put his cheek where he kissed it.
I was watching the two boys and feeling so happy that they were each bringing their own individual messages of love to Hugo. When he looked out further into the room beyond the boys, he noticed me.
I could see his eyes soften and moisture began to flow from the corners. I got up and went to his bedside and put my hand lightly on his chest. I leaned over and gave him a gentle kiss on the lips, with the face mask separating us like a condom.
I didn't want him to cry, because I didn't want him to disturb his new hearing cells. Quickly I wrote on the back of Jilder's sign. "I love you, but please don't cry and drown your new hearing cells."
He read what I'd written and smiled amid a steady flow of tears from both eyes. I dabbled the tears as they ran down his cheeks.
At that moment the nurse walked up to Hugo's bed. She didn't say a word. She smiled and offered him a small cup of water with a short, bent straw hanging from one side of it.
Hugo moved his lips, opened his mouth, and took two or three sips.
The boys again looked at one another and nodded agreement via the affirmative. They must have recalled coming out from under anesthesia and feeling thirsty. Of course, this time, Hugo wasn't feeling nauseas at all... no dry heaves... just peaceful, if emotional, return to our world, to the place in the universe where we could be with him.
In a moment, a committee of 4 doctors approached Hugo's bed and went right to his side. The boys and I stepped away as the physicians stood around Hugo's bed.
Dr. Kavanaugh held up a rather big sign to Hugo that read,
"Well, Hugo, it's done!
Everything went very well. Your stem cells are very healthy.
Now we just have to take very good care of you and wait. It's not over yet.
We are expecting the best possible result.
We are not going home. We will be staying in the University Alumni House the entire time you are with us.
We will be visiting you every hour or so-- maybe more often if we see something interesting occurring..."
Don't worry. Just relax and visit with your family until they have to go.
And thanks, Hugo, you've been marvelous!
Dr. Kavanaugh & Friends :-)!
One by one, medical personnel filtered into the Recovery Room to visit with Hugo, every last one of the people who had anything to do with the procedure, including lab personnel; you name them.
Hugo would smile but remain immobile. Only the slightest, barely perceptible nod was permitted.
Hugo must have had at least fifty or sixty visitors, some carrying Get Well Soon signs, and all concerned for Hugo's well-being.
I know Hugo. He must have wished he could leave by the back door, but, 'Good Luck', he was a celebrity now, having undergone this extraordinary stem-cell transplantation.
Jilder came up to me and got very close to me leaning up to whisper in my ear from his 4ft 9in stature. I leaned down. "Kevin, I'm gettin hungry. Do you think we can go get something to eat?" he asked.
"Yeah!" Nicky said very quietly. "I'm really hungry too. Maybe we can tell Hugo we gotta go get something to eat, and he won't worry."
"You're right, boys" I replied. While the latest group of 3 people arrived in lab coats and masks, I took the back of Nicky's sign and wrote to Hugo.
"Babe! The boys are hungry. They haven't eaten since five this morning, and it's nearly three in the afternoon (10hrs.). Will it be okay if I go with them to eat too? We're all really hungry. We'll be back here (Or in your quiet room- where ever you go.) as soon as we finish eating..."
I showed Hugo my sign between waves of visitors, and he smiled acknowledging that he understood what we needed to do. It would be okay with him.
I leaned over his bed, no matter there were people a round, and kissed him on the forehead. Then I patted him on the chest gently, and the boys and I left.
The first round of this fight was concluded, and we all knew it was a "win."
But there would be 14 more rounds, at least, before we would know whether we'd won the fight and achieved a successful end. The boys and I were going to be in this hospital with Hugo for all 14 or more of them...