Before / After
The things we don't think about
We don’t think about the After.
Before, we may imagine what the after After is. We can imagine a lot of the bad things that could happen. The failure that it could be. And if we have an active imagination (don’t we all?), then the worst-case scenario can be seen vividly in painstaking and terrifying detail.
We can, of course, also imagine the good outcomes. But those are often harder to hold on to. They slip through our minds, leaving only the faintest residue of possibility. The bad thoughts can latch on, consuming us.
So, during the Before, we toss and turn at night, fretful of the final After, desperate to hang on to any positive possible outcomes, even as the most horrifying thoughts linger just a little too long.
It is an exercise in emotional resilience.
But, even through all that imagining, the good and the bad and the ugly possible outcomes, it still never dawns on us what the After is really going to be like.
What healing is going to be like.
When my mom finally made the decision to go ahead with the shunt surgery to treat her Normal Pressure Hydrocephalus, it started months of anticipation and anxiety. While she was resigned to go through with what we can only comprehend as brain surgery, she was, for four months, terrified.
For her, she feared the ultimate After; the After that we will all experience. Death. But she also feared ineffectiveness. The What If game was constant in her mind.
What if I don’t wake up?
What if I have a seizure on the table?
Or what if something goes wrong and I’m in a coma?
And maybe worst of all: what if nothing changes after the shunt is placed?
Throughout these months, I did my best to calm her nerves. To reassure her that there were positive possibilities too. To be her cheerleader.
It was a balancing act, though, because I didn’t want to be too effusive; to be toxically positive. There can be bad outcomes. There is always risk in surgery. I couldn’t deny her those thoughts and possibilities. I did my best to assure her within reason.
It was exhausting.
Because I also had terrible thoughts.
Not of her dying, per se, but of the outcomes of her coming out in a place where I would need to make difficult decisions. Decisions that no one is ever prepared to make on behalf of a loved one’s life.
So, Mom lost sleep over the possible Afters of dying and ineffectiveness, while I lost sleep over the Afters of incapacity.
In the final days of the Before, we didn’t talk much about her surgery. It loomed large in both our minds, and we didn’t need to keep acknowledging it. What we did do was finally complete her Advanced Directive, the all-important document that gives me the ability to carry out her wishes in the event of one of those more terrifying Afters.
That exercise was hard for my mom. It brought death to her in a more tangible way. It made her nights even more restless.
For me, though, it gave me a sense of clarity. I know what Mom wants now, and while I never want to have to execute any of this, at least I have the basic roadmap to guide me.
I tried to fill the final 48 hours with good food, distractions, and laughter. She filled that time with questions, many of the same that had already been answered.
The Before filled up of scary thoughts about the After, and at some point, I realized I wasn’t going to be able to calm her anymore.
That’s when I remembered the internet’s greatest contribution to our society: cat videos.
Sitting in the pre-op area with my mom, she needed something truly magical to calm her terrible thoughts of the After. The cat videos I started streaming were just that. One of the first things she brought up in the After was how grateful she was for those videos.
The During for me was the worst part of this whole experience. Being strong for Mom meant that I had to keep my deepest fears to myself. But when I watched as she went through those double doors, I didn’t need to hide things anymore.
By then, the unknown settled on me.
I had no idea what would happen in the After.
So, I did the only thing I could do; I waited.
In the Before, I thought I would be able to calmly work on my cross-stitch, write, or generally do something worthwhile. I had a bag full of activities to keep me occupied during the 90 minutes I thought she would be in surgery.
A bag full of possibilities.
They stayed in the bag.
Instead, I sat in the lobby, transfixed by silly games on my phone, desperately keeping the negative thoughts at bay. Letting them into my mind and letting them out as quickly as I could.
It does no good to dwell on those.
When the surgeon finally came out more than two hours later, I held my breath.
“Everything went as planned. She’s in recovery. You’ll be able to see her soon.” He was gone before I could let my breath out. I said “thank you” as he walked away.
And just like that, we were in the After.
It was another hour and a half before I learned that she was transferred to her hospital room.
There are things about the immediate After that my mom would be too embarrassed for me to share publicly, and I’m going to respect that. None of them were her fault and the blame rests squarely on the staff of the recovery room, which failed to care for a woman who just went through brain surgery. It’s a letter waiting to be written.
But, for the most part, my mom was in good spirits and seemed to be fully intact in those first few hours after the surgery. The pain pills were strong and the relief of having survived was palpably radiating off her.
She did it. She was still here.
As the afternoon wore on, and the reality of her physical condition became more apparent, the tears started to fall.
Suddenly, she was in rough shape.
This is the After we don’t think about.
What it means to have been put under general anesthesia. To have five incisions made in various parts of your body. For foreign objects to be placed inside you and then to be stitched up and awakened after what my mom describes as only 30 seconds.
It is brutal on your body.
And all the emotions of the Before that have built up are released. And you are left in this After of tears and relief and tubes and catheters and reliance on strangers to care for you.
Watching Mom experience this After, the After neither one of us thought about, I wondered, for the first time, if this had been worth it.
What have I pushed my mom to do? How will she get through this? If this is what the After is like, why did I encourage her so much in the Before?
My mind raced as I hid my internal dialogue from her. She didn’t need to know how scared I was of this.
Luckily, those strangers were incredible. The nurse, Krisena, and CNA, Summer, assigned to my mom that first afternoon were gentle kind, and considerate and knew that my mom needed love. They cleaned her up, kept the pain at bay, helped wipe away her tears, found an extra pillow, and even brought some aromatherapy patches to help calm her.
My mom was in rough shape, but they made it okay for her to be exactly that. No judgment. No shame. Simply care.
This After was different than the After she had gone through with her knee replacement surgery six years ago. In that After, they had her up and walking within hours of the surgery, taking advantage of the strong pain pills to mask the new hardware in her knee.
This time around, she was confined to her bed for almost 24 hours. I was eager to see if there was any noticeable change in her mobility, and I kept asking if the physical therapist was going to come. The disappointment was written all over my face when I learned that no, they weren’t. Not until tomorrow.
So, we waited.
The After was hard. She was in more pain than she expected; in a place she hadn’t imagined.
At one point she said to me “If I had known this was how it was going to be after…I don’t know…”
But that was the immediate After.
Thankfully, there is more to the After.
I made it back to her hospital room the next morning in time to see her walk. Like she hadn’t walked in years.
And just like that, in a moment that left me breathless, the After became worth it.
The pain fades. The oxycodone is quickly forgotten. Movement becomes easier. Restlessness creeps in. Incisions start to itch.
The healing has begun.
In the years to come, in the After that is to follow this, I hope to remember what it was like in the Before. When Mom’s mobility was getting worse, and her mind was starting to go. When her body was revolting against her. I also hope to remember what it was like in the immediate After, the pain and uncertainty and tears.
Because all of that Before makes this After so much sweeter.
