The Insulin Express Read online

  We stumble onto the tourist bus a few hours later, all of us groggy and perhaps a bit hungover. More than a bit. The streets of Jerusalem are still dark as we make our way into the Negev desert. The bus rumbles to a stop at Masada, and we begin climbing the winding path up the side of the plateau to the ancient Roman fortress on top.

  Once again, I am impressed. Our new friends are awesome. They probably have no future and can’t remember the past, but they are awesome. They are the very definition of living in the present. Nico, Claire, and Sim fly up the trail as if they are well-rested and hydrated. They are neither, but that doesn’t stop them. A forty-five-minute hike takes them twenty-five minutes. If I didn’t know better, I would swear they borrowed jet-powered skates from Wile E. Coyote.

  We watch sunrise from the top of Masada as the first rays of light hit the Dead Sea. It is an awesome place to take in the dawn. Deserts are generally not considered particularly beautiful places, but the Negev absolutely is. The barren plateaus and jagged rock formations stretch into the distance, revealing a harsh landscape that makes survival a challenge for every living creature, including the recently inebriated. The sun inches its way up the desert sky, laboriously pushing its way through the morning haze in waves of red and orange. The sky is ablaze, and its reflection off the crystal-clear waters of the Dead Sea leaves us staring at the bands of light as they grow brighter and deeper.

  Moments after we see the sun, we feel its heat. The temperature skyrockets after sunrise. Beads of sweat make their way from my exposed head down my face and into my eyes, before they are collected in a sopping mess in my increasingly wet shirt. We soon make our way off the exposed mound of King Herod’s ancient city to find shade and water.

  Our bus takes us to Ein Gedi, an oasis in the middle of the desert, and then to the Dead Sea. All the while, the sun beats down on us. Waves of heat feel like physical weights on our backs. The desert sun in the midst of summer is at full force, the firecracker explosion of its heat directed right at us.

  On our way back to Jerusalem, red spots appear on Cassie’s arms, as if a colony of ravenous fire ants had scrambled over her skin and bit her all over. Cassie fights the urge to scratch. Whatever it is, scratching won’t help. The spots spread to her back as the apparently invisible fire ants keep attacking. To me, it looks a bit like poison ivy, but I know that’s impossible since there is no poison ivy anywhere near us—not in Israel and certainly not in the Negev desert. Our best guess is that it’s the sun. Too much exposure, and Cassie’s body is not handling it well. The hives cover a growing part of her back, neck, and arms.

  Two things are immediately apparent. We need some kind of medication. And we’re going to have to pike.

  We rummage through our makeshift first aid kit, imagining what Cassie would look like if we covered all of the spots with bandages. No amount of opening, searching, and closing our little kit will change the fact that we don’t have serious allergy medication.

  We venture across the hall to the hostel dorm room the Aussies share.

  “Hey guys, we can’t go out tonight,” I say to Nico as she merrily opens the door. “Cassie broke out in hives, and they’re not going away.”

  Nico studies the spots for a second, squinting just a bit. She appears to be engaged in active thought, something I had not seen from the Aussies yet. I think she’s trying to work out which insults to hurl at us to convince us to come out.

  You can’t pike on us tonight!

  How dare you fucking pike?!?

  Pikey McPikerson!!

  All of these are very real possibilities.

  “Wait one second,” Nico says, ducking back into her room.

  She comes back with an enormous plastic bag of prescription-strength medicine. Along with the usual suspects of Tylenol and Advil are some potent allergy medications, antibiotics, and upset stomach pills. For a moment, I feel like we’ve stumbled onto some Australian drug smuggling ring, which would explain the happiness and the penchant for drink, but I dismiss that explanation as somewhat too cynical.

  “Here, you should try some of this,” she says, handing Cassie some incredibly strong allergy pills that most people don’t exactly come by easily, especially not in a foreign country halfway around the world when you’ve been on the road for six months.

  “Take one of these,” Nico says. “And you can keep the rest. Don’t worry, I have tons more.”

  Cassie rotates the pills in her hand. She hesitates for a moment. “How do you have all these medicines?”

  “Oh, we’re all doctors.”

  Something clicks in this moment. Here I am, on a vacation that’s barely longer than a week, trying to cram in a month’s worth of family visits, trips, tourist attractions, and relaxation. I hopped on a flight right after I got off work last Monday, and I will get back to work a few hours before the morning meeting on Thursday. I will return more exhausted than when I left. Up until ten seconds ago, that was the only way I knew how to travel. In my six years working in television news, I never had more than two weeks off, and I worked every single holiday. I knew people took gap years, but I always thought that was only for college students.

  Yet these three Aussies are having the time of their lives, and they have very serious and very demanding careers back home. I was never willing to accept or explore the idea that I could travel long-term. I blindly believed that my trips were limited to one- or two-week excursions, racing to a destination, working as hard as possible to squeeze in as much fun as possible, then racing home to get back to my job. And I believed that because everyone else seemed to believe it.

  In pursuing the American Dream, we had not dreamed. A split-level house, 1.7 kids, a suburban school. I certainly had a fun job and was enjoying the daily grind that comprises, then defines, a person’s daily existence, and I could’ve kept doing it. Nobody would’ve questioned me. Except me. I found a glaring contradiction in the midst of my routine: in making a living, I had failed to make a life. The nine-to-five determined the five-to-nine, when it should be the other way around, not just for us, but for everyone.

  The last ten years had followed a predictable path from which I had barely strayed. High school to college to grad school to first job to second job … Sure, I tried to make my life a little less formulaic. But it still seemed very by-the-book. Only it was a book I had read too many times.

  Some people seek nothing more than a quiet, simple life with annual vacations to Florida or California or some other beach destination, and there’s absolutely nothing wrong with that if that’s what you want. But that’s not for me. And not for Cassie. The world is too big, and we had seen too little of it.

  I look back on this moment as the genesis of our journey. Without those Australians, I would never have gotten the idea to travel the world, and even if I had had the idea, I certainly would’ve dismissed it as impossible. It would take me another two years to plan my trip with Cassie, who would by then be my wife despite the objections of certain members of my extended family. But in that short exchange on a random night in Jerusalem, I find inspiration.

  And if this moment is inspiration, ten months later I find urgency.

  Chapter 2

  April 17, 2012

  39°57’01.5”N 75°10’02.6”W

  Philadelphia, PA, USA

  The company at lunch is better than the food. I eat out with one of my best friends, Josh, on a random Tuesday in Philadelphia’s Center City. We choose a place that looks decent and sit outside on a beautiful April afternoon. The meal isn’t good enough to remember, and the conversation covers work, life, and my upcoming wedding, still five months away. All very normal stuff for us, and I have no reason to believe this week, or even this day, will be any different.

  Josh has to work tonight, but my work schedule gives me Tuesdays and Wednesdays off. We go our separate ways, and I am sure I will meet him for a drink near our office on Wednesday night. He doesn’t drink, instead opting to smoke an abundance of cigarettes, one pack
a day, which sounds awful until you realize he used to smoke two packs a day, making for a commendable 50 percent improvement. One pack suddenly sounds like a good deal! But he hasn’t had a drink in five years, so he sips soda while I take care of the beer.

  Twenty-four hours later, our mutual friends blow up my phone with texts and calls.

  Brigid: “What happened to Josh? Is he okay?”

  Bill: “Is he in the hospital?”

  Jen: “Have you seen him today?”

  Brigid/Bill/Jen: “Did he really have a stroke?”

  If there were coffee in my mouth, I would have spit it out. But there is no coffee, so I choke on air.

  “Wait, what?! A stroke?”

  “Yeah, his mom posted on Facebook that he had a stroke.”

  I had nothing to do all day, so checking my email and Facebook were not top priorities. I had been content to relax and play the old-school Sega Genesis that, combined with my original Nintendo Entertainment System, make up the only video games I am willing to own and play. Now I have a very pressing need to figure out what the hell is going on.

  “Okay, let me see what I can find out. I’ll let you know.”

  There’s no way, I think. Josh is thirty-one years old, an age that I am quite confident is far too young for a stroke, not that I really know anything about medicine or neuroscience. But I’m a reporter, and I have a reporter’s intuition. Now that intuition, which often functions like an encyclopedia of overly confident guesswork, assures me this is true.

  Work confirms Josh is out. His father had called to let them know he wouldn’t be in. Josh hasn’t called out sick since he started work two years ago, with the exception of one day a couple of weeks ago when he, in fact, wasn’t sick. We had spent the whole day hanging out.

  Very quickly, it becomes obvious that whatever has happened is pretty damn serious. Josh hates hospitals as much as I hate nursing homes, having watched my grandmother die in one, so he wouldn’t allow anyone to take him there unless it were absolutely dire. Still, I can’t believe it’s a stroke.

  I’m at the hospital fifteen minutes later, where I meet my assistant news director, John, who comes over immediately. The hospital is five blocks from my apartment, and at that particular moment, I have no idea how many times I will be making that walk over the next few months.

  John is as perplexed as I am. “They’re running tests,” he says, his brow furrowing in concern above his horn-rimmed glasses.

  “Was it really a stroke?”

  “Yes.”

  I call our friend Jen and immediately tell her to get in the car. Josh needs to see her. More importantly, Josh needs her by his side, and she has a three-hour drive from Salisbury. They aren’t dating, but they’ve been great friends for a long time, and they are both integral parts of each other’s support system. Josh will need all the support he can get, tonight and every night for a long time.

  When I am finally allowed to see Josh, everything hits home. He has a breathing tube in his throat, an IV in his arm, a catheter where catheters go (which the nurse tells me about), and enough monitoring equipment to let out a steady symphony of bings and beeps. It isn’t quite Beethoven, but if it’s helping, I don’t care what it sounds like.

  Josh is in and out of a morphine-induced sleep. A white hospital sheet covers his body. His face is swollen from the bleeding, and when the throbbing in his head becomes too much to handle, he arches his whole back, clenches every muscle in his arms and hands, and grunts in excruciating pain. It is awful to watch, but by Josh’s side, I watch it again and again. I notice he always twists to his right when the pain gets really bad, and I notice that his right leg isn’t moving. The stroke attacked the right side of his body. His has no control over his right leg and barely more than that over his right arm.

  The doctor brings over a twisted piece of metal that looks almost like a tuning fork and uses it to test Josh’s nerves and sense of touch. His left foot and hand respond quickly. His right hand responds, but only after the doctor puts pressure on his palm. His right leg feels next to nothing. The doctor has to use almost all of her strength to dig the instrument into the bottom of Josh’s foot before he reacts.

  Among Josh, the doctor, and the nurse, we begin to learn what happened.

  Josh is showering before his night shift at work, blasting “Tiny Dancer” by Elton John on his iPhone.

  Josh loves the classics—he is a huge Beatles fan—and he always props up his iPhone on the shelf near his shower so he can listen to music as he goes through his daily routine to get ready for work. Today, his choice is Elton John.

  He has already powered through “Levon” when “Tiny Dancer” comes on. Elton John’s song about the stylish, sexy women of 1970s California is building toward its first chorus two and a half minutes into the song. Josh adds his own off-key harmony to John’s stirring vocals.

  The stroke hits mid-lyric and levels Josh with the force of a gunshot to the temple. He hits the floor a second later. He is able to force himself to his feet. It will be the last time Josh stands up straight for weeks.

  Josh steps out of the shower and collapses again. His right leg isn’t responding. He tries to dial 911, but his motor skills are deteriorating too quickly, and he has already forgotten his passcode.

  Thankfully, some programmer at Apple decided to add an emergency call feature to the iPhone that doesn’t require you to log in. That small feature saves Josh’s life. He can’t say much, but he repeats his address and says he had a stroke. And he says this over and over again.

  Two thoughts cross Josh’s mind in the moments before his world goes dark. First, these may be his final minutes on earth. And second, in what could potentially be his final minutes, he is soaking wet, stark naked, and blasting Elton John as loud as his iPhone speakers will allow. This is going to make for one hell of a story for the paramedics. Then it’s lights out. He doesn’t remember anything else from April 2012.

  The paramedics break down the door and rush him to the hospital. I arrive two hours later, when I finally get word of what happened.

  We wait for hours, then we wait some more. Answers aren’t exactly easy to find here. And I don’t mean they’re not easy to find in this hospital. I mean answers aren’t easy to come by when you’re dealing with brain injuries. For every question we ask, and there are many in those first days, we receive a series of answers that each include some degree of guesswork.

  The doctor shows us the first CT scans of the stroke. Josh bled 55 to 65 cc’s in his brain; 100 cc is the point of no return; doctors say it’s nearly impossible for a patient to survive after that. Josh came dangerously close.

  “The next twenty-four hours are critical,” the neurosurgeon says, stating the obvious. What he doesn’t say is that the twenty-four hours after that are critical, and the twenty-four hours after that, and so on and so forth. There is no chance to relax in these first few days, and I am by Josh’s bedside as much as work will allow.

  I have never believed life has any inclination to be fair. But this—this occurrence, this event, this medical phenomenon—seems way too far over to the other side of the spectrum to be possible. Josh is a veteran, a bronze star recipient, a hero for his service, some might say. A son, a brother, a cousin, an uncle. Above all else, he is a good person (his falsely calling out sick and a few other minor infractions notwithstanding). And here he is, teetering on the precipice of this delicate edge we call life. The slightest push in one direction, and he will be fine. The slightest push in the other …

  There are signs of hope, and some come almost immediately. I try to make some jokes to lighten the mood a bit when friends come to visit on the first night.

  “At least we have conclusive proof that Josh has a brain.”

  Josh opens his eyes and looks right at me. He is with us, and so is his sense of humor.

  Jen arrives shortly before midnight. We stay at Josh’s side until 6 a.m., politely ignoring the nurse’s insistence that visiting hours are over
until we realize that even we have to sleep at some point, and that the waiting room with its off-white fluorescent lighting and poorly padded chairs will not suffice for either of us. Nurses check with Josh every hour, making sure his condition doesn’t worsen. He is not allowed to get any real sleep, and this irritates him almost as much as the catheter securely taped to his dick.

  When they remove the breathing tube from Josh’s throat, they begin asking him questions to check his grasp on reality.

  “What’s your name?”

  “Josh Crompton.”

  “Where do you live?”

  “Philadelphia.”

  “What year is it?” asks the nurse.

  Josh’s eyes move under his closed eyelids. “1974.” And then, realizing he may be ever so slightly off, he says, “Don’t you fucking judge me.” Josh is back. I can’t help but smile.

  Josh doesn’t remember much of those first two weeks; he is so loaded up with painkillers. It’s probably best that he forgot them. But he doesn’t even remember saying his signature line, which he repeats every time I see him.

  I enter, squeeze his right hand, and ask, “Hey brother, how’s it going?”

  Josh murmurs a few words, then gets really pissed off and shouts, “And I can’t get any God damn answers around here,” before slamming his left fist into the pillow for added emphasis. He always pauses between God and damn, to let the Almighty know this question is directed partly at the nursing staff and partly at Him. And he always slams his left fist into the pillow.

  Cassie and I laugh every time we hear it, and it becomes our catch phrase when we visit Josh. We all enjoy yelling, “Can you get any God damn answers around here?” so we can trigger Josh’s inevitable response.

  “I can’t get any God damn answers around here,” he screams, as if it’s the first time he’s saying it. Little do I know it is the first time he’s saying it, no matter how many times he’s said it before. Between the blood in his brain and the painkillers in his system, his short-term memory is shot. He never remembers saying his signature line, not while he’s in the hospital, and not after he leaves.