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Presence of Another

Amanda Leskovac

“This is my first ambulance ride.”

I hate silence, will talk about the mold growing on cheese before I’ll share the same space with a stranger in silence. I need to cut through nervous silence even more urgently. I’m all by myself being taken somewhere by two strange men. It’s a plot ripped straight from a horror movie.

The nurses in the ICU had said I was going to rehabilitation, but since I’ve only heard rehab synonymous with addicts, I have no idea what to expect. The huge collar around my neck prevents me from seeing much beyond the EMT, so I’ve got nowhere else to focus my fear. I try again.

“You can call me Mandi. My friends call me Mandi.” I watch him trace the careful lines of his goatee with his thumb and index finger. “What’s yours?”

He finally turns his head and looks at me. “Henry. My friends call me Henry.” We both smile. “And Tyler’s driving.” He careens his neck up toward the front. “Say hi to Mandi, Tyler.”

I feel safer, somehow, knowing their names.

“All right, Mandi,” Henry says, pulling out a folder and shuffling through pages. “I need to make sure we’ve got the right information before we drop you off at the rehab center. That okay with you?” His smile dents his full, round face.

“I suppose. But make it quick. I’ve got dinner plans.”

His laugh booms throughout the small, metal space, then his face turns quickly serious. “So, you just turned 21 six weeks ago?” I nod as much as my collar allows “You were in a car accident?” I nod again. “Were you driving?”


“Were they drinking?”

“I don’t remember much.” And while it’s true that a couple fuzzy details remain after leaving the bar, I’m not ready to come completely clean.

“Man.” He rubs his forehead. “I got a lot of buddies who do that shit.”

Even without complete disclosure, I have officially become one of those who do that shit.

1-2-3 lifts me from the ambulance gurney onto freshly-made linen. I imagine they are 500-count, Egyptian cotton.

“I’m Gail, and I’ll be your head nurse,” says the woman who orchestrated my transfer onto the bed. She grabs my hand and holds on tightly. She’s got quite a grip for such a petite woman. “Your mom called and said your family would be here soon. I told them not to worry because we’d be with you all morning. You need anything right now?”

I shake my head, but don’t let go of her hand. I need a lot of things, but for now, her touch will do just fine.

“Looks like you’re exhausted. Shut your eyes for a bit. I need to round up some help to get you settled.” She leans over and fixes the oxygen tubing that’s in my nose, tightens up the straps around my neck holding my trach in place. I wince and take a deep breath in. She smells like vanilla, clean. I drift off to sleep.

My eyelids pop open, and a piercing pain shoots down the right side of my neck, followed by a heavy ache that reverberates through every synapse of my body. It’s the same cycle every time I wake up, even from ten-minute naps. I can’t understand the science, have never been good with science, but still.

How can I be paralyzed and still hurt this badly?

How can I feel so shitty when I can’t even feel?

It’s as if my body recognizes that it’s lost the war, as the pain has gotten worse instead of better. Pain is its way of proving a treaty has been signed, and there is no bargaining I can do to turn it around, as I’m obviously powerless. Once my spinal cord had been severed, there was only so much the doctors could do—metal plates, screws. My body says too little, too late.

“Knock-knock.” Gail and another nurse barrel around the corner into my room. By the time the last consonant in knock is enunciated, they have already planted themselves in front of me. I’m starting to understand that a revolving door comes standard with paralysis.

“We need to weigh you.” Gail pulls down the metal bed rail and introduces me to Marcia. I look up at her briefly, but…

Did she just say weigh?

They push a big metal contraption next to my bed. “We just need to roll you and get this tarp under you,” Marcia says. “Then we’ll attach it to the frame and jack you up to get your weight. Okay, honey?”

Jack me up? I suddenly feel like a ’57 Chevy.

And while Marcia technically asked my permission, there’s only one right answer. Seconds later, they roll me from left to right until I’m smack dab in the middle of the tarp. It wraps around me like a cocoon. If only this would transform me into a beautiful butterfly.

Gail begins pumping a huge silver arm, and I realize why Marcia used the verb jack. I slowly ascend into the air, and the tarp gets tighter and tighter until I can’t move my arms or see either of the nurses. Finally, Gail stops when I’m completely off the bed. I rock back and forth and feel, quite literally, like a whale being transported from the ocean to a boat. Another plus for my ego.

After a minute or so, Marcia releases a button, eases me back down and begins to unwrap me. Gail scribbles into a binder about the width of an encyclopedia; it reads “Leskovac, Amanda” across the front. I’m suddenly paranoid, wonder what she’s writing, wonder what’s already been written. My life has been condensed. Whatever came before the accident doesn’t matter. This new book is only concerned in the after.

The diary I had when I was little—trimmed in red, a teddy bear with a bow around its neck adorning the cover, full of accounts of my first cartwheel, my first kiss, my fears about the future—was completely under my control. I hid it underneath my mattress and every night, willed osmosis to make my words reality. But I’m not in charge of this new book, these new details. Only people who know me by “Amanda—21-year-old quadriplegic” can record the facts. Only they hold the key.

“Well…?” I’ve been avoiding full-length mirrors for a while, have made it an art form, even speed past windows if I catch a reflection of myself. This has been especially true in the past year when college became a late-night eating fest. Truth is, it had been more like a beer and marijuana fest, but food naturally took a close third—the domino effect.

Gail looks up from my chart. “Scale says 190 pounds.”

“A hundred and what?” Perhaps the paralysis has affected my hearing.

“Ninety.” She repeats it slowly and loudly. “One hundred and ninety.”

My head feels fuzzy. Not only am I paralyzed, but I’m paralyzed and extremely fat. I look down at my body, but can’t see it because of the collar. I imagine, estimating the length of my legs, the width of my hips. I long to tuck my feet up under my butt, lean this way, stretch that way, drape my arm across my stomach, pose my body like I’d practiced through high school and college—accentuate the positive, contort the negative.

I take a deep breath and feel my lungs strain against the mucus weighing them down, trying to suffocate me. My left lung has collapsed four times already; though each time, the doctors had to tell me it happened, that I was only getting 50% of my usual oxygen intake. I may have noticed sore ribs or difficulty breathing, but my idea of “collapsing” is way more dramatic: a hotel gets blown up in Vegas, its frame collapses under the weight; a severe pain shoots down an old man’s left arm, he collapses from a heart attack. I need proof—smoke and rubble, a huge POW of some kind. I can’t quite figure how all of this happens inside me, but I’m the last to know.

After the second collapse, they performed a tracheotomy. People can only go so long with the ventilator getting ripped in and out through their mouths, so they take a more direct approach. They cut an incision in my windpipe and inserted a tube into the opening to access my lungs. I’ve been vent-free for five days, but they’re leaving the trach in for who knows how long just in case. Mucus builds up, and since I broke my neck, the muscles in my diaphragm are partially paralyzed. And I’m up against some powerful snot.

I try to muffle the wheeze by clearing my throat, but Gail’s ears perk up.

“You need to cough, honey? I’ll help you get it up.” She grabs my hand and squeezes.

“What do mean, help me?” I’m wary. In the hospital, their idea of “help” was to stick a catheter through my trach hole and suction out the phlegm until I was gagging and out of breath.

“It’s an assisted cough.” She winks. “Trust me.”

She climbs up on my bed and looms over me. “Whenever you’re ready, I’ll follow your lead.” She places her hands in the space right below my rib cage and straightens her arms.

When I’m ready.

I inhale and taste the artificial oxygen they’ve got pumping through my nose, like I’m getting Sweet ’n Low, and everyone else is breathing pure sugar air. On the exhale, Gail plunges all of her 100 pounds into me and pushes upward. Once, twice, three times—breathe in, breathe out. Each exhale, each push against my diaphragm induces a retched gag and leaves me straining for air. The phlegm gurgles and rises up into my throat. When I’ve audibly hit my gag apex, Gail leans back and steps off my bed. We’re both panting.

“That sounded productive.” Marcia hands me a wad of tissues, and I spit out a giant mouthful of snot. It’s beautifully disgusting.

“What color is it?” Gail flips my chart open, pen in hand.

“Huh?” I wipe off my mouth and search for a garbage can. “What color is what?”

“Your mucus. Open up the tissue and let me see it. I need to record the color and thickness.” She pulls on a pair of gloves.

I hold onto the corner of the tissue and pass it over. I’ve never offered such a vile piece of myself to anyone. She opens it, shakes her head and looks disappointed. I’m confused. What did she expect?

She scribbles in my chart. “Green is not good. It’s a sign of infection— especially if it’s green and thick like yours. I was hoping for yellow. It’s still not great, but it’s better. White is the best. Looks like we have a long way to go.”

What’s next—the texture and consistency of my earwax? Gail closes my chart after recording another unsatisfactory mark—my weight and now my mucus. My body will be sent to the principal’s office soon.

Gail and Marcia show up an hour later and tell me it’s time for my shower. A woman I haven’t met before stands beside them holding towels.

“This is Karen,” Gail says.

I wave and attempt a smile, pull the flimsy cotton hospital gown tighter around me. I’ve been bathing myself since I was five. Mom says I adopted my “I do it” mantra and insisted on dressing myself, pouring my cereal, and brushing my teeth. Sixteen years later, I’m joined in the shower by three almost complete strangers. I’ve discovered that paralysis leaves no room for pride.

“Won’t it feel good to wash that hospital off you?” Karen’s voice comes out soft, like she’s coddling a small child.

I nod and touch my head. My fingers instantly tangle in a clump of hair. It’s matted and coarse. I’m well on my way to sporting dreadlocks—well on my way to being Quadriplegic Marley. Small scabs border my hairline and rise up sporadically throughout my scalp. Evidence. I don’t remember the actual accident, but the blood and dirt in my hair connects me to it, makes me part of the story—perhaps the whole story.

Marcia ducks out for a minute and comes back rolling in a big, white chair.

“What’s that? It looks like it’s made of plastic.”

“A shower chair.” Marcia situates it flush up against my bed and puts the brakes on. “Don’t worry. We’ve had patients a lot bigger than you, and it held them just fine.”

I pause. Bigger than me? I want to believe she just intended to reassure me. But my 190-pound translation tells me that she thinks I’m a cow; whatever the shower chair is made of will still hold me—the other patients had been buffalos. I want to tell them to forget it. I want to lay my dirty, paralyzed body down and tell them to leave. But I’ve got no say. My body is moving, and I’m nothing more than a passenger.

Gail slowly swings my legs off the bed then scoots my hips over, so I’m sitting on the edge of the bed. The other girls spot me from behind, make sure I can feel their hands on my back. My balance is off, partly because of the big collar around my neck, but mostly because I’ve lost the muscles to keep myself up without help.

She tells me she going to do a quad lift. I figure any lift would be a quad lift since they are lifting me and I’m a quad. But I’ve only technically been one for two weeks, so I’m not hip to all the “quad lingo” yet. As much as I usually like to be well-informed, like to know what people are saying— especially when it pertains to me—I don’t ask what it means. I want to remain as ignorant as long as I possibly can.

She pins my legs between her knees, then leans in and hugs me hard, wraps both arms around me and pulls me forward.

“Ready?” My chin is smashed against her shoulder. I nod, but it’s just a formality.

“One, two…” We rock back and forth together until “three” lifts me up in the air. I hold my breath, shut my eyes. I’m at least five inches taller than Gail and almost double her weight. I’m positive we’ll both hit the floor, almost wish it, so I can stay in bed.

But Gail’s an expert, has performed the same steps on patients before me, possibly even bigger than me. When my backside lands on the chair, Gail untangles her arms from mine and steps back.

“You comfortable?”

I stare at her. Is she kidding?

My ass has made contact only with the front of the seat, and my left cheek hangs off to the side. Plus, the oxygen tubing has been yanked out of my nose and hangs across my face. I’m slouched, twisted and irritated. Comfortable isn’t exactly the word I’d use.

Once they get me situated, Gail pushes the shower chair while Marcia pulls the oxygen tank and Karen opens the door. The water is already running, and the room is filled with steam. It isn’t until I see the enormous-sized bathroom that I understand how a wheelchair, an oxygen tank and three nurses are going to fit into a shower. It’s split in half between a toilet and sink on one side and a roll-in shower on the other. The floor of the shower is flush with the rest of the bathroom, and a vinyl curtain is the only thing separating it. I foresee a flood.

We stop in the entranceway. All three women crouch down, take their shoes and socks off, then cuff the bottom of their pants. Now I’m convinced this is going to be messy, and I wonder why they’re willing to go through such trouble for someone who made such a stupid mistake.

They stand up and wait for my go, but I say nothing, don’t know if I’m ready for this, don’t even know what this is. I try to detach myself, become “Amanda, the quadriplegic,” need to let go of before and dive into the after.

When I nod, Marcia unties the gown from around my neck and slips it off my arms. The room is filled with steam, but goose bumps instantly creep over my skin. I keep my head down, unable to look at them. Even when I’ve been intimate with my boyfriends, I’ve never allowed them to see me so candidly. Now, not only am I aware I’m 190 pounds, I must factor in the paralysis. It makes feeling impossible, but it’s got to look like something. The worst possible image surfaces.

I look up at the girls for confirmation, try to locate my reflection in their eyes. But they’re not helping. Instead, their faces are soft, their eyes locked on mine. My image shatters between us. I’m ashamed of the pieces that they don’t even see.

Gail moves the hand-held shower hose so that it shoots into the wall then rolls me into the shower. Once I’m in with my oxygen tank beside me, they put the brakes on. I’m forced to wonder exactly what happened that night, how my body had been ejected and the three other girls remained in their seats— what exactly happened to land me in an enormous wheelchair-accessible shower with three strange women. I never knew this was an option.

Gail tells me to tilt my head back and holding the shower nozzle nearby, she wets my hair. Hot water streams across my face and down my back. I sputter as water goes up my nose and finds my open mouth. Suddenly I’m back in beginner’s swimming lessons, unaware that I should shut my mouth and hold my breath when water comes at my face.

Gail brings my head back up straight. “Sorry, honey. You okay?” I’m just about to tell her I am when a tiny trickle of water sneaks down my neck and seeps into my trach hole and takes my breath away. I think the obvious counter-action is to inhale and try to get it back, but that only exacerbates the gag.

Gail points the water toward the floor and thumps me on the back while Marcia takes a towel and blots around my trach site. I work through the cough and breathe like Gail taught me, but I feel my head becoming light and ears beginning to ring. Showering has become another dangerous activity: give me cleanliness or give me death.

Gail wipes my cheeks and eyes with a washcloth. When she hits my right eye, I jump, surprised at the pain.

“I’m trying to be as gentle as I can, but you’ve got some pretty nasty cuts. I just want to make sure they’re cleaned out.” I flinch again as she moves to my forehead and wipes off the cuts there and in my hairline. I haven’t looked at my face in over two weeks, but I imagine the cuts and bruises, want Gail to polish them, keep them bright pink. They tell me I’ve broken my neck, but I can’t see that, can’t see for myself why I’ve become what I’ve become. The marks on my face are something I can hold onto, evidence that my body was hurled out of a moving vehicle. For a brief second, I feel like a bad-ass.

“Tell me if it’s too hot.” She pours water on my head; only a couple streams spill down my face and neck.

The water is hot, way too hot. I can feel every pore of my scalp open up. Unlike most of my body, my scalp pulses, whispers, I’m alive.

“It’s perfect,” I tell her.

She lathers my hair, digs her fingers in and scrubs, nails prodding, massaging. To fix my neck, the surgeons had to shave a portion of my hair. The shaved part itches with new hair growth, and Gail’s nails are my salvation.

As she finishes, Karen lathers a couple washcloths and begins cleaning my body—first my arms and underarms, then my chest and belly. She drops the first washcloth to the floor, and then uses the other for my feet, calves, thighs and between my legs. She apologizes and “excuses” herself before each touch. I never thought something could be so intimate without being sexual. Nor did I think I could sit in a wheelchair, fat and nude without crying.

But in this moment, none of that matters. I’m less embarrassed about what they’re doing and what I look like than I am about what caused this. Humbled, I want to apologize for being here, for needing them to take care of me. I want to tell them that I’m a good kid, that it was a stupid mistake, that I wasn’t even planning to go out that night.

I didn’t so much as pick up a bar of soap, but I’m exhausted. The girls plop me down onto the bed, and I’m instantly engulfed in the smell of bleach. I wonder how many other patients have laid on these sheets. Wonder how many other fat, paralyzed women have gotten showered by near-strangers beforehand. I’d like to think I’m special, that I’m the first.

I begin to close my eyes when a small, older man wearing an un-ironed seersucker suit walks around the corner. The little guy does a beeline toward me and grabs my hand. His are soft and small, and before he ever says a word, I like him.

“Hello, Amanda. I’m Dr. Brenes.” I’m jarred when I hear his accent. He sounds like a French man speaking Russian. He doesn’t hit all his syllables, and his words flow into one another, like he’s singing. Amanda feels safe coming out of his mouth.

He keeps a hold of my hand. “How are you?”

It is a simple question, but I’ve got a few answers.

Physically: My neck is killing me, I’ve got this strange pain shooting down my arms into my hands and there seems to be no end to the amount of snot I’ve got in my lungs.

Mentally: My family still isn’t here, they just weighed me like a Mack truck, and I still don’t know exactly what how I ended up here.

But I finally settle with “could be better…could be worse.”

“Okay, Amanda. You will sit up, and I will assess you.” Usually, I resist all types of movement. I’ve just sat through a thirty-minute shower and my neck is throbbing. I want to scream: I can’t. It hurts too badly. I am paralyzed!

And even though all my arguments are potentially true, I can’t seem to look Dr. Brenes in the eyes and resist. I feel like if I don’t sit up, I’ll be letting him down personally. I’ve only known him a minute, but for whatever reason, I know I can’t do that.

With Gail helping from the left and Dr. Brenes on the right, I pull my body forward to the sitting position. My stomach lurches, my neck screams, but I pull forward.

“Okay, Amanda,” he grabs my right hand and holds my wrist in place. “I want you to try to squeeze as hard as you can.” I follow his instructions, tell my fingers to make a fist, urge my long fingers to wrap around his short ones.

My brain demands squeeze. My fingers start shaking, but ignore the request, defiantly remain straight. Then my thumb gives me the ultimate fuck you by remaining curled inward and drooped. I feel betrayed and embarrassed.

Dr. Brenes doesn’t look especially surprised, mumbles a set of numbers to Gail and moves quickly to my left hand. “Okay. Now you do it again.”

He says “again” like I had done it the first time. I send the same message to my left and watch as all five fingers curl obediently. The pinky and ring finger clutch tightly around his hand while the other three aren’t far behind. It isn’t a perfect fist, but it isn’t bad. I’m proud.

“Okay.” Dr. Brenes releases my hand. “Good.”

He says good, but his facial expression only says all right. I feel like I’ve failed, and what’s worse is that I know I’ve done my best. I’m not used to getting an “all right” score when I put in a 100% effort. I could accept a “C” when I hadn’t really studied, drank a few beers the night before the test and only gotten two hours of sleep. This kind of all right is new to me.

Dr. Brenes moves to my legs, and I feel doomed. He wraps a tape measure around each one of my thighs, then takes a marker and draws a line when it has reached its circumference. I’m suddenly some kind of cutting-edge art project gone terribly wrong.

“Okay, now try to push your legs into the bed.” He stares intently at my legs. I know I can’t do what he wants. When I’d done the same thing for the doctors in the hospital, they’d nod at each other, and then hustle out of the room, none of them looking me in the face. I felt such shame. I don’t want to show anyone else, don’t want to talk about it anymore.

But he is waiting, isn’t giving me a choice.

I close my eyes and attempt to locate my leg muscles inside my body. I dig my hands into the mattress, think push and send the message down through my body for my legs to intercept. I utilize every ounce of energy I have, tighten every muscle that can be tightened. A tingling runs through my body; had I ever felt a tingle before?

“Okay, now relax.”

I let out a breath I didn’t know I was holding, open my eyes and wait. His face is blank, and I don’t dare ask. I can’t bear hearing the confirmation. I had known, of course, but it is within the trying that makes it real. Paralyzed.

He continues instructing me to try to push them left, right, push your feet up, your toes down. After awhile, I’m not sure what I’m trying to move anymore. I just know that I’m failing.

Suddenly, my body tenses up, and without any direction from me, my legs bend and pull toward me. Before I know it, I’m on my side in the fetal position. I look up at the Dr. Brenes, scared at how my body has just manipulated itself. Scared that I had no say in it. Up until now, my body has remained pretty motionless; I have been lying on my back or propped up on my side for about two weeks. Because I can’t feel it, I have barely even noticed its presence. Now I’m curled up in a ball without even a small warning.

“Your spasms are kicking in.” He smiles and grabs my hand. I’m not used to a doctor talking to me so directly. “Don’t worry. They’re natural.”

Later, someone will explain the muscle spasms as my body’s way of “talking to me,” of letting me know it’s still there. But right now, if it’s not going to allow me control, I’d rather it just shut up.

When the assessment is over, everyone leaves my room; I want the bed to open up like a tiny portal into another time and suck me in. I look down at the outline underneath the blanket, the legs that I used to own. They stare back at me, unflinching. I reach my hand out, place it on the right lump and close my eyes. I curl my fingers in, let my nails sink into the blanket, into flesh, will my body to feel it. The response is less than nothing. It is nothing wrapped in emptiness, a present I don’t want to open.