Howie’s condition continued to worsen over the next couple of days. His mother, brother, and sisters flew in from Florida to be with him as he drifted in and out of consciousness in the ICU. Sometimes his eyes would open, but he was so heavily sedated, I don’t think he was aware of anything that was happening to him. It was hard for me to see him like that, but I knew it had to be easier on him.
He had been in the hospital for a full week when Dr. Scott called a meeting with Howie’s family and me. She sat us down in a private conference room and delivered the worst possible news.
“Howie is deteriorating. He’s showing signs of severe sepsis, which is the body’s response to massive infection. We’re still running tests to look for the source of the infection, but the results have been inconclusive so far, and I’m worried we may be running out of time. The pneumonia is taking over Howie’s lungs, and his other organs are starting to fail. His latest labs indicate a decrease in liver and kidney function, and the CT scan and spinal tap we did earlier today show evidence of swelling in his brain. We’ve given him the strongest antibiotics available, as well as steroids to help with the inflammation, but so far he hasn’t responded to the treatment. We’re going to continue doing everything we can for him, but there may come a point when that will just mean controlling his pain and keeping him comfortable while nature takes its course.”
It was a lot to absorb. We all just sat there at first, trying to process the information we’d just been presented with, and for a few seconds, no one spoke. Then, in a shaky voice, Howie’s brother John asked the doctor the question that must have been on all of our minds.
“Are you saying he’s going to die?”
“I don’t know that for sure,” said Dr. Scott. “I just want to prepare you for that possibility. If we don’t see any signs of improvement in the next day or so, he’s probably not going to get better.”
It was a pretty grim prognosis. I felt sick to my stomach as I followed Howie’s family out of the room. Pollyanna and Angie were walking on either side of Mama D, their arms around her. All three women were crying, while John was more stoic. I turned to him in the hall outside the conference room and asked, “What can I do?”
John just shrugged and shook his head. “Man, I wish I knew,” he said with a heavy sigh. “Just keep doing what you’re doing, I guess. Be with him... and pray.”
I hadn’t prayed in a long time - Brian was a lot better about that stuff than me - but I did some serious pleading as I sat by Howie’s bedside that night.
“Dude, Howie, you need to start getting better so we can go on that date I promised you,” I said, rubbing the back of his hand. “We could do dinner and a movie, or maybe some mini-golf? I’ll even let you pick the place. But you gotta get better first. Please. Please get better.”
I watched his face as I talked to him, looking for any indication that he could hear me. His eyes were closed, and except for the steady rise and fall of his chest as the ventilator breathed for him, his body was completely still. Both of his wrists were tied to the bed rails to prevent him from pulling out any of his tubes in his semi-conscious state, and boy, were there a lot of tubes - IV lines, catheters, the breathing tube, a feeding tube. Howie looked about as bad as he had the last time he’d lain in this ICU, right before his liver transplant.
But he got better, I told myself, trying to be hopeful. He made it through that. He can make it through this.
He’d had an advantage then, though. The doctors had known exactly what was wrong with him and how to help; it was just a matter of waiting for a donor organ. But now, they didn’t even seem to be sure of the diagnosis, let alone the course of treatment.
So I prayed for God to guide the doctors, to help them help Howie. Lord knew he needed all the help he could get.
Personally, I’d never been a big believer in the power of prayer, but the answer to mine came the very next day, when Dr. Scott sat us all down again to share some positive news.
“We finally got some conclusive results from the blood and sputum cultures we’ve been waiting on,” she said. “The samples show Howie has a rare type of fungal infection - not pneumocystis, as we initially suspected, but cryptococcosis, which is caused by a kind of cryptococcus fungi.”
“Fungi?” repeated Pollyanna, wrinkling her nose. “How on earth did he get that?”
“He must have inhaled the spores at some point, probably more than a month ago. When his immune system was suppressed, they started colonizing in his lungs, eventually causing the pneumonia,” Dr. Scott explained. “Unlike pneumocystis, cryptococcus doesn’t respond to antibiotics, which is why the treatments we’ve tried haven’t worked. We’re going to switch Howie to a regimen of antifungal drugs that have been proven effective at controlling cryptococcal infection.”
“So... he’s going to be okay?” I asked, my heart lifting.
The doctor hesitated. “I can’t promise you that. His condition is still very serious. He has disseminated disease, which means the infection has spread through his bloodstream to other parts of his body. Cryptococcosis is a life-threatening illness for people with weakened immune systems, but now that we know what we’re dealing with and can treat it appropriately, he has a fighting chance.”
While that wasn’t exactly what I’d wanted to hear, it was enough to give me hope.
“Hang in there, Howie,” I told him, squeezing his hand. “They finally figured out what’s going on with you, and they’ve got you on some good drugs. Give it a few days, and you’re gonna be fine. Just keep fighting, okay?”
There was still no response from Howie. He didn’t look any different than he had the day before - no better, but no worse either. I prayed that we would start to see some signs of improvement soon. The next few days were critical.
Since the ICU allowed visitors at all hours, the guys and I worked out a schedule with Howie’s family to ensure someone would always be with him. We didn’t want him to wake up alone. Howie’s mom and siblings stayed at the hospital during the day, and we took over at night. AJ would head there after he’d put Ava to bed and sit with Howie until around eleven p.m. Since Brian’s family wasn’t in L.A. with him, he and I shared the overnight shift, keeping each other awake until Kevin came to relieve us at dawn.
By Howie’s tenth day in the hospital, I had adjusted to this routine as best I could. I was exhausted, but it wasn’t that hard to stay up all night and attempt to sleep during the day, considering I’d barely been able to sleep for the better part of a week anyway. It was always hard to leave Howie in the morning, but it helped knowing one of us would be there if something happened.
For the first two days after Howie was started on the new treatment, nothing changed. His labs didn’t look any better, the doctor told us; his electrolytes were all out of whack. His fever was high, and his blood pressure was low. There was still some inflammation in his brain, and without the ventilator, he wouldn’t be able to breathe.
But when Brian and I arrived on that third night, AJ met us in the hallway with a big grin on his face. “Hey, guys! Great news,” he announced. “Howie’s fever broke! His nurse said it’s been normal for the last few hours. That’s gotta be a good sign, right?”
“Thank God,” said Brian, as I nodded in agreement. It sure sounded like a good sign. If Howie no longer had a fever, that meant he was fighting off the infection.
As we said goodbye to AJ and headed to Howie’s room, I couldn’t help but notice the Thanksgiving decorations adorning the hall - fall leaves hanging from the ceiling, turkey decals stuck to the windows of each patient cubicle, and a festive cornucopia sitting on the counter of the nurse’s station. With everything that had been happening to Howie, I hadn’t realized the holiday was just around the corner.
“Do you think there’s any chance he’ll be out of here by Thanksgiving?” I asked Brian, as we settled into our usual seats by Howie’s bed.
“I don’t know if he’ll be out of the hospital by then, but hopefully ICU,” said Brian, taking a long look at Howie. He was still unconscious and hooked up to all kinds of equipment. I watched the slow, steady drip of his IV, as the heart monitor beeped softly in the background. “Thanksgiving’s in, what, five days?”
“Yeah, I think so.” It was hard to keep track of what day it was, especially with our circadian rhythms so disrupted. You could never tell if it was day or night in the ICU, where there were no windows to the outside world and the lights were always on. “What are you gonna do for Thanksgiving?”
Brian shrugged. “I guess it depends on what’s going on with Howie, but Kev and I are supposed to be heading home to Kentucky.”
“Littrell Family Thanksgiving,” I said, smiling.
“Yeah... you’re welcome to come with us, if you want to. You know you have an open invitation.” He smiled back at me.
“Thanks.” I had taken him up on his offer before, in years when I was estranged from my own family and didn’t have a significant other to spend the holiday with, but I hadn’t been to a Littrell family Thanksgiving in a long time. I’d celebrated the last six Thanksgivings with Lauren’s family. It would be weird not seeing them that year. “I’ll have to wait and see how he’s doing before I decide anything.”
Brian nodded. “I understand. No pressure, either way.”
“Thanks, Bri,” I said again, before turning my attention to Howie. If he hadn’t been released from the hospital by Thursday, there was no way I was going to Kentucky. I would spend Thanksgiving in the ICU with him if I had to. I wondered if I could smuggle in a turkey somehow.
That reminded me of something. “Hey, did you see this?” I asked Brian, pulling up a text from Leigh on my phone. She had sent me a photo of an art project James had made at school. Please show this to Howie when you can, she’d written. He told James he couldn’t wait to see it.
“No, what is it?”
I handed the phone to Brian so he could see. “Aww,” he said, smiling, as he looked at the picture. It was a Thanksgiving card with a painted turkey made from James’s handprint and a poem:
This isn’t just a turkey, as anyone can see.
I made it with my little hand, which is a part of me.
It comes with lots of love, especially to say,
I hope you have a very happy Thanksgiving Day!
Under that, James had written, I miss you Dad! Love, James, in his lopsided, little kid printing.
“Howie, man, you should wake up and see what your son made you,” I said, squeezing his shoulder. I had hoped maybe he would be more alert now that his fever was gone, but he showed no signs of even knowing we were there. He must have still been sedated because of the breathing tube, I told myself, but I couldn’t help but worry that the swelling in his brain had caused some kind of damage. What if Howie never woke up? What if he just stayed that way, like a vegetable, kept alive by machines?
I knew what the answer to that was. Howie had made it abundantly clear as we’d filled out the paperwork to make me his power of attorney. If there was no hope of a meaningful recovery, I was to pull the plug - take him off life support and let him die peacefully. I just prayed it wouldn’t come to that.
But no sooner had the thought crossed my mind than an alarm of some sort went off on Howie’s monitor. Startled, Brian and I both looked up to see a set of numbers flashing on the screen. “His blood pressure’s dropping,” Brian said, decoding what the numbers meant before I did. “Did you bump something?”
“I don’t think so,” I said uncertainly, standing up.
Brian got up, too. “I’m gonna go get somebody. Stay with him.”
My heart lodged in my throat as Brian ran out of the room. I looked down at Howie. His chest was still rising and falling steadily along with the mechanical hiss of the ventilator. Nothing appeared to have changed. I glanced back up at the monitor, watching the thin green line that measured Howie’s heartbeat spiking across the black screen, and I remembered what he’d told me: “I promise you... as long as my heart’s beating, I’m gonna do everything in my power to get better.”
“Hang in there, Howie,” I whispered in his ear, like I had every day he’d been unconscious.
I breathed a sigh of relief when Brian came back with one of Howie’s regular nurses, Ange. She had worked several of the night shifts we’d spent with Howie that week, and she seemed like someone who knew her stuff. Whatever was making his blood pressure fall, she would figure it out and fix it.
“Howie?” Ange said loudly, leaning over him. But before she could even finish examining him, the monitor suddenly went haywire. The green line looked like a child’s scribble, going up and down in random peaks and valleys. “He’s coding,” she said, silencing the alarm on the monitor. “Could one of you please hit that blue button on the wall? I need to start CPR.”
My knees buckled. I grabbed the back of my chair to steady myself, as Brian smacked the button that said “Code.” Ange lowered the head of the bed so that Howie was lying flat, disconnected the ventilator hose from his breathing tube, and began giving him compressions. It took probably less than twenty seconds for people to start rushing into the room, but it felt like an eternity that I stood there watching as she pumped Howie’s chest.
“Come on, Nick,” I heard Brian’s voice murmur in my ear and felt his hand on my back. “We need to move out of the way.” He nudged me toward an empty corner.
The room was swarming with medical staff and equipment by now. They surrounded Howie’s bed, barking out information and orders. Someone had gotten a stool for Ange so that she stood a head above everyone else, throwing her whole body weight into her compressions. Another nurse stood behind Howie’s head, squeezing a bag that was now connected to his breathing tube, while a third person wheeled over what I quickly realized was a crash cart. I watched as he pulled back Howie’s hospital gown and applied two large pads to his bare chest.
“Charge to two hundred,” said a woman in a white coat, who was standing at the foot of the bed. I recognized her as the resident who had intubated Howie a few days ago, Dr. Mikael. “Everyone clear.”
I saw several sets of gloved hands go in the air, as Howie’s body jerked with the jolt of electricity from the defibrillator. Beside me, I heard Brian draw in a sharp breath. I gripped his shoulder as we both stood back and watched, waiting for some sign that the shock had worked to restart Howie’s heart.
“Does he have a pulse?” asked Dr. Mikael.
“No pulse,” replied one of the nurses, holding Howie’s wrist.
“What’s his rhythm?”
“He’s still in V-fib.”
“Resume CPR, and give him one milligram of epinephrine.”
Ange swapped places with another nurse, who took over pumping Howie’s chest. It was painful to see his limp body flopping around with the force of the compressions. My own chest felt tight, like there was an invisible hand squeezing my heart, making it hard to breathe.
“It might be best if you two stepped out for a while,” said Ange, coming over to the corner where Brian and I were huddled, our arms around each other.
“No, please, let us stay,” I begged. “We wanna be here with him if he-” But I couldn’t bring myself to say the words.
“You’re looking a little pale,” Ange said, studying my face. “Are you sure you’re alright?”
I felt nauseous, but I nodded, knowing I had to be strong for Howie.
“He’s okay,” Brian replied quickly, rubbing my back. “We’re both just worried about Howie.”
“I understand,” said the nurse with a sympathetic smile. “Let me fill you in on what’s happening: We’re not sure exactly why yet, but Howie’s heart stopped beating. Right now it’s in an abnormal rhythm called ventricular fibrillation, which is really just a series of random twitches that aren’t strong or coordinated enough to sustain life. We’re trying to revert his heart back to a healthy rhythm with shocks from the defibrillator and drugs to raise his heart rate and blood pressure, and in the meantime, we’re doing CPR to keep oxygenated blood circulating through his body.”
I licked my lips and swallowed hard, my throat feeling uncomfortably dry. “As long as my heart’s beating, I’m gonna do everything in my power to get better,” Howie had promised. But his heart was no longer beating.
“Can he recover from this?” I croaked, trying not to cry.
Ange pressed her lips together tightly. “I don’t want to give you false hope. He’s in cardiac arrest, and his chances right now aren’t good. But as long as he has a shockable rhythm, we won’t give up on trying to resuscitate him unless you want us to stop.”
“No!” I replied, shaking my head. “Please, do whatever you can to help him. Don’t stop.”
“We’re doing everything we can,” Ange promised, patting my arm before she returned to Howie’s bedside, where the rest of the medical team were still huddled around. Brian and I stood in the background, watching them work on Howie. They injected more medication into his IV and continued CPR, stopping only to shock his heart again
“Come on, Howie,” I heard Brian whisper once or twice. “Come back to us, bro.” His hands were clasped tightly together under his chin, like he was praying. But nothing, not even prayer, seemed to help this time.
“Hold compressions,” ordered Dr. Mikael after the third shock. “Does anyone feel a pulse?”
One of the nurses shook her head. “Still no pulse.”
“He’s in asystole,” Ange said, looking at the heart monitor. Following her gaze, I saw that where there had once been a faint squiggle, there was now nothing but a flat line. It blurred before my eyes, as they filled with tears. I felt like throwing up.
“Let’s try another round of epi. Continue compressions.”
The male nurse was now in charge of the compressions. His biceps bulged beneath the sleeves of his scrubs as he pushed vigorously on Howie’s chest, making the line on the heart monitor leap to the top of the screen. But whenever he paused, the line would fall flat again.
As this was going on, Dr. Mikael walked over to where Brian and I were standing. “It’s not looking good, guys,” she said quietly. “We’ve done everything in our power to get Howie’s heart beating again, but nothing has helped. He’s been without a pulse too long. At this point, I don’t think we’re going to get him back.”
“No... no, please don’t give up,” I begged, as the tears started to pour down my cheeks. “Shock him again. Please.”
She shook her head. “I’m sorry, but it doesn’t work that way. Defibrillation stops the heart from fibrillating. It doesn’t restart the heart. Howie’s heart has no rhythm to shock, no electrical activity whatsoever. He’s clinically dead.”
I felt Brian’s arm come around me again, but I shook it off, not ready to be consoled. “No!” I cried, refusing to accept what the doctor was telling us. Howie was like a cat with nine lives; he couldn’t be dead. In the last year, he’d survived a suicide attempt, a liver transplant, an episode of rejection, and an AIDS diagnosis. He was indestructible. There was no way he would let this infection take him out now. “Can you please, please just keep trying? I know he can come back from this... I know he can. Just give him that chance.”
For a few seconds, the doctor just looked at me with pity, pursing her lips together. Then, finally, she said, “We’ll give him one more dose of adrenaline to try to get his heart going again, but if that doesn’t work, I’m going to have to call it. Do you understand?”
I forced myself to nod. “Thank you,” I whispered, wiping the tears from my eyes.
“You can come closer, if you’d like. Touch him... Talk to him. I don’t know if it will help, but it definitely won’t hurt.”
“Go ahead, Nick,” Brian said, nudging me forward.
I swallowed hard as I nervously approached Howie’s bed. The nurses who were not involved in CPR stepped back to make room for me, as the remaining two continued giving compressions and oxygen. There was an unsettling rhythm to their resuscitation efforts: the whoosh of air being forced through the tube in Howie’s throat every few seconds, the rattle of the metal bed frame vibrating as his body was repeatedly slammed against it at the rate of one hundred beats per minute.
I have to admit, it was creepy being up close to witness what they were doing to Howie. I felt horrible for him; these people were trying to save his life, but it was almost like they were torturing him. What they were putting him through seemed so harsh, painful, and artificial. It was hard to watch, and I wanted it to stop... but I wasn’t ready to give up on him yet.
“Hold on, Howie,” I begged him. “Think about your kids. Think about James. Think about Holden. They need you. I need you.” My voice cracked. “Please... stay with us.”
“Last round of epi’s in,” Ange said, as she injected another dose of the drug into Howie’s IV.
“Let’s continue CPR for two more minutes and give it a chance to work,” said Dr. Mikael. “Watch for any signs of return of spontaneous circulation.”
“Come on, man, you got this,” I tried to encourage Howie. “It’s time to prove you’re really indestructible and get that heart of yours going again. You hear me?”
But it seemed like Howie was beyond hearing.
“Hold compressions,” said Dr. Mikael when the two minutes were up. All eyes turned to the heart monitor, hoping to see a spike... but the green line stayed flat.
“Still asystole,” Ange said sadly.
The male nurse looked at Dr. Mikael. “Should I start compressions again?”
“Yes!” I shouted, before the doctor could answer otherwise. “I’m power of attorney, and I say we keep trying until-”
“Until what?” I heard Brian ask behind me, his voice cracking. He had been so quiet for the last few minutes, I’d almost forgotten he was still in the room, but now I whirled around to face him.
“Until his heart starts beating again!” I cried incredulously.
Brian looked at me sadly. “And what if that doesn’t happen? How long are you gonna let this go on, Nick?”
I felt a rush of anger at his sudden betrayal. “What the fuck, Brian?! Where’s your faith in God? What happened to believing in miracles, huh?”
Brian’s blue eyes were bright with tears. “I do believe in miracles,” he began, “but maybe this-”
“They brought you back, when your heart stopped!” I shouted over him. “What makes you think that won’t happen to him?”
He shook his head, the tears spilling down his cheeks. “My heart stopped for like thirty seconds. Howie’s been down for more than thirty minutes. There’s a big difference.”
I didn’t realize it had been that long. Turning my back to Brian, I looked at Howie’s body, lying limp on the bed. He had been through so much already. I could barely see his face behind the bag being squeezed over his mouth, but I could see the scar from his liver transplant fanning out from the center of his chest, where a pair of hands was pushing down repeatedly. Acting on my request, the nurses had resumed CPR, though their efforts didn’t seem quite as urgent as before. Either they were getting tired, or they were just going through the motions until someone told them to stop.
I picked Howie’s hand up off the bed and held it in mine. His fingers felt cold. I curled my own fingers around them and squeezed as tightly as I could, wanting him to feel my presence. “You’re not gonna die alone, Howie,” I whispered. “I’m here.” I brought his fingertips to my lips and kissed them gently. “I love you.” Then I slowly lowered his hand back down to his side and let go.
“You can stop,” I said quietly, looking across the bed at the nurse who was still leaning over Howie’s body with beads of sweat running down his arms as he continued to do compressions. “Brian’s right. He’s not coming back.”
With a solemn nod, the nurse took his hands off Howie’s chest. His partner stopped bagging. We all looked at the heart monitor one more time, wanting to make sure. When it flatlined, Dr. Mikael stepped forward with her stethoscope. She listened for a few seconds, then looked up at the clock on the wall. “Time of death, 23:45.”
For just a moment, it felt like my heart had stopped, too.