Galen Schram

Hugo’s surgical scar is a raw question mark on his scalp asking the world what the hell happened to him. You kneel beside the hospital bed to greet the forty-year-old and are pleased when he turns his head to the sound of your voice. The doctor who prepped Hugo for surgery to remove the clotted blood didn’t do him any favors by only shaving the left half. The playful curls of the right half seem blissfully unaware of the ambient, like when your uncle tried to start karaoke after your grandma’s funeral.

Hugo’s single room is cold and the shades of the window by his feet are raised to the morning fog over the East River. His cadenced heart monitor above your head makes you feel like you’re on a small spaceship.

“I’m Rafael, your physical therapist. It’s a new day and time to get up,” you say to him. Hugo pinches and wiggles his bushy eyebrows. Maybe this is his way of waving hello since he still can’t use his hands. They’re Velcroed to the bedrails to keep him from reaching for the flimsy cable monitoring the pressure from inside his skull. The doctor just removed it before your evaluation.

You offer Hugo a smile. He looks through you with absent eyes before jerking his head towards the woman dozing in the folding chair on his other side.

“Hi there. I’m Rafael,” you repeat in a louder voice. She continues to snooze with her hands clasped over her spheroidal middle. She’s old enough to be Hugo’s grandmother, though you learned long ago not to make assumptions about your patients’ relationships. A bedazzled flip phone sits on her bosom, attached to her neck by a lanyard. She wasn’t here on Thursday when you helped to roll Hugo’s somnolent body from side to side while the nurse changed the soiled linens beneath him. At that time it had been just over twenty-four hours since the air conditioner unit fell from the third floor window in the Bronx onto Hugo’s head.

Your stomach had dropped onto your bladder when you read that mechanism of injury in his chart. Hugo suffered an accident from the darkly cavalier cartoons of your childhood, an accident so catastrophically “New York” that hearing about it would stimulate paranoia for even the most level-headed city-commuter. The description in his chart included the T-shirt he had been wearing that read Little League Coach in block letters across the back.

The tang of urine wafts to your nostrils when Hugo begins to cycle his bare legs against the mattress. Now you understand why his blanket is balled up by his ankles. The sinewy muscles of his thighs flex and relax with each revolution of the imaginary bike. You tuck his gray hospital gown beneath his thigh to keep his groin covered. Next, you unfasten the Velcro binding Hugo’s wrists to the bedrail and grip his right palm.

“Squeeze my hand,” you instruct clearly, but he is already squeezing and releasing it in rhythm with his leg cycling, so you can’t be sure if he understood your instruction. You walk around to the other side of the bed. Before you continue your assessment you notice that his guest has woken up. You stand before her and wait until she’s finished fiddling with her hearing aid before telling her your name again.

“I’m sorry to be rude,” she says. “I can’t sleep on planes and I took the redeye from Miami. I’m Lucero, Hugo’s mother. He’s antsy today, isn’t he?”

“Yes, and that’s a good thing,” you reply.

Hugo’s neurologist had called you just as your shift started this morning. After spending most of the night attempting to rip the pressure monitor cable from his scalp, the doctor was optimistic about Hugo’s ability to participate in physical therapy today. “He’s waking up,” he had proclaimed, to which you replied, “Let’s see what he can do.” The two of you had exchanged a private spark that reminded you why you love your job.

Lucero sits on the edge of the folding chair clutching her flip phone while you explain to her why you’re there. She nods her understanding and you turn back to examine Hugo’s casted left forearm. The air conditioner unit shattered the two long bones in it before bruising his skull. Hugo’s quick reaction had likely saved his life.

He fails to say his name, stick out his tongue, or show you one finger when you ask him to. Lucero is on her feet behind you now, and from your periphery you notice the sway of her long pleated dress as she pulsates anxiously from side to side. She is mumbling words of encouragement to him with each of your instructions. Hugo’s gaze fixes on her, which sparks an idea. You invite Lucero to repeat the single-step commands.

“Hugo baby, I know I promised never to tell you what to do again, but right now I need you to stop writhing your legs and show me one finger,” she says, and displays her index as an example. Hugo continues to stare at her with wiggling eyebrows before lifting his arm and extending all five fingers. He grunts with the effort. Lucero gasps and looks to you. You beam at her. Then her phone rings.

“I’m going to have to call you back. Hugo’s getting his therapy now.”

You lower the bedrail and motion for Hugo to sit up.

“No, he’s not talking, but he sure is moving,” she says into her phone. Hugo kicks both ankles off the mattress and flops onto his side. You move closer to guard him from the edge of the bed but don’t touch him. You want to see if he can sit up without your help. This is a crucial part of your assessment, evaluating what intuitive motions remain programed in the injured brain.

“That woman is missing in action!” Lucero shouts into her phone. She turns a quarter away from you and cups one hand over her lips as if that would prevent you from hearing her words. Hugo is sitting upright on the mattress now, balanced but distracted. His attention is focused on his mother. His left foot bounces against the linoleum and you still it by placing one hand on his knee and pressing down.

“I always knew she was trouble. She called to say he was in the hospital, that they’ve been separated since Christmas, and I need to tell the social worker to put me as the emergency contact instead of her. That was the first either of them acknowledged my existence in over a year. I can’t piece together what happened between them and knowing Hugo, he wouldn’t tell me even if he could.”

Hugo nearly topples forward as he reaches his arms towards his mother like a toddler asking to be lifted. You brace his chest with your shoulder and guide his torso back over his hips until he is balanced once again. He places his left hand on the mattress and a glimmer from the gold band on his ring finger catches your attention. You’re not surprised when he leans forward towards his mother again, this time in an attempt to stand up. Instead of fighting his momentum you grip him tightly around the waist as he pushes through his feet, and now both of you are standing tall. Your nose is inches from the question mark.

Lucero snaps her phone shut and drops it onto her chest. When she turns back around, she’s breathing heavily and cooling herself off with a folding fan imprinted with the New York Yankees logo. When Hugo reaches for her, you shift his weight onto his left leg. He automatically takes a step with his right foot. His trunk sways for a beat before he recalibrates his center of gravity.

“Again,” you instruct him, and shift Hugo’s body to the right leg. He steps with his left foot.

“You’re walking, baby!” Lucero cries while you shift his weight for a third time. He’s still reaching both arms to her. You ask Lucero to move towards the door separating Hugo’s hospital room from the rest of the neurological intensive care unit. His feet cross one over the other with each step and his trunk lists to the left, but with your support he remains upright. You can finesse the gait pattern later. For now you’re relieved that his instinct to walk has been preserved.

Lucero waves him on. “Come to me, come on!” she repeats. Hugo’s eyebrows are static now, pinched together in deep concentration. He’s chewing his tongue. You sense through your fingertips that he’s exerting more control over his sway so you dare to loosen your hold around his waist.

When you are two feet away from her she extends her hands. Hugo bolts out of your grip. You lunge forward and grab him beneath the shoulders as he wraps his mom in an embrace. She drops the fan to the floor and takes one small step backwards to stabilize herself, but she’s okay. You hold your breath and the world becomes still. The only movement is Lucero’s hand caressing her son’s back.

“You did it, son. You did it,” she whispers.

Their moment is frozen in time and you can’t help but feel like its intruder. Yet between Hugo’s poor coordination and lack of awareness of his own strength, you become nervous that they might topple over. You hazard to give the pair another second.

“Good job, Hugo,” you say when you cannot wait any longer. You maintain one hand beneath Hugo’s shoulder and slide the other around his waist. He has loosened his arms from his mom, so in one fluid motion you redirect him away from her and towards the hospital bed. His sway is more pronounced on the journey back. He’s fatiguing but you’ve got him well secured to your side. You reach the bed and he plops into a seat on its side. You prepare to lift his legs to lay him on his back.

“Wait, wait, wait,” Lucero says. The wrinkles in her cheeks are deeper than before. “The only thing this boy loved more than me were his sneakers. He used to wear them to sleep. You want to wear your sneakers, Hugo?”

Hugo offers a joyful grunt that wrests a dimple on either side of his lips as he gazes into her face. Lucero proceeds to the cabinet beside the windowsill and withdraws a pair of white high tops. You think the crimson splatter across one of them is a checkmark until she brings it closer.

“He was wearing these when the accident happened. I don’t even know where he lives now or I’d take a taxi to get him clean clothes,” she says, stroking her thumb across the dried blood stain. She braces a hand on your shoulder and lowers herself to her knees beside you. She balks when you offer to get her a chair. You’re worried he will resist as she scoops his heels into the shoes one after the other, but instead he gently coos. Hugo sinks sideways into your arms until they become sore from the strain of holding him upright. When Lucero finishes tying the laces you rock him onto his back. He rolls to his side and tucks his knees to his chest. From this angle you can read the words Bronx Bombers in swirly writing along the base of each sneaker. For the first time since you met him, he lays still. You feel your own body relax.

You help Lucero to her feet, then reach for the blanket at the foot of Hugo’s bed. Lucero takes it from you and with a simple nod of the head, offers you thanks and farewell. You dare not sap the moment of its sanctity by speaking.

Before stepping out into the bustling intensive care unit you look back once more to watch Lucero tuck the blanket around her son.

Galen is a queer Quaker from Queens, a hospital-based physical therapist specializing in cancer rehab, and an avid runner. He has a Certification of Professional Achievement in Narrative Medicine from Columbia University.