4.

Eben IV

Once in Major Bay 1, I continued to decline. The cerebrospinal fluid

(CSF) glucose level of a normal healthy person is around 80 milligrams
per deciliter. An extremely sick person in imminent danger of dying from
bacterial meningitis can have a level as low as 20 mg/dl.
I had a CSF glucose level of 1. My Glasgow Coma Scale was eight out
of fifteen, indicative of a severe brain illness, and declined further over
the next few days. My APACHE II score (Acute Physiology and Chronic
Health Evaluation) in the ER was 18 out of a possible 71, indicating that
the chances of my dying during that hospitalization were about 30
percent. More specifically, given my diagnosis of acute gram-negative
bacterial meningitis and rapid neurological decline at the outset, I’d had,
at best, only about a 10 percent chance of surviving my illness when I
was admitted to the ER. If the antibiotics didn’t kick in, the risk of
mortality would rise steadily over the next few days—till it hit a
nonnegotiable 100 percent.
The doctors loaded my body with three powerful intravenous
antibiotics before sending me up to my new home: a large private room,
number 10, in the Medical Intensive Care Unit, one floor above the ER.
I’d been in these ICUs many times as a surgeon. They are where the
absolute sickest patients, people just inches from death, are placed, so
that several medical personnel can work on them simultaneously. A team
like that, fighting in complete coordination to keep a patient alive when
all the odds are against them, is an awesome sight. I had felt both
enormous pride and brutal disappointment in those rooms, depending on
whether the patient we were struggling to save either made it or slipped
from our fingers.
Dr. Brennan and the rest of the doctors stayed as upbeat with Holley as
they could, given the circumstances. This didn’t allow for their being at