Red Garden Hoses

Part one

The next several posts comprise a fictional story exploring a physician’s experience with critical illness, told through three perspectives: his ICU doctor’s, his wife’s, and his own.

At the end of 2025, I underwent a routine orthopedic procedure on my left arm. On postoperative day one, as my neurons emerged from the chemical haze of general anesthesia and pain medication, the idea for this story emerged.

We live in the present, but the present moment is just that—a fleeting moment. Our stories are inexorably linked to our ability to form new memories about the future and to retrieve old memories, about present moments that are now past. What happens when those connections are broken?

In the time that followed my operation, during the liminality of medical leave as a physician, through late nights and early mornings created by disrupted and uncomfortable sleep, and in the weeks before Christmas, I watched as sentences unfolded on the screen in front of me.

This is part one of four.

Alice O’Brien

Dr. Alice O’Brien arrived at Seattle Medical Center for her last of seven days rounding in the ICU. The unit had a view of Rainier, and for the first time that week, O’Brien saw the familiar mountain in the distance, silhouetted in rays of early-morning sunlight.

She loved her job, but O’Brien was also looking forward to the end of her time on service. Her husband Will was home with their two-year-old daughter, named Ophelia. He was holding down the fort during O’Brien’s seventy-plus-hour week in the unit, sending pictures of Ophelia ice skating and the two of them at the zoo. O’Brien was glad for the photos, which helped her feel present in Ophelia’s life, even on days when it felt like she was not.

But the images also triggered complicated feelings for O’Brien. Feelings familiar from her time training in Boston. Feelings she thought she had dealt with, through therapy, and with time. Joy and excitement. Inadequacy and guilt. They had come roaring back after Ophelia was born, as O’Brien tried to “do it all” even when she knew she could not. Will had been wonderful, was still wonderful, but sometimes that made O’Brien feel even worse.

Some days, she knew she had done enough. Her patient—the young doctor, flown in from Montana—was getting better, ready to come off ECMO. She knew his road to recovery remained long, but it was more clearly defined than when he arrived.

Jasper Townsend was the third patient O’Brien rounded on with the team that morning, and he was doing better than the two other patients in the unit on ECMO. When the team arrived in front of Jasper’s room, his nurse Ryan spoke up before the intern started.

“Can we wait for me to get his family?” asked Ryan, looking at O’Brien. “They’re in the waiting room and wanted to join for rounds.”

“Of course,” said O’Brien. She knew if it were Will in the bed, she would insist on being present for rounds, at a minimum. While Ryan walked down the hall to the family waiting room, O’Brien examined Jasper. He looked peaceful, but O’Brien noted the strings of tubing carrying sedatives into his body. His hands, and even his fingers, were swollen from fluid shifts and immobility.

Ryan returned, and behind him walked Jasper’s mother Vanessa, who the team recognized from her presence since Jasper’s arrival. Her simple but clean hair and makeup were flawless, and her wardrobe as expected. She wore a silk blouse, a matching, merlot-colored jacket and skirt—the subtle embroidery simultaneously both luxurious and understated—nude hose, and black heels. O’Brien could not imagine herself looking like the woman. But then, O’Brien had gotten the sense there were few parallels between Vanessa Townsend’s life and her own. Behind Jasper’s mother were two more visitors, neither known to the team.

First was a woman with wavy, walnut-brown hair, striking but delicate features, and fair skin, with remnants of summer freckles on her cheeks, unobscured by makeup. She was just shorter than Vanessa, and younger, perhaps even younger than Jasper. The woman wore a cotton blouse—with blue stripes on a cream base—a below-knee-length, navy-colored skirt, and tan flats.

On her hip, the young woman balanced a child—presumably she was his mother. The boy was cherubic, with white-blonde hair and plump, rosy cheeks. He held a worn stuffie—a horse—in his hands.

When the trio arrived at Jasper’s room, Ryan resumed his post as his computer, holding his rounding notes.

“Thank you so much, Doctor O’Brien, for waiting,” said Vanessa, breathless after the quick walk back from the waiting room. “I want to introduce you to Madison Townsend, Jasper’s wife,” she finished, stepping to the side and inviting Madison forward with her hand.

O’Brien recalled her examination of Jasper. His left hand bore no ring, though that was not unusual—they would have removed it at the hospital in Montana, and given it to his wife. There had been no ring tan, nor indentation, but he had come from winter in Montana, and his fingers were swollen.

“You can call me Maddie,” said the young woman, stepping forward with the child. “That’s what Jasper always called me…calls me…anyway.” She looked from O’Brien into the room at Jasper, before down at the white floor tiles flecked with blue.

O’Brien noticed Vanessa smile tightly, her jaw set almost imperceptibly.

Maddie held the child on her right hip, and with her left hand she rubbed a plain, white-gold ring, which hung on a simple chain of the same material around her neck. The ring finger on her left hand bore a matching band, along with a modest engagement ring comprising a solitary diamond.

“This…this is Jasper’s…” she said, indicating the ring on the chain.

Vanessa stepped over to Maddie, taking the boy from her hip, beaming.

“And this is my precious grandson. Jasper’s son, Teddy, named for my late father-in-law.”

“Yes, Teddy is our son,” cut in Maddie. “And he has very much missed his Daddy. As have I.” She looked in at Jasper as she finished speaking, wiping a tear from the corner of her eye.

“I’ll take Teddy to the waiting room, dear,” said Vanessa, in a lilting voice. “As I’m sure the presence of such a young child in the ICU is…highly unorthodox.” She smiled, turned, and walked back out to the waiting room.

O’Brien, who had yet to fit in a word, turned to Maddie and the team, “Right, welcome, Maddie. We’re going to talk shop, and then at the end, I’ll tell you the highlights, and you can ask questions, OK?”

Maddie nodded, swallowed, and took a deep breath. “Yes…yes, OK, I’ll listen.” She glanced back into the room, asking, “Could…could I just, listen from in there…and hold his hand?”

“Of course, Maddie,” replied O’Brien.

Ryan summarized overnight events and Jasper’s status that morning. Then, the intern began discussing the plan, with corrections and redirections from others on the team. They spoke for nearly ten minutes. At times, O’Brien nodded, frowned, or drew in her brow. From her position holding Jasper’s hand, Maddie’s eyes were fixed on O’Brien. In return, O’Brien noticed her careful attention, somehow both focused and overwhelmed.

Once the team formulated their plan for the day, O’Brien turned to face Maddie.

“The punchline is, he’s getting better, and I think he can come off ECMO today,” said O’Brien, smiling and watching Maddie’s face. She still looked concerned.

“Did I hear…” she hesitated, releasing Jasper’s hand and taking several steps away from the bed, toward O’Brien, “…did you say…he had a seizure? Is he awake, now?”

“The seizure was yesterday,” O’Brien answered, gently. She took three steps forward toward Maddie, crossing over the threshold into Jasper’s ICU room. “But we haven’t seen more seizure activity.” She paused, pointing to the EEG monitor screen. “And the head CT—the pictures of his brain—it didn’t show anything concerning.”

“He’s still sedated,” added Ryan. “He wakes up when it’s off, moves everything, but he’s agitated, not directable, and we need to keep him safe, with all this equipment.”

“But…” Maddie continued, as two wrinkles appeared in the otherwise smooth skin between her subtly shaped eyebrows, “…if there wasn’t anything concerning, then…why did he have seizures? Is there something wrong with his brain?”

“CT isn’t perfect. It shows big, bad things, which he doesn’t have,” replied O’Brien, imagining herself asking the same questions as Jasper’s brave, young wife. “We can get an MRI once he’s off ECMO, to look for anything more subtle.”

“Okay…okay…thank you…everyone. For…” Maddie’s stalwart voice caught, “…for taking care of him, when I couldn’t be here.” As she finished, she glanced back down the hall, toward the waiting room.

She looked at O’Brien before stepping back to hold Jasper’s hand, as the words tumbled out, “It wasn’t because I didn’t want to be here…of course I did…I love him so dearly. He’s my heart…our world. It’s…it’ just…a little complicated, is all.”

“Of course, Maddie,” said O’Brien, walking further into the room and putting her hand on the Maddie’s shoulder, as they both looked down at Jasper in the bed. “And we are doing all we can, to get him well, back to you, and to Teddy.”

With these last words, Maddie seemed to wince.

Recalling Maddie’s concern for her husband’s brain, O’Brien added, “He’s through the worst of it now, Maddie, but the road to recovery is long, and only time will tell us…will tell you…what that will look like.”

Maddie nodded, looking up from Jasper and into O’Brien’s eyes.

“Thank you,” she whispered, “for everything.”