When Quintana wakes from her coma in January of 2004, Didion tells her that her father has died. Quintana seems to understand, but later that night she asks after her father again. Quintana does not manage to absorb the news until months later, when she is again in an ICU, this time in Los Angeles.
Soon after Quintana wakes up, she is discharged from Beth Israel and taken to Didion’s apartment to recuperate. The next morning, she awakes with chest pain and a fever and is taken to Columbia Presbyterian, where she is diagnosed with a pulmonary embolism, a condition that should have been foreseen by her doctors at Beth Israel. Placed on anticoagulants, she is discharged again several days later. Quintana helps her mother plan John’s funeral service. On the night of the funeral, the family gathers in Didion’s apartment, and though Quintana is still fragile, she stands up at the service and enjoys visiting with her cousins at dinner. Several days later, Quintana tells Didion that she and her husband Gerry are flying to Malibu to restart their life, a plan that Didion encourages.
Didion must figure out how to restart her own life, now that her daughter is better and the funeral is over. The day of Quintana’s trip, Didion imagines Quintana and Gerry arriving in Los Angeles and wandering along the beach in Malibu. Quintana would be able to take Gerry to her favorite restaurants and childhood haunts. While preparing to go to dinner that evening, Didion receives a call from Tony, telling her that he is coming over to the apartment. Didion assumes that something has happened to Tony’s wife Rosemary, who has been in ill health, but Tony says that Quintana is undergoing emergency neurosurgery at UCLA Medical Center. While crossing the street to the rental car shuttle at LAX, Didion learns, Gerry had looked back and had seen Quintana lying on the asphalt. An ambulance had been called and Quintana was taken to UCLA. Upon arriving at the emergency room, she had lost coherence and had begun convulsing. A CT scan was performed, and by the time they brought her in for surgery her pupils were fixed and dilated. The CT scan indicated a subdural hematoma, a traumatic brain injury in which hemorrhaged blood puts pressure on sensitive brain tissue. Quintana had seemingly recovered from a life-threatening situation but now was at greater risk than ever before.
Tony arrives at the apartment and they call Gerry into the ER, where Quintana’s prognosis has upgraded to the point that the surgeons believe she will leave the operating table. Didion attempts to plan a flight to Los Angeles until Tony tells her that being in flight during Quintana’s surgery would be a bad idea. Instead, Didion contacts two friends in Los Angeles, who go to the hospital to wait with Gerry. She then calls a friend to ask if she can use his house in L.A., and he offers a seat on a private plane he’s taking there the next day. At midnight, Gerry calls to report that the surgery is over and Quintana is undergoing another CT scan. At 4 a.m., he calls again to say the CT scan is clean and a screen has been placed in her heart to prevent clots. The next morning, before leaving to catch the plane, Didion looks up “fixed and dilated pupils” (or FDPs) and learns the chilling fact that few patients survive after having FDPs, and the majority of those that do become vegetative or brain-dead.
Didion’s hopes for personal recovery are disrupted by Quintana’s collapse and rehospitalization, which shatters the opportunity for healing. The grief process is typically structured along a process of improvement, and the various stages of recovery have become ingrained into our cultural consciousness. Didion is no different in her expectations that, after facing the greatest personal trial of her life, things will eventually start to improve. Didion vividly imagines this for Quintana as well, taking comfort in an idyllic fantasy of her daughter recuperating on a warm beach in Malibu. Though the news that Quintana is at greater risk than ever before feels shocking and emotionally devastating in its own right, the disruption of her own narrative of progress and improvement heightens its intensity. It also opens up another opportunity for magical thinking. Didion has to believe that Quintana is getting better, because after John’s death something good has to happen. Quintana’s subdural hematoma seems to betray the pattern of recovery Didion expects her life to follow and adds a level of disruption and shock that changes the direction of the rest of the memoir.
Once again, Didion depicts her shock at the news formally, pulling herself and her personal feelings out of her description of events to emphasize that she felt anesthetized and emotionally withdrawn. Once again, Didion becomes a “pretty cool customer,” listening and absorbing the new information without describing her emotional response. While the previous chapters began to open up to analysis and self-examination, Didion’s narrative voice shuts down emotionally and is stripped down to a stark, detached style of reporting that lays out the events simply and evenhandedly. The tonal shift mirrors the evolution of Didion’s grieving process. While John’s death had been a crippling and painful blow, during Quintana’s recovery she had begun to see possible opportunities for healing. Quintana’s health became her focus, and her daughter’s steady improvement seemed to suggest that Didion too could recover. Didion suddenly has to face the fact that, after losing her husband, she now faces the possibility of losing her daughter. Plunged into a state in which healing and recovery seem impossibly far away, Didion ceases to include the thoughtful self-analysis or emotionally informed exposition that had begun to emerge in preceding chapters. In the chapters where Didion feels the most, she is the least present as a character.
Didion draws parallels between John’s death and Quintana’s collapse, which underscores the suddenness of both events and the degree to which they leave confusion in their wake, taking the illusion of agency completely out of Didion’s hands. Both collapses occur in the middle of a moment of action and set off a chain reaction of institutionalized responses. Both Didion and Gerry are powerless observers who must listen to, process, and disseminate information to the necessary people. After John’s death, Didion had been able to take steps toward gaining more agency over her situation, following the expected procedures of planning a funeral, conducting research, and going through a process of self-examination. Though the resulting agency was limited, Didion was still able to take some measure of control in a situation in which she was powerless. Once again, the rug has been pulled out from underneath her, putting her back into a position where she is a helpless observer. Didion uses the parallels to emphasize how suddenly her husband and daughter had collapsed, but also to emphasize how, even after she attempts to regain some stability in her life, she finds herself subject to a catastrophic situation entirely outside of her control.