November 1, 1994; Pg. A01

In a City Hospital, They Cling to a Costly Vigil.

Since a car hit Ziya, he has lain in a Coma. Only his Parents think he'll Wake.

By Shankar Vedantam

Ziya lies very still on the hospital bed, his uninterested gaze fixed on the blank television on the wall ahead. The gray screen looks back impassively.

It's 8 in the morning on the 38th day after the accident.

In the last few days, his eyelids have flickered, and small tremors have run through his arms and legs. When he blinks, he looks weary, as if all he wants is to rest for a while.

An array of tubes and meters and wires surrounds him. On his right, a black dial rotates and stops, rotates and stops. Each time it rotates, electrolytes drip into an intravenous tube that vanishes under his sheet.

Harry Anderson, Ziya's doctor at the Hospital of the University of Pennsylvania's trauma center, says the 23-year-old student's condition is hopeless, the central cortex of his brain damaged beyond repair. What's left is a shell, a body that breathes and digests food, but will never regain consciousness.

Part of Ziya's brain will go on responding reflexively to light and sound, telling his system when to wake up and go to sleep. His heart will beat. He will cough. But that is all.

Treatment seemed futile from the start; Anderson wanted permission to end life support. But Ziya's parents weren't available, so the doctors put him on a ventilator, pumped his body with drugs to fight infection, and had nurses with him around the clock.

Now that Ziya is stable on his own, Anderson says, a nursing facility could support him. The hospital is claiming $250,000 in charges, some of which may be paid by the state; there is little more it can do for him.

Ziya's parents, Aynur and Mustafa, believe otherwise. This is America, where the doctors are good. They know that technology - and their prayers - can bring him back.

The nurse comes into the room and checks Ziya's temperature. It has been zigzagging the last few days. It's down now, so she decides to remove the cooling blanket.

His eyes open and close as the two nurses roll him to one side and remove the cooling blanket from under him. He coughs, the supply of humid air through the trach-collar inserted in his windpipe interrupted.

§

Mustafa and Aynur Damdandusen arrive a few minutes after noon. They enter the room eagerly, looking at their son, looking for signs that he has improved.

Aynur speaks no English, and Mustafa knows only a few words. It was Ziya's accident that brought them to America after that terrible Sunday in September. It took three days to get passports, leave their daughter with relatives, and get on the plane.

Mustafa, 68, turns to the nurse as they enter the room. "Ziya . . . how . . ?" he asks, his palms upturned, questioning.

She nods. "OK. Temperature down." Her index finger describes the falling temperature.

Mustafa looks relieved. "Good," he says, groping for more to say. He can't find the words.

"Good," he says again.

He clasps his hands together, the palms at right angles to each other, the fingers closed tightly, a gesture of gratitude.

He and Aynur stand on either side of Ziya's bed, looking at the son they
sent to America with so many dreams, and with so much sacrifice. He had looked so wonderful when he left Istanbul, so handsome, so athletic. There is a moment of terrible silence as they look at him now.

Ziya blinks and a slight tremor runs through his right hand.

Aynur, 48, rubs her son's chest and then strokes his head. She runs her fingers through his hair and, with the backs of her fingers, in small circles on his cheek. "Ziya, Ziya," she calls to him softly. "Oglum . . . oglum . . ." my son . . . my son . . . "Ziya, oglum."

Mustafa places his face close to his son's ear. "Ziya. Ziya." His voice is sharper, the two syllables clear and distinct. Zi-ya.

And then Mustafa is talking into the air, the words pouring out in Turkish, thick, anguished. His hands are gesturing, how could this happen to my son? He is crying as he speaks, his strong features crumbling, the strength in his cheekbones gone. He suddenly looks terribly old. A broken old man who loves his son.

They both leave the room and lean on the counter of the nursing station. Aynur presses against her husband. He places an arm around her. She is crying, too.

Mustafa wants to know why, if the doctors say his son's reactions are all reflex, why his lips are moving.

He asks the nurse. "Why . . . my son . . . Ziya . . ." He points to his own lips: "Why he moves?"

The nurse shakes her head helplessly. She doesn't know. They should ask the trauma physicians when the doctors make their next rounds.

§

In late August, when Ziya left Istanbul for America, he kissed his mother on the back of her hand and on her wrist, and then hugged both parents.

"Don't be sad," he told them.

Ziya was going to America to get a master's in business administration at the Philadelphia College of Textiles and Science.

He made friends quickly in Philadelphia, and got together with buddies from Istanbul. He found rooms on the 4700 block of Larchwood Avenue in West Philadelphia. He loved to ride around on an old bicycle he found in the basement.

On Sunday, Sept. 18, witnesses saw Ziya hit by a car at Whitby Avenue as he was cycling toward his home.

The impact hurled his bicycle to the far curb. For a moment, Ziya hung in the air. Then he crashed against the windshield and roof of the speeding car. The impact threw him so violently, he brushed a tree branch 15 feet off the ground.

The car didn't slow down.

No one got a clear look at the occupants. Police found the car the next day, abandoned blocks from the scene, with Ziya's bloodstains.

A license plate check showed that it was a stolen car.

§

The midafternoon sunlight streams through the hospital windows as the nurses swiftly go about their work.

From down the corridor, Aynur's voice sounds thin, high-pitched, coming
from Ziya's room.

"Ziya, Ziya. Oglum. Bak yavrum." My son. Look, my child.

She repeats the call over and over. Her voice is a plea, a voice expecting response. She wants him to return to her. She will call him until he does.

Oglum, Ziya, bak yavrum.

But there is also hurt in her voice. Why doesn't he respond?

Mustafa closes his eyes as he sits on the chair next to the bed. He bows his head very slowly, until he looks as if he is praying or sleeping.

Aynur takes Ziya's right hand and massages it between her palms, then adjusts the sheet delicately around his neck. She wipes a drop of moisture that has trickled down the side of his eye.

From the start, the doctors told her it was futile. Ziya would never come out of the state he was in.

Anderson knew that if someone he loved was in a similar situation, he would have turned off life support.

No matter, Aynur had thought. We have hope. Go on.

Friends told her about another case where a Turkish man had recovered from a deep coma after 2 1/2 months. Then there was a young Turkish girl who had partially recovered from a similar coma after doctors had said she wouldn't survive.

Maybe the same thing could happen with Ziya, Aynur thought. The brain recovers slowly, and doctors say they know so little about it.

"By the grace of God, the accident took place here," Mustafa said through an interpreter. "If it had happened in Istanbul, Ziya would have died."

§

The hospital says it's time to move Ziya to a nursing unit or rehabilitation center, if one can be convinced that Ziya has a chance of recovery.

But most care facilities would demand several months' payment up front - an impossibility.

"As an honorable person I would like to accept my debt and pay it," Mustafa says. But his $200 monthly retirement pension as a bank official in Turkey will not allow it.

The hospital social workers say the best thing would be for Ziya to return to Turkey. Anderson has been in touch with a hospital in Istanbul that could manage Ziya's care.

But Mustafa and Aynur don't want that. "How can we take him back to Turkey, given the conditions there?" they ask.

When Mustafa was once at that same hospital, he had to drink milk directly
from a jug. Though it was the deluxe hospital, there weren't even any glasses.

And so they pray they can keep their son in this hospital. He is getting better, they know. He is young, he is strong. He needs at least three months. Did not the Turkish man - who was 45 - recover? And the young girl?

§

Late in the afternoon, Aynur unzips a small black bag. She removes two sheets of yellow paper with 20 lines of handwriting on each page.

Stroking Ziya's hair with the tips of her fingers, she reads from the paper. Her lips move, but her voice comes through only in snatches as she recites the prayer.

She reads the lines over and over for 20 minutes. Then she carefully folds the paper and puts it away.

Resolutely, patiently, she returns to her son: "Ziya, Ziya. Oglum. Bak yavrum."

§

In the early evening, a doctor comes by to explain that surgeons have to perform a minor procedure on Ziya tomorrow.

Aynur looks at her with concentration, then shakes her head. She turns her palm slowly upward with the fingers splayed: She doesn't understand. She suddenly looks very alone in the bright hospital room.

The doctor leaves, later finds Mustafa in the corridor, and tries again. Ziya may have to be moved back to intensive care, if he doesn't breathe well after the surgery tomorrow.

Mustafa shrugs. "Excuse me . . . I am speak . . . little English."

The anesthesiologist replaces more words with gestures and acting, to get across the idea of "breathing."

Mustafa nods tentatively. He doesn't understand completely, but he trusts the doctors.

Placing his hand over his heart, he says, "Thank you."

§

Mustafa says it's a sin to let someone die if it's possible to keep him or her alive. Both a crime and a sin.

"Allah gives us this possibility of life - it's wrong for us to take it away. All things are given to us by God."

No one should ever give up the will to live, Mustafa says. "You have to fight till you can fight no more." Aynur nods in agreement.

And so the couple come to the hospital every morning, spend the day trying to coax their son back to them, go home for a little sleep, and then return.

Aynur says that her prayers have been answered in the past when she has prayed for good things.

"If you believe in something," she says, "it will happen, if you pray."

§

Ziya's temperature is up again, 100.3 degrees.

Outside, it's very dark and the lights from Franklin Field Stadium seem harsh. Something has quieted in Aynur's and Mustafa's mood.

They roam around the bed distractedly, massaging Ziya's feet, kneading his fingers, and running their fingers through his hair. From time to time, one or the other leans forward and calls out his name.

The doctors have not come. Around 7, they send word that they will come by tomorrow. It has been a hectic day at the trauma center. They have received reports that Ziya has been stable. There was not much for them to do.

Mustafa sits on one chair and Aynur sits on the cushioned chair next to him. They perch on the edges of the seats, their arms folded. They sit like that for a long while, staring blankly at the ground.

And so they wait, Aynur, Mustafa and Ziya, silently absorbed in separate worlds.

§

At 7:45, the couple emerge from the room. They wish the hospital staff good night and walk to the elevator. They do not speak.

In the elevator, Mustafa mistakenly presses "12" - the floor Ziya is on. He realizes his error and presses "G."

The hospital has made arrangements for the parents to be taken home by the hospital's escort van. They are staying in their son's apartment, as guests of his landlord.

They wait on a bench, sitting close together.

A blast of cold air hits them each time the automatic doors swing open and shut. Aynur pulls the coat around her tightly, and raises the collar. Her fingers shield her face as she huddles.

Finally, the red van arrives. They walk out, Mustafa's hand on Aynur's arm, and climb into the van. The doors with the tinted windows shut and the van drives away.

§ § §