by Joy Fielding
“Still …” Warren interrupted, obviously wrestling with his thoughts. “Her quality of life …” He cleared his throat. “I know there’s no way she’d want to spend the rest of her life in this condition.”
“I know how hard this must be for you, Mr. Marshall….”
“It’s not me I’m thinking about,” Warren protested vehemently. “It’s Casey. We’d actually had this conversation. You remember that woman, I forget her name, the one who’d been in a coma for years, whose husband wanted to disconnect her feeding tube and put her out of her misery, but her parents were desperate to keep her alive, and they went to court, and it was such a mess, a real media circus, and I remember Casey said that if, God forbid, anything like that ever happened to her, I had to promise I’d put an end to her suffering….”
Yes, I remember saying that.
“You’re saying you want to disconnect her feeding tube?”
No, you mustn’t do that. Not now. At least not until we find out who’s responsible for what happened to me.
“No, of course I’m not saying that.”
I need to know who’s responsible.
“To be honest, I don’t know what I’m saying anymore, Dr. Keith. I know that Casey wouldn’t want to spend the rest of her life this way, and I just want to do what’s right. I don’t want her to suffer anymore. I feel like such a traitor because I know I’m being selfish, that I’m not ready to let her go.”
What would she do if their situations were reversed, Casey suddenly wondered, if it was Warren lying comatose in this hospital bed, unseeing and unmoving, week after week, and she was the one standing watch over him? Would she not be saying the exact things he was saying now? Would she not at least be considering them?
“The situation is very different here,” Dr. Keith explained gently. “The woman you’re referring to was in a profound vegetative state. She was never going to regain consciousness. We still don’t know that’s the case with your wife.”
“When will you know? A year from now? Five years? Fifteen?”
Fifteen years? Dear God, no. He’s right, Dr. Keith. There’s no way I want to live like this for another fifteen years. Or even five. Five months is more than I can bear to think about. I’ll go mad. Warren’s right, Dr. Keith. I’d rather be dead than go on living like this.
But not yet. Not until I know who did this to me.
It was this mystery, she realized, as much as the various tubes to which she was connected, that was keeping her alive. It was more engrossing than anything she’d been listening to on TV, more stimulating than the conversations of her friends, more riveting than her myriad doctors’ reports. The fact that someone had tried to kill her filled her waking thoughts and occupied her brain, like a stubborn squatter. How bitterly ironic, Casey thought, that her main reason for living had come down to finding out who wanted her dead.
“I know this is difficult,” Dr. Keith said. “But there’s every reason to be optimistic. Your wife has already beaten the odds. She survived an accident that would have killed most people. Her bones are healing nicely. Her heart is strong. Her condition is improving daily. She’s off the respirator and breathing normally. Her brain is functioning, albeit at a slowed, decreased rate of activity.”
“What about doing an EEG to determine the exact level of brain function?”
“We only perform an EEG if we think the brain is dead. Because your wife’s body is functioning, we know that’s not the case. We just have to give it more time, Mr. Marshall. We don’t know anything for sure….”
“This assessment coming from the top neurologist in the city,” Warren said with bitter resignation.
“The brain is such a complicated organ. Here, let me draw you a picture.”
Casey heard the accompanying rustling of paper, the clicking of a ballpoint pen.
“This is the brain,” Dr. Keith began, as Casey imagined him drawing a large circle on the back of her chart, “and this area at the bottom is the cerebellum.”
She fought to remember such details from her high school biology class, berating herself for not having paid closer attention. She imagined a smaller circle trespassing into the bottom right half of the first.
“The brain is connected to the spinal cord by the brain stem, which is full of nerves, twelve to be exact, that control the various senses, as well as—”
“Is there any chance my wife is more aware than we think?” Warren interrupted. “That she can see or hear?”
Casey felt herself holding her breath. Could they tell?
“Highly unlikely,” the doctor responded. “But that’s relatively easy to find out. We could do an opticokinetic nystagmus, commonly referred to as an OKN test….”
“Which does what, exactly?”
“We use a cone-shaped instrument with alternating squares of light and dark, and we spin it slowly in front of the patient’s eyes. A normal person will blink with the change from light to dark.”
“Surely the attending physicians have already performed that test.”
“They have. Several times,” the doctor agreed. “Once, after your wife was admitted, and again later, after her surgeries. But we can certainly order the test again, if you wish, although …”
“Although …?”
“Well, I would think that if your wife could see, she’d be doing everything in her power to let us know.” Casey heard a deep intake of air. “Are you suggesting your wife could be deliberately faking her condition?”
“What? No. Of course not,” Warren said quickly. “Why? Is that even possible?”
“Well, there is such a thing as a neurotic reaction to stress. Conversion hysteria whereby high anxiety turns physical. It’s not voluntary, so the patient isn’t deliberately malingering. But I’d say we could rule that out in this case. We could test for corneal sensation, I suppose,” he added after a brief pause.
“Meaning what?”
“We put a wisp of cotton on the cornea. It will produce a very powerful blink, tell us whether sensation to the eye is being received. It’s very hard to suppress a blink.”
“But she does blink.”
“A purely reflexive act. What I’m talking about is blinking in response to a direct stimulus.” Casey felt the doctor leaning over her. She heard a click. “You see,” Dr. Keith continued, “I’m shining this light directly into your wife’s eyes. A normal person would blink. A person in a coma doesn’t.”
“Which means she can’t see anything,” Warren stated.
“Which doesn’t mean that might not change tomorrow.”
“And to find out if she can hear? I read about something called ‘ice water calorics’?”
“I see somebody’s been surfing the Net,” the doctor remarked, an indulgent smile in his voice.
“Dr. Keith, the idea that my wife could be conscious but unable to communicate, that she could be a prisoner of her own body, trapped inside her head, desperate to let us know …”
“I understand your frustration, Mr. Marshall, but the test you’re talking about is more than a little drastic. It involves squirting ice water directly into the eardrum with a syringe in order to stimulate the vestibular system. The patient will react by throwing up, possibly even convulsing….”
I don’t care. Do it. Do it.
“But if it meant we’d find out for certain whether she could hear or not …”
“Believe me, ice water calorics will raise you from the dead.”
“Then maybe we should do it.”
We should definitely do it.
“I’d prefer to start with something a lot less invasive.”
Like what? Yelling in my ear?
“I’ll order a BSAEP,” the doctor said. “That stands for brain stem auditory evoked potential.”
“How does that work?”
“We put earphones over the patient’s ears,” Dr. Keith explained. “Then we present a series of tones—clicks mostly—given at different rates, frequencies, and levels of in
tensity. We record the brain’s response with electrodes, and the results go into a computer. We can actually see waveforms responding to the stimuli. This can be a bit tricky because we also have to separate the microvolts the brain is producing from the ones being put out simultaneously by the heart, lungs, and other organs. The computer has to remove these external noises and register only the ones from the brain. If the picture we get on the screen is flat, that means the brain cell is dead. If there are waves, it means she can hear.”
“Fine. Do it.”
Do it.
“Again, Mr. Marshall, I have to remind you we’ve already performed this test….”
“But not lately,” Warren stated.
“No, not lately. Tell me, has something happened to make you think your wife’s condition has changed?”
“No. Not really. It’s just something my wife’s sister said last week that I can’t get out of my head. She said that sometimes Casey gets this look on her face, almost like she’s been listening, as if she understands….”
Casey felt the doctor move in again to examine her more closely. “Frankly, I don’t see anything in her expression to indicate that. But then I’m not family. You know her much better than I do. And anything’s possible. So why don’t I schedule the auditory evoked potential test and we’ll take it from there.”
“How soon can you do it?” Warren asked.
“I would think we could get it attended to pretty quickly. Tomorrow or the next day.”
The sooner the better.
“You have to be prepared that even if the test indicates your wife can hear,” Dr. Keith added, “that doesn’t mean she necessarily understands what she’s hearing.”
“I understand. I just have to know.”
“Try not to make yourself too crazy, Mr. Marshall. If your wife can hear, which we know she couldn’t even a month ago, then that means her condition is improving. It could even mean she’s on the road to a complete recovery.”
A complete recovery, Casey repeated. Was it possible?
“Have you thought about where you’ll be sending her for rehab?”
“I’m taking Casey home,” Warren said forcefully.
“You might want to reconsider that,” Dr. Keith advised. “Casey is going to require round-the-clock care for at least another two to three months. She’ll still be connected to an IV; she’ll have the feeding tube; she’ll need to be moved every few hours so she doesn’t develop bedsores. Taking care of her will be a full-time job. It’s much too much for you to handle. If you’d like, my secretary can give you a list of places….”
“I’ve already arranged for a nurse and a physical therapist,” Warren told him, “and I’ve ordered one of those special beds to rotate her electronically.”
“Well, then, I see you’ve thought of everything.”
“I think my wife would prefer to be at home, Doctor.”
“I’m sure she would. Good luck, Mr. Marshall.”
Casey listened as Dr. Keith walked from the room.
“Well, did you hear that, Casey?” Warren pulled a chair close to her head and sat down. “We’re going to find out if Drew was right, if maybe you can hear. Wouldn’t that be something?”
It would be a start.
“If you can hear,” he continued, hesitating briefly before going on, “if you are listening, I want you to know how much these last two years with you have meant to me. You’ve been such a great wife, Casey, the best lover and companion any man could hope for. Our time together has been the happiest time of my life. It’s very important to me that you know that.”
I do know that. I feel the same way.
“Mr. Marshall,” a voice interrupted from the doorway.
Oh, for God’s sake, Patsy. Scram.
“I’m sorry to intrude. I saw Dr. Keith in the hall. Is everything all right?”
“Everything’s fine.”
You don’t stand a chance here. Go away.
“You’re sure? You look so sad.”
“I’m fine. And please, call me Warren.”
“Warren,” Patsy repeated softly. Casey could almost hear her purr. “How’s Mrs. Marshall today?”
“No real change.”
Casey felt a shift in the air as Patsy approached. The smell of lavender suddenly swirled around her head, danced beneath her nostrils, and sunk into her pores. Casey grasped at the scent as if it were the air itself. Was it real? And if it was, what did it mean? That another of her senses was returning? And if her sense of smell was coming back, how soon before her other senses returned as well? How long before she could see and move and speak, before she was a human being again, before she could hold her husband in her eager arms and whisper soothing words of love into his ear, just as he’d been doing before Patsy’s well-timed interruption? How long until she had the pleasure of telling Patsy exactly what she could do with her fake words of sympathy, and just where she could shove her good wishes?
“I see her hair’s growing back nicely where they had to shave it,” Patsy remarked, propping up the pillows behind Casey’s head. Then, “Is something the matter with your neck?”
It took Casey a second to realize Patsy was addressing Warren.
“Oh, it’s just a little stiff,” Warren replied. “I must have slept on it funny.”
“Here, let me have a look. I took a course last year in massage therapy.”
Of course you did, Casey thought.
“A woman of many talents.”
“I like to think so. Where is it bothering you?”
“Right here. Yeah, that’s the spot.”
“You’re really tight,” Patsy said. “This shoulder, too.”
“I didn’t realize I was so tense.”
“Are you kidding? What do you expect? You’re here every day, sitting in this uncomfortable chair, worrying yourself sick over your wife. I bet you’re not getting enough sleep. Your whole back’s probably a mess.”
Warren groaned.
“Just relax into my fingers. That’s right. Now take a deep breath.”
Warren inhaled.
“Now release it slowly. That’s good. And again.”
Another deep breath, followed by a prolonged exhalation.
“What you need is a proper massage to get rid of all these kinks.”
“What I need is for my wife to get well,” Warren said.
“You getting sick isn’t going to make her any better. You have to take care of yourself, Mr. Mar—Warren. Otherwise, how are you going to manage when she comes home?”
“Well, I’m counting on you to help me there. That is, if that offer you made earlier is still open.”
Oh, no. This is not a good idea.
Casey didn’t need eyes to see the smile that spread across Patsy’s face. “Of course it is. My bags are all packed and ready to go. As soon as you know Mrs. Marshall’s release date, you tell me. I’ll be there.”
“It’s a big house. You’ll have a very nice room, right next to Casey’s.”
What do you mean? Where will you be sleeping?
“Do you think it’s safe?” Patsy asked sheepishly.
“Safe?”
“You don’t think that whoever tried to kill Casey might try again, do you?”
Warren’s sigh trembled into the surrounding air. “I think that Casey’s accident was just that,” he said sadly. “The rest is nothing more than coincidence and conjecture.”
Was Warren right? Casey wondered. Could it be just a coincidence that the person who’d run her down had entered the parking garage immediately after she had, that Detective Spinetti had fashioned his theory out of pure conjecture?
“God, that feels good,” Warren was saying. “Anybody ever tell you that you have magic hands?”
“What’s going on here?” a voice interrupted. “I was under the impression the one in the bed was supposed to be the patient.”
“Janine,” Warren stated, his voice filling the room. “I had a bit of a stiff neck. Patsy wa
s just—”
“Patsy can go,” Janine said pointedly.
A hurried movement. The scent of lavender retreating.
“Sure it’s just your neck that’s stiff?” Janine asked dryly.
“I could use some coffee,” Warren said tersely. “You want me to bring you anything back?”
“No, thank you.” Janine sat down in the chair formerly occupied by Warren, brushed her long fingernails soothingly across Casey’s forehead. “What was that all about?” she said.
ELEVEN
“What’s this all about?” Casey heard herself cry, a tearful sixteen-year-old waving the morning newspaper in front of her father’s bemused face. “I don’t understand. How can you let them write these things? Why don’t you sue?”
Her father laughed off Casey’s outrage. “Let them say whatever they want. Sticks and stones. They have no proof of anything illegal.”
“Illegal?” Drew repeated from her place between them at the kitchen table. “You did something illegal?”
Ronald Lerner ignored his younger child, as if she wasn’t there.
Casey groaned silently in her sleep, distant memories of her father brushing up against her hospital bed. She’d always thought that if there was one word to best describe Ronald Lerner, it would be “too.” He was too handsome, too rich, too charming, too athletic, too successful. His hair was too soft, his hands too big, his voice too smooth, his smile too seductive. Everything—women, money, accolades, power—had always been his for the taking. His exploits—and they extended as far back as high school—were legendary: the time he’d seduced the principal’s secretary into letting him have a peek at the final chemistry exam; the time he’d not only talked his way out of a parking ticket but ended up in bed with the meter maid; the time he’d dated the most popular girl in school only to ditch her for her mother.
Casey’s paternal grandfather had been a successful trader in the stock market and had left his only child an inheritance of several million dollars, which the son had parlayed into a serious fortune approaching almost a billion. Along the way, Ronald Lerner had acquired the well-earned reputation of being shrewd, savvy, and not averse to cutting corners. There were constant rumors of his womanizing, which he never denied, and the occasional whispers of somewhat shadier shenanigans, which he always dismissed as the grumblings of jealous, small minds.