by Gary Kinder
“How is he?” he asked softly.
“Hello, Paul,” nodded Rees. “He’s got a lot of fluid in his lungs, and he’s been shot in the head. We were just discussing whether he can tolerate Jim opening his head and taking a look inside.”
“Do you expect he’ll live?”
Rees hesitated, then shook his head. “No, we don’t think so.”
Paul walked back to where Fran Heward was still standing with Maureen near the entrance. “Where’s By?” he asked.
“He’s gone over to the McKay,” said the supervisor. “He’s trying to find out whatever he can from the other survivor.”
“Have any of the kids been notified?”
“Just Brett, he should be here in a few minutes. I just hung up talking to him, but I haven’t been able to get hold of the other two yet.”
“Okay, where’s a phone? I’ll try to get in touch with Gary and Claire myself.”
Brett Naisbitt exuded the same energy and jocularity as his father, although as a child it was manifested in unpromising ways. He was the little boy who was always in a fight, who laid the plastic vomit on the teacher’s desk, who had a daily appointment with the principal to discuss all the bad things he had done in school that day. Nevertheless, Carol Naisbitt once told Brett’s wife Diane, “Of the four children, I think I enjoyed Brett the most because he was so funny, and so unpredictable.”
As a man, Brett had blond hair, green eyes, and a face lighted by a warm, pleasant smile. Though he was three inches shorter than his brother Gary, his shoulders were thick and wide. In college Brett had a quick mind and imagined himself studying to become a doctor, but instead of attending classes he preferred to ski five or six days a week in the nearby Wasatch mountains. He never graduated. He married Diane, a stunning girl with blond hair and blue eyes, when he was twenty and worked a succession of jobs as a house painter, roofer, coal shoveler, and motel manager. He also cleaned the kill floor of a meat-packing house, worked in a chemical lab, and journeyed into the Brazilian jungle to organize a diamond importing business. Now twenty-five, he had gravitated to medicine. He was an operating room technician working in general surgery and occasionally assisting neurosurgeons or the Ogden open-heart team. That morning he had scrubbed with Dr. Hauser on a craniotomy at the McKay-Dee Hospital.
For Brett and Diane it had been a pleasant evening of dinner with Diane’s parents and some of her nine brothers and sisters. The family affair broke up about ten thirty, and Brett and Diane began a leisurely drive home to Riverdale, a suburb west of Ogden. They were traveling north on Harrison Boulevard, taking the long way home, when they heard sirens coming up one of the side streets from town. Then a motorcycle cop suddenly swung onto Harrison heading south. No sooner had the motorcycle made the turn than an ambulance swerved onto Harrison behind it. Both sirens were blaring as they came around the corner, and their lights were flashing. Brett commented that whoever was in the ambulance had probably had a heart attack. But Diane had other thoughts about the passenger in the ambulance.
When we saw the ambulance, I got this funny feeling. I even said to Brett: “That ambulance really has me worried. I think it’s somebody in our family.” Brett said, “Oh, don’t be silly.” I didn’t know if it was my family or his family. I just had this feeling. So I said to Brett, “Please follow it.” Which is silly, but I wanted him to. He kept saying, “No, that’s stupid.” And I said, “Brett … please … follow … that … ambulance.” And he said, “Everything’s all right, don’t worry, it’s none of our family.” You know. He convinced me that it was all right. We later found out that it was his mother.
By now the ambulance had disappeared and Diane’s plea began to seem rather silly even to her. They continued their drive out Harrison, then looped over to Washington Boulevard and back south again through downtown Ogden. They drove past the Hi-Fi Shop. Farther down Washington Boulevard they turned onto Riverdale Road and headed west. As they neared Riverdale, Brett began to notice the large number of police cars on the streets. With their lights flashing and sirens wailing, several had passed by earlier. Now they were pulling into deserted shopping centers, combing side streets and alleyways in search of something or someone.
“There’s really a lot of action tonight,” Brett remarked. “I’ve never seen it like this, something really big must’ve happened.”
At home they put their newly adopted baby, Natalie, in her crib and went straight to bed. The ambulance was forgotten, the police cars were forgotten, and soon they were asleep. Then the phone rang. Brett was awake immediately.
“Brett, this is Frances Heward at St. Benedict’s. I think you better get over here right away, there’s been a bad accident and your dad needs your support.”
“What happened?” said Brett. “Is he all right?”
“He’s okay,” said the supervisor, “it’s your mother and Cortney, they’ve been in an accident and your dad needs your support. Hurry on up to Intensive Care.”
“What’s wrong with them?”
“Just hurry over here.”
It hit me like a great big wave, a rotten, sickening feeling. It just turned me inside out. I didn’t know what to think, or what to do, I just felt panicked. I started shaking immediately, could hardly control myself. I hurried and threw some clothes on, and Di grabbed Natalie and I drove them back to her mother’s. On the way we tried to rationalize the situation. We figured, now they’ve probably been in a car accident, and they would have been in the station wagon, Cortney and Mom, and they had probably been to a show, and so they couldn’t be hurt too badly because the theaters are close by and the station wagon is a big car. We had it all figured out that everything would be all right. So I dropped them off, and then I just raced to the hospital.
I came into the emergency room and they told me to go to ICU on the third floor. So I went flying up there, and I got out of the elevator and started running down the hall and Uncle Paul stepped out of the waiting room there and he grabbed me by the shoulders and he told me that there had been a shooting down at the Hi-Fi Shop and that Mother had been shot and killed, and Cortney had been shot and probably wouldn’t make it… . You just can’t believe something like that is real. You’re sure it is, but you hope it’s a dream, hope any minute you’re going to wake up. It was like I was paralyzed. I just stood there saying, “No, no.” And I started crying. Uncle Paul took me into the waiting room and had me sit down for a while. He had to convince me that Mother was dead, that there was nothing I could do for her. Then after that, I wanted to see Cort.
So I went in there, and he looked terrible. He really looked dead to me. They were doing the cutdowns on his wrists and ankles when I got there, putting in the monitors and the IVs and all that stuff. They had him wired from one end to the other, and he started looking more and more bizarre as it went on. It looked just like a Frankenstein movie, all the paraphernalia… . I was panicked, just barely keeping it all together. A million things are going through your mind, and adrenaline’s surging through you, and then I had this wild rage when I thought about him being shot by those characters. I would have given anything to get my hands on them.
I had been there about twenty or thirty minutes when Dad came in. He had been over at the McKay talking to the other survivor. When I saw him standing there, I ran over to him and we embraced and didn’t say much of anything for a while, I was just crying. Course, he was tough. He was what really got us through it all. We all kind of glided in on his coattails, his strength… . After a while I asked him what had happened, and he explained it, best he knew at the time. He just said that Cort had been down at the Hi-Fi Shop and got caught up in the middle of a robbery, and then Mother came down looking for him, and they got her too, and then the guy shot Mother and killed her; and he said that … I said are you … I just kept asking him, “Are you sure she’s dead?” you know. He said, “Yeah, she’s really dead.” And so I asked to see her, and he said, “Well, you can’t, she’s already … she’s already gone.�
�� It just … it just … it’s so hard to believe. It’s like hearing a story about someone else.
In another corner of Intensive Care, Drs. Hauser, Rees, and Wallace were at a disturbing, but familiar, crossroads: Did the boy have enough of a brain left to warrant saving? It was an old question, but one made fresh by the circumstances of each patient. On the one hand, Cortney was strong and young, able to endure anoxia better than an adult. The bullet had not entered his brain. His pupils had shown some vague reactions to light, and according to a blinking orange bulb on the respirator panel, he was assisting the machine on each breath. On the other hand, despite the physical damage done to his brain by the concussion of the bullet, and the damage to his internal organs precipitated by the acid, there was really only one question: Hadn’t Cortney far exceeded the few minutes even a young brain can survive without oxygen? Once the brain has been deprived for its limit, it begins to die, the more specialized functions being the first to shut down. When those brain cells have died, they cannot be regenerated.
While the nurses administered to Cortney, the three doctors huddled at a table in a room next to the boy’s, doing what they had done a thousand times before: second-guessing death. If they kept Cortney alive, could they make him whole again? If they couldn’t make him whole, was dying now preferable to putting his family through an agonizing and futile coma? Was it more benign than bringing him back only to a state of profound mental and physical deformity? They couldn’t answer these questions until after they had done everything they could to keep the boy alive. And then it would be too late to choose for him a quick, painless death.
A cup of hot coffee sat on the table in front of each of the doctors. Jess Wallace, as an emergency physician, had no further responsibility for Cortney, but was included in the consultation because of his original contact with the patient and his experience working with trauma.
“I’ve caught hell so many times,” he told the other two, “it doesn’t make any difference anymore. And I’ll probably catch hell on this one, but downstairs, even in the first few minutes, I saw something in the kid that triggered me to move on him as fast as I could. Maybe it was his pupils, they seemed to react just a little when we shortened that dead air space.”
As a neurosurgeon, Hauser’s chief concern was the boy’s pupils. They were the surest, outward indicator of brain damage. When he had examined the boy earlier, he had seen no deviation in their wide, fixed position.
“I’m still not comfortable with his eye signs,” he commented. “But then again, it’s encouraging to me to see his blood pressure’s coming back.”
“What the hell,” said Wallace, “we talk about using our clinical judgment in cases like this and really it’s more like ESP or witchcraft if we end up doing the right thing.”
Rees had his arms folded and was leaning back in his chair, rubbing his eyes. “The fact is,” he said, “I have never seen a patient this dead make a comeback. I really haven’t.”
Hauser agreed with Rees.
“I don’t think that matters at this point,” said Wallace. “I think you’ve got to keep going balls to the wall on the kid just to … how do I say this? … just to give some sort of psychological support to By.”
Wallace had verbalized what was becoming apparent to the other two doctors.
“I don’t see how the boy has a chance of making it,” said Hauser, “but after this double whammy, I’m not at all sure how much more By can take, either.”
Rees was yawning. “We’ve got to do something,” he said. “I just don’t know if he can make it through brain surgery.”
“If I do anything about that pressure in his head,” said Hauser, “it’s going to have to be soon. Burr holes won’t accomplish much if all we find is pulped brain, but if we can evacuate something besides brain, like maybe a blood clot, he might have a chance.”
“Oh, hell,” said Rees, “if he doesn’t have the burr holes, he’s not going to make it anyhow, I guess, so any way you look at it we’ve got nothing to lose. One thing,” he continued. “By probably understands the situation better than most people, but I want to explain everything to him. I want him to be fully aware of what’s going on, and what the possible consequences are.”
Byron Naisbitt stood not far away, his arms around Brett, consoling him in a little alcove by the Intensive Care nurses’ desk. Brett’s tears had dried upon his face, leaving his eyes encircled by puffy flesh. Byron gripped him tightly, watching as Dr. Rees and Dr. Hauser came toward them.
“By,” said Hauser, “we don’t need to elaborate on how serious Cortney’s situation is. I want to take him to surgery and open up his head so we can get a better idea of where we stand. Dick’s got him stabilized as best he can, but we don’t know if he’s strong enough to tolerate surgery like that, he might not be. On the other hand, if we don’t operate soon to try to relieve that pressure, it’s going to kill him anyway.”
Byron’s face was expressionless. He stood with his arm around Brett and listened. When Hauser had finished, he said: “I understand what you’re up against. Just do whatever you can for him.”
“There’s something else, By,” added Rees, “and I think we should get it out in the open right now. I probably don’t need to tell you this, but we want to make sure you’re fully aware of it.”
He paused for a moment and Byron nodded his head as though he already knew what the surgeon was going to say.
“If Cortney somehow pulls through all of this,” Rees continued, “if we can keep him alive, we may be creating a monster. We may get him back to a certain point and then wish we hadn’t.”
Byron said nothing at first. He had realized much earlier that before the night was over, he would have to make a decision. He could allow his son to die peacefully as he lay. Or he could beseech the doctors to keep him alive, despite the consequences. It upset him to think that even if Cortney lived, he would be deprived of doing all the things he had wanted to do. But then he thought, being alive’s better than being dead.
“Yeah, I’ve thought about that,” he said. “But I want you to go ahead and do everything you can. We’ll worry about the rest of it later.”
For the surgery a single rule was established: The respirator assisting Cortney’s breathing would be put on Demand, so that if the boy initiated a breath, it would assist him and flash the orange light each time. If he quit tripping the respirator, if the orange light went out, it would mean that even the central, more primitive part of his brain was gone. If this occurred during surgery, rather than keep alive the heart and lungs in a person whose brain had died, Dr. Rees would simply unplug the machine.
A three-member surgical crew, including an anesthesiologist, an RN, and an operating room technician, had been summoned to assist Dr. Hauser in the exploratory operation. But when Hauser phoned the operating room to give instructions for setting up the operation, he discovered that the OR technician wasn’t qualified to assist in neurosurgery. Ironically, the only person in the hospital qualified to scrub for neurosurgery was Brett Naisbitt. Brett overheard Hauser’s phone call and volunteered to scrub for the operation. His face still appeared stung, and Dr. Hauser questioned whether assisting in the operation would be too much for him to absorb emotionally. But Brett had already acquired a full set of pa-jama greens, the antistatic slippers, pants, top, and tie-back cap, and was walking down the hall to surgery to set up the scrub for the operation on his brother.
Though she stood a few inches taller, Claire Naisbitt seemed cast in her mother’s image. She was petite and had blond hair and moist green eyes, and there were freckles dusted lightly across the bridge of her nose. She was a pretty girl, “a girl you’d see and not soon forget,” recalled a high school classmate. Of the Naisbitt children Claire, now twenty-two, had always been the achiever: the cheerleader, the honor society member, the class officer, the award winner. At home she was the peacemaker among her brothers. But beneath her tact and achievements and appealing face lay concealed a certain
soft sensitivity. She was quick to make someone feel better with a card or a kind word; she never forgot a birthday and was hurt if someone forgot hers.
Two weeks prior to her parents’ trip to Hong Kong, Claire felt moved to write them a note. It was something she did occasionally, a thoughtful reminder to her parents of how much she loved and appreciated them. The note remained unwritten, however, until the day before their departure, when she finally sat down and wrote a card to her parents. At the airport to see them off, she handed the sealed card to her parents. It simply wished them a safe trip and added, “I just wanted you to know how much I love both of you.”
Claire had envisioned her parents in the air, opening the note and merely smiling to each other as they began their trip to the Orient. But after the last passenger had boarded, and Claire stood at the window, waiting for the plane to take off, she was surprised to see her mother coming back off the plane. Carol ran inside the terminal and hurried up to her daughter.
“What in the world are you doing?” Claire laughed.
Her mother hugged her. “I just wanted to tell you how much we love you. Claire, honey, that was the sweetest note.”
“Oh, that’s just how I feel,” said Claire.
“Well, it was thoughtful of you to do it. You’re mighty special to us.”
“You’d better hurry,” Claire cried, “You’re going to miss your plane!”
“Oh, they’ll wait,” said her mother. She kissed Claire and started toward the ramp. “We’ll see you in a couple of weeks.”
Claire waved and yelled, “Have fun!” She was glad she had written the note.