Seven Letters

by Sinéad Moriarty

  Mia felt tears pricking her eyes. She wanted to shake him. ‘I’m all the family you’ve got left, Dad!’ she wanted to shout. ‘Let’s be nice to each other.’ Instead, she said nothing and pushed down the hurt she felt with the last gulp of her coffee.

  ‘That was Robert.’ Olivia came back in, beaming. ‘He’s just finished working on the Kerrigan tribunal. The newspapers were full of praise for him. But he’s never had anything other than praise. He has such a brilliant mind. Honestly, people say he got it from me, but I don’t know about that. He’s such a wonderful son, always checking in with me. He was asking for you too, Charlie. He sends his best wishes.’

  Mia tried not to stare, or laugh, at the big black seed stuck between Olivia’s front teeth.

  Adam came rushing through the door with Rob. ‘Thank God! I thought I was late for the meeting with the medical team.’

  ‘No, it’s on at ten, another five minutes to go. Johnny’s on his way too,’ Mia said.

  Adam fell into a chair. ‘Izzy was acting up again this morning so we were late for school. Poor little thing, she’s so upset.’

  ‘She never stops asking about her mum – it’d break your heart,’ Rob said.

  Johnny walked in. ‘Bloody bus was delayed,’ he muttered, and sat down beside Mia.

  ‘I don’t know what to tell Izzy about Sarah. Should I tell her Sarah’s never going to wake up?’ Adam asked. ‘Rob thinks I should start dropping hints.’

  ‘In my humble opinion, honesty is always the best policy,’ Olivia said.

  ‘I agree with Rob,’ Mia said. She had always liked Rob – he was like a toned-down version of Adam. Less driven, softer. Mia had only got to know him a little at Sarah and Adam’s wedding, then the odd time when he was home for Christmas or a week’s holidays. Sarah had loved him. They’d hit it off from the minute they’d met.

  Looking at Rob’s fresh face, made Mia realize how much they’d all aged since Sarah’s collapse. They were a haggard bunch, worn down by emotion and sleepless nights.

  ‘Maybe start planting the idea gently, like mentioning she may not get better and things may get worse, just to try to prepare her,’ Mia suggested.

  ‘How can he tell Izzy that her mother’s dead when she’s in there being kept alive with a baby inside her?’ Charlie pointed out. ‘How can a little child get her head around that when I still can’t?’

  Olivia rushed over to him. ‘Now, now, Charlie, calm yourself. You mustn’t get upset. It’s bad for your heart.’

  His heart’s broken, Mia wanted to say, but she held her tongue.

  The door opened, and Angela came in. ‘If you’re ready, I’ll take you upstairs.’

  Charlie, Adam, Rob, Johnny and Mia followed her. Olivia stood up and kissed Charlie. ‘I’ll be here, waiting for you,’ she said. ‘Good luck.’

  Angela brought them back to the same conference room on the fifth floor where they’d been told that Sarah would never recover. Mia hated it. She stood beside Rob, getting a coffee from the percolator in the corner of the room. The medical team filed in, led by Dr Mayhew. There were six of them, which immediately made Mia nervous. She hadn’t met some of them before.

  ‘What do you think this is about?’ Rob whispered.

  ‘I don’t know, but I doubt it’s good.’

  Rob swore softly. ‘I don’t think Adam can take any more bad news. I’m worried he’s going to have a breakdown.’

  Mia put her hand on his arm. ‘I think we all are, Rob. We just have to pull together.’

  Dr Mayhew, Ms Johnston and Professor Irwin sat down. Mia and the others took the chairs opposite them.

  ‘Good morning,’ Dr Mayhew said. ‘I’ll start by introducing my colleagues whom you haven’t been introduced to yet. They are helping us monitor Sarah’s case and providing assistance to the key workers. This is Peter Long, consultant obstetrician, Karen Harrington, anaesthetist, and Kevin Strong, who heads up our neonatal paediatric team.’

  ‘Is Ben OK?’ Adam asked, the moment Dr Mayhew stopped speaking. It was a question he asked at least twenty times a day.

  ‘Yes, for the moment,’ Dr Mayhew said. Mia saw him take a deep breath. Uh-oh, this was definitely not going to be good news.

  ‘I’ve asked you all here today as Sarah’s closest relatives to discuss her treatment going forward. This is a tragic and most unusual case. We are all deeply sorry for you, her family, and we’re mindful of the pain and confusion you’re enduring. But we feel it’s important to be honest with you and to keep you abreast of Sarah’s condition. I’m sorry to say that it deteriorated late last night. She has unfortunately developed an infection in the drain site on her skull. There is fluid in her lungs and the additional complication of a urinary tract infection.’

  ‘What?’ Adam’s face reddened. ‘Well, you’re not doing your job properly. You’re not keeping her sterile or – or being careful enough with cleanliness. Give her antibiotics, clear it up.’

  ‘Serious infection is almost inevitable in this case,’ Professor Irwin said. ‘You must understand, she has a huge amount of IV lines, central lines, catheters and drains, all of which are essential to monitor her condition and treat her ongoing problems, but they also mean that infection is essentially impossible to prevent, despite our best efforts.’

  ‘But can’t you cure the infection with antibiotics? Or will they harm the baby?’ Mia asked.

  ‘It’s more serious than antibiotics,’ Dr Mayhew answered. ‘There is also evidence of cardiovascular instability now, which will require high doses of medication. There is evidence of hypertension relating to fluid overload. Sarah’s body has now swollen further due to a build-up of fluid.’

  ‘Sweet Jesus, my poor girl.’ Charlie sobbed. Mia reached over to squeeze his hand. She tried to take in and understand all the medical information.

  ‘Her pregnant abdomen is extremely swollen, and I have grave concerns that there may be an infection underneath,’ Ms Johnston explained gently. ‘We have not been able to identify all the sources of infection. Sarah’s temperature rose to thirty-nine early this morning, which would mean the temperature in the uterus could be up to forty degrees. The foetus is not designed to be incubated in anything other than the normal temperature. The higher the foetus’s temperature, the quicker the enzymes will work and the faster it will get through the available oxygen. The stretchmarks of the pregnancy are abnormally discoloured, indicating retained fluid. Sarah’s blood pressure rose sky high and we have had to treat this with high doses of drugs. Some of the drugs and antibiotics we have had to administer, and will have to administer, to keep the body alive are not licensed for use in pregnancy.’

  Leaning forward she added, ‘This is a really pressing issue now. There is a very real threat of sepsis. If that occurs, Sarah’s blood pressure will plummet. If that happens, she will require inotropic support, which is not recommended for a foetus in utero.’

  ‘Jesus,’ Johnny muttered. ‘Poor Sarah.’

  ‘We have studied all the available data in great detail and discussed it at length. I am very sorry to say that we do not believe it is realistic, or indeed safe, to continue with somatic support until the foetus reaches viability,’ Dr Mayhew concluded.

  Mia didn’t know what she felt – devastation? Relief? Grief? It was a blur. But a thought was growing at the edge of her mind and spreading out: It’s finally over.

  She looked at Charlie and Rob, and saw the same conflicting thoughts written on their faces. Then she looked at Adam, and she knew it wasn’t over.

  Adam’s face was red and he was shaking with emotion. He pointed his finger across the table at the medical team. ‘You’re all trying to blind me with medical jargon. So, Sarah’s gone downhill a bit and has fluid. Drain the fluid, get her infection under control and her blood pressure, and let’s see what happens. Loads of pregnant women get high blood pressure and infections. It’s not the end of the world. No one is pulling the plug on Ben. No one.’

  Adam’s bloodshot eye
s were wild. ‘Don’t forget that report, the one Johnny found. The Heidelberg report said that babies of brain-dead mothers can survive. The problem here is you lot. Sarah should never have got an infection. That’s on you. So fix it. Fix my wife. Do your bloody jobs.’

  There was an uncomfortable silence following this outburst. Rob leaned on the arm of his chair, closer to his brother.

  ‘If I may,’ Peter Long spoke up. ‘I’m afraid your reading of the Heidelberg report seems to have given you false hope. I just want to talk you through the findings. Of the nineteen cases reported, there was one foetus that was fourteen weeks old when the mother was declared brain-dead. The baby died in the womb. There were two other cases involving foetuses that were thirteen weeks old – one was here in Ireland in 2004. The baby died in utero eight days after its mother suffered a blood clot in the brain. The other, whose mother was injured in an accident in Germany in 1993, survived for thirty-eight days before dying as a result of miscarriage.’ Dr Peter Long paused. ‘We estimate the foetus in this case to be about fifteen weeks now. We do not believe it is possible to continue life support for seven or eight more weeks. The chances of the foetus thriving and the baby being born alive are minuscule. I’m truly sorry to tell you this, but the foetus will not survive the storm going on around it. I’m very sorry to be blunt, but your wife’s brain is now pouring toxins into the bloodstream. Her condition will continue to deteriorate and affect the baby detrimentally.’

  Adam threw his hands into the air in frustration. ‘I’ll take minuscule. My wife is dead. My seven-year-old daughter is distraught. I have nothing but this tiny speck of hope that my son will survive and I’m taking it. We wanted this baby so much …’ His voice broke, but he took a deep breath and carried on. ‘Sarah was so happy. I know she would want me to fight until the end. I will not give up all hope. You will go in there and you will keep my son alive, do you hear me? Alive.’

  ‘Hey,’ Rob put his hand on Adam’s shoulder, ‘take it easy. No one is giving up.’

  ‘It’s not giving up,’ Dr Mayhew said quietly. ‘At this point, it’s accepting the sad reality of the situation. We are trained to preserve life, that is our number-one priority, but we are also trained to recognize where life cannot be preserved. Please, Adam, listen to the facts. We’ve done our level best, but we cannot save the foetus.’

  ‘His name is Ben,’ Adam roared at them. ‘For Christ’s sake, stop calling him “the foetus”!’

  ‘Stop it,’ Charlie croaked. ‘Please, for the love of God, stop this, Adam. She’s gone, and the baby has no chance of surviving. My girl is dead in there. It’s not right. It has to stop.’

  Mia put her arm round her sobbing father. She felt so many things at once, she couldn’t think straight. But seeing Charlie so distraught was unbearable.

  ‘Maybe it’s time to think about letting go, Adam,’ Johnny said.

  ‘NO!’ Adam shouted. ‘No way! No one is giving up on Ben. No one.’ He stood up. ‘Do your jobs!’ he shouted at the team, then stormed out of the room.

  Dr Mayhew watched him go, then turned to them. He looked very shaken. ‘We’re truly sorry. We’ve never had a case like this and we’re devastated for you all. It’s the hardest thing I’ve faced, and I’ve been doing this job a long time.’

  Mia looked at the doctors’ faces. They were all in shock and distress too.

  ‘It’s a heartbreaking case,’ Ms Johnston murmured. ‘Just awful.’

  ‘I’m very sorry for my brother’s behaviour,’ Rob said. ‘He’s not sleeping, and he’s consumed by grief, so he isn’t thinking as he normally would. I’m sure you can understand that.’

  Dr Mayhew nodded. ‘We can, of course. And we’re sorry to have bombarded you all with the bleak details, but it’s essential there is a clear understanding of the current situation. Perhaps you could talk to Adam,’ he said to Rob. ‘As next-of-kin, the decision rests with him. If Adam could see that the foetus has absolutely no hope of surviving, it would help him to make an informed decision.’

  Rob rubbed his face. ‘I do hear what you’re saying, but Adam is in Hell right now and it is his decision and we have to respect that. Let’s just give him some time.’

  Johnny helped Charlie up and he and Rob led him slowly back to the waiting room. Olivia jumped out of the seat and rushed over. ‘Oh dear. Bad news?’

  Mia nodded. She was grateful that Olivia was there – she needed someone else to comfort Charlie. She couldn’t do it right now. Olivia held Charlie in her arms and clucked over him lovingly.

  ‘I’ll go find Adam,’ Rob said.

  ‘Thank you,’ Mia said. ‘I know this is really hard on you, but you’re being an incredible brother to him.’

  ‘Thanks. He’s my only family. We always have each other’s back.’

  Johnny hugged Mia. ‘Hey, I’m so sorry but I have to get to the school.’

  ‘Now?’ Mia said, confused.

  ‘Teacher-training. Half-day,’ he said.

  ‘Oh, God, I’d forgotten. Of course.’

  ‘Will you be OK?’ Johnny asked.

  ‘I’ll be fine. Thank God you remembered about the half-day. Go and get her. She’s the priority. Thanks, Johnny.’

  He left and Mia didn’t want to sit in the room with Olivia and Charlie. Her mind was racing and she needed to think. There was only one place she could do that – with Sarah.

  She went to the nurses’ station and grabbed gloves, apron and mask and started to put them on. Angela came out of Sarah’s room and froze when she saw her.

  ‘Mia, I have to warn you, Sarah’s had a bad turn.’

  ‘I know, they told us.’

  ‘She doesn’t look good. You might get a bit of a fright. The swelling is very bad now.’

  ‘I need to see my sister, Angela,’ Mia said, tears rolling down her face.

  ‘Of course you do. Would you like me to stay?’

  Mia shook her head.

  ‘Well, I’ll wait outside in case you need me. I’ll be just here.’

  Mia opened the door and walked over to the bed. She looked down at her sister. Her hand flew up to her mouth and she screamed. The body lying in the bed wasn’t Sarah. This body looked like a monster. She was completely bloated and puffy. Her eyes were so swollen that the lids would no longer close. Pus seeped out from the drain in her head. Oh, my God, Sarah? What have they done to you? What have we done to you?

  Mia’s vision was blurring and her head felt light. She heard running feet and her body was falling in space until hands grabbed her. Then blackness.

  31

  Mia came to in the ICU waiting room.

  ‘Are you all right?’ Charlie asked.

  ‘Just give her a minute to catch her breath,’ Angela told him.

  Mia looked up. Adam, Rob, Charlie and Olivia were all staring at her.

  Angela handed her a glass of orange juice. ‘Drink that.’

  Mia took a sip, then closed her eyes, but the image of her bloated sister flooded back and she opened them quickly.

  ‘What happened?’ Rob asked.

  ‘Sarah,’ Mia croaked. ‘She looks … she looks like a corpse. I can’t … Oh, God, she’s really dead …’

  ‘Jesus Christ,’ Charlie said. ‘This has to stop.’

  ‘We have to stop it,’ Mia said. ‘It’s not right. It’s not Sarah in there, it’s a … a rotting corpse. No baby could survive. I can’t believe this is happening.’ She sobbed. ‘It’s bad enough losing Sarah, but like this? Oh, my God, it’s so cruel.’

  ‘Is she that bad?’ Charlie asked, looking at Mia in shock.

  ‘Worse than you could imagine, Dad. I don’t think you should go in.’

  ‘No, Charlie, your heart can’t take it,’ Olivia said.

  ‘She’s not so bad, it’s just bloating and infection,’ Adam said. ‘It’ll clear up.’

  ‘She’s a monster,’ Mia said, her shoulders shaking.

  ‘Ben is alive! She’s fighting for him,’ Adam said.

 
‘No, no, no. It’s wrong. I see that now, Adam. She’s gone. They’re gone.’ Mia’s sobs filled the silent room.

  Rob cleared his throat. ‘Is there any way of halting the deterioration or of clearing up the infections and bringing down the bloating?’ he asked Angela.

  She shook her head. ‘I’m sorry, but it’s probably going to get worse. Her body is breaking down.’

  ‘Ah, God, my poor little girl.’ Charlie buried his face in his big white hankie.

  Olivia rubbed his back. ‘Adam, please listen to them. Sarah is gone, the baby cannot survive. The experts have said so. You have to let her go now, for everyone’s sake. Poor Charlie can’t take much more. It’s killing him.’

  Adam stepped back from them. ‘No. No, no, no, no. We keep going. We keep fighting, we do not give up. Ever. Do you all hear me? EVER.’ He turned and strode out of the room.

  Mia wiped her eyes. ‘Rob, you’re the only one he’ll listen to. You have to talk to him. What we’re doing to Sarah is not right.’

  Rob nodded. ‘I know. I get it. But he’s just clinging on to the last thread of hope. You can’t blame him for that. Let him calm down. I’ll try talking to him. But don’t push him on this. He’s too angry and upset right now.’

  Mia knew that Rob was right, but if they didn’t make Adam stop this horror show, Sarah would suffer more and it would get worse and the outcome would be the same. Sarah and the baby were not going to survive. It was over. It had to be over. It was inhumane to let her decompose like that. They had to make Adam see.

  Mia lay on the bed fully clothed while Johnny rummaged around in the chest-of-drawers.

  ‘I know Adam’s being difficult but the poor fellow’s an emotional wreck and hasn’t slept in days. Rob’s really worried about his mental health.’

  ‘We’re all a mess,’ Mia said. ‘Poor Dad is in a terrible state. But we can still see that this has to stop.’