Life Support

by Robert Whitlow

  When he finished, Pinchot asked, “Given this information, what is your opinion about Baxter’s chances of recovery?”

  “We can only wait and see. He could wake up tomorrow, or we might lose him. I can’t predict the future, but at this time he remains in critical yet stable condition.”

  “What is your recommendation about continuing life-sustaining measures?”

  “To maintain the current treatment regimen. It has worked thus far.”

  Pinchot paused. “That’s all from this witness.”

  Alexia had sparred with many types of witnesses, but the distinguished, yet kindly, doctor presented a unique challenge. The judge motioned toward her.

  “Ms. Lindale, you may conduct your cross-examination.”

  Alexia decided to start out simply.

  “Dr. Kolb, do people die from focal head injuries?”

  “Yes.”

  “How long would Baxter Richardson have lived if he hadn’t been airlifted to a hospital for medical care?”

  “There is no way to answer that question. It was a close call. Probably hours. Not days.”

  “Even after a person with a serious head injury receives medical care, is it often difficult to predict what will happen?”

  “Yes. It is not an exact process. Anytime the central nervous system is affected, the outcome can vary considerably from one patient to the next.”

  “Has Baxter improved more or less than you originally hoped?”

  “Less.”

  “Why?”

  “Once again. It’s not clear.”

  Alexia, who had been standing in front of the counsel table, stepped forward.

  “Besides his brain, what other part of Baxter’s central nervous system was injured in the fall?”

  “As I mentioned previously, his spinal cord was damaged in the cervical or neck area, and at present, he is paralyzed.”

  “Has the portion of the spinal cord that controls breathing been damaged?”

  “Possibly. Baxter was breathing on his own when he came into the hospital and placed on a ventilator to help him stabilize. We don’t know his current capability.”

  Alexia saw a tiny opening and decided to peek through it.

  “Have you tried to take him off the ventilator for even a few seconds to find out?”

  “No.”

  “Why not, if he was breathing on his own when admitted to the hospital?”

  “Because the family has not been in agreement about the action to take. Baxter might be able to breathe on his own; however, it could be so difficult for him to do so that it would hasten his death.”

  “Do you consider permanent use of a ventilator for a comatose patient medically appropriate in all cases?”

  “Not permanent use. Only temporary.”

  “How do you define temporary?”

  The doctor shifted in his seat. “It’s a judgment call based on experience and evaluation of available data that can be discussed with the family. In this situation, the hospital’s attorney told us the power of attorney held by Mr. Richardson gave him the authority to make medical decisions.”

  This was new information to Alexia.

  “If the hospital’s attorney had told you the health care power of attorney held by Mrs. Richardson took precedence, would you have stopped the ventilator upon her request to do so?”

  “Yes. But I would have suggested that it be done on a temporary basis to test Baxter’s ability to breathe on his own.”

  Alexia waited a second, debating whether to ask the question that popped into her mind. She wanted to push further and support an argument for a temporary halt to the ventilator but was afraid the doctor would drop back to his “wait and see” approach. She decided on another tack.

  “Dr. Kolb, if Baxter can’t breathe without the ventilator would that be a sign of deterioration in his condition since the time of his admission to the hospital?”

  “Since he was breathing on his own initially, I would consider that a negative development.”

  Alexia stopped. It was as far as she felt confident to go.

  “That’s all, Your Honor,” she said.

  Alexia sat down while Pinchot asked a few follow-up questions that didn’t add anything new. While Dr. Kolb was finishing his testimony, Dr. Draughton tapped Alexia on the shoulder and whispered in her ear.

  “Dr. Berman just told me he would recommend suspension of the ventilator. As a practical matter, if a quadriplegic patient in a coma with serious brain trauma can’t breathe on his own, it’s the end.”

  Alexia turned back toward the judge. She had a strategy.

  Pinchot huddled with Ezra, and Alexia made a few quick notes while waiting for him to call Dr. Berman.

  “Anything further from the respondent?” the judge asked Pinchot.

  “Just a minute, Your Honor,” he replied. “We may be finished.”

  Alexia was caught off guard. In order to cross-examine Dr. Berman about stopping the ventilator, Pinchot needed to first call him to the witness stand.

  “Has the power of attorney been admitted into evidence?” Pinchot asked the judge.

  “Yes, I show it admitted,” the judge replied.

  “Then that’s all from the respondent.”

  Alexia stood to her feet.

  “Excuse me, Your Honor, but Dr. Berman, the other neurosurgeon who has been involved with Mr. Richardson’s care, is in the courtroom pursuant to subpoena. I think it would be helpful for you to hear his testimony, and if opposing counsel is not going to call him as a witness, I would like to do so.”

  The judge gave Alexia a stern look. “Ms. Lindale, if you wanted to introduce testimony from Dr. Berman you should have done so during the presentation of your proof. The mere fact that he is in the courtroom is insufficient reason to allow you to reopen your case after you have rested.”

  “But Dr. Berman can provide relevant information for your consideration in reaching your decision.”

  “I hope it would be relevant,” the judge answered wryly. “However, I have heard enough medical testimony to render a decision, and your request to call him is denied. Anything further?”

  Deflated, Alexia replied, “No, ma’am.”

  “Very well, I will give each side five minutes for a closing argument. Ms. Lindale, as petitioner you may go first.”

  Alexia stepped back to her table and picked up the outline she had prepared in advance. It had limited usefulness. Many of the points on the sheets had never been brought out in the testimony, and Dr. Kolb’s personal relationship with the judge had taken the wind from her sails. Alexia had to look deep within her soul for the emotional energy to put zest into her advocacy. She began with a brief summary of Dr. Draughton’s testimony and then made Rena’s plea.

  “A few months ago this young couple made it clear to one another the path they wanted to follow if they ever faced this type of situation. In filing the petition to terminate life support, Mrs. Richardson has acted in obedience to her husband’s desire—a desire that is unequivocally revealed in the declaration of desire for a natural death. Baxter Richardson can’t speak for himself, but this document speaks for him.

  “Your Honor, it is unimaginably difficult for Mrs. Richardson to ask you to terminate life support. Only her love for her husband compels her to act in the face of opposition and misunderstanding, but to keep Baxter alive by attaching him to machines that artificially tie him to earth is misplaced love. There is a time to release and let go. For Baxter and Rena Richardson that time has come. Please let them say good-bye on their own terms.”

  Alexia stepped closer to the bench. “Everyone in this courtroom would like to dream with Dr. Kolb that hope exists, but hope must be based on facts. Dr. Kolb is an experienced and compassionate physician, and my client is not asking you to ignore his opinion; however, maintaining the status quo without a reason to do so does not make sense either medically or ethically.”

  Alexia paused. “Therefore, my client asks you to open the
door to a reasonable next step that will give an unbiased assessment of Baxter’s potential for recovery from his own body. We’re modifying the petition to request that you order the doctors to suspend use of the ventilator on a trial basis. This will prove whether Baxter retains the ability to breathe independently. If he can breathe on his own, we can wait for further developments. If he can’t, then my client would like the option of returning as soon as possible for a supplemental hearing.”

  Alexia walked slowly back to her seat as Pinchot stood up. Rena leaned over and whispered fiercely in her ear.

  “Why did you do that? We hadn’t discussed it!”

  Alexia sighed. “If I’d asked for everything, you’d have gotten nothing. Even now, I doubt the judge will do anything except what Dr. Kolb recommends.”

  Rena sputtered but didn’t say anything else.

  Alexia barely listened to Ken Pinchot. The older lawyer knew Dr. Kolb’s testimony was the key to the case. He abandoned any effort to slander Rena and focused on the opinion of the neurosurgeon. He concluded by directly addressing Alexia’s new suggestion.

  “Ms. Lindale’s request to suspend use of the ventilator is not based on any testimony from the medical experts, and the court is urged not to substitute the medical judgment of opposing counsel for that of Dr. Kolb. In fact, her suggestion smacks of cruelty. Doctors need to be doctors and lawyers should remain lawyers.”

  Alexia winced at the mention of cruelty.

  Pinchot pointed toward Dr. Kolb and held the power of attorney in his hand. “The two strongest factors to guide your decision are Dr. Kolb’s recommendations and my client’s exercise of the durable power of attorney. One medical, one legal—these two pillars should be the basis for your ruling. Thank you very much.”

  The judge spoke, “Given the nature of the petition, I will announce my decision from the bench. Court will be in recess for fifteen minutes while I make some notes.”

  40

  Death and life are in the power of the tongue.

  PROVERBS 18:21 (NKJV)

  While Ken Pinchot gave his closing remarks, Rena dug her fingernails into her palms. She needed physical pain to distract her from the mental anguish she felt at the sudden turn of events. Alexia’s cowardly betrayal opened wide the door for Ezra’s lawyer to waltz in and ask the judge to do what he wanted and leave Rena twisting on a spit over an open fire of impending judgment. Sooner or later, the grotesque detective would drag her off for torture.

  In answer to her premonition, she glanced over her shoulder and saw that Giles Porter had reentered the courtroom and taken a seat in the back row. Rena involuntarily ducked her head. When she did, Alexia glanced in her direction and sternly shook her head. Rena wanted to jerk out a handful of the lawyer’s hair.

  And suddenly, she realized what had happened.

  Alexia Lindale was secretly working for her father-in-law. Nothing had changed since the first meeting at the hospital. Alexia’s opening line about helping the “Richardson Family” was totally bogus. Jeffrey had been right. No one who worked for Leggitt & Freeman could be trusted, and Alexia was no exception. The fake office at the real-estate company. The phone calls from the lawyer’s house. The meeting at the restaurant. It was all an elaborate subterfuge. Even Jeffrey’s conduct in stringing Rena along became clear. He might not have been part of the plot at their first meeting but later he directed her to Alexia. Rena kicked the leg of her chair with her heel. She should have known that she wouldn’t be able to find an ally in Santee. She’d been a fool. She put her head down on the table and closed her eyes. She couldn’t think anymore. She couldn’t feel. She simply wanted to hide.

  Alexia saw that Rena was resting her head on the table. The strain of the hearing had obviously overloaded her client’s emotional circuits. She leaned over to her.

  “I’m going to get a drink of water. I’ll be back in a minute.”

  There was no response.

  When she stood and turned around, Alexia saw Giles Porter. She walked down the aisle and stopped beside the detective.

  “Why are you here?” she asked.

  The detective touched the scar on top of his head. “I’m trying to learn as much as I can about Baxter Richardson’s head injury. You know how hard it is to talk to the doctors. This is the easiest way to find out about the diagnosis and treatment. Did you hear what they said about a stel-late fracture?”

  “Yes.”

  “And it’s a good thing Dr. Kolb was in the trauma unit when the helicopter arrived.”

  Alexia shrugged. “Only if Baxter recovered.”

  The detective motioned toward Rena. “Or if your client wanted to avoid a murder charge.”

  “Why don’t you back off!” Alexia retorted.

  “Because the more I think about this case, the more convinced I am that your client is hiding something.”

  Alexia wanted to tell him the truth but kept her mouth shut.

  Porter continued, “Did your client tell you about the hiking stick?”

  “Is it a crime to carry a hiking stick?”

  “Perhaps if it has fragments of Baxter’s skin on one end. I found it at the waterfall.”

  Alexia couldn’t remember if Rena had mentioned a hiking stick or not. Porter took an ink pen from his front pocket, jabbed it in the air in front of his chest, and then touched his neck with the end of the pen.

  “It’s just a thought.”

  Alexia cut off a sarcastic reply. Porter seemed to enjoy playing petty mind games, but the true criminal was lying in a hospital bed, oblivious to the day’s events in the courtroom.

  “You’re wasting your time,” she said. “Rena Richardson has done nothing wrong.”

  Porter shrugged. “Ask her about the stick and let me know what she says.”

  Alexia turned away and pushed open the door. She had no intention of being Porter’s messenger girl. She walked down the hallway to a water fountain where she took a long drink of water. The cold water triggered a pang of longing for the peace of her boat gliding slowly through the marsh grass toward the barrier island. Alexia was a trial lawyer because she loved the excitement of the courtroom, but her internal equilibrium required corresponding peace.

  She met Ken Pinchot in the hallway as she returned to the courtroom.

  “Well done, Alexia,” Pinchot said.

  Alexia couldn’t tell if the words were spoken with graciousness in advance of victory or sarcasm. She suspected the latter.

  “Thanks,” Alexia responded. “Although I didn’t appreciate the reference to cruelty.”

  “It wasn’t personal.”

  Pinchot continued toward the restrooms. Alexia grunted as she pushed open the heavy wooden door. It was very personal and sent a message to the judge that if she agreed with Alexia, she deserved the same label.

  Ezra was standing in front of Alexia’s table talking to Rena. Alexia hurried down the aisle to quickly intervene. At her appearance, Ezra slid back to his side of the courtroom. Alexia sat beside Rena.

  “What did he want?”

  “Why don’t you ask him yourself?” Rena shot back.

  Startled, Alexia said, “I can’t talk to him. He has a lawyer.”

  Rena’s eyes narrowed. “How many lawyers does he have?”

  Before Alexia could respond, Judge Holcomb reentered the courtroom with the file and a legal pad in her right hand. Ken Pinchot returned as well.

  “Be seated,” the judge said.

  Alexia moved toward the edge of her seat. The judge looked toward Ken Pinchot.

  “I have reached a decision. Mr. Pinchot, I would like you to draft an order based on my ruling. I will furnish you with a copy of my notes to assist you.”

  Alexia slumped back in her chair. Judges always assigned the task of preparing a typewritten order to the winning lawyer.

  The judge continued. “I have carefully considered the testimony of the parties, Drs. Draughton and Kolb, the provisions of the health care power of attorney, the declarat
ion of desire for a natural death, and the durable power of attorney. My decision does not require me to rule on the priority of the powers of attorney, and I specifically do not make any findings of fact on this issue. Rather, the controlling document is the declaration of desire for a natural death executed by Mr. Baxter Richardson while he was mentally competent before this unfortunate accident occurred.”

  Alexia perked up her ears. Ezra and Rena disagreed, but Baxter’s wishes were clear.

  “My task is to apply the directions left by Mr. Richardson to his current medical condition as diagnosed by his physicians. It is undisputed that Mr. Richardson has suffered severe injuries to his brain and spinal cord; however, I do not accept the testimony of Dr. Draughton that Mr. Richardson is in a persistent vegetative state. On this point, the testimony of Dr. Kolb is more persuasive, and I deny the relief sought by Mrs. Richardson as set forth in the petition.”

  Alexia heard Rena groan. The judge was picking up steam, and it wasn’t hard to predict where she was going.

  “Hydration and nutrition for Baxter Richardson shall be continued consistent with accepted medical protocol until further order of the court or agreement of the parties in consultation with the treating physicians.”

  The judge looked down at her notes before continuing. “However, I do not believe that maintaining the current level of life-sustaining measures is consistent with the expressed intent of Mr. Richardson set forth in the declaration of desire for a natural death. By its very name, this document is evidence of a desire by an individual to restrict the use of extraordinary medical measures. The cumulative effect of the injuries to Mr. Richardson creates a sufficiently severe medical status that removal of the ventilator is consistent with his directions in the document referred to. My personal opinion about the best course of action might be different; however, my decision is strongly influenced by Mr. Richardson’s unequivocal intentions. Therefore, I hereby order that continuation of the ventilator be suspended as soon as practicable. A written order shall be prepared and exchanged between the parties prior to my signing it; however, my ruling goes into effect immediately.”