by Jodi Picoult
My mother pulls her cell phone out of her pocket and dials a number. “Tell Zirconia.”
Which is how, twenty minutes later, I find myself racing back into the courtroom as Judge LaPierre begins to speak. “Ms. Notch, I understand you have something you need to say?”
“Yes, Your Honor. I need to recall my client and a new witness to the stand. Some evidence has come to light that I think the court needs to hear.”
Joe stands up. “You rested your case,” he argues.
“Judge, a man’s life or death hangs in the balance here. This happened only moments ago, or I would have given notice earlier.”
“I’ll allow it.”
So once again I climb into the little wooden balcony built for a witness. “Cara,” Zirconia asks, “where did you go during the lunch break?”
“To visit my father in the hospital.”
“What happened when you got to his room?”
I look right at Edward, as if I am telling him the story, and not the judge. “My dad was just lying there, like usual, like he was asleep. His eyes were closed and he wasn’t moving. But this time, when I started talking to him, his eyes opened.”
Edward’s jaw drops. Immediately, Joe leans toward him and whispers something in his ear.
“Can you show us?”
I close my eyes, and then as if I am a doll coming to life, I snap them open.
“What happened next?”
“I couldn’t believe it,” I say. “I got up and walked around the bed, and he kept looking at me, all the way until I sat down next to him again. He watched me the whole time.”
“And then?” Zirconia asks.
“Then his eyes closed,” I finish, “and he went back to sleep.”
Joe is leaning back in his chair with his arms folded. I’m sure he thinks this is my Hail Mary pass, my eleventh-hour attempt to make up some crazy story that sways the judge in my favor. The thing is, it’s not a story. It happened, and that has to mean something.
“Clearly Mr. Ng thinks it’s incredibly convenient for you to have witnessed this,” Zirconia says. “Is there anyone who can corroborate what you’ve told us?”
I point to Rita, the nurse, who has slipped into the back row of the gallery. She’s still wearing her scrubs and her hospital ID tag. “Yes,” I say. “Her.”
LUKE
The hardest part about being back in the human world was relearning emotion. Everything a wolf does has a practical, simple reason. There is no cold shoulder, no saying one thing when you mean something else, no innuendo. Wolves fight for two reasons: family and territory. Humans are driven by ego; wolves have no room for it and will literally nip it out of you. For a wolf, the world is about understanding, knowledge, respect—attributes that many humans have cast off, along with an appreciation of the natural world.
The Native Americans know that wolves are mirrors for humans. What they show us are our strengths and our weaknesses. If we don’t respect our territory, the wolf will invade it. If we don’t keep our children close by, if we don’t value the knowledge our senior population has accrued, if we leave our garbage around, the wolf will overstep its bounds to let us know we’ve made a mistake. The wolf is one of those creatures that links everything in the ecosystem. Where they exist in the wild, they regulate the prey populations—not just by controlling their numbers but also by assuring their parenting skills. If a wolf is in the area, there will be fewer cold-related fatalities among other animals, because domestic animals are taken inside or hidden in brush, or herded around a youngster to keep her warm and protect her from the threat of the wolf.
When I lived with the wolves, I was proud of the reflection of myself.
But when I came back, I always paled in comparison.
EDWARD
After all the hours I spent in his hospital room, by his bed, maintaining a vigil, my father opened his eyes when I wasn’t there.
Story of my life.
Joe’s already called a recess so that he can talk to Dr. Saint-Clare, and he’s told me that I shouldn’t believe everything I see, and neither should Cara. “It’s evidence, but it doesn’t mean a thing until the doctors explain it,” he said.
And yet.
What if it had been me in the room when my father woke up? What would I have said to him?
What would he have said to me?
I wonder if the conversations you’ve never had with someone count, if you’ve been over them a thousand times in your mind.
Rita Czarnicki sits on the witness stand now, reciting all her medical qualifications and the number of years she’s worked in the ICU. “I was checking the IV,” she says. “Mr. Warren’s daughter was in the room, talking to him.”
“Did you assess your patient’s condition when you entered the room?”
“Yes,” Rita says. “He was unresponsive and still appeared to be in a vegetative state.”
“Then what happened?” Cara’s lawyer asks.
“As his daughter was talking, Mr. Warren opened his eyes.”
“Are you saying he woke up?”
“Not like you’re thinking.” The nurse hesitates. “Most VS patients lie with their eyes open when they are awake and closed when they’re asleep. But they still have no awareness of themselves or their environment and are totally unresponsive.”
“So what made this event remarkable?” the lawyer asks.
“Mr. Warren’s daughter got up very quickly and moved from the foot of the bed around to the side, and his gaze seemed to follow her before his eyes closed again. That’s tracking, and that doesn’t happen with VS patients.”
“What did you do?”
“I immediately paged the Neurology Department, and they attempted to stimulate Mr. Warren into reactivity again by touching his toes and digging beneath his fingernails and verbally prompting him, but he didn’t respond.”
“Ms. Czarnicki, you heard Cara’s testimony. Did she exaggerate Mr. Warren’s responsiveness in any way?”
The nurse shakes her head. “I saw it myself.”
“Nothing further,” the attorney says.
“Mr. Ng?” the judge asks. “Would you like to cross-examine the witness?”
“No,” Joe says, standing. “But I do wish to recall an earlier witness to the stand. Dr. Saint-Clare?”
The neurosurgeon doesn’t look happy to have been called back to court. He raps his fingers on the edge of the witness stand, as if he has somewhere else he needs to be. “Thank you, Doctor, for making time for this,” Joe begins. “It’s been quite an afternoon.”
“Apparently,” the doctor says.
“Have you had a chance to examine Mr. Warren since you testified this morning?”
“Yes.”
“Has there been a change in his condition?”
Dr. Saint-Clare sucks in his breath. “There’s some discrepancy about that,” he says. “Apparently Mr. Warren opened his eyes this afternoon.”
“What does that mean?”
“Unfortunately, not a lot. Patients who are in a vegetative state are unaware of themselves and their environment. They don’t respond to stimuli except for reflex responses, they don’t understand language, they don’t have control of bladder and bowel function. They are intermittently awake, but they are not conscious. We refer to this condition as ‘eyes-open unconsciousness,’ and that’s what seems to have happened today to Mr. Warren,” the doctor says. “Like many VS patients, his eyes opened when he was stimulated by a voice, but that doesn’t mean he was aware.”
“Can VS patients track moving objects with their eyes?”
“No,” Dr. Saint-Clare says. “That finding would be evidence for awareness and, and suggest the presence of a minimally conscious state.”
“How would a patient with MCS present?”
“He would exhibit an awareness of self and the environment. The patient would be able to follow simple commands, smile, cry, and follow motion with his eyes.”
“According to Ms. Czarnicki
and Cara, it seems that Mr. Warren was able to do the last, isn’t that right?”
Dr. Saint-Clare shakes his head. “We think that what was construed as a movement of the eyes was actually a muscle reflex of the eyes closing. A rolling of the eyes, if you will, rather than a tracking. Since this first happened, we’ve tried repeatedly to get Mr. Warren to respond again, and he hasn’t—not to noise or touch or any other stimuli. The injuries sustained in the crash by Mr. Warren—the brain stem lesions—suggest that there’s no way he could be conscious now. Although he opened his eyes, there was no awareness attached to that movement. It was a reflexive behavior, and doesn’t warrant an upgrade in diagnosis to a minimally conscious state.”
“What would you say to Cara, who would contradict your interpretation of the event?” Joe asks.
The doctor looks at my sister, and for the first time since he’s taken the stand, so do I. The light has gone out of Cara’s face, like a falling star at the end of its arc. “Often in a vegetative state, patients will exhibit automatic behaviors like eye opening and closing, and a wandering gaze, or a facial grimace that family members mistake for conscious behavior. When someone you love suffers a trauma this severe, you’ll grab on to any hint that he’s still the same person, maybe buried beneath layers of sleep, but there nonetheless. Cara’s job, as Mr. Warren’s daughter, is to hope for the best. But my job, as his neurosurgeon, is to prepare her for the worst. And the bottom line is that a patient in a vegetative state like Mr. Warren’s carries a very grim prognosis with a small chance of meaningful recovery, which diminishes further over time.”
“Thank you,” Joe says. “Your witness?”
Zirconia has her arm around Cara’s shoulders. She doesn’t remove it, doesn’t even stand up to question the neurosurgeon. “Can you tell us beyond a reasonable doubt that Mr. Warren has no cognitive function?”
“On the contrary, I can tell you that he does have cognition. We can see that on an EEG. But I can also tell you that the other injuries to his brain stem prevent him from being able to access it.”
“Is there any objective scientific test you can administer to determine whether or not Mr. Warren’s eye movement was purposeful? If he was trying to communicate?”
“No.”
“So, basically, you’re reading minds now.”
Dr. Saint-Clare raises his brows. “Actually, Ms. Notch,” he says, “I’m board-certified to do just that.”
When the judge calls for a short recess before Helen Bedd, the temporary guardian, gives her testimony, I walk over to Cara. Her attorney is holding a pair of hospital socks, the kind that boost circulation, which the nurses put on my father’s feet. “This is all you could find?” Zirconia asks.
Cara nods. “I don’t know what they did with the clothes he was wearing the night of the accident.”
The lawyer bunches the socks in her fists and closes her eyes. “I’m getting nothing,” she says.
“That’s good, right?” Cara asks.
“Well, it’s certainly not bad. It could mean that he hasn’t crossed over yet. But it could also just mean that I’m better with animals than with humans.”
“Excuse me,” I interrupt. “Could I talk to my sister?”
Both Zirconia and my mother look at Cara, letting her decide. She nods, and they retreat down the aisle, leaving us alone at the table. “I didn’t make it up,” Cara says.
“I know. I believe you.”
“And I don’t care if Dr. Saint-Clare says it’s medically insignificant. It was significant to me.”
I look at her. “I’ve been thinking. What if it had happened when we were both here in court? I mean, if it was less than a minute, that’s not a long time. What if he’d opened his eyes and you hadn’t been there to see it?”
“Maybe it’s happened more than once,” Cara says.
“Or maybe it hasn’t.” My voice softens. “I guess what I’m trying to say is that I’m glad you were there when it did.”
Cara looks at me for a long moment, her eyes the exact same color as mine. How have I never noticed that before? She grabs my forearm. “Edward, what if we just agreed to do this together? If we went up to the judge and told him that we don’t need him to pick between us?”
I pull away from her. “But we still want different outcomes.”
She blinks at me. “You mean, even after knowing Dad opened his eyes, you’d want to take him off life support?”
“You heard the doctor. He had a reflex, not a reaction. Like a hiccup. Something he couldn’t control. And he wouldn’t have even opened his eyes, Cara, if that machine wasn’t breathing for him.” I shake my head. “I want to believe it was more than that, too. But science trumps a gut feeling.”
She shrinks back in her chair. “How can you do that to me?”
“Do what?”
“Make me think you’re on my side and then cut me down?”
“It’s my job,” I say.
“To ruin my life?”
“No. To piss you off and to get you riled up. To get under your skin. To treat you the way nobody else gets to treat you.” I stand up. “To be your brother.”
LUKE
When the Abenaki tell a story, there are several ways to start. You can say, Waji mjassaik: in the beginning. You can say N’dalgommek: all my relations. Or you can begin with an apology: Anhaldamawikw kassi palilawaliakw. It means, I’m sorry for the wrong I might have done you this past year.
Any of those, when I came back to the human world, would apply.
Even though I slowly got used to the sounds and smells, and I stopped diving every time a car roared around the corner or picking up my steak with my hands at the dinner table, there were still some spontaneous bleeds between my life in the wild and my life back among humans. When you live on the tightrope of survival and there’s no safety net, it’s hard to go back to walking on solid ground. I couldn’t dull the knife edge of instinct I’d developed with the wolves. If my family went out, even just to a McDonald’s, I would make sure to put myself physically between my children and anyone else in the establishment. I’d face away from them as they ate their hamburgers, because turning my back meant possibly missing a threat.
When my daughter brought home a friend from school for a sleepover, I found myself looking through a twelve-year-old’s pink duffel bag to make sure she didn’t have anything with her that might harm Cara. When Edward drove to school, sometimes I followed him in my truck just to make sure he got there. When Georgie went out, I grilled her about where she was going, because I lived in fear that something bad would happen to her when I wasn’t there to rescue her. I was like a veteran soldier who saw flashbacks in every situation, who knew the worst was just a breath away. I wasn’t really ever happy unless we were all in the house, under lock and key.
The first Abenaki word I ever learned was Bitawbagok—the word they use for Lake Champlain. It means, literally, the waters between. Since I’ve come back from Quebec, I have thought of my address as Bitawkdakinna. I don’t know enough Abenaki to be sure it’s a real word, but translated, it is the world between.
I had become a bridge between the natural world and the human one. I fit into both places and belonged to neither. Half of my heart lived with the wild wolves, the other half lived with my family.
In case you cannot do the math: no one can survive with half a heart.
HELEN
Your Honor.
My name is Helen Bedd.
I’m an attorney and also a guardian in the New Hampshire Office of Public Guardian. I’ve practiced law for fifteen years, and for ten years before that I was a registered nurse. I’ve been appointed as a temporary or permanent guardian for more than 250 cases over the years.
When I received this appointment, I immediately spoke to the parties involved, given the expedited nature of the hearing. The medical team at Beresford Memorial told me in essence what Dr. Saint-Clare has reiterated today. There is little or no chance that Mr. Warren’s condition w
ill improve. Seeing her father open his eyes today must have been very compelling for Cara, but my medical background and Dr. Saint-Clare’s testimony reinforce the unfortunate fact that this was probably an unconscious reflex and does not demonstrate any return to consciousness.
As part of my preparation for today, I also spoke with both Cara and Edward Warren. Both children deeply love their father, despite a disagreement about his health care needs and prognosis. Cara, at seventeen, has centered her life on her father. He’s the sun in the solar system of her life. Their relationship has been extremely close, as is often the case for children of divorce who bond particularly with one parent. I don’t doubt that Cara’s shouldered adult responsibilities, given her father’s unique lifestyle and job. However, I’ve also been forced to conclude that she is operating from an emotional standpoint and not a realistic one. Due to her emotional condition at this time, and her physical condition after the accident, she is unable to accept the reality of her father’s condition—whether that reality is presented by her brother, her father’s doctors, or the social worker at the hospital. And while the accident was not her fault in any way, I believe there’s some residual guilt that influences her vehement desire to keep her father alive at all costs. While I find her unadulterated hope for her father’s recovery touching and very moving, I also see it as a function of her immaturity at seventeen, and the fact that she is unwilling to accept a truth she does not want to believe.
On the other hand, Edward is the only living relative of Mr. Warren who is past the age of majority. Although he was able to produce a signed document from his father naming him as a health care guardian, that holds less weight for me than the fact that of the two siblings, Edward is the only one who has had an actual conversation with his father about what to do in this sort of situation. However, he has been estranged from his father for six years, and some details have come to light in this court that explain further his rash decision to abandon his family when he was eighteen. I believe that it’s still quite difficult for Edward to separate his anger at his father from his current actions, which led to a very rash decision that was made without consulting his sister, and an even more rash decision to take matters into his own hands when the termination of life support didn’t go according to plan. In this, Edward still has a lot of growing up to do. One has to wonder, given his propensity to act on impulse, how much thought he’s really given to his father’s wishes.