Nate followed Susan’s tack this time. “But you have difficulty with laws when they’re applied to medical practice.”
“Not on principle, no.” Susan sighed deeply. “I have trouble when otherwise well-meaning laws cause terrible suffering in the name of preventing suffering. Medicine is not mathematics. Every individual case differs, and one scenario does not fit all. In fact, you can rarely find a scenario that fits two or three. That’s why we need the best and brightest to become doctors, why the years of study are so very long and arduous, why we still take the ancient Hippocratic oath.”
Now Nate’s head bobbed in clear understanding. “So medical legislation should be confined to the obvious extremes. For everything else, the doctor and patient need to decide the best course of action based on the patient’s or family’s wishes and the doctor’s expertise.”
“Correct. And if those clash, we could have boards of ethics consisting of medical and moral experts rather than the great unwashed.”
“Meaning, I assume, regular people.”
Susan accepted his gentle rebuke. “And elected officials. Anyone who doesn’t have the specialized education and wisdom born of experience to fully understand the specific situation.”
“Closed sessions?” Nate suggested.
Susan paused, wondering if he was trying to steer her into a trap. “Not necessarily. That could be at the discretion of the board, which would be no different, really, than the way we run courts now. What is decided is decided, and the only way to overturn it is to appeal to a higher court. That court then has the right to accept or deny the case. Ultimately, a decision is made and set in stone.”
“So, we would have an ethics board of appeal and, ultimately, a national supreme board.”
Susan challenged. “Why not?”
Nate hesitated, then smiled. “I can’t think of a single reason. It would cut down on the protestors at hospitals as well.”
Susan nodded enthusiastically. She had grown weary of the shouting and sign waving that always heralded her entrance into Manhattan Hasbro Hospital. “Then we should encourage, but not mandate, everyone to sign a living will that specifies under what circumstances they would want treatment, the level of that treatment, and when to surrender or even euthanize.”
Nate’s eyes widened. “You mean, contemplate every possible scenario?”
“Impossible.” Susan squeezed her left hand between her cheek and the armrest. “And unnecessary. Broad categories would do the trick: permanent physical dependence, permanent mental dependence, untreatable madness without intervening sanity. Obviously, if the patient is able to express his wishes, we should try to honor them, within reason.”
“What about the argument that a deeply depressed person might choose euthanasia when simple antidepressant therapy might do?”
Susan met his gaze. “A competent doctor would never let that happen.”
“With emphasis on the word ‘competent.’”
Susan sighed at Nate’s undeniable point. She would never allow that to happen. In a perfect world all doctors would be infallible geniuses, or at least the closest humanity had to offer. Unfortunately, bad doctors existed. In fact, she felt certain she had met one earlier that day: Dr. Mitchell Reefes, the head of Winter Wine Dementia Facility. He had regaled Susan and Kendall with a twenty-minute lecture on his expectations, particularly in regard to punctuality and thoroughness, after which he left for a three-hour lunch. During his absence, the nurses explained, choosing their words carefully, that Dr. Reefes was essentially lazy and almost fully reliant on protocols he had created to cover almost any situation, so the nurses did not need to call or question him. He generally allowed the rotating R-2s free rein, as long as they did not cost money or burden him.
Still deliberately taking the other point of view, Nate asked, “What if a family chose euthanasia to get a difficult or rich family member out of the picture?”
Susan did not see it as much of an issue. “Again, that’s where the competent doctor comes in. It’s not like wealthy Aunt Beryl would go in for a routine visit and a family member would have the opportunity to choose to end her life. But if Aunt Beryl is in a permanent vegetative state, the family shouldn’t have to disclaim their inheritance or prolong her suffering just to prove money is not their primary motive.”
Nate opened his mouth, but Susan forestalled him with a wave. “I’m not saying it’s a perfect system. Everything’s fallible, but you don’t hear many people arguing we should discard life-saving antibiotics because a few people might have an unexpected allergy, or dismantling the legal system because an occasional innocent person gets punished. Humans do make mistakes. We can minimize them, but we can’t make the world, or any system in it, perfect. Just because one person in a billion might awaken from a coma doesn’t mean we should keep every comatose person alive indefinitely. Just because one criminal works hard at rehabilitation doesn’t mean we should throw open every jail cell. My system might not be flawless, but it’s a damn sight better than what we have now.”
Nate brought their conversation definitively back to the original subject. “Meaning patient gardens.”
Susan nodded. “Wards of patients sobbing in desperate misery, clinging to their last incomplete memories, bits and pieces of unmatched pictures that can never interlace. Wards of patients utterly devoid of intellectual functioning or spontaneous actions, wandering around like so much animate meat.”
“Now you’re mixing metaphors,” Nate pointed out. “They can either be vegetables or meats, not both.”
The ludicrousness of Nate’s comment did not escape Susan, and it reached to the true root of her concern. Tears sprang to her eyes, wholly unbidden and equally unexpected. “Nate, what’s wrong with me?”
The spectacular leap somehow did not seem to bother Nate, though he did appear a bit confused. “You mean medically?”
“Psychologically,” she clarified.
“You’re in a much better position to evaluate that than I am.”
Susan was not so sure. Nate had read all the medical textbooks in this room, had absorbed the material in the charts and articles presented to him for review, and even had access to the global web. He retained everything, and his positronic brain gave him the ability to incorporate the material into understanding and action, so much so that he even appeared to have human emotions. For him, such simple things were not instinct but learned over a course of time interacting with, studying, and reading about humanity.
Susan got control of herself. “A year ago, I came to Manhattan Hasbro with the intention of doing everything I possibly could for every patient, of fixing them, of making them right no matter how messed up their lives or their minds. I would hold futures in my hands, and I would do everything within my power, within the power of medicine and possibility, to help them regain the best life had to offer them.” She sighed deeply. “Now, suddenly, I’m thinking about mass euthanasia of a…of a…”
“Garden?” Nate supplied.
Susan winced as he threw her own word back at her. “A unit,” she corrected. “A medical unit.”
Nate studied her in the dimness of the windowless room. “Susan, it’s nothing new. The R-1s all come to the hospital clinging to their fresh diplomas, eager, curious, terrified to make even a tiny mistake, passionately driven to become the best damn doctor in the history of medicine.”
“And?” Susan said, both inquisitive about and afraid of what Nate might say next. Everyone knew a physician so jaded he or she viewed every patient as a bothersome distraction needing to be handled before he or she could go home for the day.
Nate continued dutifully, “Every physician becomes at least a little bit cynical, even the ones used to seeing the glass as full of rainbows.” He kept his gaze directly on hers. “Not only does it come with the job, but it’s probably absolutely necessary to become the best possible doctor.”
Susan felt her features bunch. “How so?”
“Susan, it’s not yo
ur place to love and care genuinely and deeply for each and every patient. That’s the job of the family, and it’s the very reason most physicians refuse to treat their own loved ones. When you care that deeply for someone, you can’t possibly be objective. I once talked to a pediatrician who was in a near panic over his infant son’s one-hundred-five-degree fever. He would have known exactly what to do if someone else brought in a child in the same state, but when it came to his own flesh and blood, logic and reason flew out the window. Part of physician training is to learn how to limit the emotional investment in an individual patient to allow the distance to give him or her the best possible treatment.”
Susan understood Nate’s point, but she did not know if she wholly subscribed to it. “If my father ever came down with a serious illness, I’d want to be directly involved in his care.” She hated to admit she would never wholly trust another physician’s judgment.
Nate quoted a familiar adage: “‘A physician who treats himself has a fool for a patient.’ I believe that applies to loved ones as well.”
Susan smiled, and realized she no longer felt like crying. “Thanks, Nate.”
Nate sank deeper into the chair. “I didn’t do anything. Mostly just listened to you talk.”
“Which, as you surely know, is an accepted form of psychoanalysis. I know what I have to do now.”
“What?” Nate asked carefully.
“I have to go back there every day for a month. I have to give those patients the best care possible, to make the end of their lives meaningful, even if only to learn the best care for bedsores or mindless pacing.” Susan allowed her thoughts to expand. “It’s possible I might find some diagnosis someone else missed.”
“It certainly wouldn’t be the first time,” Nate reminded.
Susan added thoughtfully, “If I can rescue even one patient from that place, find someone misdiagnosed or mistreated who, with the proper therapy, can lead a reasonably normal life, it’ll be worth every moment of the time and effort.”
“That’s the Susan Calvin I know.”
And even if I can’t find anyone to save, I’ll find a way to bring something positive from this experience, whether it’s the understanding of end of life, empathy for the patients and their families, or a purpose for the incurably demented. Susan rose with new determination. “Somehow this is going to make me a better doctor, if not a better person.”
“Exactly,” Nate said. “Now get out there and do what you do best.”
“Diagnosis?” Susan guessed, heading for the door.
“Annoying your superiors,” Nate corrected.
Chapter 3
Susan entered her thumb into the lock-reader of the apartment she shared with John Calvin, her father. The whisper of a click that followed was apparently enough to clue her father, who whipped open the door and personally ushered her inside. As usual, he gave his grown-up daughter an enthusiastic hug, crushing her cheek to his slender chest. Aside from his height—a couple inches over six and a half feet—he resembled her closely: hair straight and mousy brown, though shorter than his daughter’s; eyes blue; chin undimpled and a bit prominent compared with his gaunt neck. “Welcome home, kitten.” He glanced at the Vox on his wrist. “You’re later than you expected.”
Susan did not have to consult her own wrist computer to know it was after seven thirty. “I stopped to talk to Nate.”
John’s brows rose. Closing the door with a foot, he gestured toward the kitchen to indicate he would make her some food, though the conversation had nothing to do with dinner. “You rode all the way to the hospital to talk to a robot when you have a perfectly good father waiting for you at home?”
Susan responded to the gesture first. “I grabbed a sandwich on the way home.” She had considered waiting until she arrived to eat, but it seemed pointless. Her father whipped up some of the most unique and scrumptious meals, but he had not eaten with her, or anyone else, in more than twenty years, not since the death of his wife, Susan’s mother, Amanda Calvin. A portrait of the only woman he had ever loved still took up much of the far wall of the living room. As a young child, Susan had thought little of her father’s quirk, though she did pine for the days when all three of them had eaten together as a family.
John Calvin did not allow his daughter off the hook, though he did lower his gesturing hand to his side. “And what could N8-C supply that I couldn’t?”
“Medical expertise, for one thing.” Susan studied her father in the overhead lighting. She had heard of situations where adult children left for a year or two, then returned to find their parents startlingly older. When children returned to school from summer vacation, they always looked so much different to their friends’ parents, yet exactly the same to their own. Family members as close as she and her father never noticed the years creeping over their loved ones, so she tried to examine her father through the eyes of a stranger.
He was now fifty-two years old, and Susan thought he appeared younger. Gray hair flecked his temples but had not yet found a toehold in other parts of his scalp. When she looked closely, she did notice a few lines around his mouth, forehead, and eyes. She could think of nothing in his recent actions to suggest he might fall victim to any form of dementia. He still worked full-time at U.S. Robots and Mechanical Men. He showed no propensity for mangling names, forgetting why he entered a room, or mysteriously discovering his wallet in the freezer. Neither of them had ever worn glasses or needed corrective-vision procedures, and he read without the aid of a magnifying lens or adjustment to the focus of his Vox. He had been thin almost to the point of gauntness for as long as she had known him, but he did not act in any way sickly. She had the same tendency to lose track of hunger in times of activity and stress, particularly over the past year.
Given the events of the day, Susan could not help imagining John Calvin as a patient in the Winter Wine Dementia Facility, requiring full-time care. She had smothered the thought while she toured the unit but could not help conjuring up the scenario several times since leaving it. Now, standing directly in her father’s presence, her consideration of the matter seemed more real and confusing than ever. Of course, she would continue to visit him every day he remembered her and responded positively to her presence. Logically, she knew that if he developed dementia, a time would come when he no longer cared if she came or not, could not differentiate her from a stranger. All that would remain was an empty John Calvin–shaped shell, without memory or reason. What purpose did it serve to nurture such a pitiful thing? Whether or not he felt at peace, and she doubted he would, it would prove little more than torture to her.
Susan had learned to ignore what other people thought of her. She had, at times, been a curve buster, a swot, the type of student who appears to value learning over social outlets. She could never win a beauty contest. She would never bow to societal pressures, would not visit a human vegetable, even one who had once been her beloved father, simply for appearances.
John Calvin cleared his throat. “Are you stunned by my ravishing charm?”
Only then Susan realized she was still staring at her father. With a quick shake of her head, she refocused her attention on the familiar furniture: a tan sectional sofa just beginning to fray at the edges, an oblong coffee table nestled into the muted semicircle of couch, and the metal and glass shelving that took up most of the wall space, supporting everything from the television/stereo to her father’s journals and a few classical books, mostly physics and mechanics texts. “Sorry. Just lost in thought.” She took a seat at the far end of the sectional.
John Calvin also sat. “An enigma already? I wouldn’t think there’s as much to puzzle over in a dementia unit.”
“This is more of a what-if dilemma,” Susan admitted. “There’s an area devoted entirely to end-stage dementia, and it’s got me more angry than stymied.”
“Angry?” Susan’s father pressed. “‘Frustrated,’ ‘wretched,’ ‘miserable’ seem more appropriate.”
Susan sighed. Sh
e did not wish to hash over the same ground with her father as she already had with Nate. “The nurses fawn over these patients, speaking to them as if they could understand, treating every ingrown hair and patch of dry skin, vigorously clearing every bit of mucus from the depths of their lungs, styling their hair, and clipping their nails.”
John blinked. A moment passed in silence before he said, “Did you want the nurses to verbally abuse them? To beat them? To leave them filthy and unkempt?”
Susan waved the madness away. “Of course not. I would never justify causing suffering.” She sighed deeply. “But why do we need to spend scarce health-care resources prolonging suffering when it could be better used battling illnesses we can treat? Or even researching ways to prevent the very dementia that put them in this state, so their descendants, at least, might benefit?”
“Are you talking euthanasia?”
It surprised Susan how swiftly the e word came up in these conversations. She shrugged.
“Because some people would call that playing God.”
And the G word. “I don’t see how allowing nature to take its course is playing God. Perhaps that’s why God created pneumonia and bedsores, to end the suffering of people like those in Winter Wine’s End-Stage Dementia Unit. I could maintain that forcing these empty husks to go on breathing for as long as humanity-created technology allows is playing God.”
John smiled, and Susan suddenly realized he had been baiting her more than actually arguing. They were not going to resolve an argument as long-standing as politics itself in an evening.
“And since when do you concern yourself with God? We don’t go to any church, at least not since Mom died.”
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