Gemini (14 page)

What will become of your children?
Could she ask him that? Could she let him go without asking?

One morning, six months after Lopez, she rolled close to him and said it. “I want to have a child someday, Eric.”

He stroked her hair quietly for a moment, then kissed her. “I know. I love you. I’ve never let myself . . . Give me some time.” And she loved him, too, so she let that be enough for a while.

A few months later they were with Charlotte’s family for her birthday dinner, in the house where she’d grown up. Every adult but Eric was a doctor. Will and Pamela, Charlotte’s brother and sister-in-law, were pediatricians; Charlotte’s father was a retired surgeon, and her mother had been a pathologist. Charlie was a toddler by then and latched on to Eric after he proved willing to wind up Charlie’s toy car a dozen times over without flagging. Charlotte watched them, Eric teasing Charlie with false starts the way you might coax a dog to fetch, Charlie scrunching his small body into a wad of laughter, playing on the tease as much as the racing car. A dozen times Eric let Charlie creep close and launched the car just before the baby reached him. Once, though, lunging before he’d found his balance, Charlie tumbled against Eric’s knee and Charlotte saw Eric instinctively pull away before giving Charlie the car to stop his tears. Pamela had been watching their game, and happened at that moment to turn from Eric to Charlotte with a maternal smile, a questioning tilt of her head. Charlotte blushed and only then caught Eric looking across the table at her, looking at Pamela, seeing what he was not supposed to see and no longer playful at all. Her parents were oblivious, retelling one of her father’s more raucous hospital stories. In the midst of it Eric abruptly left the table and Charlotte followed him into the kitchen. He was leaning against the wall with his arms crossed and shot her an uncomfortable smile when she asked what was wrong.

“No problem,” he answered lightly enough. “I love hearing autopsy details between the bleeding-raw steak and the birthday cake.”

“I’m sorry. We forget. I can put your steak back on the grill.” She kissed him. “We’ve always been sweet with our patients—even my mom. And most of hers were in pieces.”

He had laughed at that, but she understood that Eric had been a patient too many times himself to divorce the humor from his own history. By the time the evening was over, though, she understood that it was not her parents’ graphic stories that drove Eric from the table that night. It was the look on her own face as she watched Eric playing with Charlie.

•   •   •

It was Jane’s twelfth day in the intensive care unit. Her lungs had stiffened so much the pressure required to inflate them had blown a hole through the delicate alveolar membranes, and they’d had to put a chest tube between her ribs. Orthopedics had one bit of good news: they planned to remove her right arm cast in a few days. Jane was no longer septic, but she had now developed a superinfection in her intestines from all the antibiotics she’d gotten, and her kidney function was deteriorating. Charlotte knew only her patient’s relative youth was keeping her alive. She felt trapped in a grim version of whack-a-mole—solve one life-threatening problem just in time to discover another.

Charlotte started the day with her usual list, a computer printout of her patients’ names with her own notes penned in the margin—who had a CT scan or procedure scheduled, who was going to the OR, what lines needed to be changed, what critical labs were still pending. She had developed a system over the years, using different-colored pens to highlight different levels of urgency. Jane Doe’s name was nearly blotted out by red. Despite some trickles of good news, this morning’s lab work showed that she would have to be dialyzed soon if things didn’t turn around. And why should they turn around? Charlotte asked herself, then answered, Because sometimes, now and then, despite the APACHE II scores and SOFA scores and Glasgow Coma Scales—despite every imperfect predictor nailing the coffin closed, someone lived.

When their loved ones were unconscious and on the brink, family members would sometimes press Charlotte for any intuition she might have about their survival. She was too clinical to wade into that subjective tease, and saw it as little more than fortune-telling spun by doctors to give families a false sense of control. Instead, she gave them the best statistics she had to offer and tried to walk them through the pros and cons of necessary decisions. But in her heart she knew she
did
have a second sense about patients’ survival, something closer to hope than fact. Hope for another day outside, another birthday party, another meal taken through the mouth rather than a feeding tube. She could sense it around some patients like a visible luminescence. And some not—as if they were ready to move on, crumble back to the organic matter and energy they had started with. She knew better than to share this nameless second sense. She had not always been right. And it did not take many miraculous recoveries to decide that her job was
not
to decide when life ended—it was to give nature as much time as possible.

She jumped when Felipe Otero put his hand on her back, then laughed at herself and pulled his arm over her shoulder. “Daydreaming,” she said. “And you were the one up all night! How was it?”

“The usual fun. Three a.m. heroin overdose. Want a coffee while I report?”

They walked to the lounge at the end of the hallway and compared their lists, Felipe filling in the gaps from the day and night before, Charlotte adding a different opinion about one patient or another—the ICU beds were completely full this morning and she knew there would be pressure to move someone out. She looked up with a question and caught Felipe smiling at her; he had a dark scruff over his chin and his hair was a mess of luxuriant black waves after working all night. “What’s funny?” she asked.

“This is how Bonnie and I trade the boys now, a morning report at handoff.”

“Felipe? You didn’t tell me. You moved out?”

“Last week. I couldn’t say it.”

“I’m sorry. I really am.”

“I am too. We’ll see—nothing definite yet.” He rubbed his hand over his face quickly, the brush of skin against stubble at odds with his usually conscientiously groomed appearance, and the humanness of it somehow made his loss more palpable for Charlotte. “You know there’s a meeting about Jane today,” he said.

“I didn’t get an e-mail. Did I? I get too many. What’s it about?”

“She has a professional guardian now—I think Helen Seras wants her to meet us. The ethics board too.”

“What did Helen do? Look at Jane’s hospital bill?”

“Watch out—the walls have ears. My hope is that when they finally identify her, she turns out to be an heiress. They’ll name a new wing after her handsome donation.”

“The Jane Doe Memorial Wing—I can see it now. When she’s identified I wonder if the hospital will call her insurance company before they call her family. Assuming she’s insured.”

“You assume so optimistically. I’m going to take a shower and shave before the meeting—save me a seat.”

—

There were no seats to save; Charlotte edged behind the filled chairs toward the back corner of the room. Helen smiled at her. “We’re a little tight. The larger conference room was booked.” It seemed to Charlotte that Helen was always smiling, as if she had been hired to smile—to make it clear how completely at peace she was announcing the hospital’s policy decisions, whatever they might be and however the staff might respond. Felipe had enough business sense to appreciate Beacon’s perpetually increasing debt and balance Charlotte’s tendency to mistrust their motives, but Felipe wasn’t here and this room was already putting Charlotte into a dour mood. It was usually reserved for family conferences and Charlotte had broken too much bad news at this table, guiding wives and sons and daughters across the gap between the possible and the probable, circling surreal definitions of meaningful life.

There were four or five people here from the ethics board, a medical social worker, and some of the nurses who’d taken care of Jane. Charlotte saw Anne trying to look invisible, tucked into a folding chair at the back with her eyes half-closed like she was dozing, though she was likely memorizing every word. Sitting next to Helen was Keith Sonnenberg, Beacon’s guardian ad litem, wearing his signature dark tailored business suit and jazzy bow tie, his wiry gray hair sticking out above one ear after he took his glasses off. He’d been to the ICU twice in the last week to see Jane, and something in his contemplative response to Charlotte’s medical explanations made her trust him—the way he cupped his hand over his mouth with his shoulders hunched while she described what the fat globules dislodged from Jane’s femur had done to her brain, mulling it pensively for a moment before saying, “Hmm. I see,” to himself, and then moving on to his next question. Sitting next to Keith was a woman, probably in her early forties, whom Charlotte had never met.

Helen started. “I’m sure you all recognize that Jane is a unique case for Beacon. We’ve never had an unidentified with us for so long—an unconscious patient with no family. No voice, essentially. It’s a difficult position for the hospital. For all of you. Beacon has filed a petition of guardianship and Keith, our GAL, has been able to expedite that with the commissioner. So I . . .”

Anne’s hand shot up. “Sorry—in the dark over here. A petition for what?”

Keith looked like he was about to explain but Helen jumped in. “Guardianship. A certified professional guardian, or CPG. Given how critically ill Jane is, at some point she may need someone to speak for her—to address her medical directive.”

“You mean whether we should keep going or pull the plug,” Anne added, and when Helen went silent, “I’m just trying to be clear about what you’re saying.”

“We have no idea what Jane Doe—who has an actual name and personal story—would want if she can’t recover. It isn’t Beacon’s place to decide whether she should be artificially kept alive or”—Helen’s lips pressed into a tight line and Charlotte knew she was tempted to spit back Anne’s own words—“allowed to die naturally. And we aren’t there yet. I’m not suggesting that. Keith? Would you like to introduce Ms. Herrand to everyone?”

Keith did not look wholly comfortable being the diversion from this hiccup, but he gave a considered “Hmmm,” slowly got to his feet, and explained that the commissioner had reviewed Jane Doe’s case and officially designated her as an “alleged incapacitated person, or AIP”
(which struck Charlotte as a malignant twist of legalese—anyone who
walked into Jane’s room would know her incapacity was way beyond “alleged”) and, given this official stamp, the commissioner had assigned Jane a CPG.

Now the woman on Keith’s left stood up and Keith let her take over the discussion. Christina Herrand wore no makeup, but it suited her well-defined, lightly lined face. Her voice was so quiet everyone in the room stopped moving in their seats or shuffling papers in a collective effort to hear her. “As Ms. Seras said, this situation presents an unusual dilemma. Most Does are identified long before the legal process catches up to the point of designating a CPG, and certainly there’s hope that this patient will find her loved ones—well,
they
will find
her
—before any critical decisions need to be made. The legal system can’t replace family. You all know that. Even for professional caretakers there can be emotional attachments that feel”—she paused and looked at the faces around her—“offended, for lack of a better word. On the other hand, a complicated case like Jane’s can stir different opinions about end-of-life choices within the care team, particularly when there is no family member to advise them on the patient’s wishes. My job, as a professional guardian, is to become that adviser. So for now, think of me as Jane’s family. The one who can speak for her until she can speak for herself.”

Felipe walked in just then, gracefully introducing himself to the whole room and reigniting Helen’s smile. That Latin charm—Charlotte had told him more than once that he was wasting his best asset by being a doctor; he should be an ambassador, a Ferrari salesman, or at the least a highly paid gigolo. The conference went on for twenty more minutes as Helen called on various specialists to discuss Jane’s multiple failing systems and medical options. From across the room Charlotte watched a patchwork of notes collect on Christina’s yellow legal pad, some circled or boxed and connected with lines or arrows. The
Christina Herrand Mind Map of Impossible Decisions Made Simple
, Charlotte thought. Christina didn’t look old enough to be in this job. Only someone who had raised children and grandchildren and buried parents could have sufficient wisdom to be a mandated guardian—a stranger yesterday and as powerful as nearest kin today.

Charlotte knew the patient better than anyone here, and when it was her turn to speak, Christina seemed sensitive to that—her face softened; she attended every word. But it was more than that. There was a sympathy in her eyes that reached out to Charlotte, almost an apology, like she knew she was hearing more than clinical facts. Christina asked Charlotte to explain in lay terms what had probably happened during Jane’s initial surgery immediately after the car accident. Charlotte went step by step through the evidence that the fat emboli from Jane’s leg had caused her brain damage and seizures. “It isn’t like a stroke, is it?” Christina asked.

“Sort of. Think of the bits of fat as a shower of sparks hitting the brain, and every spot they hit is injured.”

“Permanently?”

Permanently?
Charlotte hated that question—nothing about the human condition was permanent. “There is a good chance that parts of her brain will never fully recover. But I think you’re asking if Jane could have a meaningful life again and I can’t answer that until she’s off all the sedatives and her blood chemistry is back to normal. She needs more time. All the time we can give her.” And a universally acceptable definition of “meaningful,” she was tempted to add.