Life Support (14 page)

“What if they don't agree?”

Alexia didn't answer. She had considered that exact scenario while riding the elevator up to the ICU floor. It was another reason why the same lawyer would likely have trouble representing both Ezra and Rena. A disagreement among the doctors could spill over into a court fight between the family members and a battle royal of expert witnesses with the comatose Baxter in the middle.

Alexia needed to tell Rena about the pitfalls ahead of them, but the young woman was fragile, and Alexia didn't want to hurt her. She searched for the right words. Abandoning women in distress cut against the grain of Alexia's nature. Before she could decide how to begin, Ezra returned to the room. He caught Alexia's eye and gave her a knowing nod.

“Any word on a meeting?” he asked.

“No,” Rena answered. “You know how doctors are. Everybody has to wait for them. We could be here for hours.”

Alexia decided to lobby for faster action. She walked over to the desk and waited while the young woman there finished talking on the phone. The attendant spoke first.

“That was Dr. Berman on the phone. They plan to discuss the patient's status in Conference Room B in a few minutes.”

“Thanks.”

Alexia relayed the news.

“Good,” Ezra said. “I'm going to the conference room.” He looked at Alexia. “Would you like to join me?”

Alexia hesitated. “I'll be there in a minute. I need to discuss something with Rena.”

Ezra's face showed his irritation, but he turned and left. Losing Alexia as a lawyer would be a minor hit compared to the other blows that had rained down on the young woman in the past twenty-four hours.

“Rena, do you remember when I told you that my law firm sent me here to represent the Richardson family?”

“Yes. And I should have thanked you more for stepping in to help me,” Rena said gratefully. “I don't know what I would have done without you this morning. You didn't take sides, but with you in the room, I could think about what to do without being afraid of Baxter's father. He tried to intimidate me, but it would have been much worse if you hadn't been sitting at the table. I appreciate it very much.”

“Uh, yes, but—”

The young woman at the desk called across the room. “The doctors are waiting for you in the consultation room.”

Rena stood. “Let's go.”

Alexia found herself looking at Rena's back. Picking up her briefcase, she followed.

Consultation Room B was larger than Room A. Rena's mouth was dry as she walked down the hall, and she stopped for a quick drink of water from a fountain. She followed Alexia into the room. Five physicians with their names embroidered on their white coats were examining an image on a large light box on the far wall. Ezra was in the middle of the crowd. When Rena and Alexia came into the room, everyone turned around and conversation ceased. A middle-aged doctor with dark hair, a large nose, and bushy eyebrows stepped forward and introduced himself to Rena and Alexia. To Rena, he looked more like a comic book character than a physician.

“I'm Peter Berman, one of the neurosurgeons treating Mr. Richardson.”

Dr. Berman identified the other doctors in the room. Included in the group was an orthopedic surgeon, a neurologist, a pulmonary specialist, and an internist. After they all sat down at the table, Dr. Berman turned to Rena.

“I believe you met my partner, Dr. Kolb, last night,” he began. “He's getting some sleep this morning and couldn't be here. The rest of us have discussed your husband's status and reviewed the results of the tests conducted thus far. At this time he is in a coma due to cerebral edema or swelling of the brain. As I'm sure you know, a coma is an unconscious state; however, not all comas are alike. There are different levels of unconsciousness, and there are recognized guidelines that rate the degree of brain impairment. As soon as he was admitted to the hospital, your husband was evaluated according to the Glasgow Coma Scale. It's a test that gauges reactivity of the eyes, verbal response, and motor control. Each of the three categories is assigned a number based on the level of unconsciousness and degree of dysfunction. A score of fifteen is a mild injury; a score of three is the most serious rating short of death.”

Rena listened carefully, waiting for the opportunity to ask the ultimate question.

The doctor opened a folder in front of him. “His initial score was an eight, which is the upper end of a ‘severe' head injury.”

“Does that mean he's going to die?” Rena asked in a plaintive voice she hoped expressed the proper level of remorse at the prospect of Baxter's imminent demise.

“No.”

Rena's face fell.

“And this can change, can't it?” Ezra interjected.

The doctor nodded. “Of course. The intracranial pressure or ICP that induced the coma is unstable. When I checked him this morning, I still gave him an eight even though there might have been a slight deterioration in his involuntary eye response. We are still in the first forty-eight hours since injury—the most critical phase of medical intervention.”

Rena tried to keep her expression impassive, but under the edge of the table she was wringing her hands. Like the legalese of the documents Alexia had brought from Santee, the convoluted medical terminology was an enemy, not a friend.

“That's why we are primarily focusing on the head injury at this time,” the doctor continued. “Unless the ICP is reduced we may lose him, so we have created as controlled an environment as possible. He was breathing on his own when admitted to the hospital, but we put him on a ventilator to regulate his respiration and stabilize his blood pressure. He is receiving medication to diminish ICP, and we have the option of surgery to further lessen the pressure.”

“Do the surgery if it will help,” Ezra responded and then quickly glanced at Alexia. “I can authorize it, can't I?”

The doctor spoke before Alexia could answer. “Neither Dr. Kolb nor I recommend surgery at this time. The additional trauma of the procedure might push him over the edge.”

“Don't say that!” Rena blurted out.

“I'm sorry, but it's a very serious situation,” the doctor continued. “There are no known medications that will shorten the duration of a coma. In fact, we are giving Baxter drugs to make sure he remains temporarily unconscious. Any movement at this point could create more problems.”

“What about internal injuries?” Ezra asked.

“That's the good news,” Dr. Berman replied. “Apparently, he slid part way down the rockface of the cliff and didn't land on the rocks following a free fall. He has a broken right leg, but it was a clean break and has been set. He has some scrapes and abrasions; however, except for the spine and head injury, no serious internal damage.”

“Will the paralysis be permanent?” Ezra asked.

“I've reviewed the situation; however, I'm going to let Dr. Graham, who is a neurologist, address that aspect of your son's condition.”

Dr. Graham, a young, handsome, blond-haired doctor with bright, blue eyes turned on the light box, slid a sheet of film into place, and took a retractable pointer from his coat pocket. Rena immediately liked him.

“Let me show you some pictures from the MRI performed last night. This is a view of Mr. Richardson's neck or cervical spine. He has what we call a tetraplegia between the C-4 and C-5 levels of his cervical spine. A tetraplegia is an injury to the spinal cord that results in total loss of all motor and sensory function below the level of injury.”

The doctor changed images and pointed to a place where there was obvious misalignment of the vertebrae. Even Rena, who didn't have a good view of the light box, could tell that the spine was damaged.

“This is from a CT scan that gives a better visualization of the bony anatomy of the spine. You can see there is evidence of a cervical fracture at the C-4/C-5 levels. There is also evidence of injury at C-3/C-4; however, the extent of damage is less clear. The location of injury is very important because the nerves that exit the spinal cord at each level control different bodily functions. A tetraplegia between the C-3 and C-4 levels terminates a person's ability to breathe on his own. If Mr. Richardson had suffered the same damage at C-3/C-4 as he did at C-4/C-5, he would not have survived long enough to make it to the hospital. An injury at C-4/C-5 causes quadriplegia, but the patient can usually breathe without permanent need for a ventilator. The difference in status can be measured in millimeters.”

Rena inwardly groaned. It wasn't fair. Tiny random movements of Baxter's body as it plummeted over the cliff had been the difference between life and death.

The doctor looked at Ezra. “You asked if his paralysis is permanent. Loss of function does not mean that the spinal cord has been severed. It can be caused by a contusion to the cord or by compromise of blood flow to the injured area. Based on our physical examination and the objective evidence from the MRI and CT scan, the spinal cord is not cut, but the damage is severe. If he survives, the chance of recovering any meaningful use of his arms and legs is not more than 10 percent.”

“What about speech?” Rena asked anxiously.

Dr. Berman answered. “That's more difficult to predict. The CT scan of the brain revealed what we suspected. Your husband has a diffuse injury that affects many parts of his brain. Thinking, speech, memory, taste, and other functions could all be affected. We have no clear idea at this time. However, damage to the region that serves one of these purposes doesn't mean total loss of them all. The brain cannot form new cells, but the remaining areas can take over some of the activity of those that are damaged or destroyed.”

Rena didn't hide her frustration. “I thought you were going to tell us whether life support should be terminated. I don't want my husband to continue to suffer on a tiny whim that he might get better without any realistic chance that he would be more than a vegetable. Neither of us wanted to be kept alive by machines.” She gestured toward Alexia. “Our lawyer has a piece of paper Baxter signed that says he wants to die with dignity.”

Dr. Berman's eyebrows came together in a clear expression of concern. “We face these situations on a regular basis and have to give advice based on legal standards in documents like the one you mentioned. But we're in the first stages of evaluating your husband's condition and don't recommend termination of life support at this time.”

Rena glanced around the room, hoping for signs of disagreement. None surfaced. Even the handsome Dr. Graham offered no support.

“Can you provide everything he needs at this hospital?” Ezra asked. “I'm willing to pay whatever it takes to send him anywhere in the country.”

“In terms of critical care, it's better to leave him here,” Dr. Berman said. “Our protocol is consistent with any major hospital in the country. Transferring your son to another treatment center would involve too many risks. Down the road, I might suggest a specialized facility but not now.”

“Is there anything else that can be done for him?” Ezra asked.

“No. We have to wait and see,” Dr. Berman answered. “One day at a time.”

After the doctors left, Ezra pushed his chair away from the table and spoke to Rena.

“Dr. Berman wasn't nearly as pessimistic as the neurosurgeon you talked to last night. We're going to beat this thing.”

“Did we hear any good news?” Rena asked. She held up three fingers on her right hand and touched each one with the index finger on her left hand. “Baxter is in a serious, life-threatening coma, he's paralyzed from the neck down, and he has unknown, possibly extensive damage to his brain.”

Ezra was magnanimous in his temporary victory. “But each day he survives increases the possibility that he'll get better. He's young and in good health. As soon as the doctors let me, I'm going to move him to a place where he can receive the best care available. You need to be more positive.” Ezra glanced down at his watch. “Visitation is in a couple of minutes. I'm going back to the waiting room so I can go in to see Baxter. Are you coming with me, Ms. Lindale?”

“No, sir. Since I'm not a member of the family, I don't want to intrude on your time with Baxter. I'll keep Rena company.”

Ezra locked eyes with Alexia. “Very well. I hope you have a productive talk.”

When the older man left the room, Rena put her head down on the table. Everything was crumbling around her. She needed help but wasn't sure where to find it. She heard Alexia tapping her fingers on the table. The female lawyer was a fighter. Intuitively, Rena sensed that Alexia wanted to come to her aid, but she wasn't sure how to irrevocably win her over and bind her to her cause. Suddenly, in the midst of the darkness behind her eyelids, Rena had an idea. It was so bold she suspected it might work. Rena's best decisions were always made on the spur of the moment.

Alexia waited. Not sure if Rena was crying, she knew it wasn't a time for an ill-chosen word. If Baxter survived, he would be completely dependent on Rena for the rest of his life, and Alexia was certain that taking care of a helpless invalid was not what Rena Callahan signed up for when she walked toward the flower-draped gazebo in her expensive wedding dress. “In sickness and in health” was a nice sentiment for a bride and groom with no fear of tomorrow worse than a common cold. It took on a new meaning when one spouse was as badly injured as Baxter.

“What do you think?” Rena asked in a muffled voice without raising her head.

Alexia wasn't sure what she meant. “You heard the doctors. Wait and see. That's all anyone can do.”

Rena lifted her head, and Alexia could see she wasn't crying, just profoundly sad.

“I'm not sure that's an option,” Rena sighed. “I feel like I'm under a death sentence. I can't live like this.”

It was a selfish statement, but Alexia didn't feel critical because it mirrored her own thoughts moments before. She spoke slowly. “I know the future is difficult to consider, but you have to live one day at a time. It's too soon to know anything for sure. If you let your mind race into all the things that could happen, it will drive you crazy.”