Lone Wolf Read online

"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 tre