by Jodi Picoult
"Mrs. Ng," Trina says, "I'm afraid I'm going to have to ask you to step outside."
My mother just blinks. "What about Cara?"
"Unfortunately, this meeting is for Mr. Warren's next of kin," the social worker explains.
Before my mother can go, Cara grabs her sleeve. "Don't leave," she whispers. "I don't want to be alone for this."
"Oh, baby," my mother says. She smooths Cara's hair back from her face.
I step into the room and maneuver around everyone until I am standing beside my mother. "You won't be," I tell Cara, and I reach for her hand.
I have a sudden jolt of memory: I am crossing the street so that I can walk my little sister into school. I don't let go of her hand until I know both her feet are firmly planted on the opposite sidewalk. You have your lunch? I ask, and she nods. I can tell she wants me to hang around because it's cool to be the only fifth grader talking to a senior, but I hurry back to my car. She never knows it, but I don't drive off until I see her walk through the double doors of the school, just to be safe.
"Well," Dr. Saint-Clare says. "Let's get started. We're here today to update you on your father's medical condition." He nods to the resident, who sets a laptop on Cara's bed so we can all see the scanned images. "As you know, he was brought into the hospital six days ago with a diffuse traumatic brain injury. These are the CT scans we took when he was first brought into the ICU." He points to one side of the image, which looks muddy, swirled, an abstract painting. "Imagine that the nose would be here, and the ear here. We're looking up from the bottom. All this white area? That's blood, around the brain and in the ventricles of the brain. This large mass is the temporal lobe hematoma."
He clicks the mouse pad so that a second scan appears beside the first. "This is a normal brain," he says, and he really doesn't have to say anything else. There are clear, wide black expanses in this brain. There are strong lines and edges. It looks tidy, organized, recognizable.
It looks completely different from the scan of my father's brain.
It's hard for me to understand that this fuzzy snapshot is the sum total of my father's personality and thoughts and movements. I squint at it, wondering which compartment houses the animal instincts he developed in the wild. I wonder where language is stored--the nonverbal movements he used to communicate with his wolves, and the words he forgot to say to us when we were younger: that he loved us, that he missed us.
Dr. Saint-Clare clicks again so a third scan appears on the screen. There is less white around the edges of the brain, but a new gray patch has appeared. The surgeon points to it. "This is the spot where the anterior temporal lobe used to be. Removing it and the hematoma, we were able to reduce some of the swelling in the brain."
Dr. Saint-Clare had said that taking out this piece of my father's brain would not affect personality but would probably mean the loss of some memories.
Which ones?
His year with the wolves in the wild?
The first time he saw my mother?
The moment he knew I hated him?
The neurosurgeon was wrong. Because losing any one of those memories would have changed who my father was, and who he'd become.
Cara tugs my arm. "That's good, right?" she whispers.
Dr. Saint-Clare pushes another button, and the image on the laptop refreshes. This is a different angle, and I tilt my head, trying to make sense of what I'm seeing. "This is the brain stem," he explains. "The hemorrhages reach into the medulla and extend into the pons." He points to one spot. "This is the area of the brain that controls breathing. And this is the area that affects consciousness." He faces us. "There's been no distinguishable change since your father's arrival."
"Can't you do another operation?" Cara asks.
"The first one was done to alleviate high pressure in the skull--but that's not what we're seeing anymore. A hemicraniectomy or a pentobarb coma isn't going to help. I'm afraid your father's brain injury . . . is unrecoverable."
"Unrecoverable?" Cara repeats. "What does that mean?"
"I'm sorry." Dr. Saint-Clare clears his throat. "Since the prognosis for a decent recovery is so poor, a decision needs to be made whether to continue life-sustaining treatment."
"Poor isn't the same as impossible," Cara says tightly. "He's still alive."
"Technically, yes," Dr. Zhao replies. "But you have to ask yourself what constitutes a meaningful existence. Even if he were to recover--which I've never seen happen to a patient with injuries this severe--he wouldn't have the same quality of life that he had before."
"You don't know what will happen a month from now. A year from now. Maybe there will be some breakthrough procedure that could fix him," Cara argues.
I hate myself for doing this, but I want her to hear it. "When you say the quality of life would be different, what do you mean exactly?"
The neurosurgeon looks at me. "He won't be able to breathe by himself, feed himself, go to the bathroom by himself. At best, he'd be a nursing home patient."
Trina steps forward. "I know how difficult this is for you, Cara. But if he were here, listening to everything Dr. Saint-Clare just said, what would he want?"
"He'd want to get better!" By now Cara is crying hard, working to catch her breath. "It hasn't even been a full week!"
"That's true," Dr. Saint-Clare says. "But the injuries your father has sustained aren't the kind that will improve with time. There's less than a one percent chance that he'll recover from this."
"See?" she accuses. "You just admitted it. There's a chance."
"Just because there's a chance doesn't mean there's a good probability. Do you think Dad would want to be kept alive for a year, or two, or ten based on a one percent probability of maybe waking up and being paralyzed for the rest of his life?" I ask.
She faces me, desperate. "Doctors aren't always right. Zazi, that wolf you brought here yesterday? He chewed off his own leg when it got caught in a trap. All the vets said he wouldn't make it."
"The difference is that Dad can't compensate for his injuries, the way Zazi did," I point out.
"The difference is that you're trying to kill him," Cara says.
Trina puts her hand on Cara's good shoulder, but she jerks her body away in a twist that makes her cry out in pain. "Just leave!" Cara cries. "All of you!"
Several machines behind her start to beep. The nurse attending her frowns at the digital display. "All right, that's enough," she announces. "Out."
The doctors file through the door, talking quietly to each other. Another nurse comes in to fiddle with Cara's morphine pump as the first nurse physically restrains her.
My mother bursts through the doorway. "What the hell just happened?" she asks, looking at me, and the nurses, and then at Cara. She makes a beeline for the bed and gathers Cara into her arms, letting her cry. Over my mother's shoulder, Cara fixes her eyes on me. "I said leave," she mutters, and I realize that when she told this to the doctors, she was including me.
Within seconds, the morphine kicks in and Cara goes limp. My mother settles her against the pillows and starts whispering to the duty nurse about what happened to get Cara into this state. My sister is glassy-eyed, slack-jawed, almost asleep, but she fixes her gaze directly on mine. "I can't do this," Cara murmurs. "I just want it to be over."
It feels like a plea. It feels as if, for the first time in six years, I might be in a position to help her. I look down at my sister. "I'll take care of it," I promise, knowing how much those words have cost her. "I'll take care of everything."
When I leave Cara's room, I find Dr. Saint-Clare on a phone at the nurses' station. He hangs up the receiver just as I come to stand in front of him.
"Can I ask you something?" I say. "What would actually . . . you know . . . happen?"
"Happen?"
"If we decided to . . ." I can't say the words. I shrug instead, and rub the toe of my sneaker on the linoleum.
But he knows what I'm asking. "Well," he says. "He won't be in any pain. The fami
ly is welcome to be there as the ventilator gets dialed down. Your father may take a few breaths on his own, but they won't be regular and they won't continue. Eventually, his heart will stop beating. The family is usually asked to leave the room while the breathing tube is removed, and then they're invited back in to say good-bye for as long as they need." He hesitates. "The procedure can vary, though, under certain circumstances."
"Like what?"
"If your father ever expressed interest in organ donation, for example."
I think back four days ago--was it really only that long?--when I sifted through the contents of my father's wallet. Of the little holographic heart printed on his license. "What if he did?" I ask.
"The people from the New England Organ Bank get contacted with every case of severe brain trauma, whether or not the patient has previously expressed a desire to donate. They'll come talk with you and answer any questions you have. If your father is a registered donor, and if the family chooses to withdraw treatment, the timing can be coordinated with the organ bank so that the organs can be recovered as per your father's wishes." Dr. Saint-Clare looks at me. "But before any of that happens," he says, "you and your sister need to be on the same page about removing your father from life support."
I watch him walk down the hallway, and then I slip along the wall closer to Cara's room again. I hang back so that I will not be seen but can still peer inside. Cara's sleeping. My mother sits beside the bed, her head pressed to her folded hands, as if she's praying.
Maybe she still does.
When I used to walk Cara to school, and then sat in my car making sure she went all the way into the double doors, it wasn't just because I wanted to make sure that she wasn't snatched by some perv. It was because I couldn't be who she was--a little kid with pigtails flying behind her; her backpack like a pink turtle shell; her mind full of what-ifs and maybes. She could convince herself of anything--that fairies lived on the undersides of wild mushrooms, that the reason Mom cried at night was because she was reading a depressing novel, that it wasn't a big deal when Dad forgot it was my birthday or missed her performance in a holiday concert because he was too busy teaching Polish farmers how to keep wolves off their land by playing audiotapes of howls. Me, I was already jaded and tarnished, skeptical that a fantasy world could keep reality at bay. I watched her every morning because, in my own little Holden Caulfield moment, I wanted to make sure someone was keeping her childhood from getting just as ruined as mine.
I know she thinks I abandoned her, but maybe I got back at just the right time. I'm the only one who has the power to let her be a kid a little while longer. To make sure she doesn't have herself to blame for a decision she might second-guess for the rest of her life.
I can't do this, my sister had said.
I just want it to be over.
Cara needs me. She doesn't want to talk to the doctors and the nurses and the social workers anymore. She doesn't want to have to make this choice.
So I will.
The best day I ever spent with my father was nearly a disaster.
It was just after Cara was born. My mother had been reading parenting books, trying to make sure that a little boy who'd been the sole focus of her attention for seven years wouldn't freak out when a baby was brought home. (I did try to feed Cara a quarter, once, as if she was an arcade pinball machine, but that is a different story.) The books said, Have the new baby bring the sibling a gift! So when I was brought to the hospital to meet the tiny pink blob that was my new sister, my mother patted the bed beside her. "Look at what Cara brought," she told me, and she handed me a long, thin, gift-wrapped package. I stared at her belly, wondering how the baby had fit inside, much less a present this big, and then I got distracted by the fact that it was mine. I unwrapped it to find a fishing pole of my own.
At seven, I was not like other boys, who ripped the knees of their jeans and who caught slugs to crucify in the sunlight. I was much more likely to be found in my room, reading or drawing a picture. For a man like my father, who barely knew how to fit into the structure of a traditional family, having a nontraditional son was an impossible puzzle. He didn't know, literally, what to do with me. The few times he'd tried to introduce me to his passions had been a disaster. I'd fallen into a patch of poison ivy. I'd gotten such a bad sunburn my eyes swelled shut. It reached the point where, if I had to go to Redmond's with my dad, I stayed in his trailer and read until he was finished doing whatever he needed to do.
I would have much rather had a new art kit, all the little pots of watercolor paint and markers lined up like a rainbow. "I don't know how to fish," I pointed out.
"Well," my mother exclaimed. "Then Daddy needs to teach you."
I'd heard that line before. Daddy'll show you how to ride a bike. Daddy can take you swimming this afternoon. But something always came up, and that something wasn't me.
"Luke, why don't you and Edward go test it out right now? That way Cara and I can take a little nap."
My father looked at my mother. "Now?" But he wasn't about to argue with a woman who'd just given birth. He looked at me and nodded. "It's a great day to catch a fish," he said, and just those words made me think that this could be the start of something different between us. Something wonderful. On television, dads and sons fished all the time. They had deep conversations. Fishing might be the one thing that my father and I could share, and I just didn't know it yet.
We drove to Redmond's. "Here's the deal," he said. "While I'm feeding the wolves, you're going to dig up worms."
I nodded. I would have dug to China for worms if that were a prerequisite. I was with my father, alone, and I was going to fall in love with fishing if it killed me. I pictured a whole string of days in my future that involved us, bonding over walleye and stripers.
My father took me to a toolshed behind the cage where the gibbons were kept and found a rusted metal shovel. Then we walked to the manure pile behind the aviary, where all the keepers carted their wheelbarrows daily after cleaning the animal cages. He overturned a patch of earth as rich as black coffee and put his hands on his hips. "Ten worms," he said. "Your hands are going to get dirty."
"I don't care," I said.
While he checked on his pack, I carefully plucked a dozen worms out of the soil and confined them in the Ziploc bag my dad had given me. He returned with a fishing rod of his own. Then we ducked out the back gate behind the lions and I followed my father into the woods, parting the green fingers of ferns to walk down a muddy path. I was getting bitten by mosquitoes and I wondered how long it would be until we were there (wherever we were headed), but I didn't complain. Instead, I listened to my father whistle, and I imagined how awesome it would be to show my fishing pole to my best friend, Logan, who lived next door, and who couldn't stop bragging about the Sonic the Hedgehog 3 game he'd gotten for his birthday.
After about ten minutes the woods opened up to the edge of a highway. My father held tight to my hand, looked both ways, and then jogged across the road. Water sparkled, like the way my mother's ring sometimes made light dance on the ceiling. There was a fence, and a white sign with black letters.
"What's NO TRESPASSING?" I asked, sounding it out.
"It means nothing," my father said. "No one owns the land. We're all just borrowing it."
He lifted me over the fence and then hopped it himself, and we sat side by side at the edge of the reservoir. My father's fishing rod was rusty where mine was gleaming. And mine had a red and white bobber on the line, like a tiny buoy. I sat on my knees, then on my bottom, and then got up on my knees again. "The first rule of fishing," he told me, "is to be still."
He showed me how to release the hook from the eye where it was safely tucked, and then he reached into the plastic bag to pull out a worm. "Thank you," he said under his breath.
"For what?"
He looked at me. "My Native American friends say an animal that gives its life to feed another animal should be honored for the sacrifice," my father said, and he
speared the worm onto the hook.
It kept wriggling. I thought I might throw up.
My father knelt behind me, and put his arms around me. "You push the button here," he said, pressing my thumb against the Zebco reel, "and you hold it. Swing from right to left." With his body flush against mine, he swayed us in tandem, and at the last minute he let go of the button so that that line arched over the water, a silver parabola. "Want to try?"
I could have done it myself. But I wanted to feel my dad's heartbeat again, like a drum between my shoulder blades. "Can you show me one more time?" I asked.
He did, twice. And then he picked up his own fishing rod. "Now, when the bobber starts going up and down, don't pull. There's a difference between a nibble and taking the bait. When it goes down and stays down, that's when you pull back and start reeling in."
I watched him thank another worm and thread his hook. I held my rod so tightly my knuckles were white. There was a wind coming out of the east, and that made the bobber bounce around on the water a little bit. I worried that I might miss a fish because I thought it was the breeze. But I also worried that I'd reel in my line too early; that my worm would have given its life for nothing.
"How long does it take?" I asked.
"Rule number two of fishing," my father said. "Be patient."
Suddenly there was a yank on my line, as if I had woken up from a dream in the middle of a game of tug-of-war. I nearly dropped the pole. "Itsafishitsafish," I cried, getting to my feet, and my father grinned.
"Then you'd better bring it in, buddy," he said. "Nice and slow . . ."
Before he could help me, though, he got a fish on his line, too. He stood up as the fish zipped further into the middle of the reservoir, bending the tip of his pole like a divining rod. Meanwhile, my fish broke through the surface of the water with a splash. I had reeled as far as I could; the fish was thrashing and flailing inches away from my chest.
"What do I do now?" I shouted.
