by Joy Fielding
“We do an ostium, an incision in the neck,” Dr. Zarb explained without further prompting, “whereby a trach is inserted directly into the neck, instead of through the mouth. If the patient is later able to breathe without the assistance of the ventilator, then we remove the trach tube and let the trach close up on its own.”
“Is there much chance of that happening in this case, Dr. Ein?”
“Impossible to say at this point. The patient has several things going for her: Casey Marshall is young. She’s very fit. Her heart is working perfectly….”
No. I won’t listen to this. It can’t be true. It simply can’t be. I’m not the woman you’re discussing. I’m not in a coma. I’m not. I’m not. Please, God. Get me out of here.
“… And don’t forget she’s Ronald Lerner’s daughter.”
I can hear you! How can I be in a coma if I can hear you?
“For those of you too young to remember, Ronald Lerner was a businessman of dubious moral character who made a killing in the stock market, then died in a plane crash a number of years back. He left the bulk of his very sizable estate to the young woman you see lying comatose before you, proving not only that money can not buy happiness but that it’s no protection against the vagaries of fate. Although at least Casey Marshall will be able to afford the best in private medical care once she’s released from the hospital.”
This isn’t happening. It isn’t happening.
“Any more questions?” someone asked. Casey thought it might be Dr. Ein, but the voices were getting increasingly difficult to distinguish from one another.
“When can the peg tube come out?” she thought she heard someone—Dr. Peabody? Dr. Zarb?—ask. What the hell’s a peg tube? she wondered frantically.
“Not until the patient can eat on her own,” came the response, so Casey concluded there must be some kind of feeding tube connected to her stomach.
I want to go home. Please, just let me go home.
“And the antibiotic drip?”
“Not for at least another week. The patient is very susceptible to infection because of all the procedures she’s had. Hopefully we can get her started on some physical therapy once all the casts come off. Okay? Any other questions before we move on?”
Yes! You have to start over from the very beginning. Explain everything that happened: the accident, how I got here, what’s going to happen to me now. You can’t just leave me alone in the dark. You can’t walk away and pretend I don’t exist. You have to come back. I can hear you! Doesn’t that count for something?
“Doctor Ein,” someone said.
“Yes, Dr. Benson.”
“The patient seems to be in some sort of distress. She’s grimacing and her heart rate is going up.”
What’s happening?
“It’s possible she’s experiencing some pain. We’ll increase the Dilaudid, Demerol, and Ativan she’s getting.”
No, I don’t need drugs. I’m not in pain. What I need is for you to listen to me. Please, somebody, listen to me!
“That should make you more comfortable, Casey,” the doctor said.
No. I’m not comfortable. I’m not comfortable at all.
“All right, let’s move on.”
No. Wait—don’t go. Please, don’t go. There’s been a huge mistake. I can’t be the woman you’re talking about. I can’t be. None of this is happening. You have to come back. I have to make you understand that I’m not in a coma. God, please. You have to make these people understand that I can hear them. If you do that, I promise I’ll be a better person. I’ll be a better wife, a better friend, a better sister. Please. You have to help me. I’m so afraid. I don’t want to spend the rest of my life lying here, not being able to see, or move, or speak. I want to hold my husband in my arms again, and laugh with my friends. I want to make things right with Drew. Please. Don’t let this be happening. It can’t be happening. It can’t be.
Casey felt her thoughts begin to wobble and disperse. She was suddenly very woozy. Dilaudid, Demerol, Ativan, she was thinking as she felt her eyes close.
Seconds later, she was asleep.
THREE
“Casey,” she heard someone say softly. And then again, more forcefully. “Casey. Wake up, sweetheart.”
Reluctantly, Casey felt herself being dragged into consciousness by her husband’s voice. She opened her eyes, saw Warren looming over her, his handsome features distorted by the proximity of his face to hers, so that he appeared bloated and gargoyle-like. “What’s going on?” she asked, trying to clear her mind of the strange dream she’d been having, and noting that the clock radio beside their king-size bed said 3:00 a.m.
“There’s someone in the house,” Warren whispered, casting a worried glance over his left shoulder.
Casey followed his gaze through the darkness, her pulse quickening as she sat up.
“I think someone might have gotten in through a basement window,” he continued. “I tried calling 911, but the lines are dead.”
“Oh, God.”
“It’s all right. I have the gun.” He held it up, its barrel glistening in the reflection of the half moon outside their window.
Casey nodded, recalling the argument they’d had over his insistence to keep a gun in the house. “For our protection,” he’d said, and now it seemed he’d been right. “What do we do?” she asked.
“We hide in the closet and lock the door. If anyone opens it, I shoot first and ask questions later.”
“God, that’s awful,” Casey said, using Gail’s voice. “Does anybody really talk like that?”
“They do on TV,” Warren answered.
What? What’s going on? What TV?
“I don’t think I saw this one,” Gail said.
What is Gail doing in our bedroom? Why has she broken into our house?
“I don’t think anybody did. Looks like one of those straight-to-video numbers. But the doctors seem to think keeping the TV on might help stimulate Casey’s brain, and frankly, it helps pass the time.”
“How long have you been here?” Gail asked.
“Since about eight o’clock.”
“It’s almost one now. Have you had any lunch?”
“One of the nurses brought me a cup of coffee about an hour ago.”
“That’s all?”
“I’m not very hungry.”
“You have to eat something, Warren. You have to keep up your strength.”
“I’m fine, Gail. Really. I don’t want anything.”
“They’re getting closer. I hear them on the stairs. We don’t have time.”
What are you talking about? Who’s on the stairs? What’s happening?
“Get under the bed. Hurry.”
“I’m not going anywhere without you.”
Who are these people?
“Enough of that crap,” Warren said.
A clicking sound. Then silence.
What was happening? Casey wondered, startled to realize she didn’t know whether her eyes were open or closed. Had she been asleep? For how long? Had she been dreaming? Why couldn’t she distinguish between what was real and what wasn’t? Were these people her Warren, her Gail? Where was she?
“Her color’s better,” Gail remarked. “Has there been any change?”
“Not really. Except that her heart rate has been fluctuating more than usual….”
“Is that good or bad?”
“The doctors don’t know.”
“They don’t seem to know much about anything, do they?”
“They think she might be experiencing more pain—”
“Which isn’t necessarily a bad thing,” Gail interrupted. “I mean, it might signal she’s coming back to us.”
“Patients in deep comas can still experience pain,” Warren said, his voice flat. “How fair is that?” he added.
Casey could almost see him shaking his head. This was definitely her Warren, she thought, recognizing the familiar rhythms of his voice, the gentle cadence of his tone. Oh, W
arren. You’ve found me. I knew you would. I knew you wouldn’t let me stay in this awful, dark place.
“I can’t believe this is Casey,” Gail was saying. “The last time I saw her, she looked so beautiful, so full of life.”
“She still looks beautiful,” Warren said, and Casey detected a hint of defensiveness in his voice. “The most beautiful girl in the world,” he said, his voice drifting away.
Casey pictured his eyes filling with tears and knew he was fighting to keep them from falling. If only she could wipe away those tears, she thought. If only she could kiss him and make everything better.
“What’d you girls talk about that day anyway?” he asked. “You never told me much about your lunch.”
“There wasn’t much to tell,” Gail said, a little laugh bracketing each end of her short response. “To tell you the truth, I don’t really remember what we talked about. The usual, I guess.” She laughed again, although the soft sound was more sad than joyful. “I didn’t realize I should be attaching any more weight to it than normal. I didn’t realize it might be our last time together. Oh, God.” A loud sob cut through the air, like a sudden thunderclap.
Oh, Gail. Please don’t cry. It’ll be all right. I’m going to get better. I promise.
“I’m sorry. I keep forgetting,” Warren was saying. “This must bring back painful memories.”
Casey pictured Gail lifting both shoulders in a gentle shrug, then tucking a few wayward curls behind her right ear. “Mike was in a hospice for two months before he died,” Gail said, talking about the husband she’d lost to leukemia five years earlier. “There wasn’t anything anybody could do but watch him fade away. But at least we had a few years to prepare,” she continued. “Although you’re never really prepared,” she added in the next breath. “Not when the person is so young.”
“Casey isn’t going to die,” Warren insisted.
He’s right. The doctors have misdiagnosed my condition. This whole thing is a big mistake.
“I won’t even consider taking her off life support.”
“Taking her off life support?” This time it was Gail who asked the question. “When did the doctors suggest taking her off life support?”
“They haven’t. They agree it’s way too early to be thinking that way.”
“Of course it is. Then who?”
“Who do you think?”
“Oh,” said Gail. “I didn’t realize Drew had been here lately.”
My sister’s been here?
“Are you kidding? She hasn’t been here since right after the accident. Says she can’t bear seeing her sister in this condition.”
“Sounds like Drew,” Gail said.
“She called last night for an update,” Warren continued. “When I told her there’d been no change, she demanded to know how long I was going to let Casey suffer this way. She said she’d known her a lot longer than I have, and that there’s no way her sister would want to be a vegetable for the rest of her life …”
A vegetable? No, the doctors have made an unfortunate mistake. They’ve upset everyone unnecessarily.
“… kept alive by a bunch of tubes and ventilators.”
“That’s only until she starts breathing again on her own,” Gail said forcefully. It had been a long time since Casey had heard her friend sound so intense. “Casey will get through this. The broken bones will mend. Her body will repair itself. She’ll regain consciousness. You’ll see. Casey will be as good as she always was. This coma is just her body’s way of healing itself. We should be grateful that she’s not awake, that she doesn’t know what’s going on….”
Except she did know, Casey was forced to acknowledge, as the direness of her predicament suddenly reasserted itself, spreading through the dark space around her like a nasty stain.
The patient is a thirty-two-year-old woman who was the victim of a hit-and-run accident approximately three weeks ago…. She’s on life support … multiple traumas … extensive surgeries … external fixators … massive bleeding to the abdomen … A splenectomy was then performed…. the patient might be in a coma for the rest of her life.
A coma for the rest of her life.
“No! No! No!” Casey shouted, unable to block out the truth any longer. No amount of denials, no amount of rationalizations, no amount of pretending her doctors might be mistaken could hold back the horrifying truth of her condition—that she was a thirty-two-year-old woman trapped in a possibly irreversible coma, a coma that cruelly enabled her to hear but not see, to think but not communicate, to exist but not act. Hell, she couldn’t even breathe without the help of a machine. This was worse than being lost in some dank underground cave, worse than being buried alive. Worse than death. Was she doomed to spend the rest of her days in this dark, free-floating limbo, unable to distinguish between what was actually happening and what was merely imagined? How long could this go on?
Subdural hemorrhage … burr hole into the skull to remove the blood … major concussion to the brain … Casey Marshall could be on the ventilator for years, or she could wake up tomorrow.
How many hours, days, weeks could she lie here, suspended in blackness, hearing a succession of voices float about her head like passing clouds? How many weeks, months, years—God forbid, years!—could she survive, not being able to reach out to those she loved?
The patient’s brain has been rocked.
For that matter, how long would it be before her friends stopped visiting her, before even her husband moved on? Gail rarely talked about Mike anymore. And Warren was only thirty-seven. He might hover over her for a few more months, maybe even a year or two, but eventually he’d be coaxed into someone else’s all-too-eager arms. The others would follow, lulled back into their everyday lives. Soon everyone would be gone. Even the doctors would eventually lose interest. She’d be carted off to some rehab facility, abandoned in a distant corner of a stale-smelling corridor, propped up in a wheelchair, and left to listen to a succession of lost feet shuffle by. How long before she went mad from frustration and rage, from the sheer boredom and predictability of it all?
Or she could wake up tomorrow.
“I could wake up tomorrow,” Casey repeated, trying to draw comfort from the thought. Judging by what she’d heard, the accident had happened three weeks ago. So maybe Gail’s optimism wasn’t entirely unfounded. Maybe the fact she could now hear was a good sign, a sign that she was on the road to recovery. Her hearing had returned. Her eyes had opened. Maybe tomorrow the darkness would lift, and she’d be able to see. Maybe once the tube was out of her mouth—Was it out already? Had the doctors already performed the tracheostomy they’d been talking about … when? How long ago?—she’d regain the use of her vocal chords. She was already getting better at being able to distinguish between outside voices. They no longer all blended together or sounded as if they were coming to her from the far side of a thick wall. Maybe tomorrow it would be better still. She might even be able to blink in response to any questions they might pose. She might find a way to show everyone she was alert and cognizant of what was being said.
Maybe she was getting better.
Or maybe this was as good as it was ever going to get, she realized, feeling her spirits suddenly deflate, like air whooshing out of a child’s half-blown balloon. In which case, her sister was right.
She’d rather be dead.
“Do the police have any new leads?” she heard Gail ask.
“Not that I know of,” Warren said. “None of the auto-body shops in the Philadelphia area have reported any vehicles being brought in with the kind of extensive damage you’d expect in an accident of this nature. No witnesses have come forward, despite all the publicity. It seems the car that hit her has vanished into thin air.”
“How could somebody do something so awful?” Gail asked. “I mean, it was bad enough he hit her, but then to just leave her there like that …”
Casey imagined Warren shaking his head. She saw his soft brown hair fall across his forehead an
d into his darker brown eyes. “Maybe the driver had been drinking. Probably he panicked,” Warren theorized. “Who knows what goes on in people’s minds?”
“You’d think his guilty conscience would have gotten the better of him by now,” Gail said.
“You’d think,” Warren agreed.
Another silence.
“Oh,” Gail exclaimed suddenly.
“What?”
“I just remembered something we talked about at lunch,” she elaborated, her voice tinged with sadness.
“What was that?”
“Casey said the two of you had been talking about having a baby, that she was going to stop taking the pill at the end of the month.”
Casey felt a twinge of guilt. That was supposed to have been a secret, she remembered. She’d promised Warren she wouldn’t say anything to anyone until it was a fait accompli. “Do you want everyone to keep asking how it’s going every month?” he’d argued gently, and she’d agreed. Would he be disappointed, maybe even angry, she hadn’t kept her word?
“Yeah,” she heard him say now. “She was all excited. A little nervous, too, of course. I guess because of her mother.”
“Yes, her mother was quite something.”
“That’s right. I forgot. You knew her, didn’t you?”
“I don’t think anybody really knew Alana Lerner,” Gail said.
“Casey almost never talks about her.”
“There wasn’t much to say. She was the kind of woman who never should have had children.”
“And yet she had two,” Warren observed.
“Only because Mr. Lerner wanted a boy. She didn’t have much to do with them once she popped them out. They were pretty much raised by nannies.”
“Nannies who were constantly being fired, from what I understand.”
“Because Mrs. Lerner was convinced her husband was sleeping with them. Which he probably was. He certainly made no secret of his affairs.”
“Some family.”
“It’s a wonder Casey turned out so well,” Gail said, and then started to cry. “I’m sorry.”
