Seven Letters

by Sinéad Moriarty

  She looked at the early daylight around the window blind until her eyes grew drowsy. She didn’t believe in God, but right now she needed to pray. What else could she do? ‘Please, God or Allah or Buddha or whoever is out there,’ she whispered, ‘please make Sarah come out of her coma and make the baby be OK. Don’t take her away. Izzy needs her. It’s not right to take a mum away from a seven-year-old. Please don’t do this. She’s such a great person. We all love her.’

  Riley closed her eyes and tried to sleep. She realized she was crying when she felt the damp patch on her pillow.

  Izzy jumped up and down on the bed. ‘Wakey wakey, Riley,’ she shouted.

  Riley’s eyes were stuck together like concrete. Her head ached. She felt as if she’d been asleep for a minute. It couldn’t be seven already.

  Izzy pulled one of her eyelids up. ‘Are you awake? We don’t want to be late for school. Don’t be a lazybones.’

  Jesus Christ, Riley wanted to weep. She’d barely slept.

  Her dad popped his head around the door. ‘Ah, great, you’re up. And how did you sleep, Izzy, pet?’

  ‘Good. I love sleeping with Riley. Can I stay again tonight?’

  ‘I’m sure you can. Now, off you go and brush your teeth and I’ll get the breakfast on. How does sausages and toast sound?’

  ‘Yes!’ Izzy did a happy dance, then left to brush her teeth.

  Johnny sat on the edge of Riley’s bed and pulled the covers back. ‘And how did you sleep, my little pet?’

  ‘I didn’t. Sleeping with Izzy’s impossible. She kicks and twists and turns and wriggles non-stop.’

  ‘Ah, well, the poor little thing is worried sick about her mum.’

  ‘I know.’ Riley’s eyes filled with tears. ‘She thinks she’s asleep, Dad. I was talking to her last night and she genuinely believes that Sarah is just having a rest and that she’s going to wake up on her Communion Day. She really believes it.’

  ‘Probably for the best. No point upsetting her until we know more.’

  ‘What’s going on? Did Mum come home? Can’t the doctors tell us anything definite yet?’

  Johnny shook his head. ‘No. They’re being really careful in what they say, which makes me worry. Mia stayed in the hospital last night. She was too afraid to leave. She’s working on tracking someone down. Apparently, the mother of that new boy in your class, Pam Neelan, is a neurologist. She was working in some big trauma unit in the US until recently, so Mia’s asked her to have a look at Sarah’s medical notes. I think she’s right, we need as many opinions as we can get.’

  ‘Oh, yeah, he said something about his mum being a doctor. Maybe she’ll figure out how to make Sarah better.’

  ‘We’re having a meeting with the doctors this morning. Hopefully we’ll get some good news then.’

  Riley bit her thumbnail. ‘Do you think she’ll wake up?’

  Johnny sighed. ‘I don’t know, love, but I’m worried. We’ll have to wait and see what they say, after all the tests they’ve been doing. All we can do is hope and try to be optimistic.’

  Glass half full, Riley thought. Her dad was a glass-half-full person and her mum was a glass-half-empty person. That was why they worked. That was why she and Zach worked, too – correction, used to work.

  ‘Sarah’s the best,’ Riley said. ‘She’s like Mum, but in a calmer, nicer, more relaxed, cooler, more fun way.’

  ‘Ah, now,’ Johnny said, swatting her arm gently, ‘that’s a bit harsh. Mia is a wonderful woman.’

  ‘She’s always on my case, Dad. I can’t do anything right.’

  ‘She’s had a lot on her plate lately, Riley. I want you to be nice to her. Especially now. Sarah is her sister, her only sibling, and she adores her. Remember that. Mia is utterly devastated, and you and I have to support her. She’ll be home soon to have a quick shower and then she’s heading back to the hospital. Whatever she says or does, you are to bite your tongue and just say, “Yes, Mum,” and “Can I do anything for you, Mum?” OK?’

  ‘I promise I will.’

  ‘Good.’ Johnny kissed her head. ‘Now up you get.’

  When Riley shuffled into the kitchen twenty minutes later, Mia was standing at the counter, dressed in jeans and a jumper with wet hair dripping down her back. She looked wrecked.

  ‘Hi, Riley,’ she said. She put down her coffee, came over and threw her arms around her daughter.

  Riley froze. They weren’t huggy people. It felt weird and uncomfortable. She raised her arms and put them round her mother.

  Mia pulled back. ‘How are you, pet? You’ve been a bit abandoned in the midst of all this.’

  ‘I’m fine. How are you?’

  Mia smiled sadly. ‘It’s really hard, but I’m hanging in there.’

  ‘So, uhm, how is she?’ Riley whispered, so Izzy, who was eating sausages and telling Johnny about her Communion dress, wouldn’t hear.

  ‘The same. No change. I don’t know what’s going to happen. We’re meeting the medical team this morning. It’s just so …’ Mia lowered her head and quickly wiped a tear from her cheek.

  Oh, Jesus. Riley didn’t know what to do. Her mother never cried, like never, ever, ever. She was so strong and tough, Riley often wondered if she felt real emotions. She wanted to put her hand up and lay it on her mother’s shoulder or something, but she felt too awkward. She tried to think of something positive to say. Glass half full, she told herself. ‘It’ll be OK, Mum, I mean, she could end up like that guy Stephen Hawking, and he had a good life. The wheelchair and having to speak with his eyebrows wasn’t great, but you know, he did loads and – and – Sorry, that’s a shit example, but –’

  Mia looked as if she’d been slapped. She rushed out of the room, her hand over her mouth.

  ‘Nice one, Riley,’ Johnny hissed.

  Riley’s eyes filled with tears. What was wrong with her? She should have just kept her big mouth shut. Damn it, she’d upset her mother now and that was the last thing she’d wanted to do. Riley felt sick.

  She picked at a slice of toast, then went upstairs to find her mother. She heard her voice and peered around her parents’ bedroom door. Mia was brushing Izzy’s hair.

  ‘Mummy does two plaits on the side and then she clips them and then she ties them into a ponytail at the back. It looks so pretty.’

  ‘I’m sorry, Izzy, your mum was always better at hair than me. I’ll try, though.’

  ‘I don’t mind having just a regular ponytail today.’

  ‘Thanks, sweetie.’ Mia hugged her from behind. ‘You are such a gorgeous girl, do you know that, Izzy? Your mum is so proud of you.’

  ‘She’ll wake up soon,’ Izzy said. ‘And I’m going to tell her all about my sleepovers with Riley.’

  Mia concentrated on Izzy’s hair. ‘You know, Sarah always tells me that the day you were born was the best day of her life.’

  Izzy beamed in the mirror. ‘She says that to me all the time. I was afraid the new baby would make Mummy love me less, but she said no way.’

  ‘Absolutely no way. You are her little star, always.’

  ‘When Riley was born, was it the best day of your life, Mia?’

  Mia held the brush in the air. ‘Yes, pet, it was, the very best. I was so happy to meet my little girl at last.’

  Riley bit her trembling lip and walked into the room. ‘Hey, Mum, I’ll do Izzy’s hair. You go and finish your coffee. Let me help.’

  ‘Thank you, Riley.’ Mia touched her shoulder. Riley put her hand up and squeezed her mother’s arm. It wasn’t exactly a hug, like in the American TV shows, and she didn’t say, ‘I love you,’ but it was something.

  ‘So I want two plaits at the side and –’

  ‘I’m going to stop you there,’ Riley said, sitting down on the bed behind Izzy. ‘I don’t do good plaits. Today you’re getting a messy ponytail and it’ll look really cool. Trust me, all your friends will want one.’

  ‘OK, Riley.’ Izzy smiled. ‘Mummy can do my plaits when she wakes up.’ Izz
y’s jaw jutted out. ‘And that’s that.’

  Riley tied her cousin’s hair up in silence and sent up another prayer that Sarah would pull through. The whole family depended on her. They couldn’t manage without her. Riley couldn’t manage without her. She had to pull through.

  17

  Mia, Johnny, Charlie and Adam sat at the table facing Dr Mayhew, Professor Irwin, Angela and a woman they hadn’t met before. They were in a boardroom on the top floor of the hospital. The walls were painted the same awful magnolia as the rest of the place, but it had a deep red carpet that made it seem a bit more important. In the middle of the room sat a large, oval mahogany table. Sadly, the chairs around it were the same as the ones in the ICU waiting room. Functional, dark blue conference-hall chairs. They cheapened the table and gave the room a clinical feel.

  On a trolley at the end of the room there were coffee and tea percolators. Twin towers, surrounded by mugs, a carton of milk and a bowl filled with sachets of sugar – brown and white. A plate of jaded-looking custard creams lay beside the sugar bowl. In the corner of the room was a large water dispenser.

  ‘Can we get you some coffee or tea, or perhaps some water?’ Dr Mayhew asked politely.

  ‘If I drink any more caffeine, I’ll be climbing the walls,’ Adam said. ‘I just want to know what’s going on.’ He looked completely exhausted.

  Mia’s palms were sweaty, and her heart was pounding. Beside her, her father appeared to be sitting still, but underneath the table his legs were shaking.

  Dr Mayhew cleared his throat. ‘Professor Irwin will talk us through the results of the neurological examinations that have been carried out over the past three days.’

  ‘Good morning,’ Professor Irwin said. She looked down at her notes, avoiding eye contact. That was not good. Mia could feel the woman’s dread as she took a deep breath and said, ‘I’m afraid it’s not good news.’

  Nobody spoke. They were all holding their breath. Johnny reached for Mia’s hand. Adam clenched his into fists and breathed heavily.

  ‘Sarah has a large cerebellar cystic lesion causing acute hydrocephalus and compression of the brain stem. There is an absence of blood flow in the intracranial vessels to the brain stem or to either cerebral hemisphere.’

  Adam thumped the table, making them all jump. ‘I don’t understand what you’re saying. Is she going to wake up? Is my wife going to be OK?’

  Professor Irwin looked at Dr Mayhew, then back at Adam. ‘I’m very sorry, Mr Brown, but no, your wife is not going to recover from this injury. Sarah had a cyst in her brain that caused her to collapse. The series of tests that we have run repeatedly, both the clinical tests and the scans, indicate that she has sustained a massive and devastating brain injury, one that affects the particular areas of the brain that sustain life, and these areas are no longer working. An angiogram has confirmed that there is no brain stem activity. In other words, there is no brain function. Our conclusion is that her brain injury is so severe, she will not live if we take her off the life-support machine. I am so very sorry, but Sarah is clinically dead. She will not wake up.’

  Silence.

  Into the awful silence came the sound of weeping. Mia looked over in a daze and saw that Charlie had broken down. Her brain was slowly catching up, as if the doctor’s words had been played to her in slow motion.

  ‘No,’ Charlie moaned, covering his face with his hands. ‘My poor Sarah.’ He wept openly, and Mia stared at him stupidly, still trying to process Professor Irwin’s words.

  Beside her, Johnny took her hand. She turned to him and his eyes were red-rimmed.

  She finally managed to speak. ‘Are you absolutely sure?’ she asked Dr Mayhew.

  ‘I wish I could tell you otherwise, but Sarah will not come back from these injuries. The brain is too damaged. We have repeated the tests and the results are conclusive. I’m really so very sorry.’

  Mia felt hope seep out of her. They sounded so sure. The medical jargon was confusing but ultimately they were saying that Sarah was gone, and that she was never coming back. The body in the room down the corridor was being kept alive by machines. But she looked alive, she felt alive … It was so hard to believe she was dead. Was she really?

  Adam’s eyes were flinty. ‘I’m not accepting that,’ he said fiercely. ‘No way. Sarah is still alive. We’re not giving up on her.’

  The doctors exchanged a look. Angela leaned forward. ‘This is incredibly difficult for you, Adam,’ she said. ‘It is a really cruel blow, but the doctors have been absolutely methodical. That’s why we took our time and didn’t jump to conclusions. But the fact is that Sarah has no brain-stem activity, which means she is brain dead. It’s not possible for her to recover, Adam.’

  Adam kept shaking his head, as if blocking out Angela’s words. ‘I’m getting a second opinion. I’ve seen reports on the news about medical negligence and – and medical fuck-ups. Well, my wife isn’t going to be one of them. We’re getting experts to give their opinions. A second one here and my brother is getting a third opinion in Toronto. They’re ahead of the game there. They might be able to save her. We’ll move her over there if necessary. I will not give up on Sarah, no way.’

  ‘You may, of course, get as many opinions as you wish, but I’m afraid the outcome won’t change,’ Dr Mayhew said.

  ‘Our expert is coming in this morning to give us a second opinion. I want you to talk to her and tell her everything. I want her to see all the notes and test results. I want her to give me her opinion on this. What’s her name again, Mia?’

  ‘Pam Neelan. She’s a neurologist. We’d like her to have a look at Sarah and give us her prognosis.’

  ‘She’s just back from working in the US, so she probably has a lot more experience working with – with complicated cases,’ Adam added, clinging desperately to any lifeline he could find.

  ‘I know Pam Neelan,’ Professor Irwin said. ‘I’ll be happy to have her opinion.’

  ‘And what about my son? He’s still alive.’

  Dr Mayhew turned and introduced the other lady. ‘This is Ms Johnston, the consultant obstetrician working on Sarah’s case. She will fill you in on the state of the foetus.’

  ‘Good morning. We believe the state of gestation to be about fourteen weeks. At the moment, the foetus is alive, yes. I am, however, concerned because of Sarah’s high temperature. It is currently at 38.5 degrees and rising. Babies are not designed to be incubated in anything but a normal temperature. The higher the foetus’s temperature, the quicker it will get through the available oxygen. We also need to control Sarah’s blood pressure to ensure good placental function. The problem is that very few drugs are licensed for use in pregnant women and it’s not possible to say what effect the drugs we need to use to keep Sarah alive will have on the foetus. As the gestation is only at fourteen weeks, I’m afraid the outlook is extremely poor.’

  ‘Poor, but not impossible,’ Adam said. He looked so wild-eyed, Mia worried he was going to keel over with stress. ‘My son can make it. I know he can.’

  Ms Johnston remained calm, but Mia could see her jaw twitching. Clearly she didn’t know what to say. Suddenly, Johnny leaned down and pulled a bag onto his lap. I’ve been doing some research and found a study with similar cases, the Heidelberg study. From what I’ve read, babies have survived in brain-dead mothers.

  ‘Here it says, “The researchers found that a viable child was delivered in twelve of the nineteen cases they studied. Twelve babies were born and survived the neonatal period. The management of a brain-dead pregnant woman requires a multidisciplinary team, which should follow available standards, guidelines and recommendations.”’

  Adam was staring at Johnny with a half-smile on his lips. ‘Now, did you hear that?’ he said triumphantly. ‘My boy will survive if you all do your jobs. I don’t want to hear any more about poor outcome. We all need to stay positive. I am not losing my son.’ His voice broke. ‘I am not losing everything.’

  The room fell silent again. />
  Ms Johnston explained, ‘The foetus is only fourteen weeks. It depends entirely on Sarah for its oxygen and sustenance. Sarah can no longer provide that. Her body has already started to show signs of deterioration, and that will accelerate over the coming days. I’m very sorry, but prolonging Sarah’s life won’t save the foetus and will be traumatic for all of you.’

  Adam stared coldly at her. ‘The foetus is my son, Ben. That’s the name me and Sarah had picked. No one is switching off any ventilators.’

  ‘Adam, I know this is awful for you but please listen to what we’re trying to tell you,’ Angela begged. ‘Fourteen weeks’ gestation is at least eight weeks before the foetus can reach viability, which means being able to survive outside the womb. And even if it made it to twenty-two weeks and was delivered and had full paediatric ICU care, it’s highly unlikely it could survive. And even if it did, the trade-off for extreme pre-term delivery is increased risk of brain bleeds, blindness, lung injuries … Adam, you don’t want to do that to your son.’

  ‘He can make it,’ Adam said stubbornly. ‘I know he can.’

  Angela bit her lip and looked at her colleagues.

  ‘We’ll give you some time and space to process all the information,’ Dr Mayhew said gently. ‘Let us know when you’ve decided how you wish to proceed.’

  ‘I don’t need time,’ Adam retorted. ‘You just keep my wife and baby alive.’

  Dr Mayhew nodded. ‘I’ll need you to sign some paperwork. We’re here to answer any questions. It’s a very traumatic time for you all.’ He left the room, followed by his colleagues.

  Adam turned to Mia. ‘Do you think this woman, Dr Neelan, will find a mistake? Do you think she’ll be able to operate on or treat Sarah’s brain and make her wake up? Do you, Mia? Do you?’ He was like a desperate little boy begging for reassurance.