“There,” Blythe said, pointing at the monitor. “A heartbeat.”
I narrowed my eyes and approached the ultrasound machine. The little flicker on the screen fortified me. “She’s really pregnant.”
“I’d say about eight weeks is right.” Blythe pointed, marked it, and saved the results to the hard drive. Drawing a deep breath, she turned to me. “I can make some phone calls to find out how this would work. I’ve never treated this kind of situation but, at a conference, one of the presenters talked about a case. The family didn’t know the woman was pregnant until after a motorcycle accident. She stayed in a persistent vegetative state throughout the pregnancy and still delivered a healthy baby.”
I remembered to breathe only after stars started bouncing around the periphery of my vision. “Given Elle’s history … do you think it’s possible?”
“Maybe.” Blythe shrugged. “Phil said her pituitary gland and hypothalamus looked okay. So if the injury didn’t destroy her pituitary, her body should be able to regulate her hormone levels, maintain her body temperature. But I don’t know, Matt. It’s hard to say.”
“She’s been pregnant four times; she’s never gone to term.”
“The last one was close. The reason the baby died had nothing to do with anything that we’d expect to recur.”
The blood drained from my head, remembering Baby Dylan’s lifeless body in my arms.
Blythe rested her hand on my shoulder. “I’m not trying to tell you what you to do. But I do think you should have all the facts before you decide to withdraw Elle’s life support.”
3
After the Surgery
Mom entered Elle’s hospital room carrying two cups of coffee and a bag with sandwiches from a shop across the street. I set it aside. For some reason, people try to fill you with food when you’re filled with grief. I didn’t need food. I needed a reason to keep living.
“You have to eat, Matthew.”
I shrugged and continued to stare out the window, agonizing about what Elle would want me to do.
Mom set the sandwich on my lap again and turned toward Elle. “Do you think she’s in pain?”
“No. She’s …” Elle was brain-dead. She wasn’t experiencing anything anymore, and I was so lonely for her that nothing could ever take up the hollow space she’d left vacant.
Mom bent down and kissed Elle’s cheek. “Do you think she might still be able to hear us?”
“No.” Her temporal lobes, the parts of the brain which hear, were saturated with enough blood to create their own Red Sea. She couldn’t hear. Or see. Or act. And still I’d spent most of the last hour whispering to Elle and asking her what she wanted me to do.
Touching my shoulder gently, Mom said, “It’s late. Let me drive you home.”
“I can’t.”
My mother pulled up a chair beside mine, in the already crowded space between the bed and the wall. “It took me hours and hours to leave when your father passed away. But she’s not here, if what you said is right—that she’s brain-dead—she’s not here anymore. You don’t have to stay.”
I didn’t want to start crying. Not about Elle. Not about Dad. Yet the mention of his name nearly undid me. And the longevity of grief, the endlessness of it, settled into my future reality. Besides, I was hoping Elle’s spirit lingered nearby, even though I didn’t believe in bullshit like that. “Listen, Mom, you can go. I’m fine,” I said flatly.
I could feel it in her exhalation, her desire to do what mothers do. She wanted to take me away from this sadness, but she couldn’t fix this.
Probably in an attempt to remove me from this place, if not physically, emotionally—to pull me into memory, to a happier time—Mom said, “I keep thinking about when Alice and Hank brought Elle home from the hospital when she was a baby.”
I nodded, not paying my mother much heed. Elle would probably miscarry, but everything she’d ever said about being pregnant and babies screamed she’d want me to try. In fact, almost everything she’d ever said indicated that.
Almost. Elle didn’t want to live in a vegetative state, but at the same time she had risked her life for things she deemed bigger than herself—like on the Space Shuttle.
Mom reminisced. “Her mother put Elle in my arms—well, in your arms, Matt, because you were sitting on my lap. You don’t remember it by any chance, do you?”
“I was two and a half. How could I?” Although I’d heard the story enough times, how I had held Elle when she was just three days old.
“We thought you were deaf. Did you know that?” Mom was talking to herself as much as she was to me. She needed to distract herself from Elle’s condition, too.
“You thought I was autistic.” My pediatrician said something was profoundly wrong with me because, until the day the McClures brought their new baby over, I’d never spoken. My parents had taken me to a dozen specialists, none of whom could find a damn thing wrong with me other than I didn’t speak.
Mom wiped a tear from her cheek. “I didn’t believe any of it. I knew you’d be fine, and when Elle started cooing, you said, ‘Peep.’ You called her Peep for the longest time. Until you two started dating.”
I nodded. Sometimes I still called her Peep, usually as a term of endearment, rarely in front of anyone else. I twisted my wedding band. My love, my life, Peep.
“Your father said you couldn’t stand being upstaged by the little baby girl.”
“It was probably more like I’d been waiting around for her to show up. I can’t imagine this world without her in it.” I shuddered, on the brink of crying.
My mother nodded. “Me either. It seems impossible, Matt, but you do go on. I did after your father died. You will, too.”
“She’s pregnant,” I said.
My mother’s eyes widened. “Pregnant?”
I nodded. “It looks like eight weeks, but we didn’t know. She hadn’t missed her period.”
“Oh my goodness. That is why she fainted, then.”
“Maybe.” I shook my head, thinking the pregnancy had done this to her. By getting her pregnant again, I had done this to Elle. “I found out a couple of hours ago. Part of the trauma workup.”
“I’m sorry, honey.” Mom put her hand on mine. “Too many losses.”
“Blythe Clarke thinks it might be possible to save—the baby. She’s on the phone, talking to perinatologists all over the country. A couple of similar situations made it to term.”
“Matt—Matt, you can’t be serious. There is no way Elle would want to be kept alive like this.”
“I haven’t made a decision yet, but I think she’d want me to try,” I said.
Mom blinked rapidly. “She signed a living will.”
I leaned forward. “I thought you were bullshitting about that.”
“No, she signed one. Don’t you remember how much she hated that they kept her mother going for so long?”
“I know, Mom, but Alice had cancer and was suffering. Elle’s not in pain. Don’t you think she would want the baby to live?”
Mom squeezed her eyes shut, then a moment later covered her face with her hands. “If it means staying on life support for months? No, I don’t. I can’t let what happened to Alice happen to Elle. Oh my God, it’s not even reasonable to think this pregnancy could succeed. She’s had so many miscarriages.”
“That was because of the APS. It’s treatable.”
Mom pressed her lips together and drew in a deep breath. “Honey, you treated it last time, and you still lost the baby.”
“Not from the APS.”
“But he still died.” Mom reached out and took my hand. “I’m so sorry, but he did. And it almost killed Elle. I think it almost killed you. I don’t want you to get your hopes up just to have them crushed again. Let Elle go peacefully.”
“She’d want me to save the baby.”
Mom stood, looked out the window, and sighed. “It’s too early. Are you sure you don’t want to save a piece of Elle?”
“Of cou
rse I do, but I’m pretty certain she would want me to put the baby first.”
Mom shook her head. “It’s hardly a baby at this point. Matt, for heaven’s sake, you don’t even call it a fetus until it’s eight weeks.”
I glared at my mother. I did not need a lesson in embryology.
“I know,” she said. “My heart is breaking. And I’d do anything if I thought we could bring Elle back. You’re shattered, but try to put on your doctor’s hat. What do you think the odds are that she could carry a pregnancy now when she never could before? A hundred to one, a thousand? I love her. She’s like my daughter, you know that. I want her to wake up and—” Mom’s voice broke. “And that isn’t going to happen. Letting go is hard. But she made me promise I’d never let anyone do this to her.”
“She’s my wife.”
“I’m well aware, but you’re grieving, and you aren’t thinking straight.” My mother’s expression conveyed regret but also absolute immovability.
Panic rose in my gut, not because I was afraid of my mother, but because she is the most relentlessly stubborn person I’ve ever known. “When did Elle sign this thing? Where is it? Doesn’t it say something about pregnancy?” I asked.
“It was a long time ago. I don’t remember that specifically, but I’ll dig it out and take a look.”
Blythe Clarke returned to the room, stopping short when she saw the stern expression on my mother’s face. “Hello, Linney. Matt, I have more information when you’re ready.”
I stood and stepped around my mother’s chair. “Go ahead, Blythe. I told Mom Elle’s pregnant.”
Blythe pulled a PDA device from her lab-coat pocket. “The pregnancy looks viable so far. The outcome will depend on how stable they can keep Elle.”
“But she’s only eight weeks now?” Mom asked.
“Yes,” Blythe said.
Mom squeezed her eyes shut. “I can’t let you do this to Elle. Not for months and months.” Mom reached for her purse. “I’ll be back in a couple of hours,” she said. As she exited the room, she moved so fast I felt like I was in the ebb of a semi traveling down the highway.
Blythe stared at me. “What does she mean?”
“Tell me what you learned first.”
She hesitated a moment before she replied. “I found about a dozen anecdotal cases. I can’t make any promises. It’s August. If we can keep her alive until Christmas, the baby will be twenty-six weeks.”
“That’s awfully premature.”
“Yes. I’d like to see her make it to February, but by Christmas, the baby would be small, but most likely it would live; it would have a chance anyway.”
I pictured the NICU and the preemies there, not mini, chubby-cheeked versions of the full-term variety, but sick little things, thin-skinned and struggling. “My mother said Elle had a living will or an advanced health care directive. I never heard about this until now.”
“Hmm …” Blythe furrowed her brow as if she were puzzled. “I’m on call tonight, so I’ll be around. You can page me anytime. Otherwise I’ll stop by in the morning.”
“Okay,” I said as she walked away.
Lost in my thoughts, I must not have noticed my brother Mike walking up the hall. He said, “How is she? I raced over here as soon as I heard.”
“Come in if you want,” I said.
He glanced down at his grease-stained mechanic overalls. “How bad is it?”
Unable to find words, I shuddered.
Mike grabbed me and pulled me into a hug as if I were a little kid. And he started to cry.
“Come on,” I said, taking his elbow. I led him out of the room. Even if Elle couldn’t hear us, I couldn’t say “brain-dead” in front of her. While we walked down the long hospital corridor, I told him Elle was pregnant.
He blew out air like the wind had been knocked out of him. “But months? Are you sure you’d want to do this for months?”
“There’s a chance. So yes, I guess I am. Yes. I’m certain we should try,” I said, not at all certain about anything except that I felt devastated.
4
Day 2
In the morning when Phil entered the hospital room, I straightened and rubbed the kink in my neck as my partner performed a neuro exam on Elle. Periodically, I’d checked her pupils and reflexes during the night. She hadn’t improved, and as a doctor, I did not expect a miracle. As a husband, I wanted her back, so I kept looking for a glimmer of hope.
“Melanie’s outside,” he said. “She’d like to sneak in and see Elle.”
I nodded. Although the Longfellow Memorial’s ICU usually enforced the family-only visitation policy, something told me the nurses wouldn’t balk when the neurosurgeon’s wife broke the rules. “Tell her to come in.”
Phil went to the door and beckoned. When Mel entered, she looked as if she might cry, but instead she swallowed hard and opened her arms wide to me. “I’m so sorry,” she said. She held on for longer and tighter than would normally feel comforting, and still I wished she wouldn’t let go. She offered what little comfort was within her power. Was I hungry? Did I need anything from home? What about clean clothes?
Mel sat next to Elle and took Phil’s hand as if she needed his strength. “Phil says you can’t hear me, but … Oh God …” Her lower lip quivered and she looked up at Phil. “Isn’t there something you can do?”
Phil seemed to deflate and shook his head.
Melanie pressed the back of her hand to her mouth for a moment. “Okay, listen, Elle, we love you. Don’t want you to worry about Matt—or any of us. We’ll watch out for him. I promise.” Mel stood abruptly and folded herself into Phil’s arms.
An hour later Christopher came into the hospital room. Shaken, he had declined to see Elle the previous day.
“Hey,” he said as if we were tossing a baseball back and forth, then his jaw tightened. “They shaved her head.”
“For the surgery,” I said.
His eyes shifted to the floor. “This isn’t fair.”
Fair? The statement was so typical of Christopher, but this wasn’t a playground with referees.
“It never occurred to me that she might faint,” he said.
“You want me to absolve you and say, ‘Christopher, these things happen’? Okay. Accidents do happen. But this one wouldn’t have if you’d gone up on your own goddamned ladder.”
He grabbed the bed’s footboard. “Heights never bothered her. She’s never afraid of anything.”
I shook my head and led him out of the room. Elle couldn’t hear me. She couldn’t hear her brother, or any of us, but at any second I might blast Christopher for being such a pansy that he had to ask his big sister to act as his handyman. And I didn’t want her to see me beat the shit out of her precious Christopher.
Elle.
I stopped in the hallway and looked back through the glass wall at her stilled body, her eyes closed, swollen from the surgery and the fall. Even if she could open them, she couldn’t see me.
No wonder my patients’ families struggled with denial. I understood the physiology of Elle’s injuries. And none of this made sense to me. I couldn’t grasp the shift in my world.
“Matt? Did you hear me?”
I turned toward Christopher and shook my head. “What?”
“Why did you drag me out here?”
For a second grief overpowered my anger and then, like a demon, my rage resurfaced. “It’s not true that Elle was never afraid. She just hid her fears better than most people.”
“What was she afraid of besides ending up like my mom?”
I stared at him for a moment. Elle was afraid of a slow death. How the hell could I even consider keeping her on life support? Because, I told myself, she was willing to risk her life to have a baby. “Not realizing her dreams.”
“It’s not the same.” His mouth tightened, and he avoided my gaze. “She was only afraid of dying like my mom. What time are they going to turn off the machines? I—I should be here.”
“They aren’t. I
changed my mind.”
“Why? Did Phil think of something that could save her?” Christopher’s eyes widened, and hope fell across his face like sun breaking out of a storm cloud.
Oh God, I wished I could reach out and grab a fistful of his blissful ignorance. I shook my head. “There isn’t anything anyone can do.”
His mouth tightened, and he seemed to search the corridor, my face, and then the palms of his hands, which he then pressed against his eyes. “My dad wasn’t making any sense yesterday. He never did when he was drinking.”
I shuffled my restless feet, remembering the days when Hank was falling apart, when Chris was barely eight, their mother was dying, and Elle thought she had to carry the lot on her young shoulders. “I’m kind of surprised you even remember your father’s drinking days,” I said. Hank had been sober for a long time—at least until yesterday.
“I was old enough. You’d be surprised what I remember. You can’t make Elle go through what my mom did.”
I peered through the glass at Elle again, horrified by my decision to keep her on life support. “It’s not the same. She isn’t in pain. And she’s—pregnant. If we can keep her stable long enough, we can save the baby.”
His jaw dropped. “What? Not again. How many times now? Four? Five pregnancies?” He clenched his hands as if he wanted to strangle someone, me, most likely. “Damn it. I told you last time you’d better not get her pregnant again. She almost died last time.” He turned toward the room. Chris started shaking with anger or grief.
I didn’t know what to say, so I said nothing because this time she’d suffered brain death. Because of me.
It was rare for Christopher to act protectively of Elle. She was seven years older. But after her last pregnancy he pulled me aside. At the time I’d agreed with Chris. Trying to have a baby again would be too risky.
“She didn’t tell me she was pregnant,” Chris said.
“We didn’t even know. It’s early.”
“Are you saying we’d have to keep her on life support for nine months? I don’t think so. Elle didn’t want that. I don’t want that. I already watched my mom die that way.”
The Promise of Stardust Page 3
