“I’m glad you all could be here.” Dr. Stransky raised his voice, demanding the attention of everyone in the room. Conversation ceased as he went on. “But I’m sorry to say, this is not an easy meeting for any of us.” He turned to Fanny. “I hope you know that, since your husband arrived here, we’ve done everything we could to help him.”
“I know that,” Fanny said. “Everyone has been good to him.”
“Thomas suffered a traumatic brain injury in last week’s auto accident,” Dr. Stransky continued. “We had hoped that when the swelling in the brain was reduced, we might see a return of function. Unfortunately, that hasn’t happened.”
“So his brain isn’t functioning anymore?” Fanny asked.
Dr. Benton put his hands in prayer position and rested his chin on his fingertips. “Our neurological tests show that he has lost both voluntary and involuntary function. He will never speak or walk again, and his body systems are beginning to shut down.”
“But he looks good and healthy,” Emma said. “I was just holding his hand, and it’s soft and warm. I think he’s far from dead.”
“Right now he looks pink and feels warm because his blood is still artificially being circulated throughout his body,” explained Dr. Benton. “But the ‘command and control’ center in the brain has shut down.”
“He’s dying?” Fanny said, her brows arched in disbelief.
“Yes.” Dr. Benton’s word hissed through the room like a snake.
Elsie felt her lower lip jut out in defiance. Dr. Benton was a kind man, but she didn’t like this negative side of him. Elsie shifted in her chair, surprised at how still Beth was keeping. Like a little angel.
In the odd silence, Emma began to cry. Will patted her shoulder, looking like a big man, and Emma reached an arm around him to hold him close. One of the nurses pushed a box of tissues over, and both Fanny and Emma grabbed a few.
The men were frowning, so stern, as if they disapproved of this whole thing.
Maybe they’re like me, Elsie thought. Maybe they know the doctors are wrong.
“Thomas is in the final chapter of his life,” Dr. Stransky said. “In his condition, our goal shifts to giving him comfort and allowing him to die in a peaceful state, surrounded by family.”
Caleb tipped his hat back and faced the doctors. “How do you know this?” He pointed to his head, rotating his hand in a circle. “How do you know there are no thoughts and dreams in his head?”
“We’ve run numerous tests, Caleb.” Dr. Benton’s pale eyes were sympathetic. “Brain waves are electrical impulses that are easily detected. In your father’s case, we are not seeing any brain activity, upper or lower.”
“What if you’re wrong?” Elsie cried. “I’ve heard stories of folks in a coma who woke up weeks, even months later and they were just fine. How do you know he won’t wake up today or tomorrow … or in two weeks and …” A sob wracked her voice, but she knew she had to fight for Dat. How could they sit here and talk about Dat as if he were already gone? How could they give up on him?
“Elsie, I understand your concern for your father.” Dr. Benton’s voice was soft now, more comforting than scientific. “If Thomas were my father, I’d be asking the exact same questions. But Thomas is not in a coma. He’s not going to wake up.”
“But, Doctor, I was there.” Elsie was not one to argue, but she could not make sense of any of this. “He was talking to me and he seemed just fine. It was just a bump on the head. Not even a drop of blood.”
“Brain trauma isn’t always apparent from the outside.” Dr. Benton held her gaze, and the sorrow she saw in his eyes frightened her. This was real. Impossible, terrible, but real. “You’re lucky that you got to speak to him before he was gone.”
She bit her lower lip and shook her head. She wasn’t lucky at all, and she didn’t believe in luck. She believed in blessings and miracles.
Fanny pressed her palms against the table, as if searching for a solid foundation. “What can we do?” she asked.
Dr. Stransky flipped open the file on the table. “I don’t suppose he had a DNR … a Do Not Resuscitate order?”
Fanny shook her head, her eyes glistening.
“I’ve never seen one in the Amish community,” Dr. Benton said. “But, in his state, we don’t need one to turn off the machine.”
“Can we do that? Turn everything off. All the electric things.” Fanny looked from the doctors to the bishop, who nodded.
“Then we’ll turn everything off and take him home,” Fanny said, firmly. “I think that’s what he would have wanted.”
“You are free to do that,” Dr. Stransky said. “But at this point he’s being kept alive by machines. Once we disconnect the breathing apparatus, there’s a good chance he’ll stop breathing. He’ll be gone before you can get him home.”
Fanny buried her face in her hands. “Oh, dear Gott in heaven, I don’t know what to do.”
“I think I speak for the entire staff when I say that it’s the right thing to turn off the machines.” Dr. Benton paused, taking a moment to make eye contact with every Amish person in the room. “But I just want to be sure you understand that Thomas is dying. Even if you leave him on the machines, his organs will begin to fail. If you turn the machines off, well, it will happen sooner. I see that as a more dignified death.”
But Elsie didn’t want any death at all. “Samuel.” She turned to the bishop. “Is this Gott’s way? To turn off the machines and let my father die?”
Samuel’s big nose was red, his eyes glassy, and Elsie realized that he was struggling to hold in his own sadness. “It’s Gott’s plan, Elsie. We can’t understand why the Heavenly Father calls men to Him when he does. It’s something we must accept.”
Her lower lip began to wobble as tears filled her eyes. She could not argue with the bishop. She could not stop Dat from dying.
Her life was like those bright headlights. Blinding. Verhuddelt. Veering out of control.
She tried to remember her mother’s loving arms, her father’s warm voice. She needed someone to catch her, to stop her from falling.
But there was no one.
22
Haley leaned away from the nurses’ station to check the door of the conference room.
Still closed.
“They’re taking a long time,” she said, clicking a pen rapidly.
“It’s not something you’d want to rush.” Aeesha jotted a few things in her notebook, then closed a chart. “Would you stop that clicking and find something to do? I hate people who finish before me.”
“Your patients were more challenging than mine today.” Haley was finished with her clinical work, but she had decided to hang around in case Elsie wanted to talk after the meeting.
She clicked and clicked as she thought of what Elsie and her family must be going through. Although she wasn’t privy to Thomas Lapp’s chart, she had heard that the repeated screenings had found no brain activity at all. Today’s meeting would be difficult for everyone involved.
Poor Elsie. When Haley had spoken with her earlier today, Elsie still maintained hope that her father would recover. Not being a doctor, Haley had kept mum on the subject. She knew the experts would communicate with the family in today’s meeting. Besides, over the past week they had gone over the science of brain function a few times.
“Did they tell you about the two parts of the brain?” Haley asked. She had boned up on her knowledge of brain function, anticipating that the family would have some questions and worries. “The brain is very complex, but sometimes doctors separate the upper and lower regions because they have very different functions. You might think of it as upstairs and downstairs. Upstairs is where the higher functions of the central nervous system take place. The ability to see, hear, taste, and smell. And our personality and intellect. Our reasoning skills.”
“It’s a wonder, the way Gott made us,” Fanny had said, grateful for Haley’s information.
Now Haley clicked the pen, curious about
the conversation in that meeting.
“Would you stop?” Aeesha reached up and swiped the pen out of Haley’s hand. “Enough!”
“Sorry. Nervous habit, and I hate waiting around.”
“If you’ve got nothing to do, look up the treatment protocol for postsurgical appendectomy for me.”
“Okay.” Haley was clicking on a website when she heard a shuffle in the corridor. She shot a look down the hall and saw the dark dresses and suits of the Amish people emerging from the conference room. “They’re out. Gotta go.”
Haley stepped into the corridor, then paused when she realized the group was headed this way. She held her breath, trying to get a beat on the group’s mood. The medical personnel were unfathomable; Thomas’s family seemed sad but reconciled to their loss. Most eyes were red and puffy, but there were no dramatic tears or sobs.
Elsie came down the hall, holding hands with her little sister, Beth.
“Hey.” Haley swiped a strand of blond hair out of her eyes.
Elsie looked up, her eyes pleading. “They’ve given up on Dat.”
It wasn’t that simple—Haley knew that—but this wasn’t a conversation for a crowded hospital corridor. “Do you want to talk about it?”
Elsie nodded. “Can you come with us to Dat’s room?”
“Sure.”
“But I’m getting a candy bar from the machine first.” Beth looked up at Elsie. “Right?”
Elsie gave a playful tug on the little girl’s braid. “Ya, you can have a candy bar.”
Room 303 had become familiar to Haley over the past week, with its small window overlooking the parking lot, the second bed used by Fanny Lapp, and the dozen folding chairs that had been brought in for Tom’s visitors, a group that had sometimes swelled to large numbers over the past week.
Haley helped Jenny open up chairs once again, making sure that everyone had a comfortable place to sit with Thomas. When Beth appeared with a giant Snickers bar, she told Haley that Elsie was waiting for her outside.
She found Elsie leaning against a wall by the snack machines, staring off into space.
“What’s the matter? Can’t decide between Snickers and Three Musketeers?” Haley asked.
“It would be nice if that was my worst problem.” When Elsie looked up at her, Haley noticed the dark smudges under her eyes. “They’re going to let my dat die. I’ve been praying for a miracle, but instead, everyone is giving up.”
“Have you considered the fact that no one has a choice here?” Haley glanced at the shiny linoleum floor beneath them. “Let’s pull up a seat,” she said, sliding down against the wall until she was sitting on the floor. Side by side with Elsie, with knees pulled up to the chest, they were eye to eye.
“I can only imagine the way you’re feeling right now,” Haley said. “But I want you to know that the doctors here don’t give up on a patient. If they think there’s a chance of recovery, they’re all over it. The thing is, I don’t think they’re giving up on your father. I think they’re looking at the medical facts, and the reality is that he is dying. You and I can’t stop it, and neither can the doctors.”
“Only Gott in heaven has the power over life and death.”
“That’s right. And we can cry and scream and shut down.” The way I did, until Dylan helped me. “But in the end, we can’t control these things.”
“I know that.” With a heavy sigh, Elsie let her head drop back against the tile wall. “My head knows that it’s true. It’s my heart that won’t let Dat go.”
Haley felt the sting of tears in her eyes at the thought of losing a loved one. Elsie articulated her feelings so well. “I know you’ve been praying for him.”
Elsie nodded. “I can’t be disappointed with Gott. I keep telling myself that I don’t understand His plan. But I’m going to miss Dat.”
“I’m sure you will. Do you want to be with him now? A chance to say good-bye?”
Elsie closed her eyes for a moment, fraught with weariness. Haley thought she might be falling asleep until she spoke. “Ya. I want to be with him. And Fanny needs looking after … the little ones, too.”
“I think Beth is all set for now.” Haley stood up and reached down to help Elsie. “She’s got her Snickers bar.”
Elsie didn’t smile—she didn’t respond at all—and Haley wondered if she should stop trying to cheer her friend up. Sometimes, people needed space to grieve.
Back in Thomas’s room, the mood was quiet but social as folks chatted and a nurse hovered near the patient. Elsie and Haley took a seat.
Over the past week she’d witnessed the Amish custom of bringing the entire family to the hospital whenever possible. Unlike many Englisher people who were uncomfortable around sick or dying patients, the Amish seemed at ease keeping vigil beside a dying friend.
Caleb’s tall silhouette filled the door frame. He entered and came over to crouch near Elsie. “It’s done then. Fanny signed the papers with the doctors.”
Elsie pressed a hand to her mouth and nodded.
Emma appeared with Dr. Benton, who spoke with some of the visitors about the weather and the “marvelous” cookies one of the women had brought for the nursing staff.
“I know they were meant for the nurses,” Dr. Benton said, “but occasionally they feed me if I’m good.”
To Haley, the lack of solemnity seemed a bit odd for the room of a dying man, but the relaxed atmosphere definitely made the situation easier to tolerate. Death seemed to be yet one more aspect of living that the Amish had learned to cope with.
When Fanny entered with Dylan, Haley breathed a little easier, knowing that he would be nearby to support Elsie’s family and friends. After the successful treatment of her own problem, Haley was an advocate of guided imagery therapy, and she sensed that the Amish would be equally interested in a treatment that didn’t involve drugs or surgery.
Fanny stood by her husband, touching his face fondly. When she bent down and kissed him, Haley had to look away. It seemed like such a private moment.
“We need to say our good-byes,” Fanny said, cutting through the chatter. “Then Dr. Benton is going to turn off the machines.”
Elsie rose and went to her father’s bedside. She climbed the stool that had been placed there, kissed his cheek, and whispered a few words.
Emma and Caleb followed, and then Fanny brought the two small children over. Beth leaned out of Caleb’s arms to give her dat a kiss, and Will climbed up on the stepstool and gave him a hug.
Will and Beth seemed to understand what was happening, and no one sought to take them from the room. The children weren’t being shielded from the truth; they were being taught that death was a fact of life.
Without ceremony, Dr. Benton turned the breathing apparatus off, then unclamped the tubing that went into Thomas’s mouth. From his chair in the back of the room, the bishop began singing something. It was really just a round “O,” but everyone joined him, their voices rising and blending in. Each graceful, gliding note was held for so long, Haley was reminded of a yoga chant. The sound was sweet and sad at the same time; a hopeful lament that made goose bumps rise on the back of Haley’s neck.
Whether it was a prayer or a hymn, the doleful sound that filled the room made Haley think of a soul rising to the skies. She thought of what Graciana had said about the angels carrying her daughter off to heaven, and she tried to imagine the same happening for Thomas Lapp.
Thomas’s chest was no longer rising and falling. There would be no more pain for him, but no more sunrises, either.
Summoning her sliver of faith, Haley silently said a prayer for the soul of Thomas Lapp, and the comfort of his family here on earth.
23
“Young man, will you add this to my purchases?” The old woman, who was swallowed up in the large coat, pointed to a birdhouse with a roof of copper-colored tiles.
Ruben came around the counter and lifted the hefty house from its pillar. He placed it on the counter and brushed his hands together. “There
you go.”
“I could use a big, strong man like you around the house. Ever since my knees went out, I don’t trust myself to balance and lift.”
“Can I get you anything else?”
“No, but I’m going to need some help getting these things to the car.” She peered up at him over her reading glasses. “Now I know you ride only in horse-drawn buggies. Are you allowed to deliver things to a car? As long as you don’t ride in it?”
“We can ride in automobiles,” he said. “But we can’t drive ’em or own ’em.”
“Really? Well, that explains a lot of things. So I guess you could ride in an ambulance or on a fire truck if you needed to. That’s a good thing.”
Her words reminded Ruben of the accident, and his mouth went sour. It had been a little more than a week since that awful day, but time hadn’t buffered the memory yet. How could the pain fade, when they’d just lost Thomas last night?
It’s his store I’m running, Ruben had told himself all day as he went through the motions of making sales for the Lapp family.
“You can just leave the package here for a bit,” the woman said. “I’m waiting on my sister, who’s deliberating the merits of cherry versus peach pie filling.”
Ruben leaned back on Elsie’s high stool and focused on the customer. Conversation helped keep his mind off things. “I take it this is your first visit to Lancaster County.”
“Can you tell? I live in Massachusetts, and I’m visiting my sister in Delaware. She’s never been here, either, but we’re loving the handmade crafts. I love anything that’s organic and homemade, and your store has a wonderful assortment of things. It’s a treasure. I’m so glad we found it. I’m Doris, by the way.”
“I’m Ruben.” He was about to explain that this wasn’t actually his store, then he thought better of it and kept his mouth shut. He didn’t mean to trick Doris in any way, but he didn’t want to get to the point of explaining why Elsie couldn’t run the store herself right now.
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