Richard Mabry - Diagnosis Death

"That's right," said the TV star. "And when we tell her what you did, you'll have to pay."

"You'll have to pay," joined in the doctor with the thick glasses, his eyes growing more prominent with every word. "We're calling her now to tell her."

The near-bald doctor picked up the phone sitting at his elbow and punched in ten digits.

"Please don't call her. I'll do anything. Anything."

"Too late. It's ringing."

Elena heard the synthetic tone that sufficed for a ring in most phones. But why could she hear it? Maybe if she could answer before Cathy did, she could talk her way out of this mess. Her fingers scrabbled around on the table beside her until they felt the hard, cold plastic of a phone receiver. She fumbled it to her face and fairly screamed, "I can explain. I can explain."

"Explain what?" a familiar voice asked. It wasn't that of the doctor/judge. It was someone she trusted-someone who could help her.

"David!"

"Hey, did I wake you? I'm so sorry. It's almost 9:00 a.m. I figured you'd be awake by now."

Elena swung her feet out of bed and squinted at the clock. "No, no, I should be up. You woke me from a nightmare. I should be thanking you."

"Are you okay to talk?"

"Give me time to splash some water on my face and get coffee going. I'll call you back in five minutes."

She took ten. Elena could smell the coffee brewing as she dialed David's number. "I'm so sorry. I must have sounded like an absolute nut."

"Not a problem. I've had nightmares that were so real it took me most of the day to shake them. Want to talk about it?"

"Not really." She didn't want to think about what it meant. She already knew.

"I don't suppose you'd like to go to church with me this morning?" David asked, hope mixing with resignation in both his tone and words.

Church? Oh, it was Sunday. But all Elena wanted to do was start planning for her move. "David, I appreciate the offer, but I'll have to pass."

"Well, would you like to meet afterwards for lunch? You can tell me about your interview."

She had to give him full marks for persistence. And he was a friend-perhaps the only one she had. "Sure. Call me when you're ready."

The coffee was brewed by the time Elena hung up. With cup in hand, she sank into a kitchen chair, leaned her elbows on the table, and wondered if her nightmare had been an attempt by her subconscious to cleanse her soul of the guilt it felt. Or was it a portent of trials yet to come?

The ICU was a terrible place to start the week, but Elena was drawn to it this morning like iron to a magnet. She had to talk to Erma Pulliam again. If the woman was to do the right thing for her husband and herself, she had to do it soon.

Elena pushed through the double doors into the unit. Off to her right, a nurse glanced at her and ducked into a patient room. Did the nurses resent her visits now? Chester Pulliam was no longer her patient. There was never any change to report, but conveying that information to her took precious minutes out of their already overcrowded day. Should she stop bothering everybody? But just as it was impossible not to explore a sensitive tooth with your tongue, Elena couldn't stay away.

As she paused outside Pulliam's door, Elena heard the rhythmic chuff, chuff, chuff of the respirator. Apparently the patient still had no spontaneous drive to breathe. The machine was keeping him alive.

Elena tapped lightly on the door and entered the room.

"Dr. Gardner." Erma Pulliam tried to smile, but Elena saw there wasn't much behind it. "Nice of you to come by."

The first thing Elena noticed was a plastic tube taped to Chester Pulliam's right nostril, the end plugged to keep a milky fluid from dripping out. There were a couple of vials of pills at the bedside, along with an old-fashioned pharmacist's mortar and pestle. The nurses would use those to grind medicines before inserting them into the feeding tube. No more need for IVs.

The feeding tube represented an intermediate stage. Surgical procedures came next: a gastrostomy to provide a permanent means of feeding and a tracheotomy to allow unrestricted airway access. These operations were an accepted part of the road to what physicians called a vegetative existence. Nice words, but they failed to describe what would happen to the patient-and to his family.

Mrs. Pulliam didn't know what lay ahead of her, but Elena did. Once more, she led the woman into the hall for their conversation.

"Has your family been here yet?" Elena asked.

Mrs. Pulliam shook her head. "We have two sons, both married and living on the other side of the country. They couldn't get away to come here, but they both said it didn't matter." She nodded toward the room they'd just left. "'That's not my dad in there,' they said. They want to remember him the way he was."

"And what did they say about taking him off life support?"

Mrs. Pulliam wiped her eyes with a tissue, then began shredding it. "They think I should do it. But I… I can't. It seems so wrong."

"Do you have religious scruples about it? I can ask the hospital chaplain to talk with you."

"No, I recognize the difference between taking someone's life and not prolonging the existence of a body with no brain function. It's just that I don't know if I have the courage to do it."

Elena patted the woman's shoulder. "I know how you feel. I've been where you are."

Surprise showed on the woman's face. "And what did you do?"

Elena swallowed hard. When could she stop reliving that awful experience?

"That's all right. I can see it's hard for you to talk about. I shouldn't have asked."

Elena shook her head. "No, you need to know that you're not the first person to agonize over this decision. I finally came to the conclusion that it was best for Mark-and for me-to take him off life support and let him die with dignity."

"I just don't know if I can do that."

"It's hard," Elena said. "But not doing it can lead to things that are much harder."

Mrs. Pulliam put her hand on Elena's arm. "Would you mind staying here with Chester for a few minutes? I want to walk down to the coffee shop. I need to get away for a bit. And somehow, I can't leave him alone."

"Of course. I'll be here when you get back."

The woman kissed her husband's forehead. She'd taken two steps toward the door when she turned back and kissed his cheek once more. "I love you, Chester."

Alone in the room with Chester Pulliam, Elena pulled a chair to his bedside. She drew back the sheet a bit to expose his hand. Gently, she covered it with her own.

A tap on the door jarred her away from her thoughts. Elena turned to see a nurse peek into the room, wheeling a medication cart in front of her. "Oh, Dr. Gardner."

"I can step out if you like."

"No, I was just checking on him. Do you think there's any change?" This wasn't the nurse who'd avoided her earlier. This one seemed to care.

Elena glanced at the woman's nametag. "Not for the better, Ann. And I don't think there'll be any. Do you?"

"No, I don't." The nurse nodded toward the figure on the bed. "It's pitiful, isn't it? You're so good to stand by Mrs. Pulliam through this. I know it can't be easy. I hope you help her do the right thing."

A beeping noise issued from Ann's pocket. She consulted her pager. "Oh, they need me stat. I guess the cart will be safe here with you." She looked up and it seemed that her gaze went to the center of Elena's soul. "I'll pray for you." With that, Ann hurried away.

Elena tried to recall all the people who'd told her they'd be praying for her. Most of her recent thoughts had been questions, not supplications, but surely God would count them as prayers. Other than that, she hadn't prayed since Mark's death.

She closed the door and began to look around the room. Everything she saw reminded her of a way to end Pulliam's marginal existence.