Jodi Picoult - Lone Wolf

Dr. Saint-Clare clicks again so a third scan appears on the screen. There is less white around the edges of the brain, but a new gray patch has appeared. The surgeon points to it. “This is the spot where the anterior temporal lobe used to be. Removing it and the hematoma, we were able to reduce some of the swelling in the brain.”

Dr. Saint-Clare had said that taking out this piece of my father’s brain would not affect personality but would probably mean the loss of some memories.

Which ones?

His year with the wolves in the wild?

The first time he saw my mother?

The moment he knew I hated him?

The neurosurgeon was wrong. Because losing any one of those memories would have changed who my father was, and who he’d become.

Cara tugs my arm. “That’s good, right?” she whispers.

Dr. Saint-Clare pushes another button, and the image on the laptop refreshes. This is a different angle, and I tilt my head, trying to make sense of what I’m seeing. “This is the brain stem,” he explains. “The hemorrhages reach into the medulla and extend into the pons.” He points to one spot. “This is the area of the brain that controls breathing. And this is the area that affects consciousness.” He faces us. “There’s been no distinguishable change since your father’s arrival.”

“Can’t you do another operation?” Cara asks.

“The first one was done to alleviate high pressure in the skull-but that’s not what we’re seeing anymore. A hemicraniectomy or a pentobarb coma isn’t going to help. I’m afraid your father’s brain injury… is unrecoverable.”

“Unrecoverable?” Cara repeats. “What does that mean?”

“I’m sorry.” Dr. Saint-Clare clears his throat. “Since the prognosis for a decent recovery is so poor, a decision needs to be made whether to continue life-sustaining treatment.”

“ Poor isn’t the same as impossible, ” Cara says tightly. “He’s still alive.”

“Technically, yes,” Dr. Zhao replies. “But you have to ask yourself what constitutes a meaningful existence. Even if he were to recover-which I’ve never seen happen to a patient with injuries this severe-he wouldn’t have the same quality of life that he had before.”

“You don’t know what will happen a month from now. A year from now. Maybe there will be some breakthrough procedure that could fix him,” Cara argues.

I hate myself for doing this, but I want her to hear it. “When you say the quality of life would be different, what do you mean exactly?”

The neurosurgeon looks at me. “He won’t be able to breathe by himself, feed himself, go to the bathroom by himself. At best, he’d be a nursing home patient.”

Trina steps forward. “I know how difficult this is for you, Cara. But if he were here, listening to everything Dr. Saint-Clare just said, what would he want?”

“He’d want to get better!” By now Cara is crying hard, working to catch her breath. “It hasn’t even been a full week!”

“That’s true,” Dr. Saint-Clare says. “But the injuries your father has sustained aren’t the kind that will improve with time. There’s less than a one percent chance that he’ll recover from this.”

“See?” she accuses. “You just admitted it. There’s a chance. ”

“Just because there’s a chance doesn’t mean there’s a good probability. Do you think Dad would want to be kept alive for a year, or two, or ten based on a one percent probability of maybe waking up and being paralyzed for the rest of his life?” I ask.

She faces me, desperate. “Doctors aren’t always right. Zazi, that wolf you brought here yesterday? He chewed off his own leg when it got caught in a trap. All the vets said he wouldn’t make it.”

“The difference is that Dad can’t compensate for his injuries, the way Zazi did,” I point out.

“The difference is that you’re trying to kill him, ” Cara says.

Trina puts her hand on Cara’s good shoulder, but she jerks her body away in a twist that makes her cry out in pain. “Just leave!” Cara cries. “All of you!”

Several machines behind her start to beep. The nurse attending her frowns at the digital display. “All right, that’s enough,” she announces. “Out.”

The doctors file through the door, talking quietly to each other. Another nurse comes in to fiddle with Cara’s morphine pump as the first nurse physically restrains her.

My mother bursts through the doorway. “What the hell just happened?” she asks, looking at me, and the nurses, and then at Cara. She makes a beeline for the bed and gathers Cara into her arms, letting her cry. Over my mother’s shoulder, Cara fixes her eyes on me. “I said leave, ” she mutters, and I realize that when she told this to the doctors, she was including me.

Within seconds, the morphine kicks in and Cara goes limp. My mother settles her against the pillows and starts whispering to the duty nurse about what happened to get Cara into this state. My sister is glassy-eyed, slack-jawed, almost asleep, but she fixes her gaze directly on mine. “I can’t do this,” Cara murmurs. “I just want it to be over.”

It feels like a plea. It feels as if, for the first time in six years, I might be in a position to help her. I look down at my sister. “I’ll take care of it,” I promise, knowing how much those words have cost her. “I’ll take care of everything.”

When I leave Cara’s room, I find Dr. Saint-Clare on a phone at the nurses’ station. He hangs up the receiver just as I come to stand in front of him.

“Can I ask you something?” I say. “What would actually… you know… happen?”

“Happen?”

“If we decided to…” I can’t say the words. I shrug instead, and rub the toe of my sneaker on the linoleum.

But he knows what I’m asking. “Well,” he says. “He won’t be in any pain. The family is welcome to be there as the ventilator gets dialed down. Your father may take a few breaths on his own, but they won’t be regular and they won’t continue. Eventually, his heart will stop beating. The family is usually asked to leave the room while the breathing tube is removed, and then they’re invited back in to say good-bye for as long as they need.” He hesitates. “The procedure can vary, though, under certain circumstances.”

“Like what?”

“If your father ever expressed interest in organ donation, for example.”

I think back four days ago-was it really only that long?-when I sifted through the contents of my father’s wallet. Of the little holographic heart printed on his license. “What if he did?” I ask.

“The people from the New England Organ Bank get contacted with every case of severe brain trauma, whether or not the patient has previously expressed a desire to donate. They’ll come talk with you and answer any questions you have. If your father is a registered donor, and if the family chooses to withdraw treatment, the timing can be coordinated with the organ bank so that the organs can be recovered as per your father’s wishes.” Dr. Saint-Clare looks at me. “But before any of that happens,” he says, “you and your sister need to be on the same page about removing your father from life support.”

I watch him walk down the hallway, and then I slip along the wall closer to Cara’s room again. I hang back so that I will not be seen but can still peer inside. Cara’s sleeping. My mother sits beside the bed, her head pressed to her folded hands, as if she’s praying.

Maybe she still does.

When I used to walk Cara to school, and then sat in my car making sure she went all the way into the double doors, it wasn’t just because I wanted to make sure that she wasn’t snatched by some perv. It was because I couldn’t be who she was-a little kid with pigtails flying behind her; her backpack like a pink turtle shell; her mind full of what-ifs and maybes. She could convince herself of anything-that fairies lived on the undersides of wild mushrooms, that the reason Mom cried at night was because she was reading a depressing novel, that it wasn’t a big deal when Dad forgot it was my birthday or missed her performance in a holiday concert because he was too busy teaching Polish farmers how to keep wolves off their land by playing audiotapes of howls. Me, I was already jaded and tarnished, skeptical that a fantasy world could keep reality at bay. I watched her every morning because, in my own little Holden Caulfield moment, I wanted to make sure someone was keeping her childhood from getting just as ruined as mine.