Jodi Picoult - Lone Wolf

“That’s correct.”

“Have you ever heard of Dr. Robert Veatch?” she asks.

Dr. Saint-Clare clears his throat. “I have.”

“Isn’t Dr. Veatch a renowned medical ethics professor who questioned DCD?”

“Yes.”

“Can you summarize for the court what Dr. Veatch’s position is?”

Dr. Saint-Clare nods. “Dr. Veatch points out that a heart that stops can be started again-in fact, that’s exactly how a heart transplant is done. In his opinion the cessation of cardiac function and circulation is not irreversible in DCD patients-which means it doesn’t meet the accepted standard of determination of death.”

“So basically, you’re telling me that Mr. Warren can be declared dead once his heart stops. But it can then be donated to someone else… and start beating again.”

“That’s right.”

“Then isn’t it a little hasty to consider Mr. Warren dead in the first place, given that his heart technically could be defibrillated into action again while still inside his own body?”

“The circulatory determination of death is a standard medical practice in the developed world, Ms. Notch,” the doctor says. “The five-minute waiting time is meant to ensure that the heart doesn’t start beating again by itself, without medical intervention.”

Zirconia nods, but you can tell she’s not buying it. “Is Mr. Warren in any pain in his current condition?”

“No,” the doctor says. “He’s unconscious; he can’t feel anything. We’re doing our best to keep him comfortable.”

“So he’s not currently suffering?”

“No.”

“He’s not in distress?”

Dr. Saint-Clare shifts in his seat. “No.”

“And he could continue in this state, not suffering, for how long?”

“If he didn’t contract an illness that further compromised his bodily systems, and was sent to a long-term care facility, it could be several years.”

Zirconia folds her arms. “Now, you’ve told Mr. Ng that the five people I listed initially who had severe brain injuries were misdiagnosed, which is why they eventually recovered?”

“Yes. Disorders of consciousness are notoriously hard to diagnose accurately.”

“Then how can you be sure Mr. Warren won’t be the next case study of so-called miraculous recovery?”

“It’s possible, but highly improbable.”

“Are you aware of total locked-in syndrome, Doctor?”

“Of course,” he says. “LIS is a condition in which the patient is aware and awake but can’t move or communicate.”

“Isn’t it true that evidence of a brain stem lesion and a normal EEG are both symptomatic of LIS?”

“Yes.”

“And doesn’t Mr. Warren’s brain injury reflect brain stem lesions and a normal EEG?”

“Yes, but patients in classic locked-in syndrome have pinpoint pupils and other signs that lead to its recognition. Most neurologists consider it as a diagnosis when a patient appears to be in a coma, and test for it by asking the patient to look up and down.”

“But not in total locked-in syndrome, correct? Total LIS patients can’t look up and down voluntarily, by definition.”

“That’s right.”

“So wouldn’t it be extremely difficult, without that voluntary eye movement, to know if a patient has total locked-in syndrome or is in a vegetative state?”

“Yes. It could be hard,” Dr. Saint-Clare says.

“Are you aware, Doctor, that LIS patients often communicate with assistive devices, and some of them may go on to lead long lives?”

“So I hear.”

“Can you tell this court with a hundred percent degree of certainty that Mr. Warren doesn’t have locked-in syndrome?”

“Nothing in medicine is a hundred percent,” he argues.

“Then I guess you can’t say with one hundred percent certainty, either, that Mr. Warren won’t progress from a vegetative state into a minimally conscious one, and maybe even into consciousness?”

“No. But what I can tell you is that the treatments and interventions we’ve tried have not been successful in altering his state of consciousness, and I have no medical reason to believe that would change in the future.”

“You must be aware, Doctor, that people who suffered spinal cord injuries and were told they would never walk again have, in some cases, been able to walk due to advances in medicine.”

“Of course.”

“And the soldiers coming home from Iraq and Afghanistan with missing limbs today have the use of amazing prosthetic devices that would have only been science fiction for a soldier from Vietnam. Isn’t it fair to say that medical research advances every day?”

“Yes.”

“And haven’t many people who were given dire-even terminal-diagnoses gone on to live rich, full lives? You can’t say that five years from now, someone might not develop a technique that helps someone with lesions in the brain stem to recover, can you?”

Dr. Saint-Clare sighs. “That’s true. However, we have no way of knowing how long it will be before we start seeing these hypothetical cures you’re talking about.”

Zirconia levels her gaze at him. “I’m guessing it’s more than twelve days,” she says. “Nothing further.”

Dr. Saint-Clare stands up, but before he can leave the witness stand, the judge interrupts. “Doctor,” he says. “I have one more question for you. I don’t understand a lot of the medical jargon you’ve used today, so I want to cut to the heart of the matter. If this man were your brother, what would you do?”

The neurosurgeon sinks slowly back into his chair. He turns away from the judge, and he looks at Cara, his gaze bruised and almost tender. “I’d say good-bye,” Dr. Saint-Clare answers, “and I’d let him go.”

I must have walked for six or seven days, trying to find my way back to humanity. Much of the time I cried, already feeling the loss of my wolf family. I knew they’d survive without me. I just wasn’t sure if the same could be true in reverse.

Understand I hadn’t seen myself in two years, except for the occasional muddy reflection in a pool of water. My hair reached halfway down my back and was matted into unintentional dreadlocks. My beard was full and thick. My face was full of healing scratches incurred during play with the wolves. I hadn’t fully bathed in months. I had lost nearly sixty pounds, and my wrists stuck out like twigs from the cuffs of my coveralls. I looked, I am sure, like anyone’s biggest nightmare.

I heard the highway long before I saw it, and I realized how keen my senses had become-I could smell the hot tar of the summer pavement miles before the trees thinned and the embankment of the road rose in front of me. As I stepped into the full sunlight, I squinted; a passing tractor-trailer was so loud I nearly staggered backward at its roar. The hot gust of wind it left behind blew my hair away from my filthy face.

When I came to the chain-link fence, I touched it, the cool steel pressing like a lattice into my palm and so unlike anything I’d touched for so long that I stood for a moment, just feeling the strength and the clean lines of the metal. I started to climb up it, deftly leaping over the top edge and dropping to the ground silently: these were the skills I’d been honing. When I heard the voices, every hair on the back of my neck rose and I dropped into a natural crouch. I crossed so that I was upwind, so that they wouldn’t know I was coming.

They were a group of Girl Scouts, or whatever Girl Scouts are called in Canada. They were having a picnic at this highway rest stop, while their motor coach slept like a hulking beast in the shade of the parking lot.

I felt edgy, wild, too exposed. There wasn’t any tree cover; there wasn’t anyone flanking me willing to fight beside me if I needed it. I could hear the high, ripping sound of cars whizzing by on the road, and each noise seemed to me a bullet skating too close for comfort. The laughter of the girls was deafening; it had me covering my ears with my palms.