Over His Dead Body

CHAPTER 16

SHAKEN BY EDITH'S OMINOUS REACTION to Mitch's condition, Cassie paced the hall o utside the lounge, where she had spent so many hours over the weekend. In the cluttered room, the TV was playing loudly to an audience of some ten people, who all seemed to belong to a distraught family Cassie hadn't seen before. Every minute something else reminded Cassie of her mother's death. She didn't want to sit in the lounge, in case a code was called and another family lost someone they loved. She waited impatiently for Mark in the hall, and he arrived, as promised, only minutes after noon. Time had slowed to a crawl.

"Mark." She felt safe as soon as she saw him.

"Hi, sweetheart." He kissed her cheek and peered at her intently right in front of everybody, thumb and index finger turning her chin from side to side as if he hadn't examined her face just this way only yesterday.

"Not a bad job at all," he confirmed again, shaking his bald head, since they were old friends and she hadn't trusted him enough to make the referral.

"Let's go somewhere. I can't talk in there," she said about the lounge.

"No, no, of course not. I thought we'd have a quick lunch somewhere close by." Today he was wearing a different sports jacket and different aftershave. His cheeks were smooth and moisturized. His color was excellent.

"Lunch?" A warning bell went off.

"Yes, looks like you need some sustenance." Mark Cohen was a study in contrasts. There was nothing handsome about him. In middle age, his flesh was filling in all around him. His face was round. He was shorter than she was. His nose was a blob on his face.

But to Cassie, the well-dressed teddy bear also had the suave and comforting air of a professional. His gentle and sympathetic hand on her arm, his expression of short-term deep concern for her pain combined with absolute acceptance of the inevitability of death. His wry expression, indeed his whole demeanor, seemed to say: "I've seen it all a hundred times. This, too, shall pass." This message of competence and empathy felt like the very last thing left over from the age of Cary Grant and Jimmy Stewart.

"How are you holding up?" asked the only man Cassie knew who could understand and help her.

"Oh God. You wouldn't believe what's happening. Mark, I don't even know how to tell you this." She wished she could lower her head onto his chubby chest and rest it there for a year or two and let him take care of everything. His navy blazer was the very best, just like the kind Mitch wore, with gold buttons and a pink shirt under it. The shirt had a dazzling white collar, and cuffs that were held together with gold golf ball cuff links. Mitch happened to have the same ones.

Cassie couldn't help being impressed by the close attention to sartorial detail and personal care that some men took of themselves. In Mark, it reminded her of the kidney infection he'd cured twelve years ago, and the way he'd handled her breast lump scare several years later. Mitch had left town the day of her biopsy, but Mark had remained staunchly by her side.

"Where do you want to go?" Mark patted her hand.

"Oh, that's sweet of you, but I can't go out. My aunt Edith is here with Mitch."

His face registered a moment's disappointment. "Tomorrow, then."

Cassie still had her very dark sunglasses on over the scarf tied around her head. "Oh definitely," she murmured, shaking her head no. They'd never had lunch alone together. She absolutely adored him, but how could she think about going out? She steered the subject to Mitch. "Have you seen Mitch?"

"Yes, of course, early this morning." He sniffed the air around her. "Nice perfume, what is it?"

"Really, Mark, I don't know."

"Sublime, I think. You've been wearing it for a long time, haven't you? I've always liked it."

"Well, I just saw Mitch. Have you seen what his finger is doing?" Cassie didn't want to think about her perfume.

"Of course. I saw all of him. What about it?"

"It was moving around on the sheet. It looked like he was trying to say something. Write something."

"Oh, yes. They do that sometimes. It doesn't mean anything." Mark was studying her intently.

"What's the matter?" She touched her cheek and didn't feel a thing.

He shook his head. "Nothing. Just the change in you. You really look different. I'm not sure I would have recognized you."

"I know I look terrible. Let's not dwell."

"Quite the contrary. You look very good. Really good."

"For God's sake, Mark, I don't care how I look. I want to talk about Mitch. I think he's coming back," Cassie said wildly. "He has motion in his hand. I saw it."

Mark raised a shoulder. "Well, random movements. That doesn't mean anything." He raised the shoulder again. "I don't want to be pessimistic, Cassie. But he's still in a very deep coma-"

"I think he's coming back. I really do," she insisted.

"Does he respond to the things you say? Does he seem to know you?" Mark asked gently.

"No, but-"

"Sweetheart, he's not responding to any outside stimuli. We're not seeing any brain activity on the EEG," he said solemnly. "I have to be straight with you."

"No brain activity?" Cassie asked hopefully.

Mark pressed his lips together and shook his head. "Mitch is a tough nut. He's hanging on, but we'd hoped for more of a rally, some return of awareness." He massaged Cassie's hand and put his other arm around her shoulder and squeezed that, too. "You okay?"

"No brain activity. That's-" she shook her head. Great!

"Look, on the other hand, I've seen patients who've been in a vegetative state for six, seven, eight months, even years, who just wake up one day."

"No!" Cassie didn't want to hear that.

"I know, it's rough. Are you sure you don't want something to eat? Starving yourself won't help him."

"No, no. Thank you, but I couldn't think about food right now."

"This isn't good for you. You look like you've lost about fifteen pounds. You've had a trauma. You're depressed."

More than he guessed. "Mark, I haven't lost an ounce."

"I'm your doctor. I would know." He said this with his wry little doctor smile. Then he patted her bottom, lightly. Just a touch, then he pressed those lips together appreciatively, and nodded. "Ten pounds, at least."

"Mark!" Cassie was shocked by the inappropriate gesture.

"How are you sleeping?"

"Oh, I don't know. All right, I guess." She was irritated by the tone, distracted.

"We don't want you getting depressed."

"Oh, for heaven's sake, let's not beat around the bush about depression."

"Oh?" Mark raised his eyebrows.

"It's not as if Mitch and I were that close. I bet you know the whole story," she said angrily. "Why don't you just come clean."

He changed the subject. "Cassie, I checked some things out with Parker. He knows pretty much everything where Mitch is concerned. Here's the insurance story. You're fine with North Fork, for a while. But there might be a problem down the road." All of a sudden Mark looked uncomfortable.

"Fine, you don't want to be straight with me about his personal life," Cassie said. Parker Higgins was Mitch's lawyer. She'd get the truth out of him.

"Of course I do. We'll have some things to talk about later, but you don't have to worry about them right this minute," he said evenly.

"Well, I want to worry about them right this minute. I have some decisions to make, and I need your help."

"You know you can count on me," he said staunchly.

"Can I, Mark?" She stared at him hard through those dark glasses but couldn't read him.

"Of course. We'll go through it all right now if you want to."

She nodded. "Thank you."

He steered her to a stone bench in a little alcove on one side of the glass hallway that she'd never noticed before. It looked out on a Japanese garden with three large rocks, a collection of dwarf conifers, and a pebble path surrounded by buildings that no one could get to. Cassie sat down on the bench. Mark sat next to her, still in possession of her hand.

"Go ahead, shoot."

"I think I mentioned over the weekend some of the issues surrounding the practical side of health care. I'm sure you know that the hospital and the insurance companies look at patients in a different way from patients' families. Insurance companies want to resolve the cases. The families want only the best care for their loved ones. The hospital's challenge is to find reasonable ways to work out the conflicts between the two."

"Mark, what are you talking about?" She wanted to talk about the girlfriend.

"Patients in crisis are treated one way, Cassie. Like Mitch when he came in. Every treatment possible is performed without question. Terminal patients, who've had every treatment we can give them, who are alert and aware at the end, are treated another way. They have some control over the final days of their lives. And, finally, patients in a persistent vegetative state are in an altogether different category."

"I don't understand. Cut to the chase." This got her attention.

"Just listen for a moment. I want to give you some background on this. Our job as physicians is to sustain life whatever the cost. But we can't do that in defiance of the patient's wishes…" Mark paused in midsentence.

Cassie gazed out at the neat little dwarf conifers. The Japanese didn't like messy gardens the way she did-with flowers that waxed and waned, so slow to bud, quick to bloom, showy beyond reason for only a few short days, then the long fade-out of wither and drying while the season progressed and the next crop developed. Flower gardens took so much care to look well in every season. In cultivated spaces, the Japanese preferred their gardens spare and predictable. They stuck with evergreens, pruning them down to a tidy shape, stunting nature for pretty much the same view in all seasons. She knew that Mitch was no tidy Japanese. Like her love of excess in the flower beds, he was more the messy type. He'd opt for the long fade-out, never giving up or letting go, as he'd never let go of her.

She felt as cold as that hospital garden that had no visible access. What Mark was telling her was that in her husband's time of crisis she had a spousal right to give up for him. He couldn't choose now, so it was up to her?

"You can't do it in defiance of the patient's wishes. Go on, I'm listening," she murmured.

"We're not there yet, Cassie."

"Where is ‘there,' Mark?"

"In a terminal case, we get together, the patient and the family, and together we discuss how the patient wants the end to be. And they can choose, machines or no machines, hospital or home. Patients have some control over the situation, and you'd be surprised the kind of choices they make. A lot of people don't ever want to be hooked up the way Mitch is. But acute care patients are another story. In the absence of the patient, it's the insurance company and the family-and, of course, the hospital, too-that make the decisions."

"I understand," Cassie said.

"You think so, but it can be very difficult. There are many feelings involved-and not least, guilt. Sometimes you think something is best, and later have regrets… I don't want to frighten you. This is down the road."

"Oh, it's okay, scare me to death."

"Come on, I'm being serious."

"So am I."

"You wanted the bottom line. The bottom line is we can't keep him on the respirator forever."

"I thought you said people can stay in a vegetative state for months, even years."

"Yes, I said patients in a vegetative state."

"Isn't Mitch in a vegetative state?"

"Yes. But Mitch is not in a vegetative state on his own. He's got considerable brain damage and he's being sustained. This is the issue."

"Oh, of course." The brain damage helped. And the respirator. How could she forget? "How is the decision made to… um…?"

"Oh, I said that was down the road."

"How far down the road, Mark? Are we talking days, weeks, months. How long?" Cassie coughed to cover her impatience.

"Well, there's nothing written in stone about it. But once the patient is stabilized, and there's been no improvement for a period of time. Well…" Mark looked away, then back. "You won't be alone with this, Cassie."

"His father is gaga. He only has me and the children. What would that period of time be?"

"I meant you have me and the hospital. The hospital is not cold. We like to keep them as long as possible. The insurance companies, as I said, like to move the cases along. Once the patient is stable, they will want him to move to another hospital. Here's the problem. You don't have that kind of coverage. I know Mitch's business is doing very well. There's no doubt you can handle the costs privately for some time, even indefinitely, if you choose that route."

Cassie swallowed. "What would happen if the respirator were turned off right now?" she asked softly.

Mark didn't answer.

"So what do we have-a week, two weeks?"

"Why don't you call Parker? I'm sure you have a power of attorney. You can explore the options with him."

"Yes, I'll call him." Given the situation, Cassie was pretty sure she didn't have a power of attorney. Mitch would not want his life in her hands now or ever.

Then something new and awful occurred to her. Maybe the girlfriend had the power of attorney. She closed her eyes against rage rising in her chest. Whenever Cassie thought about this girlfriend, she could hardly breathe. She told herself she had to snap out of it. Jealousy was a waste of emotion. She had to go find Aunt Edith, get rid of her, call Parker. She needed to get to the warehouse and circle the wagons. She wished her son, Teddy, were a little older and wiser, because she had no idea how to circle those wagons.

Behind her sunglasses, Cassie's eyes closed against the chilly Japanese garden out the window and the pain that roiled like lava in her stomach and her throat. Funny how her heart and lungs worked well, drawing in oxygen, circulating it around her body. Everywhere she was alive with feeling except in her numbed face. Suddenly her stomach did a little flip, heralding another feeling that had been dormant, long dormant. Mark had moved his hand. He'd dropped it to her leg and was rubbing the outside of her thigh in a lazy, but persistent circular motion. Startled, she stood up, her eyes blazing with indignation. He couldn't see them, though. She was wearing those sunglasses. "Mark, I've got to go."

He hauled himself to a standing position. He was smiling. He couldn't read her either. He thought things were going well. "How about lunch tomorrow? We'll talk about it some more then, hmmm?"

"Mitch had a girlfriend. Who is it?"

"Ah, I wouldn't know that." Mark was caught off guard. "He didn't share his private life with me."

"His private life? Come off it." Cassie laughed. "I thought I was his private life."

"You know what I mean." Uncomfortable again.

"No, I don't. He was being audited, did you know that?" Cassie went down the list of things she hadn't known.

"Yes. He talked about that. I suspect that may have contributed to this little event. The stress of having to account for one's life, well…" He spread his arms out. "No one likes having to explain. I'm sorry, Cassie."

"Thanks." She walked quickly through the glass corridor. Mark followed her, trying to catch up without skipping.

"A horrible man came over to assess the house this morning. He was sneaking around, so Edith called the police."

"Really? Who was it?"

"The IRS. It was very humiliating. Why are they doing this?"

"It's rough. Anything I can do to help?" He skipped even with her and tried to take her hand again.

"We have to stop this," she muttered, meaning his attentions.

"You can ask your accountant. Tax audits are not my department."

He didn't get it. "You don't know this woman's name?" she tried again. "I won't be mad if you tell me. It's not your fault."

"Ah, well, I don't know it." He pursed his lips, looking solid and doctorly.

"Why don't I believe you?" She heaved some oxygen into those lungs. Okay, she had the lawyer to talk to, the accountant. She'd find the girlfriend, and maybe murder her for the simple pleasure of it. She had the IRS audit to deal with. Who could she trust? No one. She found Aunt Edith with Mitch, still cajoling him to squeeze her fingers.