Comfort Zone

Chapter 41

It hadn't been easy to get through to Alison Lerner. Miriam and Edna had both left messages, and Miriam even called from a variety of phones in case the woman was avoiding all hospital calls. But finally they had succeeded. The three of them would sit and talk in the family meeting room, which seemed like a neutral location. Miriam hoped to keep antagonism to nonexistent. There would be no accusations tossed about, even wordlessly, even though Edna had checked up on Ray's story and found it to be accurate. Alison was in charge of her brother-in-law's finances. If he died, it meant one less check for her to cash.

"Greedy, greedy," Edna said. "I hope she knows what we did to the last scheming hussy we consulted on. If she doesn't, I'm going to tell her. I don't want this meeting to run on, I want to leave early today. My TV shows are on tonight, including my favorite sitcom."

An older woman with a severe frown walked by the room and Edna sprang up. "That's her, I can tell," she said, but it wasn't. Next an even older woman walked by, but it wasn't her either, or the next. Finally a woman walked in, but both Miriam and Edna knew it wasn't Mrs. Lerner because she was too young.

"Hi, I'm Alison Lerner," she said, settling into the plushest chair gracefully as a model.

"The plot thickens," Edna murmured.

The three women sat around a table, two of them trying not to stare at the third, who looked like she belonged on Ocean Drive, rollerblading in spandex and holding a tiny Chihuahua.

"You're Thomas Lerner's sister-in-law?" Miriam said. Why didn't the nurse mention this?

"Yes. And you want me to agree to stop treatment on Thomas and let him die, don't you?"

"Well..."

"Yes," said Edna. Where the hell is her professional manner tonight? You can't say that to a family member.

"Well you're wasting your time!"

"What she means to say is," Miriam started, but couldn't think how to continue. Butt out, her look telegraphed Edna.

She finally found some words and jumped back in. "As ethics consultants, our job is simply to look at all aspects of a case and facilitate communication. That's all. We listen, we may recommend, but the most important thing is to make sure you have the best information about what's going on so you can make a good decision for your loved one." Miriam ignored Edna's strangled sound.

"As you know, your brother-in-law is very ill. He had a bleed in his brain several months ago and there's really no chance of recovery. It's extremely unlikely that he'll ever be able to interact or do any of the activities that most of us think are key to a good quality of life."

"Unlikely doesn't mean impossible. Doctors don't know everything."

"True, but he's been seen by two different brain specialists, neurologists, and both independently agree that based on the evidence, he'll never recover. After three months of no improvement, it almost never happens."

"A nurse told me he's brain dead, but that's impossible! He looks right at me when I visit."

"And the nurses say that's not very often," Edna said. Miriam ignored her completely and pushed forward. People frequently confused the terms brain death, coma, and vegetative state, and the differences were important.

"No, he's not brain dead. The term we use is vegetative state. His eyes are open, they move, but there's no evidence he's seeing anything. I'm sorry, I know it's hard to hear this. The problem is that's not his only issue now. He's had so many complications in the last four months and his internal organs are failing. Even his skin is breaking down. The doctors and nurses are trying their best, but we're losing the battle despite powerful medicines and other treatments. The team fears that all the care is futile."

"I don't come here because I'm taking care of my husband," Alison Lerner said to Edna as if Miriam hadn't said a word.

"What does your husband think?" Miriam asked, when Edna stayed mute.

"He trusts me to make all the health decisions in the family."

She looked down at her hands which were clutched around her pocketbook. Not a Coach, Miriam noticed.

Alison looked back up and Miriam was startled to see her expression.

"How do you know when it's futile? How do you know that your next effort won't be the one to make a difference?" she finally said. That's what keeps us doctors going, Miriam wanted to say. That's why I kept telling Trevor Sharp to stop doing cocaine, and why I counsel patients about healthy habits even when I see their eyes glaze over. How many times do I wonder if I'm wasting my breath, but I go on anyway?

"We can only rely on medical studies and our experience," Miriam said. "Plus on the expertise of the specialists."

"You're saying he's going to die. Everyone's been telling me the same thing for months. But are you absolutely sure he won't wake up? Miracles happen, haven't you ever seen one?"

Neither Miriam nor Edna could think of an answer, and the young woman straightened up in the chair, her face rigid. "I won't let him go," she said. "I won't give permission to stop any treatment, or make him a DNR. If you stop treating him, I'll call my lawyer. I'll go to The Herald and tell them the story!"

Miriam felt the blood rushing into her face. She looked down at the table and took a deep breath, conjuring the words she'd frequently heard at the ethics committee.

"Mrs. Lerner. The question isn't whether you want to continue treatment. The question is whetherhewould want to continue, whether he would want to live like this. What would he say now if he could speak? Your job is to say the words for him."

"I'm trying but you're not listening! You don't know him. He would want to live, he would want to keep on living!"

"But Mrs. Lerner, are we prolonging his life, or prolonging his death?"

Alison gave a choked sound, but her face was stone.

"You say it's about what he would want, but I can read between the lines! You just want to write him off because he's old, you think he's not worth taking care of, or maybe he has no more insurance benefits," Alison said. "Everyone keeps telling me how expensive his care is. I bet the hospital just wants to get rid of him!"

In a rapid-fire duet, Miriam and Edna both jumped in to protest, but Alison interrupted before they had a chance to finish.

"You think I can stand seeing Tommy like this?" she burst out.

"He's the most charming man I ever met, and the sweetest, except for his brother. The day before his stroke we went to the Botanical Gardens together because I'd never been and it was his favorite place. I come to visit and I want to talk to him, to hold his hand, but every time I have to run out because I can't stand it!

"I know you need my permission, but it's wrong to even ask me! Do you know how hard it is for a person to say the words 'just let him die' when they're grief-stricken? And have you ever looked at the DNR form with the eyes of family, with its checklist of what to do and not do? They even asked me if they should stop giving him food and water!

"And how can I tell my husband about this? He knows Tommy is in the hospital of course, but he doesn't know how sick he is. Tommy's his older brother. He's crazy about him. He's so sick himself, he's recovering in a nursing home. It'll kill him! I can't lose both my husband and brother-in-law! Doesn't anyone understand that?"

Edna and Miriam looked at each other, slightly embarrassed as the truth hit them.

This one wasn't about money after all.

It was about love.