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."