"Did you assess your patient's condition when you entered the room?"
"Yes," Rita says. "He was unresponsive and still appeared to be in a vegetative state."
"Then what happened?" Cara's lawyer asks.
"As his daughter was talking, Mr. Warren opened his eyes."
"Are you saying he woke up?"
"Not like you're thinking." The nurse hesitates. "Most VS patients lie with their eyes open when they are awake and closed when they're asleep. But they still have no awareness of themselves or their environment and are totally unresponsive."
"So what made this event remarkable?" the lawyer asks.
"Mr. Warren's daughter got up very quickly and moved from the foot of the bed around to the side, and his gaze seemed to follow her before his eyes closed again. That's tracking, and that doesn't happen with VS patients."
"What did you do?"
"I immediately paged the Neurology Department, and they attempted to stimulate Mr. Warren into reactivity again by touching his toes and digging beneath his fingernails and verbally prompting him, but he didn't respond."
"Ms. Czarnicki, you heard Cara's testimony. Did she exaggerate Mr. Warren's responsiveness in any way?"
The nurse shakes her head. "I saw it myself."
"Nothing further," the attorney says.
"Mr. Ng?" the judge asks. "Would you like to cross-examine the witness?"
"No," Joe says, standing. "But I do wish to recall an earlier witness to the stand. Dr. Saint-Clare?"
The neurosurgeon doesn't look happy to have been called back to court. He raps his fingers on the edge of the witness stand, as if he has somewhere else he needs to be. "Thank you, Doctor, for making time for this," Joe begins. "It's been quite an afternoon."
"Apparently," the doctor says.
"Have you had a chance to examine Mr. Warren since you testified this morning?"
"Yes."
"Has there been a change in his condition?"
Dr. Saint-Clare sucks in his breath. "There's some discrepancy about that," he says. "Apparently Mr. Warren opened his eyes this afternoon."
"What does that mean?"
"Unfortunately, not a lot. Patients who are in a vegetative state are unaware of themselves and their environment. They don't respond to stimuli except for reflex responses, they don't understand language, they don't have control of bladder and bowel function. They are intermittently awake, but they are not conscious. We refer to this condition as 'eyes-open unconsciousness,' and that's what seems to have happened today to Mr. Warren," the doctor says. "Like many VS patients, his eyes opened when he was stimulated by a voice, but that doesn't mean he was aware."
"Can VS patients track moving objects with their eyes?"
"No," Dr. Saint-Clare says. "That finding would be evidence for awareness and, and suggest the presence of a minimally conscious state."
"How would a patient with MCS present?"
"He would exhibit an awareness of self and the environment. The patient would be able to follow simple commands, smile, cry, and follow motion with his eyes."
"According to Ms. Czarnicki and Cara, it seems that Mr. Warren was able to do the last, isn't that right?"
Dr. Saint-Clare shakes his head. "We think that what was construed as a movement of the eyes was actually a muscle reflex of the eyes closing. A rolling of the eyes, if you will, rather than a tracking. Since this first happened, we've tried repeatedly to get Mr. Warren to respond again, and he hasn't--not to noise or touch or any other stimuli. The injuries sustained in the crash by Mr. Warren--the brain stem lesions--suggest that there's no way he could be conscious now. Although he opened his eyes, there was no awareness attached to that movement. It was a reflexive behavior, and doesn't warrant an upgrade in diagnosis to a minimally conscious state."
"What would you say to Cara, who would contradict your interpretation of the event?" Joe asks.
The doctor looks at my sister, and for the first time since he's taken the stand, so do I. The light has gone out of Cara's face, like a falling star at the end of its arc. "Often in a vegetative state, patients will exhibit automatic behaviors like eye opening and closing, and a wandering gaze, or a facial grimace that family members mistake for conscious behavior. When someone you love suffers a trauma this severe, you'll grab on to any hint that he's still the same person, maybe buried beneath layers of sleep, but there nonetheless. Cara's job, as Mr. Warren's daughter, is to hope for the best. But my job, as his neurosurgeon, is to prepare her for the worst. And the bottom line is that a patient in a vegetative state like Mr. Warren's carries a very grim prognosis with a small chance of meaningful recovery, which diminishes further over time."
"Thank you," Joe says. "Your witness?"
Zirconia has her arm around Cara's shoulders. She doesn't remove it, doesn't even stand up to question the neurosurgeon. "Can you tell us beyond a reasonable doubt that Mr. Warren has no cognitive function?"
"On the contrary, I can tell you that he does have cognition. We can see that on an EEG. But I can also tell you that the other injuries to his brain stem prevent him from being able to access it."
"Is there any objective scientific test you can administer to determine whether or not Mr. Warren's eye movement was purposeful? If he was trying to communicate?"
"No."
"So, basically, you're reading minds now."
Dr. Saint-Clare raises his brows. "Actually, Ms. Notch," he says, "I'm board-certified to do just that."
When the judge calls for a short recess before Helen Bedd, the temporary guardian, gives her testimony, I walk over to Cara. Her attorney is holding a pair of hospital socks, the kind that boost circulation, which the nurses put on my father's feet. "This is all you could find?" Zirconia asks.
Cara nods. "I don't know what they did with the clothes he was wearing the night of the accident."
The lawyer bunches the socks in her fists and closes her eyes. "I'm getting nothing," she says.
"That's good, right?" Cara asks.
"Well, it's certainly not bad. It could mean that he hasn't crossed over yet. But it could also just mean that I'm better with animals than with humans."
"Excuse me," I interrupt. "Could I talk to my sister?"
Both Zirconia and my mother look at Cara, letting her decide. She nods, and they retreat down the aisle, leaving us alone at the table. "I didn't make it up," Cara says.
"I know. I believe you."
"And I don't care if Dr. Saint-Clare says it's medically insignificant. It was significant to me."
I look at her. "I've been thinking. What if it had happened when we were both here in court? I mean, if it was less than a minute, that's not a long time. What if he'd opened his eyes and you hadn't been there to see it?"
"Maybe it's happened more than once," Cara says.
"Or maybe it hasn't." My voice softens. "I guess what I'm trying to say is that I'm glad you were there when it did."
Cara looks at me for a long moment, her eyes the exact same color as mine. How have I never noticed that before? She grabs my forearm. "Edward, what if we just agreed to do this together? If we went up to the judge and told him that we don't need him to pick between us?"
I pull away from her. "But we still want different outcomes."
She blinks at me. "You mean, even after knowing Dad opened his eyes, you'd want to take him off life support?"
"You heard the doctor. He had a reflex, not a reaction. Like a hiccup. Something he couldn't control. And he wouldn't have even opened his eyes, Cara, if that machine wasn't breathing for him." I shake my head. "I want to believe it was more than that, too. But science trumps a gut feeling."
She shrinks back in her chair. "How can you do that to me?"
"Do what?"
"Make me think you're on my side and then cut me down?"
"It's my job," I say.
"To ruin my life?"
"No. To piss you off and to get you riled up. To get under your skin. To treat you the way nobody else gets to tre
at you." I stand up. "To be your brother."
LUKE
When the Abenaki tell a story, there are several ways to start. You can say, Waji mjassaik: in the beginning. You can say N'dalgommek: all my relations. Or you can begin with an apology: Anhaldamawikw kassi palilawaliakw. It means, I'm sorry for the wrong I might have done you this past year.
Any of those, when I came back to the human world, would apply.
Even though I slowly got used to the sounds and smells, and I stopped diving every time a car roared around the corner or picking up my steak with my hands at the dinner table, there were still some spontaneous bleeds between my life in the wild and my life back among humans. When you live on the tightrope of survival and there's no safety net, it's hard to go back to walking on solid ground. I couldn't dull the knife edge of instinct I'd developed with the wolves. If my family went out, even just to a McDonald's, I would make sure to put myself physically between my children and anyone else in the establishment. I'd face away from them as they ate their hamburgers, because turning my back meant possibly missing a threat.
When my daughter brought home a friend from school for a sleepover, I found myself looking through a twelve-year-old's pink duffel bag to make sure she didn't have anything with her that might harm Cara. When Edward drove to school, sometimes I followed him in my truck just to make sure he got there. When Georgie went out, I grilled her about where she was going, because I lived in fear that something bad would happen to her when I wasn't there to rescue her. I was like a veteran soldier who saw flashbacks in every situation, who knew the worst was just a breath away. I wasn't really ever happy unless we were all in the house, under lock and key.
The first Abenaki word I ever learned was Bitawbagok--the word they use for Lake Champlain. It means, literally, the waters between. Since I've come back from Quebec, I have thought of my address as Bitawkdakinna. I don't know enough Abenaki to be sure it's a real word, but translated, it is the world between.
I had become a bridge between the natural world and the human one. I fit into both places and belonged to neither. Half of my heart lived with the wild wolves, the other half lived with my family.
In case you cannot do the math: no one can survive with half a heart.
HELEN
Your Honor.
My name is Helen Bedd.
I'm an attorney and also a guardian in the New Hampshire Office of Public Guardian. I've practiced law for fifteen years, and for ten years before that I was a registered nurse. I've been appointed as a temporary or permanent guardian for more than 250 cases over the years.
When I received this appointment, I immediately spoke to the parties involved, given the expedited nature of the hearing. The medical team at Beresford Memorial told me in essence what Dr. Saint-Clare has reiterated today. There is little or no chance that Mr. Warren's condition will improve. Seeing her father open his eyes today must have been very compelling for Cara, but my medical background and Dr. Saint-Clare's testimony reinforce the unfortunate fact that this was probably an unconscious reflex and does not demonstrate any return to consciousness.
As part of my preparation for today, I also spoke with both Cara and Edward Warren. Both children deeply love their father, despite a disagreement about his health care needs and prognosis. Cara, at seventeen, has centered her life on her father. He's the sun in the solar system of her life. Their relationship has been extremely close, as is often the case for children of divorce who bond particularly with one parent. I don't doubt that Cara's shouldered adult responsibilities, given her father's unique lifestyle and job. However, I've also been forced to conclude that she is operating from an emotional standpoint and not a realistic one. Due to her emotional condition at this time, and her physical condition after the accident, she is unable to accept the reality of her father's condition--whether that reality is presented by her brother, her father's doctors, or the social worker at the hospital. And while the accident was not her fault in any way, I believe there's some residual guilt that influences her vehement desire to keep her father alive at all costs. While I find her unadulterated hope for her father's recovery touching and very moving, I also see it as a function of her immaturity at seventeen, and the fact that she is unwilling to accept a truth she does not want to believe.
On the other hand, Edward is the only living relative of Mr. Warren who is past the age of majority. Although he was able to produce a signed document from his father naming him as a health care guardian, that holds less weight for me than the fact that of the two siblings, Edward is the only one who has had an actual conversation with his father about what to do in this sort of situation. However, he has been estranged from his father for six years, and some details have come to light in this court that explain further his rash decision to abandon his family when he was eighteen. I believe that it's still quite difficult for Edward to separate his anger at his father from his current actions, which led to a very rash decision that was made without consulting his sister, and an even more rash decision to take matters into his own hands when the termination of life support didn't go according to plan. In this, Edward still has a lot of growing up to do. One has to wonder, given his propensity to act on impulse, how much thought he's really given to his father's wishes.
This is a unique case. Often when probate court becomes involved in a situation of guardianship, it's because no one wants to step up to the plate and make the hard decisions. In this case, we have two very different individuals who both want the job. But we also have something that most wards do not have--a written and video testimony by Luke Warren himself. His autobiography and the countless hours of film, both televised and amateur, that show him in his element give us a very strong sense of the kind of man he was and what he would want if someone's judgment was being substituted for his own. I have been impressed by how far Luke Warren's children are willing to go for him. I have been impressed by Mr. Warren's life, and how much he's accomplished. I've been impressed by the adventurous spirit that is packed into the chapters of his book and by the colleagues on camera who never fail to mention that sense of excitement and that constant adrenaline which were part of being around Mr. Warren.
All of this points to a man who would not relish the thought of being bedridden, at best.
And yet.
The Luke Warren that was shown to the world was only one facet of the man. If you read between the lines of his book, you can just make out the shadow of another story. The hero in his autobiography isn't a hero at all. He's a failure--someone who couldn't live with the animals he came to revere, and more important, someone who couldn't manage to live by their code when he was apart from them. You've heard both Cara and Edward say it in their testimonies: to a wolf, family matters most. But Mr. Warren abandoned his family--literally, when he went into the woods of Quebec, and figuratively, when he carried on an extramarital affair that led to a terminated pregnancy.
I've never spoken directly to Mr. Warren. But I think that it probably hurt him to know that his son's instinct was to leave home when the going got tough. A wolf would have never let his offspring out of his sight.
On the other hand, Cara's idealism is based on the very foundation of a family mattering most. The odds are against Mr. Warren's survival, but the reason she is advocating for it so strongly is simply because she doesn't want to live without her father. And if Mr. Warren is lucky enough to be one of those medical anomalies who defies science, I think he'd be delighted to get a second chance. Not just at survival but at being a father.
For this reason, I think Cara's beliefs dovetail with Mr. Warren's deepest wishes. I'd urge the court to appoint her as a guardian and to allow Cara to make appropriate arrangements for her father's treatment.
LUKE
After the Animal Planet series, I got a call from a biologist near Yellowstone. A hiker had been found in the woods, his body half devoured by wolves. It had raised fear in a community that had long ago accepted the release of wild wolves into the
Rockies.
Some of the researchers felt that the wolves had killed for sport, but I didn't believe it. I had never seen wolves behave that way toward a fellow predator, which is how they view man. Nothing in pack behavior suggests that food should be convenient rather than carefully chosen.
So why had wolves, which I had sworn would never attack a man, done just that?
I flew out to Yellowstone.
The area where the hiker had been killed had been stripped for timber. In fact, there was hardly a forest at all anymore. Without the cover and vegetation of the natural woods, the prey animals--deer and elk, mostly--had dwindled. The wolves had started eating salmon from the rivers instead.
I went back home and followed up on my hunch with one of my captive packs. Instead of giving them meat, I only fed them fish. Unlike with a land-based animal carcass--a food that has emotional value in the chemicals that run through the muscles and internal organs--now everyone was getting the same meal.
It was socialism among wolves. They were no longer eating in hierarchy, making sure that different ranks got different types of meat. Within a few months, the pack fell apart. There was no discernible alpha or beta rank. There was no discipline. Each wolf to his own, every animal did whatever he or she wanted. Instead of a family, they had become a gang.
The reason the pack at Yellowstone went after the hiker, I think, is that the natural food supply had dwindled, and the only source left to them was one that inadvertently destroyed the ranks. They killed the poor man because there was no wolf there telling them not to.
Sometimes, it's like this for a pack. You have to reach the point of utter chaos before a new leader can emerge.
CARA
You would think that having the temporary guardian's stamp of approval would have me turning cartwheels, but the judge does something no one is expecting.
He schedules a field trip.
Which is how I come to be standing beside my brother outside the glass window of my father's ICU room, watching the judge hold a one-sided private conversation with our unconscious father.
Joe rode the elevator downstairs with my mother, who's gone home to pick the twins up from the bus stop. Zirconia is in the lounge, talking to a therapy dog.