Lone Wolf

of life? Is its definition as muddy? In the 1900s, Duncan McDougal believed that you could put a dying patient on a scale and know the exact moment death occurred, because he’d lose three-quarters of an ounce-the weight of the human soul. Nowadays, the Uniform Determination of Death Act defines death as the irreversible cessation of circulatory and respiratory functions or the irreversible cessation of all brain functions. That’s why brain death qualifies as death, and why cardiac death qualifies as death.”

I look at the judge. “We’re here today, Your Honor, because Luke Warren did not leave us a directive that would show us how he defines death. But we do know how he’d define life. Life, to Mr. Warren, meant being able to run with his wolves…”

Leaving your wife and kids at home, I think.

“It meant becoming an expert on pack behavior…”

Even though you knew nothing about how to keep your own family close.

“It meant seamlessly integrating himself with nature…”

While his wife waited up for him.

“It didn’t mean lying in a hospital bed, unconscious, unable to breathe on his own, with no presumptive hope for recovery. Your Honor, you’re the one who said that we should be making a decision in line with what Luke Warren would want.” As I pause, I meet Edward’s gaze. “Luke Warren,” I say, “would ask us to let him go.”

During the first fifteen-minute recess, Edward and I head to the restroom. “Do you believe it?” he asks, while we are both standing at the urinal. “What that lawyer said?”

“You mean about all those people who recovered from brain injury?”

He nods, flushing and then heading to the sink to wash his hands. “Yeah.”

“I don’t know. But I’m sure as hell going to ask the neurosurgeon about them,” I say. I finish up and find Edward staring into the bathroom mirror, as if he cannot place his own face. “Look,” I tell him. “Today you don’t have to make any decisions about your father. You just have to win the right to make that decision.”

We leave to grab a soda before we have to go back to the courtroom. In the vending machine area, Zirconia and Georgie are seated at the small industrial table across from Cara.

“Ladies,” I say. I wink at Cara.

She looks down at the table, nursing a Coke.

“How’s your dad doing?” I ask. I know that Cara had asked to visit Luke before coming to court today.

She narrows her eyes. “As if you care.”

“Cara!” Georgie draws in her breath. “Apologize to Joe.”

“In the grand scheme of things, I think he owes me one first.” She picks up her Coke and stands. “I’ll wait upstairs.”

But before she can leave, Edward blocks her exit. He pushes a pack of Twizzlers toward her, candy from the vending machine. “Here,” he says.

“What makes you think I want these?”

“Because you used to,” Edward tells her. “You used to beg me to buy them for you when we were on the way home from school, and I stopped off at a gas station to fill up. You’d bite off the ends and stick one in the milk carton you saved from school, like a straw. Said it was a strawberry shake that way.” He looks at Georgie. “We kept it a secret from Mom, because she said you were a sugar addict and you’d lose all your teeth before you hit puberty.”

Holding her soda, she can’t grab the package; she only has one hand free. “I forgot about that,” she murmurs.

Edward tucks the candy into a fold of her sling. “I didn’t,” he says.

The hospital attorney, Abby Lorenzo, begins by calling Dr. Saint-Clare to the stand. He’s sworn in and rattles off his neurosurgeon credentials, looking the whole time like he could be doing something so much more important, such as saving lives. “Do you know Luke Warren?” she asks.

“Yes. He’s one of my patients.”

“When did you meet him?”

“Twelve days ago,” the doctor says.

“Can you tell us about Mr. Warren’s condition, when he arrived at the hospital?”

“He was brought in after a motor vehicle accident,” Saint-Clare says, “where he was found outside the vehicle. The EMTs on the scene assumed that he had a diffuse traumatic brain injury, based on the circumstances. He was given a five on the Glasgow Coma Scale, and came into the hospital presenting with an enlarged right pupil, left- side weakness, and a laceration on his forehead. When a CT scan revealed severe swelling around his brain and a periorbital edema around his eyes, I was called in.”

“Then what happened?” the lawyer asks.

“Mr. Warren was again tested on the coma scale and still scored a five-”

“What does that mean exactly?”

“It’s a neurological scale to measure responsiveness, or lack thereof, after head injury. The scale ranges from three to fifteen, with three being a person in the deepest coma and fifteen being a normal, healthy individual. For patients who test between five and seven after twenty-four hours, fifty-three percent will die or remain in a vegetative state.”

Lorenzo nods. “How did you treat Mr. Warren?”

“The emergency CT scan suggested that he had a temporal lobe hematoma and subarachnoid hemorrhage, an intraventricular hemorrhage, and hemorrhages in the brain stem in the medulla, extending into the pons.”

“In layman’s terms?”

“Mr. Warren came in with blood around his brain, blood in the ventricles of his brain, and hemorrhages in the parts of his brain that affect breathing and consciousness. We put him on a drug called Mannitol to reduce pressure in the brain, and performed a temporal lobectomy-a surgery that would give room inside the cranium for his brain to expand, so that the swelling could go down. We removed the hematoma, as well as part of the anterior temporal lobe. After his surgery, he was still not breathing on his own and did not wake up; however, his right pupil became reactive again, which suggests the swelling did indeed go down in the brain. The temporal lobectomy means that Mr. Warren would probably lose some memories, but not all; however, since consciousness has been so severely compromised by the injuries to his brain stem, it’s unlikely that he’s ever going to be able to access any of those memories.”

“So he’s not brain-dead, Dr. Saint-Clare?”

“No,” the surgeon replies. “His EEG shows cerebral cortex activity.

But none of it’s accessible, because he can’t regain consciousness.”

“How is Mr. Warren being kept alive?”

“A ventilator is breathing for him, and he’s being nourished via feeding tube.”

“What’s your professional opinion regarding Mr. Warren’s chances of recovery?”

I look at Cara while the surgeon answers. Her eyes are narrowed, her jaw set firmly, as if his words are a bracing wind. “We’ve done a repeat CT scan every two days. Although we know the pressure in his brain has gone down, the hemorrhages in the brain stem have become a bit larger. He’s still unconscious, he’s in a vegetative state. In my opinion this is a serious brain injury from which we do not expect recovery.”

Cara flinches.

“Even if there was a chance, which would be extremely unlikely, the best-case scenario for Mr. Warren would be life in a long-term care facility with limited function, never regaining consciousness.”

“How certain are you of your professional opinion, Dr. Saint-Clare?” Lorenzo asks.

“I’ve been a neurosurgeon for twenty-nine years, and I’ve never seen a patient recover from a brain injury as traumatic as this one.”

“What’s the hospital’s position with respect to Mr. Warren’s care and recovery?”

“He’s a patient, and will receive the best care we can possibly give him to ensure his comfort. However, because we don’t expect improvement in the quality of his life functioning, a decision needs to be made. Either Mr. Warren will have to be moved to another facility to provide round-the-clock care, or if the choice is made to terminate life support, he is a candidate for organ donation.”

“If Mr. Warren isn’t brain-dead, how can he be a candidate for organ donation?”

The neurosurgeon leans back in his seat. “You’re correct, he doesn’t meet the medical criteria for brain death. However, he does meet the criteria for donation after cardiac death. Patients who have a severe brain injury and