The Face[脸]
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THE DOME LIGHT ATOP OUR LADY OF ANGELS Hospital was a golden beacon. High above the dome, at the top of the radio mast, the red aircraft-warning lamp winked in the gray mist, as if the storm were a living beast and this were its malevolent Cyclopean eye.
In the elevator, on the way from the garage to the fifth floor, Ethan listened to a lushly orchestrated version of a classic Elvis Costello number tricked up with violins and fulsome French horns. This cable-hung cubicle, ascending and descending twenty-four hours a day, was a little outpost of Hell in perpetual motion.
The physicians’ lounge on the fifth floor, to which he’d been given directions by phone, was nothing more than a dreary windowless vending-machine room with a pair of Formica-topped tables in the center. The orange plastic items that surrounded the tables qualified as chairs no more than the room deserved the grand name on its door.
Having arrived five minutes early, Ethan fed coins to one of the machines and selected black Coffee. When he sipped the stuff, he knew what death must taste like, but he drank it anyway because he’d slept only four or five hours and needed the kick.
Dr. Kevin O’Brien arrived precisely on time. About forty-five, [347] handsome, he had the vaguely haunted look and the well-suppressed but still-apparent nervous edge of one who had spent two-thirds of his life in arduous scholarship, only to find that the hammers wielded by HMOs, government bureaucracy, and greedy trial attorneys were daily degrading his profession and destroying the medical system to which he’d dedicated his life. His eyes were pinched at the corners. He frequently licked his lips. Stress lent a gray tint to his pallor. Unfortunately for his peace of mind, he seemed to be a bright man who would not much longer be able to delude himself into believing that the quicksand under his feet was actually solid ground.
Although he was not Duncan Whistler’s personal internist, Dr. O’Brien had been the physician on duty when Dunny had gone flatline. He had overseen resuscitation procedures and had made the final call to cease heroic efforts. The death certificate carried his signature.
Dr. O’Brien brought with him the complete patient file in three thickly packed folders. During their discussion, he gradually spread the entire contents across one of the tables.
They sat side by side in the orange pseudochairs, the better to review the documents together.
Dunny’s coma resulted from cerebral hypoxia, a lack of adequate oxygen to the brain for an extended period of time. Results revealed on EEG scrolls and by brain-imaging tests—angiography, CT scanning, MRI—led inescapably to the conclusion that if he had ever regained consciousness, he would have been profoundly handicapped.
“Even among patients in the deepest comas,” O’Brien explained, “where there’s little or no apparent activity in the cerebrum, there is usually enough function in the brain stem to allow them to exhibit some automatic responses. They continue to breathe unaided. Once in a while they might cough, blink their eyes, even yawn.”
Throughout most of his hospitalization, Dunny had breathed on his own. Three days ago, his declining automatic responses required that he be connected to a ventilator. He’d no longer been able to breathe without mechanical assistance.
[348] In his early weeks at the hospital, although deeply comatose, he had at times coughed, sneezed, yawned, blinked. Occasionally he had even exhibited roving eye movements.
Gradually, those automatic responses declined in frequency until they ceased to be observed at all. This suggested a steady loss of function in the lower brain stem.
The previous morning, Dunny’s heart had stopped. Defibrillation and injections of epinephrine restarted the heart, but only briefly.
“The automatic function of the circulatory system is maintained by the lower brain stem,” Dr. O’Brien said. “It was clear his heart had failed because brain-stem function failed. There’s no coming back from irreparable damage to the brain stem. Death inevitably follows.”
In a case like this, the patient would not be connected to a heart-lung machine, providing artificial circulation and respiration, unless his family insisted. The family would need to have the means to pay because insurance companies would disallow such expenditures on the grounds that the patient could never regain consciousness.
“As regards Mr. Whistler,” O’Brien said, “you held a power of attorney in matters of health care.”
“Yes.”
“And you signed a release quite some time ago, specifying that heroic efforts, other than a ventilator, were not to be employed to keep him alive.”
“That’s right,” Ethan said. “And I’ve no intention of suing.”
This sincere assurance caused no visible relief on O’Brien’s part. Evidently he believed that even though the conscientious medical care given to Dunny was lawsuit-proof, a plague of lawyers would nonetheless rain down on him.
“Dr. O’Brien, whatever happened to Dunny once his body reached the hospital morgue is another matter altogether, unrelated to you.”
“But I’m not any less disturbed about it than you are. I’ve discussed it twice with the police. I’m ... bewildered.”
[349] “I just want you to know that I don’t hold the morgue employees at all responsible for his disappearance, either.”
“They’re good people,” O’Brien said.
“I’m sure they are. Whatever’s going on here isn’t the fault of the hospital. The explanation is ... something extraordinary.”
The physician dared to let hope tweak a little color into his face. “Extraordinary? And what would that be?”
“I don’t know. But amazing things have happened to me in the past twenty-four hours, in some way all related to Dunny, I think. So why I wanted to speak to you this morning ...”
“Yes?”
Searching for words, Ethan pushed back from the table. He got to his feet, his tongue stilled by a thirty-seven-year-long reliance on reason and rationality.
He wished for a window. Gazing out at the rain would have given him an excuse not to look at O’Brien while he asked what needed to be asked.
“Doctor, you weren’t Dunny’s primary physician ...”
Talking while gazing moodily at a vending machine full of candy bars seemed eccentric.
“... but you were involved with his treatment.”
O’Brien said nothing, waited.
Having finished his Coffee, Ethan scooped the paper cup off the table, crumpled it in his fist.
“And after what happened yesterday, I’d wager that you know his file better than anyone.”
“Backward and forward,” O’Brien confirmed.
Taking the paper cup to the waste can, Ethan said, “Is there anything in the file that you’d consider unusual?”
“I can’t find a single misstep in diagnosis, treatment, or in the death-certification protocols.”
“That’s not what I mean.” He tossed the crumpled cup in the can and paced, looking at the floor. “I’m sincere when I tell you that I’m [350] convinced you and the hospital are utterly blameless. When I say ‘unusual,’ what I really mean is ... strange, uncanny.”
“Uncanny?”
“Yeah. I don’t know how to put a finer point on it.”
Dr. O’Brien remained silent so long that Ethan stopped pacing and looked up from the floor.
The physician chewed on his lower lip, staring at the piles of documents.
“There was something,” Ethan guessed. He returned to the table, sat in the orange torture device. “Something uncanny, all right.”
“It’s here in the file. I didn’t bring it up. It’s meaningless.”
“What?”
“It could be misconstrued as evidence that he came out of the coma for a period, but he didn’t. Some attributed the problem to a machine malfunction. It wasn’t.”
“Malfunction? What machine?”
“The EEG.”
“The machine that records his brain waves.”
O’Brien chewed his lip.
“Doctor?”
The physician met Ethan’s eyes. He sighed. He pushed his chair away from the table and got up. “It’ll be better if you actually see it yourself.”
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