Page 50 of Seven Letters

Adam’s eyes were flinty. ‘I’m not accepting that,’ he said fiercely. ‘No way. Sarah is still alive. We’re not giving up on her.’

The doctors exchanged a look. Angela leaned forward. ‘This is incredibly difficult for you, Adam,’ she said. ‘It is a really cruel blow, but the doctors have been absolutely methodical. That’s why we took our time and didn’t jump to conclusions. But the fact is that Sarah has no brain-stem activity, which means she is brain dead. It’s not possible for her to recover, Adam.’

Adam kept shaking his head, as if blocking out Angela’s words. ‘I’m getting a second opinion. I’ve seen reports on the news about medical negligence and – and medical fuck-ups. Well, my wife isn’t going to be one of them. We’re getting experts to give their opinions. A second one here and my brother is getting a third opinion in Toronto. They’re ahead of the game there. They might be able to save her. We’ll move her over there if necessary. I will not give up on Sarah, no way.’

‘You may, of course, get as many opinions as you wish, but I’m afraid the outcome won’t change,’ Dr Mayhew said.

‘Our expert is coming in this morning to give us a second opinion. I want you to talk to her and tell her everything. I want her to see all the notes and test results. I want her to give me her opinion on this. What’s her name again, Mia?’

‘Pam Neelan. She’s a neurologist. We’d like her to have a look at Sarah and give us her prognosis.’

‘She’s just back from working in the US, so she probably has a lot more experience working with – with complicated cases,’ Adam added, clinging desperately to any lifeline he could find.

‘I know Pam Neelan,’ Professor Irwin said. ‘I’ll be happy to have her opinion.’

‘And what about my son? He’s still alive.’

Dr Mayhew turned and introduced the other lady. ‘This is Ms Johnston, the consultant obstetrician working on Sarah’s case. She will fill you in on the state of the foetus.’

‘Good morning. We believe the state of gestation to be about fourteen weeks. At the moment, the foetus is alive, yes. I am, however, concerned because of Sarah’s high temperature. It is currently at 38.5 degrees and rising. Babies are not designed to be incubated in anything but a normal temperature. The higher the foetus’s temperature, the quicker it will get through the available oxygen. We also need to control Sarah’s blood pressure to ensure good placental function. The problem is that very few drugs are licensed for use in pregnant women and it’s not possible to say what effect the drugs we need to use to keep Sarah alive will have on the foetus. As the gestation is only at fourteen weeks, I’m afraid the outlook is extremely poor.’

‘Poor, but not impossible,’ Adam said. He looked sowild-eyed, Mia worried he was going to keel over with stress. ‘My son can make it. I know he can.’

Ms Johnston remained calm, but Mia could see her jaw twitching. Clearly she didn’t know what to say. Suddenly, Johnny leaned down and pulled a bag onto his lap. I’ve been doing some research and found a study with similar cases, the Heidelberg study. From what I’ve read, babies have survived in brain-dead mothers.

‘Here it says, “The researchers found that a viable child was delivered in twelve of the nineteen cases they studied. Twelve babies were born and survived the neonatal period. The management of a brain-dead pregnant woman requires a multidisciplinary team, which should follow available standards, guidelines and recommendations.”’

Adam was staring at Johnny with a half-smile on his lips. ‘Now, did you hear that?’ he said triumphantly. ‘My boy will survive if you all do your jobs. I don’t want to hear any more about poor outcome. We all need to stay positive. I am not losing my son.’ His voice broke. ‘I am not losing everything.’

The room fell silent again.

Ms Johnston explained, ‘The foetus is only fourteen weeks. It depends entirely on Sarah for its oxygen and sustenance. Sarah can no longer provide that. Her body has already started to show signs of deterioration, and that will accelerate over the coming days. I’m very sorry, but prolonging Sarah’s life won’t save the foetus and will be traumatic for all of you.’

Adam stared coldly at her. ‘The foetusis my son, Ben. That’s the name me and Sarah had picked. No one is switching off any ventilators.’

‘Adam, I know this is awful for you but please listen to what we’re trying to tell you,’ Angela begged. ‘Fourteen weeks’ gestation is at least eight weeks before the foetus can reach viability, which means being able to survive outside the womb. And even if it made it to twenty-two weeks andwas delivered and had full paediatric ICU care, it’s highly unlikely it could survive. And even if it did, the trade-off for extreme pre-term delivery is increased risk of brain bleeds, blindness, lung injuries … Adam, you don’t want to do that to your son.’

‘He can make it,’ Adam said stubbornly. ‘I know he can.’

Angela bit her lip and looked at her colleagues.

‘We’ll give you some time and space to process all the information,’ Dr Mayhew said gently. ‘Let us know when you’ve decided how you wish to proceed.’

‘I don’t need time,’ Adam retorted. ‘You just keep my wife and baby alive.’

Dr Mayhew nodded. ‘I’ll need you to sign some paperwork. We’re here to answer any questions. It’s a very traumatic time for you all.’ He left the room, followed by his colleagues.

Adam turned to Mia. ‘Do you think this woman, Dr Neelan, will find a mistake? Do you think she’ll be able to operate on or treat Sarah’s brain and make her wake up? Do you, Mia? Do you?’ He was like a desperate little boy begging for reassurance.

Mia looked out of the window. Clear blue sky: one of those precious days when you could feel the warmth of the sun wrapping around you, like a blanket. But in here, in this stuffy, overheated room that smelt of fear and grief, all she could feel was the last scraps of hope leaving her mind and body.

The consultants were so sure. Brain dead was dead. Mia had spent hours googling coma and neurology and brain injury. She knew it was a bad idea to ask the internet, but it was impossible not to look for answers. She knew brain dead was final: she’d read it online in black-and-white. ‘Brain death is irreversible and is legally and medically recognized as death’; ‘A person who is brain dead may appear alive – there may be a heartbeat, they may look like they’re breathing, their skin may still be warm to thetouch. But there is no life when brain activity ceases’; ‘A person is confirmed as being dead when their brain stem function is permanently lost.’

Despite all of that, Mia had still clung to hope … until now. They had done the tests; they had confirmed Sarah’s condition. She was gone. Her beautiful sister was gone. Her only sibling, her best friend. Gone. Non-responsive, non-functioning, non-alive.

Gone.

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