Page 77 of Seven Letters

‘Is Ben OK?’ Adam asked, the moment Dr Mayhew stopped speaking. It was a question he asked at least twenty times a day.

‘Yes, for the moment,’ Dr Mayhew said. Mia saw him take a deep breath. Uh-oh, this was definitely not going to be good news.

‘I’ve asked you all here today as Sarah’s closest relatives to discuss her treatment going forward. This is a tragic and most unusual case. We are all deeply sorry for you, her family, and we’re mindful of the pain and confusion you’re enduring. But we feel it’s important to be honest with you and to keep you abreast of Sarah’s condition. I’m sorry to say that it deteriorated late last night. She has unfortunately developed an infection in the drain site on her skull. There is fluid in her lungs and the additional complication of a urinary tract infection.’

‘What?’ Adam’s face reddened. ‘Well, you’re not doing your job properly. You’re not keeping her sterile or – or being careful enough with cleanliness. Give her antibiotics, clear it up.’

‘Serious infection is almost inevitable in this case,’ Professor Irwin said. ‘You must understand, she has a huge amount of IV lines, central lines, catheters and drains, all of which are essential to monitor her condition and treat her ongoing problems, but they also mean that infection is essentially impossible to prevent, despite our best efforts.’

‘But can’t you cure the infection with antibiotics? Or will they harm the baby?’ Mia asked.

‘It’s more serious than antibiotics,’ Dr Mayhew answered. ‘There is also evidence of cardiovascular instability now, which will require high doses of medication. There is evidence of hypertension relating to fluid overload. Sarah’s body has now swollen further due to a build-up of fluid.’

‘Sweet Jesus, my poor girl.’ Charlie sobbed. Mia reached over to squeeze his hand. She tried to take in and understand all the medical information.

‘Her pregnant abdomen is extremely swollen, and I have grave concerns that there may be an infection underneath,’ Ms Johnston explained gently. ‘We have not been able to identify all the sources of infection. Sarah’s temperature rose to thirty-nine early this morning, which would mean the temperature in the uterus could be up to forty degrees. The foetus is not designed to be incubated in anything other than the normal temperature. The higher the foetus’s temperature, the quicker the enzymes will work and the faster it will get through the available oxygen. The stretchmarks of the pregnancy are abnormally discoloured, indicating retained fluid. Sarah’s blood pressure rose sky high and we have had to treat this with high doses of drugs. Some of the drugs and antibiotics we have had to administer, and will have to administer, to keep the body alive are not licensed for use in pregnancy.’

Leaning forward she added, ‘This is a really pressing issue now. There is a very real threat of sepsis. If that occurs,Sarah’s blood pressure will plummet. If that happens, she will require inotropic support, which is not recommended for a foetus in utero.’

‘Jesus,’ Johnny muttered. ‘Poor Sarah.’

‘We have studied all the available data in great detail and discussed it at length. I am very sorry to say that we do not believe it is realistic, or indeed safe, to continue with somatic support until the foetus reaches viability,’ Dr Mayhew concluded.

Mia didn’t know what she felt – devastation? Relief? Grief? It was a blur. But a thought was growing at the edge of her mind and spreading out: It’s finally over.

She looked at Charlie and Rob, and saw the same conflicting thoughts written on their faces. Then she looked at Adam, and she knew it wasn’t over.

Adam’s face was red and he was shaking with emotion. He pointed his finger across the table at the medical team. ‘You’re all trying to blind me with medical jargon. So, Sarah’s gone downhill a bit and has fluid. Drain the fluid, get her infection under control and her blood pressure, and let’s see what happens. Loads of pregnant women get high blood pressure and infections. It’s not the end of the world. No one is pulling the plug on Ben. No one.’

Adam’s bloodshot eyes were wild. ‘Don’t forget that report, the one Johnny found. The Heidelberg report said that babies of brain-dead mothers can survive. The problem here is you lot. Sarah should never have got an infection. That’s on you. So fix it. Fix my wife. Do your bloody jobs.’

There was an uncomfortable silence following this outburst. Rob leaned on the arm of his chair, closer to his brother.

‘If I may,’ Peter Long spoke up. ‘I’m afraid your reading of the Heidelberg report seems to have given you false hope.I just want to talk you through the findings. Of the nineteen cases reported, there was one foetus that was fourteen weeks old when the mother was declared brain-dead. The baby died in the womb. There were two other cases involving foetuses that were thirteen weeks old – one was here in Ireland in 2004. The baby died in utero eight days after its mother suffered a blood clot in the brain. The other, whose mother was injured in an accident in Germany in 1993, survived for thirty-eight days before dying as a result of miscarriage.’ Dr Peter Long paused. ‘We estimate the foetus in this case to be about fifteen weeks now. We do not believe it is possible to continue life support for seven or eight more weeks. The chances of the foetus thriving and the baby being born alive are minuscule. I’m truly sorry to tell you this, but the foetus will not survive the storm going on around it. I’m very sorry to be blunt, but your wife’s brain is now pouring toxins into the bloodstream. Her condition will continue to deteriorate and affect the baby detrimentally.’

Adam threw his hands into the air in frustration. ‘I’ll take minuscule. My wife is dead. My seven-year-old daughter is distraught. I have nothing but this tiny speck of hope that my son will survive and I’m taking it. We wanted this baby so much …’ His voice broke, but he took a deep breath and carried on. ‘Sarah was so happy. I know she would want me to fight until the end. I will not give up all hope. You will go in there and you will keep my son alive, do you hear me?Alive.’

‘Hey,’ Rob put his hand on Adam’s shoulder, ‘take it easy. No one is giving up.’

‘It’s not giving up,’ Dr Mayhew said quietly. ‘At this point, it’s accepting the sad reality of the situation. We are trained to preserve life, that is our number-one priority, but we are also trained to recognize where life cannot be preserved.Please, Adam, listen to the facts. We’ve done our level best, but we cannot save the foetus.’

‘His name is Ben,’ Adam roared at them. ‘For Christ’s sake, stop calling him “the foetus”!’

‘Stop it,’ Charlie croaked. ‘Please, for the love of God, stop this, Adam. She’s gone, and the baby has no chance of surviving. My girl is dead in there. It’s not right. It has to stop.’

Mia put her arm round her sobbing father. She felt so many things at once, she couldn’t think straight. But seeing Charlie so distraught was unbearable.

‘Maybe it’s time to think about letting go, Adam,’ Johnny said.

‘NO!’ Adam shouted. ‘No way!No one is giving up on Ben. No one.’ He stood up. ‘Do your jobs!’ he shouted at the team, then stormed out of the room.

Dr Mayhew watched him go, then turned to them. He looked very shaken. ‘We’re truly sorry. We’ve never had a case like this and we’re devastated for you all. It’s the hardest thing I’ve faced, and I’ve been doing this job a long time.’

Mia looked at the doctors’ faces. They were all in shock and distress too.

‘It’s a heartbreaking case,’ Ms Johnston murmured. ‘Just awful.’

‘I’m very sorry for my brother’s behaviour,’ Rob said. ‘He’s not sleeping, and he’s consumed by grief, so he isn’t thinking as he normally would. I’m sure you can understand that.’

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