The steel door to Dr. Timothy Hobson’s office was heavy enough to allow Mark Stanton to recognize the effort it took for him to open it, to begin this appointment long in the making and long in the dreading. It was fitting the doctor’s office was far removed from the light, airy feel of the hospital’s remodeled wing and impressive atrium. Buried deep in the hospital’s bowels, Mark Stanton could suffer in peace or in isolation, depending on how you looked at it.
“Good morning, Mr. Stanton.”
“Good morning, doctor.”
“Please, have a seat.”
Dr. Hobson’s office was right out of central casting: anatomical drawings of every part of the human body, shelves burdened with oversized books, piles of paper adding a veneer of organization to chaos, and framed degrees just far enough out of sight to underscore their irrelevance in the moment. As the doctor shuffled files and folders, Mark Stanton noticed the pictures of the doctor’s family on the rear credenza. The smiling wife, the two kids, the dog, the posed perfection.
Mark guessed the doctor’s children were around the same age as his daughters, and he was caught off guard by the disquiet roiling inside him as he watched the doctor fuss about his desk. The total lack of awareness, the entitlement Dr. Hobson enjoyed with his perfect wife, perfect children, cut right through him. The doctor, twenty years his senior, enjoyed every perk of life Mark did, and then some. And, now, the rest of his life and what was left of the perks, lay in his hands.
“Here they are, I apologize,” Dr. Hobson plead.
Mark Stanton simply stared at the doctor.
“Mr. Stanton, thank you for meeting with me today. As you know, two months ago, your wife Katy suffered a traumatic brain injury. Her car crash caused what we call a diffuse axonal injury. When she first arrived at the hospital, we could not detect this type of injury because it does not show up on a CT scan. This is a microscopic injury, affecting the nerve cells in the brain, and it is the most common form of injury in high-velocity traumas like the one your wife suffered. This is the reason she has been unconscious for the last two months.”
Mark Stanton simply nodded.
“Hey babe, what’s up?”
“Sorry, hey, I just dropped Beth and Sarah off at….Hey, watch it asshole!”
“Some jerk almost ran me off the road. Anyway, ummm, it’s been a morning.”
“Are you okay? You crying?”
“I’m just, I’m just having a morning. Sarah got into all the donuts. Mark, there was powdered sugar everywhere. She looked like a ghost with pig tails.”
“You should have snapped a picture and posted it. Bet she was cute.”
“She wasn’t cute, she was annoying. I was in such a rush because, dammit, pull over honey, I’m in a hurry….”
“Katy, calm down. It’s okay. Be careful.”
“No, it’s not okay, Mark. I’m glad you’re comfortable in your desk chair, but I’ve had to get the girls ready this morning, and I’ve got work too, okay. I…”
“Okay, okay, okay. I hear you. I hear you.”
“I had to help Beth with her school project…”
“Those mandibles were pretty cool, huh?”
“Focus Mark! Between Beth’s ants and Sarah’s body coated in powdered sugar I left the house without Sarah’s medicine. Now, I’m rushing back to get it. I’ve got a meeting at 9am. I think I’ll make it barely, but I need you to…”
“Katy, I can’t hear you, are you there?”
“Mr. Stanton, are you okay?” Dr. Hobson slid his glasses off and looked at his patient’s husband staring right through him.
“Yes, I’m sorry, doctor. I, umm, let my mind wander.”
“I know this must be very hard to hear. I’ve reviewed your wife’s entire medical file for the past two months. I cross-checked every note. I see no evidence of self-awareness or the environment, and, upon examination, she demonstrates no signs of interaction. There are no purposeful responses to external stimuli.”
“And the blinking and crying? I sit by her bed and I see her eyes move. She knows I’m there, doctor.”
“I understand, Mr. Stanton. I know how hard this must be for you.”
Mark Stanton shifted his gaze to the credenza again, eyed the doctor’s impossibly beautiful wife and children, and thought, “Do you?”
“It’s not uncommon for patients with such injuries to exhibit certain signs.”
“Yes, we see eye opening, pupil movement, yawning, even chewing and swallowing movements. Patients may cry, move their eyes, and make facial expressions that appear to be smiles or frowns.”
“They aren’t crying, moving their eyes, smiling, or frowning.”
Mark Stanton looked down at the floor.
“Mr. Stanton, patients in a vegetative state like your wife are not moving or acting volitionally. We may see a primitive motor response to pain or we may see an object grasped when it is placed in the palm, but these are not acts of volition. You are seeing a simulation of awareness, not actual awareness. Mark, I am very sorry to tell you that your wife’s vegetative state has been persistent, and, after this amount of time, given the nature and extent of her injuries, I can come to no other conclusion than your wife’s vegetative state is a permanent vegetative state.”
Again, Mark Stanton eyed the photograph of the doctor’s family, focusing on the doctor’s wife. He fingered the button on his shirt cuff and shifted in his seat. As he contemplated tying his shoe and strafed his tongue against the bottom of his teeth, he understood that, as long as he occupied his mind, he would not be required to ask the next question. He could slow the hands of time and fall into a moment where he had a wife, where life retained the possibility of normalcy, where he could romance the idea that the doctor was wrong, that it was a mistake.
“I know this is a lot to take in, Mr. Stanton.”
A knock on the door broke the spell between the two men, and Nurse Cecilia entered with Beth and Sarah in tow.
“Daddy!” Sarah proclaimed, as she rushed over to him.
“Hello, sweetie.” He stood and embraced both his daughters, twisting to envelop both of them.
“Mr. Stanton, your sister went on to work. She left the girls’ school things out by my desk. I’ll be happy to watch the girls while you and the doctor finish your meeting.”
“Thank you,” he replied, watching Nurse Cecilia walk over to the girls and gather them towards the door.
“I want you two to be big girls, okay. Stay with Nurse Cecilia; Dr. Hobson and I need to talk a little bit more.” The blinking lights on Sarah’s shoes caught his attention, as Nurse Cecilia stood behind, hands on the girls’ shoulders. The light from Sarah’s sneakers flashed off the nurse’s white pants and white shoes.
“I’ll keep a close eye on them, Mr. Stanton. Come on girls.”
Only once the girls turned their backs and headed out with Nurse Cecilia did Mark Stanton permit himself to tear up. He gave himself credit, though, for making it that long.
“Mr. Stanton, we need to talk about where we go from here.”
Mark Stanton resume staring.
“We can continue as-is, but I see no reasonable medical probability for any improvement in your wife’s condition. Or, and I know this will be difficult to hear, we can remove your wife’s artificial nutrition and hydration.”
No amount of psychological games was a defense to the doctor’s words, and the impossibility of the situation allowed for Mark Stanton to simulate bravery and look the doctor in the eye.
“If we remove your wife’s nutrition and hydration, she will pass away within one to two weeks. She will not die of malnutrition, but, rather, she will pass due to dehydration and electrolyte imbalance. I understand it is little solace, but it is my duty to let you know that, if we pursue this route, your wife will not experience thirst or hunger. She simply can no longer experience those sensations.”
Mark Stanton heard every single word, and each bounced around in his head. As each new word entered his skull, it joined the chorus of pre-existing words zig-zagging in colorful volleys across his brain. His wife’s lack of sensation became, to him, nothing but sensation.
“The removal of nutrition and hydration may result in your wife slipping into a coma, but it may not. We simply cannot tell. The only outward signs that you may see would be a dryness of the skin and mucous membranes. She cannot perceive discomfort, but we would, of course, continue to provide any other comfort necessary for her in your eyes.
“I see,” was all Mark Stanton could manage to push beyond his moist, hydrated, sensate lips.
“Of course, this decision is something you will want to talk over with your family, your friends, and any faith leader, if you have one.”
“I’m sorry, minister, rabbi, priest. You may want to discuss this decision with them. Many people find great comfort in talking this decision over with a member of the clergy.”
“They do. I see.” Mark Stanton looked down at his hands – hands that, twenty years ago, served as an acolyte in his church. Was Pastor Don even still alive? When was the last time he even went to church? If he found Pastor Don, how would that chat proceed exactly? “Hi Pastor Don, remember me? That’s right, I loved lighting those candles. Oh, why am I here? Well, you see, I need you to tell me if it’s okay to kill my wife. Before you answer, will my years of absence from the church impact your response?”
“Mr. Stanton, you take all the time you need.” The doctor pulled out a small gray console from his desk drawer. “With the recent remodel and additions to the hospital, we have upgraded all of our computer software and hardware. All of our records are stored electronically. When you are ready, be it today, next week, next month, you can enter your choice on this console. I can take you to the right screen, and it will give you three options. From there, you can choose to continue current care or remove nutrition and hydration. You just click the button.”
“What’s the third option? I see three buttons.”
“In cases of significant brain trauma, we can, occasionally, pursue experimental treatments, such as deep brain stimulation or surgical steps, and, if that were an option, you would select the third button. Unfortunately, in your wife’s case, I am sorry to say that that is not an option. None of the tests we’ve run, like the MRIs, show any evidence of cognitive activity.”
Mark Stanton studied the console, hermetically sealed in plastic and glass. It was no bigger than his e-reader or his daughters’ tablets. It was such a tidy package, with all the attendant and requisite eye-catching gleam of new technology. His choice to end his wife’s life, to end his marriage, to end his daughters’ mother would be akin to buying a ninety-nine cent song.
“I know this is difficult, Mr. Stanton. It is not an easy choice. I have all of your wife’s records, and, after you’ve had some time to think it over, we can meet again. If you would like a second opinion, I am more than happy to forward your wife’s charts to anyone you wish.”
The doctor set the small, handheld console down between himself and Mark Stanton.
Two Years Later. Mission Township Courthouse.
“Your Honor, the prosecution’s last witness is Dr. Timothy Hobson. We would call him to the stand at this time.”
“Your Honor, defense counsel renews its objections to this witness, as stated in our pre-trial motions and brief,”
“You can stop right there, Mr. Riley. As you and the prosecution know, the court received, read, considered, and ruled on all of the objections in your pre-trial motions. I see no evidentiary or other legal barrier to the doctor’s testimony.”
“No thank you, Mr. Riley. You need say no more Your objection has been noted and preserved in the record for purposes of appeal. Bailiff, please escort Dr. Hobson into the courtroom to the witness stand.”
“Thank you, Your Honor.”
Dr. Timothy Hobson walked into the courtroom and walked the short distance to the witness stand. He kept his eyes fixed on the judge and the jury, but he could feel Mark Stanton sitting in the rows to the right. He knew Beth and Sarah would be right by his side, too.
“Dr. Hobson, please raise your right hand.”
“Dr. Hobson, as of 2014, how long had you worked with Nurse Cecilia Boniface?”
“At that point, I guess it had been around one year.”
“Just a year?”
“Yes. Beginning in 2010, the hospital began a large expansion and renovation. Staff were moved around to different departments. In neurosurgery, we were always losing and gaining different staff members as the nurses and assistants were shifted around the hospital to cover for one another.”
“So, you started working with the defendant at some point in 2013?”
“At what time did the hospital install its new medical records system, doctor?”
“So, around the same time you began working with the defendant?”
“Yes. Actually, she started working for me just before we got the new system. At that time, it was a great relief to me, honestly. The new electronic medical records system was complex and difficult to learn. Nurse Cecilia,”
“You mean, the defendant?”
“Objection, Your Honor,” defense counsel interjected.
“Mr. Asher, the witness can answer in his own terms. Dr. Hobson, please continue.”
“Well, Nurse Cecilia had been working in pediatrics before she was rotated into neurosurgery, and pediatrics had been using the new medical records system for months before it was installed in our department. Since she was experienced with the system, it took a lot of pressure off of me. She was able to demonstrate the system to me, and help me when I needed it. I appreciated it. At the time.”
“At the time, doctor?”
“I mean, before I learned about everything.”
“And what do you mean by that Dr. Hobson?”
“I always relied on my nurse to organize and update the charts for all of my patients. In the new system, it was a complicated process to pull in testing from other parts of the hospital, such as an EEG or an MRI. Nurse Boniface was experienced with the system, like I said, so I relied upon her to update the charts. As far as I knew, all of the charts were always updated. I could see update dates, but…”
“But the update dates did not reflect all of the chart activity. The dates were accurate, but it did not tell me if evidence had been updated and, then,….changed.”
“Changed, Dr. Hobson?”
“Yes. Changed or deleted.”
“Dr. Hobson, did you provide care for a Mrs. Katy Stanton?”
“Yes, I did.”
“Could you tell the court why Mrs. Stanton was in the hospital?”
“Yes, Mrs. Stanton was involved in a high speed automobile accident. As I understand it, her vehicle ran a stop sign and the driver’s side was impacted by an oncoming car. She suffered a traumatic brain injury, and that’s when she came under my care.”
“Dr. Hobson, what was Mrs. Stanton’s diagnosis?”
“After her condition stabilized, she entered into a persistent vegetative state.”
“Doctor, explain that term to the court.”
“The diagnosis refers to a disorder of consciousness. Patients in a vegetative state do not enjoy true awareness of their surroundings or consciousness as we understand it.”
“So, it’s a coma?”
“No, it’s not a coma. A coma is where the patient lacks both awareness and wakefulness. Patients in a vegetative state may have awoken from a coma, but still have not regained awareness. In the vegetative state patients may appear to open their eyes or mouth, but they completely lack cognitive function. Patients that enter a vegetative state as the result of a traumatic injury, like Mrs. Stanton, can awake from the vegetative state within a year of the injury, but that timetable is only when there is some evidence of cognitive activity. If there is no cognitive function detectable, the state becomes permanent in only 2-3 months.”
“Dr. Hobson, you just mentioned cognitive function. How would you have tested Mrs. Stanton’s cognitive functioning?”
“Well, I first checked Mrs. Stanton’s clinical signs, such as eye tracking and pain responses.”
“And what did those signs tell you doctor?”
“Mrs. Stanton was unresponsive to all stimuli, which is not uncommon given the nature and extent of her physical injuries. She would, without provocation, open her eyes or occasionally her mouth, but she never did so when provoked.”
“Would the clinical signs from your examination have been the best information concerning Mrs. Stanton’s cognitive functioning?”
“What would be the state of the art in your field for that, Dr. Hobson?”
“A PET scan or functional MRI would be considered the state of the art.”
“Did Mrs. Stanton ever undergo a PET scan or a functional MRI at your hospital, doctor?”
“And, what did those tests reveal, Dr. Hobson?”
“At the time, when I reviewed the results of all of Mrs. Stanton’s PET scans and MRIs, they revealed no cognitive functioning whatsoever.”
“At the time, doctor? What do you mean?”
“I mean that I came to learn that the results I was viewing had been altered in our computer system.”
“Yes, the results I reviewed at the time were changed to reflect no brain activity.”
“And what did that mean, Dr. Hobson?”
“That means that Mr. Stanton made a choice he never should have been allowed to make.”