The Face

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