Choices

         Monday morning started off like most days for David. He was lying in bed, dreaming of something he wouldn’t remember ten minutes from now when an annoying buzzing filled the air. He groaned and slapped at the alarm clock on his nightstand. After a few misses, the buzzing stopped. He rolled over and squinted at the noisy machine. Six o’clock—far too early to be up. He could hear rain falling outside. Great, he thought. It’s raining, dark, and Monday. For a brief moment, David thought about going back to sleep and skiving off work today.
         After enjoying that sentiment for a few minutes he threw off the covers and rolled out of bed. He heard a mewling sound coming from the pile of blankets on the bed. He must have covered up his cat, Perkins. Perkins was a little thing, just over a year old. He was white and fuzzy with a long gray tail and gray patches over his eyes and ears. One thing he didn’t like was to be covered up by anything. David pulled the covers off of Perkins and he leapt off the bed and ran down the hall, sounding like a herd of elephants on the hardwood floor. It always amazed David how loud a four-pound cat could be when running.

      David knelt by his DVD collection, trying to decide what movie to watch. He had so many; it was starting to become a very difficult decision. His eyes scanned the titles: "Pale Rider," "What Dreams May Come," "The Sixth Sense," "Patch Adams," "Beetlejuice," "Four Weddings and Funeral," "The Greatest Story Ever Told," faster and faster until they all blurred together. He finally settled on a comedy, "Defending Your Life," when his phone rang.
         He stood up, arching his back and wincing as it popped in several places. Padding over to the phone, he grumbled to himself, annoyed at the interruption. He waited for it to ring again before picking it up.
         “Hello?” He ran his hand through his unkempt hair.
         “David? It’s Sue.” Sue was David’s sister.
         “Oh. Hi, Sue. What’s up?”
         “I need you at the hospital. Dad’s condition just got worse.” Sue’s voice quavered.
         David swore silently to himself. “OK, I’ll be there in about twenty minutes.”
         Stifling a sob, Sue said, “Hurry, David. It’s bad.”
         “OK. Just hang in there, Sue. I’m coming. OK?”
         She croaked out, “OK.”
         “See you in a few minutes, OK? Bye.” He hung up the phone and leaned against the wall. Crap, he thought. I don’t need this right now.
         David was still a young man; he was only 33. He still had a full head of thick, brown hair, but was starting to develop what he referred to as a “beer belly.” Still, he was considered attractive by a lot of women. At least, he’d never had any trouble getting dates. His sister Sue was a few years younger. Together they had weathered the storm that was their father’s health of late. He had been in and out of the hospital at least a dozen times over the past two years. David was having a difficult time keeping track of all his father’s maladies. So far there was congestive heart failure, gall stones, kidney stones, a hernia, arthritis, and a recurring urinary tract infection. There were a few conditions David couldn’t remember the names of, like the poor circulation in his father’s extremities that made it difficult for him to walk and he was pretty sure his father was starting to suffer from some dementia. This last visit to the hospital was for a “simple” operation to fix the hernia.
         That was yesterday. He was supposed to be out of recovery and just a few days from being released today. Obviously, it wasn’t as simple as the doctors made it out to be. Sometimes David hated doctors and hospitals.
         He pulled on a fresh shirt and grabbed his cell phone before heading out the door. His cat, Perkins sat watching him.
         “Be good, you little shit,” David said to Perkins as he went out the door.

         Traffic was light as David drove to the hospital. Normally, he’d be exceeding the speed limit by a good margin, but he was getting really sick of visiting it. Deep down in the dark recesses of his brain, he felt a little guilty about driving so slow when for all he knew, his father could be on his deathbed. But, they’d had a lot of little scares over the last couple of years, and he was getting a little cynical about the whole thing.
         He was very thankful that he and Sue had managed to talk their father into getting Living Will and a Health Care Directive about ten months ago. At least now, if something bad did happen, there would be very few questions about what should be done. It was hell getting their father to talk to them about it though. David understood that death was far down on the list of his father’s favorite subjects, especially after their Mom died in 2001, but as litigious as the country was now, and with all the bureaucratic—or as his father called it, bureaucraptic—red tape you ran into dealing with hospitals and insurance companies, it was better to have everything written down in advance.
         Sue cried a lot the day of that conversation. Their father kept asking why they were so eager for him to die. He didn’t have a lot of money, but he had a lot of insurance and he assured them that they’d get it all, so they just had to have patience; eventually he’d kick the bucket and they’d be very well off. He said that there was no way in hell he’d ever go to an assisted living facility or a nursing home because he had the kids to take care of him. He just couldn’t understand that Sue had her own family to take care of now and couldn’t just abandon them to take care of him, though she would readily do that. David kept telling him that though he was indeed his son, he was not qualified to provide the level of care that his father would need, should things get that bad. Their father could be a stubborn old bastard at times.
         The digitally reproduced sounds of Magnum, P.I., brought David out of his contemplations; someone was calling him on his cell phone. He dug it out as he took the exit for the hospital. Unknown. He decided to ignore it; he wasn’t in the mood to talk to someone with an unlisted number just now. If it was important, they could leave him a message.

         Sue stood when David entered the hospital room. Her eyes were red-rimmed and the makeup had run from her tears. She was about three inches shorter than David and was wearing a pink and blue skirt and sweater combo that would have been cute anywhere but in a hospital. Her auburn hair was tied back in a ponytail. She came over to him and hugged him tight.
         “David, I’m so glad you’re here.”
         “What’s going on? How bad is it?” He looked over at his father. The ICU was even worse than regular hospital rooms. There were wires and tubes all over his father; he looked like some sort of cyborg. A machine was breathing for him.
         “He had a stroke in recovery. They ran some tests, but haven’t been able to tell me anything yet.” Sue collapsed back in the chair. It looked like she had made it her home for the last few days. Knowing her, she probably had.
         “Crap. Shit. Dammit. Where’s the doctor?” David looked around for his father’s chart, as though he could understand it with one semester of college biology under his belt.
         “They said he was on his way up.” She blew her nose on one of the hospital tissues. It made her look even worse. David always felt those cheap tissues were one step away from fine grit sandpaper.
         David leaned back against the wall and stared at the myriad of machines surrounding his father’s bed. Their clicks, whirrs, and beeps began to drown out all the other sounds, with the quiet sobs of his sister underscoring the whole cacophonous symphony. So engrossed was he, that he gave a start when the doctor walked into the room.
         “Good afternoon, I am Doctor Goswami.” He offered his hand to David. He was a dark skinned man from India. Though, he had an accent, he was very easy to understand and had a pleasant voice. His hair was cut short and he had a wide nose. David could see a suit underneath his white lab coat. The pockets of his lab coat bulged and David could see the ear pieces of his stethoscope poking out of one of them.
         David shook the doctor’s hand firmly. “David Cavanaugh, I’m his son.” Dr. Goswami nodded. “What’s the situation, Doctor?”
         “The hernia operation went remarkably well. Everything seemed fine until your father suffered several strokes in recovery this morning. We were able to treat him for those immediately, but I ordered an MRI on him.”
         “And? What did that show?” David looked to his father, then back to Dr. Goswami. Sue was sitting straight up again, looking intently at their father.
         “There is the possibility of brain damage. The strokes were quite severe.” Dr. Goswami said.
         “I don’t mean to be rude, Doctor, but don’t sugar-coat it for me. Be brutally honest. Is he a vegetable now?” David started to dread the answer, even as he asked the question.
         “I can’t say. What I can tell you is this: he is incapable of breathing on his own. In 90% of cases similar to your father’s, the patient never recovers consciousness.” His pager cut him off. He glanced down at it. “Excuse me for a moment.” Dr. Goswami stepped out of the room.
         David turned to his sister, “Dammit, I thought Dad had a DNR in his will?” A DNR was a Do Not Resuscitate order, given by a patient who doesn’t want heroic measures taken to prolong their life should they die.
         Sue looked up at him, “He does, but they haven’t had to resuscitate him yet, David. He was still on the respirator from the surgery when he had the stroke.” David walked over to the window. The room didn’t have much of a view. All he could see was the machinery on top of another wing of the hospital.
         Dr. Goswami came back into the room. “I’m terribly sorry. Do you have any other questions?”
         David looked to his sister. She shook her head. He looked back at Dr. Goswami. “No, Doctor. Thank you, you’ve been very informative.”
         Dr. Goswami handed his business card to David. “Call me anytime if you have any other concerns, OK? Thank you. Bye-bye.” He offered a smile and left the room.
         David knelt by Sue’s chair, “Where’s Steve?” Steve was Sue’s husband.
         “He’s in London on business. I talked to him. He offered to come home, but there’s nothing he really can do. He and Dad were never close anyway. I didn’t want him to risk screwing up the deal.”
         “He’s a good guy. I don’t know why Dad didn’t like him.” He blew out a breath and stood back up, looking over to his father.
      “You’re Dad’s agent, aren’t you, David?” Sue asked. “According the Health Care Directive?”
      David looked at his sister, “Yeah, so?”
      “Do you know what that means?”
         David scrunched up his brow, unsure of what Sue was getting at. “No. What?”
         “It means that if it comes down to a decision of whether or not to keep Dad on life support, you have to make that decision.”
         David sat there. He’d heard what his sister said, but his brain was having difficulty processing it. He knew that decision would be his to make, but it never occurred to him that he’d actually have to make it someday.
         “David?”
         “David?” Sue asked again.
         “Shit.” David was not at his most articulate right now.
         “Are you OK?”
      David sighed, “Yes. I just don’t know what to say right now. I feel like I’m the guy who catches cannonballs with his stomach.” He walked over to the bed and looked down at his father, lying there tubes and wiring going into and coming out of nearly every orifice on his body. He was struck by how helpless his father looked. It almost seemed as though he were already dead.

         The next day, David called off work. They didn’t hassle him too much, and he knew he’d be useless at work today. The only thing he’d accomplished since getting home from the hospital was check his voice mail. The unknown caller had actually left a message, which surprised him. It was Janet, one of his sister’s co-workers. They’d met at a company picnic about a year ago. Sue’s husband didn’t want to go, so she dragged her brother along instead. Janet had seemed nice. She was a little short, with classic Mediterranean features. But she dressed nice and had a personality that made it difficult to be grumpy around her. Her message was short and to the point: Hi David, it’s Janet. Remember me? We met a year ago at the company picnic and then again at the mall a few weeks ago. I got your number from Sue, I hope you don’t mind. Anyway, I was just wondering if you wanted to grab a bite to eat, or catch a movie. If you’re busy, don’t worry about it, it was just a thought. Give me a call if you think about it, 587-9487. Ok, bye. He hadn’t called her back yet. He really didn’t plan on it. He just wasn’t in the mood right now. He hardly slept the night before and he knew he would be next to useless at work while he was worrying about his father.
      Oh yes, he worried, though he would never admit it to anyone. For years, he’d cultivated the image of being a rock upon which others could rely, but inside he could feel himself getting older as each day passed with his father’s mortality hanging over his head.
         So he just lay there in bed, thinking about his father while Perkins slept on his chest. Sue thought having a pet would make David mellower. Plus, Sue loved cats and thought everyone should have one. The sun peeked in through the partially-drawn curtains. Dust sparkled in the sunbeam as David wondered what time it was. He had barely moved a muscle in hours and considered getting up, showering and heading back to the hospital. He was so tired, though. He hadn’t slept a wink last night. Every time he fell asleep, he kept dreaming about being surrounded by writhing snakes. Once of them would crawl down his throat and when he would snatch it out, he would be unable to breathe.
         The phone rang, startling Perkins. He dug his claws in and leapt off of David’s chest. David winced and picked up the phone.
         “Hello.” He noticed how groggy he sounded, even though he’d been awake for hours.
         “It’s Sue.”
         “Oh, hi Sue. Did you go home?” David sat up in bed and ran his fingers through his hair. It felt particularly oily today.
         “Yeah. The nurses finally convinced me sleeping in my own bed would be better for me. They promised to call if anything changed with Dad.”
         “Did they call?” David asked.
         “No. I’ve been worried about you, though.” She sounded concerned.
         “Why?”
         “What are you going to do about Dad?”
         “I don’t have a clue. Do you think we should pull the plug?” David said, wishing Sue hadn’t brought this subject up.
         Sue replied, “I don’t know, David. What if he gets better?”
         “Beats me. That’s that damn hard part. If he can recover, and we pull it, he could die. If he doesn’t recover and we don’t pull it, he’s a vegetable. Maybe he’ll linger for weeks after we pull the plug and still die.” David wracked his brain for a segue to a new topic.
         “Stop. Just stop. You’re talking about our father.”
         That did the trick, though not quite the way David wanted. “OK, OK. Are you going to the hospital today?”
         “Of course. Are you?” Sue said.
      “I don’t want to.” David tried to think of a reason why he couldn’t go and came up blank.
         “But he’s our father!” Sue sounded like she did when she was scolding her husband.
         “I know, Sue. I didn’t say I wasn’t going. I said I didn’t want to. I hate that place.” David threw the covers off and got out of bed. He started to walk towards the bathroom, dragging the phone off of his nightstand. The handset yanked out of his hand and clattered on the hardwood floor.
         “Goddammit!” He shouted. He already wanted a do-over on this day. He could hear his sister talking into the phone.
         “David? David? Are you OK? What happened?”
         He plopped down on the floor and picked up the phone. He shook his head, “Sorry about that. I walked away from the bed and forgot that I wasn’t on the cordless.”
         “Oh.” Sue sounded worried, but was obviously trying to stifle a laugh.
         “Look, I’m going to take a shower, then I’ll head over to the hospital?” The floor was cold on David’s butt, but he sat there punishing himself for being stupid enough to try to walk across the room on a corded phone. Times like this made him glad to live alone because he felt like the world’s biggest dork.
         “OK, I’m heading that way as soon as I get off the phone with you.”
         “Fine. I’ll see you soon, then. Bye,” David said, sighing.
         “Bye, David.”          There was a click then a buzz. David sat there listening to it for a minute. He hung up the phone and placed it back on the nightstand. It was going to be a long day.
         David was just finishing up his shower when he could hear something very faintly. He turned off the water and listened. It was his cell phone. He decided to ignore it. Whoever it was could wait until he got the unpleasantness at the hospital over with.

         When he arrived at the hospital, David saw a well-dressed woman leave his father’s room. She was wearing a grey business suit and was carrying an attaché case. Her hair was pulled up in a tight bun at the back of her head. She smiled as she passed by him and he wondered if she was wearing a Chanel suit. A voice in his head said how would you know if it was Chanel? You never heard of a Chanel suit until you saw one on "The Simpsons." He walked into his father’s room. Sue was already there, standing at the side of the bed, looking down at their father.
         “Hey, Sue,” David said quietly.
         “Hi.” She looked up and David and sighed. “It gets better and better everyday.”
         He frowned. “What do you mean? Who was that who was just in here?”
         “She’s one of the hospital patient advocate people or something like that. She’s the bearer of bad news.”
         “What news? They’re kicking him out or something?” David looked back at the doorway.
         “Not exactly. She just wanted to be sure that we were aware that Medicare won’t cover this type of long-term care for Dad indefinitely. She couldn’t give me exact figures yet, but says that once Medicare runs out, we’ll have to foot the bill ourselves.” Sue closed her eyes and turned away from David.
         “Boy, you weren’t kidding. That sucks. What the hell do we pay taxes for, anyway?” David asked. Sue didn’t answer. She gripped the rails of the bed tightly. He put his arm around her and hugged her close.
         They stayed like that for nearly ten minutes before Sue finally decided to sit down. She looked much older than her thirty years with no makeup. Worry lines creased her face and her eyes were red. David thought she looked like she hadn’t slept at all last night, which was probably not far from the truth. He went outside for some fresh air. The antiseptic smell of hospital rooms always bothered him, and today was worse than normal it seemed. He just had to get out of there for a minute, the person in the room next to his father was moaning very loudly and David was sorely tempted to go and throttle that person.
         Once outside, he remembered the phone call that came while he was in the shower. He dialed up his voicemail. Hi David, it’s Janet again. God, I’m so sorry about your father. Sue told me about it. If there’s anything I can do, just let me know, OK? Give me a call if you need someone to talk to, or if you just want to get away for a minute. Anything, OK? That goes for Sue, too. Let her know, OK? Well, umm…bye. Call me if you need anything.”
         David shook his head and deleted the voice mail. His sister had some awfully nice friends. His friends all seemed to be a bunch of beer-swilling slackers. He would bet that if he called them and cancelled plans because his Dad was on his deathbed, they’d bitch about it. He looked up as a lifeline helicopter roared overhead towards the hospital’s helipad.
      He wondered if the people in the helicopter had Living Wills. Had they signed DNRs? What would I want? He wondered. Would I want to be kept alive on a machine if there was very little hope of recovery? Does Dad even know what’s going on? Or did he go to sleep before the operation and just never wake up? He took a deep breath and headed back inside.

         A week later, David and Sue were eating lunch in the hospital cafeteria. They’d both started being able to sleep again, but their father showed no improvement. Dr. Goswami said it was highly unlikely their father would ever regain consciousness, and if he did, he would not be cognizant; the brain damage was quite extensive. He wouldn’t know who he was or where he was. He wouldn’t recognize his children. He wouldn’t be able to feed himself or go to the bathroom. He would most likely never breathe on his own again. Therefore, he would never eat solid food again.
         David wondered if it was just him, but the hospital cafeteria’s food tasted like ashes. “Sue, I’ve been thinking about something.”
         “What?” She ate her food mechanically, not really looking at David.
         “I’m not sure I can sign the order, Sue.”
         “You mean taking him off life support?” She ate another spoonful of pudding.
         “I just don’t know what to do, Sue. I don’t think I can kill Dad like that.”
         Sue said nothing. She took David’s hand. David fought to maintain his composure. The truth was, he’d been thinking about it all week, and it was tearing him apart. He thought it would be a no-brainer: if his father would be a drooling vegetable, pull the plug and be done with it. If there was a good chance he’d recover, give it time and let the old man have a few more years. But now that the time had come, David felt like a helpless infant. I feel like one, he thought, but Dad is one. No…not an infant. An infant will grow, develop. Dad can’t do that anymore. He’s just helpless.
         “Just helpless…there’s no hope,” David whispered.
         “What?” Sue asked.
         He thought back to the day when they finally got their father to do the living will. When he finally warmed to the subject he was very adamant about not wanting to be burden on anyone, despite what he said earlier about wanting David to care for him. He was a proud man, and couldn’t stand the thought have having to have his every need cared for by someone else. It was one thing when you could do for yourself and someone waited on you, but to be forced to rely on someone because you could no longer control your basic functions, well, that was an indignity David and Sue’s father could do without.
         “Sue?”
         “Yes, David?” Sue looked at him.
         “I’m going to do it. I’m pulling the plug.”
         Sue withdrew her hand from his. “You want him to die?” She looked at him like she did when her husband was trying to pull a fast one.
         He shut his eyes. “No, of course not. But it’s not about what I want. It’s about what’s best for him. I’m going to have them remove the life support. He’s a vege, Sue. He wouldn’t want to live like that.”
         “You better be damn sure, David. He’s not dead.” David could feel eyes on him. He noticed a couple hospital staff had sat down at the next table and were looking at them. He ignored them.
         “Dad left this decision to me when he made me his agent. I’ve been thinking about this all week.” David rubbed his forehead. “Look, I want him back too, but everything he was is gone, Sue.”
         “He might recover.” She said in a small voice.
         “Dr. Goswami says it’s highly unlikely. I probably have a better chance of winning the Powerball than Dad has of bouncing back from this,” David said. He shoved his tray aside and took his sister’s hand.
         “Breathing on a machine…pissing down a tube. Not eating. Not knowing where you are, who you are…what you are. It’s not living, Sue. Dad’s not alive anymore. He just exists. That’s it. That’s not living. He wouldn’t want this.”
         Sue shook her head. “You can’t kill Dad.”
         “Dammit, the stroke killed him! If he wasn’t on the respirator when it happened, we wouldn’t be having this conversation.” He squeezed her hand.
         Sue pulled away again. “So that’s it. You can just discard him, just like that?”
         “I’m not discarding him. Think, dammit. Remember that day he signed the living will? He doesn’t want to be a burden. He doesn’t want to be a vegetable.”
         “I’m not ready to lose him, David.” Sue grabbed a napkin and wiped her eyes.
         “I’m not either, but that’s not really our choice, now, is it?” He hated getting stern with his sister, but if he’d learned one thing over the past 33 years, it was that if someone didn’t stay grounded, then no one in the whole family would make a decision.
         “Dad left this choice to me. I hate having to make this decision. Believe me, it sucks. I can’t sleep, I can barely eat. But I think this is what Dad would want.”
         Sue looked at him, “You think? You’re going to take Dad off life support because of what you think, huh? I want you to know that what you’re doing is right.” She pointed at David. “You can’t take this back, David. If you do this, there’s no going back. We have to live with this decision for the rest of our lives. What if he can recover? What if, David?”
         David took a deep breath and let it out slowly. “I’m…I’m not going to play grab-ass with the supernatural, Sue. The ‘What If’ game really sucks right now. I…I…I don’t know that Dad won’t recover. There’re no absolutes in medicine. No...no one can be sure of anything,” David said, trying to keep himself calm.
         “Well you better be damn sure about this.” Sue said. David’s lip trembled. He saw his sister’s expression soften a bit.
         “They say he can’t breathe on his own, Sue. I say we pull the plug and find out. Dad’s a fighter. If he’s going to recover, now is as good a time as any. The longer he stays on that damn machine, the greater chance he has of getting pneumonia, or some other complication. If we do it now, and he recovers…then great. If he doesn’t…well…at least the suffering will be over. We can’t live like this forever, Sue,” David said as he took his sister’s hand again. “Think about it. If you were in a vegetative state, never to regain consciousness, never to eat again, laugh again, cry again….never to see your children again and know who they are…wouldn’t you want someone to love you enough to end it?”
         Tears trickled down Sue’s cheeks. Her lips quivered. “Fine. It’s your decision, David.”

         Once all the paperwork was done and everything was triple-checked and checked again, David and Sue stood in their father’s hospital room as the staff made preparations to turn off the life support. It was a little more complicated than the phrase “pull the plug” would make it seem.
         Sue held on to David tightly. He glanced up at the clock at the nurses and doctors did their work. The respirator was off now.
      The clock ticked so slowly.
      Their father didn’t breathe again.
      He flatlined.
      They pronounced his death at 2:37 P.M., Monday, August 7th, 2006. Sue cried over the body for twenty minutes before she allowed herself to be led away. David held her, but gave himself the luxury of letting tears fall freely. He kept his composure though, like he always had.
      When he got back out to his car, he just sat there for fifteen minutes. Life would be different now. They’d always had their father. Now, he was gone. Magnum, P.I. came over his cell phone again, startling him. He looked down at the display. Unknown. This time, he answered it.
      “Hello? Oh, hi Janet.”