Brain Child

CHAPTER FOUR

Ellen Lonsdale knew her premonition had come true as soon as she opened the front door and saw Carol Cochran standing on the porch, a handkerchief clutched in her left hand, her eyes rimmed with red.
“It happened, didn’t it?” she whispered.
Carol’s head moved in a barely perceptible nod. “It’s Alex,” she whispered. “He … he was alone in the car …”
“Alone?” Ellen echoed. Where had Lisa been? Hadn’t she been with Alex? But her questions went unspoken as she tried to concentrate on what Carol was saying.
“He’s at the Center,” Carol told her, stepping into the house and closing the door behind her. “I’ll take you.”
For a moment Ellen felt as if she might collapse. Then, with an oddly detached calmness, she picked her purse up from the table in the entry hall and automatically opened it to check its contents. Satisfied that everything was there, she walked past Carol and opened the front door. “Is he dead?” she asked.
“No,” Carol replied, her voice catching. “He’s not dead, Ellen.”
“But it’s bad, isn’t it?”
“I don’t know. I don’t think anyone does.”
Silently the two women got into the Cochrans’ car and Carol started the engine. As she was backing down the Lonsdales’ driveway, Ellen asked the question that was still lurking in her mind. “Why wasn’t Lisa with him?”
“I don’t know that. We got a call from the police. They said to meet them at the Center, that they were taking Lisa there. I thought … Oh, God, never mind what I thought. Anyway, Lisa’s all right, but Alex—his car went off the road up near the old hacienda. Carolyn was having a party.”
“He said he wouldn’t go to any parties,” Ellen said numbly, her body slumped against the car door. “He promised—” She broke off her own thought, and remained silent for several seconds as her mind suddenly began to shift gears. I can’t fall apart. I can’t give in to what I’m feeling. I have to be strong. For Alex, I have to be strong. She consciously straightened herself in the car seat. “Well, it doesn’t matter what he promised, does it?” she asked. “The only thing that matters is that he be all right.” She turned to gaze searchingly at Carol, and when she spoke, her voice was stronger. “If you knew how bad it was, you’d tell me, wouldn’t you?”
Carol moved her hand off the steering wheel to give Ellen’s arm a quick squeeze. “Of course I would. And I’m not going to tell you not to worry, either.”
As Carol drove, Ellen tried to make herself concentrate on anything but what might have happened to Alex. She gazed out the window, forcing her mind to focus only on what her eyes were taking in.
“It’s a pretty town,” she said suddenly.
“What?” Carol Cochran asked, taken aback by Ellen’s odd statement.
“I was just looking at it,” Ellen went on. “I haven’t really done that for a long time. I drive around it all the time, but it’s been years since I really paid attention to what it looks like. And a lot of it hasn’t really changed since we were children.”
“No,” Carol said slowly, still not sure where Ellen’s thoughts were leading. “I don’t suppose it has.”
Ellen uttered a sound that was partly a hollow chuckle, partly a sob. “Do you think I’m crazy, talking about how pretty La Paloma is? Well, I’m not. Anyway, I don’t think I am. But I’m having a feeling, and if I let myself think about that, then I will go crazy.”
“Do you want to tell me what it is?”
There was another long silence, and when she spoke again, Ellen’s voice had gone strangely flat. “He’s dead,” she stated. “I have the most awful feeling that Alex is dead. But he isn’t dead. I … I won’t let him be dead!”
Ellen stared at the knot of people in the emergency waiting room. She recognized most of the faces, though for some reason her mind refused to put names to them. Except for a few.
Lisa Cochran.
She was sitting on a couch, huddled close to her father, and a policeman was talking to her. Lisa saw her and immediately stood up and started toward her.
“I’m sorry,” she blurted. “Oh, Mrs. Lonsdale, I’m so sorry. I didn’t mean to—”
“What happened?” Ellen asked, her voice dull.
“I … I’m not sure,” Lisa stammered. “We had a fight—well, sort of a fight, and I decided to walk home. And Alex must have been coming after me. But he was driving too fast, and …” She went on, blurting out the story of what had happened, while Ellen listened, but only half-heard. Around them, the rest of the people in the waiting room fell silent.
“It was my fault,” Lisa finished. “It was all my fault.”
Ellen laid a gentle hand on Lisa’s cheek, then kissed her. “No,” she said quietly. “It wasn’t your fault. You weren’t in the car, and it wasn’t your fault.”
She turned away to find Barbara Fannon at her elbow. “Where is he?” she asked. “Where’s Alex?”
“He’s in the O.R. Frank and Benny are working on him. Marsh is in his office.” She took Ellen’s arm and began guiding her out of the waiting room.
When she came into his office, Marsh was sitting behind his desk, a glass in front of him, staring at nothing. His gaze shifted, and he stood up, came around the desk, and put his arms around her.
“You were right,” he whispered, his voice strangling on the words. “Oh, God, Ellen, you were right.”
“Is he dead?” Ellen asked.
Marsh drew back sharply, as if the words had been a physical blow. “Who told you that?”
Ellen’s face paled. “No one. I just … I just have a feeling, that’s all.”
“Well, that one isn’t true,” Marsh told her. “He’s alive.”
Ellen hesitated; then: “If he’s alive, why don’t I feel it?”
Marsh shook his head. “I don’t know. But he’s not dead. He’s seriously injured, but he’s not dead.”
Time seemed to stand still as Ellen gazed deep into her husband’s eyes. At last she quietly repeated Marsh’s words. “He’s not dead. He’s not dead. He won’t die.” Then, despite her determination to be strong, her tears began to flow.
In the operating room, Frank Mallory carefully withdrew the last visible fragment of shattered skull from the tissue of Alex’s brain. He glanced up at the monitors.
By rights, the boy should be dead.
And yet, there on the monitors was the evidence that he was not.
There was a pulse—weak and erratic, but there.
And he was breathing, albeit with the aid of a respirator.
His broken left arm was in a temporary splint, and the worst of his facial lacerations had been stitched just enough to stop the bleeding.
That had been the easy part.
It was his head that was the problem.
From what Mallory could see, as the car tumbled down the ravine, Alex’s head must have smashed against a rock, crushing the left parietal plate and damaging the frontal plate. Pieces of both bones had broken away, embedding themselves in Alex’s brain, and it was these splinters that Mallory had been carefully removing. Then, with all the skill he could muster, he had worked the fractured pieces as nearly into their normal positions as possible. Now he was applying what could only be temporary bandages—bandages intended to bind Alex’s wounds only until the electroencephalogram went totally flat and the boy would be declared dead.
“What do you think?” Benny Cohen asked.
“Right now, I’m trying not to think,” Mallory replied. “All I’m doing is putting the pieces back together, and I’m sorry to say I’m not at all sure I can do it.”
“He’s not gonna make it?”
“I’m not saying that, either,” Mallory rasped, unable to admit his true thoughts. “He’s made it this far, hasn’t he?”
Benny nodded. “With a lot of help. But without the respirator, he’d be gone.”
“A lot of people need respirators. That’s why they were invented.”
“But most people only peed them temporarily. He’s going to need it the rest of his life.”
Frank Mallory glowered at the young intern, then softened. Cohen, after all, hadn’t known Alex Lonsdale since the day the boy was born, nor had Cohen yet lost a patient. When he did, maybe he’d realize how much it hurt to see someone die and know there’s nothing you can do about it. But Alex had survived the first emergency procedures, and there was still the possibility that he might live. “Let’s get him into the ICU, then start setting up for X rays and a CAT scan.”
Ten minutes later, still drying his hands with a white towel, Mallory walked into Marshall Lonsdale’s office. Both Marsh and Ellen struggled wearily to their feet.
“He’s still alive, and in the ICU,” Mallory told them, gesturing for them both to sit down again. “But it’s bad, Marsh. Real bad.”
“Tell me,” Marsh replied, his voice toneless.
Mallory shrugged. “I can’t tell you all of it yet—you know that. But there’s brain damage, and it looks extensive.”
Ellen stiffened, but said nothing.
“We’re setting up right now for every test we can give him. But it’s going to be tough, because he’s on a respirator and a cardiostimulator.” Then, as Marsh and Ellen listened, he described Alex’s injuries, using the dispassionate, factual tone he had learned in medical school, in order to keep himself under control. When he was done, it was Ellen who spoke.
“What can we do?”
Mallory shook his head. “Nothing, for the moment. Try to stabilize him, and try to find out how bad the damage is. We should know sometime early in the morning. Maybe by six.”
“I see,” Ellen murmured. Then: “Can I see him?”
Frank Mallory’s eyes flicked toward Marsh, who nodded. “Of course you can,” Mallory said. “You can sit with him all night, if you want to. It can’t hurt, and it might help. You never know what people in his condition know or don’t know, but if somehow he knows you’re there … well, it can’t hurt, can it?”
Barbara Fannon glanced up at the clock on the wall and was surprised to see that it was nearly five in the morning. To her, it seemed as if it couldn’t have been more than an hour since the ambulance arrived with Alex.
There had been so much to do.
There had been all the tests that needed to be set up, and it had fallen to Barbara to coordinate the testing so that Alex was subjected to the least amount of movement possible. Not only had she coordinated the X rays and CAT scan, but everything else Frank Mallory had requested. And, as far as Barbara could determine, he hadn’t forgotten anything: he’d ordered ultrasound imaging and a cerebrospinal tap, as well as an arteriograph and an EEG. The only thing he’d left out was a pneumoencephalograph, and Barbara knew the only reason he’d skipped it was that Alex would have had to be put in a vertical position to carry it out. In his present condition, that simply wasn’t feasible. It had taken Barbara nearly an hour simply to contact all the technicians necessary and get them to the Center. And then, of course, there had been the people in the waiting room.
They had thinned out after the first couple of hours, when Barbara had finally told them that there would be no more news that night—Alex was undergoing a series of tests, but the results would be unavailable for an indefinite period.
Now, at five o’clock, she could at last go home. Everything that needed to be done, or could be done, was finished, and she realized she was bone weary. All she had to do was check the waiting room, and she could go. She pushed the door open, expecting the room to be empty.
It wasn’t.
Sitting on the couch in the far corner was Lisa Cochran, her parents flanking her. She was dry-eyed now, and sitting straight up, her hands folded quietly in her lap. Barbara hesitated, then went into the waiting room, letting the door swing shut behind her.
“Can I get you anything?” she asked. “Some coffee, maybe?”
Lisa shook her head, but said nothing.
“If you can think of a way to convince her to come home with us, that might help,” Carol said, rising to her feet, stretching, and offering the tired nurse a resigned smile.
“I can’t, Mama,” Lisa whispered. “What if he wakes up and asks for me?”
Barbara crossed the room and sat next to the girl. “He’s not going to wake up tonight, Lisa.”
Lisa regarded her with bloodshot eyes. “Is … is he going to wake up at all?”
Barbara knew it wasn’t her place to talk to anyone about Alex Lonsdale’s condition, but she also knew exactly who Lisa was, and how Alex felt about her. God knew he’d spent enough time perched on the edge of Barbara’s desk telling her how wonderful Lisa was. And after watching her through the last several hours, Barbara was convinced that Alex was right. She sighed heavily. “I don’t know,” she said carefully; then, when Lisa’s eyes turned suddenly frightened, she went on: “I said I don’t know. That doesn’t mean he’s not going to wake up. All it means is that I don’t know, and no one else does either.”
“If he wakes up, will that mean he’s going to be all right?”
Barbara shrugged. “We don’t know that, either. All we can do is wait and see.”
“Then I’ll wait,” Lisa said.
“You could go home and try to get some sleep,” Barbara suggested. “I promise I’ll arrange for someone to call you if anything happens. Anything at all.”
Lisa rubbed at her eyes, then shook her head. “No,” she said. “I want to be here. Just in case.” She looked at the nurse beseechingly. “He might wake up.”
Barbara started to speak, then changed her mind. She’s right, she decided. He damned well might wake up. And as she absorbed the thought, she realized that she, like most of the staff at the clinic, had only been going through the motions of administering to Alex.
For all of them, all the trained medical people who had seen injuries like Alex’s before, it was a hopeless case. You did what you could, tried not to overlook any measure, no matter how drastic, that might save the life, but deep inside you prepared yourself for the fact that the patient wasn’t going to make it.
And at the end of your shift, you went home.
But Lisa Cochran wasn’t going home, and Barbara Fannon decided she wasn’t going home either, even though her shift had ended long ago. Coming to that decision, she stood up. “Come on,” she said.
The Cochrans looked at her uncertainly, but followed her down the hall. Without knocking, she opened the door to Marshall Lonsdale’s office and led them inside. “If we’re all going to stay, we might as well be as comfortable as possible.”
“This is Marsh’s office,” Jim Cochran said.
“Nobody else’s.”
“Should we be here?”
“You’re his friends, aren’t you? It’s been a long night, and it’s going to be an even longer one. I was going home, but if you can stick this out, so can I. But not out there.” She lowered the lights a little, and closed the blinds to the windows. “Make yourselves comfortable while I go find some coffee. If you want something stronger, you might poke around the office while I’m gone. I’ve heard rumors that sometimes there’s a bottle in here.”
Jim eyed the nurse. “Any rumors about just where it might be?”
“No,” Barbara replied. Then, as she left the office, she spoke once more. “But if I were you, I’d start looking in the credenza. Bottom right.”
Ellen Lonsdale sat in a straight-backed chair that had been pulled close to Alex’s bed, her right hand resting gently on his. He lay as he had been placed, on his back, the cast on his left arm suspended slightly above the mattress, his limp right arm extended parallel to his body. His face, covered with the respirator mask and a mass of bandages, was barely visible, and totally unrecognizable. Around him was an array of equipment that Ellen couldn’t begin to comprehend. All she knew was that the monitors and machinery were somehow keeping her son alive.
She had been there for nearly five hours now. The sky outside the window was beginning to brighten, and she shifted slightly in her chair, not as a reaction to the stiffness that had long ago taken over her body, but so that she could get a clearer look at Alex’s eyes.
For some reason, she kept thinking they should be open.
The night had been filled with odd thoughts like that.
Several times she had found herself feeling surprise that the respirator was still operating.
Once, when they brought Alex back from one of the tests—she couldn’t remember which one—she had been shocked at the warmth of his hand when she touched it.
She knew what the odd feelings were about.
Despite what she had been told—despite her own inner resolve—she still had the horrible feeling that Alex was dead.
Several times she had found herself studying the monitors, wondering why they were still registering life signs in Alex.
Since he was dead, the graphic displays of his heartbeat and breathing should be flat.
She kept reminding herself that he wasn’t dead, that he was only asleep.
Except he wasn’t asleep.
He was in a coma, and despite what everyone kept saying, he wasn’t going to come out of it.
Abstractly she already understood that it wasn’t a matter of waiting to see what would happen. It was a matter of deciding when to remove the respirator and let Alex go.
She didn’t know how long that thought had been in her mind, but she knew she was beginning to get used to the reality of it. Sometime today, or perhaps tomorrow, after all the test results had been studied and analyzed, she and Marsh were going to have to make the most difficult decision of their lives, and she wasn’t at all sure either of them would be up to it.
If Alex’s brain was, indeed, dead, they were going to have to accept that keeping Alex alive the way he was was cruel.
Cruel to Alex.
She stared again at all the machinery, and momentarily wondered why it had ever been invented.
Why couldn’t they just let people die?
And yet, she realized with sudden clarity, even though she understood the reality of Alex’s situation, she would never simply let him die.
If she were going to, she would have done it already. During the last two hours there had been plenty of opportunities. All she would have had to do was turn off the respirator. Alarms would have gone off, but she could have dealt with that. And it wouldn’t have taken long—only a minute or two.
But she hadn’t done it. Instead, she’d simply sat there battling her feelings of despair, strengthening her resolve not to let him die, and whispering encouraging words to Alex as she held his hand.
And even though part of her still insisted that Alex was already dead, the other part of her, the part that was determined that he should live, was growing stronger by the hour.
Suddenly the door opened, and Barbara Fannon stepped into the room, closing the door behind her.
“Ellen? It’s eight o’clock—you’ve been here all night.”
Ellen turned her head. “I know.”
“Marsh is in Frank’s office. They have the test results. They’re waiting for you.”
Ellen thought about it for a moment, then slowly shook her head. “No,” she said at last. “I’ll stay here with Alex. Marsh will tell me what I need to know.”
Barbara hesitated, then nodded. “I’ll tell them,” she said, then let herself out of the room, leaving Ellen alone with her son.
* * *

“It’s bad,” Frank Mallory said. “About as bad as it can get, I’m afraid.”
“Let’s see.” Marsh’s whole body felt drained from the shock and exhaustion of the last hours, but for some reason his mind was perfectly clear. Slowly and deliberately he began going over the results of all the tests and examinations that had been administered to Alex during the long night.
Mallory was right—it was very bad.
The damage to Alex’s brain was extensive. Bone fragments seemed to be everywhere, driven deep into the cortex. The cerebrum showed the heaviest damage, much of it apparently centered in the temporal lobe. But nothing seemed to have escaped injury—the parietal and frontal lobes showed extensive injury as well.
“I’m not an expert at this,” Marsh said, though both he and Mallory were well aware that many of the ramifications of Alex’s injuries were obvious.
Mallory decided to take the direct approach. “If he lives at all, he won’t be able to walk or talk, and it’s doubtful that he’ll be able to hear. He may be able to see—the occipital lobe seems to have suffered the least amount of damage. But all that’s almost beside the point. It’s highly doubtful if he’ll be aware of anything going on around him, or even be aware of himself. And that’s if he wakes up.”
“I don’t believe that,” Marsh replied, fixing Mallory with cold eyes.
“Don’t, or won’t?” Mallory countered gently.
“It doesn’t make any difference,” Marsh replied. “Everything’s going to be done for Alex that is humanly possible.”
“That goes without saying, Marsh,” Frank Mallory said, his voice, reflecting the pain Marsh’s words had caused. “You know there isn’t anyone here who wouldn’t do his best for Alex.”
If Marshall heard him, he ignored him. “I want you to start by getting hold of Torres, down in Palo Alto.”
“Torres?” Mallory repeated. “Raymond Torres?”
“Is there anyone else who can help Alex?”
Mallory fell silent as he thought about the man to whom Marsh was considering turning over his son.
Raymond Torres had grown up in La Paloma, and though there was little question in anyone’s mind of the man’s brilliance, there were, and always had been, many questions about the man himself. He had left La Paloma long ago, remaining in Palo Alto after medical school, returning to La Paloma only to see his mother—old María Torres. And even his visits to her were rare. There was a feeling in La Paloma that Torres resented his mother, that she was little more to him than a constant reminder of his past, and that, if there was one thing Torres would like to ignore, it was his past. In La Paloma he was primarily regarded as a curiosity: the boy from behind the mission who had somehow made good.
Beyond La Paloma, he had become, over the years, something of an enigma within the medical community. To his supporters, his aloofness was a result only of the fact that he devoted nearly every waking hour to his research into the functioning of the human brain, while his detractors attributed that same aloofness to intellectual arrogance.
But for all the questions about him, Raymond Torres had succeeded in becoming one of the country’s foremost authorities on the structure and functioning of the human brain. In recent years, the thrust of his research had changed slightly, and his primary interest had become reconstuctive brain surgery.
“But isn’t most of his work experimental?” Mallory asked now. “I don’t think a lot of it has even been tried on human beings yet.”
Marshall Lonsdale’s desperation was reflected in his eyes. “Raymond Torres knows more about the human brain than anybody else alive. And some of the reconstruction work he’s done is just this side of incredible. I’d say it was incredible if I hadn’t seen the results myself. I want him to work on Alex.”
“Marsh—”
But Marsh was on his feet, his eyes fixed on the pile of X rays, CAT scans, lab results, graphs, and other documentation pertaining to the damage his son’s brain had sustained. “He’s still alive, Frank,” he said. “And as long as he’s alive, I have to try to help him. I can’t just leave him alone—you can see what he’ll be like as well as I can. He’ll be a vegetable, Frank. My God, you told me so yourself just now. Nothing can hurt him anymore, Frank. All Torres can do is help. Call him for me. Tell him what’s happened, and that I want to talk to him. Just talk to him, that’s all. Just get me in to see him.”
When Frank Mallory still hesitated, Marshall Lonsdale spoke once more. “Alex is all I have, Frank. I can’t just let him die.”
When he was alone, Frank Mallory picked up the phone and dialed the number of Raymond Torres’s office in Palo Alto, twenty miles away. After talking to him for thirty minutes, he finally convinced Torres to see Marsh Lonsdale and look at Alex’s case.
The doctor made no promises, but he agreed to talk, and to look.
Privately, Frank half-hoped Torres would turn Marsh down.