2030. The Moralist party is in power, buoyed by the promise to end death. Chronic care specialist Patricia Jewett deals daily with the result: her ward is packed with technologically dependent patients. When a colleague ends up paralysed and nearly brain-dead, Jewett is forced to keep him alive - while knowing his wishes to terminate life support. Then a murder occurs, and Jewett, the only witness, is also the prime suspect.
Release date: May 14, 2019
Print pages: 288
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A Time to Die
Mickey Zucker Reichert
Perched on Dean Stanley Schober’s patterned couch, Patricia Jewett hugged her skinny knees, her gaze fixed on the television. On the screen, presidential candidate Benjamin Nash harangued a cheering crowd, inspiring an awe Jewett could not wholly understand. The televangelist-turned-politician sported shoulder-length, white locks that made him look saint-like; and his long-lashed, dark eyes inspired trust. Nash’s figure allowed no sharp edges. Every feature, from his moon-shaped face to his thick hands, was gently smooth. Only his movements remained crisp. His gestures punctuated his speeches at all the right places, and he struck poses appropriate for stained glass windows and Renaissance paintings. His was an act worthy of attention, even from this roomful of graduating doctors, and Jewett focused on Nash’s booming promise: “… an end to death by 2030!”
An end to death? Jewett’s hands slid to her sides in surprise. She cast a surreptitious glance around Doctor Schober’s family room. At the opposite end of the couch sat Jewett’s classmate and boyfriend, Kaign Jones, his handsome jaw slack, revealing a row of straight, white teeth. Stanley Schober occupied a stuffed recliner catty-corner to Jones, his mouth set in the same grim line he assumed whenever his magnetic imaging machines detected abnormalities in a patient’s fetus. Cross-legged on the floor in front of the television, frizzle-haired Zachary Janecek said nothing. Schober’s wife, Elaine, stood frozen in the doorway between the kitchen and family room.
Moralist party candidate Benjamin Nash posed, his hands spread and his feet together, until the plaudits of the crowd beneath his podium faded low enough for him to continue his speech. “The Republican candidate claims to be pro-life, but I maintain he is only pro-fetus!” A smattering of television applause followed. “He opposes the very social programs that will allow the babies he saves to reach adulthood. He supports capital punishment and turning off ventilators. I ask those of you with moral fiber, is that pro-life?”
Jewett pursed her lips as Nash’s supporters shouted, “No!” The Moralist Party had grown out of the inconsistencies in the standard bipartisan system. Its devotion to Christian principles and the ultimate sanctity of human life had swept it to victory in the last two presidential elections.
Nash’s features twisted into a perfect mask of revulsion. “The Democratic candidate would have us reinstitute abortion, yet he opposes the death penalty. He would put the life of criminals over that of our future generations. Gentle followers, we have to stop playing God with our children!”
Stanley Schober’s fist crashed to the arm of his chair. The fabric muffled the blow, but his shout of outrage broke the students’ Nash-inspired trances. “Playing God! Playing God, he says.”
Every eye in the room turned from the screen to their dean and host. For the moment, Nash was forgotten. Jewett craned her neck to gaze around Jones. Unnerved, as always, by shouting, she twined a strand of long, mouse-brown hair around her finger.
Schober’s friendly, aging features assumed a reddish hue that contrasted sharply with his salt-and-pepper hair. “Playing God,” he repeated for emphasis. “The expression was stupid when I first heard it as a medical student, and it’s even dumber now. For Christ’s sake, we’re doctors. Everything we do is playing God.”
Janecek grunted noncommittally, trained, as all medical students and residents are, never to argue with the attending physicians. Since their names were alphabetically consecutive, Janecek, Jewett, and Jones had been teamed on every cadaver, microscope, and project since their first day of medical school. Knowing Kaign Jones, Jewett realized the same aggressive audacity that attracted her to him and made him the ideal candidate for a surgical residency would drive him to challenge Schober’s assertion, despite the fact that some attendings would find such impudence grounds for dismissal. Jewett wished she had a tenth of his nerve and sometimes wondered how he had made it through four years of medical school without enraging some self-important professor into throwing him out of the program.
True to his calling, Jones straightened in his seat, drawing up his imposing, six-foot three-inch frame. He shook back his dark hair, though no strand ever fell out of position, and spoke through his square-cut, classic American features. “I happen to agree with Nash. True, our job is to thwart death, including the God-given afflictions like cancer and infectious diseases. But killing a microbe is not the same as killing a baby.”
Janecek sucked in a sharp breath. Jewett turned her hazel eyes to her lap, clasped her hands, and feigned an inordinate interest in her fingers. Match Day had concluded yesterday, and the national computers had already determined the type and location of each graduating senior’s residency. Jones, like Jewett, would be staying at the C. Everett Koop Memorial Hospital and Medical School, Jewett specializing in chronic care, Jones in surgery. They would both have to interact with Schober for several more years, at least; and Jewett looked forward to his keen obstetrical advice and experience. It seemed rude and foolish to alienate their host.
Schober’s features darkened. “But we’re not talking about babies, Kaign.” He emphasized the last two words, drawing out the double syllable word into three, “bay-bee-eez,” and the young doctor’s single-syllable name into two: “Kay-ayn.” “We’re talking about a fetus, a blob of pluripotential cells, and an abnormal blob at that.” He leaned toward Jones. “If you don’t know it yet, standard abortion’s been illegal for years. What grates on me is the woman who walks in, discovers she’s carrying a fetus with the body of a pulverized Buick and half the I.Q. I present the option of abortion, and she squeals …” Schober’s voice jumped to falsetto. “… ‘Oh, no, Doctor. I wouldn’t want to play God.’ “ Schober’s octave returned to normal. “Kaign, if not for the ‘miracles’ of modern hormonal manipulation, God would have seen to it that that blob of pluri-un-potential cells was miscarried. At the least, it would have died at birth. But we have the revised Baby Doe laws to thank for the fact that every baby born, no matter how unnatural, has the ‘right to life,’ too. Which is playing God? Letting this creature die or forcing it to live?”
Jones’ strong hands tensed and loosened spasmodically at his sides. “You’re using an extreme example. What about babies with cleft palate? Should we abort them? Where do we draw the line?”
Jewett exchanged wary glances with Janecek. Able to see the relative merits in both sides of the argument, she was embarrassed by her boyfriend’s display.
Schober leaped to his feet. “Where do we draw the line? Somewhere! Anywhere! Damn it, Kaign, don’t you see that’s precisely the problem? Every day of our lives we have to make decisions and draw lines. That’s how this Moralist party took hold in the first place. Human life is sacred. Period. It doesn’t draw any lines, so it’s easy for simple minds and politicians, if I’m not being too redundant, to grasp.” Schober lowered himself into the cushions of his chair. “Now this idiot, Nash, wants to make it illegal to take anyone off life support equipment. Madness! He’s not ending death; he’s just creating a sort of living death. Brainless children surviving for eternity in the hospital because it’s possible we may find a cure for their conditions before they die of old age? If Nash has his way, it won’t even be possible to die of old age anymore. I, for one, would rather go to hell than live forever.”
Jones shrugged, his calm exterior making Schober’s screaming look foolish. “Most people don’t agree. Why do you think the cryogenics labs have flourished? Why do you think the Moralists keep getting elected? The new generations do believe human life is sacred. Our ancestors promised us eternal life, or at least greatly prolonged lifespans. We grew up with that promise, and we’re going to get it. This is the first step.”
A brief silence ensued. Jewett peeked up from her hands in time to see Schober’s lips moving, his words too soft to hear. He mumbled a bit louder. “Yeah, well, it’s an unnatural attitude, in my opinion. I still remember when the military budget made the hospital monies look like peanuts instead of the other way.” Schober’s voice regained its resonance. “A lot of things have changed for the better, but this isn’t one of them. Hell, everyone thought gene-washed organ transplants and stem cells would be the wave of the future. Now they’re impossible. If choosing to sustain the brain dead takes precedence over using their cells or organs to save quality lives in order not to play God, I’d rather play God.”
As Jones gathered breath for a rebuttal, Jewett sank back into the couch. Schober was nicer and more understanding than most attendings, but even he must have limits to the amount of guff he would accept from an underling.
Elaine Schober’s husky voice interrupted the discussion. “Time to eat! Over dinner, I’d like to hear what you new doctors will be doing next year. After all, this is supposed to be a Match Day party.” Her tone was cheerful, the warning glare she turned her husband less so.
Grateful for Mrs. Schober’s intervention, Jewett rose and took Jones’ arm. From the television, Benjamin Nash’s voice rose above the silence. “Conquer death by 2030!” Beneath his podium, his followers chanted in a steady, fanatical rhythm: “End Death! End Death! End Death!”
Stanley Schober groaned.
April 20, 2030
By the eighth year of Benjamin Nash’s presidency, the argument in the Schobers’ living room had faded into dim memory. Dr. Patricia Jewett wandered between the aisles of the open life support bay, glancing across horizontal faces that seemed as gray and glazed as waxed fruit. One of four chronic care specialists at the C. Everett Koop Memorial Hospital, Jewett covered the ward duties for one-month periods only three times a year. But the patients rarely changed. The infants and children grew in length and breadth, nourished by calorie-laden liquids dripped through nasal tubes or infection-prone catheters in their great vessels. Occasionally, an aged heart crumpled beyond the redemption of even the most modern electrostimulation machines, and a body disappeared from its bed, finally truly dead.
Jewett stopped in front of Judson Payne, a six-year-old near-drowning victim who had required antibiotics the previous day. Glassy blue eyes seemed to stare back at her, unseeing. Despite daily physical therapy, the boy’s legs had rotated from disuse, making his knees appear to bend backward, like a bird’s. The feeding tube ran from his nose to a bag above his bed, its individualized formula, Nutristat, colored a tasteful tan. The standard, flexible ventilator tube jutted from his neck, running unobtrusively beneath the blankets to the briefcase-sized ventilator at the bedside to which the boy’s family taped flowers and pictures of animals.
Now, a photograph of a panting, stub-tailed mongrel sat inside a wreath of wilting daisies. The blankets hid the portal of his great vein catheter, closed between antibiotic dosages, and the wires of the electrostimulation machine; but Jewett watched the ceaseless blips on the fist-sized monitor screen at the bedside. Scattered telemeters transmitted information about the gaseous, nutritional, drug, and electrolyte content of the boy’s blood to the nurses’ station.
Jewett sighed, feeling helpless and futile, wondering when medical science would catch up to the living death it had created. True, antibody manipulation had led to cures for most viruses and cancers, but the technology had only benefited the newly diagnosed. While the application had cleared up the underlying maladies of some chronic care patients, there was still no way to restore the neurological and organ damage which had occurred in the intervening years. Despite volumes of knowledge gleaned on the function of the brain and its related systems, science had barely uncovered the tip of that iceberg.
Jewett placed a hand on the boy’s foot, feeling the warm life of his flesh beneath her fingers. The child did not seem to be suffering, and he brought joy to the parents who loved him. Every movement of his eyes, each attempt at facial expression was a sweet triumph to them, every bit as important as a normal infant’s first word. Still, sometimes to Jewett it felt easier to justify her job in the name of experimentation. Because of these patients, the form of life support equipment had advanced in great leaps. The huge, clanking monsters that had served as ventilators a decade ago had become museum curiosities, and the patients temporarily dependent on life support devices benefited from the knowledge as well. Jewett recalled intensive care units filled with the ceaseless pound, whoosh, and electric snap of machines which now hummed almost imperceptibly. Now, Jewett had become so accustomed to the steady buzz, she no longer even heard that.
The sound of footsteps at the opposite entrance drew Jewett’s attention. She glanced over the rows of patients to where the open bay resident physician, Curtis Maltorf, led five new, white-coated medical students into the room. Three women and two men in their early twenties edged into the bay, eyes darting nervously between the beds, noses twitching to catch the flowery, pleasant odor of the antimicrobial cleansers and air fresheners that had replaced the old, alcohol-based scrubs Jewett had known as a student. Like a mother hen, Maltorf herded his charges toward the first bed, his red-haired head bobbing between the patients.
The scene reminded Jewett of Ronald McDonald prancing through one of his fast food restaurants, surrounded by admiring kids. Smiling, she trotted around the rows of beds and met the group by the door. “Morning, Curt.”
“Good morning, Dr. Jewett.” Maltorf gestured at the students. “Since we’ve got a new group of studs, I thought we’d start—”
The beeper at Maltorf’s hip shrilled, interrupting him and visibly startling the students. Maltorf thumbed the button silent, pulled the device from his belt loop, and freed the catch. It fell open to reveal the speaker. “Excuse me.” He touched the inner button, and the cordless receiver automatically pulsed out the number the caller had programmed into it.
The students shifted uneasily, pocketed ophthalmootoscopes rattling against reflex hammers, tuning forks, and tape, a standard mixture of archaic and modern equipment. It was the students’ job to see to it they carried anything a resident or staff physician might need.
Jewett grinned at the students, trying to put them at ease.
Apparently in response to an answer from the beeper-phone, Maltorf nodded. “Yes. Curt Maltorf, chronic care resident. What can I do for you?” Maltorf balanced the device between his shoulder and ear. Hands freed, he rooted through his pants pocket, emerging with a pad and pen. He scribbled. “Uh huh … no, that doesn’t sound familiar to me … uh huh … uh huh.” He wrote some more. “O.K. Send him to private room 163. We’ll be expecting him.” Maltorf snapped the beeper-phone closed and clipped it to his hip pocket.
“New admission?” Jewett asked.
“Yep.” Maltorf studied his scrawled notes. “Seventy-eight-year-old white male MVA.”
Jewett clarified for the students. “Motor vehicle accident.” She frowned. Those had become rare since the electronic mapping and alerting road systems, especially in broad daylight on a weekday. Usually such mishaps occurred only as a suicide or after the driver had taken an unauthorized excess of drugs or alcohol.
Maltorf continued. “A bystander found him first and moved him from the car, resulting in a C-spine injury.”
Jewett cringed. Despite television campaigns, untrained do-gooders still moved accident victims before calling the paramedics. A cervical spine injury could turn the patient into an instant quadriplegic, and the odds were even this patient would lose his ability to breathe without machinery as well.
“Luckily, the bystander knew CPR. He kept the patient alive until help arrived, but the E.R. says he’s a definite quad.”
Jewett pulled at her lower lip. With advanced life support systems, it would have been possible to revitalize the heart even after an hour or more without beating, but the brain would die of oxygen deprivation within minutes. If the cardiopulmonary resuscitation was performed correctly, it was possible the bystander had averted brain death in the man he had paralyzed.
Maltorf closed his pad and shoved it back into his pants pocket. “The E.R. staff said the patient was a doctor here at Koop. An obstetrician.”
Jewett’s blood ran cold. Her vocal cords seemed to snap shut, and it was all she could do to ask the question in a high-pitched whisper. “Who?”
Maltorf studied Jewett, concern in his dark eyes. “A Stanley Schober.”
Jewett loosed a sharp sound of pain and closed her eyes. Suddenly dizzy, she grabbed for the nearest cot. Her fingers closed over cold metal, her nails gouging into the padding.
Maltorf seized Jewett’s skinny arm, inadvertently jerking a few strands of her straight, dark hair in the process. “Are you all right?”
Gathering her scattered wits, Jewett opened her lids. The dim lighting of the ward seemed to burn her eyes. “I’m … fine,” she managed. “You … didn’t go to med school here, did you?”
Maltorf shook his head. “No, Doctor. Harvard. Why?” He released his grip on Jewett’s arm.
Now, Jewett shook her head. There was no way to explain to an outsider the improvements Stanley Schober had implemented since he took over the dean position at Koop. The former head had been a stuffy codger; a call from an attending to his office meant the complainee repeated a year, at best, or got expelled. Schober had brought an air of friendship to the position, mediating problems and smoothing the ruffled feathers that invariably resulted when powerful men and women accustomed to success and demanding near-perfection and obedience came together. Frequently, he and his wife, Elaine, had entertained medical students on special occasions or following rotations on his obstetrical service. “How? Why?”
Jewett’s questions were rhetorical, but, since she spoke aloud, Maltorf apparently felt obligated to answer. “The E.R. docs think he had a vascular accident while driving, a C.V.A. or an M.I.”
A stroke or heart attack. For reasons Jewett could not understand, it seemed necessary to put the description into layman’s terms. Jargon seemed too distant, too incomprehensible to refer to Stanley Schober. This can’t be happening. I can’t believe this is happening. She forced composure. “Curt, why don’t you introduce the students to their patients and the ward routine? We’ll postpone attending rounds.” She glanced at her watch. Discovering it was already 15:20, she added, “Until tomorrow.”
Accustomed to talking to patients’ families, Maltorf put just the right amount of comfort in his voice to soothe without patronizing. “Sounds good. The studs and I will see to it everything’s taken care of.” He made a vague gesture, turned on his heel, and the students followed him deeper into the room.
Patricia Jewett watched them leave through a blur of rising tears. She tried not to think about Stanley Schober, but the memories came in defiance. Her mind conjured images of a day thirteen years ago. Then, Schober’s curly hair had been more brown than gray, splashed with silver mostly at the temples. Except for fewer creases, his face was the same: pudgy cheeks with permanent smile lines, a straight nose, and blue eyes that sparkled even in faint light.
Jewett had received a letter from Rudy Yates, her boyfriend since grade school, breaking off their relationship of fifteen years. They had grown up together, two scrawny, gawky kids, best friends and neighbors for as long as Jewett could recall. There was never any doubt they would marry; over the years they had planned their intertwined lives to eternity. She would become a doctor, he a medical researcher discovering the therapies she would effect. As older scientists beat them to the cures for the common cold, diabetes, and cystic fibrosis, they merely set their goals one step higher. But, where Jewett had matured from a skinny child to a skinny adult, Yates had blossomed into a sturdy, well-proportioned man. The same women who would snicker at him as a teenager fawned and purred over him at twenty. And Yates dropped the familiar to explore this new part of his life.
Crushed by Yates’ rejection, Jewett had found concentration on medical school work impossible. The professors’ voices droned by her. Computer-generated lecture notes scrawled across the screen, unread; and first-year . . .
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