Life Support (13 page)

“I like Alexia,” Rena blurted out. “She's already helped me a lot.”

“Really?” Ezra asked with raised eyebrows. “Am I coming in late to this discussion? I'd like to know what's already been covered.”

“Please, Mr. Richardson,” Alexia interjected. “We haven't discussed anything about the documents your son signed. I waited for you.”

“Alright, let's have it,” the older man said. “Explain the durable power of attorney to Rena. Ralph told me it took priority over everything else Baxter signed.”

“What are you talking about?” Rena asked.

Alexia was determined to be systematic. “There are several relevant documents. I'll start with the most recent ones.”

Alexia pulled out the declaration of desire for a natural death. In her haste to leave Santee, she'd forgotten to make extra copies. It was awkward reading the words upside down and positioning it so both Rena and her father-in-law could see it.

“This form has the highest priority because it indicates Baxter's own wishes. If he's in a persistent vegetative state or permanently unconscious, he does not want to be kept alive and requests that all feeding tubes and IVs be withdrawn. To trigger this document two doctors must certify that Baxter's condition is irreversible and death will occur within a short time once life-sustaining procedures are disconnected.”

“Why is my name on it?” Rena asked.

Alexia pointed to a line at the end of the document. “Baxter had the right to designate someone to revoke the declaration. He chose you.”

“How do you revoke it?” Ezra asked.

“Anything that shows intent to do so. It can be torn up or crossed out with a pen.”

Ezra pushed the papers toward Rena.

“We'll start there. It's time to cancel this absurd thing. Tear it up, Rena.”

Rena picked up the declaration. The young woman's hand trembled, and the papers shook slightly.

“No,” Alexia began. “That won't—”

“Keep out of this!” Ezra barked at her. “This is none of your business. Rena, do it now!”

Alexia persevered. “It won't do any good to tear it up. The original is at our office in Santee. This is only a copy.”

“What incompetence!” Ezra sputtered. “How did you expect to get anything accomplished without the right documents?”

Alexia remained calm. “I'm here to explain everything to both of you. Tearing up the copy is ineffective, but Rena could sign a statement revoking the declaration if that's what she wants to do.”

“Alright,” Ezra responded. “Write something legal on a sheet of paper and let's do it. This meeting will not go forward until Rena cancels this insane death wish. I don't believe Baxter knew what he was doing when he signed this ridiculous piece of paper.”

Rena looked at Alexia. “Should I do what he says?”

Alexia kept her voice soft. “You can, but you don't have to.”

Ezra's face grew red. “Don't let this lawyer convince you to ruin your future! If you want to be a part of this family, you'll do as I say.”

“I'm not sure,” Rena said. “Baxter and I talked about this and decided what we wanted to do. My paper says the same thing.”

“It was a mistake. Don't make another one,” Ezra said grimly. “Be careful how you choose, Rena. It will have consequences for the rest of your life.”

Rena dropped her gaze and stared at the table. Alexia wanted to reenter the conversation but couldn't come up with a way to do it. They sat in silence. Finally, Rena spoke in a steady voice.

“I'd like to hear everything before I make up my mind. Please give me a few minutes to understand the whole picture. I'll listen to everything you want to say. I only want us to do the right thing.”

The angry expression on Ezra Richardson's face lost its edge. Rena might be from a backwoods bend in the road, but she demonstrated an amazing knack for split-second diplomacy with her high-powered father-in-law. Alexia wanted to cheer.

“Alright,” Ezra grunted. “Get on with it.”

Alexia didn't hesitate. “As I mentioned, two treating physicians must concur that life support is futile. Until that happens the provisions of the declaration don't apply. Rena mentioned that one of the neurosurgeons doesn't hold out much hope that Baxter will wake up. At least one more doctor would have to concur. I suggest that all the physicians involved in Baxter's care be consulted so we can get a consensus opinion.”

Rena frowned, but Alexia continued. She took out another bundle of papers.

“Baxter also signed a health care power of attorney selecting Rena to make medical decisions if he was unable to do so. There are several options to choose. The one he initialed states:
GRANT OF DISCRETION TO AGENT. I do not want my life to be prolonged nor do I want life-sustaining treatment to be provided or continued if my agent believes the burdens of the treatment outweigh the expected benefits. I want my agent to consider the relief of suffering, my personal beliefs, the expense involved and the quality as well as the possible extension of my life in making decisions concerning life-sustaining treatment.”

“Expense is not an issue,” Ezra said. “He has great health insurance, and we can pay for the best care in the world.”

Alexia waited for Rena to respond, but she didn't say anything, so she continued. “There is also a statement regarding tube feeding.
With respect to Nutrition and Hydration provided by means of a nasogastric tube or tube into the stomach, intestines, or veins, I wish to make clear that I do not want to receive these forms of artificial nutrition and hydration, and they may be withheld or withdrawn under the conditions given above.”

Alexia looked up from the paper.

“Before the health care power of attorney becomes effective, two physicians have to certify that a patient can't act on his own. Baxter is in a coma so there's no question that his condition satisfies the requirements for Rena to step in and direct Baxter's medical care.”

“What are the conditions?” Rena asked.

“The first part I read about the burdens of treatment outweighing the expected benefits. The agent named in the power of attorney has the authority to terminate food and fluids.”

“That's what I want—,” Rena began.

Alexia shook her head. “Except there is another power of attorney signed by Baxter before you were married. It is a durable power of attorney, which grants your father-in-law extensive powers that were not terminated by your marriage or Baxter's current incapacity. The law in South Carolina gives a person named in a durable power of attorney a higher priority than the holder of a health care power of attorney unless the health care power of attorney contains a clause revoking any previous grant of authority.”

“Huh?” Rena asked.

“The health care power of attorney doesn't specifically cancel the control over medical treatment Baxter gave to his father in the power of attorney signed before your marriage.”

Rena's face was ashen. “You mean, I can't do what Baxter wanted? But he's my husband.”

“Baxter's wishes in the declaration of desire for a natural death must be considered, but Ezra's power of attorney overrides the one you obtained.”

Ezra picked up the declaration and held it out toward Rena.

“Does that answer your questions? I refuse to let a group of doctors decide whether Baxter will live or die. I listened to them when my wife was dying and regretted it ever since. As long as there is a heartbeat, I want to fight for my son's life. I'm asking you to revoke this piece of paper that is hanging over Baxter's head.”

Rena closed her eyes for several seconds. Alexia wondered if she was praying. She opened her eyes, picked up the durable power of attorney, and looked directly at her father-in-law.

“Before I answer, I have a question for you. Are you willing to tear up the power of attorney that gives you so much control over my husband's life? If Baxter could speak, that's what he'd ask you to do.”

Ezra sputtered for a moment before saying, “No, of course not.”

“Then that's my answer, too.”

It was a stalemate. Alexia glanced from Ezra to Rena. The young woman broke off eye contact with her father-in-law and faced the lawyer.

“What now?” she asked.

“I suggest we meet with the doctors,” Alexia said. “I understand there was to be a meeting this morning anyway.”

Ezra abruptly pushed his chair from the table. “We can talk to them, but I will not consent to any efforts to end life support.”

Alexia didn't argue. There was no benefit in expressing a lay opinion about Baxter's medical status. His condition sounded critical enough to trigger the declaration, but Alexia didn't want to antagonize Mr. Richardson by making an observation that might prove wrong.

“Let's go back into the waiting room and try to find out when we can have a meeting,” she suggested.

Rena immediately got up and walked to the door. Her father-in-law lagged behind. Alexia didn't know whether to rush after Rena or stay with Ezra. The older man touched her arm.

“What is your plan? How are you going to take care of this situation?”

Alexia glanced toward the door. Rena was not in sight. Alexia spoke in a low voice.

“Mr. Leggitt asked me to come to Greenville because I spend most of my time representing women in divorce cases. He thought I would be able to communicate with Rena and help your family get through this crisis. I think your daughter-in-law trusts me.”

Ezra moved so close to Alexia that she could feel his breath on her cheek when he spoke. “Should I trust you?” he asked.

Alexia tried to step back, but there was no place to go. “Yes. I'm not here trying to take sides. That wouldn't be ethical. My job is to be a mediator.”

Ezra spoke in a low but intense voice. “In the midst of mediating remember that my son's life is at stake, and I don't want to see him die. Your boss told me the durable power of attorney gives me control, and I intend to use it in every way possible. If I think you're trying to help Rena terminate Baxter's life support, you'll regret it. Is that clear?”

“Yes, sir.”

Ezra backed away and Alexia slipped past him into the hallway. Rena was not in sight. When Alexia entered the ICU waiting area, Rena was talking to the attendant at the table.

“Most doctors have already made their rounds this morning,” Rena said. “So it may take a while to get them together, but she's going to work on it and let us know in a few minutes.”

“I'm going to step outside and smoke a cigarette,” Ezra said. “Don't begin any discussion until I return.”

“Yes, sir,” Alexia responded. “I need to go outside myself. I'll be back in a few minutes.”

Alexia wanted to escape the pressure she felt in the presence of Ezra and Rena and analyze several legal questions that had come to mind while the Richardsons were sparring with one another. She needed to get alone and think. She walked out the front door of the hospital and paced up and down the sidewalk. Ezra was nowhere in sight.

Ezra and Rena were her responsibilities, but she also found herself thinking about Baxter. She didn't know Baxter Richardson, but the profound sadness of his condition was inescapable. Alexia wasn't sure what she thought about terminating life support. Ending pointless suffering for someone you love made sense. Wanting to hold on to a son you'd thought would outlive you was hard to condemn.

On the horizon loomed several dark clouds that held the threat of legal thunderstorms. If Rena refused to revoke the declaration of desire for a natural death, Ezra might use the durable power of attorney to transfer all Baxter's property out of his son's name and decimate Rena's inheritance. Only Baxter's death would end his father's control. In response, Rena would have an equitable argument that Ezra's use of the durable power of attorney should be enjoined by a court because Baxter's last will and testament gave all his estate to his wife.

Alexia took out her cell phone. She needed to call Ralph Leggitt for direction. She dialed the number, and the morning receptionist answered.

“This is Alexia. Is Mr. Leggitt in his office?”

“Yes, but he's on the phone.”

Alexia hesitated. “Could you slip him a note that I need to talk to him immediately?”

“You know he hates that sort of thing.”

“This is a real emergency.”

“Okay, but if I get chewed out, you'll have to do something nice for me.”

The receptionist put Alexia on hold for a couple of minutes before she came back on the line.

“He put his hand over the receiver and told me to tell you he was talking to Ezra Richardson. Then he wrote something on a scrap of paper and gave it to me.”

“What does it say?”

“It says, ‘E.R. is the client.'”

Alexia swallowed. “Okay. Thanks.”

12

Deceive not thy physician, confessor, nor lawyer.

GEORGE HERBERT

M
ulling over her new marching orders, Alexia returned to the waiting room and sat next to Rena, who was gingerly touching her left temple.

“My head is killing me,” Rena said. “I hit it on a rock when I was trying to help Baxter. Do you have anything for pain?”

Alexia took a small bottle of pills from her purse and handed it to Rena, who took out two and swallowed them without water.

“I wish I could trust my father-in-law, but I can't,” Rena continued. “He didn't want Baxter to marry me. Before I came into the picture, he had picked out a skinny girl from a rich family in Georgetown as his future daughter-in-law. Do you think I did the right thing in refusing to tear up the paper in the conference room?”

Alexia avoided a direct answer to the question and focused on what lay ahead.

“The only thing that matters now is to meet with the doctors and find out what they recommend about Baxter.”