Noble Vision (21 page)

“Oh, no! That can’t be! This is the end of me! I want to die! Help me to die, Doctor!
I want to die
!
”

Her hands broke away from his and pulled at her hair. She cried furiously, convulsively, interminably. Her immense capacity for joy was matched by the violence of her anguish. Each cry was like a knife slashing his skin. He waited, as if caught in a storm that had to run its course. Her tears soaked the lustrous hair around her face until the strands became dark, straight, and coarse. Then she seemed to remember something that stopped her cries abruptly. “What did you mean when you said ‘in the past’?”

“There’s a new procedure that might help you.”

A hint of hope colored her face.

“I hasten to add that it’s experimental. It’s never been tested on a human before and the animal research is incomplete, so I can make no claims about its outcome. But this procedure has been tried on some laboratory animals, and it has regenerated severed tissue like that of your optic nerves and restored lost function.”

Her eyes retained a haunting intelligence.

“It would require two brain surgeries, Nicole, and since it’s unproven in humans, it’s hard to say what the chances are that it will help you. I’d say they’re slim.”

“What are my chances without it?”

His voice softened. “Your brain scans clearly show that the nerves are completely severed. Unfortunately, they just don’t repair themselves.”

“And there is no other treatment?”

“I’m afraid not.”

“Then the procedure you mention is my only chance?”

“Which is why I offered it.”

“Doctor, I would try this new treatment even if my chances of
dying
from it were ninety-five percent.”

“I wouldn’t. If I thought there was a serious risk to your life, I wouldn’t operate. I have no evidence that the new procedure is any more dangerous than many other brain surgeries. That’s why, while you were unconscious, I thought this thing over and decided to offer the treatment, even though it’s experimental. However, I must stress that there are risks inherent in brain surgery, which I’ll explain and which you should consider seriously.”

Her voice broke as she tried to speak. “The risk to my life is this . . . horrible injury. I feel helpless. I’m scared . . . very scared.”

He thought it useless to try to convince her that she could live with total, permanent blindness. He shared her desperate desire for a cure. Wasn’t that why he had become a doctor—and why he was about to do the unthinkable?

“You see, Doctor, I have something I do—my work—that means . . . so very much to me. I couldn’t do it . . . blind. But it’s more than that. I’ve never been . . . helpless. I’ve always been on my own, able to look after myself. I’d risk everything to save the one thing I . . . I couldn’t live without. Can you understand that, Doctor?”

“Yes.”

The solemnity of his voice encouraged her to say more.

“Life would mean nothing to me if I couldn’t be . . .
free
. Do you know what I mean?”

“Oh, yes.”

“I’d take a terrible chance, gladly, for the one thing I . . . mustn’t give up. Can you see what I’m up against?”

“Clearly.”

“So you know why I’m most desperately interested in this procedure . . . why I’m . . . most . . . desperate.”

“I do.”

“Who’s the world expert on this treatment? I want only the best person to help me.”

“I am.”

“I believe you.”

Nicole liked confidence. For the first time since her injury, she smiled.

He asked her questions and checked her neurological condition, satisfying himself that she displayed no other impairments. Then he described her injury, indicating the function of the optic nerves and tracing with her fingers on her head their path through the brain. He also explained the risks of brain surgery.

She was alert, listening, asking questions, digesting every word. The knowledge that he gave her was strong medicine for allaying her fears and for restoring a sense of control, even in her desperate situation. This strange new voice with no face, this frame in her mind with no picture, had the power to calm her.

He spoke of the problems of nerve repair and of the treatment that he had devised to overcome them.

“The reason that severed nerves don’t repair themselves,” he explained, “is that they have no capacity to regenerate as broken bones do, coupled with the fact that unwanted scar tissue grows at the sight of the lesion and further impedes the nerves’ function.”

He explained how his procedure stimulated the nerves to grow with his newly discovered embryonic growth protein, and how he could stop the scar interference with another new compound, the scar inhibitor. He told her that the two jobs had to be done in separate surgeries, spaced three months apart, because the two drugs did not work together. She asked questions and he clarified points, until he felt certain that she understood.

“During the time between the surgeries, you should regain some primitive vision, Nicole, but only up to a point. You’ll perceive light, then motion, maybe even color. Because the scar tissue is also growing, it’s unlikely that your vision will advance to the stage of distinguishing objects. Then you’ll reach a point at which the rudimentary vision you’ve regained will begin to diminish, as the growing scar interferes with the growing nerves. I must stress that the timing of the second surgery is
critical
, Nicole.”

She nodded her head, listening intently.

“We must wait until the nerves regenerate; however, we must not wait until all remnants of your new vision are lost. If that happens, based on my animal experiments, you’ll never regain your sight. So, you’ll need to be available for the second surgery at exactly the right time.”

“Of course, Doctor.”

“And I don’t want to raise false hopes because I can make no promises of success.”

“I understand.”

“If we proceed with the treatment, I don’t want to delay. We have our best chance if I operate immediately; otherwise the nerve ends will start to recede and scar will form quickly, causing complications for me. I don’t even want to wait until tomorrow. But I must be sure I’ve given you enough time to make your decision.”

“I’ve already made it. I want you to go ahead.”

“Don’t you want to discuss the matter with someone?”

“Who?”

“Someone close to you.”

“No one’s close to me,” she said without self-pity.

“Don’t you want to talk to your family?”

“I have no family,” she said simply, as someone else might say, “I have no red dresses.”

“How about the people you love?”

“I don’t love anyone.”

“Don’t you want to consult with someone?”

“Why?”

“To help you in thinking about the matter.”

“Why would I need help?”

“Nicole, I’m trying to assure myself that I have your consent, given to me with full knowledge and careful deliberation.”

“You have.”

Her confident tone convinced him. “All right, but there’s one more thing.”

“Yes?”

“The surgery is illegal.”

“What?”

“It’s illegal. The state prohibits me from doing it and you from having it.”

“How could that be?”

“It is.”

“But then how could you operate?”

“I’m not worried about how I can operate. That’s not why I raised the issue.”

“But won’t you get in trouble?”

“I’m not worried about getting in trouble. That’s not why I raised the issue.”

“Doctor, I’ll sign any papers you wish. I’ll free you from liability. We’ll get witnesses. I’ll swear I begged you to do it—”

 
“I’m not worried about my liability.”

“I’ll pay you any amount you ask. I’ll pay you triple your fee—”

“I’m not worried about the money. I just want you to know that the government prohibits what I’m about to do in the name of protecting you from me. I mention it in case the state’s edict matters to you.”

“It doesn’t.”

“Then I’ll see you in surgery.” He squeezed her hands, and then headed toward the door.

“Doctor, wait!”

He walked back to her side.

“I’m . . . afraid.”

“Of what?”

She began to cry.

“What’s the matter, Nicole? Are you having second thoughts?”

“Oh, no! But I’m afraid you will. If the surgery’s against the law, why . . . why should you . . .”

Weak and short of breath, she tried to raise herself. Her arm swept the space around her to find him, to reach out to him. He gently pushed her down.

“You’ll change your mind, Doctor!” she cried, her eyes filled with terror. “You’ll back down!”

He buried two trembling hands in his own larger, steadier ones. “Don’t be afraid, Nicole. I give you my word that I’ll operate. You have my solemn promise.”

He shuddered in the knowledge that this was the
second
sacred oath he was swearing that day. He reprimanded himself for having made the first one. He detested people who broke their promises. He accused himself of being a liar, but somehow he did not feel ashamed.
Lack of remorse is further proof of depravity
, he thought, but somehow he did not care. He told himself that he had no right to perform a procedure disapproved of by the governing body of the hospital. Wasn’t he about to violate someone’s property just as surely as hurling a rock through a shopkeeper’s window? But was it the board of directors that was against his procedure? He remembered the tired flesh and weary faces around the conference table that afternoon. He thought of wooden figures pulled by a presence offstage, invisible to the casual viewer. The notion of choice seemed as preposterous to the board as it was to a herd of penned sheep. Was he to sacrifice the irreplaceable treasure that was Nicole’s life and spirit for the sake of honor owed to . . . puppets? Was that integrity? If it was, he would have none of it!

But what of the honor owed to someone else, he wondered, someone whose presence had tormented him from the moment that he diagnosed Nicole’s injury? He shut his eyes painfully against the knowledge that he was about to betray the one man whom he had no capacity to hurt. When he opened his eyes, he saw the one woman whom he had no capacity to refuse.

“I won’t back down, Nicole. I won’t let anything or anyone stop me. You have my solemn promise.”

*
  
*
  
*
  
*
  
*

The corridor and nurse’s station outside of Nicole’s room were abandoned that evening. David walked along the lonely halls in the eerie silence, wondering where the staff had gone. He encountered them in a small room, hovering around a copy machine, whispering nervously as they grabbed sheets of a document being printed.

“What’s going on?” he asked.

“Have you seen the new statement of policy?” a nurse replied.

“The what?”

“The new crack-down by CareFree. Copies are being sent to everybody. Here, take this one.”

The document that David read was titled “A Statement of Policy for All Clinical Personnel from the Director of Medicine of Riverview Hospital.”

You are hereby notified that CareFree aims to eliminate all violations of its policies and to achieve full compliance. As you know, Riverview Hospital is committed to following the regulations to the letter of the law. If circumstances have allowed exceptions in the past, you are hereby forewarned that there must be strict adherence starting immediately. This statement of policy summarizes the steps that you need to take in order to ensure your total compliance with the CareFree program. We expect your utmost cooperation.

David skipped past other information to a paragraph titled “Surgeons.”

Surgeons must obtain prior written authorization from CareFree before performing any operation. The doctor must submit diagnostic test results and patient records to the hospital’s Surgical Authorization Committee (SAC), which will relay the case to CareFree’s Surgical Advisory Department (SAD) to determine if the procedure is necessary. Then SAD will advise SAC of its decision. If SAD is closed, then SAC, staffed twenty-four hours a day, will determine for the physician whether the surgery should be performed.

The last sentence of the order was capitalized:

Under no circumstances will an operating room be assigned to a surgeon who has not obtained prior written permission to perform the procedure from SAD or SAC.

No one noticed that the serene look of radiant purpose, an afterglow from his moments with Nicole, had vanished from David Lang’s face.

Chapter 12

The Treatment

A pair of white swinging doors sliced the third floor of Riverview Hospital.
No Admittance
was stenciled across them in bold black letters. Beyond the doors was the Department of Surgery. Before them stood a small, circular stand resembling a guard’s post. David approached the high-countered station, which was manned by a petite nurse in blue scrubs, her hair tucked in a surgical cap, her eyes large in her hairless face. Among the duties of those staffing “the desk,” as the post was known, was assigning operating rooms to surgeons.