The Pestilence (25 page)

Dr Biram stared at the image for a long moment. He then placed his phone back on his desk and continued marking up Mariam's paper.

***

12.04 p.m. Jerusalem time. The Scientist took a long sip of his red wine. It had a lovely fruity aroma he found highly agreeable. His lunch of poached venison, however, was only fair to middling, the meat overdone, the jus bland. Alone, he cut a reflective figure. He had escaped the carnage of the stadium by doing what any self-respecting person would have done which was to flee at the first sign of trouble. He believed that his and Samuel's fortunes were closely tied together but he had never finished his pitch and with Samuel close to death in the St Luke's Hospital he probably never would. The Scientist had a prime window table overlooking a medieval square. The tinkling sound of jarred cutlery rose throughout the restaurant and he felt his table move under the force of a small tremor. Outside the light levels fell dramatically; it was as if someone had thrown a sackcloth over the sun.

***

12.04 p.m. Jerusalem time. They had made the journey early that morning in the captain's battered pick-up truck. From the Healed camp across the border and into Jerusalem took them just over three hours. They had to abandon the pick-up two miles from the hospital. The roads were thronged with people. They lined all the routes to the hospital, standing shoulder to shoulder. Waiting for news.

The veterans had come to stand with them, to light a candle and say farewell to the man who helped the captain walk again, removed the shrapnel from the lieutenant's spine and freed the corporal from his coma.

They held each other as the ground moved beneath their feet and when day turned to night, they knew their end had come.

***

12.04 p.m. Jerusalem time. Samuel lay inert, eyes permanently shut. The rise and fall of his chest was artificial, driven by the ventilator and the air being forced through the breathing tube into his lungs. The Srour family were gathered to say goodbye. Khalid sat with his elder brother beside the windows. He had spared his wife and children the heartache, leaving them in Haifa. By Samuel's bed Dalia and Mariam interlocked arms.

The Senior Registrar was holding court. Had Samuel been conscious he would have remembered the doctor who, under orders, refused to allow him into this hospital to heal. The Senior Registrar spoke with an air of confidence and assurance stemming from decades of practical experience. “I know this is a difficult time, but it is important that I make a few things very clear. The patient's body is incapable of supporting respiration by itself. The ventilator is simply an artificial pair of lungs we are using in order to keep the patient's body oxygenated. Disconnecting the patient from the machine at your request constitutes voluntary passive euthanasia. I know it sounds macabre but we need to be very clear on what we are discussing.”

The Senior Registrar spoke slowly, measuring the impact of each word before delivery. “The ventilator itself is classed as extraordinary treatment. You are here to decide whether or not to continue this extraordinary treatment. We never seek to withhold ordinary treatments such as food and water, but discontinuing this extraordinary treatment is legally and in my opinion given the condition of the patient, medically acceptable. The moral judgement on this course of action is yours alone.”

“With all due respect Doctor, I'm also an MD and I have a different perspective.” Khalid stood and addressed the group. Despite the softness of his voice he communicated with an air of quiet authority. “I want to counsel my mother against this action. By attaching Samuel to the ventilator, it has become part of him in the same way that implanting a pacemaker becomes part of a heart patient. If Samuel wore a pacemaker we wouldn't dream of switching that off, would we?” Khalid looked into the silent faces of his family before continuing. “Whether labelled artificial or natural it's our disruption of Samuel's pulmonary system that prevents him from getting air. By removing Samuel from the ventilator, we will kill him. I will play no part in killing my baby brother.”

It was left to Mariam to break the heavy silence that followed Khalid's words. “Khalid, they attached this machine in the hospital. It's not part of him. Without it he would be dead already.”

“Son,” said Dalia, “I don't want to see him like this. From the man he was to this.” Dalia touched the intravenous bag. “This is how they feed him, a tube goes in and other tubes go out.”

“I know, Mama, but let God decide when to call Samuel. Look at the miracles happening all around us. At the centre of these was Samuel. Look at your oldest son, raised from the dead, now standing by your side. Have faith.” Tears welled in Khalid's eyes. “Please, Deedee.”

Dalia and Mariam leaned into each other drawing on the reserves of one another's strength; their hearts riven, grief all consuming.

The Senior Registrar sensed the change in the direction of the thinking in the room and spoke once more. “If I may, let me provide a different perspective. The patient's body is, in a sense, a life support system for his brain. The body is not the same thing as the person, and in this vital sense, Samuel is not his body; he is his mind. So if we all agree today that brain death is the end of a person, we should accept that brain life is the central aspect of personhood and accept that the body is merely another type of life support. By using the machines we are keeping the patient's natural life support system functioning artificially. Samuel's brain activity is virtually non-existent. His mind has gone, which means he, Samuel, has gone.”

Khalid couldn't let go. He had led a life of loss; his father leaving, his brother, countless friends. No more. While there was hope, no more. “Why can't we just wait? Leave it to God. If he calls for Samuel let him then take him. Not before.”

Mariam stood away from Dalia. She loved Dalia as her own mother, but Khalid's words had moved her heart and the sands were shifting beneath her feet.

“If you choose to continue then legally we first must establish and test for formal brain death,” said the Senior Registrar pointedly and directly to Dalia.

Dalia's eyes swept the room, her lips a narrow line. Steeling herself she nodded imperceptibly. “Go ahead,” she whispered, her voice catching in her throat.

The Senior Registrar glanced to the junior doctor on station. The woman shifted forward and began her work. She rolled back Samuel's eyelids and shone a torch directly into his eyes. “I can confirm that the patient's pupils are fixed and do not respond to the changes in the intensity of my light.”

He's not a patient, thought Khalid. He is my brother, Samuel. The baby of our family, the one who stayed and cared for our mother and our land.

The junior doctor picked up a large syringe filled with a clear fluid.

“What are you going to do with that?” asked Mariam.

The Senior Registrar answered smoothly. “It's only cold water. We will inject it into the patient's ear. In comatose patients with cerebral damage, the fast phase of nystagmus will be absent as this is controlled by the cerebrum.”

“I don't understand,” stated Mariam.

“Sorry, the cold water irrigation should result in deviation of the patient's eyes towards the ear being irrigated. If we witness no eye movement this suggests the patient's brainstem reflexes are severely damaged.” He waved on the junior doctor. “Please continue.”

The junior doctor lifted Samuel's head and began squeezing the water into his left and then his right ear. Samuel's glazed eyes remained fixed on nothing.

“The patient has a negative response to the caloric reflex test.”

He's not a patient, thought Dalia. He is my son, Samuel. He is my proudest achievement, the best of my boys. He would think of others before himself and he thought of me above all others.

Next the junior doctor located the ridge along the upper portion of the bony structure on Samuel's eye socket. Placing the tip of her thumb in the midline she pinched hard and straight upward. Samuel's skin flamed an angry red. Dalia had to look away from the woman tugging at her son's face.

“The patient has not responded either facially or through movements in his hands and arms to supraorbital pressure.”

He's not a patient, thought Mariam. He is my beloved Samuel. We have known each other since we were four years old. At all times and everywhere I go I look to my left and expect to see him standing beside me. I close my eyes at night and expect to feel his arms holding me. He is Samuel, he is the man we are about to kill.

The Senior Registrar summarised. “These tests coupled with the patient's earlier MRI scans, in my medical opinion provide conclusive proof that the patient has suffered brain stem death. The decision as to whether you wish to terminate life support now formally lies with you, Mrs Srour.”

“Leave it to God, Deedee,” whispered Mariam, her heartbreaking.

Dalia looked to Mariam but it was Samuel's older brother who finally spoke swaying the discussion decisively. “God already decided not to save Samuel a second time. We are just standing in the way of that decision. Let him go, Mama.”

Dalia nodded slowly. She was unable to look at Mariam or Khalid. “You have my consent, Doctor.”

Khalid turned his back to Dalia as his despair enveloped him. Through the tears burning in his eyes Khalid could see beyond the hospital windows to a myriad of people and burning candles, stretching as far back as the eye could see, pledging their support and their love to his family.

The procedure ending Samuel's life was farcically simple. The Senior Registrar reached out and flicked the ventilator's master on/off switch to the off position. As the machine powered down Samuel's chest rose then fell for the last time. His junior doctor with great reverence and respect removed the tube from his throat and placed Samuel's head gently back on the pillow. His head fell naturally to one side. The junior doctor checked for a pulse. She found none. The doctors then left the family to their grief.

“It is finished,” said Dalia.

***

Timeline: The Pestilence plus 1 day. Information source: Email Message between Dr Hana Shihadah and Dr Mariam Fara.

Subject: Photo

Mariam

Thought it would be easier to email than text. The picture you sent is indeed writing, not Hebrew as you correctly surmised but Aramaic. Two sentences; the first says “King of Kings” the other “Lord of Lords”.

This expression, in this form, is found in two places in the Bible:

Timothy 6:15 where it is used as a reference name for God; and

Revelations 19:11-16 the chapter used to describe The Rider on a White Horse.
“Then I saw heaven opened, and behold, a white horse! The one sitting on it is called Faithful and True, and in righteousness he judges and makes war. His eyes are like a flame of fire, and on his head are many diadems, and he has a name written that no one knows but himself. He is clothed in a robe dipped in blood, and the name by which he is called is The Word of God. And the armies of heaven, arrayed in fine linen, white and pure, were following him on white horses. From his mouth comes a sharp sword with which to strike down the nations, and he will rule them with a rod of iron. He will tread the winepress of the fury of the wrath of God the Almighty. On his robe and on his thigh he has a name written, King of Kings and Lord of Lords.”

Hope that was useful.

Hana.

***

MARIAM, her head light, her body drowning in sorrow thought she felt the ground sway. She grasped Dalia's arm for support and was confused to find Dalia also shifting to stay on her feet. It wasn't until the cupboard above the sink burst open and paper towels showered the floor that Mariam realised it was the building that was moving and not her. The earthquake lasted barely a few seconds, a minor tremor, and all in the hospital room looked around in quiet astonishment.

Khalid gazed back at the crowds outside. The quake happened so quickly the crowd's initial reaction to the minor earthquake was one of quiet calm born out of simple confusion. Khalid's scrutiny was drawn from the people to what looked like clouds streaming in from the horizon. From all sides they seemed to be racing towards the hospital at unnatural speeds. Dark and ominous the clouds congealed high overhead, a writhing, swirling, maelstrom completely blotting out the weakened sun. In just a few moments the bright, clear Jerusalem day had turned into an unnatural ghostly night.

Mariam looked towards Samuel, who lay at peace on the hospital bed. Stefano was at the door and raised his hand in a half greeting. Mariam ushered him in. Behind him was a little girl.

Dina darted past Stefano and dashed into Mariam's arms. Mariam turned to obstruct Dina's view of Samuel, but Dina squirmed fiercely stretching to look at Samuel's lifeless body.

“He's dead Dina, you shouldn't see this.” Mariam once again tried to shield the child from death.

Dalia reached out to stroke Dina's hair, tears rolling down her cheeks. “You came to see him, didn't you?”

Dina nodded.

“I'm sorry sweetheart, but Samuel has gone.” The reality of her own words finally drove home to Dalia that her youngest had passed. He had gone from their lives long before his time. Dalia swayed on her feet and Samuel's elder brother rushed to her side.

Dina shook her head. “No, he hasn't. I can see him, the angels can see him. He is everywhere.”

Something organic flew into the windows. It was followed by another then another. The sound was like soft hail hitting a windscreen and it made all in the room turn and face the double windows looking out over the gathered crowd. Red and yellow slicks began covering the glass. The visibility outside grew steadily worse as the black swirling cloud started descending and the windows began to smear over. Mariam placed Dina on the floor and pressed her face to the glass for a clearer view of what was occurring outside. As she did so, a hideous black insect the size of her thumb landed on the glass. It had short, stubby wings, six legs and a vicious pair of pincers in its jaw. It tried in vain to chew through the glass, clawing to attack Mariam who drew back in disgust. The sky, the air and now the ground was full of these devouring insects.