The Ship of Theseus
stillness of the warm
If not for the built-in navigation system in the quad-cab Chevy Silverado, emergency responders might not have found the carnage for days. Even with a GPS location provided by the navigation service it still took paramedics nearly 20 minutes to reach the shattered truck and begin life saving measures as the offending oak tree was sixteen miles up the isolated farm-to-market road that had fallen into considerable disrepair since becoming obsolete in 1979 with the construction of the loop 180 system. The only sign of civilization in either direction, other than six or seven rusted and dilapidated butler buildings of ambiguous purpose, was a weathered green sign that read: Lord, Texas 15 Miles.
receiving a call from GM that a high impact collision had occurred at 12:41 AM
in the middle-of-nowhere with no response from the driver, the firefighters of
Lord Firehouse #9 assumed they were on their way to another drunken redneck
fatality. Late night car wrecks in the gump - the local colloquialism for the
swampy area west of
They were equally surprised to find a faint pulse on the broken and bleeding body that a driver's license and university ID card identified as one Michael Stone, a 22-year-old Callahan student. The accident report filed by the investigating St. Clair County sheriff's deputies would later reveal that Michael was thrown 40 feet clear of his truck, miraculously avoiding several more trees.
As the ambulance raced through the muggy country night back toward the lights and development and emergency room of the St. Clair County Medical Complex, the paramedics, helpless to really aid any further, quietly noted their shared belief that this patient's visible injuries were so severe that he would surely die before morning. The victim of a fractured skull, broken nose, two broken arms, dislocated knee, six broken ribs, a collapsed lung, ruptured spleen, numerous deep lacerations and ugly friction burns from the airbag, Michael succumbed to the totality of his injuries shortly after being admitted to the ICU after undergoing nearly four hours of emergency surgery in an effort to save his life.
Michael's father, Dr. Lucian Stone, was teaching his surprisingly popular morning Greek mythology class about the Athenian hero Theseus and his famed ship when the department secretary came in looking visibly uncomfortable. The professor
politely motioned for her to wait while he finished his thought.
"According to the Greek historian Plutarch, the Athenians moored Theseus's ship in the harbor in an effort to preserve it and the legend of its daring captain, and for centuries, as planks would rot and fall away, the curators of this boat would simply replace the rotten wood with new planks. So over time the ship was stripped down and built again several times, all the while the Athenians held the sincere belief that this ship, the ship in front of them, was, in fact, the true ship of Theseus. But was it? Was a boat that had undergone a complete transformation a number of times actually the same boat? Was the ship of Theseus a demonstrable physical object or was it something more than that? Think hard on that. The answer might not be as clear as you think."
Lucian then walked over to the secretary who was fidgeting awkwardly in the back of the room trying desperately to avoid eye contact with him. She took a deep breath and hesitantly whispered the devastating news in his ear. The energy and exuberance that had filled the professor only seconds before disappeared in a moment. His ordinarily bright complexion seemed to visibly melt away and his face went ashen. He abruptly dismissed his class, rushed out of the building and drove to the hospital with no regard for posted traffic laws.
Stone had spent his twenties as a small-town
Stone was a
bit of a campus legend among Callahan's more scholarly students. He was a large
man, tall and athletic, who had aged quite well. Even at 57, Lucian was
handsome and lively. His full head of salt-and-pepper hair and fit physique
made him the private fantasy of Jill, the self-conscious 25-year-old department
secretary, and more than a few of the wives of his misanthropic colleagues, who
had morphed unfavorably in the process of aging. In fact, Lucian was acutely
aware that a good many of his fellow classics professors harbored deep
resentment toward him for his smoldering good looks, affable charm and
brilliant mind. He was an unconventional professor in many ways, choosing to
teach in cowboy boots and blue jeans and embrace the
professor arrived at the hospital and found his son's ICU room, his wife
Bethany was already there, having been notified well before her husband as he
did not carry his cell phone while on campus. She was sitting in a chair,
staring at seemingly nothing. Lucian was not surprised as
He just stood in the room and stared at his son. Michael lay in the hospital bed surrounded by machines and monitors. The electrocardiogram machine emitted perfectly spaced-out beeps as it registered the rhythmic beats of his heart and displayed their rate in digital green numbers on a small screen. A ventilator forced a mixture of air and oxygen into Michael's lungs with mechanized will. A tube snaked out of a hole in Michael's trachea and connected with the ventilator. An automatic IV drip forced fluid and medication into his bloodstream by way of a needle taped to the crook of his right arm. There were several more machines and monitors that Lucian didn't recognize and was unable to quickly deduce their purpose. A large brace held Michael's right knee immobile. Both of his arms were completely covered in casts and bandages. His hair was obscured by tightly wrapped gauze bandages. A blue papery hospital gown hid the extensive damage done to his stomach and chest both by the wreck and by the surgery necessary to stabilize him.
He was almost unrecognizable, his boyish good looks hidden beneath the ugly mask of abrasions and bruises and friction burns. His swollen face was a collage of various reds and purples as the effect from each broken bone and cut began to appear physically on his skin. An inch-and-a-half of stitches closed a jagged slash across his left cheek. Both of his eyes were deep violet from the blood and fluid pooling in his eyelids from the broken nose.
"How's he doing?" Lucian asked furtively, legitimately concerned but also terrified of the potential answer. A tight knot had formed in his stomach. He felt as if he might expel his lunch onto the tile floor at any moment.
His wife's terse answer alarmed Lucian. Perhaps this was worse--much worse--than he anticipated. He had been told that his son had been in a bad accident but he didn't expect anything like this. Maybe some broken bones and some nasty cuts and a concussion, but not this.
An aging, balding doctor with thick glasses came into the room. He was slightly overweight, wearing khakis, ugly brown leather shoes, a white collared shirt that looked cheap and a green tie that didn't match anything else he was wearing. Even in the incredibly dire circumstances of the situation, Lucian couldn't help but wonder for a fleeting moment why so many highly paid doctors dressed like they blindly purchased all of their clothes off a sales rack at Sears.
"Are you Michael Stone's parents?"
"Yes, I'm Dr. Lucian Stone. This is my wife, Bethany. What happened? Is my son
going to be alright?"
"Are you a physician?" the balding doctor eagerly inquired.
"No. Ph.D. Enough with the pleasantries, doctor. What is this? What happened?" Lucian was nearly shouting. "Just tell me what happened."
"I'm Dr. James Pope. I'm a neurologist. Your son was involved in a car wreck. He's stable for now, I assure you. And if you come to my office upstairs, I can explain in greater detail what's going on with Michael here. He's in good hands."
Lucian started to ask but stopped himself. It was immediately clear that
"Okay, I'll find out what the story is. I'll be back as fast as I can."
The two men walked to Dr. Pope's office, an uninviting space with an industrial quality, bright florescent lights, and a faint smell of antiseptic lingering in the air. Cheap-looking bookshelves were crowded with textbooks and medical journals. An old metal desk and two faded green file cabinets took up most of the available space. Lucian hated the room immediately. Like the neurologist himself, the professor thought the mismatched room vaguely sinister and bureaucratic.
"I don't mean to be rude," Lucian began, "but it is absolutely imperative that you tell me immediately what happened. What is the deal with my son?"
"Of course." Dr. Pope responded. "I'm a little fuzzy on the details of what exactly happened." He paused briefly and pretended to clean his glasses, an obvious tell that Lucian noticed immediately. "But what I do know is that the patient, Michael, was brought in about 1:30 AM with massive traumatic injuries. He apparently was involved in an accident. I'm afraid you'll have to ask the St. Clair County Sheriff's office what happened because I wasn't given any details." Those details had entered the hospital with the EMTs and already were metastasizing, infected bits of information spreading rapidly and evolving from nurse's station to nurse's station, mutating and becoming more resistant to actual reality with each retelling. An all-American student from the right part of town found broken and bleeding in strange circumstances in the wrong part of town was the kind of gossip that once loosed could not be caught again. Soon everyone in the hospital except Lucian and Bethany would be aware of the grim truth - that Michael wasn't wearing his seat belt, that sheriff's deputies had found a shattered bottle of bourbon - either Jack Daniels or Evan Williams or Old Crow, depending who you asked - or that the lack of skid marks on the road at the site of the wreck indicated at least the possibility a certain malevolence of intent.
"Okay," Lucian replied tentatively. "How bad is it really? Don't sugarcoat it. Please. Please just tell me how hurt my son is." Lucian was almost pleading, feeling increasingly helpless as the daunting reality began to set in.
"It's bad. Very bad." Pope answered, noticeably uncomfortable with the realization that he was going to have to tell this man, this father, that his son was beyond help at this point. "Michael is brain dead. I'm truly sorry."
Lucian knew the neurologist was not truly sorry, if he was sorry at all. The first thing the professor learned as a graduate student with a humble Texas background amongst the advantaged NPR types of elite Northeast academia was to recognize condescension and disingenuous words. The second thing he learned was not to call people on it.
"Mike. My son prefers to be called Mike." Lucian did not seem to understand the dreadful implication of what the doctor had just said.
"My mistake. Certainly. Mike, then, is brain dead. His spleen was ruptured. The surgeons removed it. His left lung collapsed, but the surgeons managed to re-inflate it. But he requires a ventilator to breathe." Pope listed the injuries as if he were reading from a grocery list. Lucian could see him struggle to find the right words, the doctor visibly squirming as his mind seemed to scan its internal data in search of the simplest and most empathetic words to explain to this man that his son was now little more than the body's component parts. The file evidently was not found and Pope plodded on. "Your son has multiple broken bones - ribs, both arms, some in his face. The doctors set them as best they could at the time."
The neurologist paused. Lucian leaned forward, intent on gleaning all the necessary facts and details.
"As I said, Mike - your son - has lost total brain function as a result of his accident. He suffered massive trauma to the head at the time of impact, probably from the windshield. He shows no response to pain and has no cranial nerve reflexes. We've run two EEG's. And it is quite apparent that he has no brain activity. Absolutely none. In layman's terms, he is dead. In fact, in legal terms as well, he is dead. Machines are the only thing keeping your son from suffering cardiac death as well. He's never going to wake up."
"I don't understand," Lucian exclaimed. "He's breathing. His heart is beating.
"An illusion of sorts, I assure you. His cerebral neurons are necrotic. His brain is not receiving oxygen. Thus his brain is no longer capable of running his body. This means that he is legally dead. But he is not clinically dead yet. He's what we call a beating heart cadaver. Mike did not suffer brain death until after his surgery, after the ventilator was attached. It's complicated, but simply put the heart has its own electrical system. That is to say, it generates its own electrical impulses independent of the brain. Because of this, as long as the ventilator forces your son to breathe, his blood will remain oxygenated and his heart will keep beating. But if we turn off the ventilator, Mike would suffer cardiac death almost instantly."
forlorn father, wanted to jump across the desk and hold Pope's mouth shut. Just
grab that awful green tie and yank it taut against his Adam's apple to prevent
his words from escaping out into the air. How's
this for an independent electrical impulse, you useless quack? Your meatball surgeons carved my son up and then he slipped into nothingness on
your watch. This is your fault, doctor! he would shout as the neurologist wheezed and
gasped and lapsed into unconsciousness. It would be worth it as long as he
could just stop the words, for every word that passed from one man's lungs to
the other's ear carried with it a resolute truth, each word another jagged rock
upon which everything would certainly be dashed. Talking about what had
happened and what was going to happen made it all real. So better not to talk about
it. Pope's words could only increase the entropy of Lucian's life - he could
handle the disdain and hateful looks of his subordinate professors, he could
Lucian, the pragmatic academic, asked "You're sure?"
"Yes. I'm absolutely, positively, one-hundred percent certain. My colleague, Dr. Bernstein, agrees. We ran all the tests twice. The only thing now keeping Mike's heart beating and his lungs breathing is the life-support system. Nothing can be done to help him now."
Lucian leaned forward, putting his elbows to his knees and covering his face with his hands. What a nightmare, he silently mouthed. For all intents and purposes, his son was dead, his greatest achievement among many snuffed out in only a few moments in the dark of night on a isolated country road. For the first time in a long time, certainly longer than he could remember, he did not have a plan of action, an idea about how to face the future or handle such a brutal reality. He wanted to cry, to scream, to trash this frumpy doctor's institutional office but all he could do was sit there shrouding his face with his hands.
After a few minutes of uncomfortable silence, Dr. Pope spoke up as gently as he could, almost as if he was talking to a young child, "Mr., - excuse me, Dr. Stone, - there is another issue that we are now compelled to discuss." He paused again, racking his brain for the perfect words, the words that wouldn't break a broken man even more.
"The reality is that Mike, the Mike you know and love, is gone. Gone forever. Like I said before, he will never wake up. There are limits to medicine and science and we've done everything for him. Believe me, if there was anything, I mean anything at all, that I could be doing to help him, even in the slightest, I would be doing it right now. But there's not. And...As difficult as this kind of thing is to talk about, we have to discuss it. The machines that are keeping your son alive are simultaneously preserving his organs, organs that could help many people."
Lucian lifted his head, his eyes watery and puffy, the cracks in the ordinarily concrete man were starting to become apparent. "What?" was the only response he could muster.
Dr. Pope began to speak with less delicacy and more purpose. "Your son sustained substantial physical damage in the crash. His left lung was punctured and is no longer a candidate for transplant. But his right lung, his heart, kidneys and even corneas are. In fact, there is a man in Dallas, a 42-year-old married father of two dying of heart disease. I'm told Mike is a perfect match. I mean dead on perfect. The odds of that are like 100,000 to one. Enormous really. His life can be saved by tonight, potentially. But there's a problem. Mike's driver's license doesn't indicate that he is an organ donor. Does he have a will?
The sick feeling that had plagued the professor since arriving at the hospital unexpectedly and fiercely manifested itself. Lucian painfully splattered Elmer's pulled pork and sweet tea all over the floor of the office. He muttered an apology that he did not mean, closed his eyes and slumped with the awareness of defeat. His son, his precious child, the flesh-and-blood human being laying in a hospital bed three floors below was as good as dead. And now the doctors wanted to cannibalize his body for usable parts.
The neurologist continued his full-court press. "Has he ever made his wishes clear regarding a situation like this?"
Lucian disliked the frumpy doctor before but now he hated him with every last ounce of his now-sapped energy. Situation? You mean my son who's being held together by machines? You mean my son who you want to go all Victor Frankenstein on? That situation?
"Yeah. We've talked about it."
Lucian immediately thought of the First Bank of Lord Texas, where his son's living will sat obscured in darkness inside the small steel cavity of safety deposit box #288, a living will that Lucian had made Mike fill out just in case, a living will that clearly indicated his son's wish to terminate life support and donate his organs in the event of--what had been up to that morning, at least--the unthinkable. He doubted that anyone was aware of his son's will beside his son, himself and Bethany. Perhaps he could excuse himself somehow, go to the bank, remove that damning document and set fire to it in the alley behind the building, erasing the worldly wishes of his son and making himself sole arbiter of Mike's fate.
if the organ donation box on his license had been checked none of this would be
an issue and we would have already begun harvesting his viable organs. However,
since you're his closest relative, only you and your wife have the authority to
order that his life support be turned off. If you do so, we will immediately transfer
him to an operating room and begin the difficult and arduous task of removing
his organs and trying to find recipients. But his heart will immediately be
sent to UT Southwestern in
The two men sat and stared at each other. The elementary school classroom clock on the wall ticked audibly, each second that passed propelled Lucian deeper into a nightmare from which he could not seem to wake. Pope's eyes seemed to say, "Your kid is a patient, not a person, a patient, a chemistry set basically that I get to play with now because I found it, a frog that I caught on the river bank and soon my other friends will be here to poke it with a stick, a patient, not a person, not anymore." Lucian's eyes retorted, "Screw you!"
After what was the longest few minutes of the professor's life, Pope finally broke the uncomfortable silence, "Do you have any questions?"
Do I have questions? Of course I have questions. Why did this happen? How did this happen? What else is going to happen? How does someone even begin to make a decision like this? Why do you have such an awful office? How do I tell my wife about this without just emotionally manhandling her? Why do good things happen to bad people? How do I move on with my life? Who do I see about trading places with my son?
it. Let me talk to my wife first though. I need to tell her myself."
Lucian responded. He knew he had to keep it together in order to break this
No, you don't. He slowly walked back
down to the ICU ward with the same tentative gait of a condemned man walking to
the gallows, unhurried and resistant. Entering Mike's room he noticed
Lucian pulled a chair up next to her and his son and took her hands in his. Instinctively she seemed to know and tears began to slowly meander down her cheeks. The sight of his wife's tears only compounded the professor's already staggering grief and he too began crying.
His voice trembled, "Mike is never going to wake up. He has no brain activity. He's essentially gone. In the eyes of the law, he's dead."
Lucian was surprised at how well his wife handled this distressing, life-altering news, almost as if she already knew, as if her motherly instinct, the intangible maternal bond, had already cued her in on the brutal reality of her son's situation. He continued, "Baby, there's something else."
what he was about to say,
Lucian momentarily hated himself for the words that circumstance was forcing him to say. "Bethany - baby - time is an issue here. Mike is the same as dead. Our son, our baby boy, that person is gone. He died out there on that road. His body now is an empty vessel, just flesh and bones and organs, it has no personality, no awareness of being."
He stopped, let go of his wife's hand and pulled her face close to his.
"We'll have the rest of our lives to grieve but right now we have to pull it together. Honey, we have to face this moment, this decision with some clarity and rationality. Mike can still do some good, make a tangible difference in the lives of others. His heart is a perfect match to another man, a man with a family, and he will likely die without this tremendous gift that Mike can give him. The doctors can use him to try to save others."
passed as these two people attempted to process the cruel reality that faced
them. Strangely, Lucian felt closer to his wife in this awful moment than he
had in years. It was an ugly feeling. He tenderly touched his forehead to
could think about was that freezing February morning 22 years earlier in the
tiny maternity ward of a tiny hospital in the tiny town of
An hour passed with the cold, empty silence being broken only by the metronomic beeps of the heart monitor and Bethany's slow, almost yelping sobs as she grasped Lucian's hand and stared wistfully at her only child in a way only a grieving mother can, as if by the sheer force of her will she might compel him to wake up as if nothing had ever happened. She felt as if she might suffocate under the forceful weight of her grief. Finally, after what seemed an eternity to Lucian, she squeezed his hand and asked almost rhetorically, "We can survive this, can't we"
Lucian was unsure. "Yes."
Lucian let go of his wife's hand, in the process regaining some of the composure and decisive action that he normally possessed in spades. He went to the nurse's station where Dr. Pope was waiting and scrawling something into a small, black notebook. The neurologist asked in his most diplomatic and doctor-like voice, "Are you ready?"
"Yes," Lucian could barely bring himself to actually say the words out loud, "There is no point needlessly prolonging the inevitable if lives can be saved."
Dr. Pope did not seem interested in Lucian's explanation. He picked up a clipboard of papers and handed them to the professor, explaining, "You, as next-of-kin, need to sign these documents allowing us to harvest his organs."
Lucian flipped through the papers, angrily scratching his name in each little box, each letter bringing Mike one moment closer to physical death. Again, the words. He could not help but feel as if he were his son's executioner, signing a life away that did not really belong to him. He finally finished and handed the clipboard back to the neurologist. The whole process felt surreal, as if Lucian was lucidly dreaming and might wake up any moment. He desperately wished that it all were a dream.
immediately handed the clipboard to a nurse standing there and told her, "Call
the hospital in
"Yes. Of course. You can have until the transplant team arrives. It should be about an hour."
"Thank you. We only want to say goodbye."
walked back into his son's room.
The two parents watched their son breathe his final breaths. Each seemed to instinctively know that this was not the time or the place to properly mourn their son, not in such a cold and artificial place. They merely stood there in that hospital room looking at Mike, frantically holding onto each other in a world that no longer seemed safe or inviting. After several minutes passed two more doctors and a nurse came in and the older of the two asked, "Are you ready?"
After what seemed like only a few minutes, the whirring chop chop chop of helicopter rotors slicing the air filled the room. Lucian and Bethany each leaned down and kissed Mike's forehead. His mother put her face to his ear and told him, "I'll always love you." Then she stood up and did her best to wipe away her tears. As the two walked out of the room hand-in-hand. Lucian reached into his pocket for his keys and his knuckles brushed against a folded piece of paper--a doodle he had made that morning while waiting for his students to trickle in of the ship of Theseus.