Free Ghost Child by Caroline Overington Page B

situation like this, I would like to be able to give you a best-case scenario. Unfortunately, today I have only a worst-case scenario. Jacob is currently breathing with the aid of a respirator. When the respirator is removed, he will be unable to breathe on his own.’
    Peter said, ‘He’s not breathing?’
    I said, ‘That’s correct. He is not breathing unassisted, and he cannot breathe unassisted.’
    Lisa said, ‘Can you keep him on the respirator – ’ It came out something like respa-rader – ‘until …’
    I waited.
    ‘Like, until he comes around or whatever?’ she said.
    The tissue box was still on her lap, and Lisa had begun to wrap herself around it. It was to me a familiarpose: a human being under attack will cover their central region as best they can, to shield the tender organs, not least the heart.
    As gently yet firmly as I could, I said, ‘Jacob’s brain injury is irreversible. He will not recover.’
    In forty years in the medical profession, I’ve never overcome the guilt I feel at having to break news of this type. Obviously, children die every day, and it is surely conceivable to every one of us that one of our children will pre-decease us. Nevertheless, it is the thing we most fear. It is the thing we in modern medicine devote our greatest energy toward preventing. In modern times, it still seems to most of us that the death of a child is a gross violation of the pact we have with our God. He gives us children. We should, therefore, be allowed to raise them. That is the natural order of the world.
    Lisa said, ‘I’ve heard of people waking up from a coma.’
    I knew what she was doing. She was holding out hope, even where there was none. My role, then, was to help her move quickly through the stages of loss – the disbelief, the denial, the bargaining, and the acceptance – so that Jacob would be allowed to die.
    I said, ‘He won’t wake up, Lisa.’
    Peter said, ‘How do you know that?’
    I met his gaze. Perhaps some more information was necessary. I had a common metaphor up my sleeve, one I often used to explain a brain injury to people, andalthough by using it I would run the risk of trivialising Jacob’s injury, I decided to employ it now.
    I said to Lisa, ‘Have you ever had a swollen ankle?’
    Lisa nodded, as I knew she would. Most Australian girls have twisted an ankle on the netball court. It is normally no great trauma and once the pain subsides it can be amusing to be bandaged and on crutches, essentially unharmed and yet the centre of attention.
    I continued, ‘Good. Then you know that when you have an injury to any part of your body, it swells?’
    She nodded, yes.
    ‘Your ankle is able to swell with fluid because its capacity to swell is essentially limitless,’ I said.
    Now she was confused again.
    ‘Your ankle is not encased in your skull,’ I said. ‘The brain is encased in your skull. Your skull is like a hard shell. When the brain swells, it comes up against that shell, and there is a limit to how far it can swell.
    ‘Pressure builds up, Lisa, and blood vessels that supply the brain with oxygen become constricted, which means they get squashed.
    ‘The swelling pushes down on the brain stem, which controls the breathing and the heart. The damage is permanent. Part of the brain dies, Lisa. The skull protects the brain but in a case like this, it can also damage the brain, and that is what we have found with Jacob.’
    Peter said, ‘Can’t you do something?’
    I said, ‘We have taken some of the fluid and drained it to the abdomen, to reduce the swelling. That will make Jacob more comfortable. The damage to Jacob’s brain cannot be reversed, however. It is permanent.’
    We sat for a moment in silence. Lisa said, ‘There must be something you can do.’
    I said, ‘No.’
    The weight of this news appeared to be settling on Lisa’s spine. She had become a curled ball of agonised flesh upon her chair. She had pulled her knees up to her chest, and her