Excerpt

Pulling the Plug

Annamelia O'Reilly was born in 1929 to parents who couldn't agree on most anything, including her first name. Her father wanted Ann, after his mother, and her mother leaned toward Amelia, her favorite sister. So they compromised, and forwarded the name to the Greene County board of health six weeks after she was born.

She came into this world in a downstairs bedroom in a Victorian home surrounded by an expanse of green on the main street of the picturesque southern Ohio village of Jamestown, (pop. 812). Few people were born in hospitals then, and the family doctor would spend hours waiting at their home for the moment of delivery.

Blessed with Mediterranean blue eyes and honey blonde hair, Annamelia won a county beauty contest at the age of two, and as she grew into womanhood, her striking features attracted the attention of just about every male in town, except Wiley Wilson, who was legally blind.

At Silvercreek High School, she edited the newspaper, wrote the class prophecy, learned to play Bach on the church organ, and painted portraits of town characters, including old Johnny Swyers, who always wore his woolen Civil War uniform on summer holidays. She could have been an art instructor, or a model or movie actor or a musician, but during the Great Depression, all such dreams had to be scuttled. Her mother had spent the $10 beauty contest prize on groceries, and in the ensuing years, family finances worsened. Her father's life insurance business failed. Unemployment in the county reached 35 percent, transients, or "tramps" as her parents dubbed them, came to the O'Reilly kitchen door for handouts, and she and her brothers wore hand-me-down clothes, courtesy of their cousins. A knock at the front door was a signal to run and hide from bill collectors. So it was folly to think of Annamelia running off to college or Hollywood.

Instead, she ran off with Ned Malone.

Ned operated his ailing father's 300-acre farm, two miles outside of town. He was Annamelia's high school classmate, an honor student, a champion debater, and a hard-nosed athlete who despised defeat. Built like a beanpole and as awkward as a new-born calf, he played center on the basketball team, mainly because no one else in the school was six foot six.

Annamelia's parents objected to their courtship. "She can do a lot better than getting mixed up with a farmhand," her mother observed.

"Who else would show up for a date wearing bib overalls?" She liked to describe Annamelia and her boyfriend by quoting George Bernard Shaw: "They have nothing in common except difference in sex."

Ned and Annamelia were married by a justice of the peace, a move quickly repaired by the O'Reillys, who arranged a modest wedding at St. Augustine Catholic Church. The pastor had waived the instruction sessions and the six-month waiting period, because the couple already had gone to housekeeping in a four-room white-shingled tenant house on his father's farm. And Annamelia was three months pregnant.

Though it was a quiet wedding, everyone in the community knew about it, and Annamelia's mother never hid the fact that she made annual Novenas for the couple to St. Jude, patron saint of hopeless cases. Her friends surmised that the prayers were a plea for the stability of the marriage, but they were in truth an entreaty to God not to let the pair disgrace the O'Reilly family by getting a divorce.

Annamelia adapted to farm life. Reading by kerosene lamps, hustling to the outside privy on a snowy night, heating water on a cook stove, bathing in a wash tub, stoking up the fire every morning -- these were inconveniences she accepted. In exchange for working the land, they lived in the home rent-free, and received half of the income from the sale of hogs, cows, corn and wheat.

There was little to remind Annamelia of her former home except for two Magnolia trees, which provided shade to the back porch. God seemed to allot too little time to enjoy them before the pink petals would wither and fall to the ground. But for a week in May, if the spring rains held off, they were a glorious sight.

Ned raised the crops, and Annamelia reared their two children -- Jeannie, a lithesome, fetching blonde who became a nurse at St. Elizabeth Hospital in nearby Dayton, and Tim, who was born eight years later, after his mother began using the rhythm method in reverse. To the dismay of a series of high school sweethearts, Tim entered the seminary at age 18 to study for the celibate priesthood.

The Malone's marriage was not made in heaven. They disagreed on a wide range of subjects: the music of Beethoven vs. the Beatles, the death penalty for the Rosenberg's vs. life in prison, Lindbergh's defense of Nazism, Roosevelt running for a fourth term, Mickey Mantle vs. Willie Mays, Eisenhower's entrance into politics. They even argued over the pronunciation of either, and tomato. Ned gave little thought to social and economic issues or current events, but he would perk up and quickly voice an opinion seconds after listening to Annamelia's views. For the sake of a good argument, he reveled in taking the opposite stand.

Annamelia told him he was as contrary as the donkey they had to sell at auction because it refused to be bridled.

Nevertheless, their marriage survived spirited debates, perhaps because they never argued over religion, children or money. Ned had inherited the farm after his parents' deaths, and there was enough money for weekly dinners at nearby restaurants, ball games, square dances, a new car every 100,000 miles, Florida in winter, Jeannie's nursing school tuition, a new house with electricity and indoor plumbing, and for religious order appeals to save pagan babies.

After graduation from nursing school, Jeannie married, and had two sons, before her husband, Don Springer, a fitness freak, went out one evening for his daily 10-mile run. He never returned, and months later she learned he ran away with a health store clerk who had just inherited her mother's estate.

About once a month, Ned and Annamelia would drive 25 miles to Dayton to visit Jeannie and their grandsons. They would also stop by the rectory of a suburban parish, where Tim was serving as a deacon the final year before his ordination to the priesthood.

On a misty day in March, they arrived at Jeannie's house and immediately began some chores. Jeannie was at work, the grandsons were playing with a neighbor's children down the street, and Annamelia started preparing dinner. She had baked meatballs at home, and she had only to drop the spaghetti in a pot of boiling water.

Her husband went upstairs to fix a drip in the bathroom faucet. Within minutes, he heard a sudden scream.

"Ned," she called. "Help. I'm dizzy."

In a swift moment, their lives were transformed.

* * *

When Tim and Jeannie joined their father in the emergency room at St. Elizabeth Hospital, they found doctors and nurses working feverishly to revive Annamelia. An hour earlier, she was a vibrant woman of 52, still beautiful, and seemingly fit, a perfect choice as a model for a physical fitness or perfume ad. Now, lying on a raised, white-sheeted gurney, her arms were a bluish gray, and a mask over her face forced oxygen to her lungs.

Electrically-charged paddles shocked her heart back into action, just as a nurse was dialing the coroner's office to report her death. Her pallor improved, and to Ned's relief, they hooked her up to a ventilator.

Gathered around her bed, the family waited for hours for some sign of recovery -- a squeeze of the hand, blinking of her eyes, a sigh or a moan. There was no reaction.

The stillness was broken only by the monotonous squishing sound of the breathing machine, pumping air into the lungs, expelling carbon dioxide, then squishing again. The bellows worked like an accordion; each time it compressed, it pushed oxygen-rich air through a rubber tube into Annamelia's mouth and lungs. Her chest was rising and falling in a steady rhythm.

"She's in a deep coma," an ER physician said. "We'll give her a couple of days on the ventilator, test for brain activity, and then we'll be able to give you a prognosis."

Over the weekend, Annamelia was moved to the intensive care unit, and then transferred to a hospital room. The rubber breathing tube had been taken from her mouth, and inserted surgically through the neck into her trachea. If and when she regained consciousness, a nurse advised, speech would be impossible. A feeding tube was attached to her arm, a catheter allowed the free flow of urine. She wore a diaper. She stared blankly into space.

In times past, Ned didn't remember exactly when, they had a dinner table conversation about medical techniques to prolong life. Annamelia said she dreaded having to rely on machines and tubes to keep her alive unless hope for recovery was certain. The thought of being paralyzed and confined to a wheel chair was utterly repugnant, and the idea of depending on others to dress, feed and bathe her, and heaven forbid, change her diaper, was reason enough, she said, to stop all treatment. Ned ignored her remarks and countered that if Annamelia had to make an emergency decision about extending his life, he hoped that she would wait a month or two before shutting off the machine and donating his organs.

"I don't know of any organ you have that anyone would want," she said, half seriously.

In the hospital, Jeannie and Tim joined Ned at her bedside. Except for an occasional visit to the farm, meals in the hospital cafeteria, a quick shower, a change of clothes, and visits to the chapel, Ned was there all day and all night, stretched out uncomfortably in a reclining chair, peering at his wife's chest expanding and contracting, and sometimes watching the TV perched on a shelf in the hospital room. He slept in fits and starts.

By coincidence, Jeannie was assigned to the same hospital wing, and looked in on her mother several times a day. After finishing her shift, she arranged for a sitter for her two sons, and stayed until midnight. Tim came after dinner from the parish rectory, only six miles away, and usually remained until visiting hours ended.

When the three were there together, Dr. Karl Kochensparger entered the room. He had a Salvador Dali mustache, a brusque demeanor, a perpetual frown, and the look of a Prussian general, minus a steel helmet.

His news was grim.

"Mrs. Malone is in a deep coma," he began. "She's had a massive stroke. I have to tell you that her brain activity is not detectable, and that quite frankly there is no hope of recovery."

"We should be thankful she has survived," Ned said. "You'd never know she had a stroke -- her color is great. She is actually the picture of health."

"I'm not going to give you any false hope," the doctor responded. "The ventilator is keeping her alive. It is prolonging the dying process." He noted that with few exceptions, most patients in similar straits die on a ventilator within two weeks. "With your written permission," he said, "we can turn off it off today. Otherwise, all we can do is to keep your wife comfortable, and wait."

"There are exceptions," said Ned, trying to counter the doctor's diagnosis. He remembered a TV medical drama, which related a story of a comatose patient who, after a respirator was turned off, woke up after three months.

"That's TV," Dr. Kochensparger said. "Not reality."

"I think we need a second opinion," Ned said.

"Two doctors in the department agree with me. I'll give you their names," he added. "Meanwhile, you don't have to make a decision immediately."

Ned noticed that when the doctor pronounced "immediately," his lower lip curled upward. "Let's wait," he said.

He was beginning to dismiss all doctors as hopelessly pessimistic and humorless until he met Dr. Chen Li, a Chinese-born resident whose personal approach endeared him to patients and staffers alike.

Dr Li held Annamelia's hand and talked to her as if she understood. "Don't worry about a thing," he said. "Just rest a while longer and everything will be okay."

He sought to cheer Ned with one-liners which he attributed to his country's most famous philosopher. "Confucius say beware of reading health books; you may die because of a misprint...Confucius say don't pay too much attention to what I say. I'm not young enough to know everything...Confucius say man who jumps off cliff jumps to conclusion."

Did he really say all those things?"

"Oh, no. But since I come from China, people believe I know all about Confucius. They don't realize I've read Mark Twain and Oscar Wilde."

He seemed to be the only physician to understand Ned's reluctance to pull the plug, and cut short Annamelia's life.

"It's something you can't do, as long as you feel guilty," he said. "You don't want to have your conscience bother you the rest of your life."

Ned liked Dr. Li and looked forward to his daily visits, even though he often asked if he had changed his mind about keeping his wife on life support.

"No, let's wait," he replied.

"Fine. It's your decision," the doctor replied. "Listen to your conscience."

As time passed, the squish, squish sound of the ventilator droned on, nurses monitored the life-giving machine, checking every hour the volume and flow of oxygen, and re-filling the bag with a clear liquid, which supplied nutrition. Periodically, Ned would firmly grip Annamelia's hand, call her name, and hope to feel her fingers clasp his. Her hands were limp. Sometimes, she would move her arms and legs, and the first few times it happened, he would ring a bell alerting the nurses.

"Muscle spasms," was the explanation.

Jeannie brought in his two grandsons, Jerry and John, for a short visit. It was an awkward moment, communication was impossible, and both giggled. "She looks like Sleeping Beauty," said Jerry. "If Grandpa kisses her, she'll wake up."

On his daily rounds, Dr. Kochensparger repeated his diagnosis: Annamelia's coma was permanent, her condition was irreversible, she could not breathe on her own, and Ned should seriously consider signing a consent form to allow the ventilator to be turned off. A nurse had given him the form the first night in the ICU, and he had folded it and stuck it in his back pocket.

"Give her more time," Ned responded.

Hospital routine had become familiar. Change the sheets, turn the patient, bathe her, take blood pressure and body temperature, and change the urinal bag. Tim's pastor, Msgr. Paul LeBeau, and Father Moore, the hospital chaplain, took turns coming daily to pray. At first, the prayers were for her recovery, but as time passed, Ned heard the chaplain praying for a "happy death."

"That's a contradiction," Ned said. Having been told of Ned's proclivity to argue, the priest ignored the comment.

Days turned into weeks, and soon it was May. Her condition was unchanged. Their patience at an end, Jeannie and Tim decided it was time to reinforce the doctor's recommendation.

Tim weighed in, summoning the knowledge he had learned in a seminary ethics class."Dad, opinion is divided on stopping intravenous feeding, and allowing a patient to starve to death" he began.

"I wouldn't do that to a stray cat," Ned said. "That's murder."

"But on the other hand it's not mercy killing or murder to withdraw extraordinary means of preserving life," Tim continued. "Pulling the plug gives the patient a chance -- if Mom could breath on her own, she might survive."

Tim knew that outcome was all but impossible since doctors emphasized that she was in a vegetative state.

"If she can't breath on her own and is in a coma," he continued, "it's wrong to keep her alive on a machine."

Ned was silent.

"To be honest, I think we are merely postponing Mom's funeral," Tim said.

Jeannie nodded her agreement, and mentioned that here was an opportunity for her mother's kidneys, heart, skin and corneas to be donated to gravely ill patients. She remembered a nursing instructor saying that as many as seven people could benefit from the organs of one deceased person.

"But she's not dead," Ned replied.

Later that day, after driving back home in a savage rainstorm, he found Annamelia's purse on a nightstand in their bedroom and retrieved her driver's license. He knew what it would say. Beneath her photo on the white plastic card was a small red heart, and the words "organ donor."

She must have given that consent without any forethought, he concluded. He vowed to tell no one. He imagined a surgeon cutting out her heart and plucking out her eyes and transferring them to a box filled with dry ice. Butchery was the fate of hogs and cattle, he thought, not for his wife.

In the early evening when he returned to St. Elizabeth, the downpour continued. It was a typical spring storm in southwestern Ohio, an area which was named "thunder alley" after a tornado blew away blocks of homes and stores in the neighboring city of Xenia several years before. The Miami Valley Electric Company never took responsibility for its service failures. Any prolonged rainstorm which often plunged the county into darkness was always "an act of God."

Water splashed in torrents against the hospital windows of his wife's room, and Ned visited the nursing station to ask what would happen if one of those blackouts occurred.

"Would the ventilator be affected?" he inquired.

A supervisor assured him there was a fail-safe feature in the hospital electrical system -- in fact the power had just failed a few minutes earlier, and few knew it because the hospital generator in the basement automatically kicked in.

While his father talked to a nurse in the hallway, Tim was alone with his mother in the room. He said a prayer by her bedside and then walked over to the electrical hook-up.

Making his daily rounds, Dr. Li entered the room unexpectedly. "I know what you're thinking," he said to Tim. "It's a temptation. But don't do it. It might alienate you from your father the rest of your life."

Before Tim could respond, Ned walked in, holding a list of nursing home phone numbers. It was time to hunt for a long-term nursing facility where nurses were not shoving consent forms in his face, and where Annamelia could remain on a ventilator indefinitely. He imagined her waking up one morning, and asking him about Russia's deployment of nuclear missiles, the space mission of the Challenger, Henry Fonda and Katherine Hepburn's Academy Awards for "On Golden Pond" and the embargo President Reagan placed on Libya. He asked Smitty, his neighbor, to save the daily papers so that she would not miss any important news.

He spent the evening dialing various rest homes, but they all turned him down. They were either outrageously expensive, wouldn't accept his insurance, or were unable to handle respirator cases. One receptionist's response was puzzling. She said her home was filled "beyond capacity."

"You mean you put residents in the furnace room?"

"No," she answered. "But our solariums are now bedrooms."

The storm continued to rattle the windows. Ten inches of rain had fallen in less than a day, and the weather forecast offered no relief. The sewer system was becoming overloaded.

Back home, the pelting rain had stripped the Magnolia trees of blossoms. Nature's spectacular display was all too short.

And as Ned settled in searching the yellow pages for more nursing home phone numbers, as Tim scanned the sports section of the Dayton Daily News, as Jeannie stopped by to check her mother's vital signs, they were oblivious to the fact that the water level was rising quickly in the hospital basement.

In minutes, the generator was flooded, and the lights went off.