Decisions and Regret

 

 

Upon the red table, with the spread-eagled captain’s body empty, new hands began a fight of motion. Into the wet interior were placed organs of copper, brass, silver, aluminum, rubber and silk; spiders spun gold web which was stung into the skin; a heart was attached, and into the skull case was fitted a platinum brain which hummed and fluttered small sparkles of blue fire, and the wires led down through the the body to the arms and legs. In a moment the body was sewn tight, the incisions waxed, healed at neck and throat and about the skull – perfect, fresh, new. The captain sat up and flexed his arms…
                        - The City (Ray Bradbury, The Illustrated Man 1951)

 

There’s a John Varley novella that I reread every couple of years.

It’s a terrible terrible tale, this story.

Not terrible in that it’s badly told or poorly written (Varley is incapable of either sin), no, rather Tango Charlie and Foxtrot Romeo is terrible in its vision.

On the surface, in simple black and white terms, Tango Charlie is a rescue story describing efforts to save a little girl living in a doomed space station.

Underneath, it’s a detailed exploration at the foreseeable edge of social ethics and the terrible morality of gambling the life of one dying child against the lives of others, both children and adults. The story is less about right and wrong, black and white, and more about the shadowy gray area in between those two poles. It’s about personal choice.

That’s the real business of speculative fiction, you know, to explore the human experience and its place in the universe, to look ahead and to the sides and into the past, to seek answers before most of humanity even knows there’s a problem.

The job of people like Varley is to ask one simple question: What if?

What if? And then to chase after the answers for as deep as the rabbit hole goes.

What if it was possible to keep a body running long, long after the person inside has died?

I won’t give away what happens, but a subplot to the main story involves a computerized mechanical sawbones – which today is a lot less far-fetched than the idea was in 1986 when the story was written: 

She was dead, of course, by any definition medical science had accepted for the last century. Someone had wired her to a robot doctor, probably during the final stages of the epidemic. It was capable of doing just about anything to keep a patient alive and was not programmed to understand brain death. That was a decision left to the human doctor, when he or she arrived. The doctor had never arrived. The doctor was dead and the thing that had been Charlie's mother lived on […] All of its arms and legs were gone, victims of gangrene. Not much else could be seen of it, but a forest of tubes and wires entered and emerged. Fluids seeped slowly through the tissue. Machines had taken over the function of every vital organ. There were patches of greenish skin here and there, including one on the side of its head which Charlie had kissed before leaving…

A rotting corpse, dead by any reasonable standard you’d care to employ, given a macabre illusion of life by mindless mechanical fanaticism and through a perversion of technology designed to save life, not to prolong death.

On the pages of a science fiction novel it’s an interesting exercise in What If? But in reality? In the here and now? It’s a travesty.

Every time there is yet another one of these horror shows, like the grotesquery that finally, finally, came to a conclusion last Sunday evening in Texas, I am forcibly reminded of that passage, of that stiff green tinged corpse from Varley’s Tango Charlie and Foxtrot Romeo moldering for thirty years in a ghastly imitation of life under the inflexible attention of a dogmatic agency too stupid to know when to let go.

Nothing, and I mean nothing, exposes the morally bankrupt hypocrisy of the right-to-life zealots like the case of Marlise Muñoz. 

On November 26, 2013, Muñoz, three months pregnant, awoke in the middle of the night.

She got out of bed and went into the kitchen to warm a bottle for her son, a toddler. 

After a while, her husband, Erick, realized she hadn’t returned to bed.

If you’ve been married for a while, you know how this goes. You wake up and the other side of the bed is empty. You vaguely remember your wife getting up quietly in the dark. You thought, if you thought about it at all, that she was just going to pee. Pregnant women, right? (and middle aged men, for that matter). But she’s been gone too long, you know something’s not right. You wait for a while, figuring she’ll be back in a bit. But it goes on, the absence, and on. Eventually you get up to see what’s wrong. You’re expecting what? She’s sick maybe, morning sickness. So you listen for the sound of retching from the bathroom, check to see if there’s light under the door, trying to remember if there’s any Ginger Ale in the fridge – knowing that it’s your job as the husband to run down to the 24-hour store if there’s not. But no, she’s not throwing up in the bathroom. So,  perhaps it’s the kid. Nightmare, loaded diaper, colic, earache, it’s always something with kids.  You expect to find her in the nursery, rocking the child back to sleep. You’ll smile, she’ll roll her eyes, quietly, and damn but don’t you love that image? But she’s not there either and the kid is sound asleep. You start to really worry now, but you know you’re just being foolish. It’s just insomnia. You know how pregnant women are, sure, she was laying there, watching the red digits of the clock count away the minutes, wide awake, so she got up and went into the living room to read or surf Facebook on her laptop. You’ll ask her what’s wrong, nothing she’ll say, couldn’t sleep, didn’t want to wake you, go back to bed.

But she’s not sitting on the couch either.

Instead, Erick Muñoz found his wife collapsed on the kitchen floor.

She wasn’t breathing. She had no pulse.

She was, in blunt point of fact, dead.

She was dead by every clinical definition you’d care to name.

She was already dead when Erick Muñoz awoke and realized something was wrong and went stumbling through the darkened house looking for his wife.

Muñoz was a trained and experienced paramedic, he’d seen it before, hundreds of times.  Medics, doctors, cops, soldiers, firemen, emergency workers, they’re trained to deal with these things in a detached and professional manner, but you never expect it to be your spouse, the love of your life, the mother of your children, laying there lifeless on the kitchen floor.

Muñoz frantically called 911 and started cardiopulmonary resuscitation.

But he knew, as a medic he had to know, what the blue color inside her lips and under her nails meant. Severe oxygen deprivation. He knew, as he bent down to breathe life back into her body, what the slack cooling lips under his meant.  He could feel that her heart wasn’t beating. Her bowels would have let go, along with her bladder, you can smell death. Her skin would have been slack, her eyes already clouded and lifeless.  He knew what it meant … and what it meant for the baby she was carrying.

He had to know.

There was absolutely no way that he could not know the horror of what it meant: she’d been dead for a long time, at least 30 minutes.  Too long.

Now, human beings have been successfully revived after 30 minutes of clinical death. In fact, the record for a successful resuscitation is a bit over three and a half hours, but that was for a victim who was severely hypothermic (immersed in ice water after falling off a ship). The success rate for anything over a couple of minutes at normal temperatures becomes less and less likely with every passing second outside of very special conditions. The body, the organs and limbs, might remain viable, but the brain suffers massive irreversible damage at normal temperatures when deprived of oxygen. It doesn’t take long at all for the brain-stem to die, cutting the brain itself off from the body. At that point, no matter what you do, the heart and lungs and the rest of the vital organs will never work on their own again. At that point, when the brain dies, you, the person, you’re dead and there isn’t any coming back.

As a paramedic, Erick Muñoz would have known that. He would have been thinking about just exactly that – how long had his wife lain there without breathing? without a heartbeat? He would have certainly thought about that while he worked feverishly to save the two beloved and precious lives under his hands, while he waited for the ambulance to come as each frantic second ticked past.

By the time Marlise Muñoz reached John Peter Smith Hospital in Fort Worth, it was far too late.

She had been dead too long.

Pulmonary embolism, the doctors say, a blood clot that blocked a critical artery and stopped her heart.

No warning. No time to unsay all the things he wished he hadn’t said, you know, like people do.  No time to say all of those things a husband wishes he would have said to his wife, that he always meant to say but never did. No time left to do all of those things they planned together. No chance for a child to see his mommy one last time. No chance to say goodbye.

Erick Muñoz went to bed a husband and woke up a widower trapped in a nightmare.

Just bang, blood clot, and gone.

A tragedy.

A horrible, horrifying tragedy.

Marlise Muñoz was not in a coma. She wasn’t in a vegetative state. She was dead. Her brain had died. You can argue about the nature of consciousness all you like, you can ponder the existence of the soul and what might wait behind this mortal coil, but whatever we are at the fundamental level we are electrical impulses firing in a block of meat. And we can measure that to a fine degree. When those sparks no longer pulse between neurons, we, whatever we are, are no longer here.  There was absolutely no doubt about it. Marlise Muñoz was dead.

This isn’t my opinion, this is the clinical diagnosis of her doctors, this is the consensus of more than a millennium of science, this is even the conclusion of religion.

And yet, through the application of modern technology, her body still lived … after a fashion.

And there it is. Right there.

That single terrible moment. That single terrifying, horrible, hideous, despairing lonely moment when there is no longer a chance, when hope and prayer are exhausted, when you are left alone and bereft and there’s nowhere left to turn, and  you realize that it’s now up to you, that they are looking at you, and you, you, have to decide.

And so Erick Muñoz did, he decided.

As a paramedic, as a husband, as a father, he knew. He knew what he was doing. He knew what it meant. He knew what was right for his wife and what was right for their unborn child. He knew. And he decided to pull the plug because for him, for them, it was the right thing to do.

And that was his right.

More, it was his duty to make that decision. Not yours, not mine, his.

There comes a moment when it’s just you. When it’s your decision. When the entire universe rests on your shoulders. And so it was for Erick Muñoz that day. It was his decision. His duty. Not yours, not mine, not the mob’s. Not the hospital. Not the church. Not the government. His. Period.

I’ve been there. Right there.

You see, last summer I watched my father die.

My brother, my mom, and I, we made the only call we could – others might have decided something else, but it wasn’t their decision to make. It was ours. It was our right, our duty, it fell to us to decide. Not you, not the government, not even the doctor, us.

And so we did, we decided, each of us, separately and together: pull the plug.

And then we stood there at his bedside in the ICU as they turned off the machines, as he pulled in his final ragged breath and then was still at last, and it was horrible.

I served in the military for more than twenty years. I served in two wars and numerous actions short of war. I’ve risked my own life and ordered men to risk theirs. I’ve seen men die in terrible ways. But not like that. It was the hardest, most horrible thing I’ve ever done and I don’t wish it upon my very worst enemy. I never dream of war, but I wake at night sometimes and think of that final moment at the side of my father’s deathbed. And the pain never goes away.  But we had to do it.  We had to. Because, for my dad, it was the right thing to do. You couldn’t decide that. You couldn’t know that. You couldn’t tell right from wrong in that particular case, you didn’t know him, you didn’t love him. Only we could decide, it was on us, his family, and us alone.

Could we have decided differently? Was there really a choice?

They could have kept him alive, his body anyway, maybe even some of his mind. Maybe. The machines could have kept his blood oxygenated and flowing, once a day they could have taken him down for dialysis, they could have kept the dozens of IV’s going. They could have fed him through a tube and carried away his waste.  Certainly they could have kept him going, drugged and without pain. His body might even have lived on to this very day, many months later. 

But what about him? His mind? I don’t know, maybe, in a drugged haze of dim awareness perhaps, unable to speak, unable to move, unable to live. Spread out and pinned down like a science experiment, half machine, half rotting meat. Despite multiple organ failures, despite the fact that he couldn’t breathe, despite the fact that his kidneys would never work on their own again, despite the heart damage, despite the fact that he would likely never really wake up again, not really, sure they could have kept him going. Despite the fact that when he was alive he told us many times that he didn’t want to end up a vegetable animated by clockwork and wires. Despite all of that, they could have kept him alive … after a fashion. Warehoused in some care facility, I guess, and I wouldn’t have to wake up in the night with tears in my eyes. 

He didn’t leave a living will, so we could have decided differently.

But he didn’t need to, he had us. And we knew what was right, what was moral. We loved him dearly and so we decided. We did what was right, for us, for him.

We decided to let him go.

We decided to turn off the machines because to do anything else would have dishonored the wonderful marvelous man he was and all of the memories of our lives together.

Because keeping his body plugged in wouldn’t have been for him, but for us.

Because to do anything else would have been pure selfishness.

And so, we decided to let him go.

Just as Erick Muñoz decided for his wife.

Just as Erick Muñoz decided for his unborn child.

 

There is no decision more excruciatingly painful, more terrible, more horrifying, more hideous, more personal. None. Period.

 

Not a day goes by that I don’t wonder.

If we’d waited another day, maybe, maybe some miracle – and that’s what it would have taken, a genuine no kidding divine miracle from upon high, a miracle that I don’t believe in. But, maybe just this once, just maybe, if we’d only waited, my dad might have recovered. You always wonder. You wake up in the middle of the night and stare at the ceiling and you think about your own mortality and hope that your son never has to make that hideous decision and you wonder.

What if?

What if there was a chance?

In the cold light of day, I don’t think so.

I don’t think we did the right thing, I know it.

But still, maybe, just maybe…

It’s natural to feel regret, to wish without hope that the past can be altered by sheer desire, that we can bring our loved ones back from the abyss.

It’s normal to regret the hard, hard decisions you’ve had to make.

And I do.

I do regret what I had to do, but it’s my regret, mine and mine alone. Not yours, not the government’s, not the doctor’s, and most certainly not some howling mob of selfish sons of bitches who think they have a right to intrude into my life, into my pain, and to take my regrets from me. Those regrets are mine and I cherish them even though the pain is terrible.

Those who condemned Erick Muñoz for his decision are like the robot described above, dogmatic, unthinking, inflexible in belief, and utterly inhuman, just following the program. The difference is that a machine can only do what it’s programmed to do, it has an excuse, it does what it does not out of selfishness because it can’t do anything else.

A machine also can’t be a hypocrite.

But those who shed crocodile tears for Marlise and Erick Muñoz’s unborn child certainly can be.

Almost without fail, those who condemned a grieving husband as a murderer and a monster are the very same, the very same, people, the very same governments, and the very same institutions who vehemently oppose research into the very technologies and treatments that might one day actually save and repair such terrible damage. They see nothing wrong with turning a rotting corpse into an incubator for a monstrously malformed fetus, but gasp in horror and scream “Frankenstein!” when it comes to organ cloning, genetic manipulation, fetal tissue and stem cell research.  They demand that this poor child be born, no matter the terrible toll on those who loved it, no matter the damage, no matter the wishes of the parents, and yet these are almost without fail, the same, the very same, people who vehemently oppose social programs such as government funded prenatal/postnatal healthcare and nutrition programs, who derisively label SNAP and WIC as “socialism” and “communism” and who can’t discuss sex education without including the word “Nazi.” These are the very same people who sit smug and pious in their pews each and every Sunday and listen to the words of their prophet who commanded them to feed the hungry, heal the sick, clothe the poor, and to do unto others as they would be done unto themselves, yes those people, these are the very same selfish sons of bitches who daily turn a blind eye and a sneering averted cheek to the sick and the hungry and the destitute – calling them lazy and entitled instead. In a state that repeatedly threatens to secede from the Union over the matter of individual rights and supposed government overreach, these are the very same people, the very same people, who would take away Erick Muñoz’s right to decide and award that duty to the government, to the court, to the mob, to people who never knew Marlise Muñoz as anything other than just another front in their bankrupt and selfish war.

But it’s not their right.

It’s not their decision and it never was.

Texas Lt. Governor David Dewhurst declared on Sunday, “I’m a strong believer of the sanctity of life. This baby could have been born. If I had been in that judge’s shoes, I would have ruled differently.”

The sanctity of life? The sanctity no less. Life. The Lt. Governor of Texas, a state that has executed more than three hundred people in the last decade and is considering a return to the electric chair in order to save money on execution drugs, proclaims the sanctity of life? That’s rich.

Dewhurst is running for reelection, one of his main opponents is State Land Commissioner Jerry Patterson, who weighed in with, “It’s a tragic intersection, the right-to-life concerns and when life ends. We should always err on the side of life. I think we have to change the law.”

Change the law in support of life … by mandating that a corpse be kept on maintenance until the state, or the church, decides otherwise. Right to life, he says, and when life ends. Not only do these people want to control how life begins, they want to decide on when it ends – but, sure, you can trust people like this to leave what comes in between the beginning and the end alone, right? Leave life up to you to decide how to live it. Sure. You go right ahead and believe that if you like.

State Senator Dan Patrick, also a contender for Lt Governor, said, “Life is so precious. There is nothing more precious than the life of a baby in the womb. We are born in the image of God. Whenever we have the opportunity to preserve life, we should.”

Ah yes, God.

The image of God, he says. Preserve life, just like God, you bet.

That would, of course, be the same God who, what? Killed every first born child in Egypt to make a political point? The God who by His own word, drowned every single human being on the planet, less eight, in a fit of pique and for nothing? That God? The one that sent Marlise Muñoz a blood clot as a baby shower gift? Is that the God we’re talking about here? Because if that’s the case, and if you really believe in this stuff, then it would appear on the face of things that Patrick’s God has made His decision brutally apparent: pull the plug. That’s what He did right? Pulled the plug and left Muñoz dead on the floor of her kitchen. Left her surviving son motherless and her husband horribly alone. If you believe in signs and portents, I honestly don’t see how it could get any clearer.

And that wasn’t enough, was it? Then He sent in a bunch of fanatics to torture this poor man for two and half months.  Because, why again?

You want to look up these right-to-lifers’ stance on guns? On military force? On the Texas death penalty? On WIC and SNAP and social programs to feed the hungry, heal the sick, and clothe the poor?

Tens of thousands of children die every month. They cough out their lives on parched ground, starving, diseased, destitute, abused, poisoned, the victims of war and conflict and neglect. They die in the millions every year, unknown and unlamented, here and abroad. Meanwhile, these right-to-life fanatics protest outside a hospital in Fort Worth, Texas, they intrude into the grief and personal tragedy of a stricken family, smug in their morality over one tiny death out of millions, believing that they’ve actually done something worthwhile.

Sanctity of life my ass.

They’ve done nothing, not one goddamned thing other than feed their own diseased egos.

This isn’t about life, it’s about them, it’s about their guilt at their repeated and deliberate failure to live up to the tenets of their own belief, their abject refusal to feed the hungry, to clothe the poor, and to heal the sick. These people aren’t in it for Marlise Muñoz’s unborn baby, they’re in it to make themselves feel better and make no mistake about it – because if they weren’t, if they really truly actually believed in the sanctity of life, well then they’d actually do something about the lives they could save.  All of them.

 

This wasn’t our decision.

This most certainly wasn’t a decision for a politician.

This wasn’t the government’s decision.

This isn’t the press’ decision, or some ad hoc group on Facebook, or the mob’s

This isn’t the church’s decision, and it most certainly isn’t God’s decision – should he in fact actually exist and give a good goddamn about his creation.

For Erick Muñoz, there is no right or wrong, for him there is only grief and loss and tragedy.

Whatever his decision, it was the right one, because only he could make it.

This was his right, his duty, his burden and his regret.

His and his alone, as a husband, as a father.

Nobody else should get a vote.

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Note about commenting: Due to the nature of this essay, and the inevitable lunacy it will no doubt attract (has already attracted) comment moderation is on and will remain so.  I will review each comment before allowing it to post. Stonekettle Station isn’t 4-chan, or The Blaze, or Yahoo News, or any other capering monkey shit-fight, so don’t act like it is. You’re entitled to your opinion but you’re a guest here and you’ll damned well behave like a rational adult or you’ll get a boot in the teeth. This is non-negotiable and I don’t care if you don’t like it.  If you want your comment to post, adhere to the following guidelines:

Edit: Since it’s glaringly apparent that evangelicals, anti-abortion nuts, and other such shrill fanatics have trouble with reading comprehension, as the roughly 200+ and counting discarded comments from such can attest, I’ve taken the liberty of bolding the relevant commenting criteria below. Take heed:

1) Don’t be an asshole. Be polite. Be well spoken. Use proper punctuation. The ability to spell and assemble a sentence to the 8th grade level is also appreciated.
2) Keep your religion to yourself. I won’t be proselytized nor will I allow you to preach at my readers, not in any way whatsoever, period. If your God is offended by something I said, he/she/it is welcome to contact me directly, I don’t need you to act as an intermediary.
3) Any comment that includes the word “abortion” will not post. Repeat: It. Will. Not. Post. REPEAT: IT. WILL. NOT. POST.
4) Personal attacks will not post. I don’t care if you think I’m a (insert your favorite insult: Nazi, Commie, Satan Worshipping Baby Murderer, Pinko Liberal Fag), I don’t care.  I. Don’t. Care. So don’t bother. You may assume that I’ve heard it all before by better people than you. 

Hope that clears things up.

Also, if you mention abortion, your comment will NOT post.

//Jim