Patient’s same-sex husband.
Patient’s middle-aged aunt.
Fourth-year Medical Student, part of the patient’s care team. Female. Very young in comparison to other cast.
TIMEEarly evening, during visitor hours.
(A hospital room, during visitor hours. A family is gathered around the unconscious body of Jimmy Catalano. Chuck, Jimmy’s husband, is comforting Aunt Bella.)
AUNT BELLAWhy don’t someone tell us something?! We been here 45 minutes and nobody will tell us nothing. Where is James’ friggin’ doctor? That nurse at the front desk won't tell us a damn thing.
CHUCKShe can’t. Nurses are forbidden from discussing a patient’s prognosis with family members. That’s the doctor’s job.
AUNT BELLAThen where the crapola is James' doctor?
RESIDENTExcuse me, may I come in?
(Charging the Resident.)Where the hell is Doctor LeDoux? We been waiting here one hour. I want James’ doctor to get in here and explain to us what the hell is going on!
RESIDENTI’m sorry you’ve been waiting so long. Doctor LeDoux is not available right now. She’s in the O.R. That’s why I’ve come in.
AUNT BELLAAnd who the hell are you?
RESIDENTMy name is Veronica Melbourne, I’m a Resident. I’m part of the team that’s taking care of Mister Catalano.
AUNT BELLAA Resident? We want a real doctor!
RESIDENTI assure you I am a real doctor. I’m in my last year of Medical School, and residency is the final step in my training. As I said, I’m part of the team who’s been caring for…
AUNT BELLAThis is how Tulane treats families? We find James unconscious, unresponsive, with a tube down his throat. But no! The doctor makes us wait and nobody tells us nothing! Except that orderly. He walked by here, looked in and muttered “Oh, that coma guy”. Holy Mother of God! A coma?!
RESIDENTI am so sorry that orderly said that. That is grossly inappropriate. I will personally follow-up with the orderly staff to find out who said that and make sure it never happens again.
CHUCKIs that what’s going on? Is Jimmy in a…a coma? Why is he in a coma?
RESIDENTSir, what is your relation to Mister Catalano?
CHUCKJimmy is my husband.
(beat)I have some difficult information to discuss with Jimmy’s…Mister Catalano’s legal next of kin. Does Mister Catalano have a…um, wife?
AUNT BELLADo you hear what Charles just said, young woman? He and James are married. Just as married as I was to my dear, departed Alonso.
RESIDENTI understand that. Unfortunately, the State of Louisiana does not yet recognize same-sex marriage as legal. I mean no offense, but..
AUNT BELLAWe are offended! How would you like if YOUR husband was in a coma…
RESIDENTI did not say coma. And my hands are tied on this matter. As a medical professional, I do have to work within legal guidelines. Does Mister Catalano have any adult children?
CHUCKNo. We don’t have kids. Jimmy doesn’t have kids.
RESIDENTI see. Are his parents alive? Does he have adult siblings?
AUNT BELLACharles and me are James’ only family. His parents kicked him out when he was 16 for being Gay. Then they died in a house fire—God have mercy on their souls—in their own bed. Now I am James’ only blood relative.
RESIDENTMa’am, your relationship to Mister Catalano?
AUNT BELLAI am his aunt. James’ mother is my sister. James and Charles are practically my own sons.
RESIDENTThen that makes you Mister Catalano’s legal next of kin. As I said, I mean no disrespect to you, Mister…??
CHUCKCaldwell. Chuck…Charles Caldwell.
RESIDENT(to Aunt Bella) And how may I address you?
AUNT BELLAMrs. Isabella Lorraine Alfaro. The boys, they call me Aunt Bella.
RESIDENTMrs. Alfaro, hello. Again, my name is Veronica Melbourne. Before we begin our discussion about Mister Catalano’s care, what would you like to happen right now? Should I discuss with you alone, or would you prefer Mister Caldwell to also be present?
AUNT BELLAAre you retarded in the head? Of course I want Charles present! He is James’ husband! You have the moral responsibility to discuss James’ healthcare with James’ husband!
RESIDENTAlright. As long we all understand that any decisions regarding Mister Catalano’s care can only be made by his legal next of kin. Please, may we sit down?
CHUCKIs it that serious?
RESIDENTWhat I came to discuss is difficult. Sitting down is a good idea.
AUNT BELLASit here, Charles. No thank you. I will stand.
AUNT BELLAPlease, include us both.
RESIDENTYes of course. Mrs. Alfaro and Mister…??
AUNT BELLAHe said Caldwell!
RESIDENTExcuse me. I’m so forgetful with names when I feel nervous. Mrs. Alfaro and Mr. Caldwell, please prepare yourself for difficult news.
CHUCKIs it a coma?
RESIDENTBefore I answer that question, can you explain to me what you understand about Mr. Catalano’s condition?
AUNT BELLAJames came here this morning to Tulane for knee replacement surgery. Now he won’t wake up. Got that tube down his throat.
CHUCKI dropped Jimmy off myself. Bella and I came back now, together, to check on him. Assumed he would need to rest up a couple days, then we’d take him to our home. But we don’t understand why he won’t wake up.
AUNT BELLAAnd that chooch in scrubs looked in and called him “the coma guy”!
RESIDENTAgain, that was inappropriate. Mister Catalano’s surgery did go well. Only a couple hours ago he was alert and speaking.
CHUCKIs he in a coma now?!
RESIDENTNot a coma, Sir. Please allow me to continue. I promise I will answer all your questions after I give you complete information. As I said, Mister Catalano was alert and speaking. Then the Charge Nurse informed the medical team that he was complaining of shortness of breath.
CHUCKOh my god.
RESIDENTI was part of the team that rushed into the room to help Mister Catalano. By the time we arrived, he was unconscious and non-responsive. We started CPR and then requested a Code Team.
AUNT BELLAA what?
RESIDENTAn emergency trauma team. They confirmed that Mister Catalano’s heart was not beating, and they took over the CPR.
CHUCKHis heart stopped beating? Why?
RESIDENTAfter knee surgery, it’s common for a deep-vein thrombosis to form.
AUNT BELLAMissy, you better start speaking English. We have every right to understand this. And we can. If you speak language we understand.
RESIDENTOf course. I apologize for my word-choice. Let me back up a little. After Mister Catalano’s surgery, a blood clot formed in his leg. The clot broke away from the site of the surgery, and travelled in his blood stream to Mister Catalano’s lungs.
CHUCKYou said his heart stopped beating. He had a heart attack?
RESIDENTNot exactly. The blood clot blocked the major artery between Mister Catalano’s lungs and his heart. We call that a pulmonary embolism. Because of the blockage, his heart could not receive oxygen, and that’s why he had a cardiac arrest. His heart stopped beating.
CHUCKBut Jimmy doesn’t have heart problems!
RESIDENTIt was the clot, Sir. One possible risk of this kind of surgery is the formation of blood clots.
CHUCKSo why is he unconscious? Why the tube in his throat?
RESIDENTThe Code Team did CPR to get his heart beating again. After numerous attempts, they were finally successful. But although his heart did start again, in the meantime, Mister Catalano’s brain was also deprived of oxygen.
CHUCKHis brain? For how long?
RESIDENTWe don’t know for sure. Long enough that his brain suffered anoxic brain damage.
RESIDENTBrain damage due to the lack of oxygen. That tube you see is helping Mister Catalano breath. The brain controls breathing. But because of the brain damage, Mister Catalano’s body cannot breath on its own.
CHUCKPeople wake up from comas all the time.
RESIDENTThis is not a coma, Sir. The damage is more severe than that.
AUNT BELLAWhat do you mean more severe than coma?
RESIDENTWe don’t believe Mister Catalano will wake up.
AUNT BELLAHe’ll wake up. Look, he’s breathing. I see him breathing!
RESIDENTI’m sorry to tell you this bluntly, Ma’am. But what you see is a machine breathing for him. If we remove the machine, his body won’t breath on its own.
CHUCKHe will die?!
RESIDENTI’m so sorry.
AUNT BELLAJames chose Tulane! He didn’t have to come here for surgery. He did the research. Tulane is supposed to be the best in Orleans Parish for this kind of knee replacement surgery. How could you let this happen?
RESIDENTWe are investigating right now how this happened. The best we can tell, after surgery, Mister Catalano should have received an anti-coagulant medication to prevent blood clots. He wasn’t.
AUNT BELLAWait, what? You were supposed to give Charles medicine to prevent THIS! And you didn’t? This is your fault!
RESIDENTI’m so sorry.
AUNT BELLASorry?? Sorry won’t feed a mockingbird! Sorry won’t wake up my nephew!
RESIDENTOf course you’re shocked, angry, and grieving. I don’t claim to understand exactly what you’re feeling. But I am here to help you any way I can.
AUNT BELLAHelp us by waking up my nephew!
CHUCKBella, please. It’s not her fault. She’s the bearer of bad news. (to the Resident) You tried to save him. You gave him CPR. Thank you for that.
RESIDENTI did everything I could, everything I know how to do.
CHUCKAnd now Tulane rewards you by making you give us the bad news. You’re a very fine young doctor, Miss Melbourne.
RESIDENTOh! Thank you, Mister Caldwell. It’s my duty and my honor to be with your family at a difficult time like this. (beat) There’s more for us to discuss.
AUNT BELLAGod in Heaven! Are you kidding us?
CHUCKBella, please. Let her continue.
RESIDENTMrs. Alfaro, did Mister Catalano ever discuss what he would want if something like this ever happened?
CHUCKWhat do you mean?
RESIDENTHow would Mister Catalano, James, want us to care for him? For example, we can keep him on the ventilator. And if he has another cardiac event, I mean, if his heart stops again, we could resuscitate him.
AUNT BELLAOf course we want that. We want him to live!
RESIDENTIs that what James would want? If his quality of life is compromised like this?
AUNT BELLAMy nephew wants to live! Tell her, Charles.
RESIDENTEven knowing that he probably won’t ever wake up? Or if he did, he would not be the James you know?
AUNT BELLAWell, I want him to live! You said I’m his next of kin. His legal next of kin. You have to do what I say. I want him to stay alive!
AUNT BELLAI'm sorry, Charles! But I can't just do nothing. Let them pull the...I can't stand by and watch James... He's my boy! You're both my boys.
CHUCK(to the Resident)
We cannot possibly make a decision like that. Not minutes after you just walked in here and dropped a bomb on us.
RESIDENTOf course not. Mrs. Alfaro, you do not have to make any decisions right now. I’m introducing the topic. Begin to think about what I’ve said.
AUNT BELLADon’t ask me! You should ask his husband! Charles! Charles is his husband!
RESIDENTMorally I agree with you. But you are the legal next of kin. Discuss it together then. Decide as a family the best course of action for Mister Catalano. What he would want. What the two of you together think is best.
CHUCKJimmy and I watched that whole Terry Schiavo fiasco in disgust. We never imagined it could happen to us.Never talked about what we would want. We both thought the real tragedy was that family’s grief put on display, held up to public scrutiny. Judged by Fox News and Facebook.
AUNT BELLATerry Schiavo! No! No!
RESIDENTI know this is unthinkable, terrible news. But is there anything I can explain better? Do you have any questions for me right now?
CHUCKNo, not right now. Bella, Dear, any questions?
AUNT BELLAIsn't there any hope?
RESIDENTI can assure you he's in no pain.
CHUCKMy God! Oh my God! I don't want Jimmy to be in pain! Bella, I don't want him to feel pain!
RESIDENTMister Caldwell, we also have medications we can give Jimmy to ensure he does not feel pain. Medication and other forms of palliative care...to ease his transition.
Perhaps I should give you some time to talk and absorb this. I can come back any time you need me. If you do think of other questions, ask for me by name, Veronica Melbourne.
AUNT BELLAThank you, Miss Melbourne. We need time alone now, to talk...to grieve as a family.
RESIDENTOf course. Again, I’m so sorry, Mrs. Alfaro. Mister Caldwell... (Attempts to touch Chuck's arm, hesitates, then exits)
AUNT BELLAI don't understand what just happened to our family!
(The dam breaks, and Chuck finally has the break down he has struggled to hold back. Bella embraces and comforts him)
CHUCKJimmy is my husband!