noticed, had become strangely silent. He gave a short laugh that reminded her of the sound that a very old and faithful bicycle tire makes when it is deflated for the last time.
It was then that she knew why Khun Suphit was sitting in her office now. She knew why this important man had honored her by coming to her little office in the hospital’s basement. And why he looked so uncomfortable.
“You see,” he said slowly, “I’m not sure she knows about her husband.”
“You’re not sure? Ah, Khun Suphit, so you mean you’re not sure she understands what you’ve told her?” Ladarat was almost certain this was not what the director meant.
“Well…” Again the sad laugh.
“Yes?”
“You see, we have not told her yet.”
“Indeed?”
“Indeed.”
So the director did not want to tell the woman. He did not want to be the bearer of bad news, and above all, he did not want to cause distress. So very Thai. And yet so very wrong. Did he not have an obligation to share this news honestly? He most certainly did.
“Ah, I see,” she said. “And so… when you do tell her, you are worried that she will be upset. Of course I understand. When you tell her, we should invite one of the monks from Wat Sai Moon.” That was the monastery across the road from the hospital. “Would that be helpful?”
He shook his head. “No… I mean, yes, it would be helpful. But it’s just that we… I… thought that it might be better if you tell her.”
Oh dear.
“I see,” she said. “But why would that be?”
Ladarat knew exactly why that would be, but she pressed on. “You know his condition better than I ever could. After all, you’re his doctor, and the director of the ICU. Such information should come with authority. Who better to explain his condition and prognosis?”
“Ah,” he said. “But you… you’ve spent time in America. In Chicago.” He pronounced that city with singsongy Thai vowels that oddly seemed to fit her memories of the city better than the prosaic pronunciation to which she’d become accustomed.
“I thought that since you know Americans, and how they think,” he continued, hurrying, “you’d be better able to explain his condition.”
“And what is his condition?”
Relieved to be back on firmer ground, the director stopped fidgeting and assumed the calm, patient demeanor to which Ladarat was accustomed. He smiled sadly and explained that the man’s condition was very grave indeed. “He has no evidence of brain function. His pupils are not contracting, and he cannot breathe on his own.” He paused. “It is, truly, very bad.”
Ladarat nodded, beginning to see why the director wanted her to convey this information. In the United States, she knew, this man would be brain-dead. His life support would be stopped. That would be very sad for the man’s family, of course. But at least they would be able to close that door behind them.
But here in Thailand there was no such door for them to close. There were no such hard-and-fast rules about what to do. So it would be difficult indeed to explain the man’s situation to his wife. And if his situation were not explained correctly—and perhaps even if it were—she might insist on keeping him “alive” and supported artificially, for weeks or even months.
Their hospital could not afford that. Their ICU was always full, she knew, and there was always a waiting list. As long as the American was there, there would be patients who would not get the ICU care they needed.
Of course she would help. There was no question of that. Wasn’t this why she’d been sent to receive ethics training at the University of Chicago? Wasn’t this why she had braved a year of extreme cold, and rude people, and bland, salty food? Food, in fact, that was so tasteless that eating a meal was no more satisfying than reading a menu. She suffered all of that for a year so she could bring the principle of ethics back to the best hospital in northern