Saturday, May 10, 2014

Heartbeat by Elizabeth Scott

One heartbeat, two heartbeats, three heartbeats, more, and you never know when you have used yours up.
That's the thing. You don't know.
How long will your heart beat for? How many heartbeats do you have?

Scott tackles an unusual ethical dilemma in her latest novel, Heartbeat. Seventeen year old Emma's mom, Lisa has "died" and is being kept alive on life support by her mom's new husband, Dan, so that their unborn baby son can continue to develop in-utero long enough to be delivered. Emma is horrified by Dan's apparent unilateral decision, believing that this is not what her mother would have wanted.

"I mean, I know it's a baby and it's partly Mom, but I wish Dan had just once thought about what Mom would have wanted." p. 15

Shortly after her mother and Dan married, Emma's mom began taking fertility treatments. She spent two years in fertility treatments before she finally succeeded in becoming pregnant. However as Emma's mother had previously had a blood clot in her leg, her pregnancy was not without some risk. Then one day, at twelve weeks into her pregnancy, Emma's mother was reaching for a piece of toast and collapsed.  She had a massive embolism in her brain.

Dan was given the option to turn off the ventilator or keep Emma's mom on it and save their unborn baby. He chose to try to keep his wife alive to save their unborn baby believing that this is what she would have wanted. But Emma is distraught because she feels Dan has chosen the baby over her mom, who has now been on the ventilator for almost four weeks.

Emma's anger over her mother's situation is so overwhelming that it threatens to destroy her entire life. She isn't on speaking terms with her stepfather, Dan, and spends most of her time at her friend, Olivia's home. Emma was an excellent student working towards gaining admission to one of the top ten schools with the goal of obtaining her PhD in history. Now she doesn't care about school, her assignments are late or not completed at all. And most of all she doesn't care about her ex-boyfriend, Anthony, the self-absorbed boy who made out with her and then dumped her.

But then Emma meets bad boy Caleb Harrison. Emma has already formed an opinion about Caleb who has a reputation at school for being a "total druggie" and who steals cars. He drove his father's limited edition Porsche into the lake and watched it sink. When Emma goes to the hospital to see her mom, she runs into Caleb doing volunteer work. But when Emma really looks at Caleb she realizes that he is sad, although she doesn't know why.

Emma continues to encounter Caleb at the hospital and when they talk she realizes that he understands how she feels. As their relationship develops amid a shared loss, Emma discovers that Caleb empathy and understanding give her the strength to confront her stepfather about what she's feeling and about what happened to their family.

Heartbeat considers a very specific medical situation, one which has been in the media recently, involving keeping a pregnant woman who has been diagnosed as "brain dead" on life support so that her unborn baby might have a chance to survive to viability.The concept of brain death is something Scott never directly addresses in her novel but it is central to the story and important to understand.

A person is declared brain dead when a specific set of criteria have been met. These criteria were  developed in 1968 by the Harvard Medical School specifically so that organs could be retrieved from living donors for transplantation. What many people do not know is that organs "harvested" from a dead person without a beating heart are unsuitable for transplantation because they deteriorate within minutes of death. For organs to be suitable for transplantation, the donor must have a beating heart and continue to breathe and must do so until the last organ, usually the heart, is removed.

While most doctors have accepted the brain death criteria, some doctors are now questioning both the neurological criteria for declaring brain death and its use. One of the main criteria used in declaring brain death is the apnea test where the patient is removed from a ventilator to see if they can breathe on their own. This inability to breathe is not necessarily a sign of death. A ventilator might be needed to aid in the patient's recovery and in some cases removal either causes more damage or results in the patient's death. Complicating the brain death issue is the fact that patients who have been given a diagnosis of brain death continue to behave as a living person; hair and nails grow, food is digested and expelled, unborn babies continue to grow. Are these patients truly dead?

Further complicating this issue are the countless situations related in the media over the past thirty years, of people declared brain dead, who regain consciousness sometimes immediately prior to having their organs removed. It seems that we do not fully understand injuries to the brain and how the brain heals from these injuries.

Recently there have been several situations which have re-ignited the discussion around brain death - namely pregnant women who have been kept alive so that their unborn babies might grow to 24 weeks and be delivered. There is no doubt that these situations are terribly traumatic and complicated for the families involved. Each case must be taken on an individual basis as each pregnancy is different.

While this short novel doesn't go into all this detail, Scott does a good job of demonstrating how traumatic this situation is to Emma and her stepdad. It rips apart their relationship as both make assumptions about how the other felt about the wife and mother they loved and lost and what she was experiencing during the pregnancy and what she would have wanted for their family.

As Emma's life disintegrates, it is her relationship with Caleb that ultimately helps her get back on track, confront Dan about what happened when her mother collapsed, and what their relationship will be in the future. Although Emma's situation is difficult, Caleb's is tragic as his parents seem unable to cope in any way with the death of their daughter, Minnie. Their personal tragedies allow Caleb and Emma to forge a bond and develop a relationship that is both affirming and supplies mutual support. With Caleb, Emma can begin to grieve and this helps move her forward to the next steps of acceptance and hope.

The timeline regarding Lisa's pregnancy seems confusing in the novel. Emma tells Caleb in Chapter 15 (p. 74) that her mother died "a little past twelve weeks pregnant" and that she is now on life support at sixteen weeks. But at the end of the novel, in Chapter 50, Emma states that is been "forty-three days since Mom died" and that she is now twenty-five weeks pregnant. However, forty-three days is a little over 6 weeks which would make her mother only 18 weeks pregnant, unless Scott means that is was forty-three days since Lisa's 16th week.

Fans of Elizabeth Scott will enjoy the emotional drama in this novel, as will those readers who read Lurlene McDaniel's novels which focus on characters struggling with a chronic illness.

Book Details:
Heartbeat by Elizabeth Scott
Don Mills: Ontario  HarlequinTeen    2014
244 pp.l

No comments: