‘How are you this morning?’ William asks. He was watching carefully from behind the glass when I ran the press gauntlet outside. It amazes me how grown men and women can, in the name of journalism, shove their cameras in my face and obstruct my path and be downright obnoxious about how they speak to me. It’s nothing less than populist bullying condoned by the authorities, unwanted, consistently negative behaviour that’s allowed – or as has been my experience – encouraged to happen. Journalism, my arse.
‘Okay.’ I say and we both nod knowing that I’m neither okay nor does he want to talk to me about it. I suspect emotion is not his strong point; his currency is cold hard facts. It’s probably why we all play this charade. How are you? Subtext: I’m only passing myself politely, please don’t answer and burden me with your feelings. If you lie and say you’re grand, I’ll pretend to believe you and we can all go about our day as though nothing has changed. We all do it, this mental dislocation thing of putting our heads in the sand to protect ourselves from having to face the unpleasantness experienced by others. The we all have our own shit to contend with and there’s no room for more, or the I’m happy right now so don’t rain on my parade brigade. If we don’t see it, we can pretend it’s not happening, leave the difficult stuff to the shadows and keep the sunny side up. What would William do if I said I wasn’t okay? What would he do if I told him that I’m about to lose my mind?
Should I tell him that when Abbie and Josh had both gone to bed, I spent the night reading every comment anyone had ever made about me and my family and believe me, since Jenny died last June, there have been a lot. Should I tell him that a simple google of my name would have me sentenced to death in some states in America. Although I’m sure he and the team have seen the vile comments for themselves. I even, in the early hours of the morning, looked up the definition of guilt. It says to take account of one’s own actions. To be culpable, blameworthy, responsible, accountable. I am to blame. I’m responsible for everybody’s upset at the moment, Abbie’s, Josh’s, Alex’s – even Sarah’s. ‘And how are you today, William?’ I ask in response.
‘Yes, good,’ William takes the seat beside me and nods towards Lucinda. ‘She’ll most likely call the medical witnesses today, Jennifer’s doctors, and if she still has time, the state pathologist.’ He follows the focus of Lucinda’s eyes. They’ve fallen determinedly on the man just to her left. I presume him to be Jenny’s doctor. I have never met him. To my shame, I had left Jenny by the time she was diagnosed and therefore never had to bring her to any of her hospital visits. He’s a wiry-looking, middle-aged man, most probably the same age as I am, with the body of a runner. Lean, tall, with round glasses worn tight to his face. Did she feel abandoned when I wasn’t with her at her hospital visits? Did she feel aggrieved that the ‘in sickness and in health’ promise I made wasn’t worth the price of the four-tier wedding cake that we never ate?
‘Worst part of the week is over with,’ William says and I scrunch up my forehead trying to understand what it is he means. ‘Monday. Monday’s always the worst, he whispers benignly by way of explanation and I nod as though I agree and do a mental check to make sure I’ve got the right day. It’s Tuesday, the fourth day of the trial. The doctor is ushered towards the witness stand and the room falls silent.
*
I can remember, almost to the hour, the day I first saw Jenny. Her lips were probably one of the first things I noticed about her, that and the way her auburn hair fell down her back. It was in the bar of the Shelbourne Hotel on St Stephen’s Green on the 10th of December 1995. It had been a work Christmas party. I had seen her with her friends and when she broke away to go to the bar, I did the same in the hope that I’d get talking to her. When I noticed what she was ordering, Jack Daniels and Coke, I ordered the same from a different barman and orchestrated a mix-up just so I could talk to her.
‘Eh, I think that’s mine,’ she had said, looking to the barman to confirm and then back to me as I lifted the drink that was placed in front of her to my lips. I remember looking at her and thinking how beautiful she looked up close. She had the most luscious auburn hair and a smattering of freckles across her nose and the green dress she wore clung to her body in all the right places. She was the epitome of Irish beauty. I had told her as much that night.
‘It is?’ my answer had come only after I had cheekily taken a sip. ‘Oh, sorry, you’ll have to let me buy you a drink now to make up for it,’ I had said. ‘It is Jack and Coke, isn’t it?’ I asked her, knowing full well that it was.
‘It is,’ Jenny had been shaking her head slightly in what looked to me at the time to be disbelief. I nodded at the barman to bring two more and we each poured the coke over the crackling ice and whiskey before we lifted the glasses to our mouths in unison, all the while looking at each other.
‘So,’ the whiskey had warmed the back of my throat. ‘What are the chances of that?’ There had been an undeniable sparkle in her eyes, she was the most beautiful woman I had ever seen.
‘The chances of what?’ she had asked grinning. ‘Jenny, by the way,’ she had placed her glass on the bar and had held out her hand for me to shake.
‘Liam,’ I had said. ‘I meant what are the chances of you and me ordering the very same drink at the very same time?’
‘Do you mean what were the chances or what might the chances be in the future?’ she had a playful grin on her face. ‘Because one refers to the probability or the likelihood of the same thing happening in the future, you know?’
‘Yes,’ I had beamed at her reply, trying but failing to come up with anything that sounded even remotely as clever. ‘I do indeed know the difference,’ I had managed and hesitated while she moved closer to me, grabbed my arm and led me away from the bar area so we were standing by the alcove just inside the bar doors with our rattling iced-whiskey glasses in our hands. As I had moved behind her a heavy scent of perfume wafted up my nose, intoxicating me more than the double whiskey I had just lowered.
‘That’s better, so what were we saying?’ When she had leaned into me, her hair brushed off my cheek, sending shivers down my spine.
‘I’m not sure what we were saying but I think you were actually flirting with me by insinuating that my grammar, or use of auxiliary verbs, was incorrect,’ I had been delighted that I had remembered some terms from English class. Her eyes had widened in equal measures of surprise and interest with what I had said.
‘No, I wasn’t,’ she had a smirk on her lips trying to feign indignation. ‘I don’t flirt, and there’s no need to go all auxiliary on me,’ they way she had lifted her hands up as though she was surrendering had made me smile. ‘I was just checking on whether you want to know if there is a likelihood of it happening in the future or whether or not us, you and me, getting a drink together was all in the past.’ She had this way of biting her bottom lip when she was nervous and even though she had come across quite confident, I could tell she wasn’t in the habit of being so forward. ‘Anyway, you got the last drink so now I’ll have to buy you one back, you know, just to keep it even.’
‘You don’t need to…’ she had placed her fingers on my lips to stop me from objecting and her touch was like electricity.
‘I want to, I prefer things to be like that.’ She had said.
‘Okay.’
‘And I must say, the whole ordering the same drink as me just so you can pretend that you just happened to be drinking my drink by mistake was smooth.’
‘So you’re on to me, then.’
‘Yep.’
‘Well, just so you know, the whole grammar line… has to be the most original chat-up line that I have ever had the pleasure of being victim to, that was smooth too.’
‘If not the most grammatically correct,’ she had added matter-of-factly and clinked her glass off mine.
*
When I think of it, the night I saw Jenny for the very first time, it takes all my strength to hold back the tears. It was so perfect then, the night I fell in love with her. The night I vowed never to hurt her.
‘Professor Hegarty,’ Lucinda juts her chin forward a touch and stretches her neck sideways. Every time she stands she looks as though she grows an extra inch and the sincerity in her expression is hard to deny. It’s the same obscure expression she has in the video clip that both the news stations ran last night and the night before. I expect it’s the same clip they’ll use every night. Lucinda Cassidy looking refined and professional, followed by me scurrying clumsily from a silver Nissan Almera taxi, my head down as though I was facing into a headwind and a contorted expression on my face. ‘Can you tell the court what you were treating the deceased, Ms Jennifer Buckley for?’ she looks in the direction of the jurors making sure they know she means them. It’s them she needs to convince, they’re the ones she’ll manipulate with her turn of phrase, her academic sleight-of-hand and she’s not leaving anything to chance. Dr Hegarty nods, takes a sip of his water and begins to speak.
‘I was treating Ms Jennifer Buckley for motor neurone disease. MND for short.’
‘And can you tell the court what MND is?’
‘MND is a rare neurological condition that causes the degeneration and loss of function of the motor system. It’s quite a complex, multi-system disease.’
‘And briefly, if you could, outline what the motor system does?’
‘The motor system includes the cells and nerves in the brain and spinal cord which control the muscles in our bodies.’
‘And what are the life expectations for a patient with MND?’
‘Most people with MND live within a range of two to five years after experiencing their first symptoms and at least one in ten people live more than ten years. MND is progressive and symptoms worsen over time. Sadly, MND severely reduces life expectancy and the variable rate of progression makes predicting prognosis difficult.’
‘When was Ms Buckley diagnosed?’ Lucinda looks directly at me when she asks the doctor this question. I drop my eyes. Her question, even though not directed at me, will be the trampoline that everyone will jump on to reach their conclusion when Dr Hegarty answers. Did Liam Buckley leave his wife even though he knew she was terminally ill?
‘It was February 14th, 2016.’
‘So, for a patient to present in your office with symptoms would it be a fair presumption that they would have been experiencing the symptoms for quite some time before that?’
‘Judge, if I may?’ William is on his feet objecting to the way the question is phrased. ‘Fair presumptions are not medical facts, the witness is a witness of fact.’
‘I’ll rephrase,’ Lucinda nods before Mr Justice O’Brien has a chance to reply. ‘Professor Hegarty, what is the normal procedure every patient must engage in to end up with an appointment at your office?’
‘Every patient would have, in the first instance, presented at their GP’s office with typical symptoms. Their GP would then make a referral to a consultant for further investigation.’
‘So, there is no direct appointment system, Jennifer Buckley did not wake up on the morning of the 14th of February with symptoms of MND and make a direct appointment with your office for that day?’
‘No. She would have been referred by a GP.’
‘And in the medical notes of record, when did Jenifer Buckley first notice the onset of these symptoms, that brought her to her GP?’ she glances at William, her rephrase dripping with defiance.
‘She reported that she had been noticing a drag in her foot, extreme bouts of fatigue and muscle spasms since November 2015.’
She looks at me then, the accusation is in her expression. ‘So is it a reasonable assumption, in your medical opinion, that the symptoms would have presented themselves in the latter half of 2015.’ The nuanced jibe at the timing of when I left Jenny doesn’t go unnoticed. The suggestion is all it takes.
‘And could you give a brief outline of how MND affects the body.’
‘Well, as the disease spreads, the patient’s muscles will weaken or start to stiffen and their range of motion will decrease and muscle pain will increase.’
‘And how do you determine the rate at which a patient is deteriorating?’
‘Patients are usually quite astute at identifying even the most miniscule of deteriorations themselves. Because of this we take account of a patient’s own observations, they know their body best, and we monitor patients on a regular basis.’
‘How regular?’
‘Every three months and we evaluate deterioration by putting the patient through a range of tests… functional tests that examine changes in breathing, speaking, sleeping, swallowing and walking.’
‘So, since Jennifer Buckley’s first appointment on the 14th of February 2016 how many times would you have seen her, before her untimely death?’
‘Nine, nine exactly.’
‘And in this time, did you observe clinical deterioration at a rate expected for someone with Jennifer Buckley’s diagnosis.’
‘Yes, it was within expected parameters.’
‘And would you say that Ms Jennifer Buckley, in your expert opinion, had reached the late stages of her disease?’
‘No, based on the scales we use—’
‘Which are?’
‘The Barthel disability scale and the MND Functional Rating Scale, based on these results I would place Ms Buckley at the middle stages of progression.’
‘Middle stages?’
‘She tired easily, used a wheelchair when needed, her breathing became laboured from time to time, but she hadn’t yet reached the point where she would have needed the assistance of a BIPAP machine,’ he scrambles to be less technical and stretches forward to the mic. ‘It’s a breathing machine,’ he adds for clarity. ‘Nor had she reached the point where she needed artificial feeding assistance.’ Lucinda delays a moment letting the information sink in. A female juror in the front row coughs to cover the awkward silence Lucinda’s pause leaves.
‘So, in your expert opinion, Professor, Ms Buckley was only at the middle stages of progression, nowhere near the late stages of the disease?’
‘Again, it’s hard to predict the progression rates due to the complexities of the disease. In fact, it’s usually post-mortem that the exact age of the disease is confirmed but as Ms Buckley presented on her last visit with me, she was not at the end stages of the disease.’
‘And did Jennifer Buckley ever provide you with information about her preferences when she did eventually get to the end stages of the disease?’
‘Yes, she did. We encourage all patients with life-limiting illness to think about an advanced care directive that allows them to express their preferences when it comes to their specific care if and when they reach their end of life. Ms Jennifer Buckley did complete an advanced care, directive.’
‘And what did that state?’ Lucinda asks.
‘It stated that if and when there was no prospect for her recovery, and she was to become unable to take part effectively in decisions regarding her medical treatment, she wished that no life-sustaining treatments were used.’
‘Can you state for the court, what life-sustaining treatments are?’
‘It could be any treatment that, in the absence of it being provided, the patient would die.’
‘Could you give us examples?’
‘Being placed on a ventilator, a dialysis machine, artificial feeding either through an NG tube, a PEG tube in the abdomen or intravenously,’ he pauses before he adds. ‘It also covers cardiopulmonary resuscitation.’
‘And in your opinion, Professor Hegarty, was Ms Jennifer Buckley at the point where her medical care required any of these treatments?’
‘No.’
‘Nothing further.’
The courtroom falls silent for a moment while William stands to his position at the bench. He turns the pages of his brief in front of him. ‘Professor Hegarty, can you confirm for the court that in the course of Ms Jennifer Buckley’s illness you saw her a total of nine times?’ He says the number nine as though it’s incredulous, as though it’s entirely insufficient and unsatisfactory, a whole other systemic fault. ‘Nine?’ he asks again for good measure.
‘Yes, we saw Ms Buckley a total of nine times.’
‘Can you clarify, who you mean by “we”?’ William asks.
‘By “we” I mean my team.’
‘Okay, so did you personally see Ms Buckley all nine times?’
‘No, that’s not…’ he hesitates, looking at the expression on Lucinda’s face. ‘That’s not the way it works, my team are tasked with seeing all the patients in the clinic, I might not get to see all patients that present at all of their visits, but I do review their charts, oversee their care.’
‘So, you didn’t see Jennifer Buckley all nine times?’
‘No.’
‘Thank you, Professor Hegarty. You mentioned earlier that you record and take account of a patient’s observations while recording the changes in their abilities, can you repeat why you do this?’
‘Well, as I said, patients are quite astute and can identify intrinsic changes more readily than a battery of tests might be able to.’ He leans forward to the mic. ‘They know their own bodies and whether or not something has changed.’
‘So, the patients are better at identifying changes in their own bodies?’
‘Well, yes, I suppose.’
‘And just one last question before I let you go. Can you accurately predict the progression rates of motor neurone disease?’
‘Well, no, as I said, due to the complexities of the disease…’
‘Thank you, Professor, nothing further.’