My cousin Johnny, who turned 40 yesterday, lies in an extended care facility in western Massachusetts. He has been there for sixteen years, languishing in a coma, more specifically a persistent vegetative state. The year John was born, May 14 fell on Mother’s Day.

What landed Johnny in this exclusive club of unfortunates? Car accident, of course. Statistics alone would probably tell you that.

Late on a snowy night, in early February, Johnny dashed into his car upon receiving an invitation to earn some extra money.

“The first four guys to show up will get to plow.”

The race was on. The seatbelt, however, was not. You can guess what happened next. Johnny’s car met with a patch of black ice and then with a tree. His head violently hit the windshield.

John’s medical status was grim in the immediate days following the accident.  He appeared to have broken a wrist as well as a rib or two, but it was his head that bore the brunt of the impact in the collision. His brain had sustained major trauma and a portion of his scalp had to be removed to allow for the inevitable tissue swelling.

In fact, of all the medical acronyms that we became so familiar with during that time, one all-important marker became seared into my memory: the ICP, or Inter-Cranial Pressure. The ICP measures brain swelling and John’s ICP was monitored with great care since it remained dangerously high in those early days and weeks. In spite of the surgery, and various shunt procedures, John’s brain continued to swell.

His family never left his side and I got out to see him as often as I could.  Sometimes I’d sit by John’s bed, terrified by the tubes and bandages. I’d talk to him softly, “Hey Johnny, we’re all here for you. You’re safe now. Try to heal. We love you, honey.”

What else was there to say? Mostly I just sat quietly with him and I’d match my breathing to his.

It was an anguishing time for his family. His parents, three brothers, and extended family had no way of knowing if John would survive the accident. If he did survive, there was no way of knowing the extent of the damage. The team of neurosurgeons who treated Johnny were outstanding, but still, there was absolutely no way of accurately gauging his prognosis.

After a while, John’s condition stabilized. He would live. We waited then, rather expectantly, for him to wake up. By this time, CAT scans revealed that John had suffered extensive traumatic brain injury and would require rehabilitation, but it was never clear what exactly that would look like. When John’s team of physicians were pressed with these kinds of questions, they consistently replied that only time would tell the extent of the damage.

Time indeed.

Sixteen years have passed and Johnny has never fully awakened. Sure, he has periods of wakefulness, but he has no voice. He is immobile and his vision is seriously impaired. It seems he can hear, as he responds to the sounds of his family’s voices.

Over the years, it has been suggested to me that perhaps my aunt and uncle should have “pulled the plug.” To which I’ve responded: “John breathes on his own. There is no plug to pull, except his feeding tube. Could you really disconnect that and watch your child starve to death?”

Sadness gives way to anger and then cycles back to sadness. Not so much because of that question, but more because of all that John lost when he hit that patch of black ice. All that his family lost too.

I think of my aunt and uncle, assaulted by this tragedy, yet so brave and dedicated. Every day they visit him, and read to him, and hold his hand. Every day, faithfully, for sixteen years. He is clearly soothed by the sounds of their voices and they, in turn, are soothed when he smiles at them.

If John could speak, would he ask to be released? Would he thank them for the gift of their constant company, for the depth of their love, and then whisper his goodbyes?

Impossible to know, of course, but I sometimes wonder about these things. 

Especially yesterday, on John’s birthday.