"Where do you want to go?" Mark patted her hand.

"Oh, that's sweet of you, but I can't go out. My aunt Edith is here with Mitch."

His face registered a moment's disappointment. "Tomorrow, then."

Cassie still had her very dark sunglasses on over the scarf tied around her head. "Oh definitely," she murmured, shaking her head no. They'd never had lunch alone together. She absolutely adored him, but how could she think about going out? She steered the subject to Mitch. "Have you seen Mitch?"

"Yes, of course, early this morning." He sniffed the air around her. "Nice perfume, what is it?"

"Really, Mark, I don't know."

"Sublime, I think. You've been wearing it for a long time, haven't you? I've always liked it."

"Well, I just saw Mitch. Have you seen what his finger is doing?" Cassie didn't want to think about her perfume.

"Of course. I saw all of him. What about it?"

"It was moving around on the sheet. It looked like he was trying to say something. Write something."

"Oh, yes. They do that sometimes. It doesn't mean anything." Mark was studying her intently.

"What's the matter?" She touched her cheek and didn't feel a thing.

He shook his head. "Nothing. Just the change in you. You really look different. I'm not sure I would have recognized you."

"I know I look terrible. Let's not dwell."

"Quite the contrary. You look very good. Really good."

"For God's sake, Mark, I don't care how I look. I want to talk about Mitch. I think he's coming back," Cassie said wildly. "He has motion in his hand. I saw it."

Mark raised a shoulder. "Well, random movements. That doesn't mean anything." He raised the shoulder again. "I don't want to be pessimistic, Cassie. But he's still in a very deep coma-"

"I think he's coming back. I really do," she insisted.

"Does he respond to the things you say? Does he seem to know you?" Mark asked gently.

"No, but-"

"Sweetheart, he's not responding to any outside stimuli. We're not seeing any brain activity on the EEG," he said solemnly. "I have to be straight with you."

"No brain activity?" Cassie asked hopefully.

Mark pressed his lips together and shook his head. "Mitch is a tough nut. He's hanging on, but we'd hoped for more of a rally, some return of awareness." He massaged Cassie's hand and put his other arm around her shoulder and squeezed that, too. "You okay?"

"No brain activity. That's-" she shook her head. Great!

"Look, on the other hand, I've seen patients who've been in a vegetative state for six, seven, eight months, even years, who just wake up one day."

"No!" Cassie didn't want to hear that.

"I know, it's rough. Are you sure you don't want something to eat? Starving yourself won't help him."

"No, no. Thank you, but I couldn't think about food right now."

"This isn't good for you. You look like you've lost about fifteen pounds. You've had a trauma. You're depressed."

More than he guessed. "Mark, I haven't lost an ounce."

"I'm your doctor. I would know." He said this with his wry little doctor smile. Then he patted her bottom, lightly. Just a touch, then he pressed those lips together appreciatively, and nodded. "Ten pounds, at least."

"Mark!" Cassie was shocked by the inappropriate gesture.

"How are you sleeping?"

"Oh, I don't know. All right, I guess." She was irritated by the tone, distracted.

"We don't want you getting depressed."

"Oh, for heaven's sake, let's not beat around the bush about depression."

"Oh?" Mark raised his eyebrows.

"It's not as if Mitch and I were that close. I bet you know the whole story," she said angrily. "Why don't you just come clean."

He changed the subject. "Cassie, I checked some things out with Parker. He knows pretty much everything where Mitch is concerned. Here's the insurance story. You're fine with North Fork, for a while. But there might be a problem down the road." All of a sudden Mark looked uncomfortable.

"Fine, you don't want to be straight with me about his personal life," Cassie said. Parker Higgins was Mitch's lawyer. She'd get the truth out of him.

"Of course I do. We'll have some things to talk about later, but you don't have to worry about them right this minute," he said evenly.

"Well, I want to worry about them right this minute. I have some decisions to make, and I need your help."

"You know you can count on me," he said staunchly.

"Can I, Mark?" She stared at him hard through those dark glasses but couldn't read him.

"Of course. We'll go through it all right now if you want to."

She nodded. "Thank you."

He steered her to a stone bench in a little alcove on one side of the glass hallway that she'd never noticed before. It looked out on a Japanese garden with three large rocks, a collection of dwarf conifers, and a pebble path surrounded by buildings that no one could get to. Cassie sat down on the bench. Mark sat next to her, still in possession of her hand.

"Go ahead, shoot."

"I think I mentioned over the weekend some of the issues surrounding the practical side of health care. I'm sure you know that the hospital and the insurance companies look at patients in a different way from patients' families. Insurance companies want to resolve the cases. The families want only the best care for their loved ones. The hospital's challenge is to find reasonable ways to work out the conflicts between the two."

"Mark, what are you talking about?" She wanted to talk about the girlfriend.

"Patients in crisis are treated one way, Cassie. Like Mitch when he came in. Every treatment possible is performed without question. Terminal patients, who've had every treatment we can give them, who are alert and aware at the end, are treated another way. They have some control over the final days of their lives. And, finally, patients in a persistent vegetative state are in an altogether different category."

"I don't understand. Cut to the chase." This got her attention.

"Just listen for a moment. I want to give you some background on this. Our job as physicians is to sustain life whatever the cost. But we can't do that in defiance of the patient's wishes…" Mark paused in midsentence.

Cassie gazed out at the neat little dwarf conifers. The Japanese didn't like messy gardens the way she did-with flowers that waxed and waned, so slow to bud, quick to bloom, showy beyond reason for only a few short days, then the long fade-out of wither and drying while the season progressed and the next crop developed. Flower gardens took so much care to look well in every season. In cultivated spaces, the Japanese preferred their gardens spare and predictable. They stuck with evergreens, pruning them down to a tidy shape, stunting nature for pretty much the same view in all seasons. She knew that Mitch was no tidy Japanese. Like her love of excess in the flower beds, he was more the messy type. He'd opt for the long fade-out, never giving up or letting go, as he'd never let go of her.

She felt as cold as that hospital garden that had no visible access. What Mark was telling her was that in her husband's time of crisis she had a spousal right to give up for him. He couldn't choose now, so it was up to her?

"You can't do it in defiance of the patient's wishes. Go on, I'm listening," she murmured.

"We're not there yet, Cassie."

"Where is ‘there,' Mark?"

"In a terminal case, we get together, the patient and the family, and together we discuss how the patient wants the end to be. And they can choose, machines or no machines, hospital or home. Patients have some control over the situation, and you'd be surprised the kind of choices they make. A lot of people don't ever want to be hooked up the way Mitch is. But acute care patients are another story. In the absence of the patient, it's the insurance company and the family-and, of course, the hospital, too-that make the decisions."