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ICU was new and modern, with glassed-in cubicles arrayed around a central nursing station. The place was busy with mechanical conversation. There was the rhythmic whoosh of breathing machines, layered over the background babble of beeps and buzzes and chimes coming from various monitors that were all trying to have their say. It could easily have been the ICU in Chicago where she learned about ethics. Or any other ICU in a major city.
    She knew that people in the United States and elsewhere had a tendency to look down on medical care in countries like Thailand. She certainly heard dismissive questions from people in Chicago. Do you have antibiotics? they asked. Or chemotherapy? Or surgery? A brisk walk through this unit would convince them quickly enough that we have all of those things. But, she liked to think, we haven’t forgotten about the caring part of medicine the way the West has.
    Now they were standing in front of cubicle 8, where the American named Andrew Fuller was lying on a hospital bed. In his throat he had a breathing tube that was connected to a ventilator, which was breathing for him. His head was bandaged, and his eyes were taped shut to prevent them from drying out, but she could see fresh bruises across his right cheek and jaw. There was bruising around both eyes, too. Raccoon eyes, she remembered from nursing school, were a sign of fractures of the bones that surround the eyes. The heart monitor over the bed was blipping along, but that was the only sign of life.
    “He looks… peaceful,” she said hesitantly.
    Khun Suphit winced.
    “Do you really think so?”
    Ladarat nodded.
    “Ahh, yes. Of course you are right, Khun. I suppose he does.”
    Ladarat nodded again. That was part of the problem. The American appeared to be resting. It was a comforting appearance of peacefulness, but a misleading appearance, too. He looked like he could wake up any second. And once those bruises healed… well… it would be hard for his parents or his wife to believe that anything was wrong. And that would make it much more difficult for them to make a difficult decision. Oh dear.
    She had to ask the obvious question. How could the director be sure that the man didn’t have any brain function? How was it possible to know that, after such a short period of time? But she couldn’t ask in that way.
    No. She didn’t want to question Khun Suphit’s medical expertise. It was, she knew, a delicate situation that she’d faced many times as a nurse. Fortunately, it was a problem for which she had developed… strategies.
    “When I tell the family that his brain is no longer working,” she said slowly, “they will have questions.”
    Khun Suphit nodded unhappily. He knew that they would. That was why she was here.
    “What shall we tell them?” she asked. “How do we talk to them in a way that will help them to understand his condition?”
    “You can tell them three things,” the director said. And he didn’t hesitate. “First, that his pupils don’t respond to light. Second, that the vestibular canals in his ears don’t respond to hot or cold water the way that they should. That means that the part of the brain that controls balance and coordination isn’t functioning. Finally, you can say that we’ve done EEGs two times since he’s been here, and we’ve seen no response. So you see, his brain—it is not sending any of the signals that even a sleeping brain makes.”
    “Eehhh. That is bad.”
    And it was. Those are the tests that she’d learned about in Chicago. But she also knew that there were other tests, like a brain scan, that Western countries sometimes did. She hoped the family wouldn’t ask about those tests, because they didn’t do them here. Still, she knew that they might ask.
    “And if they ask about a PET scan, what should I say?”
    He nodded. “Oh, no doubt they will ask. Or they will have a U.S. doctor call me to ask. We can tell them that although that test is used sometimes in the