by Laurel Dezieck, School of Medicine, Class of 2016
First Prize Winner 2016 Gerald F. Berlin Creative Writing Award
The page is only two words long. “It’s time.” No callback number. It didn’t matter, I know where I am being summoned, and for what. I stand up, and after hesitating, shrug on the white coat that is draped unceremoniously on the chair behind me, half hanging off. There are piles of frayed papers in one pocket, a stethoscope in the other. I tell my colleagues that I’ll be a while. They nod acknowledgement from behind their computer monitors, typing furiously.
I walk out into the main hallway, my usual hurried, long legged stride, intended for efficiency, effectiveness, responding to emergencies. Then I stop abruptly. This evening, right now, I can walk slower, more evenly. Tonight there is no hurry. A nurse looks up from her station, startled by my sudden stop, so I give her a wane smile and wave my hand to indicate that there is no need for concern. Then I start walking again. Gently, I thought, I’ll walk gently tonight. I want everything about this to be gentle. My hands swing at my side, empty. The unit is quiet for once, and I can hear my own footsteps, the murmuring of staff, monitors humming. Tonight warrants presence; soft steps, loose features, mellow thoughts. Tonight there is no hurry.
I get to the end of the hallway and step into the last room. It’s a good room to die in. There’s a big glass window opposite the bed, and outside the night is starry and cold and vibrant. Traffic whirs by in the distance and the fluorescence of billboards and storefront signs, blurred by falling snow, make for a lively light show. The nurse is in the corner hanging clear, liquid filled bags, the therapist on the other side is fiddling with the ventilator which suddenly starts beeping madly, fighting the command to shut off, to stop breathing for its charge. He unplugs it. The chairs in the corner, a little more padded and comfortable than the other chairs in the hospital, are empty, and they sit at odd angles, not the way they’d be set up if visitors had been in to sit at the bedside.
He lies in the middle of the room, surrounded by lines and tubes and pumps, silent, still, the only way I had ever known him; he had come to us like this. Everything I knew about him, his life, his illness, had come from his proxy, an old, leathery skinned, wheezing friend who had come and gone. He had smelled like tobacco and wet dog and had sat in our waiting room long enough to tell a sad story and dutifully hand over stained, crumpled papers that delineated his friend’s last wishes. It had been a brief but kind visit. He had shuffled in to this room earlier, bowed his head a little and taken a few deep breaths. He didn’t sit down. He didn’t want to be called when it was over. He didn’t want to stay, he had told me. He’d been present when his father had died, in a room like this one, and he couldn’t stand to hear the sounds of a dying man again.
Sticky blue gloves on, I pick up the syringe on the bedside table and attach it to the tubing coming out of the patient’s mouth. Gently I pull out the air inside, deflating the cuff. Then I pull out the endotracheal tube. I know that the staff would do this for me if I wanted, that I don’t need to be here, but I feel responsible for this task. I wrote the order. Comfort measures only. Fentanyl for pain. Midazolam for agitation. Glycopyrrolate for excessive secretions. Extubate now. I am responsible for helping him to die tonight. Somehow pulling the tube myself makes this knowledge more tangible.
Gloves, tubing, tape, syringe, and catheters go into the trash. The therapist wipes down the ventilator, wishes me goodnight, and wheels the machine out; there’s nothing else for him to do here. What place is there for a respiratory therapist when the only task left is to watch the breathing stop? The nurse fusses with the sheets, the bags of medication pumping benzos and opiates into his veins, gently dabs his cracked lips with Vaseline. She asks me if I need anything. I thank her and tell her I’m all set. I’m going to stay for a while. She looks surprised but simply tells me she’ll be down the hall and leaves. Now it’s just the two of us.
I feel awkward for a moment, as though I’m imposing on something intimate. Death must be as momentous a milestone as any other, certainly. Like all the passages of time we mark, it is the most significant. The way we’re remembered, the acts we’ve committed, the memories we collect, become set and unchangeable. Even first impressions, which are held with such high regard don’t have the same finality as the last, because there is no going back, no more crafting or creating. Only that which already exists, the structures of a lifetime we have built. How long they stand, or crumple and decay, is beyond our reach in death. And here I stood, alone with him, a stranger, to orchestrate and note his departure. To sign the book and close it.
The monitor alarms and I reach over to shut it off.
He’s still breathing on his own, for now. It’s shallow and wet, but unlabored. His eyes are still closed, hands by his side. He hasn’t stirred.
The window is cold when I walk over and put my hand against it. I look out at the street lamps, the snow- covered concrete, cars rushing by, people going about their evenings. They’re probably rushing home at this hour to get dinner on the table so they can sit down with a sigh, another long day over. For a fleeting moment I think about going home to my dinner and family and bed, but I know that they will wait for me, and I will wait here, for the man in the bed. My hand leaves fingerprints when I take it away. I drag one of the corner chairs over and position it next to the bed, so its back is to the door. Sitting down, I hesitate, and then I reach under the sheet and take his hand with mine. His feels rough and calloused, except for the pads of his fingers, which are soft. They feel as cold as the icy window, flesh dying into frozen glass. I wonder if he’d mind if he knew a stranger was holding his hand as he died, and then I wonder for whose benefit I had decided to reach for it.
He’d been healthy until last summer, his friend had told me. And then the cough started. The friend who was also his landlord, was named John or Joe or something that was one syllable and forgettable. He had known something was truly amiss when he had come to collect the September rent and noticed how haggard and tired his tenant looked. His father had looked like that, he explained in a raspy Boston drawl, before he died.
When he had come to collect the December rent, his tenant had asked him for a brief postponement of that month’s payment, and whether the other man would mind being his healthcare proxy. John/Joe agreed to both, albeit with some surprise. It was a little sad, he told us, because they were friends but only the kind that kicked the threshold and shot the breeze, talked about last night’s game and the best way to fix a leaking pipe. It was something he thought a wife or a child should do. Since his friend didn’t have a wife, and his daughter was too strung out something, maybe heroin this time, he would have to do. If had has any siblings, they weren’t in touch.
In January, things got even worse. The patient- whose name I didn’t know for sure, but whose hand I was clutching, must have known how much worse because he signed a do-not-resuscitate form. He had told his landlord not to let anyone keep him alive on machines, and let him in on the secret: he was dying. That was a small blessing, for everyone. It was a brave and generous parting gift, for the living strangers and the friend he barely knew: his reassurance and willing goodbye. It was a reprieve for us, knowing we wouldn’t have to torture him with futile heroics, as is so often the case with silent, damaged bodies that come up to the unit without wishes attached.
His breathing starts to slow down; it is dry and shallow now. I can feel his pulse, sluggish and fatigued on the tips of my fingers. He doesn’t squeeze my hand back. There’s a mark on his chin from where the tube was taped. He’s cleared shaved recently, maybe only a day or two ago.
The paramedic who brought him in earlier had told me he was laughing, joking in the ambulance. That he was a pleasant guy. He didn’t look like he was dying then. If he knew that he was leaving in a few short hours, he didn’t tell anyone, but then again he had kept the news of his decline so quiet and unheralded for so long. It wasn’t until he got to the ED that he had decompensated, that we realized that the labored breaths that prompted him to call the ambulance were has last. They were the dregs, pulled laboriously from him, the bottom of the bottle, diluted and unsatisfying.
Sitting with the dying man, my bleary thoughts of task lists and hectic days ahead for once clear away to the back of my mind like so much fog. They can wait until later. Tonight there is no hurry. I think about this man’s wayward daughter, his parents, perhaps long gone or maybe only a few miles away, a woman out there he might have loved sometime back, maybe a brother or sister who moved elsewhere- to Pennsylvania or Oregon, out of reach. Did he ever hold their hands? Maybe in his mind he’s with them now, maybe my hand is a young girl’s or a middle-aged woman’s. I wonder if any of them will find out that he died tonight, if they’ll wonder about what his face looked like the way I wonder about theirs.
The nurse steps back in, asks me how he’s doing. I tell her I don’t think it will be much longer. She tells me I don’t need to stay, she’ll grab me when it’s time to perform an exam and pronounce him. I shrug. I want to be here right now. His breaths are turning into sighs, cool and slow and grounding. I lean back in my chair. Tonight there is no hurry.