I was the night intern, on call when she came in with fever after chemotherapy. Her nurse called me for admitting orders. I went to see them, down the dim corridor between the workroom and the room at the end of the hall that looked out over the darkness of the park, speckled with streetlight beyond the blinds. I saw as soon as I came into her room that she was dying but not ill. I reviewed her cancer treatment history and I went down the list of intern questions for the chart.
“Allergies?” I asked.
“None.”
We went through a modest review of systems, a medical history, her surgical history. She confirmed the cancer history in the admission note from two weeks before: increasingly radical failed operations, first-line chemotherapy, second, third, names of drugs, sites of recurrence, dates. I examined her, finding only cachexia, a cardiac flow murmur, and a tumor-ridden liver that pushed her belly out like a pregnancy.
“Do you have a living will?”
She looked at the wall. The painted white plaster revealed nothing. She looked back at me. “No.”
I should never judge; I always do, though sometimes I hide it. I didn’t then. In her chart her occupational history listed her as a former intensive care nurse, someone who had seen the detritus of futile resuscitations beyond count: the scattered papers, torn wrappers, soiled bedding, blood, and the corpse in the center, violated, smashed, dead in spite of all. She had a lethal cancer. Her gaze told me she knew and was unconcerned.
“Have you considered one?”
“Yes. But my husband isn’t ready.”
“But you?”
She shrugged, looked off at the light rimming the bathroom door. “He isn’t ready.” She looked back at me. “He’s stood by me for forty-three years. He’s been good to me. It’s my gift to him.”
We got the lines rigged to the port in her chest, ran in the fluids and the antibiotics and the growth factors and the antiemetics. I went on to someone else I couldn’t help.
I wondered what would prompt a gift like that: living through the sham of treatment for the cancer she knew would kill her, waking up from surgery with her belly torn up and sutured closed, enduring the chemotherapy which was easy enough with premedication but not the nausea that followed nor the fatigue that left her bedbound for days nor the confusion nor the trips to the hospital when she was too spent to get up but did, and then having to face the self-satisfied intern who thought her a fool for doing all that when she might be home with a hospice nurse and he might be sleeping. It showed a special courage: not the courage of the cancer support group that applauds survivors for sustaining hope against impossible odds, but the courage to continue knowing that the odds are impossible and the struggle is futile and the pain is meaningless except as an offering to a man who had no comprehension of how deep a sacrifice she’d pledged to make.
Compounding that, he did not come to sit with her. He did not watch the little television on the articulating arm off her headboard, as other husbands did. He did not visit to chat, or to hold her hand, or to read to her, or to show her pictures of their terrier. He did not come in to plead with her to get up and walk, to eat, search the web with him for postings of experimental trials or testimonials from patients treated with Mexican immunotherapy or Bulgarian detoxification regimens or prayer. He did not marshal
the children; they had none. He stayed at home and came in only when her marrow had recovered and she’d been given another round of chemotherapy and she had the strength to walk to the wheelchair and roll away. That was during the day, and I did not see him.
* * *
She came back several times before she died, always at night, each time thinner, paler, more bruised by falls needles and a lack of platelets. Each time I asked her.
“Do you have a living will?”
“No,” she said, every time.
After, I went out and wrote the orders that diverted the course of her dying, that nudged the trajectory of her decline into a curve less steep. It was only a question, a standard that every second year medical student knows to ask. But the repetition was my penalty to her for persisting in treatment when hospice care at home would have been easier for us both.
I would go by her room after being called to place a nasogastric tube, or to assess a hypoxic lung cancer patient, or declare a death. I’d stand in the doorway and make sure she was breathing, under the light the nurses left on to quiet her confusion when she woke thinking she might be home, or healthy. I wondered what sin she was expiating, dying in the hospital. Something dreadful, I was sure, some soul-wrenching infidelity, not just a physical cheat but abandonment that had gone wrong and he had forgiven. It had to be something that deep to merit such a gift.
I never asked her. It was not my place even to wonder. Whatever it had been, I hated him for having endured it.
* * *
She died in the end, of course. I was away, spending a week’s vacation on a medical mission to Honduras with an ICU nurse I’d met on a prior rotation. We spent our days trying to cure diseases of poverty with antibiotics and antihypertensives and hypoglycemics. We spent our last night in a concrete cell in a hotel in Tegulcigalpa, trying to stay awake for the dawn flight home, trying to fight off the overwhelming sense of mortality we both felt by drinking aged rum and fucking till we were both too exhausted to sense anything at all.
When I got back, I did not think to ask what had happened to the dying woman: we were interns, and deaths happened around us all the time. We did not ask after them. But then one morning I stopped in the ICU to see my friend. I always looked into the cubicle doors as I passed, trying to assess whether the inhabitants might survive, how long they might last. She was in one room by the nursing station. She was yellow and dead still, her hair spread out on her pillow, her hands on the sheet, only the whites of her eyes showing, her chest rising and falling with the pulse of the ventilator. I went over to the nurses station. My friend was there.
“Hey,” I said.
She looked up and smiled at me. “Hey, yourself.”
“What’s up with 23?”
Her smile went askew, her eyes rolled. “Cancer everywhere. Found pulseless. Coded. Brought down here. Husband wants everything done but wouldn’t come in to see what everything is. The bastard. The unit attending made him.”
I went back to the room. He was in a recliner behind the partially pulled curtain, his hands in his lap, staring at her. He was nondescript, a man used to being taken care of, now on his own. He was balding, with an ineffectual comb-over. He wasn’t obese, but pudgy, the build of an athlete who couldn’t outrun age. His shirt was rumpled from sleeping in the chair. His shoes were sensible, scuffed. Nothing to inspire heroism.
When I came back the next day, the bed was empty, the sheets made up nicely with crisp hospital corners, the pillow centered, the mattress leveled, the monitor dark. The husband was gone. My friend was off. We were meeting after my signout.