Bobbi and Soul

by J. B. Marsden

  At home later that evening, sipping tea after dinner, Bobbi sat in the uncomfortable chair in the living room of her rented condo. She flicked through an issue of the Journal of the American Medical Society devoted entirely to articles on rural medicine. The articles spanned the gamut of topics, from electronic means of treatment and rural social medicine to rural health policy. Her eyes grew heavy, and she noted that it was after eleven. She’d read longer than she thought.

  She went to bed after a long, hot shower, yawning. Her condo tended to be on the cool side, so the shower warmed her hands and feet. Just as she lifted the sheets to get into bed, her phone buzzed with the number of the clinic’s after-hours answering service. She answered, wrote down the patient’s number, and phoned it.

  “This is Dr. Webster.”

  “Doctor?” A woman’s voice.

  “Yes. Who is this?”

  “This is Maria Sterling. My dad, Harold Mendes, is a patient at the Delaney Clinic. I’m here at our house and he isn’t responding to me.” Her voice became high; she sniffled. “He’s breathing, but I can’t wake him up.”

  In her head, Bobbi ran through the possible issues. “How old is he?”

  “My dad’s ninety-nine.”

  Could be anything at his advanced age, Bobbi reasoned to herself. “Okay. Call an ambulance and get him to Babcock County Hospital. I will meet you at the emergency room.”

  “Can you come here, please? The hospital’s so sterile and impersonal. He would hate it, I know.”

  Bobbi closed her eyes for a minute to think. After she asked Maria some other information, she said, “Okay. What’s the address?” Bobbi typed Maria’s address into her phone. “I’ll be there in ten minutes.”

  Bobbi quickly rose from the bed, pulled up her wool trousers, shrugged into a turtleneck, and threw a sweater over top, not noting whether it all matched or not. She opened the closet, checked her medical bag, got on her parka, hat, gloves, and scarf, and headed out the door to the private drive where her Honda was parked in the snow.

  In less than ten minutes, the GPS led her to a small bungalow on Rancho Delgado Street with the right number. Two cars filled the short gravel driveway, so she parked on the street. When the door opened, she met a petite woman with pixie-cut, brown hair and glowing, creamy skin. Her heart immediately beat faster. She’s small, petite. Bobbi quickly took a deep breath. But, what a cutie.

  “Maria?”

  “No. Come in, Doctor. I’m Harold’s priest. Maria called me first and I suggested she phone the clinic.”

  Bobbi nodded, glancing at the small, attractive woman who said she was a priest, and took off her winter outerwear before going farther into the overheated house.

  “He’s in the bedroom.” The priest led her down a small hall. “I’m Erin, by the way.”

  Bobbi took her hand and stared at her face, complete with dimples and twinkling eyes. Not quite like Stephanie. Breathe, she told herself. She looks like an elf, Bobbi thought. “Dr. Bobbi Webster.”

  The bedroom was stifling hot. A very old man’s pale, wrinkled face peeked out of a heavy, navy blue comforter.

  “Hello, thank you for coming, Doctor.” An older woman looked up at her for a moment and went back to stroking what little hair the old man had. “I’m Harold’s daughter, Maria.”

  “I’m Dr. Webster. I’ll do short assessment and see what’s going on.” Both women stood quietly to the side. Bobbi opened her medical bag and fished out her stethoscope, thermometer, and blood pressure cuff, but when she saw his face drooping to one side with drool dripping down, she asked, “How long has his face drooped?”

  “Never before,” Maria answered.

  Bobbi checked the blood pressure, which was quite high. She tried to rouse him without any success. “Is he being treated for anything at all? High blood pressure? High cholesterol? Heart condition?”

  Maria looked thoughtfully and said, “No. I’ve been taking him to his check-ups for the last year. They only said it was old age.”

  “Um-hmm.” Bobbi took out her tablet. “Does he have Wifi?” She kicked herself as soon as the words were out of her mouth.

  The priest raised her eyebrows with a quick, teasing grin. “No. No Wifi. No internet. No cell phone. He’s ninety-nine years old.”

  “Sorry, dumb question,” Bobbi mumbled, feeling herself blush. “I would like to get him to the hospital as soon as possible. He’s had a cerebral vascular accident and we need to treat him as soon as possible. The sooner you treat a CVA, the better the outcome.”

  Maria looked at Erin. “What’s a CVA?”

  “Stroke.”

  Marie shook her head and said, “He would definitely not want to go to the hospital.”

  Erin stepped closer to Bobbi and produced a paper. “This is the DNR order and the living will I helped him fill out last summer. He does not wish to have any extraordinary measures.”

  “That’s not what those documents mean.” Bobbi eyed them briefly. “They mean that he wishes not to be put on life-saving equipment that would breathe for him. He’s breathing on his own, so that’s not the issue.” Bobbi’s eyes slanted into Erin’s, trying to get her to understand what was happening here.

  “We know that,” Erin answered. “But Maria and Harold and I all had a specific conversation a few months ago. He did not wish to be in a hospital in his last days. For anything. It’s spelled out here.” She held out the document again.

  “Look here, er, Reverend,” Bobbi said, her heart starting to beat in her ears. I will make my opinions known. I will take control. “My job is to make sure he makes it to another birthday. I won’t be able to help him do that unless his daughter takes him where he can receive the proper treatment. First, we need to restore blood to his brain by giving him some anti-coagulants. Get an MRI, CT, check his carotid arteries. Then later, therapy—”

  Maria’s tears coursed down her cheeks. “No. No. You don’t understand. He wants to die here at home. He’s never been in a hospital. He wants to stay here. He asked that we help him stay home. I’ll take some days off to take care of him.”

  Bobbi puffed out her cheeks while she took in the two stubborn women in front of her. “May we continue this conversation somewhere else?”

  They gathered in the small living room. Erin and Maria sat together on a flowered couch. Bobbi sat on the matching, frayed chair. “Are you saying he wants end-of-life care? He wants no medical care to prolong his life?” Bobbi looked intensely at them each.

  “Yes.” Maria sat up and nodded. “That’s it exactly.” Erin put her hand on Maria’s shoulder.

  Bobbi rubbed her temple. A headache began pounding. “I’m not sure he’s dying. He could recover quite nicely.”

  “Yes. But he could do that here at home.”

  “Maria, are you your father’s power of attorney?”

  Maria looked at Erin. “What’s that?”

  Erin answered, “She means, do you write his checks, make his decisions?”

  “Oh. Yes, yes all of that. He hasn’t been able to write checks since he fell last winter.”

  “Your father fell? Did he have a head injury? Did anyone, anyone medical that is, look at him?”

  “No, Doctor. You don’t understand. He didn’t go unless I took him. He said he was fine after he fell. But I noticed he was a little slower. Moved slower. Lost some memory, maybe.”

  Bobbi nodded slowly. She tried hard not to groan. “Reverend, is this all correct?” Bobbi decided to get all the information. This was becoming one killer headache.

  “I’ve lived in Colorado only since last May, over in Johnson County. I’ve visited with him and Maria several times when I brought communion. Maria lives with her father, provides his meals, and takes care of getting him to his check-ups. She is very competent. His cognitive abilities have been very good up until tonight and he made these decisions with a clear mind. He knows what he wants, and that’s not to go to any hospital. To die in any hospital.” The Elf raised her head and s
traightened her narrow shoulders.

  Bobbi sighed deeply. “I’m sorry. I’m not used to this kind of problem. He may not be approved for hospice care if he has some rehabilitation capability. Also, if he wanted to die at home, why did you call the clinic tonight?”

  Maria let out a small, “Oh.”

  Erin said, “I had Maria call so that we could get his condition checked out, maybe get the right kinds of medication for him. We did not call expecting him to be hospitalized.”

  “I am beginning to see,” Bobbi said wearily. “Do you have his medications? I would like to see what he has been taking.”

  Maria rushed into the bathroom and returned with four medication bottles.

  Bobbi took them from her and studied them. “Let’s see. We do have a blood pressure medication. An arthritis medication—”

  “He had terrible arthritis in his hands,” Maria piped up, worry lines deep in her face.

  “A blood thinner. And an iron pill. Is this all? You’re sure no heart medication?” Bobbi handed them all back to Maria.

  “That’s it.”

  “So, where are we?” Bobbi had written the meds and the doses into her tablet. “I could give you a prescription for a larger dose of the blood pressure medication, which is certainly indicated.” She handed Maria a prescription. “Tomorrow I could call hospice and get someone over to assess him as a candidate for care.”

  “Yes,” Erin said. “Very appropriate. Hospice would bring comfort for both Maria and her brothers. And it’s Harold’s wishes.”

  “I must be honest with you both. My training prepares me to treat and heal. Only after all other treatment is no longer indicated do I bring in hospice. It’s the last-ditch effort, palliative care, that is. Care for comfort only. I’m going against my own instincts not to bring Mr. Mendes into the hospital. But, on the other hand, I understand a man of his age not wanting to leave home. My dilemma is that I haven’t made an effort to make him as functional as I can with my skills, as I have taken an oath to do. Do you understand where I’m coming from?”

  Maria and Erin looked at each other. Maria looked directly at Bobbi and said, “You’re a healer. My dad doesn’t want healing; he wants to go peacefully.”

  Bobbi nearly whimpered. “You’ve said that, yes. But I don’t believe he is dying. My expert opinion is that he may be capable of recovery. His stroke is new. With quick intervention, he may be fully functional again.”

  Erin eyed the doctor. “Do you really believe he’d talk, walk, and eat like he has been, without any disability at all?”

  Bobbi stammered, “He may, yes.” This elf wanted to be the boss, Bobbi realized. Breathe, just breathe.

  “But, a ninety-nine-year-old man also needs his dignity and independence. Chances are quite low that he’d retain any of those skills after a very severe stroke. You can’t argue with a person’s needs, Doctor.” The priest’s face turned cold.

  Bobbi pulled her hand through her short hair and rubbed her eyes. “Dignity and independence.”

  “Yes.” Erin stared at her.

  Bobbi met her stare. “I’ll call hospice tomorrow.” She went into Mr. Mendes’s bedroom to retrieve her medical kit items. She checked his pulse. It was steady but barely perceptible. Perhaps he wanted to die.

  Maria and Erin stood as Bobbi stepped back into the living room to go to the front door. “Good night, Dr. Webster. I hope we haven’t called you out for nothing. But you now know what my father wants.”

  “Yes. It’s abundantly clear to me. Good night to both of you.” Bobbi strove to keep a neutral face. She nodded to Erin and Maria, put on her cold weather gear, and Maria opened the door for her.

  Chapter Four

  “And you say he may have some rehabilitation potential? In your opinion, he may not be actively dying?” Dr. Gen Lambert drilled her eyes into Bobbi with her best clinical demeanor. Not challenging her exactly, but helping her think through Mr. Mendes’s issues.

  Bobbi ran her hand through her disheveled brown hair, a little intimidated by Gen’s stare. “It was hard to gauge. His pulse,” she looked down at the patient’s file on her tablet, scrolling to find the vitals she had recorded last night, “was very low.” She detailed the high blood pressure reading and other findings from her assessment.

  “I see,” Gen said. “We can’t go against the living will he signed.”

  Bobbi puffed out her cheeks. “I hate this.”

  Joe Manning put in, “I had a patient in this limbo once in Arkansas the first year of residency. She died very quickly, even though my assessment showed she was not in bad shape. She’d had a successful surgery for a benign brain tumor but developed a brain bleed and went into a coma. Anyway, similar problem. I fought with the family, but they were adamant she wanted to die peacefully.”

  The third fellow, Jaime Garcia-Brown, chimed in, “I grew up here. Coloradans are a stubborn, independent bunch. I knew Mr. Mendes in his heyday, when he ranched for sixty years before he retired. Proud. But a good man. He’s the kind of independent guy who wouldn’t want to lie around a hospital with tubes coming out of him, surrounded by beeping machines.” Jamie steepled his hands beneath his chin.

  Bobbi relaxed the squint in her eyes. “I agree. The rural folks I’ve treated are more self-sufficient, sometimes stubbornly so, as far as medical care goes.”

  Gen nodded, shuffling papers around her. “You all know how our rural patients can be. Add to that the system issues and you have a perfect storm. I am not saying that Mr. Mendes has no right to refuse reasonable treatment, but lack of insurance and long drives to the medical facility also keep folks out here from even considering getting care.” Gen rested her hands on her papers and gazed at Bobbi. “Your patient, your call.”

  Bobbi couldn’t read her expression. Dr. Lambert gave off neutral vibes about the decision, leaving it all to Bobbi. “I’ll try to get out to see him again later this week. I’ll call first and talk with his daughter and see if she at least wants some home nursing help with him.” Bobbi blew out a breath.

  Gen asked, “Have you called hospice?”

  “Yes, this morning. They’ll call Maria, his daughter, and go out later today for a nursing assessment. It, of course, means I’ve signed off that he will receive no more treatment for stroke other than the blood pressure medicine and any palliative meds for comfort here on out.”

  Everyone around the table nodded, but Bobbi shifted uncomfortably in her chair, still uneasy about the whole affair. The daughter and her priest had ganged up on her. The priest even looked happy when she whipped out the papers. What was it about spiritual types? In her experience, death did not daunt them. While the old man couldn’t speak for himself, she supposed the priest and his daughter had brought up the issues of treatment versus death with him before his stroke. She wondered if this was really what he had in mind—not to receive treatment for a treatable condition. On the other hand, he’d lived a full life, at age ninety-nine. She wished Mr. Mendes’s condition were more clear-cut. The decision still nagged at her.

  Chapter Five

  “Yes, Mrs. Barrington, that’s right…No, please don’t do that, I’ll take care of it. We don’t need you to fall and break something…Thank you for calling. Bye and God bless.” Erin rubbed her head, rolled her stiff shoulders, and got back to composing her sermon with a deep sigh. Another Saturday afternoon rush.

  Invariably, something like this complaint would come in while she feverishly worked to finish her sermon. She hated when she had to complete her sermon well into Saturday afternoon. Some priest friends from Chicago did that every week, even writing into the wee hours of Sunday morning. It would drive her mad. Early on, she had set her goal to finish sermon-writing on Thursday, to take a day off on Friday, and to do small tasks in the office on Saturday to prepare for Sunday. Fat chance of that working this week.

  As the cold weather settled in, icy patches formed around the church’s sidewalks. Thank God, they didn’t have the added hassle of a parking lo
t to take care of. Her older ladies got in a tizzy about salting and shoveling clear paths for them on Sunday morning.

  As soon as Erin typed the last word in her sermon, she saved it to her hard drive, with the idea of printing it out later, so she could shovel and salt right now before she forgot and some parishioner broke something. Unfortunately, all the most physically capable of the retired parishioners went to Arizona for two or three months every January, so she figured it was up to her to do the shoveling.

  She straightened her shoulders. Why would a Chicago girl have trouble putting some salt on a few frozen, icy patches? In the mechanical room downstairs, she found the de-icer bag covered with cobwebs, sitting on the concrete floor next to the large red snow shovel. She grabbed the bag, tugged to get it unstuck from the floor, and grunted, dragging it up the five stairs to the side door of the church. She sweated already.

  Try as she might, she had little effect on the icy, packed snow with the red shovel’s puny aluminum edge and plastic body. Because the temperature would dip below ten tonight, the de-icer might work while the sun still shone for a short while this afternoon, but not overnight. The whole task may be a waste of time; nevertheless, she sprinkled as much of the gritty stuff on the ice as possible, then turned to drag the heavy bag back to the door and down the stairs. As she turned, her foot caught the ice and skidded out from under her.

  Seemingly in slow motion, she felt herself fall toward her left side. She immediately put out her left hand to catch herself and her wrist bent back painfully. Her face hit the pavement with a whack. She thought her head may even have bounced, the impact was so rough.

  It took a minute for the pain in her wrist and forehead and a bunch of other places to begin to register. Then bells rang in her ears. Her knees burned from meeting the pavement. Someone had socked her in the jaw, or so it felt. The left wrist looked okay under her cardigan, but the pain sparked a double “fuck” under her breath.