by Jill Ciment
The nurse helps her husband undress for a sponge bath. His exposed skin looks so white against her black hands. Black and white, the only two colors photographers had to work with for the camera’s first hundred years.
Before leaving, after promising she will return tomorrow, the nurse hands Hannah a booklet, When the Time Comes. The photograph on the cover is a leaf floating on water. Hannah only allows herself a glance at the table of contents.
Goals at the End of Life
Withdrawal
Changes in Eating
Changes in Toileting
Changes in Breathing
Changes in Body Temperature
Confusion
Restlessness and Anxiety
Vision-like Experiences
Wave of Energy
Saying Goodbye
When Death Is Near
Moment of Death
A fever consumes her husband one night. In his delirium, he throws off the blankets, peels away his T-shirt. Hannah can see that all the bruises on his back and buttocks have connected. They are no longer islands.
After she explains to the hospice nurse on call that her husband is feverish and a continent of bruises has taken over his body, the nurse instructs, “Take his temperature.”
The number is just shy of one hundred and two.
“Give him two Tylenols,” the nurse instructs, “then take his temperature again in a half hour, and call back with the results.”
At the half-hour mark, the results baffle Hannah. Her husband has gone cold.
“He’s shivering,” she tells the nurse.
His teeth are chattering so violently that he gives himself a nosebleed.
“He’s hemorrhaging.”
“Have him sit up and tilt his head forward. Pinch the soft part of his nose shut. If the bleeding doesn’t stop in the next fifteen minutes, call me,” the nurse says.
Pinching his nostrils doesn’t stop it. Tissues don’t dam it. The face towel is useless.
Only five minutes have passed. How much blood can he lose?
She calls Graham: “All the blood that was dripped into him four days ago is gushing out. What should I do?”
“Do you want me to come over?”
“He’ll recognize you.”
“He never met me.”
“Who will we tell him you are?”
“The night nurse.”
* * *
· · ·
The bleeding has subsided to a manageable drip by the time Graham arrives. Hannah stops him at the front door to tell him that the emergency is over and to turn him away. She almost feels as if she should provide proof that the emergency was real—the wadded red tissues—and that she didn’t betray her husband for nothing.
“Have the night nurse come in, he’s here anyway,” her husband calls from his hospital bed in the living room.
Graham asks her husband to continue pinching his nose while he examines the bruises on his back, listens to his heart. The image is so teethed with irony that even if Hannah had her camera, she wouldn’t take a picture.
Yes she would.
He reaches for her husband’s arm to slip a cuff above the elbow and pump air into its pressurized sleeve. Her husband’s muscles have shrunk from ropes to strings. She wants to tell Graham that her husband was once a mass of energy, a gravitational force that drew worlds to him—not the skeleton whose blood pressure Graham is taking.
“The daytime nurse never takes my blood pressure,” her husband says.
“I can stop if you want.”
“No,” her husband says. “What’s my blood pressure?”
Graham glances at Hannah for her permission to toll the death bell. Her husband’s numbers are shockingly low, the numbers you might read on a bicycle pump when the tire is nearly flat.
“What is happening to me?” her husband asks.
When Graham again studies Hannah to verify her permission, her husband says, “Don’t look at her. I have a right to know.”
“You’re in circulatory failure.”
“What does that mean?”
“You’re dying.”
“Now?”
“You have days, not weeks.”
It has begun, Hannah thinks. Can you say “It has begun” about the end?
She walks Graham to his car to thank him, but all she wants is to get back to her husband.
“I don’t want to put us through this any longer,” her husband says when she sits on the edge of his hospital bed, positioned in the living room so that he can see the lake at all times, if he can keep his eyes open.
“I’m only going to get worse,” he says.
His voice has returned to its former confidence.
“If I was your old dog, tomorrow is the day you would put me to sleep.”
“Let’s see how you feel in the morning,” she says, though that makes no sense to a man who has days.
“If I was your old dog,” he tells the daytime nurse when she asks him to rank his pain on a scale between one and ten, “today is the day you would put me down.”
This time he says “down,” not “to sleep.”
“Only if my dog was ready,” the nurse says.
“I’m ready,” her husband says.
In muffled hysteria, concealed behind a mask as expressionless as Anca’s, Hannah watches as the nurse lines up three different pill vials, liquid morphine, ten oral syringes, and eye drops.
“The prescription says to take .5 milligrams by mouth every two hours as needed for pain and distress.” She fills one of the oral syringes all the way up to the top, ignoring the halfway point indicated in the directions. Then she fills a second syringe. “I find it is better to have two or three syringes prepared beforehand. Hands get shaky. Why don’t you try filling one yourself?”
Hannah inserts the plastic nose into the tea-colored liquid, pulls back the stopper. When the fluid reaches .5 milligrams, she looks over at the nurse, whose return stare remains completely neutral, almost beatific. Hannah fills the syringe.
“The bottle says to administer every two hours, but it also says ‘as needed for pain and distress,’ ” the nurse says, handing Hannah another syringe. “If your husband is in pain and distress, I would give him the medicine every hour, maybe every half hour.”
There are now four full syringes on the kitchen counter.
“You know, if you want, you can fill all ten syringes,” the nurse says. She waits for Hannah to acknowledge her subtext. When Hannah nods enigmatically, the nurse repeats, “Do you understand?”
“What if I run out of morphine?” Hannah asks.
“Why don’t I have the doctor call in a second prescription, just in case you accidentally spill this one.”
The nurse reaches for the first vial and shakes out three tiny white pills. “Alprazolam. For anxiety. Sometimes patients get very restless. This will calm him.” She picks up the second vial, also little white pills. “Hyoscine butylbromide. It helps with secretion.”
Secretion?
“Give it to him with the alprazolam,” the nurse instructs. She uncaps the third vial. “Haloperidol, for delirium. Just in case.”
She takes two teaspoons and crushes the pills into powder. “Extend his lower lip and put the powder between the lip and gums.”
She holds up the eye drops. “For nausea. If he can’t open his eyes, gently pull back his lid and give him .3 milligrams.”
Hannah can only imagine what it will be like to open her husband’s lid, and see the fear underneath, or, worse, the absence of fear. Her kitchen table now resembles a hospital cart. “What if I make a mistake?” she asks the nurse.
“There are no mistakes,” the nurse says.
* * *
· · ·
&nbs
p; Her husband is alert when Hannah returns from walking the nurse out.
“I feel better than I have in days,” he says, sitting himself up with the help of the bed’s hydraulics. “Maybe the transfusion is working?”
Hannah read the chapter Wave of Energy in the hospice booklet: The dying may experience a sudden burst of energy. It is easy to see how this can give false hope that the patient is getting better. The patient may be building up strength for the last full-body moment in this life.
“I think I’m hungry,” her husband says.
By the time Hannah returns with a tray of possibilities—cookies, crackers, yogurt, ice cream—he has fallen unconscious again. She can no longer call the state he occupies “sleep.” She can almost sense the energy as it evaporates off his skin.
Is he ready? Is she? Does she wake him up to ask permission again, just to be sure? Do you still want to die? Who would want to be asked that? Shouldn’t his last memory be of appetite, of hope? If there is still hope, he had told Dr. Death.
She gives him one full syringe of morphine, between his gum and his lip, as the nurse instructed. Twice the amount prescribed, but not lethal. While his mouth is still open, she dusts his gums with the pulverized pills, spilling powder on his chin.
Is he already moving through the tunnel toward the white light? Is he about to be greeted by dead loved ones? Neurologists ascribe the experience to a flood of dopamine. What if such an ecstasy of chemistry exists and the morphine robs him of that final pleasure?
She opens his lid to administer the eye drops. What she sees isn’t ecstasy. His pupil eclipses the watery brown iris, which appears to be seeping into the adjacent white. Is this what suffering looks like?
She gives him another dose of morphine, and then waits at his bedside for his presence to disperse into the universe.
She doesn’t cry. The tears would only be for herself.
She reaches for the hospice booklet and reads the chapter When Death Is Near.
Below is a list of signs that may mean death will take place soon. Each person’s dying process is unique. Keep in mind, this is only a basic guide.
Changes in skin color.
Long breaks between breaths.
Weak heartbeat.
Drop in blood pressure.
Less urine or no urine.
Eyelids don’t close all the way.
She looks up at his eyes, which have opened.
“Are you there?” she asks.
She looks closer. His pupils have shrunk to pencil points.
At the two-hour mark, when the prescription allows for another .5 milligrams, she empties three syringes.
She helps herself to two of his tranquilizers, and stretches out on the sofa, within earshot of his rattled breathing. His gasps for air are now broken by longer periods of silence.
He is still alive when she wakes up five minutes or five hours later. She doesn’t know.
She repeats the routine. Three doses of morphine. Three pulverized tranquilizers, two crushed hyoscine butylbromides, and a dollop of water. If she were on trial, couldn’t the prosecutor make a good case for murder? The younger wife, the lover, the old husband. When the pills have completely dissolved, she rubs, as gently as possible, the paste between his gum and his lip. She opens the drapes so that her husband has a view of the lake. If the stalkarazzis are out there, let them take pictures.
This is anything but murder.
This is the bravest, kindest act she has ever done.
She reaches for the eye drops. His eyes have closed again, and she has to open a lid. The iris is now gone. It has floated away. She suddenly realizes that she hasn’t heard a breath for some time. She presses her ear to his chest. The hammering from the sunken ship has stopped.
* * *
· · ·
Her husband only observed one religious act, cherry-picked from his Orthodox Jewish upbringing: the lighting of the Yahrzeit candle on the anniversary of his mother’s death. Hannah has read somewhere that Jews wash their dead loved ones as a form of respect and farewell.
Do you use a common washcloth?
She prepares a bowl of water with a dollop of liquid soap. There is no longer any reason to wait for the water to get warm.
As she washes the body, it no longer feels like her husband. He only abandoned it minutes ago, and it is already not him.
Did his memories exit with those last exhalations? His childhood. Gone. Their marriage. Gone. The deformed rib on which she rested her head already decaying.
After she finishes washing the body, she gets her camera. The unspoken bonus of their ridiculous age gap had been that her husband knew enough not to compete with her photography. He would have wanted her to take the memento mori. He would have encouraged her to be as merciless as need be for a good photograph. He would have reminded her of what she had told him: You either photograph what you know, or you photograph what you want to know. But the giants photograph what they don’t want to know.
She aims the camera, but she doesn’t click.
Does she need proof of what she is seeing? Couldn’t she just blink, as she has been doing lately, record the image for her memory alone?
She blinks.
And blinks.
And blinks.
Not to take symbolic photographs, not to record, not to score the image on her brain, not to block out visual stimuli.
She blinks simply to fight back the tears.
Then she thinks, Why fight?
“Your prescription is ready,” says an automated voice.
Hannah hangs up.
An hour later, the landline rings again: “Your prescription is ready.”
She presses the only number on the menu that promises a human voice.
“Your prescription is ready,” the pharmacist tells her after a ten-minute wait.
“For what?”
“Morphine.”
“I no longer need it,” Hannah says. “It’s too late.”
“You’ll need to come in to sign a form saying you never picked it up. It’s a Schedule II narcotic.”
“My husband died twenty-four hours ago, and I must appear in person with a photo ID to stop the harassing calls.”
“I’m sorry for your loss.”
After a harrowing drive of her own making, she strides past the candies, the shampoos, the pet food, to the rear of the store, where four people ahead of her are waiting for the pharmacist. Shouldn’t there be a separate line for the bereaved? Next to the register is the rack of tabloids. She drinks in the headlines, bracing herself for a mention of the trial, or, worse, the stalkarazzi’s photograph of her screaming, “ENOUGH!” Or, worse still, a telephoto close-up, taken from the angle of the woods behind her house, of her killing her husband.
A new face, as pretty as Stephana’s, now occupies the upper right-hand corner of OK! MURDER BY TEXT, the headline reads. “IT’S NOW OR NEVER,” MICHELLE CARTER TEXTED HER SUICIDAL BOYFRIEND WHEN HE FLINCHED BEFORE TAKING HIS LIFE.
We’re yesterday’s news, Hannah tells her husband. She isn’t talking to herself. Just because he is no longer here doesn’t mean that their marriage has ended. “Till death do you part” is a suggestion, not an edict.
She taps her foot, scratches her arm, glances around. A man is buying hearing aid batteries, a woman is reading a vitamin label. Hannah’s anonymity has been returned. No one is watching her.
Including her husband.
* * *
· · ·
Grief doesn’t feel as if a rug has been pulled out from under her. There is no rug. There is no floor on which to lay a rug. There is no ground on which to build a floor to lay a rug.
* * *
· · ·
Lenny calls.
“Did he leave directives?” he asks whe
n she tells him that she hasn’t made any funeral arrangements.
Hannah vaguely remembers a file her husband once showed her, titled “Dementia or death.” She opens the cabinet in her husband’s study. The file contains all his passwords, copies of their wills, both monetary and living, a list of their bank accounts, his frequent flyer numbers, and a letter from the Anatomical Board of the State of Florida.
Dear Mr. Richler,
We have received one copy of the properly executed form on which you dedicated your body to the Anatomical Board of the State of Florida for use in medical education.
Please accept this letter as a very small demonstration of our gratitude and respect for your enormous generosity. You are to be commended for your broad-minded decision. It is our sincere hope, as we know it is yours, that such acts will contribute to the advancement of medical knowledge and thereby improve the quality of life for others.
The letter is dated twelve years ago, when her husband first started teaching at the university, before he knew about the anatomy professor.
“He willed his body to science,” she tells Lenny, then asks him, as her lawyer, to call the university and get her husband’s body transferred to another medical school.
She doesn’t explain her request. Lenny already knows about the anatomy professor.
He is quiet long enough for her to think the call was dropped.
“It’s not your decision to make,” Lenny says. “Last wish means exactly that, the very last hope someone had.”
If there is still hope.
* * *
· · ·
A dissection isn’t only about how someone died, Graham had told her, it’s about how someone lived. Her husband, who had recycled rubber bands and tin foil, wanted his body not to be wasted.
He will lie prone, only his back exposed, supposedly the least personal part of the body, but Hannah was skeptical when Graham first told her that, the night he demonstrated on her. Maybe the back is impersonal to a stranger, but Hannah knows her husband’s back as intimately as she knows her own hand, the most personal part of the body, if she is to believe Graham.