The Ninth Inning
A Miami Jones Florida Mystery
AJ Stewart
Jacaranda Drive
For Mum.
I shouldn’t have been so lucky, but I was.
And Heather, for the same.
Chapter One
On the face of it, Phoenix, Arizona, and South Florida are as different as two places can be. One is an oasis, kept artificially alive by an artesian basin eons in the making. The other is a wet tropical swampland. One is landlocked, surrounded by miles of desert, the other surrounded by ocean and so close to sea level that the waves practically break across the width of the state. But the two places have a couple of things in common.
One is that without air conditioning, human life would probably not exist in this day and age in either place. And the second is the heat that brings both tourists and retirees in an annual tsunami of humanity and commerce.
Like South Florida, the greater Phoenix area is a retirement mecca. Not that I could tell this by the sample of people disembarking the flight we had arrived on from Miami. It was a late-night flight, and the passenger list skewed young. I assumed that all the older people preferred to travel during the day and arrive in time for the early bird dinner specials.
Danielle and I had flown in late after she had gotten a call from her sister about her dad’s health. Dr. Ryan Castle had suffered from ALS for several years, but recently his mind had joined his body in failing as dementia set in. The message from Danielle’s sister was simple. He’s flagging, his time and memory fading fast. If you have something to say, you should come.
We took a cab from Phoenix Sky Harbor Airport along the road to Mesa. It was a town that I imagined had once been quite separate from the others around it: Phoenix, Tempe, Scottsdale. But now, like much of South Florida, the greater Phoenix area was one large interconnected metropolis.
It was after midnight, the still air pleasant enough for sleeping. Like Miami, the real heat was yet to come. Some people loved the fall, but in parts of the world where the colors barely changed in autumn, I thought springtime was the best time.
We pulled into the hotel that Danielle’s sister had booked for us. She was sitting in the lobby when we walked in. Jane Castle was two years older than Danielle, but she had the same long limbs and serious eyes. They didn’t look like twins—few sisters did—but the familial lineage was obvious.
Danielle went over to Jane as I checked us in to the hotel. Once I had the keycards, I joined them in the lobby. It was an off-white-and-taupe kind of motif. The sort of bland palette that business travelers seemed to prefer. As I approached the women, Danielle gestured toward me.
“Jane, this is Miami. Miami, this is my sister, Jane.”
Jane offered me a weary smile, and we shook hands. I was going to say something about it being a pleasure to meet her, but in the circumstances, it felt wrong.
“Jane’s just been telling me about Dad.”
I nodded, and the three of us sat around a small coffee table.
“It’s not good news, I’m afraid,” said Jane. “The dementia has worsened. You’ll probably see tomorrow.”
“And the ALS?” asked Danielle.
“The ALS is still the terminal condition,” said Jane.
I watched her speak and recalled that Danielle had told me she was a nurse practitioner back in Seattle. She spoke about their dad’s medical condition with the kind of clinical dispassion that I suspected belied what she was truly feeling.
“But the dementia is the reason I called you.”
“Why?” asked Danielle.
“It’s getting worse. The doctors suspect that it won’t be long before he just doesn’t recognize anybody. I thought we should be here before that happens.”
“Okay,” said Danielle. She said it quietly, like she had a lot on her mind. Her relationship with her father was complicated, and I suspected the same could be said for her sister. In my experience, most family relationships were complicated in one way or another, but some more than most.
We spent a few minutes doing small talk and chitchat and the general catching up that people do—the stock phrases, the rote answers, the polite inquiries that are barely heard. When that was done, we agreed to meet for breakfast the next morning back in the lobby.
Danielle and I made our way up to our room and tossed our duffels on the floor. I was tired and ready for bed. But I could see Danielle was wearing an altogether more profound level of weariness. I took our toiletries out of each of our bags and put them in the bathroom, then I brushed my teeth and offered her the room.
I was in bed by the time she came out, and she slipped in beside me and snuggled her head into my shoulder. We fell asleep without words.
The next morning was clear and cool, in an Arizona kind of way. I could feel my lips drying out as I went down the elevator for breakfast. We met Jane in the lobby, and the three of us ate one of those institutional hot breakfasts that make people feel better about the amount of money they’re paying for a room. I got the sense from looking around the breakfast space that the hospice provided a lot of trade for the hotel.
The hospice was within walking distance. The lobby to the hospice wasn’t a lot different from that of the hotel, more off-white and more taupe, but a hint of blue where the hotel had gone brown, just to set things off.
Jane went to the reception desk and spoke to the duty nurse there. Jane seemed to be known and got an easy smile from the nurse. I suspect that in such a place, easy smiles were well appreciated.
We waited for a short while before a tall, lean guy in a white coat came out and introduced himself.
“I’m Dr. Maxwell,” he said. He shook hands with each of us and then asked us to follow him back into his office.
His office looked like an office rather than an exam room. There were the usual doctor-type tchotchkes: the framed diplomas on the wall, photographs with an important donor or two, crayon drawings by a child’s hand, a picture of the doctor’s family on his desk. He also had one of those Newton’s balls devices, the apparatus with the little steel balls hanging from strings. The idea was that you lifted the ball at one end and dropped it so it would collide with the others and make the ball at the other end fly up, the whole process going back and forth for eternity. Of course, like everything in real life, their energy dissipates, and eventually they give up and stop moving at all.
Dr. Maxwell gestured to the two seats in front of his desk. It was at that moment that he seemed to realize there were three of us, and he made a movement to go and find a third chair. He seemed to me to be slightly absentminded, in a way that was pretty common among doctors. They focused long and hard on the things that were important: the medicine, the care, the whole saving-of-lives thing, but everyday processes sometimes seemed beyond them.
I told the good doctor not to bother, that I was happy to stand. He seemed relieved by this suggestion and made his way around to his own chair.
“So I understand you’ve moved Dad out of the managed care facility,” said Danielle.
Dr. Maxwell nodded. “We have. His condition is such that we feel the best level of care is now with us here in the hospice.”
“And what is his condition, exactly?”
The doctor looked from Danielle to Jane and then back again. I suspected that he had already gone through all this with Jane, but I also expected that doctors repeated themselves a lot. There are often many family members who needed to be kept updated, and they probably didn’t always arrive as a group.
“As you know, we have dual issues. The ALS has been the overriding condition for some time. It in itself continues to worsen, and from a medical point of view, this is the condition of most concern.” He again looked toward Jane and then b
ack to Danielle. I assumed he was trying to make everybody feel included, except for me, and I was okay with that.
“The ALS is causing his respiratory system to fail. He is finding breathing difficult, and swallowing is becoming a challenge. We have him on a nutrition tube, so he doesn’t have to take solid foods, but the respiratory issues are something we can do very little about.”
“Because of the no-intubation request,” said Jane.
“That’s correct. Your father has put in place specific requests for his end-of-life care. One of those includes not being put on a ventilator.”
“So if he can’t breathe for himself, he’ll die?” asked Danielle.
The doctor nodded. It wasn’t something that Danielle would have done. Law enforcement types don’t like to give answers as nods and shrugs and winks. They like to make sure, one hundred percent, that their message is getting across. I had had cause to do a death notification to the next of kin recently with Danielle, and she had been compassionate but to the point. No gray area, no misunderstandings.
“But the most immediate issue for you,” said Dr. Maxwell, “is the dementia. He has good days and bad days, times of complete lucidity and understanding, and other times when he knows no one and recalls nothing. Unfortunately, the latter times are becoming more frequent. When you see him, you should be prepared for that.”
“So should we act as if he doesn’t know us?” asked Danielle.
Jane said, “I’ve found that the nurses generally have a good idea of whether he’s having a good day or a bad day. If they think he’s doing well, I try to assume that he’ll know me. When he’s lucid, he gets somewhat upset if you try to introduce yourself to him. But on the other days, it’s better to just assume you’ve never met.”
“But that doesn’t mean that you can’t remind him who you are,” said Dr. Maxwell, “or that you can’t talk to him like you’d normally talk to your father.”
I saw Danielle tilt her head to look vacantly at the doctor’s desk. I wondered for a moment what talking to a father she believed to have been absent for most of her life would look like.
The doctor stood and said he would take us through to see their father. We left the office and walked through the lobby that looked like a hotel, into an area that felt and smelled like a hospital. The flooring was designed to be easily cleaned, and the air had an antiseptic tang to it.
Dr. Maxwell reached the door to a room and then stopped. The door lay open, but the doctor didn’t go in. I was last in line, so I couldn’t see what was giving him pause, but then a woman in nursing scrubs appeared in the doorway.
“Nurse Gabriela,” said Dr. Maxwell. “This is Dr. Castle’s family.”
“Miss Jane,” said the nurse with a nod of her head. She turned her attention to Danielle but didn’t offer a hand to shake. Perhaps it was a sanitation thing.
“I’m Gabriela,” she said. “Your father’s primary nurse.”
“I’m Danielle. This is my fiancé, Miami.”
Nurse Gabriela offered me a nod and the same easy smile that I’d seen from the nurse in reception.
“How is he today?” asked Dr. Maxwell.
“Not so good.”
Her voice dropped by a major fifth, but I noted that she still sounded upbeat. I imagined when your business was helping people at the end of their lives, being upbeat was a pretty handy character trait.
“He’s not having a great day. He’s not really himself. But he’ll enjoy the visit.”
The nurse turned and stepped back into the room, and Dr. Maxwell moved aside so Jane and then Danielle could go in. I hesitated. Despite the fact that Danielle had been pretty much the entirety of my family for a decade, I suddenly felt like I didn’t belong there. Ryan Castle wasn’t my father. I’d never even met the man. And I felt as if I was intruding on private business. That was until Danielle extended her hand back toward me and I stepped forward to take it.
The space was a hospital room made to look like it wasn’t a hospital room, as if it were a hotel room designed for easy care and cleaning. As if all the machines and tubes were perfectly normal. There was artwork on the wall, what looked like Camelback Mountain to my untrained eye. There were flowers on a small chest of drawers in the corner of the room, and beside the bed there was a table piled high with books.
Ryan Castle looked like a man who was dying. I certainly didn’t say so out loud, but I couldn’t find any other way to frame it in my mind. Despite the doctor’s advice to be prepared, I wasn’t. Ryan’s color was all wrong, at various points too light and too dark, too red and too yellow to be considered healthy. Although he was lying down, the bed had been raised slightly so he could see around the room more easily. It looked like his body was collapsing in on itself. There was a tube coming from the wall to his nose to offer him oxygen, and another from an IV drip into his arm. There was another line connected to a bag that snaked under his sheets toward his abdomen.
I stood back and let Danielle and Jane visit with him. I didn’t really know what to say, anyway. I had no experience with such things. I guessed that most of us didn’t, until we did.
My own mother had died from cancer when I was in middle school, but through limited visitation rights, judicious use of makeup, and a collection of wigs, my memory of her was not of a woman who was sick to the point of dying. I knew she wasn’t well, and I could see it in her eyes, but some people looked worse when they had a hangover.
My dad had died in a car accident while I was in college, although he had steadily gone downhill for years after my mom passed. He found his medicine in a bottle made by Jack or Jim, and watching him slowly lose himself was as close as I’d come to this moment.
Jane introduced herself to her dad and then introduced Danielle. He offered each of them a slight nod, and I wondered if that was all he was capable of mustering. Jane glanced toward me, and I waved her off. It seemed more than the old guy could handle. Three at a time was one too many.
Jane and Danielle each took a seat by the bed and chatted with their father as if he were a man they really didn’t know. I wondered to what extent that was true. They took turns asking him questions, about what he’d eaten that day and what television programs he might like to watch. He seemed noncommittal on most subjects. And he made no attempt to confirm who they were exactly, or why they had come to visit him.
Perhaps he knew, or perhaps he just didn’t care. Perhaps when you’re lying in a hospital bed alone and dying, any visit is a good one.
We stayed for about fifteen minutes, and I wasn’t sure if Nurse Gabriela cut the visit short because Ryan was flagging or because she felt the conversation had run its natural course. But either way, she suggested that Dr. Castle needed some rest, and she got no argument in return.
Jane and Danielle took their father’s hands and said it was nice to see him and they hoped to do so again soon. Neither offered him any kind of embrace or kiss.
Being a nurse, Jane had more experience than any of us of these situations, and I could see Danielle following her lead on such things. Perhaps a kiss might make the whole thing weird for their dad, make him wonder why a strange person was doing that. Or maybe they just plain didn’t want to.
We left Ryan Castle to watch television, a show about some kind of courtroom judge who appeared to also act as both jury and executioner. The nurse directed us back toward the lobby, and by the time we got there, Dr. Maxwell was waiting.
He gestured us back to his office. He’d been busy procuring a third chair while we’d visited Dr. Castle. I sat behind and between Danielle and Jane, like the middle kid in the back seat of a car. The doctor sat down and asked if they had any questions.
“So it’s Alzheimer’s?” asked Danielle.
“We can’t say that definitively,” he said. “It’s certainly dementia, but we can’t diagnose further without tests—MRIs, that kind of thing. At this point there’s really no reason to put his frail body through those tests, because they won’t tell us anythin
g helpful. The dementia isn’t the thing that’s going to take him.”
“Aren’t Alzheimer’s and dementia the same thing?” I asked.
“No,” said Dr. Maxwell. “That’s a common misconception. But Alzheimer’s is a disease, dementia is a symptom. He certainly has dementia, that much we know for sure, because we can observe the symptom. But whether it’s actually caused by Alzheimer’s or something else, we don’t know. Think of it like having a sore throat. That condition might be caused by a virus or just a common cold or even having yelled too much at a football game. But the symptom is the same either way. The underlying cause is what we need to know if we’re going to treat that condition. But as I say, in this case, treatment is moot.”
“So you said that the Alzheimer’s, or dementia, or whatever it is, isn’t the thing of most concern,” I asked. I felt a touch ridiculous dancing around the words the thing that will kill him, but it felt like the way to go.
The doctor shook his head. “No, that’s right. We’ve moved Dr. Castle into hospice because of the ALS.”
“And what is that, exactly?”
“ALS, or amyotrophic lateral sclerosis, is a neurodegenerative type of disease that affects the nerve cells in the brain and the spinal cord. You may have heard of it referred to as Lou Gehrig’s disease.”
I nodded. I had heard of Lou Gehrig’s disease, although I knew very little about it.
“Is that the thing that Stephen Hawking had?”
“Yes,” said the doctor. “But it affects different patients in a variety of ways. As I’m sure you know, Professor Hawking lost his speech but kept his respiratory function for many years. Where ALS often leads to death within three to five years, Professor Hawking was able to live until he was seventy-six. But he’s the exception, not the rule. Dr. Castle is the opposite. His speech is a touch slurred now, but it’s not so bad. In his case, his respiratory system is the thing that’s failing.”
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