Nicotine

by Nell Zink

  The nurses stand upright, touching the bed rails. “Whole blood and platelets,” the first nurse says. The other nurse rushes out the door.

  Blood runs from his mouth. He breathes noisily through his nose. The color of his face changes from beige to gray. He inclines his head to the left to let blood flow to the pillow, breathing with great effort. His hands, hidden under blood-soaked blue towels, never move. His bare arms are spotted with subcutaneous pools of purple.

  He has some kind of acquired hemophilia, and his bone marrow is not keeping up.

  Penny, light-headed, sits on a sofa in the waiting area. She calls her mother and says fearfully, “Dad’s going to die.”

  “Bring him home,” Amalia says firmly. “Let him die here at home.”

  A SOCIAL WORKER ON THE hospital staff, a handsome, curly-haired woman in a navy blue blouse, invites Penny into her office. “You look exhausted,” she tells her.

  “It’s been busy,” Penny says. She pulls her legs up under her on the sofa, discarding her shoes askew on the floor. The pose makes her body seem child-size. Her hair shades her eyes and covers her bare shoulder.

  She does not see herself as adequate to the task at hand. She knows dying is natural and universal and that anyone can do it. That everyone will do it. Not a challenge, but child’s play. Having subtracted her doubts and fears, she is left with nothing. Her gaze is empty as a pigeon’s.

  “From here on out we’re going to hospice care,” the social worker says. “No more interventions. We keep him comfortable. He’ll have another event like he did this morning, and bleed out. It’s a gentle way to go. Most likely he’ll bleed from the rectum in his sleep.”

  “We already talked about it.”

  “His wife told me she wants to care for him at home. Is she your mother?”

  “Yeah.”

  “Does she work?”

  “She’s an HR manager at an investment bank in the city. I’m between assignments, so I’m completely free.”

  “You have any siblings?”

  “I have two brothers. One lives on this South Pacific island. But the other one is in Fort Lee, and he’s his own boss, so he can swing by Morristown during the day to help me out. Then Mom will be there at night.”

  The social worker touches her on the knee. “You want to take responsibility. You’re a good daughter. But my task here is to make a judgment call. You say your mother is a professional and your brother in Fort Lee has his own company. Those sound like busy people to me. Your father needs attention and care twenty-four seven, and you need to get your rest. If he starts bleeding, he’s going to need somebody with steady hands to administer a sedative. Of course it could be a professional. Would that be an option for you, financially?”

  “I would need to ask Dad. I can ask Mom when she gets out of her meeting.”

  “Okay,” the social worker says. “From the way this sounds, given your father’s condition, I’m going to work on a referral to inpatient hospice.”

  “But what about taking him home?”

  “If you can line up the caregivers. But for now, to be on the safe side, I’m going to knock on some residential hospice doors. What religion is he?”

  “Shamanist.”

  “I mean the one he was baptized in.”

  “Jewish.”

  “Hmm,” the social worker says. “They have a long waiting list.”

  ANOTHER DAY PASSES.

  “I want to die with my boots on, like Ambrose Bierce,” Norm tells Penny, his voice thin and dry. He is still lying in the same position in the same hospital bed. His hands, also in the same positions, are now adorned with tiny translucent pipes and green plastic valves. His hair, beard, and the sheets are all the same shade of white. His eyes are gray flecked with red.

  “He went to Mexico to join Pancho Villa, and you can’t even sit up,” she says, standing at the foot of the bed. She reaches down and strokes his pink left foot. Friction with bedding has made the outer skin peel away. His toenails are striated, thick and brown as hooves.

  “I waited too long,” he says.

  “You were bleeding out the day before yesterday, and you made them give you a transfusion,” she reminds him. “Maybe if I stayed put, and held your hand, you could do it?”

  She feels how sharp her tone is. She wants to be gentle. She wants to feel close to him. But she is trapped in an emotional paradox: his condition means they have nothing in common. Every time they speak of his dying, they become more alien to one another.

  “I need to say good-bye to Matt and Patrick. That’s what’s stopping me. Have you talked to either of them?”

  “I know Mom did,” she says. “I follow them on social media. That’s how I know they’re alive.” (The intrusiveness of ringing phones is something only older people arrogate to themselves. The younger generation is more considerate. Norm knows this. It’s why he doesn’t call Matt or Patrick.) “I could set up your phone to read their feeds aloud, if you want.”

  “No thanks,” he says. “But get them to come see me in the hospice, okay?”

  “Mom wants you to come home. She wants to do home hospice.”

  He shakes his head. “I saw what it did to you when I started bleeding out. I don’t want you anywhere near me when it all goes down.”

  His reference to her fear makes her afraid. The strength and courage they desire—and lack, both of them—are the strength and courage never to see each other again. Fear is something they have in common. The fear breaks the emotional paradox. Her soft heart floods briefly with love, and she says, “Dad.”

  “Go home. I need to rest up. They’re going to move me soon. But first give me a sip of water.”

  She picks up a plastic cup full of ice cubes and holds the straw to his lips. He says, “Ugh. I’m nauseated,” and she puts it back down. He closes his eyes and his face goes slack. The dark color of his eyelids, matching the purplish circles under his eyes, makes them seem to recede, like eyes on stalks being retracted into a shell.

  She thinks for a moment that he looks already dead that way. She anticipates that when he dies, all her shaky bravado will crumble. She will let out her suppressed love in a fury of crying, and everyone around her, even strangers, will understand and respect her desolation. She envisions herself a mourner in a long line of out-of-control female mourners, going back to the Greek tragedies.

  “I’m heading out, Dad,” she says.

  He opens his eyes again and says, “Wait. There’s a favor I want to ask you for tomorrow.”

  “Sure.”

  “I want you to bring my laptop from home. There’s some dictation software on there that I never use. Maybe I can get it trained and dictate some things. My confessions.”

  “I would love that,” she says brightly. “I have so many questions, especially about before I was born. Stuff like Matt and Patrick’s mom. I know everything there is to know about your Philip Roth childhood and Mom’s crazy-ass village, but I don’t even know her name!”

  “What I need is a time capsule. There’s so much I want to tell you. But when you’re an old lady. After the others are gone, like in that poem—‘When you are old and gray and full of sleep, and nodding by the fire, take down this book—’”

  Penny’s throat constricts.

  “You’ll be all that’s left. You and your children. You’re twenty years younger than the boys and your mother, and you’re going to live for seventy years after I die. The eggs of your children are already right there, inside of you. I can almost see them. It’s like knowing my own descendants who can see into the future. I’ll never be prouder of anything than I am of you. I was so lucky to get you.”

  Penny stands there with tears in her eyes, too upset to speak.

  “Hey!” Norm says. “Don’t cry, koala girl. Everybody dies.”

  Her voice is an elfin squeak. “I love you so much, Dad.”

  NORM GROANS AS A GIGANTIC ambulance driver and his slightly smaller assistant move him from a high, heavy g
urney into his new bed at the Anglican hospice in North Bergen.

  The room is spacious. It has an upholstered bench where family members can sleep, two armchairs, and four straight-backed chairs around a big table. The morning sun comes drilling through the windows bright as an atom bomb. The bed is wide, of heavy construction, like something manufactured to the highest specifications. The vase on the table holds a bouquet of birds-of-paradise—green, orange, and blue. The card from Amalia says, “Love you, darling!”

  After the emergency medical technicians leave, Penny sits down in one of the armchairs. She sets the laptop case at her feet with her bag. At Norm’s request she lowers the blinds. Sitting in an armchair facing him, she plays with the controls for the bed, resting her feet on it and letting the bed pull her into a slump.

  He smiles and says, “Leave it like this for a while. I like this position.”

  “How are you doing?”

  “Not perfect. I have this god-awful crick in my neck. Maybe it was the ambulance ride. I felt like I was going to get bounced right out of that thing.” He moves his head from side to side and sighs.

  She offers to do acupressure. She positions her hands and finds a certain spot between two cervical vertebrae.

  “That’s the spot,” he says.

  Three minutes later, he says it’s not helping. When she releases her hold, she is dismayed to see that the pressure has caused a dark bruise. She asks, “You want to do the dictation software thing?”

  “Not right now. I had a busy morning. You could read to me a little. Maybe I’ll fall asleep, and then I’ll see you tomorrow when I’m awake. Don’t forget to take the laptop when you go.”

  “Nobody’s going to steal it.”

  “What makes you think that? You see any expensive equipment in this place?”

  “There’s towels and a pillow,” she says after opening a few closet doors. “Want a pillow?”

  “Sure, I’ll take it.”

  She folds the pillow and arranges it artfully to support his head. “How’s that?”

  “It’s helping,” he says. “I guess it’s just muscle strain.”

  Over the course of the next hour, she leaves, taking the laptop, and he moves his head. The pillow falls down.

  He sleeps through the fall of the pillow. He wakes up with a terrible crick in his neck.

  EARLY EVENING. A FIFTYISH, BLOND-HAIRED woman in a blue lab coat knocks twice on Norm’s open door and enters his room. He is wide awake, staring at the blank TV screen.

  She introduces herself as the deputy director of the hospice. She says that there are important decisions to be made about his care. Of course family members can be involved, but they aren’t indispensable.

  Norm says he feels qualified to decide on his own. She produces a form on bright green paper. She runs down a long list of ways he might procrastinate, from defibrillation to antibiotics, all of which he rejects. She shows him where to sign, and he inscribes legible initials.

  She concludes by asking—somewhat unexpectedly, in his view—“And what do you want?”

  “After all that? I want for it to be 1951, and for you to be a root beer float.”

  “It’s a serious question. Think carefully.”

  “How about 1968 and a smack overdose? I just don’t want to be an old man dying in a hospice. But I guess that’s what I’m stuck with.”

  The doctor is silent. She blinks.

  “As you might imagine, I’m in bad shape physically,” he adds. “I’m weak. The discomfort keeps me from concentrating, so I’m bored out of my mind. And it’s driving my daughter crazy. I hate for her to see me like this, but I can’t make her go away.”

  “She loves you very much.”

  “She adores me. It’s heartbreaking.”

  The doctor nods and smiles. Cautiously she asks, “Are you religious?” He doesn’t respond. She asks, “Have you tried prayer?”

  “To whom? I don’t imagine God is in charge of this. This seems more like a case for the other guy.”

  “Mr. Baker—”

  “God is life. I’m not one of those people who thinks death is part of life. I think it’s pretty darn obviously the opposite of life, to be perfectly frank. That’s why I have trouble getting psyched up for it.”

  “That doesn’t mean help won’t come to you if you ask. Ask, and it shall be given. You have to open your mouth and ask.”

  “I’m an enlightened person.” Seeing her trace of a smile, he adds, “Not like a Zen Buddhist! Enlightened as in the Enlightenment. Rational. Open-minded. I don’t believe in God, but I do believe in religion. Ritual and tradition go a long way toward resigning you to a lousy prognosis. I spent half my life studying shamanism, and I’ve been asking every spirit I know for help, believe me. But until they get off their butts and help me out, maybe you could scare up some kind of painkiller for this crick in my neck.”

  “We have a volunteer massage therapist on staff who’s very good.”

  “Is it tantric massage? That might really help.”

  “I beg of you, Mr. Baker, please take your situation seriously. Tell me what form you want your care to take.”

  “Ma’am, I am not catching your drift. I have no idea what it is you want to hear!”

  She lacks legal authorization to tell him what she wants to hear—that he would like to be knocked out cold, and dead in a week—or that this moment, the one he drowned in morbid lightheartedness, now already past (she dares not harp on her theme), was the moment when he could have asked to sleep soundly through his last days on earth.

  The request would have been honored. But general anesthesia isn’t a menu item, because the hospice is run like one of those brothels that are nominally strip clubs. The license affords no protection to the dancers, who must turn tricks as furtively and nervously as hospice staff dispensing painless deaths.

  And Norm does not want to die. Not yet. He wants to say good-bye to his sons. He craves the good-byes. Knowing all that he knows, he thinks it is worth greeting death with open eyes and intact senses if it means he can see his sons one more time. He is an emotional man. He can’t turn it off.

  “I’m dying, and I’m terribly depressed about it,” he insists, trying to reassure the doctor that his feelings do justice to his surroundings. “I’ll be grateful for anything you can do for me.” He sees that she is still disappointed. He frowns and faces forward again. “Is Jeopardy on yet?”

  At his request, she turns on the TV. Alex Trebek descends from his orbiting satellite into the box, bearing images of certainty and fair play.

  Norm relaxes. The doctor places the remote, with its built-in speaker, in his curled right hand and leaves the room.

  THE NEXT MORNING AT TEN-THIRTY, Penny arrives at the hospice in Norm’s Mercedes S-Class, not forgetting the laptop.

  He says he is in too much pain to do anything but train the dictation software. She says she is a fast typist and could take dictation while he speaks. He laughs and says that would take a stenotype machine. He reads a list of words aloud to the computer. She suggests recording an oral history on audio or video. She says her phone has voice recognition software that works without training. He asks to be left alone.

  He feels too poorly, he says, to speak anymore at all, because the pain in his neck and shoulder is spreading. “It’s like a crick in my neck that reaches all the way around my rib cage and into my back,” he tells her. “Like being twisted too far.”

  Penny fetches a nurse, who tells her to tell him to try to sleep. He agrees to try. She goes to the common room to drink coffee and read the hospice literature. When she comes back, he is awake. He asks to hear Mahler’s Fifth Symphony.

  EARLY IN THE MORNING, TWO days later.

  Another doctor stands at Norm’s feet, a sixtyish woman with elegant platinum jewelry. A laminated plastic tag identifies her as the hospice director. She wears a peach lab coat over taupe gabardine slacks and carries a clipboard.

  “How are we doing?” she asks. />
  “Not so good,” Norm says. “My neck hurts like hell.”

  “On a scale from one to ten, with ten being unbearable pain, where would you place this pain?”

  “Eight and a half.”

  “Have you been letting the staff change your position?”

  “Unfortunately I can’t lie any other way but this way,” he says. “Because of my neck.”

  She flips pensively through the papers on her clipboard and says, “I’m going to be open with you. There are some notes in your file that make me concerned you might be a drug seeker.”

  “I’m a seeker, all right, but I never took a recreational drug in my life!”

  “What I’m hearing now is a drug seeker’s request for opiates.”

  “Where’d you get that? I don’t even believe in opiates.”

  “There has been concern on the staff, I don’t know how to say this”—she shakes her head, as though doubting the notes on her clipboard in her own handwriting—“about a Satanic drug cult of some kind that you were involved with in Brazil?”

  “What did they do, Google me? I thought this was a hospice, not the NSA!”

  “Palliative care means treating the whole person,” she parries smoothly. “With all his quirks.”

  “So give me some palliative care! I don’t know what’s wrong with my neck, but that massage your volunteer gave me sure didn’t help. I remember some of my clients used to be on something called Dilaudid. Supposed to have euphoria as a side effect. You guys have that?”

  She shakes her head. “We rely exclusively on modern therapies to keep our patients comfortable.”

  “Well, I’m not ‘comfortable.’ I’m in hell. Of course I feel right at home, as the founder of a Satanic drug cult.”

  “Mr. Baker, if you would prefer not to receive care in a Christian institution—”

  He rolls his eyes. “Can’t you tell I’m joking?”

  The doctor folds her arms. “Being comfortable means not being in agony. It means not dying the way people used to die. Screaming. It means being able to function mentally.”

  “Well, thanks so much for the timely definition, now that I’m stuck here on my ass until I die.”