by Nell Zink
“Mr. Baker, I would ask you to remain civil.”
“All right. Civilize me. You’re the renowned specialist in palliative medicine. Do something about my fucking neck.”
For a moment, the director twirls her pen. She wriggles pensively, as though thinking with her intestines. Finally she says, “It could be muscle cramping. Some patients respond to a muscle relaxant.”
“Then why doesn’t somebody try it already?” Norm begs.
PENNY SPENDS AN UNPRODUCTIVE DAY with Norm, not working on his memoirs.
That evening, she returns to Morristown in a state of agitation and restlessness. The gate opens when it senses the car’s transponder.
The house is H-shaped, very large; the exterior, white stucco with high, black-shuttered windows. The black perimeter fence encompasses one and three-quarter acres.
When she comes into the kitchen through the side door, Amalia is drinking beer and soliloquizing to Norm on the phone. She says, eyes on Penny, “Got to go, cariño. Your baby’s home. Love you. Bye.” She hugs her daughter and says, “I know, honey.”
“You should come see him,” Penny says. “He’s not getting the right painkillers.”
Amalia shakes her head. “On Sunday I will definitely come,” she says. “Work is so crazy. We’re up to our necks in a merger. It would be so much easier. I could see him every day, if he would be here at home.”
“But what about the bleed-out? And taking care of him? I don’t know, Mom.”
“If he says he will do it, I will find a way. I will help you. Can you talk to him? Make him come home?”
THE NEXT MORNING, NORM HAS a new symptom. “Ih er eenh,” he tells Penny. “Ah unh unh ee ah unh-ur unh.”
“Slow down. I can’t tell what you’re saying.”
“Anh uh eh ih ee. Ah ehr. Oh. Eh ee oh.”
“Are you in pain?”
“Eh!”
Penny marches to the nurses’ station, tears in her eyes. “My father’s still in pain,” she tells the nurse sitting there. “And now he can’t fucking talk.”
“I’ll ask you to use civilized language,” the nurse says, looking up from her cell phone. “Terminal distress and agitation are normal. If he doesn’t fall asleep in a few minutes, I can send for the chaplain.”
“He’s upset because he’s in pain and they won’t give him any painkillers! All he got was a muscle relaxant!”
A doctor sits filling out a form at a desk behind the nurse. He looks up and says, “I could ask him whether he’d like a sedative.”
“That’s an idea,” Penny says. “He told me once he used to take Valium on boat rides, after he was on this ferry on the Amazon that burned and he got this fear of ships. He said Valium set him right up!” She almost laughs herself at the ridiculousness of Norm’s phobia, so she is surprised when the doctor says something even sillier: that Valium could damage his liver.
“Damage his liver? Who cares? He’s dying!”
“It could hasten death,” the doctor says. “We don’t assist anyone here to die more quickly. It’s God who decides how and when that will happen. We simply allow nature to take its course.”
“We didn’t come here to let God and nature decide. We can get them for free by walking out the door.”
“What you need to understand is, your father is not dying. Not yet. His lungs sound normal. No crackles. His kidneys are functioning. He’s at a very early stage. But if he’s having more psychological distress than he can tolerate, I could consider starting him on twilight sedation. It’s state of the art in end-of-life care.”
“First you have to get him off those muscle relaxants so he can communicate! He wasn’t distressed before, just in pain.”
“I’ll go see him now, and I’ll ask him if he wants sedation, and we’ll think about alternatives. I promise.” The doctor gives Penny his hand. “You should go home and relax. Take a day off and get some rest.”
“What if he dies today?”
“Not a chance,” he assures her.
FOUR DAYS PASS. PENNY SITS by Norm, giving him ice cubes to eat. He coughs. He runs the ice cubes around his mouth with his tongue, but he can’t swallow the liquid water. It runs into his beard, which is cut very short.
“He’s not thirsty anymore,” a nurse explains.
“Wah,” he protests.
“He’s asking for water,” Penny insists.
“It’s a habit,” the nurse explains again. “He’s on twilight sedation. He doesn’t know what he’s saying. He’s used to asking for water. It’s a habit like anything else.”
“Wah,” Norm says.
“YOU CAN DO ORAL CARE yourself,” a friendly orderly tells Penny two days later. She shows her how to dip a rough rectangular sponge on a lollipop stick in water and offer it to him.
Norm sucks it hard. His spit forms a sticky web around the green sponge. The inside of his mouth is yellow, crusted with dried snot. The orderly shows Penny how to swab his teeth and tongue gently so that the crust still obscures his soft palate completely, obstructing his windpipe.
“Can’t you get that stuff out so he can breathe?” Penny asks.
The orderly shakes her head. “It’s not our policy to perform suction. That would only prolong his life.”
Penny runs a swab around the back of Norm’s throat and twirls it. The substance collects on the swab like cotton candy. She throws it away and tries another swab. A plate of dried mucus flakes off his throat like a loose poker chip. She hauls it out with the swab. Nothing disgusts her. She is gentle and caring. He moans his word “Wah.” The inside of his mouth is almost clean. It is red, gray, and gold. His golden molars shine. She feels a sense of achievement.
She wets a swab and inserts it in his mouth. His teeth clamp down on it and he sucks the water.
“It’s a reflex,” the orderly says.
After three more wet swabs, Penny marches down to the nurses’ station.
“I’m taking my dad home,” she says to the random doctor who is sitting behind the desk, doing paperwork. “I don’t care if it’s against medical advice.”
“It’s normal for patients to say they want to go home,” she says. “It’s a universal metaphor for being at peace in God’s love.”
“Do you even believe in God? You sound like the hospice manual.”
“I believe there’s a higher power.”
A room door opens and a very old man with thick, strong limbs lurches into the hallway, wearing a hospital gown made of paper. He elbows the nurse who pursues him. Penny follows them as far as the glass double doors to the garden. The old man stands next to the birdbath, scanning the parking lot for his car, while the nurse remonstrates with him. He has no keys or clothes. The weather is chilly. A security guard brings a wheelchair, and three staff members accompany him back to his room.
Penny returns to the nurses’ station and says to the doctor, “If there is a higher power, how come it lets people get as weak as my dad and leaves their capacity to feel pain?”
“If he had pain, we’d know it.”
“That’s not true,” Penny says. “He’s a stoic.”
“We don’t know what he’s feeling,” the doctor says. “When people are very sick, their cognition is altered. We don’t hasten the end of life. Every human being has a right to self-awareness, especially at the end, when we’re making our peace with God. You might want to talk with our chaplain.”
She turns away, defeated.
She goes out the front door and follows the concrete walk past the handicapped parking spots until she is off hospice property. She smokes a cigarette by the road. Butts line the gutter. A passing driver slows and raises his eyebrows. She turns back to face the hospice.
PENNY’S DISTRESS AND AGITATION ARE profound.
Norm built the world she once lived in, calling its entities into being word by word. But his word, which once was law, has surrendered to higher laws. He is so weak that a fly, landing on his nose, would be a higher law. He couldn’t s
wat it away. He and Penny share a world not their own.
When his eyes seek hers, bright with the need to die and hopeful that she will help, she feels love, like a serrated knife, carving out her heart and giving it to her father.
FOUR DAYS LATER, AMALIA COMES to visit, bringing Norm’s pet cat in a travel carrier.
The cat, a neutered male named Schubert, is small and black with orange eyes, very pretty. He presses his body against the back wall of the carrier. “Look who I brought!” Amalia says, swinging the carrier up onto the bed and knocking it against Norm’s hip. “He’s sleeping,” she whispers to Penny.
“He could be awake. His eyes are stuck shut.”
Amalia leans closer and sees that Norm’s upper and lower lashes are gummed together with dried mucus. “Oh my god! I should have come earlier! I was just so busy.” She places the cat carrier on the floor at her feet and asks, “Did you talk to Patrick?”
“No. Was I supposed to?”
“He said he called you. He can’t make it, but he knows Norm will understand. He’s hanging a major show of photographs in Jakarta.”
Norm says, “Wah.”
Amalia seizes both his hands in hers. “I’m here, honey,” she says. “Go back to sleep. I love you!”
Norm rolls his right hand from side to side.
“I haven’t seen him move his hands in weeks,” Penny exclaims.
“Oh, your kitty misses you, too,” Amalia tells him. She pulls Schubert from his carrier on the floor and seats him on the bedspread facing Norm. Holding his forelegs tight against his rib cage, she shoves him toward Norm’s hand for petting.
Very slowly, Norm raises both hands and closes them around the cat’s throat as though to strangle him. His thumbs press hard on Schubert’s trachea.
The cat snarls and scratches him deeply on top of his right forearm.
“Fuck,” Penny says, moved by her father’s display of physical effort and will.
“Oh my god,” Amalia says, moved by the blood that streams from his torn flesh. Norm does not wince or make a sound. His hands drop to the blanket. His right forearm gapes like a split pomegranate, and he seems to fall asleep. Schubert escapes and hides under the bed.
Penny is entirely sure—100 percent certain—that he was trying to communicate to Amalia that she should strangle him. That he does not trust her, Penny, to carry out such a wish, but that he wouldn’t put it past her mother.
“Here, kitty, kitty, kitty,” Amalia says, on her knees on the floor. “I should never have put this poor kitty in the car. Now he thinks he’s at the vet!”
THE NEXT MORNING, NORM’S WOUND is badly infected. A spike of sepsis reaches to his shoulder. Under a thick wad of bandaging, his arm continues to bleed.
“Blood poisoning a-going to kill him now,” an orderly tells Penny. “This man got no immune system.” He smoothes a fresh sheet with his hand while two nurses support Norm, who has been rolled over onto his side. His skin, soft as silk and drained of muscle and fat, lies draped over his skeleton like a shroud.
Soon after, the assistant deputy hospice director surprises Penny by inviting her to sit down in the foyer between the baby grand piano and the flickering gas hearth. “I spoke with your mother,” she says, “and we’re discharging him to home hospice this afternoon. He’s had no events requiring intervention. His vital signs are good.”
“You are kidding me,” Penny says.
“We admitted him expecting a bleed-out. His platelets are minimal, but there simply hasn’t been sufficient trauma. He hasn’t been eating or getting up. At this stage we anticipate death from kidney failure, assuming he doesn’t start drinking again. I would strongly advise against intubation or intravenous fluids.”
“Right, right,” Penny says. “No painkillers because they hasten death, and no fluids because they prolong life.”
The assistant deputy hospice director places a hand on Penny’s shoulder. “This must be hard on you.”
“It’s harder on him!”
“It gets easier. He’s going to die fairly quickly of systemic sepsis, with that arm.”
Norm’s advance directive—an end game far too much like Final Jeopardy for comfort—rejects antibiotics.
Penny bites her lip and says nothing.
SHE SITS WITH A SOCIAL worker in a cramped office behind the reception desk and discusses the equipment and assistance she will need in Morristown.
She will take delivery of an adjustable bed just like the bed in the hospice. Twice a day, a nurse’s aide will help her change Norm’s diaper. She will learn to administer the “e-kit” in emergencies.
Penny agrees to everything, and the social worker makes a phone call. She asks Penny whether anyone is at home, because the bed is already on the truck.
Penny retrieves her bag and the laptop from Norm’s room—he is sound asleep—and drives to Morristown to wait for the bed.
She clears space in his library, the only room on the ground floor that lacks carpeting. The end tables are small, easy to move to another room. She sees the books that will surround him during his last days: Norman O. Brown, Georges Bataille, Jack London, Lévi-Strauss, Castañeda, Teilhard de Chardin, William James. And his own works: Shamanism: Modern Social and Cognitive Aspects. The Cosmic Snake of Healing. Disengaging Death: From Cancer to Dancer. If he could express an opinion, would he say he cares about books? She doesn’t know.
Late that afternoon, an ambulance arrives, staffed by two burly EMTs. Norm rides his gleaming silver-and-red catafalque into the front hall, wheezing but not groaning as it lurches up the steps. The men heave Norm into the low, heavy bed and cover his body with an oversize sheet. Schubert curls up on his stomach. Penny prepares a cup of ice cubes and some swabs, in case he opens his mouth. He seems inert. A home health aide arrives to train her. He shows her how to put ointment on his bedsores with rubber gloves and use a hypodermic needle.
THAT EVENING AFTER WORK, AMALIA rushes to his side and kneels by the bed. “Darling, darling,” she says, kissing him. “I am so glad you could come home.” To Penny, she adds, “He doesn’t answer.”
“He’s on morphine and Haldol.”
“I wish we could talk.”
“No, you don’t! I’m so grateful they finally knocked him out.”
“Stop that. He’s just tired. He can hear you.”
AROUND 4:00 A.M., NORM HOWLS. He howls again. He bellows loudly that he wants to go home. Penny finds him asleep, bleeding lightly from the nose, with his left arm over the bed railing. Amalia sits by him until seven o’clock. Then she heads out to work.
Penny spends most of the day perusing social media in the kitchen, drinking coffee with Baileys, smoking Marlboros. She helps the aide with Norm’s hygiene and rubs his feet with urea cream.
NOT LONG AFTER—ONLY FIVE days—Matt drives to Morristown to say good-bye.
For days Norm has done nothing but breathe. Things happen to him, but his own activities are twofold: sonorous intake of breath and stuttered expulsion. Inhalation is shrill. It sounds painful. The home health aide says it isn’t painful.
Matt’s hair is still full and black, longish and wavy, something of an art-director mane. His beard, clipped short, is graying. He appears very large and solid, but slim, in a black merino sweater and charcoal gray slacks.
At first he stands at the foot of the bed, hands clasped below his belt buckle. He sits down on a chair by the head of the bed and reaches over the rails to place his hand on Norm’s forehead.
Matt’s face freezes at the sight of Norm’s open mouth. It is a red hole through which his tongue pokes yellow, caked in a giraffe-skin-like pattern of dried mucus. “Jesus, Dad,” he says. “You look atrocious.”
Norm breathes.
“We always spoke our minds, so there’s nothing left to say,” Matt says. He waits. He takes Norm’s left hand. “Good-bye, Dad,” he says. “I love you.”
He lowers his forehead to the bed railing and remains motionless, dry-eyed, for two minutes. He
stands and leaves without speaking to Amalia or Penny.
Penny sits by Norm until deep in the night.
A WEEK LATER, WITHOUT ANOTHER peep of complaint, Norm stops dying.
Penny is holding his hand. There is no sound. At one moment he is dying audibly, each breath quick, forced, harsh, through whistle-like apertures in the material blocking his windpipe. The next moment he is still.
She glances at the window and sees gratefully that it is open. She becomes aware that humans have souls. These are slender birds like swifts, invisible and made of moist living breath. When a person dies, this bird urgently requires free passage to the sky.
In essence, if Norm hadn’t smelled so horrible that she’d had to open a window in summer and let in the humidity, his soul would have been trapped in his library forever, unable to join the other souls.
She doesn’t believe in the soul thing at all. She just knows it all of a sudden.
She places his left hand on his chest. She sits and stares at the rotting body in its leaky diaper for a quarter of an hour. She leaves the room and closes the door.
Seeing a flower arrangement on the side table in the front hall, she removes a few flowers. She goes back to the library and lays them on Norm’s chest. They help, she thinks. Flowers really help. The dead thing looks a lot better with flowers on it.
She makes herself two espressos in a row, using the ultrafast pod machine, and calls Amalia at work.
“Don’t do anything,” Amalia says. “I’ll be right there. Call that nurse and tell him not to come anymore. Tell the hospice agency to pick up that nasty bed.”
PENNY DRIVES OUT TO BUY groceries with altered perceptions. She breezes through a stop sign and almost misses her turnoff. In the store, the very ugliest white people seem beautiful to her, their red noses and inflamed pimples alive with oxygen-saturated hemoglobin. At the deli counter she gets in line for pastrami, but lasts only a few seconds, fazed by cold cuts embalmed in nitrite solution and mummified ham. She pushes her cart to the cereal aisle and buys a box of Post Raisin Bran.