A Schedule of Drugs in the Valley of Death

by Sarah Reith

  “He’s a boxer,” I told her. “See his nose?”

  She examined me closely. Then she looked at the drawing again, more carefully this time. Photorealism isn’t what I strive for, but I didn’t say that out loud, because it’s the kind of thing you only say if you’re a pretentious jerk who can’t draw.

  “A boxer,” she said thoughtfully. “With very small ears.”

  She was right. The ears were tiny pink deformities, like lumps of scar tissue on people who have been horribly burned or partially devoured. It takes so little to make a human face grotesque. Sometimes, you can do it with the stroke of a pastel.

  “It’s not done yet,” I said lamely.

  “No, of course not.” She was still examining the drawing. “Lots of colors,” she murmured. Then she fixed me with a look I will not refer to as respectful. It was, rather, a re-evaluation. “It’s very bold,” she said, and watched me.

  I began to feel mildly horrified, like I’d opened the fridge and realized I was staring into a pair of highly intelligent eggs: smooth, impassive, full of secret thoughts. “Oh, well, you know,” I murmured, or something very much like it.

  She was watching me steadily. “I would not have expected you to make something like that.” She sounded like she had taken it for granted that I was utterly without insight and now, without wasting too much thought on the matter, had changed her assessment and was indulging in a few moments of casual astonishment.

  It always makes me feel a little oppressed, when people let me know they’ve been paying attention to me. I don’t even like it when waiters remember my regular order. But this: being closely noticed by a woman who occupied my entire field of vision—this was a form of surveillance I had never experienced.

  Had she been aware of me, all those times I’d rolled her back and forth and rummaged in her secret parts? She always stared off into space when I changed her diapers, her eyes as blank as egg yolks. It was comforting to believe that she had no idea what was happening. If that sounds unlikely, please allow a few moments for a brief anecdote: once, I spent close to an hour with a truly traumatizing quantity of semi-liquid shit. When I pulled back the blankets, the bed looked like the inside of a microwave where the world’s most unappealing entrée has exploded. The shit had stiffened into a shell on her skin, halfway to her shoulder blades in one direction and almost to her knees in the other. The knowledge of how much shit a human body can produce has had a permanent effect on my concept of what it means to be human. Remember that Mariana was enormous. There were times when I felt like I was rummaging around in the cushions of a couch, for one more shred of shit-soaked diaper, one more ineffective mattress guard, one more corner of a soiled nightgown. It was undignified and strenuous in the extreme.

  Hours later, she began to look around in alarm, as if she’d misplaced something personal and was afraid it might turn up somewhere embarrassing. “It came out of me like lava,” she reported, with what sounded very much like satisfaction. “And now it’s gone.”

  In Mariana’s house, everything was neatly labelled. She had a complete set of Allen wrenches, and knew exactly where they were. Her VHS films were filed alphabetically by director. This was not a woman who lost track of her shit. Until she did. But then, in the latest switchback of her own decline, she turned her gaze on me and said, “I would not have expected you to make something like that.”

  She was watching me. She knew who I was. But what did that signify? It wasn’t like those searching eyes would slash my furniture, throw my dishes on the floor, or smash the glass terrarium, where a pair of gentle young iguanas spent their days immobile as the statues of a pair of sitting gurus. No. This was not my father’s house.

  Then, as suddenly as if someone had hit a breaker switch inside her, the moment of examination passed. The light in her eyes went off. The refrigerator was still humming, but the eggs within were no longer watching. They were just a pair of sloshing things, contained by a shell as durable and fragile as the force of life itself.

  AND THEN THE dying began. Heaven defend me from a death of old age. If I ever find religion, I will fall down on my knees and beg to be spared. There were convulsions, for one thing; and for another, there was Fiona.

  I should mention the death kit at this point, since we’ve come to the dying already and I’ve failed to produce it. When someone dies at home, surrounded by loved ones or random strangers off of craigslist, the local hospice provides an assortment of painkillers, anti-anxiety medications, and anal suppositories. The expectation appears to be that a peaceful home death will be characterized by agony both physical and mental; and the inability to take an unassisted shit.

  I remember a sense of motion; but that can’t possibly be accurate. Mariana often woke up screaming about how her bed was careening across the floor, carrying her fast into the darkness. Did I mention that the metaphors of death are not subtle?

  Because Mariana was terrified of the dark, Fiona hung a red paper lantern over the bed. This is how it happened that the scarred old veteran lay dying in a soft red glow, as warm as a womb in July of that year.

  The night it began, the shadows huddled at a respectful distance, not entirely dispelled by soft red lamps or the golden glow of obsolete light bulbs. I remember the sensation of something crashing. If there is to be motion where nothing is moving, let there be a great cacophony where there is only a whisper.

  I still don’t know how someone who can barely move can do so with such force. How does a person who is mostly paralyzed convulse in a way that creates an impression of crashing and shattering, on a peaceful summer evening full of crickets singing songs?

  All she could do was slowly flail her arms. She made no sound. Her face was a series of roundnesses: round, terrified eyes and a round black mouth full of silent screams. She looked like a mountain covered with trees, the movements of their limbs implying gently that the mountain is about to explode.

  Fiona was in a half-crouch at the head of the woman whose death was no longer pending; whose dying, at this precise moment, in this light that would never be exactly the same again, had become an active thing.

  I always thought the name Fiona had a graceful, catlike sound. And Fiona did have a certain cut-throat delicacy. Her manners were brutal and finicky. She had a devastated nervous system and a way of slinking that made her look skillful and sly. But now, in her bony half-crouch at the head of the bed, she had the stark angularity of a shadow puppet. That she was suffering I have no doubt. But the shape of it was unaffecting, like the passionate surrender of one who is utterly undesirable. It wasn’t artificial—or at least it wasn’t faked. But it was made, and held up to the light, where it led a most examined life.

  “Isobel.” She wasn’t crying. Her eyes had gone so dark and deep there was no possibility of light at the ends of them. “Isobel.” It was unmistakably an order; but there was something else there, too. It was a plea. Please obey me, it said. If you have the least compassion, you will allow me to command you. “We need your help.” She turned to Mariana. “We need to give her these, Isobel.” She held a pair of blank white pills in the palm of her quivering hand. “Reuben said I could, if it came to that. It’s really urgent. Isobel! We need to do this now!”

  She was talking to me the way people talk to someone who is standing open-mouthed in a moment where swift decisive action is required. And I will tell you that I felt the call to action, stirring in the darkest, tangled parts of who I am. But at the same time, I saw something sloping away in that darkness; something awkward and stubborn and difficult to visit with. I lunged for it.

  “Is this going to finish it?” I blurted. “Because I am not okay with that.” It is humiliating to remember that my moment of greatest moral fortitude involved my decision not to murder a helpless old woman who would be dead in a matter of days. It is also humiliating to recall that as I made my stand, I was acutely aware of the fact that I was being annoying.

  I saw that Fiona would never forgive me for inter
rupting her this way. She was swept along on the most powerful current of her life, and here I was, quibbling over details.

  “Reuben has given me permission,” she reiterated. She was a lonely crewman on a storm-tossed sea, repeating orders the absent captain had given at dinner, before crockery smashed and provisions heaved into the sea; before the world began to churn with certain death and there was no longer any way to tell the ocean from the sky.

  “I want to know what it is,” I insisted. I knew I sounded like a lesser crewman with imaginary food allergies, examining labels as the last of our non-vegan edibles were swallowed by the waves.

  “It’s . . . I don’t remember the name of it right now, Isobel.” Fiona snatched at the death kit and flung it at me. I caught it clumsily against my chest and fumbled with the zipper.

  “I’m sorry, Fiona. I have to know what it is.” I was a bureaucrat on the lost continent, combing through visas as the shoreline sank out of sight.

  “It’s an anti-anxiety medication,” she finally admitted, tearing her attention away from Mariana. “It’s in that little bottle.”

  I found it. Lorazepam, I read. Administer as needed for the treatment of anxiety.

  It must have been obvious by now. It would have been obvious, to anyone even mildly attentive to other human beings. I literally took a pill out of the bottle and compared it to the ones she held in her hand. I thought Fiona Jones was incompetent. I thought she was insane, and possibly homicidal.

  “I’ll help you,” I said. The storm began to subside.

  DEATH IS A voyage. I know because I read the entire hospice brochure. Hospice literature is illustrated with somber drawings in bright colors, like the ones that catch your eye before you realize you’re looking at a cheesy religious publication. The brochure features a ship sailing over a horizon, against the backdrop of a setting sun. It’s classic death imagery, though it omits the flames and regalia and the terrified sacrificial slaves a proper Viking funeral calls for. Clearly, it is not a requirement to have a Viking warrior funeral, every time you have a corpse and a boat in the same reference.

  What the brochure is trying to convey is that death, like birth, can be beautiful and terrifying, with lots of water imagery. There are people in the world who call themselves “death midwives,” because of the resemblance they see between the two great journeys. If you are one those people, I would like to let you know right now that I would rather not so much as have a cup of coffee with you. Ever.

  To my mind, the part about death that most closely resembles travel is the interminable waiting around for the train that is never on time, the flight that’s been cancelled, the donkey with a twisted gut, and finally, the room that hasn’t been cleaned because the staff have all got dysentery. Death is all the headaches and a few of the soul-searing epiphanies of travel in an unmarked land. And, like all trips, the most important part of this one is choosing your companions wisely.

  I know I made it sound like Fiona and I were adrift on the dark sea of death, our leaky dinghy provisioned with nothing more than heavy-duty palliatives and a few buttplugs. Well, we were. But we could also call a twenty-four hour hospice hotline and talk to a nurse who was endlessly patient and sometimes even kind.

  After speaking with this nurse at great length, Fiona began to administer morphine. She kept immaculate records. Her handwriting was large, looping, and unmistakably feminine. It was slightly out of date. It was a little foreign, exactly what you might expect from someone half a generation older than you are, from a country very much like yours but just a little different, in every way.

  Fiona called the nurse when Mariana seemed frightened or restless. She called when Mariana’s breathing changed. She called when Mariana’s breathing had not changed following the first change; and she called when Mariana broke out in a sweat and when her hands and feet showed a shady purple dappling, which is normal for a dying person. And natural. Which reassurances have never, in the history of all reassurances, had a single measurable effect on anyone’s sense of well-being.

  When you call the twenty-four hour hospice hotline, you tell the operator who you are, what your patient’s name is, and what you wish to discuss with the nurse. After a while, a nurse calls you back. It is not always the same nurse, but they all know everything about your patient, which is either an indication of good record-keeping, or an insight into how interchangeable we all are in our final hours. A hospice death is a grueling lesson in accepting what you cannot change, so there is no sense of emergency. Sometimes, the nurse doesn’t call back for over an hour.

  While we waited, Fiona paced. Mariana had been dying with a sense of purpose for two days now. Reuben and his family had appeared for part of an afternoon, spoken of snakes, and departed. I do not remember exactly what they said about snakes. I seem to recall that Hunter was morbidly allergic to peanuts, which led somehow to the inevitability of his being bitten by a rattlesnake and dying horribly. I got the distinct impression that Reuben and Colleen felt they were providing their son with advantages that they themselves had not enjoyed.

  “I just don’t believe it’s enough,” Fiona insisted.

  She had never come out of the crouch she’d gone into the night the convulsions began. Her back was in such agony, she could no longer carry a basin of water to Mariana’s bedside. She could not reach the towels on the upper shelves, which was just as well, because she could not bend to pick them up when they fell from her nerveless hands.

  “I’m going to go meditate. I’ve got to focus on this.” She scrabbled for the door, crouching like a gnome in one of those fairytales with deep Freudian implications.

  I leaned against the counter by the telephone and thought about a patch of green on the curve of a cheekbone in the photograph from my mother. I was working on a painting now, from the same reference. In the painting, I had rendered this cheekbone in striations that were nearly chartreuse. They were interspersed with reds and pinks I’d mixed myself, following an intuitive recipe I’d never be able to duplicate. It occurred to me that this part of the painting looked like exposed musculature. I was just thinking about how someday, I would get an anatomy book and study the muscles of the face, when the phone rang. I picked it up.

  “Is this Fiona?” The voice sounded compassionate but wary. Someone who knows Fiona, I realized at once. The voice identified itself as Agnes the hospice nurse, returning a call from Fiona Jones about Mrs. Blanchefleur. “Is Ms. Jones there?”

  I made a few enabling excuses before introducing myself. “I’m living here, too. I’m one of the caregivers. I’m taking care of Mariana.” I hoped I didn’t sound resentful about being excluded from something distasteful and sad.

  Agnes hesitated. “Fiona is concerned. Fiona feels that Mariana is in pain.”

  “I’m not a nurse,” I replied. This was pot country. I knew when I was being invited to say something incriminating.

  “What is your thinking on that?” she asked, as if I hadn’t said a thing—which I hadn’t. Not really.

  “I’m not a medical professional. Mariana isn’t speaking, so she can’t exactly tell us how she’s feeling.” A surge of adrenaline did a few laps around my chest. “Hold on a second,” I heard myself say. I felt my body propel itself into the bathroom and lock the door. I turned on the water and sat down on the edge of the tub. “I had that tub built specially for me,” Mariana used to sigh, “and now I am the only one who cannot use it.”

  “She looks to me like she’s in a coma,” I said. I felt like a teenager, gossiping about the mean girls with that one cool old person who understands. It was exciting, to fly in the face of an authority that isn’t quite legitimate, but is still very real. Agnes was silent. “I mean, I’ve never seen anybody who’s actually in a coma.” Don’t take me seriously, I begged silently. I’m just a nobody. I’m just a buttwiper. “But, ah, she’s not really moving. I mean, she’s breathing . . .”

  “Can you check on her for me?” Agnes was suddenly alert.

&nbs
p; I hesitated. Because of Fiona’s policy about the doors, I was trapped in the kitchen and bathroom until Fiona emerged from her room. You remember that the living room, where Mariana lay, was not to be used as a thoroughfare. However, both of us could use the outside door on the master bedroom, where Fiona slept—as long as Fiona’s need to rest and meditate in privacy could also be respected. Because Fiona was meditating right now, I could not approach Mariana from the sliding glass doors, which, for reasons that were never quite clear to me, was the only acceptable direction. How did Fiona enforce this policy? By being fragile and in pain.

  “I would be happy to,” I replied, feeling bold and almost brutal.

  I do not remember how it felt, to move across the hardwood floor as I made my forbidden approach. I stopped beside the bed and looked down at Mariana. Her mouth was open. Her eyes were closed.

  “She looks like she’s sleeping,” I said.

  It felt almost crude, to state the fact so bluntly. To be sleeping, rather than dying, implies the indignity of snoring and farting and shifting around with no great purpose; of regenerating the vulgar body so it can go on living like there’s no such thing as death.

  “Any agitation?” Agnes wanted to know. Clinical language like this is also disrespectful. I could tell that Agnes would fail to account for the presence of spirits, changes in energy currents, or the implications of past lives when she made her assessment of Mrs. Blanchefleur’s condition. I reported briskly that the patient did not appear to be agitated.

  “She’s probably not in pain,” Agnes told me. Then, with the air of a lady gathering her skirts before setting off across a muddy field, she asked a question that sounded very much like she was trying to establish culpability. “Who is administering pain medication?”

  I admitted that I hadn’t concerned myself with such complicated matters. I was experiencing a severe adrenaline comedown. “Fiona can’t really do much of anything else,” I began, and trailed off lamely. I sounded exactly like an incompetent criminal’s lazy, dumb accomplice.