Beyond Physical

by D Pichardo-Johansson

  At ten, Joy came to apologize because they hadn’t had a chance to get consent from the Hospice House patients ahead of time.

  “I’m sorry, Richard. From here, I have to rush to a family meeting at the hospital and then to my afternoon practice. Maybe we should start tomorrow, instead.”

  “Doctor, let me go with you. I’ll ride in your car, and I’ll be happy with whatever we can catch up on while talking on the way.”

  “But I feel bad to have you waiting here.”

  Richard didn’t mind continuing his bonding with the staff. It would help him later as he inquired about what they knew of her and O’Hara.

  “I’ll walk around the place until you get done. I wasn’t paying much attention the day we got the tour with Nana.”

  “In that case, wait. Ava?” She knocked at the door of a side office. A tall, middle-aged woman with salt-and-pepper hair opened the door. Richard recognized her as the office manager. “Would you mind taking Mr. Feilds around the center and giving him the full tour, please?”

  “It would be my pleasure.”

  “Thank you.”

  While Joy rushed back to her busy clinic, Ava led the way.

  As they walked, Ava explained the premise of the place. He learned that the Hospice House was a pilot project pitched by Dr. Clayton to the government to help mitigate the spiraling health costs predicted to bankrupt Medicare. She’d written a detailed proposal presenting the results of research about the hospitalization costs of patients at the end of their lives. She showed that the government was spending hundreds of millions of dollars in futile, heroic life-preservation attempts—mechanical ventilation, defibrillators, ICU stays—for patients who were only dying naturally of extreme advanced age. In addition to the traditional hospice care—care for patients with terminal illnesses, such as end-stage cancer patients—she proposed to extend the definition of hospice to include the care of elderly patients having voluntarily opted out of medical treatment that wasn’t directed toward quality of life. Florida, being the country’s capital of elderly population, was the perfect place to try the idea before applying it to other states. The government had agreed to subsidize the first three years of the project.

  The concept wasn’t what amazed Richard the most; it was the cheerful elderly patients gathering in small groups around the central courtyard area, involved in diverse activities from arts and crafts to playing card games. Something didn’t make sense. Everybody seemed too happy. Definitely too happy to be dying.

  They toured the different areas. The center was a U-shaped complex with a courtyard garden in the middle. The three sides of the U consisted of the three wings of the building; and the fourth side, the south end, was an open area with a pool. The wings to the east and west of the courtyard held residents, functioning as a short-term nursing home. The first floor’s north wing was the outpatient area where Dr. Clayton saw patients still strong enough to stay home with the support of visiting nurses. Floors two and three of the north tower held the admitted patients who were “actively dying.” Ava didn’t elaborate, and he didn’t ask.

  As they toured the rooms, Ava explained how every detail in the place, from color palette to furniture, had been handpicked by Dr. Clayton to make the place look like a cozy house instead of a hospital. Every room had large windows, as Dr. Clayton had the theory that the sunlight was energizing. The north tower’s fourth floor included a praying room, a party room, and a movie theater that played only comedies. Dr. Clayton was the ultimate believer in the healing powers of faith and laughter. Richard could guess Ava was starstruck by her boss.

  “I now understand that uncommon mixture of specialties she has, Medicine-Psychiatry and Pain Management,” he said. “So, she convinces people to stop fighting for their lives and then combines pain medicine and psychotherapy to make them hang in there without panicking until they die.” He couldn’t help using a cynical tone. “Quite cost effective, considering that morphine is cheaper than open-heart surgery. Dr. Clayton must be a heck of a business woman.”

  Ava sighed. “I wish I could agree, but you’ll soon discover that Dr. Clayton is . . . how do I put this mildly—a little unconventional in her way of seeing the world. The truth is, nobody knows how this place hasn’t gone bankrupt yet. Besides the government subsidy, we survive on volunteers and . . . prayers.”

  As they were leaving the courtyard, his trained eyes flicked, identifying unusual images. The middle-aged woman teaching the group of residents how to paint watercolor landscapes had no hair and was wearing oxygen. The man pushing the cart with the food trays seemed to be a hundred years old. Now back in the front office area, he caught a glimpse of Nana engaged in an animated conversation with the elderly lady he helped scan documents earlier. He noticed the lady had a chemotherapy port identical to Nana’s sticking out above the neck of her shirt.

  He turned to Ava, scared to ask the question. “Ava, is Dr. Clayton putting the dying patients to work?”

  “Why, yes!” Joy Clayton joined the conversation. “Sometimes we have patients who don’t want to go back home after they meet criteria for discharge because they love to be here, so I hire them for little jobs around the office. Helping the front desk staff, doing small repairs, valet parking . . . I call it my ‘daycare for grown-ups.’ It helps the patients feel useful and gives their caregivers a break.”

  Scowling, he glared at her. “You’re telling me that the valet whom I let park my car can potentially be one of your dying patients all druggy on pain meds?”

  Joy froze, as if the danger of the idea had never occurred to her. “Uh . . . maybe?”

  Richard looked through the sliding glass doors and pointed at the old man. “Him, he’s the one who parks my car every time I come here.”

  Squinting, Joy looked in the direction he was pointing and then smiled, relieved. “Oh! Bruce? No! You have nothing to worry about. Bruce isn’t one of our terminal patients.” She gave Richard a candid smile before concluding, “Bruce is the homeless guy who sleeps in our spare room.”

  As she walked to her office, Richard turned back to Ava, shaking his head. “Please tell me she’s kidding.”

  Ava lowered her head and looked at him through her lashes with a small smile. “I’m afraid she’s not.”

  What did I get myself into?

  Groaning, he quickened his pace and caught up with Joy.

  * * *

  The decor in the spacious office was simple. Abstract art and inspirational messages covered the walls, along with pictures of Joy’s kids. Feminine colors dominated. The soothing murmur of running water rose from a small fountain on a side stone top table. The mild, pleasant scent of cinnamon aromatic candles filled the air.

  Behind the large L-shaped desk, Joy sat, typing on the computer. “Take a seat, please; this will only take a minute.”

  He sat in the first chair he found and was pleased. It was the most comfortable seat he’d ever tried. Realizing it was a recliner, he couldn’t resist lying back and putting his feet up.

  “I’m in heaven! Is this what you use to hypnotize your patients?”

  Her eyes didn’t move from the computer screen. “I don’t see patients here. That recliner’s for me. I use it to meditate when I’m about to go crazy.”

  He made a mental note. She meditates, like Bonas. “Great. Please wake me up before they close the place, would you?”

  “If you want a blanket, I have that too.” Her voice was distracted. It was hard to know if she was kidding or serious.

  Getting back up, he moved to a regular chair in front of hers. She typed a few more characters and clicked the mouse.

  “Done. We’re barely on time to make it to my meeting. Shall we?”

  “After you.”

  As they walked out of the office, Richard started a conversation. “So, Joy, when did you have time to build this amazing place while having three kids?”

  “I worked on the project while on mandatory bed rest during my twin pregnancy.”
/>   They arrived at the parking lot and entered her car, a red Prius.

  Driving off, she said, “I never asked, Richard, how are you related to Nana and Kate?”

  He smiled. “Nana’s kind of an adoptive mother for everyone she meets. She’s Kate’s aunt, but she raised her, rescuing her from abusive parents.”

  “That’s sweet. And Kate is your . . .”

  “Ex-girlfriend.”

  With a soft gasp, she put her hand on her chest. “How nice of you to still be there for her!”

  Richard snickered. “Don’t get the wrong idea; I do it for Nana. Kate and I are over. I’m now in another relationship.” His drinking-buddy-with-benefits, Hailey, barely qualified as a “relationship,” but knowing her name could come out from Nana, he’d decided to upgrade her to “girlfriend” in his character’s background story, to make him appear more grounded.

  Joy seemed surprised. Maybe disappointed? “Oh. Okay.”

  She was quiet for a brief time.

  “You mentioned that you had a son and that you’re divorced.”

  He smiled. She was obviously having trouble making sense of his busy romantic history.

  “Yes. I’ve been divorced for seven years. My ex agreed to move to Fort Sunshine with my son when I relocated here for work five years ago. He lives with her and spends most weekends with me.”

  “Is he doing okay with the divorce?”

  The worry in her voice sounded sincere, but Richard’s smile was cynical. “He’s doing better with the divorce than with the marriage. Trust me, you don’t wanna know how ugly it got.”

  Silence fell.

  As they took US-1, Richard’s attention was caught by the Indian River view. Distracted, he heard Joy ask, “How was your parents’ marriage?”

  The sudden question caught him off guard. “Excuse me?”

  “I asked you, ‘How was your parents’ marriage?’ How was your life as their kid?”

  Richard lifted one hand. “You’re not trying to psychoanalyze me, are you? Please don’t.”

  “I’m not. You told me you wanted to find out if psychology was the right path for you, and that’s what I’m doing. Most people who choose counseling professions, me included, do it out of a need to put their own lives in order.”

  “I want to make it clear that I’m your . . . student, not your patient.”

  She smiled, amused by his attitude. “Message clear. Not my patient! Now, rephrasing the question. How do you think the experiences of your early life influenced your decision to go into this profession? How was it, for you, to be a child?”

  There was a long pause. “I can hardly remember. I grew up too fast. I had to watch my younger brother, take care of my mother financially as soon as I was old enough to work—”

  “How old were you when you started taking care of your brother?”

  Her questions were making him feel unsettled, but for some reason he kept answering with the truth. “I must have been nine or something like that.”

  She raised her eyebrows. “Why was a nine-year-old taking care of other people? You were young enough to be taken care of instead.”

  He’d had enough. “I don’t know. I don’t remember much from my childhood.”

  She bit her lower lip. “Oops, that’s a bad sign.”

  “Why?”

  She paused. “Well, let me give you your first lesson in psychology. That’s called repression.”

  “Repression?”

  “Yes. Memories too painful to handle are pushed away from awareness. They’re not forgotten. They’re stuck in the subconscious, hurting us every day and ruling the way we behave with others.”

  Richard pondered her words. “I’ve heard of the concept. But I thought it was a defense mechanism for catastrophic events. Nothing like that ever happened to me.”

  “That mechanism is activated in normal life events too. It’s the reason why people often believe that the old days were better, and it’s why people only remember good things about the dead. We conveniently forget what was painful about the past.”

  “Interesting. But I still don’t think that applies to me.”

  * * *

  Richard had been at Holloway Hospital too many times, the last few in the ICU. The place was the most depressing building he’d ever visited—old, white, and gray. Contrasting with the steaming heat outside, the air conditioning was set to a freezing temperature, making him wish he’d brought a jacket.

  Joy went straight to a family meeting involving pulling the plug on a patient on a ventilator. It was her last week working on the Hospital’s Ethics Committee. Unable to participate due to HIPA issues, Richard sat in the ICU waiting area, browsing the Internet on the burner cell phone he got assigned for the case. The meeting was over quickly. A weeping older woman and two disturbed middle-aged men walked out of the family conference room. Joy stayed in.

  He peeked into the room and saw her sitting in front of a computer, typing a note. The expression on her face was of grief and exhaustion.

  “Are you okay?” he couldn’t help asking.

  “Just drained.”

  She typed in silence for a few more minutes and then got up.

  “The other patient I was supposed to see here today already died. I feel guilty for saying this, but I’m relieved. That gives me just enough time to grab lunch before heading to the Masden Center.”

  “Great. I mean, I’m sorry. Where should we go?”

  “Let’s go to the doctors’ lounge. The food isn’t great, but at least it’s quick and free.”

  They went through a never-ending maze of twisting hallways and passed at least a half a dozen elevators. Richard wondered if people could get lost in that place and their skeletons be found years later. Arriving at the lounge, she swiped her ID and pushed the door open.

  The place looked like a high school cafeteria. One counter displayed the hot food while another one displayed salads. A third area held pastries and desserts next to a soda machine.

  They grabbed a light lunch and sat at one of the tables. “The food isn’t great” had been a euphemism. It was bad. He could feel Joy’s distress as they ate in silence.

  Releasing a long sigh, Joy said with a tired voice, “I need a chocolate mood-fix.”

  He jumped off his seat to the dessert area and came back with two brownies.

  Surprised, Joy smiled. “Thank you! I was kidding, but that was very nice of you.”

  “If you only get to eat when someone dies, I better make sure the meal is worth it, right?”

  She laughed.

  Joy touched the brownie with her fork, feeling its consistency. “Well, I think there are few things in life that chocolate can’t fix. If people ate more chocolate, we psychiatrists would be much less busy.”

  He chuckled. “And bariatric surgeons would be even busier.”

  She laughed again, her eyes lighting up. She seemed deeply grateful for his dry humor. He thought she looked prettier laughing than psychoanalyzing him.

  Pushing aside their unfinished plates, they started eating their brownies. They were amazing, especially considering how dull the food was.

  He was about to make a joke about stealing the rest of the dessert tray, but something made him freeze.

  She was moaning in pleasure.

  Her eyes were closed. As if unaware of her surroundings, she licked her spoon and sucked her fingers, an ecstatic expression on her face.

  Moaning again, she licked her lips. A flush went through his body; and instantly, the freezing room felt suffocatingly warm.

  “This is so worth the calories!” she said, opening her eyes. “Who needs food with dessert like this? All I need, now, is a good cup of coffee.” She paused. “A large caramel mocha with whipped cream!” The expression on her face was both delight and sinful guilt.

  It took all of Richard’s training. He imagined himself pulling back the cloud of lusty thoughts around him, pushing them inside of a bottle, and then putting a cork in it.


  She tasted one more bite and shook her head, smiling. “I retract myself. Don’t give me chocolate and coffee in the same hour, or you’ll regret it.”

  “Why not?” he asked, recovering his composure.

  “I have an oversensitive brain to all chemicals. I get drunk by barely tasting alcohol; and when I mix chocolate and coffee, you’d think I had cocaine or something. I get super hyper. I think I’m unstoppable.”

  Pushing away the mental image of getting her drunk, he commented, “From what I know about you so far, you are unstoppable!”

  She looked up from her plate to meet his gaze. “What do you mean?”

  He pointed at her with his open hand. “Well, look at you. You’re what, twenty-five?”

  “Thirty-five.”

  “You are thirty-five years old and have already conquered your dream about the Hospice House, have three jobs, three kids, two medical specialties, one subspecialty . . . did I hear somewhere you have another degree too?”

  “A master’s in ethics and philosophy.”

  “That you completed when?”

  “I took night classes at the same time I finished my residency.”

  “While having children too. That was inhuman!”

  She nodded. “You see, I used to be an overachiever.”

  Raising his eyebrows, he tilted his head. “Used to? As in not anymore?”

  She didn’t seem to notice the sarcasm in his voice. “Oh. You should have met me back then. I was terrible. I couldn’t take anything less than an A plus.”

  “What’s different now?”

  “I did my own internal work. I realized I was stuck in the role of superstar in my dysfunctional family of origin, balancing the black-sheep and scapegoat roles my younger sister, Hope, was playing. I know you don’t like to be psychoanalyzed, but I guarantee you that wherever you go to study mental health, the curriculum will include some self-analysis.”

  He chuckled. “Don’t worry. Overachieving has never been my problem.”

  A silky voice interrupted them. “Joy! My darling! How lucky I am to find you!”