“And then, just as he was about to take the picture,” Jeanine prompted, “just as he said to the girls, ‘Say “Ice cream—”’”
“We all said, ‘Ice cream!’ ” Marie’s face lit up with the words. “But just then—” She caught her breath. We all caught our breath.
“Out of a clear blue sky . . .” Jeanine whispered.
Marie shook her head as if a fly had touched her face. “The most enormous wind came up, and whirled around us so hard it seemed it would pick us all up into the sky.”
Jeanine, Francie, and even Roger were all leaning forward, intent on the figure in the bed, and as Marie’s pallid jaws worked I could see the rest of them moving their lips in unison.
“And when the wind blew away . . .” Jeanine began.
“When the wind died,” Marie continued, “Mary Ellen had her ice cream.” The silent chorus echoed, Ice cream. “And Marguerite had her ice cream.” We were all of us leaning toward her. “But when I looked at my ice cream, it was gone! My ice-cream cone was empty!”
We stirred, the spell on the verge of breaking, sharing looks in a ritual of amazement in which I, too, was included.
“We looked and looked, on the bench and in the grass, in my dress and even in my little pocketbook, but no matter where we looked—no ice cream!”
Marie’s eyes were shining now.
“And then,” Jeanine prompted one more time, “Grandaddy said . . .”
“Daddy said,” Marie began, her eyes softening, turning inward again.
“Granddaddy said,” Jeanine repeated as Marie faltered, “ ‘Don’t worry, Marie, God sent that wind to blow that ice cream up to heaven.’ And Momma said, ‘Daddy, that don’t make sense. There’s all the ice cream they need up in heaven!’”
The ritual wound up in an outburst of gaiety, but Marie, wattles quivering with indignation, shook her head. The outburst died.
“That’s not what he said.”
Jeanine and the others stared at her, stricken.
“I know that’s how Mary Ellen liked to tell it, Jeanine, but I was there. What he said was, ‘The good Lord knows where your ice cream went, Marie, but I sure don’t.’”
She clamped her jaws together and glared at nothing in particular.
Out of the awkward silence, Francie’s voice rose.
“What happened to the photograph?”
We all looked at her. Defensively, she added, “I’ve always wondered. If Granddaddy was taking their picture, wouldn’t that show where the ice cream went?”
We all turned to Marie, who shook her head again.
“Daddy said when he went to rewind that film something went wrong. The sun got in and spoiled the whole roll. Every negative came out as black as black.”
“No picture?” Francie asked plaintively.
Marie’s expression softened. “No, Francie,” she said quietly. “There never was any picture.”
“And your ice cream?”
Marie, looking inward again, said almost inaudibly, “No ice cream, either.”
THAT EVENING, I LOOKED in briefly, but the room was quiet, Marie asleep, one of the girls slumped half over the bed. The monitor high over Marie was the only sign of life, the green light dancing in the darkened room. She was restless, her face twitching, brow furrowed, but still she seemed asleep. Dreaming, I thought, then pushed the thought away. I stopped at the nursing station to order two more milligrams of morphine.
In the morning, after rounds, after another sleepless night, I went in to shut off Marie’s dobutamine. Her pressure had started drifting down, but otherwise there had been no change. The whole family had gathered again at the bedside, joined by a few more faces that shared the stamp of Marie’s pointed chin and broad forehead. There was also a large, freshly bathed and shaved figure introduced as the pastor. It was time.
I went to the head of the bed. Marie looked up at me. “Hello, Doctor,” she said.
“How are you?” I asked, the question sounding less inane than I expected it would.
She waved a hand vaguely. “Here,” she gasped, attempting a laugh, and then the hand subsided.
“I’m going to turn off the dobutamine now. Is that all right?”
“Yes. Turn it off.” She almost rose from the bed with a sudden vehemence that startled me.
“Are you sure?” I asked reflexively.
“Yes.” Her voice rose sharply. “Turn it off. Now!” With her left arm she gripped my sleeve. “You promised.”
She was wandering, I thought, addled by morphine and fatigue, drifting in and out of a place she did not trust. I only nodded, and turned to the nurse who had quietly followed me in. She bent beside the IV pole. The pump sighed to a halt, the grinding noise that had been unnoticeable up until then suddenly loud in its absence.
Nothing changed. The family stood still, looking at Marie as if they expected her to expire on the spot.
I moved back to the bed. “There,” I said.
She looked at me.
“Are you okay?” I smoothed a curl back from her forehead.
“Fine now,” she said. And then her right arm reached around and gripped my shoulder, pulling me toward her. I bent, obediently, thinking she wanted to say something.
Instead she planted a dry kiss on my cheek. I hung there a moment, holding my breath. Then I kissed her back. The skin of her cheek was very cool. She sighed, and her grip relaxed. I turned and left the room.
It took Marie four hours to die. I was in and out of the room, checking for signs of distress. There were none. On one of those visits, I reached up and turned off the bedside monitor: she had a pacemaker, and I didn’t want the family to see the tracings continue after she was dead.
Around three-thirty, the nurse found me at the station.
“Twelve is gone.”
I sighed, and pulled myself upright.
MARIE’S BODY: THE FACE gone slack and chalky, the eyes blank; her lips, half open, expressionless. Within her chest I heard nothing. A fugitive creak and gurgle as fluids shifted in her, but the heart itself was still. Time of death was 3:32. Cause of death, congestive heart failure. I filled out the papers as quickly as I could.
“DOCTOR?”
I looked up, focusing with difficulty. It was Jeanine. Her eyes were red, mascara smeared across both cheeks.
“Marie wanted me to tell you.”
“What?”
“Two things. She said to thank you. And that she knows where that ice-cream cone went.”
I waited.
She shook her head. “That was all she said. ‘Tell that doctor I know where the ice cream went.’”
I looked at her and she shrugged, smiling.
I smiled back and we parted, hugging each other in the decorous way strangers should.
LATER THAT DAY, FINALLY, I went home. I lay awake a long time that night, in the desperate insomnia that seizes me sometimes, post-call. I was thinking about that ice-cream cone, wondering what Marie had meant, what revelation had come to her as her brain, starved for oxygen, fogged with drugs, had started to shut down. I have seen it before. My own father, dying on a morphine drip, his kidneys gone from a failed dobutamine tune-up, had spoken in his last coma. Stray words. Words I hung on through the long afternoons. I no longer remember them.
Where could that ice-cream cone have gone? It had fallen somewhere they hadn’t thought to look. Everybody in the room, all of them sharing that story over all those years, must have known it. That wasn’t the point, though. But then what was? I tortured the question for a long time, as my wife stirred beside me in her sleep, and one of the children murmured something over the carrier hum of the baby monitor, and nothing came to me. Just ice cream, Marie’s finale, the long slide downward into night.
That night I dreamed. I have found that picture. Deep in it, the figures move, the three little girls in their neat white dresses throwing up their arms and shrieking silently as the wind whirls, leaves and debris fly around them, and in the distance trees thr
ash their limbs against a glaring sky. I scan the picture, searching it for a dim white blur ascending, flying skyward out of the frame. That night and three times since I have dreamt this, and each time I awake into the dull non-knowledge that I have failed to find the ice cream. I know that one day in this dream I will learn where the ice cream has gone, where Marie has gone, where all of us will someday vanish, ice under the sun. Unaware that this is but the dream still upon me, I watch helplessly as it recedes into the light, whirled upward on a wind that leaves me cold and dark and dumb.
THE
SURGICAL
MASK
THE REFERRAL HAD COME IN THE DAY BEFORE. Richard, the on-call nurse, had jotted down a sketchy story: Sylvia Turner, a fifty-seven-year-old woman being discharged from Memorial after treatment for a sinus infection. I looked up from the form at the duty nurse with whom I was rounding that morning. “Sinus infection?” I said. “Is that really an indication for hospice?”
Linda laughed. “Is that what he wrote down? Give me that.” She took the referral from my hand and swiveled it around. “That idiot.” She laughed. “He left out the part about the cancer. Squamous,” she added, and tapped the side of her nose.
“Ah,” I said, meaning I was sorry for Mrs. Turner. Like leprosy, only worse, runaway squamous-cell cancer whittles its victims away until the tumor reaches something vital to life, and then they die. “Anything else about her?”
“Husband says she’s stopped eating.”
“Is that a problem?” I asked. With hospice patients, when they stop eating it’s usually a good thing.
Linda shrugged. “That’s where Richard ran out of info. She’s first on the list, however,” she added brightly. “Shall we go ask her?” She hoisted her red backpack and stomped out the door. Linda, I had learned, despite the impression she gave of having spent the weekend playing electric guitar in a goth band, was a highly reliable if somewhat profane nurse. In my four days so far with the hospice team I had also learned to follow her obediently from house to house.
My presence on the hospice service was an elective month, one of two my residency program permitted. Hospice had looked promising because: (a) it got me out of the hospital, and (b) I didn’t have to come in on weekends. And, I had told myself, it would be a relief to work with patients whose deaths were welcome.
I spent the drive in a pleasant half doze as Linda drove. I suppose if I’d paid attention to her driving I’d have been less relaxed, but in this, as with her dispensing of morphine and laxatives, I was content to let her steer.
I know now that much of this passivity was simply evasion. It hadn’t taken many visits to homes where death had become part of the décor before I started to think that in electing a month of hospice I’d possibly overdone it. But it was only a month, I told myself; if I had learned nothing else from residency so far, it was that I could do anything for a month. So I did what I’d learned to do very early on in my training: pull in the antennae, lean back, and watch the scenery go by.
Which it did, in an alarming series of loops and swerves, until we scattered gravel in front of a rambling one-story farmhouse standing in the midst of a rain-soaked yard. The sparse lawn was broken by a barely graveled arc on which we had come to rest beside a large gray pickup truck loaded with what appeared to be chicken coops. An old fruit tree, thrawn with age and neglect, dripped rainwater across a faint trace of bricks that marked the approach to a swaybacked porch.
Linda, muttering as she backed the Accord into a vacant patch of gravel, scanned the yard and surrounding outbuildings. The back of the house seemed to abut on an overgrown orchard. Linda surveyed this suspiciously for a minute. “Don’t see any,” she announced finally. She was talking about dogs, which she had explained to me our first morning were the only thing she really worried about on these visits. She had illustrated this by displaying a large, crescent-shaped scar on one calf. I followed her to the porch, hunching my shoulders to keep the rain off my neck.
On the screen door a handmade sign, black marker on a sheet of cardboard, read No Visitors. Behind the screen, the door stood slightly ajar; it bore another handmade sign with the same message. As we stood looking at the signs, the door opened abruptly, framing a very large man in a faded flannel shirt, with a round face and pale curly hair fading to bald on top. He eyed us warily.
“Hospice,” Linda called through the screen, a jaunty singsong, two notes, descending. She showed him her backpack as if it explained our mission.
A weary look of relief broke through the suspicion. “Sorry about the sign,” he said as he backed out of the doorway. “We had trouble yesterday.”
“What sort of trouble?” Linda was already in, peering around the darkened interior like a bird looking for something to peck.
“Some ladies from our church.” He fell silent for a moment and I could see the muscles of his jaw knot suddenly. “They wanted to tell Sylvie how she’s going to Hell.”
“Shit,” said Linda.
Mr. Turner nodded once emphatically. For a moment he looked as though he was about to cry.
“Is she okay?”
He glanced reflexively into the darkened interior. “She had a bad night.”
“Could we see her?” She shouldered her pack, then caught herself, held out a hand, and made introductions.
He took her hand, looked over his shoulder at me. “Charles Turner,” he said gruffly. “Thanks for coming.” He turned toward the interior. “She’s in here.”
He led us down a dim hallway, and as my eyes adjusted to the interior murk I was startled: under a ceiling at least twelve feet high every wall was filled with paintings. Not reproductions, I realized: oils on canvas, framed and hung one above another from the chair rail to the pressed-tin ceiling. Landscapes, most of them, graceful imitations of Constable; some were portraits after Reynolds. They were beautifully executed: solemn, Academy-quality exercises in every way, except that in almost every one the classical landscape was disrupted by the presence of large tropical birds: scarlet macaws, cockatiels, lovebirds, flocks of parakeets. In the portraits, birds perched on shoulders, peered coyly from behind the sitters’ heads, or preened on outstretched fingers, the sitters gazing lovingly. Massed above us in the darkened hallway, their effect was slightly hallucinatory.
Turner paused as we stared upward. “I framed them,” he said quietly.
We looked at him.
“They’re Sylvie’s,” he added, surprised at our obtuseness.
He led us through a doorway at the end of the hall. We entered a dining room, which by the clutter everywhere had not been used for dining in a long time. A battered mahogany table, chairs and sideboard cowered beneath canvases depicting enormous parrots; these were minimalist, primary-color cartoons on a stark white ground. We moved on to another low hallway. At the far end, a half-light door let out onto what looked like a chicken house: wire cages and roosts, rustling forms, an occasional muted screech. Turner led us through another door and there was the bedroom.
The curtains were drawn. The dim light of the rainy day outside barely illuminated the canvases that lined each high wall: a kitchen table in sunlight, large earthenware bowls with birds roosting on their rims; a picnic after Manet, the figures holding out crackers toward the trees; a tropical waterfall with small pink forms that I realized after a moment’s confusion were human infants, winged, fluttering through the mist. In the surrounding trees, enormous cockatoos were sheltering untidy nests, from which more small human faces peeped. In a queen-sized bed Sylvia Turner lay, shrouded by a flesh-colored chenille spread. She had watched us come into the room: her eyes—large, liquid, and brown—had followed us as we entered, and I’d been aware of them on us as we stopped and took in the display on the walls. Her expression as we gazed upward was hard to read.
I’d had the impression that the bedspread had been pulled up almost to her eyes, but as I stopped staring, finally, at the paintings and turned to the bed (where Linda was already bending over, he
r hand out to take Sylvia’s), I saw that what I had mistaken for part of the bedspread was a surgical mask covering the lower half of her face. It ballooned slightly in rhythm with the rise and fall of her chest; it fluttered when she spoke. It muffled her voice as she said something in reply to Linda’s questions about her pain, or I thought it did, and then I realized her voice was simply indistinct, as if speaking around a mouthful of pebbles, the consonants slurred or reduced to soundless puffs into the mask.
It was the sound of her voice that made me look at her.
She looked back, the eyes shrinking from mine at first, then coming back to meet my gaze a moment, then sheering away.
I continued to stare. There was nothing there but a surgical mask, no sign of anything unusual about it at all, except that it was overlarge: the edges lapped over her ears, the ties barely visible as they extended around her head and neck. Just a large white surgical mask. I could barely keep my eyes off of it.
I realized Linda was speaking to me.
“She says the Roxanol isn’t working.”
I nodded, still struck mute at the mask fluttering in and out.
“Roxanol,” I said stupidly. Roxanol is an old brand name for a concentrated elixir of morphine, the mainstay of hospice care. No IV needed: just a drop or two under the tongue and it’s absorbed.
“I think maybe she’s not absorbing.” Linda bent and whispered something. The eyes closed briefly as the head bobbed once on the pillow. Guttural noises whispered back into the nurse’s ear.
Linda straightened abruptly as if recoiling, caught herself, and walked around the bed to my side to speak confidentially.
“She says her tongue’s pretty much gone.” She paused, suppressing something I could not read in her face, then added, so softly and fast I almost couldn’t catch it, “Most of it sloughed off a few nights ago.”
Internal Medicine: A Doctor's Stories Page 12