Authors: Rafael Yglesias
Dr. Goldfarb returned his focus to Margaret. “Why don’t you want to have sex with your husband?” he asked.
“I do want to,” she protested. “I’m just not turned on all the time like he is. And I can’t make the switch from diapers to blow jobs like that—”
“Why not? It’s the same general area,” Enrique said and laughed—alone. She no longer deigned to provide oral sex, he wanted to say. She was stingy in her affection. That had to mean she didn’t like him. She was hiding that from the shrink. Maybe she loved him, but she didn’t like him. And he neither liked nor loved her. That was the truth. This marriage was a mistake.
“I can’t just flip it on like a switch,” she insisted. “There has to be some romance, some intimacy.”
“That’s ridiculous. We’re totally intimate,” he said and, while he said it, believed it.
“What about as parents?” Goldfarb asked, a bizarre question Enrique thought, from out of nowhere. “How is Enrique as a father?” he asked Margaret.
“Oh, he’s a good father.” She dismissed the compliment, an achievement beneath contempt.
“Margaret’s a really good, really loving mother,” Enrique con
ceded in a tone that suggested her maternal skills were some sort of facile trick.
That was all the ground they could cover in a first session. Enrique looked at the psychiatrist for an answer. Margaret did too. They wanted a verdict. The judgment was that they would benefit from further therapy at one hundred twenty dollars an hour and that if they had insurance, they should bring the forms next time.
They caught a cab on Fifth and rode home in silence. When they stopped at a red light on Fifty-ninth, he looked away from the Plaza hotel and saw tears were rolling down her cheeks. Feeling his eyes on her, she wiped them away with the flat of her hand. When her delicate fingers came to rest on the taxi’s vinyl, he put his hand over hers. She didn’t object or move it away, but she didn’t react. She stared ahead, and her hand lay beneath his lifelessly.
They arrived at the apartment and listened to their nanny’s report on Gregory’s day. He’d had a tough one. Took a fall running in the park and scraped his knee, a striation of at least a dozen cuts across the joint that still looked raw. He’d also gotten sand in his right eye, which was bloodshot and puffy. Nor had Greg taken his afternoon nap, so he was overtired and generally uncomfortable. And to top off the day’s derangements, once he felt water touch his wounded knee, he had refused to bathe. His hair was matted and his neck dirty. “You’re a wreck,” Margaret said with sad affection, taking his plump torso into her arms. Greg embraced her, throwing his chubby arms around her neck, shutting his eyes with relief. “No bath, baby. You don’t want to have a bath, that’s okay,” she mumbled, kissing him on his sweaty brow.
The nanny left. Margaret and Greg settled on the couch with his comforting yellow blanket, the satin edge worn away. The frayed ends promised a disastrous erosion over the next few months. That had already prompted Margaret to get a second yellow blanket and gradually introduce it as an acceptable substitute. Greg
would agree to clutch the new one only if the original blankey was there. With the two fetishes entwined, all but the top of him disappeared under a yellow tent, fragrant and warm from the bakery of his twenty-month-old skin.
Enrique settled in the Eames chair nearby and watched them, thinking hard about when to tell her that he wanted a divorce. Their next session with Goldfarb was a week away. The harshness of today’s session didn’t make him look forward to more. He still hadn’t apologized to her, or told her that he loved her with the earnestness and reassurance she deserved. “Of course I love Margaret,” he had whined to Goldfarb. “I married her,” he had offered as proof. Replaying that highlight of the session in his head while watching Margaret soothe his son, he winced at his ungenerous words. Okay, he thought, gazing at mother and child, can I do this? Can I really do this to them?
It was a cliché of his social class and time, New York 1983, that a bad marriage was worse for a child than a divorce. Most of his friends, as well as his half siblings, Leo and Rebecca, were children of divorce. Although they were all neurotic and unhappy, many were less so than Enrique, the product of a factious but as yet unbroken home. Unquestionably, a divorce would be better for Enrique. Listening to the rejected Margaret, he had to conclude that it would be better for her. The truth is always better was the mantra of the generation that had endured the Nixon administration. What he felt—that she didn’t like him—and what she felt—that he didn’t love her—amounted, no matter how you judged those claims, to the same sum: they shouldn’t be together. If I’m right and she’s too controlling, then she needs a man who doesn’t mind. And if she’s right, that I don’t know how to be happy with her, then she needs a man who does. Ultimately who was right and who was wrong about the summation of the evidence was irrelevant to the verdict.
“He’s asleep,” Enrique said, noticing that Greg’s heavy lids had shut and the rise and fall of his yellow-covered chest had become slow and deep.
“I know,” she said.
“Isn’t it too close to bedtime to be napping?”
She shrugged and frowned as if to say, Who cares? The world is coming to an end. “I have to pee,” she announced.
“Give him to me.”
She glared. “Don’t wake him,” she warned.
“Of course I won’t wake him,” he said in a disgusted voice. She rose gingerly. Greg briefly opened his eyes, made a soft peep of complaint. She cooed at him, kissed his brow, and lowered him into Enrique’s lap. Greg nestled his hot head into the crook of his father’s shoulder and fell back into a comforted sleep.
Margaret paused before leaving. She looked at her child’s calm head on his father and smiled with approval at that conjoining, and only at that.
“We’re ordering in?” Enrique asked.
“Chinese,” she said and walked away.
Enrique looked out the living room window. Although they lived on Tenth Street, a block north of Margaret’s old studio apartment, this view was eleven stories above a courtyard facing south. The yard wasn’t fully enclosed; an opening provided a view of Ninth Street. He didn’t remember that he had once anxiously paced between those trees killing time before Margaret’s Orphans’ Dinner. He watched without memory the same branches swaying in a gentle breeze and smelled the muffin fragrance of his son, and saw himself in a burgundy convertible Beemer, driving on Sunset Boulevard with Sally’s blond hair flowing beside him, and he thought:
Who the fuck am I kidding?
He discussed his decision with Porter and with Porter alone. Only his half brother, a man so unfaithful to his marriage that his
advice would be useless, also knew of the affair. Porter didn’t offer counsel. He sighed and complained about his own miserable child-ridden, sex-starved marriage.
Enrique phoned Sally in Santa Monica two days later. He told her that he loved her, that she was good for him, but that he had made a mistake. He had had a son with Margaret, and although he didn’t love her and never would, he believed it would be worse for everyone—Margaret, Greg, and himself—if he left.
She argued, of course, but was frustrated by Enrique’s lack of a defense. He agreed that he was miserable, and that he would be miserable for the rest of his life. He agreed that Margaret would be happier in the end if he left. He even conceded that it was possible a divorce would be better for Gregory. “I just can’t do it” was the only explanation he gave, and it was the complete truth of what he understood of his feelings.
It took more than a week of daily wretched, painful conversations before Sally gave up. She was suffering, of course, but he never comforted her during those agonized calls by telling her how forsaken he felt by the loss of their romance. After a few more dishonest sessions of counseling, Enrique announced to Goldfarb and to Margaret that he was going into individual therapy, that he had problems he needed to resolve before his marriage could improve. He didn’t think that was entirely a lie, or even mostly a lie. He was unhappy about every aspect of his life. It couldn’t be that his marriage was the sole cause. Margaret and he resolved to keep the hour they had set aside for therapy as a regular date, an oasis of intimacy in their crowded marriage. They also arranged for a regular babysitter on Tuesday nights to spend an evening alone together. Their relations, including their sexual relations, became friendlier, although without passion.
And he began his own therapy, the sole relief in his private mourning for what he had sacrificed. He told no one besides his
new shrink of the affair and swore Porter and his half brother to secrecy. Acute loss blackened his days for a year. He trudged to his office at eight-thirty every morning and returned at five o’clock every afternoon, back and forth in echoing steps of despair, his head aching with longing, his heart wincing in pain. With every step he was certain that he was doomed to live without love, and without the hope of love, for the rest of his life.
E
VERYTHING ABOUT
Margaret’s disease seemed to have been designed to occur with malicious timing. The crisis struck while Natalie Ko was away for twenty-four hours at a conference in Atlanta. Dr. Ambinder, a young doctor on call, was diligent. He returned Enrique’s message promptly and consulted about Margaret’s condition over the phone at length, but the multiple social connections they had with Dr. Ko would have led her to check things out herself. Although she no longer saw patients in the hospice service directly, a consequence of her administrative duties, she had made an exception for Margaret when she came to their apartment to discuss how she could die. Ko’s exceptional coverage of Margaret was an example of the special privileges granted to them because of people they knew through Enrique’s career, and had been of considerable use and comfort during the fight to pre
serve her life: gaining after-midnight admission to hospitals, leapfrogging waits for procedures, obtaining doctors’ cell phone numbers and e-mail addresses. Those extras had been reassuring and helpful and had let Enrique feel useful, but they had not saved his wife’s life.
“She’s got shaking chills and she’s delirious,” Enrique reported in the neutral tone that he had learned to maintain no matter how panicked he felt, so that medical personnel wouldn’t lose confidence in him.
“What’s her temperature?” the young Ambinder asked.
“I haven’t taken her temperature. She goes from shaking uncontrollably and feeling cold to kicking off the covers. Half the time she feels like a furnace. She’s also incoherent or asleep, so it’s obvious that she’s running a high fever. I don’t think it makes any difference how high, given that she doesn’t want to live, but if you really think the degree is significant, I’ll take it. Right now that’s going to make her very uncomfortable. She’s buried herself under blankets and gets upset if I uncover her at all.” There was a time when for him to make so mildly disobedient a speech to a doctor of any age would have been unthinkable.
“No, that’s okay, we don’t need to know her exact temperature. You’ve given her Ativan to control the chills?”
“Yes, two milligrams by mouth.”
“Okay…” Ambinder said slowly and fell silent, stumped. Enrique understood his dilemma. The source of Margaret’s fever wasn’t supposed to be treated. Therefore no antibiotics. She had already received a sedative to alleviate the fever’s effects. What else was there to do except add more palliatives, which would send her into unconsciousness?
Enrique’s half sister, who had turned around from heading home on the Long Island Expressway at the news of Margaret’s abrupt decline, was standing helpless over the bed. Rebecca
looked up from watching Margaret’s huddled shape tremble beneath two heavy quilts in June to ask, “Should I get another blanket?”
Enrique shook his head no and said to the phone, “I gave her the Ativan by mouth, not by IV.”
“Oral dose is fine,” the young doctor answered.
Enrique argued without arguing. “Um, it isn’t clear how much of the Ativan her stomach can absorb because of her PEG.”
Ambinder contradicted him confidently: “Her PEJ wouldn’t make any difference—”
Enrique interrupted, “Her stomach PEG. Not her enteric PEJ. I understand her enteric PEJ wouldn’t affect the oral dose, but the stomach PEG drains it immediately. I just don’t know how much of the Ativan she can absorb that way.” He was being conscientious in pointing out that perhaps she ought to be getting the sedative intravenously. He wished he didn’t feel so obliged. Margaret was delirious, and it was impossible to communicate with her. That might be reversible; Enrique might yet have a chance to talk with her if he could diminish the fever. But if Ambinder ordered him to infuse Ativan, she could easily become so sedated that she would remain unreachable whether the fever abated or not. Unfortunately, that was his Margaret-given task: she had asked him to help her die at home and with as little consciousness of what was happening to her as possible. If that meant sacrificing his urgent desire to have a true good-bye, then so be it.
“She has a stomach PEG. Right.” Ambinder absorbed this fact. As Enrique suspected, he had forgotten. “To make her comfortable…,” he trailed off. “What hospital are you near?”
“She wants to die at home. Dr. Ko promised Margaret that she would do everything she could to make that happen. What are you considering?”
“Giving her an antibiotic to help bring the fever down. But if she needs it IV, I have to admit her—”
“I have two IV doses of cefepime here,” Enrique interrupted. “I can give them to her. You can send more bags down. I can also give her the Ativan IV.”
“You have cefepime?”
“Yes. Two bags left over from an infection in March.”
“You’ve kept it refrigerated?” Ambinder asked.
“Yes. I can give it to her, but she doesn’t want anything done to prolong her life.”
“Antibiotic won’t prolong her life if she’s not getting any hydration.”
“That’s my question,” Enrique said, looking at the small shape of his wife quivering under a mound of blue quilts. “Is there any harm in trying to get this fever under control so she can die peacefully?”
“It may not be an infection,” Ambinder said.
“What could it be?” Enrique asked, although he could guess what Ambinder was going to say. He sat down in Margaret’s desk chair, where she liked to work with Photoshop on her computer, playing with the images she had taken years ago—the present altering the past for the entertainment of the future. “It’s fun,” she’d said a year ago, when she was in remission and had returned to photography with a happy grace, the gratitude of the pardoned. He was exhausted. Here was another diagnosis, another remedy: the catacombs of her illness seemed to have no outlet. She wanted the struggle to end. How could giving up be so arduous?
“Could be toxins released by her kidneys as they shut down.”
That was what he’d been afraid the young doctor would say. Natalie Ko had warned Enrique that while a body dehydrates, in a small percentage of cases, the kidneys or the liver may release poisons in the final days that they would normally process, toxins
that cause delirium. She had prescribed a bottle of liquid Thorazine to relieve that reaction should it occur. He was looking at the minifridge where it was stored only a few feet away, along with three spare bags of hydration, the cefepime, a month’s supply of IV Ativan, and a pump to provide continuous dosing if necessary to keep her fully sedated. Enrique had been under the impression that Thorazine was exclusively used to treat schizophrenics. Suspicious of why Dr. Ko wanted to add an antipsychotic to deal with his wife’s final days, he had asked her how Thorazine, presumably used to alter brain chemistry, could possibly deal with toxins released by the kidneys or liver. She’d supplied an answer that Enrique had often heard from doctors, and whose vagueness he didn’t like. “We don’t know why it works, but it does.” Does Thorazine actually destroy the toxins or diminish their effect? Enrique wondered. Or is it simply so powerful a sedative that it paralyzes the patients and convinces the beleaguered caregivers that their charges feel better when actually they are only easier to manage? He suspected the latter.
“I have Thorazine here for that,” Enrique volunteered.
“Yeah, I see that in Dr. Ko’s notes,” Ambinder said. “Maybe you should give her a dose of Thorazine and see if that helps,” he added with a tentativeness that didn’t inspire confidence.
Enrique proposed his own course of treatment. “Shouldn’t I start some cefepime and give her another dose of Tylenol suppositories and see if that makes her comfortable before resorting to Thorazine?” He was pushing his own agenda, proposing a treatment most likely to restore Margaret to lucid consciousness. So they could talk. Not for long, just a paragraph or two of farewell. Enrique finally felt able to explain what she had come to mean in his life. He was ready to articulate that in their twenty-nine years together both of them had been transformed, not once but three times; that he had come not only to need her but to love her more
profoundly than ever: not as a trophy to be won, not as a competitor to defeat, not as a habit too long to break, but as a full partner, skin of his skin, head of his heart, and heart of his soul. That was his secret objective, but he also believed that his course of treatment would be best for Margaret. She wanted to be comfortable while she died but not frozen by drugs into a quiescent torment.
“Why not do both?” Ambinder asked, as if Enrique were the senior doctor.
The lump of Margaret under the covers had stopped trembling. Perhaps she had fallen asleep. “This feels to me like fever, not toxic delirium,” Enrique said.
“Difficult to tell the difference,” said Ambinder, assurance returning.
“My father had an infection of the brain casing from a defective heart valve, and I took care of him for a shift until I could get a private nurse,” Enrique informed the young doctor. He paused, wondering why he was bothering to go into so much detail. Am I complaining? “Anyway, that seemed different. Dad was moving his bowels uncontrollably. He was thrashing about, saying crazy things. Margaret’s just shaking and not talking except to moan or ask for water. Right now she seems to be asleep.”
“You’re giving her water?” Ambinder interrupted.
“She has a stomach PEG. So yes I am.”
Again the doctor on call had forgotten. He covered by adding, “Well, it does pass through her stomach. Like with the Ativan, she may be absorbing some of that water. It could prolong things.”
“By what? An hour? I don’t want her throat to be parched if it doesn’t have to be. Is it really necessary for me to stop giving her water with a stomach PEG?” Why am I arguing? He’s not here. I can do what I want. In fact, I could kill her. I should kill her. I should put a pillow over her head and end it. Or pump all the Ati
van at once into her veins and stop her heart. That’s what she wants. If I truly want to do her bidding, that’s what I should do.
“Okay,” Ambinder conceded. “Give her cefepime. I’ll send a full cycle down. And the Tylenol suppository. If she doesn’t improve in three hours, call me and we’ll discuss our options.”
Enrique went into the bathroom to wash his hands. While drying them, he called out to Rebecca detailing how she could help him. He donned gloves, removed the antibiotic packaging from the fridge, broke the seal, and hung the bag of cefepime. Unfortunately, Margaret was disconnected from all her IVs, and in order to reach the port on her chest, he needed to lift the two quilts. He might have to take off her top; he couldn’t remember whether she was wearing something that could be unbuttoned. He hoped he wouldn’t have to disturb her to that extent. Before pulling back the covers, he also readied the Tylenol suppository, handing it and the lubricant to Rebecca to have at the ready, since he would have to expose Margaret’s bottom half for that and he didn’t want to subject her to the painful air twice.
For months these nursing tasks had distracted him from terror. There had been times when dealing with tubes and needles and invasions of his wife’s body had repelled him, but the tactile job of caring for her, knowing that he could bring relief to her dread of what was ahead, or supply nutrients to keep her alive to say farewell to their sons, the distraction and comfort of these practical tasks, after a lifetime of doing so little that was useful to anyone, helped to suppress his own wild incomprehension at what approached.
That illusion of usefulness as his motivation was stripped away as he prepared these last desperate measures. The truth was that his nursemaid duties supplied more than mere busyness. There was the unacknowledged magical thinking: as long as he was doctoring her, she would live. His brain had understood for nine
months that Margaret would soon cease to talk and respond, her body would get cold and stiff and be taken away, hidden in the earth; but standing over the bed armed with these futile palliatives, he knew that his heart didn’t understand this irretrievable finish, could not comprehend that within three or four days something other than argument, infidelity, boredom, or hatred would, no matter what he said or did, end his marriage forever.
He handed Rebecca the Tylenol suppository and a packet of lubricant. “When I ask for it, give me the lube first, then the suppository.”
His sister looked anxious and squeamish. She wasn’t accustomed to this hands-on nursing duty. Though she had gotten used to seeing the contents of a stomach PEG, she had never witnessed the rest of Enrique’s chores. But she maintained a brave front, and he was confident she wouldn’t fail him should Margaret resist.
He hesitated for a moment, studying the stilled, small curlicue of a lump under the quilts, and felt stupid for disturbing her oblivion. She wanted the agony to end; why couldn’t he leave her alone? I am trying to ease her suffering, he reassured himself against the worry that giving her these remedies was for his sake, so they could talk. He held the end of the IV connection to the cefepime and lifted a corner of the covers to see her upper torso. Her eyes were shut tight, her narrowed face as still as a death mask. She didn’t stir or complain. He saw her chest rise and fall very slightly. She was alive, which relieved him, although he supposed that was selfishness. Luckily, the neck of her T-shirt was low enough for the three brightly colored baubles of her ports to hang outside. He put his forehead under the tented covers, unscrewed the blue port’s top, cleaned it with the antiseptic swipe he had already opened, and connected the antibiotic. He backed away gently, the covers burying her again, then adjusted the rate of the drip on the pole and started the antibiotic flowing.
He had just defied Margaret’s wishes. He was treating her for a possible infection though she had asked him to cease all treatments. He told himself that she wouldn’t object if she were conscious and not delirious, since the cefepime, though it might relieve her symptoms by fighting an infection, wouldn’t prolong her life, as long as he didn’t, in addition, give her hydration.
He paused before taking the next step, inserting the suppository. “Everything okay?” Rebecca asked. He nodded. A sinful thought had come into his head. He had given the antibiotic against her wishes, why not connect a bag of hydration? She was running a fever. A liter might make her feel better, and it wouldn’t add more than half a day to her life, he guessed. Would she really begrudge him twelve additional hours?