Authors: Rafael Yglesias
“No.” Margaret had to blow her nose to clear a drip. “After this week, I want to stop everything. I don’t want to linger. “
This was not news to Enrique. Nor was the description of how Margaret would deteriorate. A hospice social worker had pointed him to a reputable Internet site to learn about the process. He checked them off in his head while Dr. Ko explained aloud the stages of dying from dehydration. When all intravenous fluids ceased, Margaret would get weaker and weaker, sleep more and more, and pass into a coma after four or five days, six at the most. Once she was comatose, Margaret’s breathing would become rapid, shallow, and irregular, sometimes ceasing for what might appear to be forever before resuming its rapid pace in a startling fashion. She might also make the guttural sound that literature fancifully called the death rattle but that was actually the result of accumulating secretions in the throat and did not necessarily signal that death was imminent. Without hydration, her heart would stop after seven days, eight at the outside. Other than a drying out of her mouth, nasal passages, and throat, the process was not painful, and anyway those discomforts wouldn’t arise for Margaret until she was in a coma. Since all liquids she took by mouth were drained through her stomach PEG, she could drink freely while conscious and thoroughly alleviate the dryness without prolonging her life. If there were any discomfort, physical or psychological, she would be given painkillers or Ativan to hurry her into unconsciousness. “It will be very quick once we stop all hydration,” the doctor repeated. “Just a few days before you become very sleepy. Is that how fast you want it to go?”
Margaret at last showed some impatience. “Yes! If this were Oregon, I’d just have you shoot me in the head.”
The hospice doctor flinched. In a low voice, with a shy glance at Enrique, she said, “Actually, there are studies which show deliberate suicide, even in hopelessly terminal patients when death is imminent, is very hard on”—she met Margaret’s eyes—“not you, but the family members.”
For a moment, Margaret didn’t move a muscle, eyes unblinking, expression blank, as if she didn’t understand what she had just been told or was so struck by the information that she needed to think hard about it. Her great blue eyes remained fixed on Dr. Ko, who waited quietly for her patient to react. Enrique knew his wife was not considering what had been said. This silence and this stare were familiar. It was how Margaret reacted to her mother scolding or nagging her. It was how Margaret defied Enrique when he got angry, a resistance at once passive and unmovable. Gandhi would have envied it.
But this time Margaret surprised him. She turned to regard Enrique as if just noticing that he had come into the room. “I know it’s terrible what I’m doing,” she said. It wasn’t clear if she was speaking to him, or to the doctor, or to God. “I’m putting it all on poor Endy,” she said, using another of her nicknames for him. “But he’s so strong.” Water glistened in her eyes and he felt sure these were not chemo tears. “He can take it. Right, baby? You can do this for me?”
Natalie Ko didn’t understand what Margaret was asking. She answered, “This is fine. This way is okay for families. This is a good way to do it.”
Enrique understood. Margaret had realized that her practical need to die as easily and quickly as possible might feel to his heart like cruel abandonment. He moved to the bed and took her hand. “I’m okay, baby,” he whispered. “We’ll have time together and you’ll be comfortable. This is good,” he said and had to stop because tears were rising and he knew they both needed to be calm
with this doctor. Margaret wanted to leave her life gracefully and at home in their bed. He was determined she get that wish.
While Enrique studied the calendar to find options to accommodate the great Bernard Weinstein’s apparently very tight schedule, he knew, almost to the day, how much time was left. Seven days of steroids and full hydration for the good-byes, seven more until death. Fourteen days of Margaret.
Seven of those days and nights would go to others, unavailable to him for their final conversation. Of course Lily would come every day for a few hours all the way to the end. And Margaret’s parents had announced, distressingly, that they intended to visit each day of the final fourteen, driving in from Great Neck, where they still lived for half the year, the rest spent in the obligatory last stop for their generation of Jews—Boca Raton, Florida. They had come yesterday for eight hours, but Enrique guessed they wouldn’t keep that up. He had observed the slump of Leonard’s shoulders, and the agitated, ceaseless motion of Dorothy, sitting on the edge of a chair in her alert military posture, popping up every few seconds to check on something she was heating, or to straighten some errant object, or to ask Max for the tenth time if he wanted to eat. The effort they were making to maintain a brave front—they didn’t weep or yell or even permit their clothes to wrinkle—was too great to sustain day in and day out. In healthy times Margaret saw her parents sparingly, on Thanksgiving and Passover and another two dinners spread over the calendar, less than a week altogether each year. Enrique was fairly confident that during those last two or three days before coma cast Margaret into permanent silence she would mostly be his. He could lie beside her in their bed and have a summing-up. There would be, finally, a respite from the hurly-burly of disease, the mess of flowers and exams, the spikes of fever and hope, the tuneful jargon of science and the worrying chatter of life. They would gaze back across the
horizon of their marriage, and see together in a single glance what they had lived.
“Enrique?” Gertie’s voice buzzed in his ear as she returned from her consultation with some Greater Authority on Bernard Weinstein’s schedule. The sound hurt. He pressed the side button on his Treo to lower the volume. Instead, in organizer mode, the effect was to jump his view of the second week of June into the first week of July. He pressed buttons frantically to get back to the relevant dates, while Gertie, her Brooklyn harshness made painful by the high setting, complained, “I checked with Marie—”
“Marie?” Enrique interrupted.
“Bernard’s assistant. Normally she handles his schedule. I’m terrible at this. Sorry. Bernard can’t Tuesday. He’s got a premiere thing, but we will be in New York, so is Wednesday evening possible? Maybe for drinks?
Ha!
” she shrieked without warning or apparent cause. Enrique had to pull the earphone out. He did that so violently his half sister, Rebecca, paused on her way upstairs with a strawberry frozen fruit bar for Margaret. The easily processed treat reminded Enrique of another worry. Margaret could theoretically eat anything, since it would all be drained through the tube exiting her stomach, but bulky foods could cause, and had caused, blockages. Enrique was unsure how she was going to pass tomorrow’s feast, a last brunch with her parents and brothers and their wives that, on Margaret’s request, would come from the Second Avenue Deli. “I’ll chew the dogs thoroughly,” she had assured Enrique. “And the knish? That’ll just be mush. Dr. Brown’s black cherry soda will push it through,” she’d asserted with a crooked smile.
Having lost contact with Gertie, Enrique shook his head to indicate to Rebecca that nothing was wrong and pressed the speaker button on the Treo. A compressed, still loud version of Gertie’s voice blared to life in the room: “Ha! Listen to me!
Drinks. You must think we’re all insane. You poor man,” she said, with a quaver of emotion. That was unexpected, given that he hardly knew Gertie, and that she was defensive of her husband, whom she correctly suspected Enrique thought didn’t deserve his success. “How about five-thirty or six?”
“No, I’m sorry,” Enrique said in a profoundly sad voice. “Wednesday all day and evening belongs to Gregory, our older son—”
“Sure, sure,” Gertie pleaded, to abort his painful explanation.
He persisted, to drive home the point that trying to make Margaret’s schedule fit anyone else’s was grotesque. “—He is coming up from D.C., where he lives and works, to spend one last day, all to himself, with his mother, and although by five it might be over—”
“Sure, I understand, I understand.” Gertie begged for mercy.
Enrique was relentless. “I don’t want to risk shortening her time with him by having anyone show up. So I’ve reserved all of Wednesday for Greg.”
“Of course, of course.” Gertie managed to sound gentle. For once, her voice was low and sweet. There was a silence he didn’t understand until, when she spoke again, he heard her gulping back tears. “Tell me…when you can see us…and I’ll make sure Bernie is free. Just tell me what time makes sense.” Not to imply that pity had provoked a complete surrender, she added, “But not Tuesday. Tuesday’s just impossible.”
“How about Monday? Two or three o’clock?”
“Hang on. Can you hang on, Rickey?” she asked, committing the sin of Anglicizing his name.
He took this opportunity to reconnect to the headset, mumbling to himself, “My name is Enrique,” in the singsong of a child introducing himself to the class on the first day of kindergarten. He restored the Treo to its calendar and thought back to the odd
encounter with Dr. Ko. After the discussion with Margaret about how and when she would die, he’d escorted the doctor downstairs. Natalie paused en route to her raincoat draped over a chair—that summer almost every day in June seemed to be cloudy and threatening—her clever, angular face crinkling with distress. She sighed heavily. “She is a very, very brave woman.” Enrique agreed. That had been brought home to him by Margaret’s illness, and it had been a great surprise. Margaret had many flaws, in particular a form of passivity that sometimes seemed like cowardice. That had been misleading. In the face of a deadly challenge she had turned out to be an astonishingly brave person. “I have to ask you something,” Dr. Ko continued. “Please understand: what she’s doing is completely rational. I have no problem with the logic of her decision. She wouldn’t last more than a month or two if she did everything to survive, and she’d be really, really sick. But most people let it happen that way. They let the disease take them. They want it to—”
“Mug them,” Enrique finished for her, remembering his father’s stumble into death.
“Yes.” She nodded, looked back upstairs. “They don’t choose to face it like this. I’ve been treating terminal patients for over twenty years, and I’ve only had one other do it this way, so clean and so direct.” She dropped her sober eyes to Enrique.
“Really?” Enrique was surprised. Many people he knew swore that they didn’t want to linger, that if they were in Margaret’s place they would do the same.
“Yes, it’s rare, so I have to ask you.” She paused for emphasis: “Is this consistent with her character?”
That a hospice doctor felt obliged to ask this question also surprised Enrique. He was ready anyway, because he had asked it of himself over and over since Margaret made the request that he help arrange her farewells, her funeral, and her death. “I’d like to say no
because I am not really happy about it. But I’ve lived with Margaret since I was twenty-one, almost thirty years, and I love her very much, but the fact is she’s a control freak. She learned to be that from her mother, who is also very kindhearted and also very, very controlling.” Natalie Ko, perhaps thinking of her demanding Chinese mother, smiled ruefully. “In some ways that’s been great to live with. In some ways it hasn’t, to be honest. It was great in dealing with her illness. She’s fought this disease very hard—”
The doctor interrupted, “I know. I looked at her history. She’s had a rough time. And she tried everything. More than everything.”
Enrique nodded, silent for a moment, to choke off the swell of pity for all that Margaret had endured. “She fought the disease,” he said in a television announcer’s voice, booming the words as he pushed emotion down into the closeted darkness of his heart, “to control it. To beat it. And now that she knows she’s going to lose, that death is certain and imminent, she wants to decide how and when she dies. It’s all that’s been left to her to control. Yes, it’s consistent with her character.”
The doctor swallowed and nodded. She cleared her throat. “As I said, it’s entirely rational. But I had to ask.” She moved to the door, explaining about deliveries of medicine and about hospice care workers who would come daily. She handed him a card with phone numbers to reach her at all hours if something went wrong. Enrique opened the door and, because she had been so gentle and direct with Margaret, and because they had friends in common, he leaned forward to kiss her on the cheek. But she avoided his aim at her cheek, and lifting herself up to reach his tallness, she moved her mouth onto his. She shut her eyes and parted her lips. He felt the wet and warmth of more than mere friendliness. He had the impression that if he leaned in at all, they would be making love.
Enrique withdrew from this kiss abruptly, startled more than anything else. And Natalie Ko looked puzzled, as if someone else had done it. She left quickly. Her somber, formal manner had vanished in a moment. Like Gertie, who had dissolved from demands into heartbroken pliancy. It occurred to Enrique that this was another of fate’s jokes on him, the irony that he must be more attractive to women now than he ever had been, or would be again. He had never felt less horny or less tempted. He knew that his apparent sacrifice of everything to Margaret was as much a gift to himself as to her, but to these grown women it must have seemed like their girlhood illusions of love come to life. And it was so much more pleasant, even for a hospice doctor well-acquainted with death, to contemplate his devotion rather than Margaret’s suffering.
“Monday works,” Gertie blared in his ear with a trill of excitement. “We’ll be there at three-thirty. And we can stay until four-thirty, but then we have to go.”
Enrique smiled a crooked smile, but no one was there to appreciate it. “Margaret will only have about fifteen minutes. There’s a very close old friend, from summer camp days, who’s coming at five, and that’s going to be a tough good-bye. I don’t want to exhaust Margaret. She needs breaks between these visits. They’re, you know, kind of tiring.”