Wednesday, June 30, 2010

Death takes a holiday. Then gets back to work.

So it turns out that Grace's little tick bite healed for a full week, then got all bumpy and weird and started to itch. There was no classic bullseye rash. But since Lyme Disease is bad enough that you treat it even when you're not sure, Grace's Brooklyn pediatrician told us to get her checked out.

To add to the medical fun I've been so enjoying this summer, this entailed yet another visit to the E.R. at Dartmouth-Hitchcock Medical Center.

You would suppose that in a civilized town like Hanover, New Hampshire, there might be a walk-in clinic for minor medical events like this one. If you had lived in any other developed nation for any length of time, you would confidently expect there to be something like the cabinet medicales in France, and expect to be able to pay twenty-two euros for the privilege of visiting it and getting a simple blood test.

You would be wrong. Instead, Grace and I were to take up space in an All-American E.R. for an hour and a half, and likely will pay several hundred dollars. This country is completely nuts, making its Emergency Room doctors take up all its slack.

We showed up just before dinner time on a Monday night, only to find the waiting room packed with distressed-looking people sitting under blankets in wheelchairs. Apparently Monday night, after work, is when all the injuries and illnesses of the weekend come in for attention. Nobody was actually bleeding from a gunshot wound in the waiting room (as we once discovered in the Jamaica, Queens E.R.) but a whole lot of people's grandparents looked pretty darn ill. The very nice lady at the intake counter suggested that we might have better luck early Tuesday morning, when sick people tended to be sleeping rather than showing up in droves to the hospital.

So the next morning, I dragged the girls out of bed as early as we could and showed up a little after 6:30 AM. Grace got her hospital bracelet, and went right into one of the little rooms to read and wait. Grace was pretty nervous, and started asking me a series of questions that revealed her vague and dire sense of what might be happening to her.

"What kind of parasites are inhabiting my body right now, Mommy?"

“What are all those tubes and dials on the wall for?”

"Is Lyme Disease like cancer?"

"How do you keep from getting cancer your whole life?"

“How does cancer kill you?”

Having been Grace's mother now for so long, I've gotten pretty good at offering reassuring, yet accurate answers to enormous questions about life and death. I keep it simple and boring, and point gently to the bright side of things, without lying to her about what's actually going to happen. I told her that a lot of people live for a long time, even when they do get cancer, and even gave her some examples of people she knows who have done so.

And today’s visit was a pretty simple matter, I told her. I said, I know that the ER is scary, and even a little bit scarier to you in particular, but all those tubes on the wall don’t mean that they will need those for you. They will use a small needle to take a little bit of blood out of your arm. They will either give you some antibiotic pills, or not. Since we were lucky enough to have noticed the tick, and since we were lucky enough to have good doctors to take care of us, you are going to be just fine. You do not have parasites. Or cancer.

(Which was all to say, without saying it in so many words: don't worry honey, even though we’re sitting in the ER for a simple blood test, you're not going to die. At least not today.)

She smiled a little half-smile, and we both quieted down to read our books and wait.

After a few minutes, I couldn't help but overhear a conversation going on in another room across the hall. We were screened by curtains, but the voices came right through.

First I heard a nurse talking on the telephone, friendly but matter-of-fact. Yes, she said, we need you to come right away. No, not later this week, that wouldn't be a good idea. Sir, I'm telling you as a daughter and as a nurse, it's important that you come here right now so that you can spend some quality time with your father. We've given him some medicine to slow the rise in his potassium levels, but they’re going to go back up very quickly. He wants to see you now. Before it is too late.

I'm no doctor, but I remember how my grandmother June died. She had lymphoma for a long time, but at the end, the tumor took her away on a sea of potassium. She was with us, lucid and clear and herself, and then she was gone. First in a coma, and then gone forever.

While I didn’t tell this to Grace, this is in fact how you die from cancer.

And this was in fact the phone call when somebody told this man's son he was about to lose his Dad.

"Would you like to talk to your father?" the nurse finally asked. "We've just explained what's happening to him, and he understands it all.”

I realized that I had been hoping that nurse had been talking out of earshot of the dying man with the reluctant son. No such luck.

But the father's voice sounded young and strong. He didn't weep, and he didn't curse his fate. He sounded resigned, and philosophical, and like he was talking about the weather. "It's all just happening faster than we thought, James. I'd really like to see you before I go." Eventually it seemed that James got the picture, as his father talked for just a few minutes before signing off. "So long," he said. I couldn’t help but start to weep.

After he and the nurse had lit that awful fire under poor James, they sat and talked for awhile. The nurse had clearly been there before, and she had no trouble letting him know what he was in for. She used his first name a great deal as she spoke, every chance she got. She was speaking straight into the window that had opened to his soul, no pity and no bullshit.

"You know, they say you do fifty percent of your lifetime of psychological learning right before you die. You're going to grow a lot today. Keep growing."

The man replied. “It’s really just so fast. And I had hoped to drag it out a little more, but it’s not to be. I was always a believer in destiny, and I guess this is just a part of it. “

They talked about some of the things he had done in his life. He had fought in Europe during the Second World War. He had sold insurance just outside of New York City for fifty years. After he retired, he and his wife had moved here for the quiet pace of life. She asked him if he’d like to go outside. Or if she could get him something to eat. She didn’t say it, but we all heard it: these were in fact his last chances to do either one.

The dying man was not weeping, but I still was. As silently as I could, and with my head sort of turned to the side so Grace wouldn't see. But she's a smart kid, and has super-hearing for any detail that alludes to illness or death.

She spoke as quietly as she could. "Why are you crying, Mom? Is it because that man is going to die today?" I could only nod.

After some time, at his request, the nurse dialed the phone so that the man could leave a message for his wife. The wife had just left, probably to get a little sleep or walk the dog or something, and she was going to arrive home to the voice mail message that this was his last day. The nurse left the room while he talked, but I still could overhear.

"We need you to come back right away, I guess." He talked for a little while longer, and I tried hard not to listen. After that, he was quiet, except for some little noises in his throat for what felt like a long time. When I poked my head out to go check on Abigail in the waiting room, he called out to me.

Our curtain had been shut, but his was half open. He was holding the phone in one hand. I realized that those little noises were his way of trying to get somebody's attention without his being too demanding. He was a lot older than his voice had sounded.

"Miss," he said, calling to me. "Miss, could you please hang up this telephone for me?"

Mostly these days people have started calling me "Ma'am." I loved that “Miss.” And I loved this sweet, dying man, so polite that he wasn't willing to call out for help, even on his last day, even for this last phone call, ever. I would have hung up a million telephones for him, every phone of his whole life.

I so badly wanted to tell him it was OK for him to tell James "I love you," instead of "So long." But instead, and thank god, I said "You take care," which I hope he knew meant the same thing.

Last night, as I was putting the girls to bed, I stopped to really look into their little faces. Abigail suddenly looked to me a full year older, after just two days away at summer camp. We hadn’t had the best evening together, as they had been tired and cranky, but I wanted to tell her how much I loved her. “You’re getting so big, Abigail. I’m so proud of the way you’re growing up.”

“I know.” She said. “But I don’t like growing up.” And then, although I couldn’t believe my ears, she said exactly the words Grace and I had heard from the dying man. “All of the sudden it feels like it’s just going so fast. I want it to last longer.”

I thought of the man, moving so quickly through that last half of what he had yet to learn. “Maybe growing makes time go faster,” I said. And then, “I love you so.”

Today the girls are at camp. Bill and I are at home. The sun is shining, and I can go outside anytime I want. I can pick up the phone and hang it up. I can have any meal I wish, and be pretty sure it’s not by any means my last. Grace could need some more antibiotics, or maybe she won’t. But today we’re safe. Today we’re whole. Today we are still building up towards that first fifty percent of whatever it is we’re here to learn.

James and his mom and dad are elsewhere. They are in that place from which you never return. I hope somebody eventually convinced them to go outside. I hope he threw off his politeness enough to ask for whatever it was he most loved to eat. I hope James heard him say I love you, even if the words never came out that way.

Thanks to Kristen, whose entries these last few days at set my thoughts off in the direction of the metaphysical. And thanks to the talented staff of the Dartmouth-Hitchcock ER, who treat little girls and dying old men with remarkable professionalism and skill.


  1. Wow, Launa. Wow.

    First off, I hope that Grace is okay and that all of her bloodwork comes back looking good.

    Second, I can't thank you enough for drawing my attention to this piece and to all that it says about the Big Questions and about keeping our kids safe. I'm shocked in both good and bad ways by your experience in the ER. On the one hand, it saddens me that you and Grace had to go to an ER to get treatment and that this gentleman's last day conversations couldn't help but be public in that same space. On the other, I am impressed not only by the nurse who tended to him, but also by your grace in bearing witness to his final day through your tears and your conversation with your daughter.

    I hope you enjoy this day of safety and of many choices.

  2. Beautiful piece, mon amie. Merci de Lynn à Quinson.

  3. Once again, your blog blew my mind and heart wide open, Launa. Your story. Your daughter's story. The story of your ER neighbor and his passing from this life to whatever is yet to come. The wisdom and perception of your precious and well-spoken daughters. Reminding us that this day is the only one we've got, whether we have cancer or lyme disease or aging, ill parents or none of the above. Beautiful. Gentle. Poignant. So well done.

    PS> I'm sure glad Grace's test turned out negative. So very glad.

  4. Really touching, Launa. Thank you. xoxo

  5. It's sort of an essay that's also a short story, like those old "it's a floor wax/no, it's a dessert topping!" SNL sketches. Very nicely done.

    Tony Asdourian