Ronald Friedman
Jackson Rowley sat hunched over on a stool in the nurse’s station and waited for his vision to clear. Bright streaks jittered in the center of his visual field accompanied by stabs of pain.
He shut his eyes and the pain receded a little. The three-legged stool jerked about on the polished floor as his muscles strained in response to the jolts of pain. All around him, muffled and distant, like the soundtrack of a television movie playing in the next room, he heard the familiar sounds of organized chaos in the intensive care unit.
A hand on his shoulder interrupted Rowley’s thoughts. Now he could hear ringing phones, shouted orders, shuffling feet. The conversations around him became distinct. “Are you all right, Doctor?”
He forced his eyes open and hesitantly rubbed his palm across his face, knowing he couldn’t hide the ravages of the pain.
“Just getting a slow start.”
“Can I get you anything?”
Rowley looked up and saw Elsie Cerioni, the supervising nurse. He hadn’t recognized her voice, although he knew her well.
He managed to smile, knowing he alarmed her, seeing it in her face. He was a little over six feet tall. He had always been thin, but in the past month he’d lost 10 pounds. “A headache out of nowhere,” he said. “I’ll be fine.” He got to his feet. The pain was receding.
“Are you doing the consult on Robert Tremain?”
“The gunshot. Yes. Why are you keeping him in the ICU?”
Elsie shrugged her shoulders. “It’s beyond me.” Then she shook her head slowly. “We can’t take that bandage off. Help us with the mom.”
“I’ll talk to you as soon as I’ve seen them.”
“He’s in eight.”
Rowley felt Cerioni’s eyes on him as he walked across the floor. There were no secrets in a hospital. He wondered if she knew how sick he was.
* * *
The intensive care units fanned out around a central nurse’s station. Electronic monitors and direct observation allowed doctors and nurses to watch over their patients without interruption. Smart sensors and automatic data synthesis programs delivered needed changes in medication, oxygen, and other life support measures smoothly and efficiently. In Robert Tremain’s room most of this sophisticated technology had been turned off.
“Good Morning,” Rowley said as he entered. He was greeted with a familiar sour smell, a combination of antiseptics mixed with rancid sweat and body waste. The room was small and crowded. “I’m Dr. Rowley. I’m a psychologist from the Department of Pediatrics.”
His vision had finally cleared. So far the attacks were painful, but brief. He knew that wouldn’t last.
He stood at the foot of the bed and looked at each of the three people gathered around the patient. They would be Robert’s parents, Harold and Emma and his sister, Tasha. Only the immediate family was allowed in the ICU. There were two brothers as well, most likely in the family room down the hall. The faces of the three were drained of color, their eyes red and swollen from crying, but he saw the flicker of hope appear in Emma Tremain’s face as she turned to him. For Rowley, the expression was familiar. He was a doctor she hadn’t seen before. Perhaps he brought good news.
Harold Tremain looked grim. He nodded in response to Rowley’s greeting.
Tremain was a short narrow faced man with sharp features and thin black hair combed back over his head. He wore a gray suit that was wrinkled and stained. The points of his shirt collar were twisted right and left, but his tie remained tightly knotted at the throat.
“Good morning, Doctor,” Emma Tremain said. For a moment longer she stared, as if challenging him to dare to give her anything but a good report.
In the bed lay the unmoving form of 14-year-old Robert Tremain, a large white bandage like a turban covering his head to a point below his eyes. His chest rose and fell regularly solely as a result of the air pumped into his lungs by the ventilator inserted in his trachea.
Rowley glanced at the monitors mounted above the bed, but he already knew what he would see. Robert’s stubborn heart was still beating, but the EEG showed only occasional random bursts of activity when someone jostled Robert or bumped into the bed.
Robert Tremain was dead. He had died 48 hours ago, shot in the center of the forehead about two centimeters above his eyebrows with a hunting rifle owned by the father of a friend. The powerful bullet had flattened when it hit his skull and tumbled through a large swath of his cerebral cortex turning it to pulp, finally exiting through the crown of his head taking a large portion of his brain and skull with it. His brainstem had been spared the worst of the trauma so he was still breathing and his beating heart sustained the illusion of life.
Despite having been told their son was dead, Emma and Harold Tremain refused to allow the ventilator to be removed and had not told the other children their brother had died. They remained focused on his evenly rising and falling chest as a sign that all was not beyond hope as if, through the raw power of love, they could forestall his terrible fate.
Rowley had spent his professional life taking care of people like the Tremains. He understood their wishes and prayers, the despairing longing for a gentle soothing parent’s voice to wake them and assure them that this nightmare would end when morning came.
Robert’s mother had begged the nurses to remove the bandage so she could see her son better, but the medical staff wanted to save her from the image of her son with half his skull missing. Nothing remained of his head above the level of the entry wound.
Rowley shook hands with the boy’s parents and turned to Tasha who looked young for her 12 years and said, “You must be tired, Tasha. Were you here all night?”
Tasha shook her head.
“ slept in the family room down the hall,” Emma Tremain said. She reached out and stroked the girl’s hair. “Her brother is so ill. Harold and I sat up with Bobby. We wanted to be here in case…” her voice trailed off.
All three were looking at Rowley. The rhythmic sound of the ventilator pump hissed in the background. Muted sounds from the public address announcements were a constant murmur beyond the glass door.
In case of what?” Rowley asked.
Harold Tremain looked at Rowley with pleading eyes. “In case there’s a miracle. In case he wakes up,” he said, finishing the sentence his wife could not speak.
His voice was barely audible. “He could wake up. We have to give God a chance.”
Every minute of denial, every second that Robert’s chest rose and fell in a simulation of breathing the parents could pretend their son was still with them. But now it was past time to turn off the ventilator and allow normal grieving.
“When will Robert be better?” Tasha said.
“ have to be patient, sweetheart. Robert is very sick,” her mother said. She turned her face from her daughter as she spoke.
Rowley knew he had to stop this quickly. He was sure that a good portion of the parents’ own reluctance to acknowledge their son’s death grew out of their fear about telling their other children that their brother was dead. Rowley had to work through this terrible circumstance, forcibly if necessary.
Rowley recognized that both parents knew the truth even if they did not admit it. But by insisting that Robert was still alive, the parents denied the children and each other the support each could offer to help work through their loss of Robert.
“Can you take the bandage off his head so I can see him?” Emma Tremain asked.
“,” Rowley said firmly. “There’s nothing to see under the bandage, Mrs. Tremain. The bullet destroyed the top of Robert’s head. I want you to remember your beautiful boy as he looked before his awful thing happened.”
Rowley kept his eyes fixed on her. She closed her own eyes and shuddered.
“Mrs. Tremain? Are you with me on this? Do you understand what I just said?”
She shook her head, but at least she wasn’t arguing. She was responding to her own sense of loss and regret, but Rowley could not follow her there. Finally she looked at him. “He was such a beautiful boy,” she said.
Emma reached for her purse on the nightstand next to the bed and fumbled around inside for a moment. She brought out a small picture of a smiling teenage boy looking into the camera holding a baseball bat in his hands.
“Almost too pretty for a boy,” Emma said. She turned to her husband and gave him a weak, sad smile. His eyes were flooded with tears.
Rowley wanted the parents to explain to their other children that Robert was dead. It would not have the same effect if the words came from Jackson or another member of the medical staff.
“Tasha, I have to talk to your mother and father for a few minutes. Would it be okay if you stayed here with Robert or would you rather wait in the other room with your brothers?”
“ want to stay here,” Tasha said.
Rowley felt the pain stab behind his eyes. He took several slow breaths in an effort to calm himself. There was no way to predict the violence of each attack. His symptoms the past few days convinced him that the glioma had invaded the optic chiasm and was putting pressure on nearby brain structures including the internal carotid artery. The vessel ran alongside the bundles of nerves that carried impulses from the retina to the portion of the brain that controlled vision.
Each jolt of pain was like an electric shock triggering thoughts he was trying to avoid.
He was at urgent risk of a ruptured vessel.
Do you really want to die of a stroke?
He had family, grandchildren.
He was only 58 years old.
He managed a smile and a calm voice. “I’ll be back in just a few minutes.” He would find an unoccupied room and wait out the pain.
* * *
“You have to stop working,” Dr. Carol Sunday had said when Rowley met with her in her office that morning. He sat across the desk from the Chief of Neurology and nodded. “You’re right.” He shuffled through the Mylar sheets with pictures of his brain, the results of the MRI, set out in rows and columns.
No more stalling, Jack, Today’s the day you have to decide what you’re going to do.” Sunday shook her head. “Two weeks ago you were eager to fight this thing.”
” was, but that was just a reflexive response to a threat. Now, I’ve had some time to think about what’s at stake.”
“There’s only one thing at stake.”
Rowley shook his head. “No,” he said.
“What does that mean?”
“There are other things to consider.”
“Besides your life?” Sunday looked at him like an angry parent.
Rowley thought about the evolution of his thinking over the past few weeks.
“It’s important to me how I die. It’s important to me whether I put up a useless fight.”
Sunday ran her fingers through her loose brown hair and rubbed her temples as if she were the one who suffered from pain. “Trust me on this one. This is neurology, not witchcraft. I’m sorry, Jack. It’s stage 4 and very aggressive. You cannot afford any further delay.”
“You really think it’s still worth treating?” Thinking about never seeing his grandchildren again brought a flood of desperate emotion that made it hard to breathe.
Sunday looked at him for a moment, her head tilted as if to get a more revealing look at him. “It would have been better if we had started two weeks ago, but I wouldn’t put you through radiation and chemo if I didn’t think you’d have a decent chance.”
“So I get a couple of years.”
“Eighteen months to three years with the first six months pretty rough.”
“Six months? C’mon, Carol. Who do you think you’re talking to?”
Sunday held out her arms with her palms up, a supplicant’s gesture, but she did not back down. “You’ll still be weak after that.”
“Jesus, Carol. A year of agony and maybe a few months that aren’t so bad? Is that the life I get if I’m lucky?”
“You could get three years.”
“If you radiate the tumor it will leave me blind, won’t it?”
The neurologist sighed. “Probably. But that’s three years with your grandchildren.”
Rowley closed his eyes and nodded slowly. “I think about that a lot. How long with no treatment?”
Sunday shook her head. “ You could have a stroke right now and never walk out of this office.”
He tried to smile. “No long-term patients for me then”
“What work are you doing?”
He told her about the Tremain family. “Here’s the craziest part. I thought about helping them keep the boy on the vent for a while longer. As long as they can see his chest rise and fall, they think he’s still with them. I can coach them on what to say that would force the hospital to keep the vent going for another week or month.”
He paused. “What would be the harm?”
“But you didn’t”
“Of course not. I’m supposed to help them stop pretending he’s alive.”
“You think I’m deluding myself about you?” Sunday asked.
“Carol, I get sicker and weaker every day. I have this fantasy that I’ll slip right past the moment I die and just keep going through the routines of my work.”
“Like Robert Tremain.”
“Exactly like Tremain. For all practical purposes I’m dead already.”
“Who’s helping you with this?”
“Just you.”
“I mean the personal side.”
“I know what you mean.”
Sunday shook her head. She would not let him be. “Who did you talk to when your wife died?”
“ was different.” Helen had been sick for a long time. He’d needed an outlet for the sorrow that haunted him and the bitterness that grew inside him as he witnessed her pain. “I needed strength to take care of her.”
“This is not something you do alone. Have you talked to your son?”
“He’s a surgery resident.”
Sunday smiled. “He’s your son first. Not every surgeon with a knife is a megalomaniac.”
“I talked to him yesterday. He’s angry I haven’t started treatment. I’ll call him tomorrow. After I decide.”
“I’m angry with you too,” Sunday said. “Talk to McMillan, then. He does our family and grief groups.”
“Carol, I’ll handle it.”
“You’re a stubborn asshole. Just because you’re taking care of a family who won’t let their dead son rest in peace doesn’t mean the same thing is happening to you.”
Rowley stood.
Sunday held him with her gaze. “Today, Jack.”
* * *
Dr. Rowley led Robert’s parents into a consulting room across the ICU. He closed the door and invited them to sit. He took a seat in the chair next to Mrs. Tremain. Rowley wore a long white coat with his name embroidered in red over the breast pocket. He usually wore a sport coat and tie at work but he knew that the white coat was comforting for parents and children so he always wore it when he worked in the ICU or the emergency room.
In a gentle, but firm voice Rowley said, “Robert died two days ago. He died immediately when he was shot. Do you understand that?”
Neither parent responded.
“Emma? Harold? Please look at me.”
He waited until both were looking at his face. He reached out and put a hand on Emma Tremain, then, after a moment, did the same with Harold. “No one can imagine the pain you both are experiencing right now.” Emma nodded.
“You have to explain to Tasha and Donald and Andrew. They don’t know what’s going on here and it’s best if they hear it from you.”
“,” Harold said.
“Mrs. Tremain?”
Emma sat with her hands clenched tightly in her lap her eyes on the floor, her strained breathing, laced with frequent cries.
“Not my boy,” she said.
Her husband reached to touch her shoulder but she shook him off angrily.
“You’re not his mother,” she said harshly and Rowley saw Harold wince, but he put his hand back on her other arm. This time she allowed it to stay there.
Rowley remained quiet, his full attention on Emma and Harold. Emma was being forced now to acknowledge Robert’s death. Then he saw it, first in Harold and a moment later in Emma, the slight shift in posture, the release of clenched muscles, a breath like a sigh, which indicated the acceptance of what they had resisted for days.
Rowley leaned forward slightly.
Emma finally looked up at Rowley. Her face was empty. “My baby is dead,” she said simply as her face twisted in pain and tears poured from her eyes.
“I’m very sorry.”
For several moments they sat silently the only sound the quiet weeping of both parents.
“In a few minutes I’m going to bring in the children,” Rowley told them. “I want you to tell them that Robert has died. Let’s just sit here a few more minutes.”
When he thought the time was right Rowley said, “Are you ready for me to get Tasha and the boys?”
Emma nodded her head as her husband said, “We’re ready.”
Rowley got to his feet gingerly. He felt lightheaded.
A few minutes later he returned with the three children and directed them to chairs next to their parents.
Rowley glanced at the parents. Neither was looking at their three children.
“Kids, your mom and dad want to talk to you about Robert.”
Tasha and Andrew turned their gazes to their mother. Donald looked at his father.
“Mr. Tremain?” Rowley said.
Harold hitched his chair closer to his three children. He still had not looked into their faces. Now he did and tears began to roll down his cheeks.
“You know that Robert was hurt very badly,” he said.
The children stared at their father. He seemed unable to continue.
“He’s sick,” Harold said.
Rowley started to correct Harold Tremain, but his wife interrupted.
“He’s dead,” Emma said firmly.
The children turned their heads to her.
“You heard me,” she said. “Your brother’s not sick; he’s dead.”
The children began to cry and their parents moved closer to pull them together and held them tight.
Rowley stayed with the Tremain family for another half hour while they talked and comforted each other until it was clear they would prefer to be left alone with their grief.
* * *
He thought about Verity and Valor. Since his wife had died, their grandchildren had been an emotional compass and anchor at the same time even though they lived so far away. Just the thought of them soothed him. This was his greatest regret. He felt a desperate agony at the thought of them growing up and not being part of their lives.
He had hoped he would be able to continue seeing a few patients for a while longer, but he knew that was not possible. His work had given him a great deal of satisfaction. It helped him know who he was. He’d been good at it, too. At times, he found himself wondering how many patients he had cared for over the years, but it was usually a trivial question of the moment and he never checked to see.
Carol Sunday had been feeding him a line of bullshit. She knew he wouldn’t choose the treatment option because she knew him and she knew medicine and she knew he was aware of its false hope. He could no more choose the route of hopeless treatment than he could have encouraged the Tremain family to live with the fantasy that their son was still alive and some miracle might yet save him.
He took great pleasure from his ability to get close to his patients, to gain their trust, to help them make their lives whole. He was a man who had spent his professional life helping people face the harsh realities of life and death and here he was struggling to make a decision about his own life. But had he really struggled?
Not much, he thought. In the end it turned out to be easy to decide.
Rowley stood outside Robert Tremain’s room until the ventilator was shut down and removed and the plastic tubes that had sustained his body taking away. He entered the room and stood next to the bed. Robert’s body already appeared sunken in on itself, his hands closing in contractures that looked like claws.
The boy was dead. He didn’t look peaceful. He looked dead. He thought about the force of will the boy’s parents brought to their desperate desire to imagine him alive days after they were told he was dead. It had been madness really.
What madness drove him to deny, even for a moment, that he had passed the point of no return in his own life? Were Carol and Mark just as much under the spell of desperation as were Robert’s parents? He couldn’t join them in pretending that chemotherapy and radiation would give him back his life anymore than he had been able to support the Tremain’s and their unjustified fantasy that some miracle would bring their son back to them.
He would remain with Robert until his family came to say goodbye. Then he’d call Mark and tell him that he’d made arrangements with a hospice across the city, affiliated with a different hospital. After that, he’d stop by Carol’s office to tell her what she already knew he would do. Her office was on the other side of the hospital.
He would enjoy walking through the corridors one last time.
© 2013 Rind Literary Magazine. All Works © Respective Authors.
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