The Doctor's Stories

By Xlibris US

After reading William Carlos Williams The Doctor Stories the patients of my own past began to haunt me. Driving in my car, musing in elevators, winding down at my desk at the end of the work day; the patients in my own past just crowded out all thoughts in my mind. Their compelling stories nearly became an obsession. I began to keep a journal. In it, I kept track of who was haunting me and as much of their story as I could remember.
As their numbers grew and I had more details clear in my mind, their stories took form and shape. I have always been one that remembers people by their face more than their name and the faces would appear and their stories would come back to me as though it was yesterday.
Some of these patients had not been remembered for over thirty years going back to my time as a student and intern. And yet when I started to compose at my computer, the words just flowed. The stories wrote themselves. The emotions attached to the patients had not dimmed and propelled me forward in the effort to put their stories down in narrative form.
There are scores of patients whose stories came back to me that I have organized into approximately 30 different chapters. Each story stands alone but all have the common themes of pathos, compassion, trial and triumph of the human spirit. The theme of the triumph of the human spirit suffuses the entire book. I am continually amazed at how humans can handle what life throws at them. We never know how much we can handle until we are asked to rise above extraordinary circumstances.
At the same time there are the oddly amusing stories. Sometimes it is enough just to put a smile on ones face. There are stories like that too.
The patients in my book all have had to deal with the extraordinary. Everyone is vulnerable to illness and death. The patients described in the pages of my book stand out in some way as remarkable. The book is a memoir, but it is not about me. The book is about the patients and their struggles.

• Language: English
• Publisher: Xlibris US
• Release date: Dec 19, 2014
• ISBN: 9781503524644

Book preview

DR. FLETCHER AND CARRIE

HE WAS AN arrogant man. He was a nephrologist, but it was the responsibility of each, in turn, of all the medical subspecialists to mentor a general medical team for a month at a time and supervise the residents, who in turn supervised the interns, who in turn supervised the medical students. In theory, there were three echelons of supervision for the four layers. This was for the protection of the patients and for the edification of those being supervised. In theory, the supervisors were also supposed to teach those below them. That was how medical education worked when I was an intern.

Dr. Alex Fletcher, the team leader that month, was pretty sure of himself. As a nephrologist, he was always carping that surgeons made more money when he had just as much education and took just as much risk as they did. I suppose now his complaints resonate a bit more. For instance, if I go in to the hospital in the middle of the night and read a CT scan of the brain and make a medical decision based upon that interpretation, I take all of the liability of that decision for which I will be paid nothing. The radiologist waltzes in the next morning and reads the film after the fact and collects a handsome fee to provide old information that has already been acted upon.

But as an intern, I really didn’t care about his complaints. I was just trying to survive and not hurt any of my patients. Primum non nocere. From the Hippocratic Oath, it means, First, do no harm.

Dr. Fletcher was always immaculately dressed. His shirts were pressed, and his slacks always looked brand new. His white coats were cleaned and pressed twice weekly, and he had them heavily starched. I never saw him wear the same tie twice. He had heavy block lettering on his lab coat so that you couldn’t miss the fact he was an attending doctor, and if that wasn’t enough, he pushed a resolution through the faculty senate that only attending staff were allowed to wear white coats that had a belt across the back. Residents and interns were allowed to wear long white coats—but sans belt. Students wore trim white jackets.

He always started rounds precisely on the hour in the conference room. He could always be found seated at the head of the table. He would have a Diet Pepsi in front of him that he would consume during the course of the sit-down portion of our rounds.

I don’t know how he paced himself or how he planned it, but the walking-around portion of rounds started and the sit-down portion always ended at the precise moment that he drained the last of his Diet Pepsi.

The only excuse to be late for the start of rounds was to be conducting the emergency resuscitation of a patient. Even then, he would ask if you made any effort to hand off to one of the other teams so that you could make rounds. (No one ever did, but they always claimed to have made the effort, and that seemed to satisfy him.)

He never had a hair out of place. He would have it cut twice a month. I would manage to get a haircut three or four times a year by contrast. I heard that every year he bought a new Corvette, trading last year’s model for a new one. Many of the graduating residents would vie for the opportunity to buy the model he would trade in because it would be immaculately cared for and just like new and, being a year old, was substantially discounted compared to the price of a brand-new one.

Dr. Fletcher was the attending physician and, admittedly, a good one. On the other hand were the patients we served. Dr. Fletcher tolerated them as necessary evils. As the supervising attending, he was not all that involved with the patients, and he regarded them differently than he did his private patients. He had much more control over that audience. The private patients were the audience that he devoted himself to. He had more time and interface with them.

Carrie, on the other hand, was foisted on him by the circumstances of his teaching obligations. He would have preferred not to have to deal with her or patients like her. Those of us on the house staff served as interference for him so that he didn’t have to get his hands dirty. Carrie had other ideas.

There are some individual patients that you can learn from, and there are some famous patients that will teach an entire generation of doctors. In my internship, my supervising resident told me that there were only about three hundred patients, and that the same three hundred patients kept cycling through the hospital system and served as living textbooks for the interns and residents.

Carrie was the prototype for that type of patient. She was demented, psychotic, aggressive, uninhibited, and would teach an intern with a will to learn and a world of patience, about twenty chapters of Harrison’s Textbook of Internal Medicine. She had diabetes, high blood pressure, renal failure, fluid and electrolyte issues, thyroid disease, drug reactions, gangrenous extremities, bed sores, heart disease, angina, transient ischemic attacks, and the worst dentition imaginable.

She was crazy. She was wild-haired and wild-eyed. She had a face like Bill the Cat of cartoon fame in that her hair was wild and spiked. She had a perpetual scowl. One eye was wide open and bulging with the other shaded by a cramped eyebrow unilaterally obscuring the shaded eye and emphasizing the bulging one. She described herself as a black Jewish witch. She happened to be African American. We could never verify that she was Jewish. She said she was a witch, and we took her word for it.

As a senior student and during internship, I had occasion to be involved directly with her care, cross-cover others involved with her care, or observe that she was in the hospital on some other team’s service at least two dozen times. That meant that she was in the hospital for a tune-up on an average of once a month. When she was ready to return to the nursing home where she ostensibly lived, the treating team would throw a Carrie Party to celebrate her departure from the hospital.

I got to know her well, at least as well as anyone can know a psychotic, demented, aggressive, diabetic, hyperthyroid, self-described witch. I will say that I learned a lot from her and had intimate knowledge of her numerous and voluminous charts.

My introduction to Carrie was as a senior medical student. We were in a conference room across the hall from her hospital room. She was singing loudly at the top of her voice. She did not have a melodious voice. The attending physician, Dr. Fletcher, was getting irritated that he was having to raise his voice to be heard above the din.

The noise coming from Carrie’s room was beginning to annoy the attending. He finally had enough and walked into her room. She stopped singing. Then we heard her loudly exclaim, C’mere and fuck me, cracker! There was a pause, and then she gave out her signature exclamation that I was to recognize and fear for the rest of my senior year and my entire internship year. She would rear back her head and let loose with a cry, Whoooooooweee! I’m a black Jewish witch, y’all!

I’m not sure why she felt the need to exclaim that on a semi-regular basis, but she did, and no one ever confused that cry to originate with anyone but Carrie.

Dr. Fletcher walked back into the room with a sort of dazed look on his face. He was so particularly arrogant; it was refreshing to see that someone had actually been able to get to him. For the first time that I had observed him, he was nonplussed.

The team that was taking care of Carrie leaped up and scrambled to hustle into her room to see what had so disarmed the attending. A list of things ran through the minds of those of us taking care of patients—things that might get us into trouble. If you screwed up, there were attendings who would say things, such as Here’s a quarter. Go call your mom and tell her you’re not going to be a doctor. We all hoped it wasn’t something like that. Dr. Fletcher was one of those likely to pull that kind of stunt.

The team was worried that Carrie may have slipped out of her restraints, that she might have pulled her IVs out, or that she might tangle herself in her sheets threatening to accidently hang herself.

They returned just as sheepishly as had the attending. I later learned that Carrie had managed to wriggle out of her hospital gown even though she was in full restraints and was lying on her back, buck naked and spread-eagled because of the restraints. That must have been quite a sight. I was glad to have missed it. Little did I know then I would have my own tender memories of that remarkable lady.

A little over a month later, I received a call from Allen Siberling, my supervising resident. It was two thirty in the morning. I had just gotten to bed after working up the day’s admissions.

Al was my supervising resident. He was in his last year of training and being recruited hard by several groups in town. He was smart, he was efficient, he was effective, and he didn’t scare patients with long hair, sloppy dress, or an accent. He saw my partner and me as lost causes. We were green. It’s amazing how quickly one forgets the feeling of ineptitude one has as a newly minted doctor-intern.

In July, the academic calendar starts anew. Medical students who haven’t graduated and are continuing on in their particular clinical rotation even rank above the interns who have just recently graduated by virtue of their knowledge of the patients. At least the students have the brief experience and knowledge of the patients that they have been taking care of, and that counts for something. It temporarily puts them ahead of the interns.

Al saw us as projects. We were to be supervised for our own good and for the good and the safety of the patients. It must be said—he did a really good job. He was straightforward. It wasn’t so much that he would do didactic teaching, but he made sure that we found ourselves in situations from which we could learn if we applied ourselves.

He knew all the attendings and their quirks. He made certain that we looked in the right places and at the right things to be sure we didn’t embarrass ourselves at morning report.

We were on call every third night. Supervising residents were on every fifth night, so we wouldn’t necessarily always have him on call with us. But he would still check up on us. The only morning when we didn’t have morning report and thus could sleep in—everyone was expected to go to morning report every day—was Sunday.

However, Al was a type A personality. My partner and I shared a call room with twin beds with a nightstand that had a phone on it between us. The first Sunday that we were on call, we were luxuriating at sleeping in. We had both gotten to bed at around two-thirty. The phone rang. One bleary eye stared at the bleary eye of my partner. Silently, we shook our hands in a game of rock, scissors, paper. I lost.

Hello? I said it with as much molasses and croaking in my voice as I could muster so no one could possibly miss the fact that I had been awakened by their insensitive and unwelcome phone call.

Wake up you turkeys. What’d you get?

Although I was still mostly asleep, I was also in shock—a little bit. I mean, this really wasn’t fair.

Al. It’s six thirty. What are you doing up? You’re not even on call. I tried to sound petulant and annoyed but not seriously hostile. I mean, this guy could really hurt me if he’d wanted to.

I’ve been up for an hour already. I’ve got to get ready for church. I wanted to check on you guys and find out what we’ll have for tomorrow’s rounds.

Where do you go to church—New Life Rooster Dawn’s Early Light Morning Lark Chapel? I tried to say it with an edge, not for comedic effect but to let him know I was annoyed.

"Very funny. No, really, what’d you get? Fletcher is on service this month, so if you have any renal failures, check out your Harrison’s [textbook of Internal Medicine]. He will grill you on fluid and electrolyte disorders. He usually does that the first week on service."

Thanks for the heads-up. Al, don’t you ever sleep?

What for? It’s highly overrated.

He was stoic, and he talked a good game, but even he could be beaten down. He could handle most anything on the nights that he was the in-house supervising resident. He had to see all the admissions, and not just for his team (my partner and me), but for all the other intern teams in the house taking call and admissions. He would take about a quarter of the time to evaluate a patient that we would require. He was faster in part because he was that smart and that good and partly because he could farm out the time-consuming grunt work (starting IVs, drawing blood, doing Gram stains) to us.

When he was on call with my partner and me, we could tell if it was a bad night. A usual night was four or five admissions. Anything over six was onerous to say the least. Mike Thompson, my partner, could read Al like a book. If it was really busy, Al would get a grimace on his face that would start at about six hits (admissions) and get increasingly taught with each subsequent admission. Mike dubbed it Al’s six-hit grin.

Al was this unstoppable machine that could and would work all night long to ensure that the rest of us took good care of the patients. After we thought we had finished our workups, somehow he found time to look at our charting and make helpful suggestions on things that could be better.

He liked things to be tidy, and he hated loose ends. If you ordered a test, you had better know the result of the test—or at least when the result would be ready.

He was on call the night that I was awarded Carrie. I had just gotten to bed at about one-thirty.

Wake up, you turkey. I have an admission for you. I was hoping for an asthma attack or a patient with dehydration, just something easy that would not delay my return to bed for very long.

Watcha got for me, Al? I asked hopefully.

He just held the phone out away from him, pointing it in the direction of the patient who would become my admission. I heard, Whoooooweeee! I’m a black Jewish witch! Oh god. It was Carrie. I had drawn the short straw, and she was now mine.

I’ll wait down here for you. I think I heard Al chuckle as he hung up.

When I got down to the emergency department, Al had left to go run a code 99 resuscitation of a patient with a cardiopulmonary arrest. He did leave a message for me, though. It read, Enjoy the reading!

The typical chart of a patient that has even difficult problems rarely exceeds an inch in thickness. Carrie’s combined charts were an even eighteen inches thick. It would take me the rest of the night to abstract the charts, and I had to because the attendings all had intimate knowledge of Carrie’s medical history and could quiz me on any facet of her many illnesses with alacrity at morning report.

Morning report was where the team gathered in the morning to find out about the admissions overnight. It served several purposes. It was an opportunity to learn from the Socratic method. The attending would fire questions about the illness that the new admissions had. You were expected to tuck the patient in after working them up and then go research the medical problem they had so that you could say something intelligent about it at morning report the next morning.

God help the hapless intern that didn’t completely work up the patient, including doing your own Gram stain and looking at it under the microscope. If you weren’t able to answer the preliminary questions, the attending would bore in, asking increasingly more difficult questions. The experience was designed to use humiliation to motivate you to study so that you wouldn’t be subjected to such treatment a second time. Only once did I ever hear anyone complain that they had been overwhelmed. It was possible to get five or six admissions in an evening. Each admission could take one to two hours of work and preparation to ensure that they were properly worked up and prepared for morning report.

On the one occasion that I heard someone complain that they had been overwhelmed with admissions and the attendant work and didn’t get a chance to prepare for morning report, I heard this exchange.

Well, I had eight admissions and didn’t get a chance to look anything up.

Did you get any sleep?

Yeah, about two hours I guess.

Then that is two hours you could have spent reading up on your patients.

Fortunately for me, the attendings were all familiar with Carrie and tired of talking about her.

Carrie came back in last night. She’s a sixty-four-year-old diabetic, demented, hypertensive, with renal failure that has been poorly compliant. She was in the nursing home and became poorly responsive and was brought to the emergency department, where she was noted to be hyperglycemic, dehydrated, hypokalemic, hypertensive to 190/120, and poorly responsive.

Yeah, well, we’ve beat that horse to death about a thousand times before. What else’d you get?

At sit-down rounds preceding walking rounds the next day, she had recovered to the point that she was singing again—loudly. She must have been feeling better because the refrain in her made-up song was a string of expletives that she shouted at the top of her considerable voice.

Dr. Fletcher was not amused. Whose patient is that?

That would be me.

Look, if you can’t get her to stop, then you’ll have to sedate her. She’s upsetting the other patients and disrupting our rounds.

She’d had so much Haldol by then that it was beginning to lose its effect on her. I asked the nurse to give her an unusually large dose. Carrie was not affected. Not a bit. The din continued.

I thought I instructed you to sedate that patient.

I gave her ten milligrams of Haldol.

No one could withstand that much Haldol.

That’s our Carrie, Al proudly piped up.

The attending decided that he had to see this for himself. Without a word but with a very cross look on his face, he stood up, harrumphed, and strode into Carrie’s room.

Who you? She fixed her bulging eye on him, and the other slowly followed.

I’m Dr. Fletcher. Look, you’re creating quite a disturbance. You’ll have to be quiet.

That was the wrong thing to say to Carrie. She was demented, and there was no way to reason with her. She was like an obdurate two-year-old and just as hard to reason with, which is to say there was no reasoning with Carrie.

She picked up her plate of spaghetti and threw it at Dr. Fletcher. He was so taken aback that he was just barely missed—by the plate. The spaghetti and sauce made a lasting impression on his starched white shirt and coat.

Get out of here, you asshole! Whoooweeeee! I’m a black Jewish witch!

At that point, rounds were finished. I don’t think Dr. Fletcher even showed up for his afternoon clinic.

Al told me to make sure that she was sedated for the next day’s rounds even if it required general anesthesia.

With much help from Al and a lot of effort from the team and myself, in due course, Carrie was tuned up and readied for her return to the nursing home where she ostensibly lived. I say ostensibly because she was spending more time with us than she was with the staff at the nursing home. Rumor had it that the nursing home would only take her back on the condition that she would be readmitted at the slightest provocation. The hospital put up with the arrangement even though they lost money because she was such a good teaching case.

All that day, as we made rounds, when we encountered other teams, we passed the word, Carrie party at five. Everyone who could make it would show up at the snack shop, and whoever had launched Carrie back to the nursing home after the latest admission would buy chocolate malts for the other team members. Sometimes no one could make it because of the pressing workload. Of course, when it was my turn to buy (it was my party after all), just about everyone showed up. I didn’t care. I was just so glad I didn’t have to deal with that witch anymore… at least not for a while.

On cue, as we raised our chocolate malts in a toast to her, we heard, Whooooweee!

I wasn’t to hear that cry for another two weeks, and fortunately, when she did come back in, I wasn’t on call, and she wound up on some other unfortunate intern’s service. Things got tighter after that admission, though. She managed to escape her restraints at the next admission. She was found wandering through the hospital and was just about to enter the scrub room in surgery when someone yelled at her not to contaminate the clean area. Fortunately and uncharacteristically, she backed off and fled—to the laundry area, where she made a mound of clean towels into a large bed where she slept and where security, who had been frantically searching for her, finally found her.

She was restrained with full leather restraints after that, and when she was particularly agitated, she had a medical assistant assigned to her one-on-one to ensure she didn’t escape. That couldn’t have been a fun job.

She was still coming and going when I finished my internship and was moving on to other things. I don’t know how she died or even if she did. She was just obstinate enough to carry on for another thirty years. Just don’t get too close to her, though.

THE BATH

I WAS ASKED TO participate in a program for attorneys to explore the medical, legal, and moral issues at play in end-of-life decisions. Also, serving on the guest panel was one of the wisest, most skilled nurses I have ever met.

Diane Kinsey is a skilled ICU nurse who sought new challenges and went to law school in the middle of a successful nursing career. She shared with me the story of how she dealt with a difficult end-of-life situation.

In ICU nursing, neurology, oncology, and similar specialties, one is confronted with the terminally ill on a routine basis. It is sometimes difficult under those circumstances to recall that there are families attached to those patients in the hospital bed. While we deal with death and dying on a regular basis, the families do not. This story served as a reorienting for me to recall that the families are dealing with the death of their loved one on a unique and emotionally wrenching basis.

John Konrad was a fifty-three-year-old man who, in addition to having horrible genes with a disposition toward heart disease, had a lifestyle that fanned the flames of that disaster in waiting. He smoked a pack and a half of Marlboros a day, ate trans fat (jelly donuts with an éclair was his usual breakfast when he didn’t have time for bacon and eggs), and drank more than what was good for him.

He had suffered two earlier heart attacks that did nothing to slow down his destructive lifestyle. When confronted with a need to change, his answer was always a shrug and, I’m still here.

The third time, he was not so lucky. He was in his car. With the first pangs of chest pain, he had the presence of mind to pull off to the side of the road. It was a while before anyone found him and sent help. By then, he had suffered an anoxic insult to his brain from lack of blood supply from his heart, which was undergoing its third attack. He had lapsed into a coma. When the nutrient and oxygen supply to the brain are interrupted, the brain is injured. The heart, which, after all, is only a muscle, can recover much better than the brain, which is much more fragile. After only four minutes of oxygen deprivation, the brain will usually experience profound irreversible damage.

John’s indestructible heart suffered the damage, regained its footing, and showed signs of recovery. Unfortunately, John’s brain did not. As is so often the case, he became a resident of the ICU dependent upon the ventilator and other life-sustaining tubes running in and out of his body, bringing him all the medicines, nutrition, and fluids needed to cling to his tenuous perch on life.

Unfortunately, his brain was not responding to the expert treatment afforded him by the doctors, nurses, respiratory therapists, and ancillary personnel. He was permanently altered. The person his family had known and loved was gone, never to return. They were having a hard time with that.

Everyone on the care team tried to broach the topic with the family. Does John have a living will? Did he ever discuss with you what he would have wanted in this circumstance?

The family was just overwhelmed.

To complicate things a bit, John had divorced and remarried. His first wife was out of the picture, but his children were at the hospital regularly as was his still living mother, and, of course, his present wife. Although cordial, relations between the three groups of people were strained.

Mae, John’s mother, looked weary. In her eighties, she looked like she could still do an honest day’s work if she needed to. Retired, she still managed her home and spent as much time with her grandchildren as they could spare for her. She was small and spare. Dressed in the manner of the finery of the professional style, she was proud that she would shop at Kohl’s and T.J. Maxx to find bargains. She was proud of her frugality and yet enjoyed the finer fashions.

Now at the bedside of her severely injured son, none of that seemed to matter to her anymore. The light went out of her eyes. Her graying hair was in a neat bun, but wisps escaped and lingered carelessly around her face. She had the face of someone much younger and retained much of her beauty.

Her hands gave her away, though. They had seen much of life and continued to help young people with their school projects, extracurricular activities, and increasingly typing and presentations for college students. She did this all in the loving service of her beloved grandchildren.

Diane was at the bedside taking care of John this Saturday morning. She knew that Mae had been there all week and had barely left John’s side except when Janice, John’s second wife, was in to sit silently by his bed, hold his hand, and sob in that heart-wrenching silent way that makes you want to weep too.

Diane knew as did the entire health care team that John’s chances for recovering to a meaningful life were nil. He would never again interact with his environment in any way that made him human, much less a human known as John Konrad. After a week of caring for John and knowing he was never going to get better, Diane thought the time was right for broaching the subject of his prognosis in earnest.

Does John have a living will? I asked, using the phrase that usually serves as a good icebreaker in end-of-life discussions.

Yes, he does. She looked lovingly at her son and stroked his hair. It was lush and full, and even though John was fifty-three, not a trace of gray passed under her hand. She went on, He would never have wanted this. She continued to gaze upon her stricken son. The doctors tell me that there is no hope for his ever recovering to a meaningful life, that he will never recognize me, his children… or his wife ever again.

Diane noted the pause before Mae mentioned John’s wife. Mae continued, It’s probably time to let him go. The doctor called it ‘letting nature complete what has been started.’ The kids are ready. They deplore seeing him this way. She paused and looked at the tubes, the ventilator, and the multiple IVs with fluids running into and out of him. She slowly shook her head. I just hate seeing him being tortured this way.

Diane had known many families in similar circumstances in the past. At different stages, families eventually arrive at the conclusion, correctly, that medical efforts are not saving a life but are prolonging a death.

Still, there are some families that stubbornly cling to false hope. God is going to work a miracle. He is going to save our loved one. It would be unwise to discount miracles. They do happen. But patients that have suffered catastrophic brain injury as a result of lack of blood flow to the brain don’t fall into that category. The statistics are very telling.

Are you ready to stop life-sustaining measures for John? Through experience, Diane had found it best to be direct. Families know what is going on with their loved one, and questions like hers are expected. Indeed, families are almost relieved to hear them.

I’m ready, but Janice isn’t. I don’t know why she doesn’t face the reality. John’s gone, and he’s not coming back. We have only the shell of the man that we have loved. I think it’s time we let him go. We are only torturing this poor man. This is not what he would have wanted.

Diane was confused. This did not sound like a family that was clinging to false hope. She sensed this was a family that was ready to throw in the towel. There wasn’t really anything more that needed to be said on behalf of this poor man. She returned to what she could do for Mae.

You look tired. She knew that Mae had a room at the hotel across the street from the medical complex. Why don’t you go lie down for a bit? I’ll call you if there are any changes.

You know, I could do with a bit of a rest. She gathered her things and slowly departed the room with a visibly heavy heart.

Shortly after that, Janice, John’s wife, arrived to take up the afternoon vigil. She was a handsome woman. She was a mid-level executive at an investment house. She was fairly successful in her profession, and it showed in her Doncaster suit and gold chains.

As she entered the room, she nodded at Diane, who was administering John’s afternoon medications. Diane held her voice and nodded in a friendly enough manner but didn’t say anything just yet.

How’s he doing? Janice asked.

Oh, about the same. No changes really.

That’s what the doctor said we could expect. There followed an awkward silence, while Diane tried to capture the moment when Janice was in tune with considerations about John’s prognosis. It seemed an opportune time. Janice had just acknowledged her understanding of the doctor’s assessment of John’s prognosis. Diane decided to seize the moment.

Somewhat bluntly, she weighed in. Did John ever talk with you about what he would have wanted in these circumstances? Diane was curious about what was holding up the inevitable for her patient.

Oh, he would never have wanted this. He told me on many occasions that he wanted me to let him go if it ever came to this.

Are you ready?

Janice looked down at John as much the same manner as Mae had just done. She also stroked John’s ample head of hair and looked around at all the tubes and IVs and the ventilator. Tears welled up in her eyes. She began to choke back on sobs that stuck in her throat.

She sighed. Yes, I’m ready, but his mother just won’t let him go. The doctors have told us that we can remove the ventilator anytime we want. She avoided Diane’s steady gaze. But she just won’t let him go.

Diane did some quick calculation in her head. One of them, mother or wife, had read the other wrong. Calling on her experience with mothers, wives, and children in this circumstance, she quickly deduced who was holding on, and it wasn’t the mother. She kept that deduction to herself. Diane saw an opportunity to find out how much Janice was willing to hold on to her broken husband.

I was just about to give John his bath. Would you like to help me?

At first, Janice was a little taken aback. She hadn’t thought that she might be called upon to actually assist in the care of her husband. It also presented a bit of a dilemma. If she didn’t assist, it would appear that the love she had for her husband was somewhat less than she made it appear to be. She overcame her natural aversion to dealing with the seriously ill person in the bed with tubes running in and out in order to demonstrate her love for her husband. Sure, I’d be glad to help. What can I do?

Diane thought it odd to use cocktail party icebreakers in such an emotionally charged atmosphere, but she needed to get Janice at ease before she could draw her out.

Where are you from?

You mean, where did I grow up?

Yes.

I’m from Saginaw.

How did you meet John? Diane moved the plastic basin close to the bed where John lay. She handed a fresh washcloth to Janice and began to remove John’s gown. Janice paused, watching another woman ministering lovingly to her husband and undressing him. Diane quickly picked up that vibe.

Can you help me with this gown? I’ll lift up his shoulders so you can reach the ties and untie it so we can get it off him. Diane thought Janice would appreciate performing the more intimate parts of his bath.

Janice untied the gown and began to pull it off him. Not for the first time she stifled a sob.

"OK, let’s start with his legs. Diane wet her washcloth and applied some soap and began to wash John’s right foot. Janice mirrored her actions on the left. Diane looked at Janice with raised eyebrows, inviting her to tell the story of meeting John even as they worked their way up his legs to his knees with the washcloths.

"We were both divorced. I think we were both just tired of giving everything to our kids. I mean we loved them an’