Deborah was burning out. Years spent caring for people in comas, people with terminal illnesses, people lost in dementia — they had taken a heavy toll. Then she got a glimpse of the miraculous.
by Kathe Koja
In the water-green half-light his lips protrude, moist starlet red. Glossy and swollen as sweet infection; his irises are gray. When she touches him, he makes no sound at all; but his lips move.
He might be praying; or trying to speak.
He never says her name.
Down the hall again; still. Just after nine on the heavy clock, white face in dust behind bland mesh and big black numbers you could see from either end of the hall; the all-purpose institutional clock. Hospitals and schools. And prisons. And nursing homes. Walking, her back threatening to lock, that feeling again like grinding bones in sockets scraped dry and she leaned for a moment against the wall. Tired inside and out, calf muscles cramping like they had all day; every day; she was so tired of working here. Continuing care; right. Tired of bending over, of the smells and the way shit feels between your fingers, you’re wearing gloves but that doesn’t really help, does it? The endless rosary of pills, meds twice a shift and she was tired of that too. Tylenol and vitamins; and Darvocet. And Xanax. She wished she could have some Xanax. In the room closest to her, Mrs. Reichert was screaming again. Pretty soon they would all be screaming.
She was so tired of hearing people scream.
She had been here for four years, but they were all still people to her; helpless. Most of the aides called them by their illnesses, their ailments, walking tragedies: the Parkinson’s, the CVAs, the Alzheimer’s; a whole family’s worth of Alzheimer’s. Strokes and dementia, congestive heart failure.
Her name was Deborah, but he never said her name.
The first time she saw him he was wrapped like a pupa, mummy in white, bony and incongruous, shivering mute with some vast disturbance; he could not talk; his family talked too quietly and at such length that she could not stop to listen; she had work to do. Count meds, her fat shifting pile of paperwork, charting BMs and electrolyte counts, blood and urine, all the fluids rich and thin; a whole future in a plastic sample container: I can tell you where you’ll be in a year, six months; six weeks.
The family was in a hurry, despite the time they spent talking; she saw them go. None of them said goodbye to their — what? Husband? Brother? Little brother. He was barely forty, she saw: Elliot. His name was Elliot and he had had a stroke, a cardiovascular accident. Some accident. With good care he would live a long time, but he would never know a minute of it.
Would he? Did they know, the ones whose brains took disaster’s brunt while leaving their bodies intact, slow wreck of blood and shoaling bone, endlessness replicated with each breath, each intubation? The nurses and aides debated this, when they had time, a few minutes with coffee or a Coke, one of the aides dropping ashes on his shoes; sneakers. She wore sneakers too. She used to wear regular nurse shoes but found she liked sneakers better, sometimes she had to move very fast and the crepe soles had slowed her down.
“Does he even know he’s in there, that’s what I wonder.” The aide dropped ashes again. “I mean, look at him. Look at any of ’em.”
She shrugged. The other nurse sipped coffee, cursed softly for a scalded lip; shook her head. “They’re not there anymore, no way. They’re just empty bottles.” The image seemed to please her; she said it again. “Empty bottles,” and when Deborah shrugged again, “Come on, Deb. You know that.”
“I don’t know anything.”
Her back locked again in half a motion, dry pestle grind. The aide put out his cigarette. “Hey Deb,” the other nurse said. She had a jaundiced bruise shaped heavy as a thumbprint above her left eyebrow. “You really believe that? That they can hear us, they know what’s going on?”
No. I don’t know. “I don’t know what I believe.”
“If it ever happens to me,” quick paper squeeze between strong fingers, tossing her empty cup in the trash, “I know what I want and fuck my family. No code, no way.”
“Get a MedAlert bracelet,” Deborah said. “ ‘Slow Code’. ”
Full code meant resuscitate; no code meant what it said. All the patients wanted was a way out, but sometimes the families were obdurate: Do everything possible, they said. Guilt and rage and terror, as if keeping them alive meant anything anymore; rag talismans, strapped and bleeding and feeding from tubes, tubes for food and tubes for shit and someone’s daughter, someone’s niece, someone’s grandson shaking their heads: Bring her back, they said. If anything happens, bring him back. Slow code was the compromise, the last mercy unspoken: Stop for a drink of water; stop to check your watch. Inside the room the decision is in progress, relentless as the process of birth. We did everything we could, and it is a fact, like oxygen; it is simply the truth.
Elliot was a no-code.
Nothing was too likely to happen to Elliot, though; except for an essentially empty head he was in pretty good shape. Waxy as a still pietà Christ, long muscles in the cheap cleanser-blue pajamas and less trouble than a potted plant; the smell from his body was warm, the way a baby is warm, damp smooth skin against a sheltering cheek. Deborah’s notes on his chart were routine. She never wrote down the way he smelled, the peculiar oval shape of his lips as if steeped in a pleasing dream. He never screamed, cried, cried out. No one ever came to see him.
Which in its way was good. Immersed in permanent solitude, he missed no one; unlike some of the others, the daily pitiful litany: Where is my husband? Where is June, my daughter June? Is Michael here? A very few of them had families who came every day, to nurse their own, each deadening chore made sacred by abundant martyring love. To feed, coax with homemade delicacies mouths too slack to chew; to wash them, to change their laundry, soft pastel percale, bright flowers. To read to them, to talk. It was sadder that way, hideous the families’ suffering, but it made Deborah feel obscurely better. The ones she hated to see were the ones who came once a year, hectic with their own agenda, guilt and loathing vivid as a blood trail and full of complaints and rages for the staff: perhaps the patient has not had her diaper changed this hour; perhaps the patient’s hair has not yet been washed. They explode as if finding vivisection in process, curse and call names. Last month a man poked Deborah in the name badge, stiff finger so hard the thin plastic edge eased like a needle through her uniform and into her skin.
“I don’t,” poking, “want to see my mother like this. Ever. Do you understand me?”
Go fuck yourself. “What’s the matter?” leaning a little away from him, his pointing finger, his bitter cigarette breath. His mother was Mrs. White, Susanna: another CVA, victim of a carotid artery angioplasty that loosed a clot unseen like death itself come claiming through her veins. Quad and trach and tube feed and oxygen, that was Susanna. She had two daughters living three thousand miles away, and a son close enough for daily visits. It was two days after Christmas, his annual appearance and he poked Deborah again.
“She smells,” he said.
“We’ll take care of it,” Deborah said.
“Don’t patronize me,” he said. “I’m paying for all this.”
And heaven too. “We’ll take care of it,” she said, in the tone of voice she sometimes used when a patient was particularly hysterical, an iron gentility that usually worked on some level and it was working now, the man was turning away, pulling on his coat; expensive coat. After he had gone she went into Susanna’s room and stood beside her for a moment. In the room a faint antiseptic smell, less offensive than an open container of Vick’s. Susanna’s closed eyes were lidded in layers, like sand dunes, like snow drifts. Deborah felt tired, exquisitely tired, exquisitely sorrowful, but did not cry. Sometimes the patients cried, when the pain got too bad. “Kill me, Debbie.” That’s what they said. Kill me, Debbie; oh Debbie let me die.
“I can’t do that,” she would say. “That’s not what I’m here for.” Then she would go home and vomit — or sit in a chair without moving, without taking off her coat or shoes, a peculiar red illness moving like a secret snake through stomach and lungs as if her body itself were crying, tears of slow and heavy blood.
Elliot never cried. Or moved. Or spoke. Elliot’s muscles were holding up surprisingly well; he was not withering as quickly as expected. The first time his eyes came open, Deborah immediately beeped his doctor, who upon inspection informed her that what she had reported had not happened.
Nothing there, pale gray as winter water frozen in the last moment of motion. Drowning Elliot, slender bony chin, sarcophagus profile and her stethoscope brushed against his chest as now she bent, back painful, to adjust the slender slope of a tube
and his eyes did not move
and from his lips extruded a delicate drop of matter as fragile as a pearl, that rolled across his cheek to lie like an angel’s tear on the black-stamped linen of his bed.
She picked it up.
There in the baggy pocket of her clinician’s coat and her hand kept moving to touch it, roll it between nervous fingers; she had checked him twice as often as necessary through her shift but there was no change, no others like it lying beside him, Elliot inert, winter windows gray with the breath of others; it was a creamy color, hard as bone. Maybe it was bone.
She checked him once more before leaving; the pillows, the linen beside him was bare. His lips looked slightly sore, as if chapped by the wind. His vitals were OK. “Elliot,” she said, not to him.
His mouth moved, lips pursing almost like a kiss, an exaggerated Hollywood kiss, but nothing came out, nothing she could see. Her hands shook as she bent to the pillow, the face upon it calm as a dead saint; his eyes did not open, but moved, slow, slow, beneath the shelter of his lids, back and forth like thoughts, the nature of rumination, the play of muscles whose services are by time made moot.
“Elliot?” she said again, to him, a question.
In the hall the sound of the midnight shift, the aides talking quietly to one another; the pearl was in her hand as she left the room.
Instead of sleeping she sat up, the pearl before her on the kitchen table, a space pushed clear of half-empty cereal boxes and Sanka jars and a napkin holder shaped like a triangle. She looked at it dry-eyed in the wash of overhead light. It was not bone; it was not a tooth, or part of one. It was not a gallstone, or kidney stone; it was not a real pearl. She had an impulse to cut it in half, scrape its surface with a nail file but in the end did not, left it whole, left it there on the table on a pale paper napkin and when she slept at last dreamed thinly; not of it or Elliot but of walking forever on a helix still and dusty, no feeling at all but the silent grind of sand beneath her feet.
According to his chart, in two shifts’ time Elliot had not produced anything other than some unexceptional urine, but the rest of the last shift had been busy: Hakim Richardson had had another stroke and was sent to the hospital; Mr. Zelinksi died. Mary Yost had escaped her restraints and ate half an Efferdent before she was caught. This brought on some reminiscences of a former patient, an Alzheimer’s who ate soap, slim motel-size bars of Ivory; she would not touch another kind.
“Ivory was her brand,” the day nurse supervisor said, smiling as if at the antics of a particularly precocious child, or a clever pet.
“Maybe she liked the taste,” Deborah said. She was irritable with lack of sleep, her eyes as sticky-dry as the bottoms of her shoes; she had stepped in something on her way down the hall, back from Elliot’s room. Today he seemed paler; his closed eyes did not move at all. His hair looked dirty. There was nothing on the pillow or sheets but she lingered, wanting somehow not to touch but to reach, to connect.
Screams from down the hall; someone hollered “Deb!” and she ran, stethoscope banging back against her chest, pounding dull and painful like a little metal heart.
By the time she gave report to the midnight shift it was 11:30; there were still narcotics to count, she had to finish up charting but — stopped, inevitable, before Elliot’s door, tired now, and ready to concede it as sheer strangeness, to reaffirm her correct decision not to chart the pearl, any of it; to tell no one.
Inside, a distinct smell, not one she knew.
Her heart felt strange, tight in her body like an overdeveloped muscle and she approached Elliot as if he might spring up; already she saw his eyes, closed and restless back and forth and then a soundless string like bubbles, spit bubbles and there were at least a dozen of them, popping from between his lips to roll on a snail’s path of drool down to the wet square between pillow and blue shoulder, thirteen, fifteen; she swept them all into her cupping hand, hot and wet and her hands were shaking hard enough to be clumsy; she thought she might have dropped one of the pearls but now he had stopped producing them; nothing there but saliva and closed lips.
His eyes had stopped moving.
“Elliot,” whispering, the air between her lips warm with that smell, “Elliot.” Urgent. “What do you want?”
She had to count the narcotics twice to make them add up correctly, her hands so awkward the other nurse noticed, asked if she were all right. “Fine,” lying; what a poor liar she was. “Just tired.” The pearls made a wet square in her pocket, visible moisture. Did anyone see? She almost ran a red light going home, stumbled in the kitchen and scraped her shin against the bare leg of a chair. There were too many pearls to fit on the napkin so she hunted up a little jar, little glass cosmetic jar long bare of whatever sweet cream folly it had held, still trapped inside the faint emollient smell. The pearls lay three deep, nestled in the smell, matte against the glass and she took them with her to the bedroom, set them square on the scarred night stand so she could lie on one elbow and consider them: light on, eyes open. There were seventeen; she counted them twice and firmly; seventeen pearls that were not pearls. Elliot’s extrusions. Elliot’s . . . what? Voice? Words. Pearls of wisdom, and she smiled a little but without true humor; there was nothing funny here; there was nothing that she understood. Maybe you had to be like he was to understand; maybe you had to be locked like a boat stuck in ice, like a bricked-in pet, a fetus bobbing endlessly in faint formaldehyde against a jar just like this one, here in her hand
filled with pearls
that as she watched turned from pale to pink, to dark pink, to red, heavy red and then almost brown, like menstrual blood. Like the surface of a fresh scab. Like an insect crushed juicy and left to dry, mummy-dark on the plane of a screen.
She did not know whether to scream or drop the jar, or call and see if something had happened to Elliot, or empty the pearls down the toilet and pretend she had never seen anything. In the end she did nothing, and in that elongation found sleep to be a long nod, waking to instant consciousness with the pearls primly jarred beside her, safe and snug and surely there.
The day shift nurse’s report, hurrying through the patient list till his name, leaping out — and beside it, no change. Nothing.
“How was it?” not so much casual as flat, peripheral gaze. “Anything interesting?” Anybody extrude anything, you know, pearls? No?
“Same old same old.” The day nurse supervisor, purse in hand. “You’re short-handed today, looks like. David called in sick just a little bit ago.”
She shrugged; felt as if there were wires pulling her down the hall, thin almost invisible flesh-colored wires. “Have a good one,” the day nurse said.
Elliot’s room smelled of nothing, dust, furnace exhalation. His sheets had not been changed: She could see the faint indentation, pattern of wetness dried where the pearls had been. He lay very still as always but informed somehow by a new — weariness? Can one be weary who never moves? Exhaustion, then, say, or say weakness and see its signs; around his lips faint brackets, wrinkles, deeper around the eyes, forever closed in sockets bruised and plummy as an old man’s, the skin there softer, soft as the skin of his lips unmarred by blisters, by fluid, by pearls.
Crossly, and her own huge startle; from the doorway, leaning in: “What’re you doing? Come on, we need to get going.” The other nurse, bruise above her eye now a fruity green, harassed already. “Did you know that asshole David called in sick? Again?”
Down the hall; grinding spine and the tug of wires and it stayed that way all day, even the patients seemed worse, fractious, shrieking; there were fights and falls and everything, showers, meals, meds, running late; she did not see Elliot again but did not cease to feel the wires. A headache began about ten, heavy, thick behind the curve of her forehead like beating blood; three Tylenols with a grimace of cold coffee and as she swallowed thought, Did Elliot feel it, when the pearls came out? Did they hurt?
Did he know she was there?
Troubled dreams; the headache was there when she woke; the pearls were still that deep blood-rusted red. A bad day, bad week; the pearls stayed dark but no new ones came; his fragility increased but no one seemed to see. Her day off came without relief; she had copied his records and spent the day going through them, going through the literature to see if there was anything she might begin to lean on, learn, understanding’s crutch but then her disgust and weakness harsh as pain, she pushed the books and charts away and took up the jar: Reliquary, was that the name? The resting place for relics, saints’ bones, last drops of holy blood; in the light the pearls lay smooth, gentle distortion against the glass and she wept, finally, slow tears that ran against her cheeks, crying with her mouth open dull as a cow’s and hands palms-up and flat against her legs like a postulant’s prayer, the confession of a man on his deathbed, a voice without inflection imbued with flat and terrible haste.
His weakness accelerated, deeper the weights that held him, the hands that pulled him down: death’s hands, death’s fingers slipping like thread through the skin of his silence, weaving like strands through the hair brushed clean and flat against his quiet forehead. And she watching, knowing: It was the making of the pearls that caused this deterioration; but how to chart that? How to explain without evidence! Show, tell, see? How? Unable to spend time beside him, still she checked, quick, compulsive, watching for eye movement, the telltale drop of pearls, the deepening weakness like a road leading only one way. No one caught her, or rather she caught no one watching, but they were curious, or would be; one day they would ask.
Let them. Stubborn, she would not stop; she had to know. Watching him and tired, more headaches, the pain in her back and snapping at the aides, she did not make mistakes with the patients but neither was she kind — and regretted it, riding home and she wept at a red light and wished for the first time that Elliot would stop, just stop.
When she got home she saw that all the pearls had turned black.
The next day she tried her best, pathetic avoidance of his room, tried to leave his maintenance to others, tried to do her job and only her job. Not to worry; not to participate; not to understand but only to work and if he wanted to spit pearls then let someone else find them, oh, someone who would call out, “Hey Deb!” and show them to her, warm and slick in the rubber valley of a palm amazed and, What do you make of this? And she would shrug.
He had lost more weight; he lay like paper in the bed, like some cunning wasp’s construction of what a human being might be, spun gray and weightless: death’s cocoon and no, instantly, her denial: No.
This morning, checking the pearls, she saw that one of them had deteriorated, turned seemingly to dust, or ash; human ash, gray talcum against the side of the jar.
Dark, clean sheets and on the bed beside him, only watching as his eyes beneath their lids began to move, back and forth like fish in elemental motion, back and forth and the instant bubble of pearls, two, three, a handful. Watching, heart beating breathless and she had a wild desire, in the shadow of those moving eyes, to
and raising it to her lips, her shaking hands and inside her mouth, warm, warm on her flat tongue, against her palate like a special stone and she spat it out, gently into her palm that closed instinctively around it like petals concealing the flower’s heart. His hand, inert in its place, seemed nonetheless to touch hers; one finger crooked closer than the rest, heaven’s rebus and she swept the rest of the pearls into her pocket, rose clumsy and at once at voices in the hall; she almost forgot her purse, there on the floor, tucked under the bed like a visiting friend. Out of the room like a criminal but she did not feel bad, or sad, felt instead the intense absorption she had felt once, when? Long time, her premed courses and learning, slow, the mystery of the body, its failures and desires too stringent to be less than exigencies, less comprehensible as logic than commands from spirit to flesh, less truly understandable than the nature of life; and entropy, death’s sweeter sister, hand in hand in decay’s pavane begun as soon as birth. The way organs rot, and breathing slows, the way wrinkles and scar tissue form.
The way pearls turn from white to black, to dust.
Driving home, beneath streetlights the pearls glimpsed and already turning and then she was turning too, quick deliberate reversal and back, streets and streetlights and she did not look at the pearls again, did not stop at the desk to speak to the midnight shift nurse. Instead immediate to his room, no more pearls but the moving eyes so rapid and intense and she bent to him, spoke his name now with such assurance that in the speaking his own lips moved, sluggishly at first but then with surer animation. Did he know she was there?
She snapped on the small overhead, aquarium color: her hands were sweating but absolutely firm. His mouth kept moving, she checked his vital signs; they were very bad. BP and temp, pulse and respiration and after she had charted them, meticulously charted them, she set aside her pen and took up his hand; it was cool, and scarred across the palm, some old scar from the days of light and motion, days of a life now lost to this pitiless vacuum of weakness; held his hand, death’s hand in the dark as a mother holds a child, tenderly, tenderly. She said his name, “Elliot,” softly in his ear but did not expect recognition, an answer, anything; his lips kept moving, strongly, as if he spoke now through a wind, a torrent, a peeling storm and she said “Elliot” again, the pearls in her pocket between his body and hers and she thought she could hear it, that wind, could almost feel it wash across her own skin, the absolute clarity of cold and his hand now colder, his lips moving in one long grimace, one last powerful rictus and then nothing; silence; no wind at all.
And understanding then, with a calm vouchsafed by Elliot as himself and more than himself, as circumstantial conduit, meant to show her what she was meant to see, to be: angel for the dead, the queen of angels; to accept for and with them, mediatrix, what death is meant to be. Accept as well for herself: angel, finally, of mercy. Can she doubt it now, now with his hand in hers, cool and damp as modeling clay and she finds she can go anywhere, feel anything, reach any state she chooses: coma, nirvana, the bright dead bliss of no feeling at all. His lips are heavy, purple as a leathery grape; inside him everything is light, ether and feathers, weightless as tears in the middle of the night and she will stay beside him until the family comes at last, to find him laved and anointed, dead king propped beside her in his cloak of spirit-white, her pocket ripe with pearls of purest darkness turning slow to palest ash, and one beneath her tongue, black and sure and secret as the secret that leads us finally to where at last and always we were always meant to be.
— For Denice
Photo illustration by Robert K. J. Killheffer. Image: Timothy Cole (timcole / 123RF Stock Photo)
©1994 by Kathe Koja. First published in OMNI July 1994.