Sitting the Death Watch

By Stewart Smith

i2 lie on the chrome and plastic couch in the hospital corridor, drugged by the fuzz of half sleep, listening to her fight for oxygen.  The cancer has its knee on her throat, but she continues to fight.  Metastatic carcinoma.  What a lyrical name for a death sentence.  The sound is almost poetic.

The gasp, when it comes, is loud, wavering, trailing off into a tiny gurgle at the end, then silence.  I start the count.  One-one thousand, two-one thousand, three-one thousand.  Another gasp.  Louder and more labored this time.  The doctor calls it Cheyne-Stokes breathing.  Coma breathing.  One one-thousand, two one-thousand, three one-thousand.  The third gasp.  Weaker than the last one.  Then nothing.  Sitting the death watch is worst at three in the morning.

Waiting between the cycles is a slide into agony.  It goes on for two, sometimes three, minutes.  Each time, I wonder.  Will she breathe?  Each time the fight goes on: Gasp…wait…Gasp…wait…Gasp.  Then, nothing.  Was that her last breath?  Please let her breathe again.  How long can she keep this up?  Sweet Jesus, how long?

Wait!  Was that it?  It’s been longer this time.  That was her last breath.  It’s the end.

I sit up on the couch.  The cancer wing is dim, silent and cold at this time of night.  A solitary nurse, intent or her paperwork, sits at her station in a puddle of yellow light.  At the end of the corridor the polished tile reflects a red exit light.  There is no one else here.  I am alone and the patients on the wing are silent.

She gasps at last.  A long agonizing cry in the vocal cords instead of a healthy, silent, inrush of air.  The cry goes on for seconds as she struggles against the carbon dioxide that has built up in her lungs, then she lapses into silence.   A second cry follows the first.  Does this one sound more desperate?  Is this a sign she’s losing the fight?  Silence.  Three seconds pass.  A third, as she sucks in precious oxygen.  This one is longer than the last.  She falls silent then, satiated.  Carbon dioxide poisoning has been averted for another minute or two.  I collapse back onto the couch.

Why is it always three breaths and not two?  If she only takes two, does that mean she’s closer to the end?  What will I do if she only takes two next time?  Dad’s in the cafeteria getting coffee.  Do I race down in the elevator to get him?    I’m being silly.  He’ll make it back before she dies.  He has to make it back.

Dad has become a mystery to me.  I never know what he thinks behind that stern expression.   What must it be like, to have it end like this, in this savage struggle?  I wonder, does he still see the girl he fell in love with when he was sixteen?

How long has it been?  She isn’t breathing.  It’s been too long.  I sit up on the couch.  He didn’t make it.  It’s the end and he didn’t make it.  Should I go get him?  How long have we been here?  What day is it? I look at my watch.  It’s Thursday.  Thursday at three twelve in the morning.  What a terrible time to die.  I run my hand over my cheek.  The stubble is soft.  Four days.  I haven’t shaved or slept in four days.  I should grow a beard like one of my professors.  School is distant, suddenly trivial now.  My mouth tastes of stale hospital coffee.  When did I eat last?  Oh, shit!  She’s dead and Dad didn’t make it.

The gasp echoes down the hall.  I let out a breath I didn’t even know I was holding.  Not yet, cancer.  Not yet, death.  She’s still fighting.

I rub my eyes.  They’re gummy from lack of sleep.  My whole body feels old.  The second gasp echoes down the hall.  Louder than last time.  Why was it louder?

Please, God, she’s suffering.  Please.  Why don’t you end it?  No!  Wait!  I don’t want her to die.  She can’t die.  Please, no.  Not now.  Not till Dad gets back.  I didn’t mean it, God.

The elevator dings and Dad shuffles out of the doors, carrying two paper coffee cups.  He looks ragged.  His clothes are rumpled.  His normally immaculate hair is uncombed from where he has slept, sitting up, head against the wall, in the only chair in her room.  I can see the gray in his beard, his eyes bloodshot.  He moves like an old man.

The third gasp stops him in his tracks, half way to me.  He has an expression like he has just been stabbed in the heart.  I flinch at the sight.  It is the first time I see his façade crack, the first time I see him reveal his emotions.  At the end of the breath, he leans forward and hands me a cup.

“When did you eat last?” he asks.

I shake my head and admit that I don’t know.  He rummages in his pocket and hands me a ten, then lowers himself to the couch, holding the cup away from his body, trying not to burn his fingers.

The coffee scalds my lips on the first sip.  It is strong and bitter, without milk.  The kind served at three in the morning on the cancer wing.  It is death watch coffee.

It’s better to have Dad here, even though he says nothing.

I wonder what it will be like after she dies.  She’s the one I’m closer to.  Between her two bouts of cancer, she talked me down to earth after the train wreck of my first real love affair.

She’s never mentioned her cancer.  Ever.  It has to be the most momentous thing in her life, but she never said a word to me about it.   Dad told me.  Both times.  A detached recitation of the facts, delivered in a state of shock.

I saw her scars once.  I walked into her bedroom while she was changing her blouse.  She didn’t turn away.  They took more than a breast.  It looked like some monstrous beast had taken a bite out of her arm pit.  The chest muscles were gone, along with shoulder muscles and the inside of the top of her arm.  She was still taking heavy doses of radiation and the wounds wouldn’t heal.  A jigsaw puzzle of white adhesive tape and gauze covered her armpit and the side of her chest.

Horrified, speechless, I turned away, went to my own room, sat on the bed.  The vision of her wounds wouldn’t leave.  It was the first time I realized that she might die.  I don’t think she ever showed the scars to Dad.

I look at him now and he is not stern.  I see only fatigue, the first faint inklings of grief in the slump of his shoulders.

Another Cheyne-Stokes cycle interrupts my thoughts.  Automatically, I count the seconds: One-one-thousand, Two-one-thousand, Three-one-thousand.  A new gasp rattles down the hall.

I take a sip of the burning coffee and close my eyes for a moment.  The third gasp jars me.  I’ve fallen asleep in three seconds between her breaths.  How can that be?  I shake my head and stand.

“Gonna pee and get something to eat.”

“Food line’s closed.  You’ll have to get it out of a machine.”

The night nurse looks up.  I nod to her as I pass the station on the way to the elevator.  Downstairs, I throw the rest of the coffee in the trash, then find a toilet.  I fight a coin dispenser for change from Dad’s ten and lose, then fish in my pocket for coins to feed the sandwich machine.  I settle for a frigid, plastic-wrapped tuna salad on stale white bread.  I jam the sandwich in my mouth and re-board the elevator.  The fluorescent lights flicker and buzz on the ride up to the fourth floor.  Despite the hour I feel more alert from moving around.

I know there is something wrong the moment the elevator doors open.  The nurse is missing from her station.  Dad is standing at the door to the room.   A nun stands next to him.  We aren’t Catholic, but it’s a Catholic hospital.  The nun is fingering her rosary beads, praying.  Light shines out of the room, into the hall.  Oh, Christ!  I’ve missed it.  I’ve missed her passing.  I dash the remaining steps to the door and look inside.

The head of her bed is elevated, her head is thrown back, her mouth open and her eyes closed.  Her arms lay outside of the covers, palm up.  The morphine drip is connected on the inside of her right elbow, covered with white tape.  There are bruises on her arm from the other times they’ve put the drip into her.  She looks pale in the blue-white fluorescent lights.  The room has a faint smell of Lysol.

The nurse stands next to the bed on the far side, the rubber bulb of a blood pressure cuff in her hand.  She stares at the watch on her wrist.

There is another gasping breath, much smaller than before.  The cancer is pressing down.

The nurse tears the Velcro blood pressure cuff loose from her arm and looks up at me.  “It’s very close, now,” she says, unwilling to grapple with the word, the unmentionable word, the word we all understand but never utter lest it become a self-fulfilling prophesy.  “I’m going to call the resident.”

Dad and I approach the bed, one of us on each side.  She gasps again, stronger this time.  She is fighting it.  She lurches up in the bed, her eyes still closed, her mouth open.  Dad and I lunge to support her.

I glance at the nurse, stopped half way to the door, an expression of shock on her face.

At the third gasp, Dad and I lower her back to the bed.

“Kiss your mother while she’s still alive,” Dad says.

I look up at him.  His normal squint is gone.  I see the whites of his wide-open eyes, his lips drawn together in an o.  I hesitate.  He’s terrified.  She’s dying right in front of him and there is nothing he can do about it.  He’s lost it.  The room is freezing and I shiver.

I bend to kiss her on the forehead.  She is dry and hot-feverish in the cold hospital room.

Dad bends to her forehead and kisses her.

She cycles through Cheyne-Stokes one more time.  Each gasp more enfeebled than the last, then the long wait begins.  I place my hand on her forehead.  She is still hot.

The nurse looks at her watch.

In the doorway, I hear the nun praying, “Holy Mary, Mother of God, Pray for us sinners, now and at time of our death, Amen.”

I look up at my Dad, but he is not there.  He stands staring past me, his eyes unfocused.  He is somewhere else.

I don’t cry.

I push down on the grief.

I am a rock.

I am alone for the year Dad descends into alcoholism.

Years later, I stand at the foot of her grave.  I scatter Dad’s ashes on her grave and try to tell her about the grandchildren she never met, but I’m submerged in a flood of memory: the hospital room, the hot-feverish feel of her forehead, the sound of her breathing.  Automatically, I count.  One-one thousand, Two-one thousand, Three-one thousand, then collapse on a bench in the cemetery and cry.

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