Internal Medicine: A Doctor's Stories (17 page)

Modern medicine cannot—thank God—administer that quick twist. The only way to save Marie from feeling that long fluttering was morphine. But my attending was instructing me that it had to be done carefully because morphine, while it masks the sensation of suffocating, also suppresses respiratory drive. And so it has to be done carefully. If at all possible, it should be her heart failure that kills her—not our attempt to save her from suffering.

None of this, of course, entered into my conversation with Marie and her girls. Despite its impossibility, the discussion went off well enough. I hemmed and hawed, then explained what we could do to honor Marie’s request. They listened to me with a respect that always unnerves me, nodding solemnly as I stepped them through what I thought Marie might need. When I was done, I looked at her. She was lying there with the washed-out look of someone who has in fact quit fighting. “What you think best,” was all she said.

Two hours later I checked back. Marie had absorbed two milligrams of morphine, a dose that does more to sedate than cut pain, which was fine. She needed to get some of it ahead of time, to feel it working in her and know what it was. More family were there. They drew me into the room, by some Brownian kinetics of handshake and question pulling me toward the head of her bed.

“Here he is,” I heard her say. The morphine had, paradoxically, livened her up a little. She was propped in bed, keeping court. As I was drawn into her orbit, the crowd parted and fell in behind me. “Here’s my doctor,” she said proudly. “Jeanine, tell him what we were just talking about.” She dimpled deeply, and Jeanine explained, “We were talking about her ice-cream cone. It’s a story we tell.” A general murmur, the laugh we give in appreciation of a long-loved joke, welled behind me.

I did my part, looking puzzled, prepared to be amused.

Jeanine started. “One day, years ago—”

“It was the year after Mother died,” Marie explained quietly.

“Yes. It was Easter. And Granddaddy took Momma and Aunt Ellie and Aunt Peg out for ice cream.” Jeanine paused, looking to Marie to take up the prompt.

“He promised us if we didn’t fuss in church we’d all get ice cream.”

Jeanine smiled. “After church, he bought each girl an ice-cream cone. And then he set them out on a bench in the park across the street.”

“He wanted a picture of us in our Easter dresses,” Marie said, coming in so quickly she almost cut Jeanine off. Her voice had taken on an authority I’d never heard there. “And he wouldn’t let us start to lick until he took the picture. They were starting to drip, but he wanted a picture before our faces got all messy. He had a Brownie camera that was always difficult for him, unfolding it and all the settings. We sat there wanting to lick our cones and so afraid they were going to drip and spoil our dresses.” She stopped, winded. The expression on her face was intent but turned inward, concentrating on her breathing, or pursuing something in the story she could not quite recall.

“And then, just as he was about to take the picture,” Jeanine prompted, “just as he said to the girls, ‘Say “Ice cream—”’”

“We all said, ‘Ice cream!’ ” Marie’s face lit up with the words. “But just then—” She caught her breath. We all caught our breath.

“Out of a clear blue sky . . .” Jeanine whispered.

Marie shook her head as if a fly had touched her face. “The most enormous wind came up, and whirled around us so hard it seemed it would pick us all up into the sky.”

Jeanine, Francie, and even Roger were all leaning forward, intent on the figure in the bed, and as Marie’s pallid jaws worked I could see the rest of them moving their lips in unison.

“And when the wind blew away . . .” Jeanine began.

“When the wind died,” Marie continued, “Mary Ellen had her ice cream.” The silent chorus echoed,
Ice cream
. “And Marguerite had her ice cream.” We were all of us leaning toward her. “But when I looked at my ice cream, it was gone! My ice-cream cone was empty!”

We stirred, the spell on the verge of breaking, sharing looks in a ritual of amazement in which I, too, was included.

“We looked and looked, on the bench and in the grass, in my dress and even in my little pocketbook, but no matter where we looked—no ice cream!”

Marie’s eyes were shining now.

“And then,” Jeanine prompted one more time, “Grandaddy said . . .”

“Daddy said,” Marie began, her eyes softening, turning inward again.

“Granddaddy said,” Jeanine repeated as Marie faltered, “ ‘Don’t worry, Marie, God sent that wind to blow that ice cream up to heaven.’ And Momma said, ‘Daddy, that don’t make sense. There’s all the ice cream they need up in heaven!’”

The ritual wound up in an outburst of gaiety, but Marie, wattles quivering with indignation, shook her head. The outburst died.

“That’s not what he said.”

Jeanine and the others stared at her, stricken.

“I know that’s how Mary Ellen liked to tell it, Jeanine, but I was there. What he said was, ‘The good Lord knows where your ice cream went, Marie, but I sure don’t.’”

She clamped her jaws together and glared at nothing in particular.

Out of the awkward silence, Francie’s voice rose.

“What happened to the photograph?”

We all looked at her. Defensively, she added, “I’ve always wondered. If Granddaddy was taking their picture, wouldn’t that show where the ice cream went?”

We all turned to Marie, who shook her head again.

“Daddy said when he went to rewind that film something went wrong. The sun got in and spoiled the whole roll. Every negative came out as black as black.”

“No picture?” Francie asked plaintively.

Marie’s expression softened. “No, Francie,” she said quietly. “There never was any picture.”

“And your ice cream?”

Marie, looking inward again, said almost inaudibly, “No ice cream, either.”

T
HAT EVENING
, I
LOOKED
in briefly, but the room was quiet, Marie asleep, one of the girls slumped half over the bed. The monitor high over Marie was the only sign of life, the green light dancing in the darkened room. She was restless, her face twitching, brow furrowed, but still she seemed asleep. Dreaming, I thought, then pushed the thought away. I stopped at the nursing station to order two more milligrams of morphine.

In the morning, after rounds, after another sleepless night, I went in to shut off Marie’s dobutamine. Her pressure had started drifting down, but otherwise there had been no change. The whole family had gathered again at the bedside, joined by a few more faces that shared the stamp of Marie’s pointed chin and broad forehead. There was also a large, freshly bathed and shaved figure introduced as the pastor. It was time.

I went to the head of the bed. Marie looked up at me. “Hello, Doctor,” she said.

“How are you?” I asked, the question sounding less inane than I expected it would.

She waved a hand vaguely. “Here,” she gasped, attempting a laugh, and then the hand subsided.

“I’m going to turn off the dobutamine now. Is that all right?”

“Yes. Turn it off.” She almost rose from the bed with a sudden vehemence that startled me.

“Are you sure?” I asked reflexively.

“Yes.” Her voice rose sharply. “Turn it off. Now!” With her left arm she gripped my sleeve. “You promised.”

She was wandering, I thought, addled by morphine and fatigue, drifting in and out of a place she did not trust. I only nodded, and turned to the nurse who had quietly followed me in. She bent beside the IV pole. The pump sighed to a halt, the grinding noise that had been unnoticeable up until then suddenly loud in its absence.

Nothing changed. The family stood still, looking at Marie as if they expected her to expire on the spot.

I moved back to the bed. “There,” I said.

She looked at me.

“Are you okay?” I smoothed a curl back from her forehead.

“Fine now,” she said. And then her right arm reached around and gripped my shoulder, pulling me toward her. I bent, obediently, thinking she wanted to say something.

Instead she planted a dry kiss on my cheek. I hung there a moment, holding my breath. Then I kissed her back. The skin of her cheek was very cool. She sighed, and her grip relaxed. I turned and left the room.

It took Marie four hours to die. I was in and out of the room, checking for signs of distress. There were none. On one of those visits, I reached up and turned off the bedside monitor: she had a pacemaker, and I didn’t want the family to see the tracings continue after she was dead.

Around three-thirty, the nurse found me at the station.

“Twelve is gone.”

I sighed, and pulled myself upright.

M
ARIE’S BODY: THE FACE
gone slack and chalky, the eyes blank; her lips, half open, expressionless. Within her chest I heard nothing. A fugitive creak and gurgle as fluids shifted in her, but the heart itself was still. Time of death was 3:32. Cause of death, congestive heart failure. I filled out the papers as quickly as I could.

“D
OCTOR?”

I looked up, focusing with difficulty. It was Jeanine. Her eyes were red, mascara smeared across both cheeks.

“Marie wanted me to tell you.”

“What?”

“Two things. She said to thank you. And that she knows where that ice-cream cone went.”

I waited.

She shook her head. “That was all she said. ‘Tell that doctor I know where the ice cream went.’”

I looked at her and she shrugged, smiling.

I smiled back and we parted, hugging each other in the decorous way strangers should.

L
ATER THAT DAY, FINALLY,
I went home. I lay awake a long time that night, in the desperate insomnia that seizes me sometimes, post-call. I was thinking about that ice-cream cone, wondering what Marie had meant, what revelation had come to her as her brain, starved for oxygen, fogged with drugs, had started to shut down. I have seen it before. My own father, dying on a morphine drip, his kidneys gone from a failed dobutamine tune-up, had spoken in his last coma. Stray words. Words I hung on through the long afternoons. I no longer remember them.

Where could that ice-cream cone have gone? It had fallen somewhere they hadn’t thought to look. Everybody in the room, all of them sharing that story over all those years, must have known it. That wasn’t the point, though. But then what was? I tortured the question for a long time, as my wife stirred beside me in her sleep, and one of the children murmured something over the carrier hum of the baby monitor, and nothing came to me. Just ice cream, Marie’s finale, the long slide downward into night.

That night I dreamed. I have found that picture. Deep in it, the figures move, the three little girls in their neat white dresses throwing up their arms and shrieking silently as the wind whirls, leaves and debris fly around them, and in the distance trees thrash their limbs against a glaring sky. I scan the picture, searching it for a dim white blur ascending, flying skyward out of the frame. That night and three times since I have dreamt this, and each time I awake into the dull non-knowledge that I have failed to find the ice cream. I know that one day in this dream I will learn where the ice cream has gone, where Marie has gone, where all of us will someday vanish, ice under the sun. Unaware that this is but the dream still upon me, I watch helplessly as it recedes into the light, whirled upward on a wind that leaves me cold and dark and dumb.