What Is Broken

I opened the email from my patient, J., a 44-year-old environmental activist and farmer, sent seven months after his leg was amputated for aggressive sarcoma. The subject line read: To Make You Smile, Also, Thanks.

The attached photo didn’t succeed in making me smile, instead I laughed out loud at the sight of J., steadied on crutches in his Halloween costume, the white cloth of a sweatshirt and pants adorned with colored flaps of paper, the tube of the missing leg pinned back almost to his groin, a shock against his long form, an emptiness that took up space.

Beside him, his wife N., dressed as a small child with a big stick. The size of their grins bent the screen.

A broken piñata, he had written below, see?

I saw. I remembered.

***

A rare laugh brought my daughter to find me in my room, three mini Snickers as an offering, bottoms starting to melt from the heat of her palm. She was at the age to understand the portent of her peanut allergy, to recall the tingle on her tongue and the rasp in her throat and to separate her candy without having to be told. She added the Snickers to the naughty pile along with Butterfingers, Reese’s Cups, Reese’s Pieces, Mr. Goodbars. And for the hate of coconut and just to be safe, all the Almond Joys.

“Who’s that?” she asked over my shoulder, her cheek at my cheek, ear to ear. Mouth sticky and voice garbled from the non-killing candy, the Milky Ways and Three Musketeers, Sour Patch Kids and Rolos.

“My patient.”

“Why doesn’t he have a leg?”

“Cancer,” I said.

My daughter nodded wisely, at an age to understand cancer, dying, death, and dead, because of me. Because of my work. Because of thin walls and the forced proximity of 900 square feet and the calls that came, it seemed, always during dinner, watching TV, while car-singing to Katy Perry or at the mall. Calls where the odd set of words I spoke to the hospice nurses had been repeated so often in her presence they took on morbid, sentient meaning, when before I had been able to shield her.

Because I was at the age to have left my marriage and brought her here to an apartment with hallways that smelled of cabbage and steep sets of stairs that took our breath away. Three rooms and no place to run to when the death pronouncements came.

“He looks happy,” she said.

***

J. came into the clinic screaming, begging for us to cut his leg off right then and there, with a box cutter, if necessary. The same leg he flung over horses and up into tractors, the leg he used to walk the wild perimeter he was growing on the corners of his property for migratory birds to rest, full of weeds for butterflies. He told me he’d inherited a cruel legacy and wanted to do better. Better for the land, for the animals, for everyone. And now he wanted it off, the leg crowded with cancer chewing its way north, ravenous for muscle, hungry for nerves, most desirous of bone.

“C’mon, doc,” he’d said in my clinic room, “I promise not to sue. Just get a tourniquet and have at it. I’ll help.” He gripped his upper thigh and squeezed. “How about starting right here?”

His wife N. rolled her eyes as way of an apology. “He can’t help himself,” she said. “Once a jokester, always a jokester.”

J. once told me, “Going through cancer without a sense of humor is like taking a walk in boots without socks. You get where you’re going just the same, but it hurts a helluva lot more than it has to.”

Going through divorce without a sense of humor felt the same, some wounds self-inflicted, prone to festering and leaving scars. But I couldn’t find my lost sense of humor amongst the droning of financial disclosures, bitter text exchanges, endless lawyer-speak, or hear my old friend over the sobbing squall of my daughter’s nightmares.

I missed being able to laugh, I imagined, the way J. was missing his leg. Oh, the frailty of the word ache.

***

You’re only dead once a doctor says you’re dead. We have to check the body, say certain words, announce the time. It’s state law, but law tends to go soft when a death is expected and a doctor isn’t present. The hospice nurse calls me instead, having laid their eyes and hands on the dead in my absence. She or he tells me the time and I repeat it back. I say, “I am happy to pronounce”, which I know is an awful choice of words, because I chose it. I’m not pleased to pronounce, I’m every other possible emotion. Sometimes annoyed. Sad. Detached. Grateful. Just not happy.

“He is happy,” I said to my daughter as she looked at J. “His leg was hurting him terribly.”

“So they cut it off?”

“They cut it off.”

She nodded, ready to move on to additional hits of sugar and unrestricted access to the Disney Channel, then stopped. “Show him our picture,” she said. “Can you?”

How could I not?

I pulled up a photo of my daughter and I as witches, black pointy hats and smudged eye makeup, ragged cloaks and snarling faces. My expression not pasted on for the costume but revealed by it. We matched, my daughter at the age to revel in choosing a co-costume, taking as much pleasure in the act of dressing me up as in trick-or-treating.

I attached the one she chose, a head and shoulders shot with our faces scrunched together, delight in our blackened eyes and bared teeth.

“Good?” I asked.

“Good,” she said, now not in a hurry to leave my side. Divorce had turned her cuddly, needing more skin-to-skin time than she’d wanted as an infant, more than prescribed by the NICU nurses during her weeks in that sterile, buzzy-with-light place, a feeding tube taped to her sunken, yellow cheeks.

“Can you come with me?” she asked. “Liv and Maddie’s on.”

How could I not?

***

J. woke up sweating, grasping for his leg. When he felt its absence in the bed he howled like an animal. For two days he wept and shook and swore and fought, tearing at the sheets, looking for what he’d lost.

On the third day, he said, “Hey, doc, if I get through this, I’m going to dress up as a piñata for Halloween. I swear I will, and I’ll send you a picture.”

His wife N. nodded, as way of confirmation. “He’ll do it, she said. “And I’ll hold the stick. I might even use it on him if he doesn’t shape up in here.”

And just like that, he found a pair of thick socks for worn boots.

***

The first time my daughter figured out what the calls meant, while I stood in the bathroom holding my hand over the phone, whispering, “I’m happy to pronounce”, my daughter waited on the other side of the door to destroy me.

“When you say that, it means someone died, right?”

Damn, I thought, I’m a fool. Our tiny couch, ragged from cat scratches, came up to meet the back of my legs.

“Yes,” I said, hating myself for telling the truth and hating myself more for having to.

“Isn’t it sad?” she asked. “Aren’t you sad?”

“Sometimes, yes, but sometimes not. Some of the people are ready to go. Some of them are so tired of hurting, it’s better if they go.”

My daughter climbed into my lap, barely fitting, and reached her arms around my neck. Held me there while I cried.

***

Sometimes our patients are our teachers. J. was mine, and still is.

Finishing the email, below the witchy picture, I wrote back to him: To Make You Smile, Also, Thanks.

Thanks for the laugh, I didn’t say. My first laugh in these months of breathless dread and cabbage smells, getting blisters I didn’t need to get, walking the rutted road in threadbare socks.

Thanks for reminding me that what is broken needs to go.

Dying Wishes, Living Wants

She asked to meet the firemen. In the hall of dying, sirens screaming, the dying woman asked for her bed to be rolled out into noise and chaos. How could we do anything but comply, but witness? Gnarled hands reached for muscles hiding under heavy canvas and she whispered to shocked faces, come closer. I watched years drop from her, eighty or so, as she stroked stubbled chins and squeezed their offered, tentative fingers.

A mouth unable to eat tasted desire, again, always.

He asked for a bottle of whiskey, a blonde, and a brunette. Whiskey he sipped from a spoon, memories he feasted upon, sensation flitting like summer lightning across lidded eyes and sunken cheeks.

They asked for BBQ ribs and the hottest sauce, extra napkins, cold Pepsi. They feasted on a hospital bed, slopping sticky crimson onto white sheets from flimsy Styrofoam containers, making a mess like trauma, touching heat to dry lips, cackling at the response of their loved one, the rise of pleasure, the wakefulness after days of swimming in the murky limbo of not living, not yet dying.

She asked me to call her Sam. Not Gertrude, the hated syllables passed down by a cruel, dead mother. She showed me a photo of the stripper at her 70th birthday party, Sam with her head thrown back, bottled beer and a cigarette dangling from either hand, the lawn chair tipping, the almost fall captured on cracked Polaroid.

More, she asked for, more. Not less dying, more living. More being alive.

Do not be trite with your dying wishes. Ask for the hottest sauce, the firmest flesh, the deepest desires. More. Ask for more.

Do not be timid with your living wants. Demand ecstasy.

Starlight and Sympathy

My residency savior—how fitting—was named after a star. Aldebaran, the red giant, the bull’s flaming eye, burns bright in the winter sky. Aldebra was my intern, technically my student, and she taught me how to survive medical training. Aldebra began her intern year like most of us, in wild-eyed, mute shock. She just didn’t stay quiet.

My star-friend loves listening to jazz in smoky nightclubs, wearing leather cat suits and practicing yoga. She makes jewelry and a mean cup of tea. When it hit her, what residency was all about—rote obedience, sleep deprivation, the inhumanity innate in learning how to take care of other humans—she protested. Maybe it was her years of waitressing, serving cocktails to handsy men while wearing fishnets, that gave her such a voice. Maybe it was wisdom pouring forth born of lived-in, hard years getting to where we now cowered, shells of ourselves and beat into submission by our own compassion. She spoke out. She spoke up. She said, “We can’t be treated this way. We need lives, we need to breathe. We need to be human to be doctors.” No one seemed to listen—at least, no one in charge. Yet everything changed inside me.

We became a club of two, the be-more-human club. At my first yoga class, scrunched and sweating, uncomfortable in lots of ways, I watched her lithe limbs bend, I noticed her smile. I was not smiling. I almost cried as my limbs trembled and my joints protested. Yoga was not my happy place. Being with a friend was. And for the first time in more than a year, I felt human again.

We spent long afternoons hunched over her kitchen table--stringing beads, drinking tea, hearing each other. Grieving over our patients who died, weeping more over the ones who lived, in bodies that now betrayed them. We spent long nights in cramped wine bars and jazz dives, dancing until we couldn’t stand. We broke the silence of despair, through the salt of sweat and tears, together.

The application of tea and kindness didn’t change residency. The hours were just as long, the months I didn’t see my husband as isolating, the exhaustion numbing. Tea and kindness changed me. My friend, the bright light of her, transformed me from student to teacher, from resident to doctor.

So many years later, I try to make that space with my patients who cannot be cured. We carve out a safe, warm place, about the size of a kitchen table, under glaring fluorescent lights in sterile exam rooms. We drip tears into imaginary cups of tea, we string stories like beads. Fatal diseases don’t change their ravaging course, but suffering—in the pulling gravity of starlight and sympathy—on good days suffering itself bends into a manageable shape.

Stuck

The needle tip, shiny and curved and bloody, winked at me. After 36 straight hours of helping deliver babies and sewing up their mothers, I had stuck a needle all the way through my thumb. I felt nothing. Well, not nothing, just not physical pain. Despair at the idea of having to go to the ER to get my blood tested for HIV and hepatitis. A numb disbelief that it would be an extra hour before I could drop down into blessed, dreamless sleep.

Getting stuck is actually what woke me up. I was an intern, and I was drowning. There were always a few residents who loved the pressure, who hardened into brilliance like diamonds under stress. I admired them, but I couldn’t relate. Some of us exercised or drank to excess. Some ate for comfort, or barely ate at all. There were addictions and affairs and divorces, families ripped apart in sacrifice to the gods of medicine. 

I learned where to turn, and it wasn’t my family. I’d called home weeping, thumb throbbing, thinking of quitting, thoughts of liver failure or AIDS weighting my head. My mother told me to suck it up. My father said I’d known what I signed up for. I got the message: failure was not an option, crying gets you nowhere.

As in my childhood home, the first place I lived where the walls had teeth, I turned to books. To read is to escape. To feel weightless at the turn of the first page, waiting for the hard yank of acceleration taking you out of yourself. I survived those months on candy bars, Diet Dr. Pepper, and stories. I became known as the resident who had novels in her bag instead of medical texts. The strange one who went to the movies by herself and emerged hours later, alive, breathing, feeling again.

After a needle stick they test you every few months for a year to make sure you’re free of disease. Every time the syringe filled with my blood because the needle had gone in, I thought about sitting alone in a theater, waiting for the screen to go dark, hovering in anticipation. Cracking the spine of a new book and being exactly where I wanted to be in that moment--stuck in someone else’s story.