alone

Leaning against my car, I didn’t see any water. Void of any geographical sense, I wasn’t sure where the Long Island Sound was situated but I wasn’t really looking for it either. Though the space between, between where I was and where the bank of trees ahead lay, steeped down and gave a feeling of being higher up, the parking lot was likely not elevated enough to afford a view. It was cold, not bitingly so, just so to match the gray that comes too early in the day during months like December. The sky held a dull solid gray, the trees blended a hazy one.

It’d been a short and unfamiliar drive from New Haven to the Connecticut Hospice, and now that I’d entered and left the entrance of the building, it was easier to stay. The stray leaves clinging to deceptively precarious branches didn’t keep the trees from being bare, but made them feel heavy, and I tried to focus on the lean trunks. I tried not to choke on my heaving breaths. And to stop the flow of salt and water from my eyes to the air around, air that you could tell was dry by the way it soaked up the moisture layering my skin.

He’d been transferred from the hospital to hospice the day before. He hadn’t been happy about it, had responded with “horrible” when asked how he was doing, the last two syllables swallowed by the effort of the first. Often his breathing was too labored for fluency, and sometimes words took a long time, occupying a space that I didn’t realize was open until his voice closed them. Even though his voice sounded the same whether he was comfortable or uncomfortable, it moved more than anything else about him. It was never accented by the rest of his face; his lips didn’t migrate from the straight road they naturally formed, the taut white of his forehead never disrupted even while his lungs crumpled into rough coughs.

He lived in a bed next to the door in a room of three, and when we waved from the hallway he called out hello if he saw us. The wet brown of his eyes drew a full film from one corner to the other and felt protective of something, but they kept him from seeing his food well enough to eat. He didn’t want to eat anyway, and he directed his gaze towards the sound of the television, even when the hospital headphones slipped off his ears and forward onto his chest like a necklace. It made me think that hospital gowns don’t lend themselves to accessories.

He had been a patient on our list of patients to see every morning for almost a week before I really met him, when the physician taking care of him allowed another medical student and me to sit in on a conversation she had with him about his health. Earlier that day she had talked of him as a patient she knew would stick with her; “he’s sweet; you can tell life’s been unfair to him.” I’d felt somewhat guilty for not noticing, as once I sat down on his bed it was palpable through the blankets.

The doctor touched his shoulder, which was usually enough to rouse him if his eyes were closed (at this time they weren’t), and told him she wanted to talk to him about things.

She gently explained the state of his major organs and how in trying to support one, we hurt another. When things reach a balancing act where balance would be unstable, when piling or removing things from either end keeps hurting, we turn our attention to the fulcrum. Again nothing in his face moved, but he said he wasn’t ready. He’d have to talk to his wife. She didn’t visit because they didn’t have a car, and a taxi would be too costly for their resources. She didn’t like seeing him so sick, anyway. But Thanksgiving was coming up, and his nephews and nieces had cars that could carry his family, and turkey with cranberry sauce in plastic containers, to the hospital then.

I was also in the hospital on Thanksgiving, when his room went from three patients whose beds were separated by cloth curtains maneuvered by nurses and doctors, to a flock of relatives standing in their puffy winter coats that they didn’t remove once inside. His wife’s shape matched her voice on the phone but she looked much older than him, with the gray in her hair prominent since she’d let it go long while his hair was still brown, and the wrinkles I sometimes imagined to be hiding in his forehead openly lined her eyes. A teenager with glasses and thick strands of hair across his forehead, a nephew I presumed, brought him a walkman. The headphones that came with it weren’t any more stable around his head than the others, but he took them with him to hospice; we had to disentangle them from the other pair to make sure he had the right ones.

I said hello to the group forming a sort of semi-circle at the foot of his bed as though participating in an icebreaker, and saw the cranberry sauce. It is strange to meet people whose lives give a disproportionate amount of substance to yours when compared to vice versa. I wasn’t in the room when the doctors talked to them about the future. But I saw them leave the room and walk down the hallway in a choppy stream, some visibly upset and others subtly so.

His wife nodded as I passed and said that she would like him to be comfortable. I nodded back, and went into his room out of an invisible inertia, without thought to if I had anything to offer and if so what form that would take. And so I started as we did every morning.

“How are you doing?”

“Oh, half and half.”

“I saw your family in the hallway. It must’ve been nice to have them here.” I looked at his bedside table to see if he’d eaten, but I couldn’t really tell. It was only then that I heard what he’d said, which was something he would say often in the following days. When evaluating his physical state, the doctors taking care of him spoke of him as having good days and bad days. It is true that on some days his face looked cleaner and his lungs sounded clearer, and other days the crackles that our stethoscopes could hear would rattle his chest so that he looked limp and for some reason during those times, the crust that develops from standstill remained in his eyes instead of being washed with blinks. “Half and half?”

He nodded, which for him meant bringing his chin down to his chest. By the time he’d bring it back up, you may have forgotten the first motion.

“Did you talk to your family about things?”

“We’re looking for a place. There’s one near my house so my wife can walk there and see me.”

Surprised that the logistics of things had already been discussed, I nodded.

Back in the room with the computers where we typed records of how our patients were doing today versus yesterday, they tried guessing what would take him, eventually: his kidneys, said one; his lungs, said another. How does that work, when his cancer had started in his throat? He never asked, but I wondered and despite the daily updates on his physical state I never knew.

Later through a process of which I wasn’t aware but trusted, it was decided that he go to Connecticut Hospice in Branford, not to the place he mentioned in his town. We told him it would probably be better when he was settled into a place, in a room with more privacy. He asked whether he would be in his own room, and was told that it was likely to be shared but that the rooms were vast. Although he seemed to want his own room, he wasn’t eager to leave the company of the people passing his open door in the hallway, though he never stated either sentiment directly. “It’s nice to just see faces,” he said in what felt more like a confirmation than a confession.

On one Friday, after having seen him on our morning rounds every day he’d been in the hospital, I said I’d miss him over the weekend.

“Well, then you should work on the weekend.”

I paused. “I’ll come by to see you.”

There was no pause, and no movement of his eyes from their station. “That’s very nice, but you won’t.”

Our interactions were not scarce, but brief. We ran out of things to say. I didn’t find out much about his life before here, or his life at that time outside of that bed. The natural course of asking how he was would be to discuss the present and near future, and I didn’t know how to bring the past in relief. On days when he wanted to be in limbo or something more than that, he’d talk about the new cancer center and what his doctors had told them. On the days it was explicit, mostly he said he didn’t want to die. Asking why would have felt too easily misunderstood, but now feels too easily absent.

So the day he left for hospice was one of the half and half days; to his doctors it was a bad one. In the hours before the transport from hospice arrived, he was having trouble breathing, and when they arrived he was receiving a breathing treatment to help open the vessels in his lungs. The man and woman in uniform who had come for him stood by the window and told us to take our time; they were “in no rush.” When he finished breathing into the mask, they brought a thin stretcher alongside the hospital bed.

“We’re going to move you from there into this so we can drive you there, okay?”

“How far is it?”

“The ride will be over before you know it. Barely twelve minutes.” The woman’s conversation was proficient, and I became acutely aware that this was my first time seeing all this happen. Her hair was tight where her braid started to form and then throughout. Nothing about her gave way, but still she was kind in a way difficult to pinpoint with tone or act. Maybe it was this softness without known source that made me turn away when they put the rails down on his hospital bed.

But I watched as they gathered the sheet below him and swiftly transferred him to the stretcher. Narrow as he was, the stretcher still just accommodated him. The man and woman layered him with blankets that had the texture of towels.

“There will be a brief period, less than a minute, where you’ll be outside as we move you into the van. It’ll be cold, but we’re putting these blankets on you, and it’ll be very quick.”

His belly was large, but he was seamlessly consumed by a swarm of blankets. Once covered, his arms and legs disappeared. His small face lacked sharp edges and fell into underlying pillow without difficulty. There were hints of him against the sheet: the deep brown of his hair splayed in tufts, the red in his cheeks dissolving thinly out and down to his jaw and seeping into the pillowcase, the wet in his eyes making all else feel dull. This was all I could see of him; everything else was white on the black stretcher.

“We’re going to strap you in now, okay?”

He brought his chin down to his chest, and coughed, “Okay.”

The woman pulled on a black belt with a heavy buckle, stretched it to as far as her arm extended, and handed the other end across his body to the man, who pulled down and tightened it. This spanned his torso. They started another across his lower body but as the transfer of buckle was taking place, one caught the other’s eye and they paused. “It’s probably not necessary.”

I’d never seen him walk while in the hospital, though I knew he went to and from the bathroom on his own, but it wasn’t until now that it seemed that he couldn’t move, with or without the one buckle. He was breathing less heavily now and unlike when he was sitting up in bed with his gown in full view, as he lay there I couldn’t see his chest struggling.

“I hope you’ll come see me.” We’ve been advised never to promise anything, and despite instincts, we force ourselves to rephrase things into “I’ll try.” It was a Tuesday, and I told him I’d try my best to come see him, though it might not be until Thursday or so. I watched them wheel him through the door and down the hallway, no further though I could have rounded the corner to the elevators with them.

I’d never been to Connecticut Hospice but had heard it was beautiful, overlooking the water. I looked up its information on the internet on Wednesday morning. I called their number for his room number, and was given it, though they said I wouldn’t need it. The person at the front desk would help me once I got there.

It was late afternoon when I got there. Though the streets were a little confusing, I’d found the way fairly easily with my friend’s GPS. The parking lot was large and three fourths full. As I walked to the main entrance, I felt glad the transition had been made, and looked forward to seeing him in a brighter place, one designed for comfort. The front desk was where they said it would be, and I found myself thankful for the ease of things. The woman manning it wore a thick sweater upon which her light curls rested. When I gave her his name, she carefully scanned a list in front of her. As the seconds crawled, I regretted forgetting the room number I’d called for in the morning.

She picked up the phone to call for his room, and as I waited I watched others pass through the front desk and down a corridor past large glass windows, without stopping. She spoke softly, but I heard her say his name. Then, “oh,” to the phone and to me, “Are you a family member?”

“No. I’m a med student. We took care of him at the hospital.”

“Oh,” to me, and to the phone, “She took care of him at the hospital.”

I watched her nod several times at the phone, continuing to speak softly, and hang up. “Someone’s coming.”

“Thank you.” I waited and watched more people pass, without waiting.

Someone whose face and shape I don’t remember came. “Hello, are you a family member?”

“No. I’m a med student. We took care of him at the hospital.”

“Oh.” She nodded. I gave a small smile. She told me she was very sorry; he’d passed away that afternoon.

“Oh. That was fast.” So fast. Twelve minutes to get from the hospital to there. What happened in between? I’d called that morning. He’d had a room number. One with a letter, so he was sharing space. But it was more space. Blinking to buy time, I paused before it came to me to ask, “Was his family there?”

“No. We called his wife. She didn’t want to come.”

I nodded. “Thank you.” I wanted to give her more than that thank you, or to fully give the thank you, and paused. But it was too brief, and the sentiment too blurry. I turned slowly, maybe to match the stride of what had come before. But once out the door, the passing air that grazed my skin on its way to elsewhere held in it the shortness of my time inside, taking it for itself and carrying it away. Maybe because of that I stayed outside.

He hadn’t asked to be moved to a building with a view, or for much of anything other than our presence. It wasn’t much to give, and it wasn’t hard to want to give it, but in the end it was the most elusive. When asked about how he wanted to proceed, he’d defer to what we thought, saying we knew best. There were a lot of us: the respiratory team watching over his lungs, the oncology team monitoring his cancer, the renal team reminding us that his kidneys were failing, and the geriatric team checking every morning for a bad or good day. Each of them explained things, and asked questions to cater to his needs, trying to provide care in the niches they’d formed in training and in experience. Because the weight of confrontation and decision was too much for him, and because this weight had become a part of their anatomy, they let him give it to them, in the hopes that they could give something to him.

I thought this too, thought that though it felt viscerally out of place to attach him to that stretcher and move him, it would take him to a place that would be better, eventually. What happened in that transition to this place, that took from him the time required to make it better? We’d left him alone before.

Never having seen him in a new place, standing with the hospice in close distance I only saw him as he looked when I first knew him. After not too long I left for home, with the water still out of view behind the low level of trees.