Bethann's Death

Last summer, my sister-in-law Bethann died. She was thirty-nine years old. She had had cardiac arrhythmias for many years. Nobody knew why. Maybe congenital; maybe she'd had rheumatic fever as a child that had never been diagnosed. Growing up on a farm, they'd never gone to doctors. They took care of themselves. And they had no money. Now to keep her heart beating regularly, she had to take three different drugs daily. Some were quite new and expensive, and her husband Ed, a construction worker, didn't have health insurance. I managed to get her the medications at cost from the pharmacy of the hospital where I work. Even so, they cost $150 per month. She died in her own backyard, just after preparing a picnic for a family reunion. About twenty-five of us were feasting on freshly picked corn-on-the-cob, fried chicken, enchiladas, salad right out of the garden. The kids were playing tag, the dogs were begging for handouts, the sun was setting over the rolling hills of northeastern Pennsylvania. Her mother, my mother-in-law, Evelyn, had been diagnosed with breast cancer two years earlier, had a lumpectomy, and two years of chemotherapy and radiation. Her hair had turned white and she'd lost some weight but come through it OK, largely because Bethann had been there to help with the driving, some housework, the loose ends. The picnic was a family reunion called, in part, to celebrate Evelyn's "cure". We loved to visit Bethann and Ed. They were not farmers, but they lived what seemed to us an idyllic rural life. They lived in the house that Bethann's grandparents had built, on a hill overlooking a farm that had been in the family for generations. She nurtured a huge perennial garden, and dried flowers in the attic to make into wreaths and wall hangings. They kept goats, honeybees, and chickens, heated their house with wood, canned tomatoes, lived simply. We had moved to the south side of Chicago, and put our kids to bed each night to the sound of sirens and, occasionally, of distant gunfire. When the kids got to the farm, it was as if they started breathing again. After supper, Bethann stood up, grabbed her chest, and collapsed. My wife and I are both doctors. We ran over, felt for a pulse. Nothing. Bethann's eyes were rolled back in her head. She was gasping. Her color was terrible, pale, bluish-gray. We looked at her, at each other. This is it. I told somebody to call 911. We were way out in the country. Miles from nowhere. Better start chest compressions. 1-2-3-4-5. Nancy couldn't do mouth-to-mouth on her own sister. We switched. She did the chest compressions. I started mouth-to-mouth. I had never done CPR in the field before. In the hospital, CPR is, weirdly enough, a friendly, communal activity. When a "code" is called, the team comes running, just like on TV. There is familiar equipment. People work together. Anesthesia intubates. Respiratory therapy has the ambubag. Residents start intravenous lines. Nursing, poised by the wellstocked crash cart, hands me the meds. Monitors beep. In the hospital, you never have to do mouth-to-mouth resuscitation, so I had never actually done it on anybody except on the plastic "Resusci-Annie" dolls in CPR class. It was a little like that. Head tilt. Watch the chest. Puff. Count it out. 1-2-3-4-5. Breathe. 1-2-3-4-5. In another sense, it was nothing at all like CPR class or anything else. It was gruesome. The sun was going down. We could hardly see what we were doing. Mosquitoes were buzzing by my ears. Kids were screaming and crying, but I only heard them like a distant sound track, and I hardly noticed when they were gone. Bethann vomited the supper she had just cooked and enjoyed. We had no suction equipment, so it got harder and harder to breathe for her. I cut my lip pressing it against her teeth and my blood began to drip onto her lips and chin. Suddenly, I remembered that we should have given her a chest thump. We stopped CPR. I raised my fist above my head and smashed it down upon her chest. …