No Loneliness on His Face

Worried, determined, and respectful, she was at his side in the emergency room. Her husband, a stocky, barrel-chested man of 50 had worked his whole life in the tobacco fields of western Massachusetts—“the large leaves used to wrap cigars” she stated quickly, anticipating my question—but had never smoked since that right-of-passage cigarette at age 14, furtively shared with two other boys on a summer Saturday afternoon. “So we just don’t understand,” she mused, “why these problems with his lungs don’t get any better.” It had started 2 or 3 years ago as coughing at night, followed by an almost imperceptible progression of shortness of breath, fatigue, and his third bout of pneumonia in less than a year. With both tenderness and tenacity she grasped his huge hand, smiled, and stated earnestly, “He’s a good, dependable man. He’s the best father our two boys could have. He works hard, and he’s always been strong”—unease and worry creeping audibly into her voice. No one with labored, effortful breathing can look strong. The cause is immaterial—asthma attack, emphysema, pneumonia. The inevitable culmination is a horrifying combination of fear and loneliness. Dreadful fear—not just of dying, but of seeing and feeling death skirting and flickering about the room, flowing closer with every weak exhalation and ebbing farther with every determined inhalation. More insidiously, agonizing loneliness came with the loss of speech, not having spare breath enough even to whisper “She’s too good to me,” to the intern physician hurriedly moving his stethoscope around his heaving chest and back. In the intensive care unit she was by his side, and not just during the restrictive visiting hours. No one could disagree with the simple truth of her declaration that she was both comfort and strength to him—strength he would need to come off of the ventilator as quickly as possible. We adjusted that ventilator, gave him antibiotics, took his blood, and ran more tests. During those early days of uncertainty she shared their stories. Stories of meeting in their senior year of high school. His timid advances: “He’s 6’3” and 250 pounds, but a kitten inside” she explained with a smile. Stories of her deliberate coquettishness: “After all, it’s fun to play with kittens” she said, the smile growing across her gentle face. She told me of their happy, unrushed romance—“when he told me he loved dirt!” she exclaimed, looking quickly at him to make sure he was still asleep. “He always tells me not to call it dirt. ‘It’s soil!’ he would say.” The fertile soil of the Connecticut River valley, from which grew delicious tomatoes, squash, corn, “and the best quality tobacco for rolling cigars,” he proclaimed on one of their first dates. That soil had been good to his family for two generations; with him, it would be three. She stood up and adjusted the cool washcloth on his forehead, her voice trailing off as her mind filled with happy memories. His sons arrived from out of town. Young men, warm, caring, and mature, they joined their mother’s vigil. And he got better. Breathing on his own, he was transferred out of the ICU. Gaunt but cheerful, he made laps around the hospital ward—IV pole on one side, wife on the other. We received his test results; he had a rare disease of unknown cause. His lungs were becoming fibrotic, like ever stronger rubber bands encircling and compressing a balloon. His condition was already at an advanced stage; there was no treatment. Sooner or later, the next pneumonia would be his last. He and his family listened, asked questions, talked and understood. At least they had an answer. Plans were made for discharge to a rehabilitation facility to help him regain his strength, but on his final night in the hospital, the coughing, shortness of breath and fever returned. Antibiotics were restarted and an oxygen mask was placed. We reserved an ICU bed. In the afternoon she called me into the room. They were all there—she on one side of the bed, the sons on the other. Air: inhalation, exhalation. Death: ebb, flow. The fear was in his eyes, but he could still speak. Inhalation. “We made a decision,” he said. Pause. Inhalation. “No ICU. No breathing machine,” he said. They all knew what this meant. She lowered the bed rail and leaned her head onto his chest. “If he doesn’t go to the ICU, will the antibiotics really make a difference?” she asked. I understood what she wanted. We removed the IV lines and their noisy pumps, shut off the hiss of the oxygen, turned off the lights. The sons and I left the room. An hour or two later I looked in. In the rays of the setting sun I saw her in the bed, lying next to him—one arm around his massive chest, the other hand stroking his hair. Silent tears flowed freely down her face, and mixed with his sweat on the sheets. Her arm rose and fell with each of his mighty breaths, but the quiet pause between breaths was long—very long. I took another step into the room, and he turned his head towards me. He could no longer talk, but there was no loneliness on his face. After another hour it was over. Framed by an open window in the waiting room, his tall sons stood together like saplings against the violet autumn sky. At once tearful and sanguine, they thanked me for all I had done. Extraordinary, I thought, them thanking me. Their remarkable father was dead at 50. A warm breeze sifted through the open window, ferrying the rich aromas of sweet autumn clematis and freshly cut grass, probably the last mow of the season. Olfaction—memory, primitive limbic system connections we can neither control nor ignore. “We’ll have to stow Dad’s mower for the winter,” the younger son thought out loud. “He really did have a good life,” the older son stated with quiet certitude. An organic silence rose around us, a cocoon in which each of us contemplated the elements of his (or any) good life. “Your mother shared some delightful stories about their early years together,” I offered, wondering if they too had heard those stories around the dinner table, or when being tucked into bed. A perceptive twinkle appeared in their eyes, accompanied by childish grins as they turned towards the open window, the arm of the older son around his younger brother’s shoulders. “Soil!” they exclaimed in unison, pointing at the ground below.