Issue #3 |

A Different End

I’m all confused. What if she hadn’t gone to Emergency that last time? She didn’t want to go. I told her she had to. “Listen, you’re sick. You can’t stay at home. We can’t chance it. You have what seems like pneumonia again. After four times in two years, I can recognize the signs. You’ve been talking gibberish. I don’t mean to be mean. Not gibberish. Just that at times you don’t make any sense. For a few moments you didn’t know who I was. Like the last time you went there, they’ll move you ICU and put you on antibiotics and a couple of IVs to keep you hydrated and fed, and you’ll be cured in a week. Maybe two. I don’t want to lie to you to convince you to go. But no more than two weeks, I’m sure, and this time no post-hospital rehab in some critical-care center.”

“I’m not going to the hospital. Don’t take me. Don’t force me. Don’t have the emergency medical people strap me down on a stretcher and drive me there. You have no right. If I’m a patient, I have my rights. I don’t sound confused to you now, do I? I can hear myself talking and I don’t.” “No, you sound good. But you don’t look well, my sweetheart.” I put my hand on her forehead. “You have a temperature. That I can tell just by touching you. Your forehead’s burning. And your face is red, especially your nose. All those were signs of pneumonia before. An infection in your chest. Your lungs.”

“What before? What are you talking about? Am I sick, do you think? Then I have to stay home. The hospital will kill me.”

Even there, see? You’re saying things you don’t know you’re saying. I’m saying, they make little sense. Let me call 911. The EMS, or whatever the fuck its name is—the ambulance truck. They’ll come and the paramedics in it will examine you right here in your bed and maybe they’ll say you don’t need to go to Emergency.”

I’m not going to Emergency. If I have to die, I want to die here, but in my regular bed.”

You’re not dying. You’re going to be all right. Can I call Marion and have her come over and look at you and speak to you?”

“Why would you call Mary Anne?”

“It’s Marion. She was once an Emergency room nurse and she’s become your best friend here. You know she’ll level with you. If she says you should go to Emergency, will you go? I won’t force you. We’ll do what you want. You get to make the final decision, but first let Marion have a look at you.”

“Call Marion. Call. Call anybody you want. I don’t care.”

“So I’m going to call?”

“Isn’t that what I’m saying? Call her. Call my mother, call my father, call the police. But what I’m saying is what I’m saying. Nothing will make me go.”

“Even if Marion says you should?”

“You’ll just get her to side with you. But we’ll see.”

“Let’s hope she’s in.” I put my hand on her chest above the breasts. “You’re warm here too, and sweaty. More signs. I don’t know what I’m going to do if she doesn’t answer.”

“I hope she doesn’t. I want to stay here. If I am sick, I know I’ll get better staying home. I at least won’t get worse.”

“Okay. I’m going into the other room and calling. I’ll be right back.” I went into our bedroom. Abby was in our older daughter’s room, which I had set up like a hospital room. Hospital bed, oxygen if she needed it, other equipment and machines and supplies to take care of her for various things. I dialed Marion’s cell phone, her only phone. It wasn’t a working number. I went back to Abby. “You okay?” She just stared at me. “Are you feeling all right?” She continued to just stare at me. “I tried calling Marion. Thought I knew her number by heart. Do you remember it?”

“I don’t know what you’re talking about. I’m fine. Why are you calling Marion? The house is crowded enough.”

“It must be in your address book. Are you comfortable? Do you need another pillow behind you? Something to drink?”


“I’ll only be gone a minute.” I look up Marion’s phone number in Abby’s address book. Dialed. She was in. I told her Abby’s very sick again. “I’m almost sure it’s pneumonia. All the same signs. Temperature. Confusing. Everything. But she won’t let me call 911. I thought if you came over and told her she needs to the hospital, she would.”

“I’ll leave right away.”

I went back to Abby’s room, pulled a chair up to the bed and held her hand and kissed it and stroked her forehead. “Still warm. But you’ll be all right. We’ve gone through this before. We’re old hands at it. I love you, my sweetheart. Everything I do is for you. Marion should be here soon.”

“Good. I like her. Better than I like you. She doesn’t make me do things I don’t want to.”

“I understand.”

Marion came in ten minutes, was in the room with Abby for about five minutes, the door closed. She said she’d be able to reason with Abby more if I wasn’t in the room. “Girls’ heart-to-heart, okay?” She came out—“We’ll be right back, Abby. I have to give Phil something”—walked me to the living room and said “she doesn’t want to go, but she probably should. She’s not well. Her temperature feels like a hundred-three. I don’t need a thermometer. Disoriented. A little trouble breathing. She should be in intensive care. But we can’t force her. It wouldn’t be right.”

“Even if it’d be saving her life?”

“Even that. She might hate it so much and fight everything they try to do for her, it could make her even worse.”

“Let’s try. Maybe the two of us can get her to agree.”

We went into Abby’s room. Marion sat on one side of the bed and I the other. I said “Please, my darling Abby; for me and the kids. But for you mostly. Let me get you to a hospital. And by that I mean calling 911 and them taking you to it in a special van. Anytime you want to leave the hospital once you’re there, I’ll take you home in our van, no questions asked.”

“You’re lying.”

“Believe me, I’m not. If I were lying you’d never trust me on it again.”

“What does Marion think? She told me I don’t have to go.”

“She meant we can’t force you.”

“No, she meant I’m not sick enough to go. And that if I am a little sick, I’ll get better faster by just staying home. That being in my own home with you is the best medicine I can get.”

“Marion, what do you think? Be honest? Do you think Abby would be better off staying home?”

“You probably should go to the hospital, Abby. It’ll be best for you. You’ll get a complete checkup, possibly some medicine to take, and you might not even have to stay overnight. In and out. But we can only that if you go.”

“Do I have to go to the ambulance? I hate them. They hurt my head and back.”

“That way they’ll be able to deal with you faster at the hospital that if Phil wheels you inside in the chair.”

“All right. If you say so. The two of you. You broke my defense. But when I say I want to come home, I’m coming home, even if it’s today.”

“That’s okay with me. I want you home. And you’re speaking so clearly. Great.” I stood up and kissed her forehead. She looked away when I did it. “Okay with you too, Marion?”

“I think it’s going to work out. I won’t even go with you, and I’ll probably see Abby here tomorrow.” “Oh. You’re both such fibbers. Anything to get rid of me.”

I called 911. The EMR truck, or whatever it’s called, was at the house in a few minutes. We heard the siren from far off—“I wonder if it’s for us,” I said—and then it was turned off when they pulled into our driveway. The paramedics examined her quickly. One said she should be taken to Emergency. “Her lungs sound congested.” They got her on a gurney and into the back of the truck. This time they said I couldn’t ride with them in the front passenger seat. Some new rules. There was an accident. “We’ll see you in the emergency wing of the hospital. GBMC good for you?” I called in and they have room, not too jammed.”

That’s where we’ve gone before, every single time. It’s the closest and I guess as good as any.”

Marion said she’d call me tonight. “Or you call me if you’ve time. I’ll be here first thing tomorrow morning. And you better call your girls. I’d do it for you, but I’m sure they’d rather hear it from you.”

“What do you think? She’ll make it?”

“Sure she will. She’s so strong. Look at those last times. They gave her a one to three percent chance of surviving, and she fooled the experts.”

She was in the intensive care unit for five days. Every day she said she wanted to come home and I always said “Give it one more day. The antibiotics haven’t kicked in yet.”

“They’ll never kick in. You’ve gone from being a bad fibber to an even worse liar. You know it’s hopeless. They didn’t even put me on a respirator. No need to, thank God. I’m finished. They’ve given up on me. One thing, though. If by some miracle I come out of his, I’ll never let you drag me into a hospital again.”

The doctors in the ICU said she needed to have a feeding tube put in. It’s a simple operation, they said, and is the only way she’ll get nourishment. She said “No feeding tube. That would be the end of living for me. One tube, the trach, isn’t enough? I was told it’d be in only a month or two and it’s been a year and we all know it’s never out while I’m alive. And then those other tubes around my waist inside to my back for my baclofen pump. Did I need that too? The MS specialists said I did, but I now think the baclofen pills I was taken would have been enough. Everyone’s lied to me. Everyone’s a liar except my daughters. And doctors are the worst liars. Or should I say ‘husbands too’?”

“Mommy,” one of my daughters said. “Dad’s doing the best he can.”

“You don’t think I know that? Everyone is. What a joke.”

The hospital’s palliative team is asked by the ICU doctors to examine her. After the exam, what seemed like the head of the team signaled my daughters and me to step outside the room. With the three other members of the team standing around her but not saying anything, she said “We have to break this to you, but the hospital can no longer help your wife and mother. Nothing more can be done for her, other than making her as comfortable as she can be, and she now needs a different and much less aggressive kind of care.”

“Wait a minute. Slow down. Let my daughters and me take this in. She’s dying? Nothing more can be done? Everything’s been tried? This time, unlike the last four times she was here, the antibiotics failed and the pneumonia can’t be cured and you’ve no other medications or antibiotics or any other means to help her, and you determined this in just four to five days?”

“That’s precisely what we’re saying. There’s been irreparable damage don’t to her lungs the last few years. If she goes home now, she’ll be back here in a week or two, or even less, and in much worse condition and probably in great pain and discomfort, and again there’d be nothing we could do to reverse it. Everything possible has been tried. What hasn’t been tried are medications we know won’t help her. As doctors, this isn’t easy for us to accept and is very difficult for us to tell the patient’s loved ones, but there it is.”

“So what now?”

“There’s an excellent hospice care facility not too far from here. Gilchrist. Maybe you’ve seen the entrance to it on Towsontown Boulevard. You should pay it a visit. Just go right in. You don’t need an appointment. Tell them you’re scouting it out for your wife and mother. And take your time in all this. We’re not rushing her out. Make your decision in the next coupld of days. I’ve spoken by phone to her general physician—filled him in—and he agrees that this is the course she should take. If Gilchrist doesn’t appeal to you, we’ll give you the names of others. They’re all much the same, you’ll find. The one advantage of Gilchrist, though, isn’t only the proximity to the hospital and your home. Mrs. Berman spoke with great delight of her love for you cat. Streak is her name?”

“His. Close. What are you getting at?”

“It permits patients there to bring their pets with them. Just one, or one at a time, and to keep it so long as the door remains closed. That can be an added asset in keeping the patient’s spirits up. Another advantage, although I believe they all do this, is that you and your daughters can stay in her room overnight and they’ll provide the cots.”

“I’m sure my wife wouldn’t like being in a hospice—I know her. But we’ll visit the one you said, just to have something to report back to her and to give her the final choice.” And we did—took a tour, as the woman at the hospice’s front desk called it—and told Abby about where we’d been the last hour.

“Even if the one you saw were like an Arabian palace and they’d wait on me hand and foot as I slowly expire, I’m not going to it. It sounds like a death camp. The hearses are probably flying out of there several times a day. I also wouldn’t want Sleek to experience it, my poor dear cat. Listen, you’re wasting what little precious time I have left. Besides making me even more miserable with this repulsive talk. While you were out I came to a decision, and you can’t stop me from going ahead with it. I’m coming home. Today, not tomorrow. In the next hour, if it’s possible. Don’t argue with me about it or I’ll scream, I swear it, I’ll scream and cry and make you feel even worse than you already do. And once home—and listen carefully; this is a part of my decision—I’m not going to eat, drink or take oxygen anymore. And no medications, either, except what you give me to keep away the pain before I fall into a coma and then when I’m in one if I show pain. Morphine. Make sure there’s plenty of it around and you don’t run out. They’ll give it to you if you’re taking care of me at home. Home hospice care will. I’ve heard. But I want to die in my own bed even if it has to be the hospital one at home. Now what do you say? Today!”

“I want you to first let them put in a feeding tube. You have to try it. It’s a painless procedure and they say you need it to live. The food will give you strength.”

“You awful person. I wanted to say much worse. Why are you acting so despicably to me?”

“Mommy, don’t be so hard on Daddy. You know how he feels. And Daddy, you have to do what Mommy wants.”

“I don’t have to. I want to help her.”

“You do have to. And you’re hurting her with your demands.”

“Let’s give it one more day. Please, my darling Abby. If you haven’t changed your mind about the feeding tube—”

“I won’t.”

“I know. But if you haven’t by tomorrow morning, we’ll take you home. Is that fair? Is that fair?”

“All right. Now all of you leave. I want to be completely alone in my room tonight. Not with you, one of the kids or private nurse hired for the night. I just want to think.”

“Okay. We’ll be here, or only I will, bright and early tomorrow morning. Now will you let me kis you good night?”

“Of course. Have a good dinner at home. Or all of you go out for dinner. There’s still time.”

Phone rang very early the next morning. It was still dark out. No trace of dawn yet. My first thought was that she had committed suicide, or tried to, in some way. That that was why she wanted nobody to stay overnight with her. Because I would have. I had no intentions of going home. It was the head nurse in ICU. Abby was hysterical, wanted to know where I was. Wanted to be discharged from the hospital right away. “I told her she couldn’t be discharged till much later this morning. There were forms, procedures, instructions. The people who took care of that don’t come in till nine. We almost had to keep her down with wrist restraints.”

“Are you in her room?”


“Can you give her the phone receiver?”

“She doesn’t want to speak to you. ‘No more malarkey,’ is how she put it. I’ve tried to explain things to her. But she says she only wants you to get here immediately and take her home.”

“Tell her to relax. I’m coming. That I just have to wash up and dress. Did she say anything about a feeding tube?”

“That’s mainly what she’s so hysterical about. It’s a no.”

After dealing with the paperwork and instructions on how to take care of her at home, we left the hospital around ten. She went home by regular ambulance this time, not the big emergency medical truck. The previous times I drove her home. She died in her hospital bed at home fifteen days later. Was conscious the first five days and then slipped into a coma she never came out of. She refused food, drink, medicine and oxygen. The visiting home hospice care nurse, who came every morning for about twenty minutes and, once Abby was comatose, resupplied me with morphine whenever I was almost out of it, was surprised Abby was still alive on the sixth or seventh day of her coma. “No medicines? Nothing to eat or drink or for her breathing since she came home? I thought she’d be gone before I got here today.” The only thing she drank the first five days other than ice chips every so often, and I suppose you can call that drinking, was a sip of champagne from a glass held up to her lips. Only foods she ate during that time was chocolate-covered strawberry—it was around St. Valentine’s Day, so something the bakery at the market he goes to had—and a small piece of nova on half a rice cracker that had to be placed in her mouth. Both of these and the champagne on the second day she was home, when we had a little party in her room with our daughters and her best friend and her best friend’s husband who came down from New York. She didn’t want to see anybody else. “I don’t want to scare people with how I look.” I don’t know whose idea the party was. Maybe it was mine. I remember wanting to lighten the mood in the house, and it seemed to work for an hour or so, at least for her. “My last bite,” after she ate the nova and cracker, or part she bit off. “I might throw it up, but oh, it tasted so good, This is one of the foods I’ll really miss. Nova. Sturgeon. Smoked whitefish. Russian caviar. Raspberries and artichoke hearts. Quite a spread. And the champagne. Such a good one too. Everybody: eat up. So much great food I can’t touch. Finish the champagne—it can’t keep—and open another bottle for yourselves. Phil, we must have another good bottle of champagne around. What we didn’t drink but intended to last New Year’s Eve. There’s no law saying it has to be chilled.”

I haven’t got all this down exactly right. I could ask my daughters for help with some of it, but I don’t want to bring any of it up to them again. It only makes them sad and me sad and they don’t want to be. Me? I don’t mind, and the truth is, sometimes it feels good. I don’t even know if I got the order right of what happened those last fifteen to sixteen days. But I think this is how it generally went. I didn’t take notes or keep a journal. I never do about anything. It’s all memory, in my head. If it doesn’t come out when I’m thinking of it, it usually comes out sometime later. But to get back to where I started from: I’ve been wondering if she would have lived longer—and I’m not talking about a few days or weeks but months; years, even, where she still might be alive today—if she hadn’t gone to the hospital that last time. Crazy thought? You bet. But possible, I’m saying, possible. A thought just to make myself feel even worse than I already do about her? Maybe that too. But maybe she would have got better—recovered completely from the pneumonia, that last time—if she hadn’t gone to the hospital. No threat of a feeding tube or fear of being intubated again, which is the worst thing that can happen to you there, the air tube or whatever it’s called forced down your throat into your chest and kept there, with you on your back the whole time, for God knows how long. For Abby, the three times it was done to her, it was more than a week. And the fuss and discomfort and anxiety, too, of being driven to the hospital in that truck and wheeled into the emergency room and then the intensive care unit and tests and x-rays and oxygen mask and IV’s and everything else including screams all night from patients in other rooms and nurses and aides waking you up every two to three hours to take your temperature and blood pressure and draw blood and empty your urine bag and maybe change the catheter and check your IV’s and ask if you need to use the bedpan or are in pain and give you medicines in liquid or pill form. Maybe it all got too much for her, just as she might have thought it would, once she was in the hospital for a couple of days, and she gave up trying to fight the disease and complications like pneumonia that often go with it, and thought what’s the use? She’ll only be back here in a few weeks under the same if not worse conditions, the ICU doctors and palliative team giving up on her even more than they did the last time, and got the idea, or finally settled on one she’d been thinking about awhile, to starve and dehydrate herself to death at home. So what am I getting at? I lost what I was thinking. Then what was I thinking? That maybe I shouldn’t have pressured her the way I did to go the hospital. Not “maybe.” I shouldn’t have, period. And also not got Marion to urge her to go to the hospital too, which Abby absolutely didn’t want to do. She wanted to stay home. She might have got better. I should have done what she wanted, or at the very least thought about it more. No, done what she wanted and not just what I had it in my head she should do. Getting ganged up on the way she was and being so unhappy and frightened in the hospital, and because she’d gone through it a few times the last two years, weakened her to the point where she couldn’t fight me or anything anymore and just wanted to die. I don’t know. But I definitely think I did something very wrong. Weeks after Abby died, or months—I forget; could even have been a year, two—Marion so much as told me so. We were having drinks in the living room of my house. Marion, just tea. Her husband was there. Actually, we were sitting in the enclosed porch off the living room, it was the last time they came to the house, alone or together, though I’d invited them for drinks a couple of times after that, and I haven’t been to their youse since Abby and I had dinner there a few months before she died. I’ve no idea why. Maybe some things I say depress them, and I cried the last time they were at my house and Marion then started crying too. Or being with me reminds them of Abby and that depresses them; at least it does Marion. I’d put out a plate of different cheeses and a bowl each of hummus and I made and crackers and olives and a small dish for the pits. We talked mostly about Abby. How much we all miss her. She’s not someone you can ever forget, Marion said. The last book she translated that Patrick was reading and enjoying. “It feels like I’m reading the actual Russian. I don’t know how she did it.” That I think of her many times every day and have a dream or two that she’s in almost every night. “Sometimes she loves me in them and says so. More times, though, she hates me or is very angry at me and won’t let me make up to her. And those last fifteen to sixteen days How it became, Marion said, more and more difficult for her to drop by for even a few minutes to look in on Abby and listen to her lungs and take her pulse, which she wanted to do daily. “It broke my heart to see her deteriorate so quickly once she went into a coma. Though I thank God she didn’t seem to be in any pain. So thank God, also, for morphine. But I want to tell you something, Philip. To get it off my chest, so to speak, or out of it, is more like it. Patrick knows what I’m about to say. I’ve prepared him. And I don’t want to make us feel any sadder than we already do about our Abby. But okay. I’m stalling, so here it is. I think we should have, that last time, since we knew her chances of surviving another round of pneumonia were rapidly decreasing with each hospital stay and that this one could easily be her last one and she’d never come home from it—”

“You don’t need to go any further. I’ve had similar feelings myself sometimes. And don’t blame yourself, remember, since I was the one who asked you to come here to help me convince Abby to go to the hospital.”

“Thank you. I still feel guilty for my part in it, but what you just said makes me feel a whole lot better.”

“I have to say I don’t feel any guilt. What I thought then, and I haven’t changed my mind about it, was that we had no other choice.”

“That might be true too.”

So where was I? My tendency is almost always to get off the track. Guilt. Hospital. Abby dying before she had to. I’ve said to myself the last two nights when I was in bed and trying to go to sleep; “I did something terrible to you at the end..” And the first night: “The you is you, of course.” And both nights; “I helped keep you alive for years and then I hasten your death and maybe even cause it.” That’s what I’ve been getting to and finally got there. I failed her. I failed her. I should have done what she wanted. Abby. I should have said “You don’t want to go to the hospital, you want to stay home and not leave the house and take your chances here, then that’s what we’ll do. Anything you think is good for you is good for me too.” Should have said that. Also: “Anytime you change you mind about it, if you ever do, and it’s all up to you, I’ll take you to the hospital in our van, not the big EMS truck. The hell with that. Who needs another uncomfortable ride? I won’t even call 911. I’ll just make sure you’re dressed warm enough for the outside, because I don’t want you catching a cold on your way to the hospital. Then I’ll get you in your wheelchair and wheel you up the ramp in the van, lock the wheels to the floor, get your seatbelt around you and maybe a little blanket over your lap and tucked in at the shoulders, and drive you to the hospital’s Emergency entrance. We could even wait, if you want to, for the kids to get here from New York, and we’ll all go together in the van. And I’ll stay in the room with you every night there if you want me to, or hire an overnight private nurse to stay with you if that’s what you’d prefer. And everything will be all right. But we’ll only go if you want to, I promise. If you don’t ever want to go, and I know I’ve said this before, that’ll be fine with me too.”

Photo courtesy of Robert Juergens. View more of his work at Flickr.

Stephen Dixon (1936-2019) is the author of 15 story collections and 15 novels. His work has twice been nominated for the National Book Award for Fiction, and he has been awarded a grant from the National Endowment for the Arts and a Guggenheim Fellowship. In 2016, he published his latest novella BEATRICE on Publishing Genius …

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