Chapter Five
It was her third week in the ER, and Lark was a little surprised at how competent she felt. In Oncology, the cases were so complex and fraught and challenging, and she had loved that part of it. In the ER, though, things were a bit more straightforward. If a patient was complicated, you did your best to narrow down the reasons, ordered tests and worked the problem. But the problem lasted for only your shift. Either you had the patient admitted, or someone else took over. Granted, she spent the drive home wondering if she’d done the right things, but Dr.Unger was a great supervisor, so she had that reassurance.
She’d worked overnight, and the vibe was different, for sure. Some standard emergencies—a seven-year-old boy with a broken arm, courtesy of a tumble out of his bunk bed, where he’d been wrestling with his brother. A patient who’d overdosed on fentanyl, treated in the field with Narcan, brought in for evaluation. A chef who’d sliced the webbing between his thumb and forefinger and needed a referral to a hand surgeon. A young man who said he was coughing up blood, but really wasn’t…he just had a bad cough, and his throat was irritated, causing a speck or two of blood.
There’d been a toddler with a diaper full of black poop that had his parents thinking he was either bleeding internally or possessed by the devil. Turned out the little guy had just eaten half a quart of blueberries, and that’s how blueberries looked on the other end. The mom had burst into tears of relief.
“You have NPS, I’m afraid,” Lark had said with a smile. “New parent syndrome. My sister brought her daughter to the ER four times in the first year. It’s normal to worry.” She bent down to look at the beautiful little boy. “You are the cutest little guy in the whole world, mister,” she said. He sparkled up at her, all dark gray eyes and drooly smile.
Babies. God, she loved babies. She hoped Addie and Nicole would have another. It was the closest thing to her own she could imagine right now. Would she ever have a family of her own? Her own baby? The kind of love her parents shared? It had once seemed so close, and now was a million miles away, a shimmering city so foreign and far it felt like a barely remembered dream.
Well. Anyway. The ER had also hosted a woman who thought she had a spider in her ear (she didn’t), a young man with a nasty cut on his foot that Lark got to stitch up (so much fun!) while he flirted with her. There’d been a boyfriend patient, as Luis called them…Horace, a sweet little old man who was a repeat customer, in from his assisted living facility with another UTI. Lark knew she spent too much time with him, but she didn’t care.
Emergency room medicine was a microcosm for all that was right and wrong in American healthcare. A couple of true emergencies (the sliced hand, the cut foot, the broken arm); a couple of “it was good that you came” cases, like the blueberry baby. The guy with the cough just needed some antibiotics and cough medicine, but he didn’t have a primary care doctor. The specks of blood had scared him, so rather than a routine visit to the doctor, or a trip to urgent care, he’d ended up in the ER at 10:00 p.m. on a Tuesday, which would cost him a lot more than necessary. Assisted living facilities tended to be revolving doors—the patients lived there, were cared for, but if anything was even slightly off, they were shuttled to the ER, treated and often admitted, returning to their facility to repeat the cycle.
And the computer work! She probably went through twenty-five screens per patient, clicking, dictating notes, checking boxes, logging in, logging out. She was getting better at dictation, and she and Lalita would look at each other and smile, seeing who could murmur their notes in faster. No one was as fast as Howard Unger, though, who sounded like a New Yorker on speed when it came to that.
But in most cases, the patients were happy or relieved to see her (or any one of the doctors, PAs or APRNs). Usually, the staff could either treat the problem or reassure the patient. That’s what she’d wanted in Oncology. Still wanted.
To that end, she’d started volunteering with the hospice program here at the hospital, and had seen her first patient last week—Alice Fontaine, late-stage Alzheimer’s, admitted to the hospital so her daughter, herself in her seventies, could have a little break from caregiving.
“Hello,” Lark had said upon entering. She kept her voice low, since Mrs.Fontaine appeared to be sleeping. “I’m Lark, your hospice volunteer.”
Mrs.Fontaine opened her eyes. “Mama?” she asked. “Will you take me home?”
Immediately, Lark felt tears surge. But no. She was not going to cry in front of this woman. Her job was to provide comfort, a peaceful presence, companionship. Not to make the patient feel worse.
“I’m Lark,” she said, clearing her throat. “I don’t think I know your mother. What’s she like?”
“She’s pretty. She loves me.”
“I bet she does,” Lark said, swallowing. “What do you like doing best with her?”
“I like baking. She makes the best pies. Is she here?”
Was it okay to lie? That hadn’t really been covered in the training sessions. “She’ll be here soon,” Lark said. It seemed kinder. “Is it okay if I call you Alice?”
“That’s my name. Alice.” The old lady reached out for Lark’s hand, her skin so thin and dry and speckled.
“Can I put some lotion on your hands, Alice?” Lark asked.
The patient didn’t answer, so Lark decided it was okay. She always carried some, since she washed her hands so often at work. Now she took out the tube and gently rubbed it into Alice’s little bony hands. She’d done this for Grammy, too.
“That feels nice, Mama,” Alice said.
Lark swallowed again. “I’m glad.” After the lotion, Lark just sat there for a while, watching Mrs.Fontaine sleep. The poor woman had barely eaten in eleven days, according to the notes, and had been refusing water. Her breathing had a catch in it, but wasn’t exactly Cheyne-Stokes just yet, that pattern of erratic breathing that was a harbinger of death. But Mrs.Fontaine looked dead, that was for sure. Her skin was pale, her mouth open, and she was so still. Lark waited, watching her chest. There. Another breath. Another minute.
Lark wished she could stay till the end. Hold Mrs.Fontaine’s hand until the last breath. Whisper something comforting that would help. As it was, she could only sit here and…well…just be. It was hard to wrap her brain around that. She couldn’t do anything as a volunteer, and of course, with the patient’s age and condition, there wasn’t anything to be done. Just bear witness. Just be there.
She sang a lullaby, the same one she sang to Esme and Imogen, an old-fashioned song about flowers falling asleep and mouse babies curling up in their beds. She’d learned it, gosh, in second grade? A memory of a springtime school recital, Justin standing in the row behind her, flashed from the depths of her memory, and she held it gently, its realism and power dissipating even as she tried to keep it close.
The song had stayed in her head all week. Not just the sweet words, but that memory of Justin standing right behind her. It felt possible, though, for someone to be part of your DNA. Your cells. Imprinting so early and so deeply that you would never be apart.
“You going home, sweetie?” Luis patted her shoulder as he walked past her in the locker room.
“Yes.”
“How was your shift?”
“Good! Actually really good.”
He smiled. “Yeah, I like it here, too. What are you up to for the rest of the day, chica?”
“Dinner with friends.”
“Nice. Have fun, honey. I gotta get in there.”
It would not be fun. As if on cue, her phone dinged. She had a slew of texts she hadn’t yet looked at, but this one was from Justin’s mom.
Are you still free for dinner tonight?Heather asked.
Yes, of course. What time?
Five o’clock at the cemetery?
See you then. Love you, Heather.
She looked at her other texts, which always poured in on this date.
There were six photos from Addie of Esme and Imogen eating breakfast. Try to be happy just for a few minutes today, the text read. Love you.
A picture from Harlow, too—her dog, Ollie, looking at a seagull, being adorable.
Thinking of you today, sweetheart. Love you.
Winnie, Robbie and Dad had also texted. Last night, just before she’d left for the hospital, she saw that Mom had left a mason jar of peonies and a loaf of rhubarb bread on her steps with the simple note I love you.
She listened to a voice mail from Grandpop. “Hello there, young Lark, it’s your grandfather speaking. I know this is a sad day, my dear. I think Justin would be very proud of you. I know I am.”
Tears rushed to her eyes. Grandpop always knew what to say. He was perfect. She texted back and said she was doing okay and reminded him that she was cooking him dinner on Saturday. What did she have to do until five? Nap, hopefully. Shower. Pick some flowers.
One more text…Lorenzo. It was a link. Nothing else. She clicked, and there was a stunning halter dress in a deep, luscious pink. Silk with a low back, crisscross rhinestone straps, slit on one side…super sexy, but also really sophisticated. From the front, it was just a lovely dress, not formfitting, but from the back, it was a fuck-me dress in the best possible way. She scrolled lower to see the cost. Sweet baby Jesus, $2,000!
Three dots showed that Lorenzo was typing something.
Another link, this time to shoes in same shade of pink, but metallic. Three-inch heels. Eight hundred fifty dollars. And one more link…a beaded clutch bag. Frickin’ gorgeous.
I see you have a great interest in women’s fashion, she typed.
I don’t want you to look poor and out of placewas his response.
“What a kind thought,” she grumbled, then typed, It’s your money.
I’m well aware.
She sighed. Can we meet? I have questions and we should get to know each other a little more.
There was a long pause. No waving dots. With a sigh, she walked out of the locker room, slinging her bag over her shoulder.
“Lark?” Luis said, standing up at the nurses’ station. “Good, you’re still here. We have a code, two minutes out. Patient is elderly, no advance directives, so it’s all hands on deck.”
“Okay. Thanks, Luis.”
Tonight, Naked Oyster, 7:30 p.m.
Apparently, the Naked Oyster was going to be their place. I have plans tonight. Sorry.
Then why didn’t you say so? Tomorrow, same time. Don’t be late.
Rather than an answer, she just gave a thumbs-up, then ran down the hall, her fatigue melting in the rush of adrenaline. The patient was being wheeled in, barely visible on the gurney, a paramedic straddling her, doing compressions, and a panicky-looking man following close behind.
Dr.Unger was running the scene, getting the history from Anton, the paramedic alongside the patient. “This is Mrs. Almeida, age ninety-four. She collapsed at her rehab center forty minutes ago,” Anton said. “History of dementia, atherosclerosis, stroke, breast cancer. Two milligrams of epi in the field with no response.”
Ah. The patient was gone, then, but Lark knew they’d keep working on her. You didn’t just pronounce someone without even trying, especially with a family member present. It was a commandment in Dr.Unger’s ER.
“Mom! Mom, don’t leave me!” said her son, who had to be close to seventy. “Please, Mom!”
“Dr.Smith,” said Dr.Unger, “take over compressions, and Danny, work the bag.”
“Bagging,” Danny said.
“Taking over compressions,” Lark said.
Shit. Compressions on a very old lady were akin to beating her with a baseball bat. It wasn’t a request, though. Lark went to Mrs.Almeida and started, the Bee Gees’ song “Stayin’ Alive” immediately playing in her head, keeping her compressions fast and hard. She heard a rib crack and winced.
On TV or in the movies, CPR looked like nothing more than a brisk massage. In real life, to make blood flow through a still heart, you had to push so hard the whole rib cage compressed and expanded, and ribs often cracked under the pressure. It was brutish and dreadful for the patient, with about a hundred compressions a minute. Only occasionally did someone come back fully after CPR, and most of those people weren’t ninety-four.
Lark herself had a DNR already in place. Most doctors and nurses she knew did.
“Give her another milligram of epi,” Dr.Unger said.
“One milligram of epi going in,” said Mara. It was habit, Lark had learned, for people to echo the order to avoid any mistakes.
A bead of sweat fell off Lark’s forehead and onto the patient’s chest. She could hear Dr.Unger giving the talk. “Your mom is very sick…we’re doing everything we can…do you think she’d want this level of intervention?”
“Give her everything!” the son yelled, an edge of hysteria in his voice. “Save her! I don’t care what it takes!”
“I understand, and we’re doing everything we can,” Dr.Unger said, his voice low and kind. “The problem is, I’m not sure we’re helping at this point.”
“Don’t give up, Mom! Please, Mom!”
Another rib cracked under Lark’s hands. I’m so sorry, Lark thought. The patient was so thin…if she had severe dementia, like Mrs.Fontaine, she might not have been eating much.
“Amiodarone, three hundred mil,” Dr.Unger said. “Charging to one twenty.”
“IV amiodarone, three hundred mil,” Luis said.
“Stop compressions and clear.”
Lark stood back, and for a second, silence fell over the room. Dr.Unger put the paddles on Mrs.Almeida’s naked chest, which was bony and thin, her small, shriveled breasts barely visible. The charge made her body jump, but no pulse showed on the monitor.
“Again,” said Dr.Unger. Another jolt. No response. “Continue compressions. Lalita, take over for Lark.”
“Taking over, Lark. Good job.” Lalita took her place, and Lark wiped her brow with her arm.
Dr.Unger looked at her. “Dr.Smith, would you mind speaking to the patient’s son?”
She nodded, still breathing hard, and went over to the man. His face was stained with tears, and his eyes were too wide. Oh, God. This shouldn’t be his last memory of his mother alive…not that she was. But research showed that it was better for a loved one to see that the staff was doing their best, to witness the process themselves, rather than be shoved into a room to wait.
“I’m so sorry about this, sir,” she began.
“You have to get her back,” he said. “Try everything. I’m not ready to lose her.”
“We’re trying, but her condition is grave,” Lark said, putting her hand on the man’s sleeve. “We’re doing everything we can.” She knew—everyone in the room knew, except the son—that the woman was not going to make it. The patient had been down for almost an hour now, and she had earned the right to die. But without advance directives, and with the son standing right there, CPR continued. “I’m afraid she’s not responding, even though we’re doing our best.”
“I don’t care about your best! I want her back! Mom, please!” There was a primal anguish in his voice, unguarded and raw.
Oh, it was wrenching, and on today of all days…Lark’s eyes filled with tears. “I’m so sorry,” she said, swallowing a sob. “There’s nothing more we can do.”
“Please don’t give up,” he wept. “Please.”
On impulse, Lark put her arms around him and hugged him close. Was that against protocol? She didn’t know. Didn’t care that much, either. “I bet she was an amazing mom for you to love her so much,” she whispered.
He clutched her hard, a desperately sad man on a terrible day, and she felt his whole body shake.
“Be a good son now,” she said, “and let her go.”
His grip tightened, and she felt him sob. Then he straightened and looked at her, and she gave a little nod.
“Okay,” he whispered, wiping his eyes. “Okay. They can stop.” His mouth worked, and then his face was suddenly calmer and so, so sad.
“Stop compressions,” Lark said, taking his hand.
They all looked at the monitor, which showed a flatline. Mrs.Almeida’s face was gray underneath the mask.
“Call it, Dr.Smith,” Dr.Unger said.
“Time of death, seven thirty-four a.m.” She squeezed the son’s hand. “Why don’t we go down the hall for a minute?” she suggested. “They’ll tidy her up and you can see her again. Okay?”
“Okay,” he said, his voice shaking, and she took his hand and led him to the family quiet room and sat with him as he wept.
Yes, his mother had been old and frail and her mind and personality had been eaten away by dementia. But she was his mother, and he’d never spent a day of his life without her in this world. That was absolutely worth crying about.
When Dr.Unger came in, the son was talking to someone on his phone, crying softly as he detailed what had just happened. Howard squeezed Lark’s arm. “Nice work in there,” Dr.Unger said quietly. “The kindness, I mean.”
Lark wiped her eyes. “Well. Thank you.”
“You’re a human golden retriever, Dr.Smith. You make people feel calm and special.”
She huffed a laugh. “That may be the nicest thing anyone’s said to me.”
“There’s generally a moment when you kids go from being residents to being doctors,” he said. “Was that today for you?”
She tilted her head. “Um…I don’t think so. I think today was just my golden retriever moment.”
“Well, it’ll come. You won’t have to ask yourself when it does.” He smiled. “Hey. Give Heather and Theo my best, okay? Heather, um…posted about today.”
Her throat clamped shut, and an awful thought came to her. The Big Lie of her and Lorenzo had already spread through the hospital. What if…
“Dr.Unger,” she said, swallowing, “you might have heard something about…um, my personal life recently.”
“That you’re dating Lorenzo Santini?”
Crap. “Yeah. It’s very, um, casual and new and I’d rather not tell Theo and Heather anything until there’s actually something to tell.”
He looked away from his screen. “Got it.” He paused. “Can’t say I’d put you and Santini together, but maybe it’s a beauty and the beast thing. Good luck all around.” He smiled and turned back to his computer.
Napping had proved elusive. She thought about going to Addie’s or stopping by the bookstore to see Harlow and Grandpop, but she wanted to be alone, too. So she got her bike from beneath the deck where she kept it and rang the little bell on the handlebars. Joy would still be sleeping, but Connery had a doggy door. Sure enough, he came flying through the yard and jumped up against her legs. “Want to take a spin, handsome?” she asked, scooping him up and putting him in the basket.
A nice long ride on the bike trail, a cute dog for company. She headed west, needing to fill the hours of the day. Down past Blue Willow Bakery, past Maurice’s Campground, already full of RVs and tents, past the spot in Eastham that smelled like roasting coffee, courtesy of Beanstock Roasters. The sun was warm, and the bike path was filled with other bicyclists, walkers, runners and rollerbladers. On autopilot, Lark smiled and said hello to every single one.
She was grateful for the life she had, for her family, for her health. But she was sad, too. Seven years ago, Justin had died, the only boy she’d ever loved, and for seven years, she hadn’t been able to shake this feeling that she was a ghost, too. Not really here. On the days when reality broke through, it felt like she was walking across a partially frozen pond, and every step had to be careful and deliberate, because if she thought too much about the icy water below, she’d fall straight in and drown.
She got off the bike path near Bridge Road and pedaled her way past the lovely old homes and bursting gardens to Boat Meadow, the prettiest bayside beach in Eastham. She had never come here with Justin. It was one of the best things about the place. No memories of the two of them here, nope. She sat on the warm sand and watched her little dog snuffle and run for the next hour or so. “Cute dog,” someone would say, and she’d answer “Thanks!” That was about all she had room for today.
But she had to get back, of course. Took a shower, changed, kissed Connery’s little head and then said “Go home!” and watched as he streaked over to the big house. Texted Joy that he was on his way.
The evening was painfully beautiful…June, just before the tourist season began in earnest. Already, Wellfleet was cheerfully busy. The Ice House and Winslow’s had people sitting on their patios, sipping and eating. Tourists and locals alike walked down to the water, past her mom’s gallery, to stare at or walk over Uncle Tim’s Bridge. Lark drove carefully, throat locked, heart flopping in her chest.
Justin had been cremated, and Heather and Theo (and Lark) had buried some of his ashes in the Deans’ backyard, where his old swing set had been. Some they’d taken out to sea to scatter in the bay, and some were buried here, at Pleasant Hill Cemetery, where there was a small stone marking his spot. Lark knew the way without looking; she visited at least twice a month. Cemeteries were beautiful in general, and this one was especially so. Sometimes, she’d bring a picnic, which felt maudlin but also appropriate.
After all, they’d loved picnics. For their engagement, the Deans had given them a splendid, high-end picnic basket, the kind where the forks and knives tucked into leather straps, and the plates were blue-and-white porcelain, the wineglasses sturdy. The Yorkshire Breakfast Hamper, such a ridiculous, over-the-top name. When she and Justin would plan a picnic, they’d ask each other at least five or six times, “Darling, do you have the Yorkshire Breakfast Hamper?” or “My love, would you like me to carry the Yorkshire Breakfast Hamper?” The last time she’d brought a picnic here, she said, “I hope you’re noticing the Yorkshire Breakfast Hamper, honey,” then surprised herself by the fury of the tears that followed.
She got to Justin’s spot. Cape Cod rambling roses spilled neatly around the headstone, the daffodils and tulips now past.
Justin Edward Dean
A beautiful and courageous soul loved by all.
These words, while true, did nothing to capture Justin. What about his sense of humor? How good he was at listening, that intent expression on his face, the pause before answering? Where was the stuff about how dazed and befuddled he was every morning, like a chick who’d just pecked through its shell and blinked at this new thing called daylight? What about his intelligence? How about the way he’d cook and pretend to be on a cooking show, talking in a goofy voice as he narrated the steps? What about his beautiful hands and unexpectedly loud laugh? The way he’d narrow his eyes just before kissing her, as if he wanted to get it just right. Where was that, huh? Beautiful and courageous, loved by all…meh.
Heather and Theo were approaching, and Lark fixed her face. “Hey,” she said, and her voice shook.
“Sweetheart,” Theo said, hugging her. There were tears in his blue eyes, the same dark blue as Justin’s had been. She swallowed hard and smiled (she hoped), then moved on to Heather, who grabbed her so hard.
“Oh, Heather,” Lark whispered, hugging back.
“Hello, sweetheart,” she wept. “You’re so good to be with us.”
“I wouldn’t be anywhere else.”
The three of them stood there, looking at the ground. It felt awkward and sad and ridiculous and forced. Seven years. No Yorkshire Breakfast Hamper today.
She had known Justin Dean for twenty-one years. Twenty-one. Someday, he would be gone for twenty-five years, and her life would tip into a new sphere, in which she’d be without him longer than she’d been with him.
“It doesn’t get easier, does it?” Heather whispered.
“It gets harder,” Theo said, reaching for his wife’s hand.
“We miss you so much, Justin,” Lark said, her voice breaking, and they all cried then, no toughing it out, no being brave.
Then, as they had for the past seven years, they went back to the Deans’ house for a dinner of Justin’s favorite foods—barbecued ribs, street corn, guacamole, hot dogs. A strawberry-rhubarb pie sat on the counter.
Once, when Justin was still alive, she’d made almost this same meal and packed it into the Yorkshire Breakfast Hamper. It was when they were in college, and they’d eaten till they were stuffed there on the Common, lying back on the blanket afterward. They’d held hands. At least, she thought they’d held hands, looking up at the sky. They probably had. Maybe they’d talked about baby names.
Or she was just making that up, false memories to soothe her broken soul.
We loved with a love that was more than love.
Damn straight, Mr.Poe. The man had known what he was talking about.
“How’s the ER treating you?” Theo asked, and Lark stepped up with some funny stories. “Last week, we had someone come in during active labor,” she said. “She didn’t know she was pregnant. I mean, the baby’s head was crowning, and she said, ‘This can’t be possible, I just went through menopause. I haven’t had my period in, like, nine months.’ And the kicker is, she was twenty-six.”
“Oh, no!” Theo laughed.
“So lucky,” Heather said, and Lark instantly regretted the story. A surprise baby for them—or for Lark herself—would’ve been very welcomed. As if in response, her abdomen cramped. She’d never have Justin’s baby, and because Justin was an only child, his DNA would be gone when Heather and Theo died.
“But you’ll go back to Oncology, right?” Theo asked.
“Oh, yeah. Definitely. This is just a temporary switch. It’s so I can work on some…skills. Mostly in giving out information.” Without sobbing. “In the ER, you have to be fast and clear, and my adviser thought it would be really helpful. But back to Oncology, yes, once this is done. I’m actually doing some hospice volunteering, too.”
“Oh, God, you’re an angel,” Theo said.
“Lark, really,” Heather said. “I’ve never met someone who knew so young what they wanted to do.”
“That was all because of Justin,” Lark said. “He was so…” Shit. Here came the tears. Again. “You two raised the best person I’ve ever known. He’s the foundation of my entire life, even now.”
“That means so much to us,” Theo said, reaching for her hand. “You’re part of his legacy, Lark. People in his shoes will be better off because of you.”
“Are you, um, seeing anyone, Lark?” Theo asked, and Lark flinched a little. Heather was giving her an apologetic look, but it was part of the tradition of this day. The Deans would ask, assure her they’d be fine with that, and then sag in relief as she said no.
“No, of course not. I mean, it’s just…I haven’t met anyone I want to…get to know.” Heather was nodding. How could anyone compare to Justin? No one could, and Heather knew it as well as Lark. Certainly, Lorenzo Santini wasn’t a contender. “But guess what? I got the sweetest text from Grady Byrne yesterday. He wants to know what Addie, Winnie and I think about a ring for Harlow.”
“Oh, how wonderful!” Heather said. “I just love your sister. And that store! Did I tell you I joined their Mystery Lovers Book Club?”
“Really? What are you reading?” she asked, and for the rest of the evening, she and the Deans sat and talked and tried not to look at the space where Justin should have been.