Chapter Eighteen
In addition to reading case studies on new oncology treatments, listening to oncology podcasts, and taking online classes in oncology, Lark was getting a lot from being a hospice volunteer.
Her last client had been a sweet old man who smiled when she came into the room and enjoyed holding her hand. She had read to him—Odd Thomas by Dean Koontz—and while he’d been nonverbal, he’d smiled in places at the unique way the title character spoke. He had died after three weeks—cerebral vascular disease. His lovely wife had written Lark a note afterward, thanking her for cheering him up. Lark would keep that forever, she knew.
She’d also visited with a Mrs.Kaye, whose profile said she enjoyed listening to Dean Martin songs. Lark had pulled some up on her phone, and the old lady had smiled at the sound of the crooner’s voice, though she didn’t open her eyes. She died the next day, and though they’d only had that one visit, Lark felt a pang.
Lark wasn’t allowed to act as a physician in the program. She was just a person, not allowed to administer meds, adjust the patient, even give a drink of water. Her job was simply to be present, and it was strangely difficult not to be able to help in some way—to bathe the patient, or transfer them from bed to chair, or help them in the bathroom. Her job was to talk if they wanted to talk, ask the family members how they were doing. To listen. Not to fix.
She’d just come off the night shift in the ER and was washing up in the locker room when she got another request from Darlene, the head of the hospice volunteers.
Lark liked the night shift (so far, anyway). She had the advantage of being single with no kids, so she could go home and fall into bed afterward. Generally, the patients who came in at night were more of the true emergency types—cuts, falls, seizures, accidents. There were also more patients suffering substance abuse, whether it was alcohol or heroin or anything in between. The “my foot hurts” type of patient was less likely to show up at 3:00 a.m. than 3:00 p.m.
Lark liked the camaraderie when the department slowed down for a collective breath, as it seemed to at least once per night. Last night had been a good shift—two heart attacks, stabilized and sent upstairs; an obstructed bowel, sent upstairs; a baby with a stomach virus, given IV hydration and heading home. The loser of a fight had required three stitches in her chin; the winner required a cast on her hand, since she’d broken four bones delivering the punch. A very bloody woman had cut her head on the corner of a cabinet—she looked like Carrie on prom night—but had required only two staples. Three frequent fliers had overdosed, been rescued in the field, brought in, observed and sent out to use another day, unfortunately, having rejected the offer of counseling. The opioid crisis had its claws deep in Cape Cod.
But that was life in the ER. Lark was getting used to it. Every shift, someone was made better. That was something. It was good to be busy. She was sleeping better than when she’d been an oncology resident. That was notable, too.
She was washing up when Darlene’s text came in. A patient’s husband had asked for coverage this morning so he could do a few errands. An hour, ninety minutes tops. Lark hesitated, then offered to go. It was on her way home, after all.
Great, Darlene texted. Sending you the info now.
Nancy Doane, a fifty-six-year-old woman with end-stage stomach cancer. Married, three grown children, the youngest about to graduate college. She has a four-month-old granddaughter, her first grandchild. Family is very close and involved. Nurse thinks days, not weeks.
Shit. For a minute, Lark thought about rescinding the offer. She could just call Darlene and say she couldn’t make it. She was tired and deserved a long nap. Fear of what she’d see at the patient’s house made her knees feel weak.
But if Lark wanted to be an oncologist, she was going to have to make friends with death, as Dr.Hanks had said.
She said goodbye to Mara, who had worked the night shift with her, and hello to the oncoming shift, then drove to Dennis, where the patient lived.
Lark got out, took a breath of the damp air, and went in the house.
“Hi,” she said when a man about her father’s age answered the door. “I’m Lark, the hospice volunteer.”
“Oh, fantastic,” he said. “Andrew Doane. Can you stay with my wife while I run to the drugstore? I have to get a prescription refill and thought I’d grab some groceries, too.”
“Of course,” Lark said. Her hands were shaking.
“Let me introduce you.” He led her down a hallway lined with family photos—the family at the beach, babies, weddings, someone with missing teeth, a boy with a baseball mitt, a couple in front of the Eiffel Tower. The images flashed past, and then they were in a bedroom, where a skeletally thin woman lay on a hospital bed.
“Babe, this is Lark, from hospice. She’s gonna stay with you while I do a quick errand, okay?”
The woman turned to face Lark. She had a few tufts of hair left, no eyebrows, and her eyes rolled a little—morphine, Lark guessed.
“Hi,” she breathed. “I’m Nancy.” She smiled, and her teeth looked enormous and yellow, thanks to the chemo.
“Lark,” she said. “Great to meet you.” Her gaze bounced around the room. More pictures of children. A small statue of a dog. A jewelry box on the bureau, a necklace hanging from the corner of the mirror.
“I’ll be back in an hour, ninety minutes tops, okay?” her husband said. “Love you.”
“Love you more. Wait.” She took a slow breath, eyes closed. “Can you…go to the…beach and get me…a white stone?” She probably had lung metastases, Lark thought. God.
The husband hesitated.
“Alone time,” Nancy breathed, and she smiled, though her eyes were closed.
“You’ll have plenty of alone time soon enough, don’t you think?” he said, trying for a joke. But his voice caught.
“Breathe the…air for me. Come back smelling…like the…ocean.” Breathing was definitely labored. If Lark had her stethoscope, she knew she’d hear all sorts of horrors.
“Okay, honey,” said the husband, his voice thick. He kissed her hand and rested his forehead on her lap for a second. His wife touched his hair with a thin hand, and Lark had to look away. “Okay.” He stood to leave. “Whatever you want. Thanks, um…what was your name again?”
“Lark. Oh, does she have everything she needs? I’m not allowed to give her any food or drink.”
“Right there,” he said, nodding at a water bottle with a straw on the night table. There were at least ten prescription bottles there as well, in addition to tissues, wipes, a lollipop. “I’ll be back soon. Love you, honey.”
“Love you,” Nancy whispered back.
When the front door closed, Lark sat in the chair next to the bed. Nancy seemed to be asleep. Someone had painted her nails recently. Bright pink. Very cheerful.
“Is there anything I can do for you, Nancy?” Lark whispered.
No answer but for her labored breathing. Lark’s heart shook, but she took Nancy’s fragile hand in her own. “You’re safe,” she whispered. “You’re home. You’re okay.” Dante’s words. Just the thought of him made her feel a little braver.
“Thanks,” Nancy breathed. She opened her eyes, looked at Lark’s T-shirt, which read Sorry I’m late. I saw a dog, and smiled. “I’m more of…a cat…person.”
On cue, a striped cat jumped up on the bed and started purring. “Who’s this handsome beast?” Lark asked.
“Oscar. My…buddy.” Her other hand found the cat and stroked his fur. “I’m pretty close,” she said. “I can…feel it. I was thinking…” She paused for breath. “Now…would be good.”
“Good for…” Lark’s toes clenched, and her heart rate kicked into A-fib. This is not about you. Or Justin. Be here. Be present.
“Dying.” Her voice was so weak. “I don’t want them…to see me go.” Tears leaked out of her eyes. “The kids…were here last…night. Baby, too.” Her breath was rattling now. “Don’t want…to say goodbye again. I can’t.”
“I hear you,” Lark whispered. It was one of Dr.Unger’s lines, just to let the patient know that whatever the reason they were here, he was listening. “That white stone is more for him, then.” Her voice shook, but not too badly.
“Exactly.” Nancy opened her eyes again and looked at Lark. “I’m tired,” she whispered. “I don’t want…to die. But this…isn’t living.”
“I understand.” Her eyes burned, but she’d be damned if she’d let a single tear fall. “I get it.”
“Talk…to me. About anything.”
“Um, sure. Sure. Well, it’s kind of humid out, and um, I guess…rain maybe later.” Oh, God. What would she want to hear about? What had Justin wanted to hear? “I can feel how much love is in this house, Nancy,” she said. “All the family pictures. Three kids, thirty years married, your file says?”
Nancy, eyes closed, gave a faint smile, a half nod. “Thirty…two.”
“How lucky,” Lark said. “A little granddaughter, too.”
“Wanted to see her. Stayed alive…to meet her.”
The tears did spill at that statement, but Lark’s voice was steady. “You did, Nancy. You did that. Your daughter will always have those memories of you and your granddaughter.” Fight, she wanted to say. Fight. Give them another day, another week. Maybe there’d be an experimental—but no. Nancy was dying. Right now. Her hospice training had told her this happened quite often. People chose to die alone, to protect their loved ones from having to see it.
Had Justin done that? Did he die on purpose before she could get there?
No time for him right now. Nancy’s breathing was irregular and jerky. And she wouldn’t die alone. Lark was here.
She’d been around a lot of dying people. But she’d been there to try to save them. To cure them. To give them a little more time. There was always something more that could be done to prolong life.
She’d never been there just to bear witness.
This was a different animal. Hospice was about making the best of the last part of your life. The end was not in question. And Lark’s job, right now, was to help this very last part be…be something more than just a tragedy. To be, perhaps, something a little bit beautiful.
“What was it like, when you held your granddaughter for the first time?” she asked. Tears spilled out of her eyes, but her voice was steady. The cat remained firmly against Nancy’s side, still purring. “Did you smell her head? I bet her skin was so soft. Those sweet little hands, grabbing on to your finger.”
Nancy made a humming sound of affirmation.
On impulse, Lark let go of Nancy’s hand. “Hang on one second.” She dashed from the room into the hallway. There. Six or seven people, plus a baby. Andrew looked the same, more or less, and Nancy was smiling, a scarf on her head. The baby was a newborn, just a little pink burrito with a pink cap on.
She ran back into the room, sat back down and held the picture. “Open your eyes, Nancy,” she said. “Look at all this love. You made that happen. You did this.”
Nancy did open her eyes. She smiled again, and then her eyes drifted closed. Lark set the picture next to her and took her hand in both of hers.
“I’m here, Nancy. You’re not alone.” A rattling breath. “You’re safe. You’re home. You’re not alone. It’ll be okay.”
Another noisy breath. A pause. A breath. A longer pause.
Another breath did not come.
Lark counted to thirty. Put her free hand on Nancy’s chest and felt nothing except bone. For a few minutes, she just sat there, tears streaming silently out of her eyes.
“Great job, Nancy,” she whispered. “Well done. You can rest now.”
Then she let go of Nancy’s hand, gently, gently put it on top of the photo. She stroked Oscar the cat.
“Good boy,” she whispered.
Then she called her supervisor, who said she’d send out the bereavement counselor.
When Andrew got home, Lark met him at the door.
“I’m so sorry,” she said.
“Ah, shit,” he said, his face crumpling. He went into the bedroom, and Lark waited. A few minutes later, he came out, his face streaked with tears.
“I’m sorry,” Lark said again, and he hugged her.
“Thanks for being here with her. I should’ve known she’d sneak out if she had the chance.”
“It was really peaceful,” Lark said.
“You brought her the picture. That was…that was so kind. My kids will be glad to know that.”
“Oscar was with her, too.”
“Oh, yeah? That’s…that’s nice.” He wiped his eyes. “You think you’re ready for this, but you’re really not, are you?”
“I don’t think anyone could be,” she said.
He nodded, sighing. “I guess I should call the kids.”
“Do you want me to straighten up the room?” she asked.
He nodded, patted her shoulder and pulled out his phone as he went into the living room.
Lark went back into the bedroom, tilted the hospital bed back and adjusted Nancy so she was a little straighter. Brushed her hair and wiped off her face with a warm, damp facecloth. Neatened the covers, found a bag in the corner and put all her medications in there. No need for the trappings of sickness. Nancy wasn’t sick anymore.
In the end, all medicine, all interventions fail. Lark knew that. And now she’d seen it up close, borne witness to it, had watched as death came in and quietly, kindly took Nancy away.
“Thank you,” she said, putting her hand on Nancy’s. “Thank you for the privilege.”