“Miss, can I speak with you for a moment?”

I was walking down the hallway at the hospital.  It was early evening, my sister having left with my young son to keep him overnight at her house.  Today had been the last day of school before Winter Break, and my mother had asked me to bring in Z to visit.  Her room was private, and had real walls (her last one had just folding partitions, which had made Zach visiting a real challenge), and so he could play on the carpeted floor with toys or on the edge of her bed.  He had tons of questions about the tubes that were sticking up her nose, or the pills that the nurses offered to let him feed my mother, or the machine that kept a constant eye on her blood pressure, heart rate and oxygen levels.   She smiled as I offered simple but silly explanations and seemed to enjoy the distraction.

“Sure,” I answered, looking in the direction of the voice.  It was my mother’s doctor.

My mother had been in the hospital now eight days.  As had happened before, there seemed to be no real explanations being offered as to why my mother’s heart rate seemed to spike with minimal exertion, and at other times seemed more stable.  The first order of business had been to stabilize her, as had happened before, but she seemed to be no different now than she was the day she was admitted.  No better, but no worse.

The doctor led me into a small food prep area, brightly lit despite the dusk that I knew had fallen outside.

“You do know that her cancer has returned.”  It wasn’t a question.  It was a statement, matter of fact.

The world stopped.  I looked around and heard the amplified sounds of the nurses at their station down the hall, the sound of a patient door closing, the rush of a faucet turning on somewhere.  “Yes,” I said, just as matter of factly.  Of course I had known it was true for weeks now.  It was the only possible explanation.

“She is terminally ill.  She will die from this.”  He looked at me directly, as if to be sure I understood the gravity of his words.  I understood.

“I understand,” I said, feeling very small and childlike.

The doctor reached for a napkin and pulled a pen out of his white coat.  He started drawing on the napkin.  I looked down to see lines and curves start to form.  What was he doing?

“This is your mother’s chest.  Do you see?”  I looked down.  Yes, now I could see.

“Here is her heart.  And this here is her esophagus.  The tumor is growing here, around her heart and pushing inward on the esophagus.”

“I see,” I responded numbly.  I needed to remember this, every word, every bit of it to tell my brother and sister.  I needed to know.  Finally, someone was telling me what I needed to know.  I forced myself to focus, not to let my mind wander to the awfulness of what he was saying and to stay in the moment.

“See, this is why her heart rate is elevated.  Her heart cannot pump fully, because it is constricted.  So it has to beat faster to get the blood oxygenated.  Which is also why we see her oxygen levels dropping, because it’s starting to be less effective at it.”

“You can’t do aerobics every second of the day without getting tired at some point,” I offered.

“Exactly.  So your mother will die one of two ways,” he continued.  “Either her heart will just tire out and stop beating because the tumor is constricting it too much, or the tumor will infiltrate the esophagus  and block her airway to the point where she will suffocate.”

“Oh.”  I could feel the breath leave my chest, as if it was being sucked out.  I looked around me, cornered in this tiny awful breezeway with this very direct doctor, amazed that people were going about their business as if the world hadn’t just cracked in two.

“We’ll be talking to your mother tomorrow about Hospice and palliative care.  We will probably not give her quite this level of specificity in what we tell her, but I wanted you to know since you are her primary caregiver.”

“Of course,” I answered, trying to sound like the grown up that I was supposed to be in this moment.  “I appreciate your honesty.”

The doctor reached out to shake my hand.  I put my hand in his, surprised to feel the warmth in his hands.  Mine were like ice.  “Good night,” he said, and then walked away.

I stood there, alone, in the tiny breezeway, looking at cups of pudding and boxes of dry soup, unable to move.  No tears, no anger, no thoughts whatsoever.  As I had nine months prior, all I could think about clearly was the date.

December 22, 1992.  Three days before Christmas.


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