Nicotine (3 page)

“There's towels and a pillow,” she says after opening a few closet doors. “Want a pillow?”

“Sure, I'll take it.”

She folds the pillow and arranges it artfully to support his head. “How's that?”

“It's helping,” he says. “I guess it's just muscle strain.”

Over the course of the next hour, she leaves, taking the laptop, and he moves his head. The pillow falls down.

He sleeps through the fall of the pillow. He wakes up with a terrible crick in his neck.

EARLY EVENING. A FIFTYISH, BLOND-HAIRED
woman in a blue lab coat knocks twice on Norm's open door and enters his room. He is wide awake, staring at the blank TV screen.

She introduces herself as the deputy director of the hospice. She says that there are important decisions to be made about his care. Of course family members can be involved, but they aren't indispensable.

Norm says he feels qualified to decide on his own. She produces a form on bright green paper. She runs down a long list of ways he might procrastinate, from defibrillation to antibiotics, all of which he rejects. She shows him where to sign, and he inscribes legible initials.

She concludes by asking—somewhat unexpectedly, in his view—“And what do
you
want?”

“After all that? I want for it to be 1951, and for you to be a root beer float.”

“It's a serious question. Think carefully.”

“How about 1968 and a smack overdose? I just don't want to be an old man dying in a hospice. But I guess that's what I'm stuck with.”

The doctor is silent. She blinks.

“As you might imagine, I'm in bad shape physically,” he adds. “I'm weak. The discomfort keeps me from concentrating, so I'm bored out of my mind. And it's driving my daughter crazy. I hate for her to see me like this, but I can't make her go away.”

“She loves you very much.”

“She adores me. It's heartbreaking.”

The doctor nods and smiles. Cautiously she asks, “Are you religious?” He doesn't respond. She asks, “Have you tried prayer?”

“To whom? I don't imagine God is in charge of this. This seems more like a case for the other guy.”

“Mr. Baker—”

“God is life. I'm not one of those people who thinks death is part of life. I think it's pretty darn obviously the opposite of life, to be
perfectly frank. That's why I have trouble getting psyched up for it.”

“That doesn't mean help won't come to you if you ask. Ask, and it shall be given. You have to open your mouth and
ask
.”

“I'm an enlightened person.” Seeing her trace of a smile, he adds, “Not like a Zen Buddhist! Enlightened as in the Enlightenment. Rational. Open-minded. I don't believe in God, but I do believe in religion. Ritual and tradition go a long way toward resigning you to a lousy prognosis. I spent half my life studying shamanism, and I've been asking every spirit I know for help, believe me. But until they get off their butts and help me out, maybe you could scare up some kind of painkiller for this crick in my neck.”

“We have a volunteer massage therapist on staff who's very good.”

“Is it tantric massage? That might really help.”

“I beg of you, Mr. Baker, please take your situation seriously. Tell me what form you want your care to take.”

“Ma'am, I am not catching your drift. I have no idea what it is you want to hear!”

She lacks legal authorization to tell him what she wants to hear—that he would like to be knocked out cold, and dead in a week—or that this moment, the one he drowned in morbid lightheartedness, now already past (she dares not harp on her theme), was the moment when he could have asked to sleep soundly through his last days on earth.

The request would have been honored. But general anesthesia isn't a menu item, because the hospice is run like one of those brothels that are nominally strip clubs. The license affords no protection to the dancers, who must turn tricks as furtively and nervously as hospice staff dispensing painless deaths.

And Norm does not want to die. Not yet. He wants to say good-bye to his sons. He craves the good-byes. Knowing all that he knows, he thinks it is worth greeting death with open eyes and intact senses if it means he can see his sons one more time. He is an emotional man. He can't turn it off.

“I'm dying, and I'm terribly depressed about it,” he insists, trying
to reassure the doctor that his feelings do justice to his surroundings. “I'll be grateful for anything you can do for me.” He sees that she is still disappointed. He frowns and faces forward again. “Is
Jeopardy
on yet?”

At his request, she turns on the TV. Alex Trebek descends from his orbiting satellite into the box, bearing images of certainty and fair play.

Norm relaxes. The doctor places the remote, with its built-in speaker, in his curled right hand and leaves the room.

THE NEXT MORNING AT TEN-THIRTY,
Penny arrives at the hospice in Norm's Mercedes S-Class, not forgetting the laptop.

He says he is in too much pain to do anything but train the dictation software. She says she is a fast typist and could take dictation while he speaks. He laughs and says that would take a stenotype machine. He reads a list of words aloud to the computer. She suggests recording an oral history on audio or video. She says her phone has voice recognition software that works without training. He asks to be left alone.

He feels too poorly, he says, to speak anymore at all, because the pain in his neck and shoulder is spreading. “It's like a crick in my neck that reaches all the way around my rib cage and into my back,” he tells her. “Like being twisted too far.”

Penny fetches a nurse, who tells her to tell him to try to sleep. He agrees to try. She goes to the common room to drink coffee and read the hospice literature. When she comes back, he is awake. He asks to hear Mahler's Fifth Symphony.

EARLY IN THE MORNING, TWO
days later.

Another doctor stands at Norm's feet, a sixtyish woman with elegant platinum jewelry. A laminated plastic tag identifies her as the
hospice director. She wears a peach lab coat over taupe gabardine slacks and carries a clipboard.

“How are we doing?” she asks.

“Not so good,” Norm says. “My neck hurts like hell.”

“On a scale from one to ten, with ten being unbearable pain, where would you place this pain?”

“Eight and a half.”

“Have you been letting the staff change your position?”

“Unfortunately I can't lie any other way but this way,” he says. “Because of my neck.”

She flips pensively through the papers on her clipboard and says, “I'm going to be open with you. There are some notes in your file that make me concerned you might be a drug seeker.”

“I'm a seeker, all right, but I never took a recreational drug in my life!”

“What I'm hearing now is a drug seeker's request for opiates.”

“Where'd you get that? I don't even believe in opiates.”

“There has been concern on the staff, I don't know how to say this”—she shakes her head, as though doubting the notes on her clipboard in her own handwriting—“about a Satanic drug cult of some kind that you were involved with in Brazil?”

“What did they do, Google me? I thought this was a hospice, not the NSA!”

“Palliative care means treating the whole person,” she parries smoothly. “With all his quirks.”

“So give me some palliative care! I don't know what's wrong with my neck, but that massage your volunteer gave me sure didn't help. I remember some of my clients used to be on something called Dilaudid. Supposed to have euphoria as a side effect. You guys have that?”

She shakes her head. “We rely exclusively on modern therapies to keep our patients comfortable.”

“Well, I'm not ‘comfortable.' I'm in hell. Of course I feel right at home, as the founder of a Satanic drug cult.”

“Mr. Baker, if you would prefer not to receive care in a Christian institution—”

He rolls his eyes. “Can't you tell I'm joking?”

The doctor folds her arms. “Being comfortable means not being in agony. It means not dying the way people used to die. Screaming. It means being able to function mentally.”

“Well, thanks so much for the timely definition, now that I'm stuck here on my ass until I die.”

“Mr. Baker, I would ask you to remain civil.”

“All right. Civilize me. You're the renowned specialist in palliative medicine. Do something about my fucking neck.”

For a moment, the director twirls her pen. She wriggles pensively, as though thinking with her intestines. Finally she says, “It could be muscle cramping. Some patients respond to a muscle relaxant.”

“Then why doesn't somebody try it already?” Norm begs.

PENNY SPENDS AN UNPRODUCTIVE DAY
with Norm, not working on his memoirs.

That evening, she returns to Morristown in a state of agitation and restlessness. The gate opens when it senses the car's transponder.

The house is H-shaped, very large; the exterior, white stucco with high, black-shuttered windows. The black perimeter fence encompasses one and three-quarter acres.

When she comes into the kitchen through the side door, Amalia is drinking beer and soliloquizing to Norm on the phone. She says, eyes on Penny, “Got to go,
cariño
. Your baby's home. Love you. Bye.” She hugs her daughter and says, “I know, honey.”

“You should come see him,” Penny says. “He's not getting the right painkillers.”

Amalia shakes her head. “On Sunday I will definitely come,” she says. “Work is so crazy. We're up to our necks in a merger. It would be so much easier. I could see him every day, if he would be here at home.”

“But what about the bleed-out? And taking care of him? I don't know, Mom.”

“If he says he will do it, I will find a way. I will help you. Can you talk to him? Make him come home?”

THE NEXT MORNING, NORM HAS
a new symptom. “Ih er eenh,” he tells Penny. “Ah unh unh ee ah unh-ur unh.”

“Slow down. I can't tell what you're saying.”

“Anh uh eh ih ee. Ah ehr. Oh. Eh ee oh.”

“Are you in pain?”

“Eh!”

Penny marches to the nurses' station, tears in her eyes. “My father's still in pain,” she tells the nurse sitting there. “And now he can't fucking
talk
.”

“I'll ask you to use civilized language,” the nurse says, looking up from her cell phone. “Terminal distress and agitation are normal. If he doesn't fall asleep in a few minutes, I can send for the chaplain.”

“He's upset because he's in pain and they won't give him any painkillers! All he got was a muscle relaxant!”

A doctor sits filling out a form at a desk behind the nurse. He looks up and says, “I could ask him whether he'd like a sedative.”

“That's an idea,” Penny says. “He told me once he used to take Valium on boat rides, after he was on this ferry on the Amazon that burned and he got this fear of ships. He said Valium set him right up!” She almost laughs herself at the ridiculousness of Norm's phobia, so she is surprised when the doctor says something even sillier: that Valium could damage his liver.

“Damage his
liver
? Who
cares
? He's dying!”

“It could hasten death,” the doctor says. “We don't assist anyone here to die more quickly. It's God who decides how and when that will happen. We simply allow nature to take its course.”

“We didn't come here to let God and nature decide. We can get them for free by walking out the door.”

“What you need to understand is, your father is not dying. Not yet. His lungs sound normal. No crackles. His kidneys are functioning. He's at a very early stage. But if he's having more psychological distress than he can tolerate, I could consider starting him on twilight sedation. It's state of the art in end-of-life care.”

“First you have to get him off those muscle relaxants so he can communicate! He wasn't distressed before, just in pain.”

“I'll go see him now, and I'll ask him if he wants sedation, and we'll think about alternatives. I promise.” The doctor gives Penny his hand. “You should go home and relax. Take a day off and get some rest.”

“What if he dies today?”

“Not a chance,” he assures her.

FOUR DAYS PASS. PENNY SITS
by Norm, giving him ice cubes to eat. He coughs. He runs the ice cubes around his mouth with his tongue, but he can't swallow the liquid water. It runs into his beard, which is cut very short.

“He's not thirsty anymore,” a nurse explains.

“Wah,” he protests.

“He's asking for water,” Penny insists.

“It's a habit,” the nurse explains again. “He's on twilight sedation. He doesn't know what he's saying. He's used to asking for water. It's a habit like anything else.”

“Wah,” Norm says.

“YOU CAN DO ORAL CARE
yourself,” a friendly orderly tells Penny two days later. She shows her how to dip a rough rectangular sponge on a lollipop stick in water and offer it to him.

Norm sucks it hard. His spit forms a sticky web around the green sponge. The inside of his mouth is yellow, crusted with dried snot. The orderly shows Penny how to swab his teeth and tongue gently so that the crust still obscures his soft palate completely, obstructing his windpipe.

“Can't you get that stuff out so he can breathe?” Penny asks.

The orderly shakes her head. “It's not our policy to perform suction. That would only prolong his life.”

Penny runs a swab around the back of Norm's throat and twirls it. The substance collects on the swab like cotton candy. She throws it away and tries another swab. A plate of dried mucus flakes off his throat like a loose poker chip. She hauls it out with the swab. Nothing disgusts her. She is gentle and caring. He moans his word “Wah.” The inside of his mouth is almost clean. It is red, gray, and gold. His golden molars shine. She feels a sense of achievement.