Being on hospice doesn’t mean I’ll be dying tomorrow, although I’ve hoped it would be that easy. If only I could take my last breath while sleeping—one last inhale, roll over and be gone, leaving only a deep stillness in my room. But, despite the suffering, I want more time to prepare my children on how to keep up the house, the yard, to nurture the staghorn ferns and entice the glossy white dendrobiums hanging from the patio trellis into blooming. Everything I’ve ever possessed seems to be closing in on me. I’ll need to loosen my grip on all of the precious things I’ve garnered during my seventy-one years. My garden beckons outside the bedroom window. The dogs bark and the cat hisses, but the mute plants can only signal for attention by denying their plumes. Surely, my children will remember me stumbling out with the hose every morning, but will they care about the tender fronds and buds unfolding to reveal the tiny miracles inside of their world?
While my garden surges with vitality, my body declines. That first scorching week in September 2012, after I enroll in hospice, Dr. Carmel visits my home. As the harbinger of death, I’d expected her to be tall and gaunt, solemn and mysterious, dressed in heavenly blue or earthly red but instead she’s short, plump, and bubbles with mirth. Multiple-jeweled bangles encircle her wrists. A magenta-and-lime scarf clings to the bodice of her violet dress. From underneath her furry lashes, her eyes dart from my IKEA birch-framed bed to the gunmetal gray commode and settle on a side table littered with plastic pill bottles, tissue, pencils, paper and a small white reading lamp. “Where’s the television?” she asks.
“Nada,” I reply, lying on my back looking up at the brass-framed light fixture hung from the ceiling of the square room, my swollen legs propped high on pillows and my hair damp with sweat. I’ve vomited my breakfast egg sandwich and hope the room doesn’t reek of bile. My tummy rumbles and churns, but those things I won’t talk about, not yet. I don’t want her to think of me as just another whining patient. The hospital doctors had had little tolerance for that. “Why so dismal?” the nurse practitioner would ask if I didn’t smile.
Dr. Carmel drags a chair over to my bedside, pulls her laptop from her roller bag, and sets it down on a stool. Her belly jiggles when she laughs. Already, I’m noticing that she’s different than those clinic doctors who’d been serious about poisoning my tumor and often imparted false hopes. After a year-and-a-half of chemotherapy and a whole new vocabulary, the actual dying part still remains a mystery.
She points an index finger over to the metal case of her laptop. “We just started using these things, but I’ll be sticking with pencil and paper so we can actually talk. Few patients know much about hospice, so we’ll start at the beginning, hospice 101. How much pain can you tolerate?” she asks.
“None,” I reply.
With the hospital doctors, I had tried to be stoic and brave but with Dr. Carmel, I feel no need to bolster false reassurances that treatment was helping me. No more scans or infusions. No longer do I have to pretend that I’m hopeful about remission as a viable goal. I knew just what to expect in those drafty rooms at the clinic, but now the terrain has changed. On my final visit to the clinic, my oncologist asked if there was something I’d been able to enjoy in those final months before hospice. And I’d responded, “Gelato!” When I’d hobbled out that day, they were the ones with the smile on their faces.
“That’s my job—to keep you out of pain,” Dr. Carmel says, bobbing her head. “Any pain now?”
I look over at the vials and feel guilty that I haven’t been taking as much medication as I should. “Yes, but it’s bearable.”
She reaches into my pillbox and grabs the syringe, tears off the plastic wrap and measures out .75 ml of liquid morphine. “Under your tongue,” she says, standing over me. Within minutes, my discomfort fades. Pain, no pain, maybe pain, almost pain, that blurry line doesn’t matter.
She sits back in her chair. “Better?” she asks.
My lips pucker. “Ugh…the taste.”
She chuckles. “Well…morphine.’’
I grab onto the glass handle of my mug of fennel tea and sip.
What’d you eat for breakfast?” she asks.
As the room swirls around me, I struggle to focus. “Eggs and toast. I try to eat healthy.”
She frowns. “You’re just feeding your tumor.”
“Well… what should I be eating?” All that time I’d been spending in the aisles of the Whole Foods Grocery, checking each jar and box for the USDA organic seal, and now these things don’t matter?
“You’re eating for pleasure and habit—not nutrition,” she says.
I smile. “Gelato for breakfast, lunch and dinner?”
“As often as you like but before you eat, take the Reglan tablet to help your digestion.”
“Do I need it?”
“It eliminates the nausea and vomiting. Let’s look at what else you’ve got in your pill kit that might help.”
I gesture toward my collection of vials on the table. So many that it makes me cringe. Has my life come to only this?
First, she plucks out the long-acting morphine tablets that I’d been given by the hospital doctors. “Only 30 mg—a baby dose! We’ll double that, twice a day with the fast-acting liquid morphine every two hours as needed. After three doses of the liquid, it’s time to double the number of tablets. You’ll need it.”
“I hate that groggy feeling.”
“And pain…where’s that on your list?”
“I’d rather skip it.”
She grins. “And steroids…how do you feel about those?”
My body twitches with the remembrance of those spurts of energy during my chemotherapy. I’d been able to plant and weed in my yard and visit the Arboretum and the Huntington Gardens with my family. My legs had seemed more like part of me. Then, my arms had reached higher. But I was only allowed to take those pills for 3-5 days during each cycle. I ask, “Aren’t they bad for you?”
“Do we care about the long term?”
I try to roll over but feel a pain in my side. “Any idea how long I might live?”
“I’m not God,” she says with a sigh, as if dying were a special gift and there was so much more to tell me. “You’re wasting your time if you’re trying to kill yourself. There’s not enough morphine. That’s not our job—to kill you. Each body shuts down in a different manner. We’re here to make you comfortable.”
I kick my feet against the blanket. “How will I know when the end is coming?”
She leans back and takes a deep breath. “Let’s hope you don’t.” The flickering of her eyelids foreshadows my curtain dropping. “Dying isn’t easy,” she says.
But couldn’t it be? Just this once—for me! Don’t let me linger. Promise that I’ll slip away quickly. Those are the things I can’t say, but she knows what I want. I have to believe that she’ll ease my suffering at the end.
When my head falls back against my pillow, I see her scarf swirling around her shoulders and hear her stuffing her laptop into her roller bag. “Enough for today,” she says. “When you have pain, phone immediately. Don’t assume it will go away. It will only get worse unless we increase your morphine.”
That she’s leaving so soon, I wonder about, but my conception of time differs from hers. When I close my eyes, an hour can disappear. Now she’s on her feet, heading for the door. As I mumble about not forgetting to turn the lock behind her—poof–she disappears like a desert mirage.