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Crumbs of Hope
By Mark Russ
Having unintentionally left his mother to die alone at Our Lady of Mercy several years before, Malcolm was determined to remain with his father until the end.
“The dialysis didn’t do what we hoped. His heart is weakening and his lungs are filling with fluid." Dr. McArthur patted Malcolm on the back and gently moved his hand up to squeeze his shoulder. They watched the squat orderly push Malcolm’s eighty-eight-year-old father out of the ICU room that he had occupied for three days and down the hall.
"He’ll be in a single so you can have your privacy. We'll keep him comfortable.”
Malcolm, a bachelor dermatologist in his fifties, unaccustomed to being in acute medical settings, nevertheless knew what was coming. He used a pay phone in the lobby to phone his sister at home. "Multiple organ failure… a day or two… morphine… Morphine. No, it won't make him better… It helps the sensation of drowning... Room 264. Flannery Pavilion." Malcolm could hardly believe he was having this conversation.
Malcolm’s sister arrived thirty minutes later, having completed some errands. She greeted Malcolm with an air kiss and half-hug as she entered her father's room and inquired about his condition. No change. The siblings sat on either side of the bed in silence, interrupted only by the sound of dinner trays being served to other patients. “What’s the plan for tonight?” Barbara asked, as if they were going to be ordering Chinese.
“Why don’t you go home, Barbara? Your kids will want you close by. It’s been a long few days. I’ll stay with him tonight.” Malcolm, wearing a rarely used stethoscope he'd brought “just in case it was needed,” glanced toward the nurse who'd been charting on a clipboard at the foot of the bed. “Would that be okay? If I stayed with him tonight? I can sleep in that chair,” Malcolm said, pointing to a green Naugahyde recliner in the corner of the room. The upholstery was frayed on the armrests and seat cushion, and the faint smell of cigarette smoke gave away its age.
“I'll get you a pillow and a blanket,” the nurse offered. Her eyebrows were slightly furrowed over the bridge of her nose and the corners of her mouth drew downward.
“Thank you. There. It’s settled. I’ll see you in the morning.” Malcolm hugged his sister deeply. Barbara knelt by her father's bedside. Tears streaming from her mascaraed eyes formed dark rivulets on her cheeks.
“Tateshi. Daddy,” Barbara whispered. Malcolm was moved to see his sister's attempt to recapture a girlhood intimacy that would soon be gone. She kissed her father's forehead, squeezed his hand tightly, and took her leave, blotting with a Kleenex the blackness on her face.
Malcolm exchanged places with the nurse who stood at the foot of his father’s bed. Moving gracefully in her caregiver dance, the nurse finished settling the patient in for the night. The head of the Hill-Rom bed was raised about thirty degrees. Oxygen prongs were properly placed in his nostrils. The little ball in the oxygen flowmeter read 4 liters/minute. A Foley bag with scant urine hung from the side of his bed. An IV drip was inserted in his left antecubital vein, maintained on “KVO,” keep vein open, to provide access for the morphine that would be needed. That’s all there was. Spartan trappings by hospital standards, and certainly bare compared to the ICU. No machines were beeping. Just the machine that was his father, fading in and out of consciousness, breathing with effort.
Malcolm took all this in, then made his way to the coffee shop for tuna on toast and a cherry coke. Even after days in this hospital, he could not distract himself from the immaculately polished floors and strategically placed crucifixes along the walls. He ambled down the hall, bidding good evening to the staff and the occasional nun.
“I’ll have a tuna on toast. No, make it a BLT, and a cherry coke.” Malcolm mused he was being influenced by the Our Lady of Mercy milieu. He had found it curious that his parents, Holocaust survivors, who spoke primarily Yiddish, and English with an extremely thick Yiddish accent, felt comfortable in this supremely goyish environment. Having abandoned organized religion “because God abandoned us” in favor of a fervently secular, left-wing Jewish life, they were not particularly bothered by the Catholic accoutrements. “The hospital is next to us and Dr. McArthur is a mensch,” they said. Malcolm, for his part, grew up with the same cultural sensibilities as them and spoke a fluent Warsaw Yiddish.
“Well, at least I didn’t order a milk shake,” he remarked to the heavyset waitress with Jesus tattooed on her forearm in elegant blue script, complete with curlicues. Looking up at her rotund face, he knew she did not have a clue what he meant. Malcolm wolfed down his sandwich, finished his drink, stopped in the restroom, and returned to his father’s room for the night.
His father’s condition was unchanged. Eyes closed. Unresponsive. Periods of near-agonal breathing, a sure sign he was near the end. Still not much urine in the Foley bag. Everything was shutting down.
Malcolm decided to shut down for the night as well. He lay down on the Naugahyde recliner; it was as uncomfortable as it looked. Malcolm settled into a rather unencumbered slumber, comforted by the feeling he was just where he needed to be.
“Gib mir khotsh a shtikl hof!” rang out from across the room. Malcolm sprang up with a startle, awakened by that undeniably frantic plea fracturing the quiet of the night. Had he heard what he thought he heard? “Give me at least a crumb of hope?”
Malcolm had assumed his father had lived a long life and had had enough.
“What did you say?” his voice rose, but not loud enough to disturb the sleeping patients down the hall.
Malcolm reflexively removed the stethoscope from around his neck and listened to his father’s heart and lungs. He heard the gurgling of fluid that was relentlessly filling his father’s lungs, despite the infusions of morphine. His heart was another matter. Lub dub, lub dub, lub dub, lub dub. The heart sounds, while somewhat muffled, were still stubbornly strong. A distinct S1 and S2, Malcolm thought. He strained to hear an S3, a sign of the heart failure that Malcolm knew would kill his father, but he could not discern a third sound. Twisting the moment into a medical school practicum was all Malcolm could do to quell his angst.
“Dad. Popi. Say again what you said. Zog es nokh a mol.” Malcolm instinctively switched to Yiddish, magically thinking that this might generate a response. Malcolm caressed his father's forehead and gently combed his hair with his fingers, morphing between physician and son and back again.
“Vos hostu gemeynt? What did you mean?” Malcolm pondered the possibilities. His differential diagnosis placed delirium at the top of the list, the meaningless output of an oxygen-deprived brain.
Yet Malcolm was not satisfied with this explanation. His father's demand for hope seemed so insistent, so lucid. He let his thoughts wander through his father's tormented life. Was it the pale-white hope of a frightened boy of six forced to live with indifferent relatives after his father had perished in the Spanish flu pandemic? Was it the swastika-flag-red hope of a frantic young man fleeing the Nazi beast in 1939, barely outrunning the rumble of hobnailed boots? Was it the steel-blue hope of the haggard man in Siberia in 1941, starving, freezing, forced to cut timber for his Soviet enslavers? Was it the leaden-gray hope of an emaciated carcass returning home from the East, numbly learning that he was his family's sole survivor? Or was it the lay-me-down-in-green-pastures hope of a dying man begging for one more morsel, even at the end?
“What did you mean, Pop?” Malcolm turned his father’s utterance over in his head until it began to spin faster, like some mirrored carnival spinning wheel of promise. Slowing, as all such devices inevitably do, the pointer landed on Malcolm’s own reflection.
“Did you really think I could do something to turn this thing around?" Malcolm’s tone grew panicky and a bit angry as his mind flooded with the familiar leitmotif of self-imposed expectations. “I can’t do life and death. I can’t make everything better.” Now it was Malcolm who was pleading.
“I could never… make you whole.” Malcolm buried his face in his hands and his sobbing became uncontrollable, drowning out his father's labored breaths. As fatigue set in, Malcolm’s tears gradually subsided. His attention shifted slightly to the illuminated dial of his wristwatch. Two-o-seven, two-o-eight, two-o-nine. Malcolm unwittingly began to interpose his breaths in the uncomfortably widening silences between those of his father's.
“Zorg zikh nisht, mayn zun. Don’t worry, my son. You did… the best… you could.”
Malcolm looked up from his tear-soaked hands, the only light coming in from the slightly cracked open door. He strained to hear his father say those words that he had never heard before, just as he had strained to hear that abnormal heart sound that he knew had to be there.
Malcolm moved to his father’s bedside with trepidation. Bending over, stethoscope fixed in his ears, he listened intently for heart sounds. There was no S1 and there was no S2. There could be no S3. His father was dead.
Spent, eyes swollen with tears, Malcolm saw an apparition hovering above the lifeless corpse. His father's soul, Malcolm surmised. It appeared to be swimming in the space just below the ceiling, lacking substance but radiating brilliant, luminescent colors: now cobalt, now gold, in short-lived bursts. It reminded Malcolm of a sleek octopus that could instantaneously change color to camouflage itself and thereby avoid danger. He gently motioned to the soul and coaxed it to descend. The three embraced.
