Transition

In the quiet kitchen, Anne washes spinach and imagines slapping the hospice nurse. She pictures herself walking purposefully into the living room, stopping at the edge of the sofa that is, these days, her son Darren’s bed, and bringing her open palm into swift, cracking contact with the young woman’s smooth cheek.

“I’m going now, Anne.” The voice brings Anne around, a guilty flush staining her throat and chest. “I’ve got him settled for the evening. He’s got a new morphine patch in place, but you’ll need to keep a check on him. With so little fat, there’s not a good blood supply anymore. It may not be enough. I want you to think about what we discussed, about the pump.” The last words are spoken slowly, as if a soothing presentation might lessen their provocative nature.
Anne stands motionless in her spot against the sink. The water is running, splashing against the edge of the bowl of spinach and onto the back of her blouse.

“So, okay.” The nurse, Shelly, lifts the stethoscope from around her neck and folds it into the pocket of her blue smock. “I’ll be here by 1:00 tomorrow. Call if you need me before that.” She starts out of the room, then turns, an index finger raised, ready to make one last point. She pauses and nods as if answering some unspoken question, and then she is gone.

Anne waits until the front door clicks shut before she turns off the water and goes into the living room. The curtains are open and the light of the early summer evening is still enough. It is the time Darren called playout when he was younger, the hour between supper and bedtime when the heat of the day is fading and the fireflies are starting to circle, when something, maybe the softness of the air, seems to allow sound to carry easily. Anne can hear the chime of children’s voices and a barking dog.

A low humming begins, sliding in beneath the other noises, and Anne knows that it is Darren. It is the way, now, that he gets her attention, saving his energy for the few words he most needs to say. She turns to face him and waits.

“Hm-m-m-m-m.” He purrs.

“I’m here.” She resists the urge to settle her palm across his forehead as she had when he was small and the worst she might need to tend was a fever from a cold, when cancer was a disease of the old, of others. “Do you want something? A drink?”

His pale lips, still wide and beautifully shaped, move together and apart, as if tasting the question before he lets it out. “Shelly gone?”

“Yes. She’ll be back tomorrow.” Anne tries to keep the critical edge from her voice. “What do you want? I can get it for you.”

“It hurts.”

“Can you tell me where?” Perhaps it is something that can be fixed with another blanket, a fresh pillow.

There is an almost imperceptible shift of his head. “It hurts.” The eyes, which now seem too large for his face, are barely open, the thin lids the color of skim milk.

Anne drops to her knees beside the sofa and slips her fingers into Darren’s curled ones. “Shelly put a new patch on you, honey. Just before she left. Let’s give it a little longer to start working.” She runs her thumb down the side of his fist, the dry, fragile skin like old paper under her caress. “Just a little longer. I think it’ll help soon. If it doesn’t, I’ll crush up one of the tablets.”

Anne and Shelly have reached an impasse on the subject of Darren’s medication. It has been at the center of all their discussions the past few weeks. Shelly appears to be focused on eliminating every trace of pain, even at the cost of his already diminishing level of consciousness. For someone whose general demeanor is so gentle, she strikes Anne as having an almost vicious antagonism toward the idea of any physical discomfort. In contrast, Anne feels pushed into a position of defending the pain, desiring it even, but nothing could be farther from the truth. If Shelly had ever had a child, which she has not, she would understand. It is only when Anne considers her own position in this, her need to maintain control of the quality of the time that she and Darren have left, that she is conscious of this aspect of being a single parent. If there were a partner, which there has not been in the 15 years since Darren was a toddler, she might have an ally. There might be another person to whom the remaining brightness of this child, the sweet edge of his humor, are too precious to dim before the last necessary second. But there is no such person.

“Hm-m-m-m-m-m.” Darren croons, bringing Anne back to the moment.

“I’m still here, sweetie.” She returns the slight squeeze he gives her fingers. The lines across his forehead are softer and his breathing is less labored. “Can I get you some ice chips? Does that sound good?” She thinks of his sudden relapse a month ago, moving from solid food to thick liquids, and she remembers her despair, her unwillingness to accept the clear indication of decline. Now even a milkshake is more than he can handle and the refrigerator is filled with juices, sodas, flavored waters, anything that might tempt him to drink. “Could you try to get down a little juice, do you think? Would you try for me?”

She hates the whine she hears in this, knows he would hate it, too, but he has drifted off again and it doesn’t matter. She slips her fingers from his slackened grasp and begins to stand, when she is suddenly ambushed by fatigue, her legs leaden, her head too heavy for her neck. With only a passing thought for her half-prepared dinner, she lowers herself to the floor and sleeps.

When Anne wakes the room is dark, only a thin strip of wall and floor in the path of the beam laid down by the streetlamp. Darren is just a shadowy mound against the sheet, his breathing raspy and quick. It is a rhythm Anne has come to dread, the messenger of distress. Then the humming begins.

In the kitchen, squinting against the florescent brightness, she fumbles with the bottle cap, child-proof and invincible, a cruel joke in this place. In frustration, as the keening from the other room becomes more insistent, she pounds the orange plastic cylinder against the edge of the counter, dislodging the top and sending a spray of tablets in a snowy arc onto the floor.

“I hear you, Sweetie. I hear you.” Anne bends and scoops the pills with one hand into the cupped palm of the other. She funnels all but one of the pills back into the container, ignoring the crumbs and dust which have come along. The moan has become not louder, but punctuated in a way that makes it more imperative. “I’m coming, Darren. Just let me mix this up.” She presses the back of the teaspoon against the inside of the glass, grinding the last bits into powder, then lets a thin stream of grape juice trickle down onto the mound, stirring until there are only a few floating particles visible. She reaches for the flexible straw, then the 50cc syringe, and goes to her son. She switches on the small table lamp, settles herself on the edge of the sofa, and begins to work the end of the
straw between Darren’s dry lips.

“Suck in, baby. Can you get some of this in?” She watches the colored liquid begin to rise, fall, rise again. “Pull hard. That’s it.” The drink has reached the top of the straw and Darren swallows, but a lavender bubble appears at the corner of his mouth. He strains upward, not so much movement as intention, and Anne knows that it is beyond him. She slides the straw out, catching a dribble with the side of her hand. “That’s okay, buddy. It’s late. Let me do it this time.” She draws some of the doctored juice into the syringe and snugs the tip deep inside the cup of his cheek. Applying slow, steady pressure to the plunger, stopping occasionally to run a light, encouraging finger along the curve of his throat, Anne is able to give him most of what she has mixed. It is enough to take him, for a while, back into that drowsy twilight between consciousness and relentless pain. It is not the place Shelly would have him linger, but, for now, it is all Anne can manage.

Standing at the sink, Anne rinses the syringe and thinks of a smaller version she used when Darren was younger; he had had a run of ear infections and gone through several antibiotics. She remembers the bubblegum flavored one, pink and sweet as candy, and she begins to weep, a quiet spill of tears running, unchecked, down her cheeks. After all these months, she is no longer shocked when such a small thing, a familiar photograph, one random sock, a line from a song on the radio, can take her by surprise, almost bring her to her knees. Now, haggard and stiff from the cramped hours on the floor, she gives in, letting the swells of grief carry her. There is nothing to be done, no retreat, but only waiting until it passes.

She makes her way across the room, reaches for a chair and sits, resting her forehead on the cool vinyl of the table. Her face is damp and puffy and her eyes burn, but the crying is done. She is thinking of making a cup of tea when Darren calls.

“Mom.” His voice is whispery, but it reaches her.

In four long strides, Anne is beside him. “What is it? Is it hurting again, Darren?” She steels herself for his response, knowing that this will mean that the tablets are no longer enough. “Are you hurting?”

“M-m-m-m-m.” He takes in a shuddery breath. “Thirsty.”

She slumps with relief, such a tiny thing. “How about some ginger ale?”

“M-m-m-m-m.”

“Yes? Ginger ale?”

Anne is almost gleeful as she fills a plastic cup with crushed ice and pours in the pale liquid. This time, she’s certain, a straw will work.

Darren takes in a sip, swallows, takes in another. After a third, he uses his tongue to push the straw from his mouth and his lips form a word, but the sound is too soft and she leans closer. “Jean jail,” he whispers. Then he makes a sort of hiccup and his thin chest gives a lurch. It is his laugh at his own joke, his silly childhood name for the drink. His eyelids flutter open and, for the moment, he is completely present, his gaze direct and focused. He smiles, and though it is little more than a twitch of the muscles at the corners of his mouth, Anne smiles back.

“God, I’d forgotten about that.” She allows herself an instant of pure remembering, recollection without longing. “Jean jail and busketti.” There is the quiver of his smile again and she scrambles for another image that might keep him alert for a while longer.

“And roast beast. You loved my roast beast.”

His nod is a small movement.

“And smashed potatoes.” She settles into a squat, her head level with his, close enough for her to see the fine sprouting of blond fuzz edging his cheeks and chin. The hopefulness of this, a young body maturing, blind to its foreshortened course, could bring her to tears, but she will not let it, not now. “Do you remember what you used to do with smashed potatoes?”

His eyes are on her, staring straight into hers. “Vol– vol–”

“Volcano.” She waits for him to repeat it, but he only watches. “You piled them up into a volcano and dribbled gravy over the top for lava. Remember?”

“M-m-m-m-m.” He tries for another smile as he hums, and Anne suddenly sees how much this effort is costing him. The veins in his thin neck stand out like cords under the waxen skin and pearls of sweat glisten at his hairline.

“Oh, baby.” She brings the straw to his lips, hoping that this is all he needs, knowing that it is not. “Try a little more jean jail. You’re thirsty.”

“Hurts.” Then, “Sorry.”

What she hears in this one word, the plea for forgiveness, is like a blow. She searches his face, hoping to find some hint that she has misunderstood, but the regret is as raw and evident as the pain. She sets the cup on the floor, and brings her fingers to lie along the too sharp curve of his jaw.

There is a spiky cramp in the center of Anne’s own chest. Breathe, she tells herself, breathe through it. She remembers these as the words of the midwife who was with her during the hardest part of her labor with Darren 16 years ago. Transition, it was called, the stage when the powerful contractions were the closest together, allowing no rest time between. It had required all of Anne’s concentration, the focusing of every ounce of strength she had. And it was at the point of greatest intensity, of the most dramatic shift in her perception of everything around her, that she had been nearest to losing control, to calling out for something, anything, to give her ease. Once transition had passed and the pushing could begin, the midwife had promised, it would be better. Just make it through transition and the rest will be a relief.

Now, Anne takes one intentional breath, then another, willing her lungs to expand, and willing herself to recognize and accept any brief respite that might come to either of them, in whatever form it might take.

“It’s okay.” She is speaking to herself as much as to Darren. “We can get Shelly. It’ll be okay.” Standing, breaking this slightest physical contact with her child, Anne feels as if her flesh has been peeled away, that there should be raw patches at her fingertips where they left his face. She reaches for the telephone and begins to dial, aware of the throbbing that continues beneath her breast. It is less peaked, but settling into a broad, dull ache, something that will have a very long half-life. She feels the air pushing into that space, and for the moment she is doing what she can, all that she can, for them both. Breathing through it. Breathing.