Passing Page 22

  I remembered reading about the death of Atul Gawande’s father in Being Mortal: “The suffering [he] experienced in his final day was not exactly physical, the medicine did a good job of preventing pain.” It was what was in his father’s mind that caused the pain, the knowledge that he was dying. None of us can know what this feels like until we get there, which most of us will, except for those who die instantly and without warning, or those who are so lost in senile dementia that they slip unaware into death. The vast majority of us will go as Margaret was going, knowing in some corner of the mind that we are moving inexorably into the unknown, floating away from life toward extinction, our mind awash in memories about to be forgotten forever, hopes for the future that will never be fulfilled, things we wish we’d never done, things that we’d hoped to do and never will, words that we wish we’d never spoken, words that we wish we could speak but it’s now too late, fears for those we are about to leave behind, and for ourself.

  Did she remember being given her first pony Snowy at the age of the four, Sunday dinners at Robin’s Mill with her father and mother, the silverware gleaming on the table and her father cutting paper-thin slices of roast beef (Paul was a masterful sharpener of the carving knife and carver of paper-thin slices, and Margaret expected her husbands to be as well), her first love, the years in Kenya, her marriages? Did she remember how she used to be able to bring a room full of people to awed silence simply by sweeping in wearing white silk pants from Jax, skintight from the waist to the knees, belled below, and a black silk blouse without a bra (she never needed one)?

  Perhaps her favorite song was Jim Morrison of the Doors singing “Twentieth Century Fox.” “Well, she’s fashionably lean / And she’s fashionably late / She’ll never wreck a scene / She’ll never break a date / But she’s no drag / Just watch the way she walks . . .” It might have been written with Margaret in mind, it was her theme song, at one time in her life she sang it as she walked around the apartment on Central Park West naked, “No tears, no fears / No ruined years, no clocks,” she was “the queen of cool.”

  Did she remember the first time we made love after riding in Central Park in that same apartment, when I had to struggle to pull off her tight riding boots without a bootjack as she lay on the bed? In a marriage our own happy memories are not necessarily the same as those of the other person. That is perhaps the last secret we take with us.

  Dr. Gawande is right to remark that his father was “at peace in sleep, not in wakefulness”—so was Margaret. Awake, her hands began to tremble and she struggled to speak, often unable to find the word she was looking for or to pronounce it when she had. Asleep, her eyes closed, her breathing was calm—already slightly irregular, but not yet alarmingly so—she looked relaxed, perhaps dreaming of the past. It would have been nice if she had been carried toward death dreaming on an unbroken tide of happy memories, whatever they might have been, but it didn’t happen, perhaps it doesn’t happen to anyone unless they die in their sleep. I held her hand and talked to her about places we had been, things we had seen, dinner parties she had given in the days when she still gave formal candlelit dinner parties, black-tie, all her parents’ silver on the table, the Spode red-and-gold-dragon-pattern china glinting in the candlelight, the Baccarat glasses that had to be hand-washed because they were too fragile to put in the dishwasher; about dinner parties we had gone to, about our trip to India, which had been a disaster, and our trips to Egypt, which we had both loved. I talked until I was hoarse, what mattered was the sound of my voice, not what I said. Silence increased her restlessness if she was awake; after all, she was about to get an eternity of it.

  I waited for “the surge,” the sudden, unexpected burst of energy that is supposed to precede death in what the HVH caregiver’s guide calls “the end-of-life,” a new experience for both of us. Margaret as far as I know had never attended a deathbed. I had seen plenty of people killed in the ten days I spent in Budapest during the 1956 Hungarian Revolution, but that’s not at all the same thing as sitting for hours next to someone you love who is dying.

  A day later the surge came at last, Margaret suddenly seemed to revive, her speech improved, thin and bedraggled as she was, she looked more like herself. If one hadn’t known better, one might have thought she was recovering, but it was a cruel illusion. When I came back into the room after taking a short break, one of the nurses said that Margaret had been talking about hoses, did it mean that the tube of the catheter might be causing her pain? I sat down and listened to her carefully, and after a time I recognized the word “horses.”

  Of course Margaret would want to be reassured, above all things, that her horses would be looked after even though we had already made arrangements that this would happen, so I took her hand, which felt as thin-boned and fragile as a bird’s wing, and promised her again that I would look after her horses, and the ghost of a smile passed across her face, following which the surge ended, her eyes closed, she slept.

  I sent an email to Donna to say that Margaret was very quiet now, and weaker, although her breathing was still normal.

  The next day, Donna came by in the morning for coffee. After she had examined Margaret I asked her how long Margaret had to live, a question I could not have imagined asking a year ago. It could be a matter of a few days, she thought, perhaps even only a few hours. Had I thought, she asked gently, about making the funeral arrangements?

  As it happened, I had already been in touch with our local funeral home, so at lunchtime Dawn and I went down to meet with the owner, Michael Sontheimer, and finalize the arrangements. As an admirer of Jessica Mitford’s The American Way of Death, I was expecting the kind of nerve-wracking, high-pressure negotiation that accompanies the purchase of a new car, but nothing of the sort happened. Sontheimer was gracious, his manner was sympathetic, he was businesslike and quick to put me at my ease. I explained that Margaret wanted to be cremated, she did not want to be embalmed or to have an open casket. He did not try to talk me into or out of anything. She could be cremated, of course, and her remains placed in any container I chose, and the viewing, when it took place, could be focused on the container rather than a casket. I leafed through the catalog of containers. Are there really people who put their loved one’s “cremains,” as they are called in the funeral trade, in a faux-magnum of Dom Pérignon champagne, with the name and dates on the label? Nor did I think Margaret would want to be placed in an elaborate urn or a statue of an angel with unfurled wings and a screw-in base either. I chose a simple polished wood box instead.

  Apart from signing the contract there was nothing more to do—Sontheimer would have the body picked up night or day as soon as Margaret “passed,” arrange for cremation as soon afterward as possible, collect the ashes, and arrange for the certificate of death. Since I was a writer, I might want to have a stab at preparing an obituary, people often left this to the last moment, but he thought it was best to be prepared. We exchanged a solemn handshake and I returned home. It had not been difficult at all, much easier than buying a car, although I felt some guilt, as if I had betrayed Margaret by talking about her cremation while she was still alive. Could I look her in the eye and say, I was just down in Pleasant Valley arranging for your funeral?

  But of course there was no need to do that, she was now fast asleep, the surge, such as it was, had passed. I went down and started to gather the information I needed for writing her obituary, and emailed our friend Carol Kozlowski, president of the United States Eventing Association, to get a list of Margaret’s competition highlights over the years, conscious that it would be the thing she most wanted me to get right. Carol sent it at once, and I saw that from 1996 to 2006 Margaret had placed in the year-end awards nine times, five times winning national first place. “She was a force to be reckoned with, for sure,” Carol commented when she emailed the list. More remarkably, Margaret was sixty-six years old when she won her last national first place, amazing in a tough, demanding, and dangerous sport where most winners are in their t
hirties and forties. It didn’t take much time to write the obituary. I had been thinking of it for several days, and as a regular reader of the obituaries in the New York Times—as I get older I am always interested to see how many people in my age bracket have died, and whether I know any of them—I did not find it difficult to strike the right note. I wrote a long obituary for our local paper the Poughkeepsie Journal and a shorter one for the Times.

  Upstairs, Margaret was much the same, asleep, which was surely a blessing, the only change was that her teeth were now so firmly clenched that giving her a pill was very difficult, nor did she react to having them pried open just wide enough for the nurse to slip the pill in and under her tongue. Over the next two days Margaret followed the “Signs and Symptoms of Approaching Death” to the letter, except for the one entitled “Saying Goodbye”: there would be no opportunity to “share forgiveness, or let go of past conflicts,” as the booklet put it, nor to “share expressions of gratitude.” Otherwise, all followed in exact order as the booklet predicted: restlessness, difficulty swallowing, further discoloration of the skin, ongoing changes in breathing, rattling breath sounds, weak pulse, further decrease in blood pressure, decreased urine output, eyelids no longer able to close completely. Well, no rattling sounds as yet, but the changes in breathing were the most difficult to bear, it was as if she were struggling silently for breath. She no longer tried to speak, but her eyes were partly open, staring at some point above the fireplace that faced her. She could still see and hear; it was fearful to imagine what must be going on in her mind despite the Valium, Haldol, Ativan, and morphine. Did any of it reduce or obliterate her knowledge of what was happening to her? Perhaps, her eyes did not reflect terror or fear; I would like to think that they showed resignation, the recognition that the struggle was coming to an end, perhaps even gratitude that it was so. But it may be that we simply read what we want to in the eyes of someone we love who is dying, we want them to go peacefully, and therefore we see in their eyes the sign that they are at peace. They can no longer contradict us, they can no longer blame us for having been unable to help or for anything else. If they are focused on anything, they become, at a certain point, focused inward.

  Was Margaret saying to herself, I am Margaret, I am, I am, you can’t take that away from me—but of course death can and does, and was about to do so. Death, I reflected, is the most democratic of human experiences, we are all going there eventually, even the richest, the most beautiful, and the luckiest among us, nobody can buy their way out of it.

  Priscilla, the kindly, patient HVH aide who gave Margaret her sponge bath every two days, came that afternoon to bathe Margaret, but Margaret was unresponsive, in fact hardly seemed to notice that it was happening. I stayed, holding her hand, helping to give Margaret her medications, until late that night when I finally lay down on my cot outside the room. I was too tired, or too emotionally exhausted, not to sleep, although I was still wearing my clothes, but I was woken early in the morning by a series of long, urgent, terrible cries. I rushed into the bedroom, and looked at the nurse. She shook her head; whoever was crying, it wasn’t Margaret. Ruby was curled up on the bed beside Margaret, fast asleep.

  I looked at my watch, it was five in the morning. I could still hear the cries, louder now, and more urgent. I went downstairs, following the noise, turning on the lights as I made my way toward the kitchen. There, in the laundry room, Kit Kat was lying squeezed in the V-shaped space between the door and the wall, in obvious pain. I tried to put her on her feet, but she gave a piercing scream and was unable to move her back legs at all. I did not want to leave Margaret, but I knew what she would have wanted me to do or would have done herself. So I went upstairs, explained what had happened to the nurse, grabbed a blanket from the linen closet, wrapped Kit Kat in the blanket as gently as I could, and took her out to the car. Kit Kat had always had great presence, yet when I picked her up it felt as if she had shrunk to nothing.

  It had been many years since Margaret and I had last been in the emergency veterinary clinic off Route 55 in Poughkeepsie, and I wasn’t sure I could find it in the dark by myself without Margaret to do the navigating, nor was I even certain it was still in the same place and open 24/7, but it was. A kind vet examined Kit Kat. She thought the cat might have had a heart attack and fallen from the kitchen counter or wherever she had been and broken her pelvis. Kit Kat had been a hugely ambitious jumper, she took such big leaps (and broke so many objects that were in her way on tables and countertops) that we called her “the Flying Cat.” The vet said she could try to repair the pelvis, but . . . Her expression made it clear that it would be hopeless. Kit Kat was over fourteen, there seemed no reason to put her through the trauma of surgery. I sighed and asked her to put the cat down. I hoped Margaret would have done the same.

  I left at daybreak and drove home in the bleak dawn through empty streets lit by orange streetlights. I could see no reason to tell Margaret; even if she understood, it could only add to her woes, so what was the point? Her breath was now irregular and noisy, followed by long pauses during which she hardly seemed to be breathing at all. I sat holding her hand through the day. When Sylvan arrived at eight o’clock that night to begin his shift, he took one look at her and sighed. He was a professional, he knew what he was looking at.

  I did too that night. When the “death rattles” finally came, they were not as loud or as dramatic as they are sometimes described in fiction (and even in nonfiction), but they were distinct, and unmistakable for anything else.

  I gave her a kiss. I have no idea whether or not she knew it, there was no sign that she felt it, it was as if her whole being were being consumed in the death rattles. I dozed for a few minutes, then I felt Sylvan shake my shoulder gently. I guessed what was coming. Margaret’s breaths had become shallower, with longer pauses between each one, and finally at one-fifteen in the morning on Saturday, April 22, the pause grew longer and went on without interruption, no breath came.

  Sylvan leaned over, closed her eyelids, and said, “She’s gone.”

  AFTERWORD

  I worried a lot. Will the garden grow, will the rivers

  flow in the right direction, will the earth turn

  as it was taught, and if not how shall

  I correct it?

  Was I right, was I wrong, will I be forgiven,

  can I do better?

  Will I ever be able to sing, even the sparrows

  can do it and I am, well,

  hopeless.

  Is my eyesight fading or am I just imagining it,

  am I going to get rheumatism,

  lockjaw, dementia?

  Finally I saw that worrying had come to nothing.

  And gave it up. And took my old body

  and went out into the morning,

  and sang.

  —MARY OLIVER,

  “I Worried”

  LATE THAT NIGHT, after two men from the funeral home had taken her body away just as smoothly and unobtrusively as promised, I sent a message to everyone who needed to know that Margaret had “died peacefully at 1:15 a.m.”

  It is what one writes, it’s the standard phrase, like ending a letter with, “Sincerely.”

  Dying, or “passing,” as so many people prefer to call it, is a process, death the completion of the process. The truth is that I don’t know whether Margaret died peacefully or not. She died quietly . . . after the death rattles her breathing slowed and grew fainter until it stopped.

  Over the last few weeks of her life, her body, as Donna Engle predicted, started to shut down, whole systems simply failed, the body closed down organ after organ trying to preserve the spark of life at the core for as long as possible. Breathing, and with it the heart, are the last to stop, and then we are gone, to wherever or nowhere. Whether the experience was peaceful or not, who can say? Certainly, we all want a peaceful death, a painless transition into the unknown, and perhaps Margaret had one. I hope so.

  It took Margaret almost exactly a year to d
ie, if measured from her diagnosis until her death, but of course the process had begun years before, with the first appearance of the melanoma and her hesitation to have it biopsied, the enemy was already within the gates. Perhaps even five years ago it had already been too late to stop it from digging in somewhere in the body until it was ready to metastasize.

  One is left only with questions. Should she have had the patch on her cheek biopsied instead of covering it with makeup? Most certainly so. Should she have been told that she needed to have a PET scan once a year after the melanoma surgery? Very likely, but perhaps we should have thought of it ourselves. Was it worth having the second brain surgery after the tumors returned? Hard to say; she would have died sooner, and perhaps more unpleasantly, without the surgery. Certainly Margaret was mistaken to choose radiation instead of a second brain surgery when the tumor returned—she ended up having to undergo the second brain surgery anyway, and by then it was too late, she only lived for two months after it.

  We should have moved faster, we should have done this, we should have done that, perhaps Margaret should have been pushed harder into trying immunotherapy once everything else had failed, but you can’t push someone further than he or she is willing to go, and by that time it was clear to Margaret that whatever happened, the life she knew wasn’t going to come back, she wasn’t going to ride with the wind in her hair again, and she had the courage to recognize when she had had enough. One can torment oneself endlessly about what we might have done, but ultimately the person who has the cancer has to decide if and when to surrender, and do it knowingly, without guilt or blame.