Grave Secrets

(Contains themes of dying)

She lies on her left side, the skin of her right hip stretched over the protruding hip bone. Her legs are smaller than my 8-year-old’s. I touch her pale, clammy skin, feel the coolness, the lifelessness. I speak gently, just out of habit. The cloying antiseptic smell, with its undertones of earthiness, raw and slightly acidic, reveals the early stages of decay.

“Hi, Annie. It’s Kerri. Another night together.” I brush her hair with my hand, away from her forehead, and tuck it behind her ears. When I finish, a clump of the dirty blonde hair clings to my fingers. I take a long, slow breath and hold it, gathering my strength.

As I prepare to administer her midnight drugs—something for pain, something for nausea, something to keep a fever away, something to treat her bladder infection, something to make her rest, and something to keep her immunocompromised—I think about the two weeks she has been hospitalized.

Annie is a frequent flyer in oncology. Each time she looks more—less than. She’s losing weight after the initial plumpness from the steroids. Her eyes are glazed over, like the film on my bathroom mirror. One of these times will be her last.

She is a DNR, do not resuscitate, but her family is starting to waver. It happens. People make their decisions while lucid, still fighting, still brave enough to face their future. No one realizes that if their world becomes silent and small, if they lose their ability to speak, then family sometimes becomes afraid of the end and rescinds the DNR. I think that’s a shame. Worse, abhorrent. But I respect that each person must make their own decisions. I’ve seen it countless times.

Annie stopped talking three days before. I’m haunted by that night. I had finished giving her meds, turned her, rubbed lotion on her skin to ease the sheer friction from sheets. She seldom talked anymore and kept her eyes closed the entire time I cared for her. She unexpectedly grabbed my wrist with her skeletal hand, an impressive grasp that I didn’t think she had in her. Startled and slightly scared of this action, I looked at her. Annie’s eyes opened while she mouthed breathy words, lost immediately in the stale room air. I leaned my face close to her.

“Please, help me. Let me go. Make this stop.”

“What is it, Annie? How can I help you?” I placed my hand over hers.

“I’m done. Please. I’m done.” And she closed her eyes. Those were her last words. Every shift reported that she was nonverbal for the past three days.

I keep that night, those words, to myself. I don't tell the family, the doctors extending her care, or the other nurses. I cringe when I review her medical records at the beginning of each shift and note that her pain meds are being held. I only ask one nurse about the morphine.

“Why didn’t Annie get any morphine today?”

“She didn’t ask for any. She’s slept the whole day.” Innocent, maybe. Uncaring? I hope not. Most likely, she is unaware that Annie can’t tell us she’s in pain. Perhaps we should give the meds around the clock, regardless of Death sitting at her bedside?

“What are you afraid of?”

“That she would quit breathing, of course!”

I look at her, trying to keep my face passive, not showing disgust. “Maybe that would be a blessing.”

Now, I feel I’ve put a target on my back. If all the nurses have quit medicating Annie, and I’m the only one, it might look suspicious.

Hospice has not been called in yet, allowing morphine and sedatives to be freely given, and sometimes even increased. You can’t tell me that we don’t practice active euthanasia at times, under the guise of comfort care.

I have two nights off and pray for Annie’s comfort. I have grown close to her during her other admissions. I know her children's names, Charlie, 14, and Claire, 12. They know their mom is dying, Charlie silent and stoic on visits, Claire, unashamed, crying and holding her mom’s hand. Annie was diagnosed when they were just 9 and 7. The first years of surgery and treatment allowed quality time with her family. Between chemo rounds, they took trips, visited old friends, saw new places, and eventually rested on beaches. Annie talked about time with her family; her goal was to live long enough to see them through school.

Without a miracle, she won’t see them finish high school, but at least they are older now and have good memories with their mom, before things spiraled down these last few months.

When I return two nights later, Annie is still here. Well, the shell of her, anyway. She never regained her speech; she doesn’t attempt to verbalize. I’m again in awe at how long the human body can hang on. I swipe her dry, cracked lips with lemon-glycerin swabs for some minute moisture. I notice she doesn’t reflexively suck on the swab, as some patients do in a semi-comatose state. Her tongue is like a strap of leather, too dry to absorb this tiny gesture. Her body is withered and cracking like a desert bed at the end of summer.

Her parchment skin, translucent and slack, has a few new skin tears. This is my final straw. I cry. I sob as my tears drop on her arm, and I rub them into her skin.

“What can I do, Annie?”

I wish I knew if she is suffering. I tell families their loved one is no longer in pain at this stage. But what do I know? What is Annie thinking? Can she think in this state? God, I hope not.

And then her words come back to haunt me.

“Please, help me. I’m done.”

I’ve not forgotten. But I’m helpless. No one has given the morphine, so it’s not like I can give a generous dose and ease her out of this world. And it’s so wrong. But she’s dying. Who is to say it will be tonight, or another week? She’s still fed through a gastric tube and receiving supplemental oxygen. She could hang on a bit more. Is this fair?

I think of my old dog, Archie. I had to put him down last year. Poor thing suffered from severe arthritis and failing kidneys. I had to carry him outside. Archie was in pain and afraid, reflected in his cloudy eyes. He would whimper. I did what I had to do out of love and respect for our life together. He was 16, the end of his journey.

But a human being? Still breathing? Somehow. I question the essence of life at these moments. This isn’t my first death watch.

But she asked for help. She’s going to die. She begged. She is my friend. It’s not like I’m a beneficiary in her will. I gain nothing by helping her. But she gains release.

“I won’t let you be alone, Annie.”

I hope she is not afraid. I hope she is not capable of thinking or feeling. Perhaps the moment we die is glorious. I want to believe those final seconds are peaceful and magnificent, filled with a mystical and magical swirl of indescribable color and sound. I wish I knew whether she wanted her family to be at her bedside.

I wash her gently and put fresh linens on the bed. I cover her sparse hair with one of her colorful scarves. I walk out of her room and down the hallway, seeing all the nurses are in other patient rooms or off on break. I go to the medicine room, open the refrigerator, remove the vial, and slip it into my pocket. I grab a syringe.

I return to Annie, still lying precisely as I positioned her. I silently pray while I remove the insulin vial and draw up an entire syringe. I connect the syringe to the needleless port of her IV and slowly push while I talk softly to Annie. I discard the syringe in the red box and leave the room to call her family, telling them I think the end is near if they want to come. I go back inside. There will be no trace of the insulin, and the cause of death is expected. There is no record of morphine. Annie will simply fade away when her blood sugar reaches a critical level, and her heart will stop. The family arrives just minutes before her final breath.