Unremarkable Ends

Unremarkable white men have caused me more trouble in my life than any other demographic by far. I do not believe this to be a particularly unique or novel perspective, just one that deserves a featured mention, and consistent repeating. Moving on. 

I work as a registered dietitian, a nutritionist, except with more degrees and qualifications. I work in a hospital, with walls of glass and views of the bay. Clean lines, polished floors, and technology that is always being swapped out for something new and shiny. My last stop for the day is to visit Kevin in room 126. Kevin is a vegetable. I monitor Kevin’s enteral nutrition. His tube feeding. The slurry of calories and protein and micronutrients that flow through a sterile tube and directly into a surgically placed hole in his stomach. Osmolite 1.2 at a continuous drip, twenty-two hours per day. 

I am underfeeding Kevin. Not by much, not in any way that I can’t justify in my chart notes with the lines, kcal and protein adjs no longer required for activity or wound healing, and, some weight loss to be expected r/t pts current condition, will continue to monitor. These are not necessarily the best standards of care, but they are points I can argue should anyone ask. Though I doubt anyone will.

Kevin was once an unremarkable white man. I suppose he still is, though he hasn’t had any brain function for almost a year— which, to be fair, isn't so far off from all the others. Buh-dum-ch! His car went careening off of a dark road and into a tree one rainy night, while driving home from Tuesday Trivia at his local dive bar. He was drunk at the time. Kevin was usually drunk, so it’s not surprising that he was then too. It also shouldn’t have been surprising that he wasn’t wearing a seatbelt, as he was of a generation barely at the cusp of having such stringent safety precautions beaten into their heads by cartoon sedans and bouncing melodies. Buckle up for safety, buckle up! Buckle up for safety, always buckle up! 

It might not seem as such, but Kevin was very lucky. The form of a human body turns into more of a suggestion when it free falls into a tree going fifty-five, and it was a wonder he even managed to survive at all. Luck. Unremarkable white man luck. Someone’s luck. In any case, as I am curious by nature, I felt compelled to piece together the details of this miraculous feat, which I was able to accomplish by reviewing the ER notes, as well as the police report from the scene. Both of these I found conveniently labeled for me in his electronic chart.

Apparently, the car stopped moving when it hit the tree, but Kevin did not. His legs shot forward, only a few inches, before driving into the floor where they stuck in, then snapped at the knees when his torso retained its initial momentum. This is where the seat belt might have come in handy. 

For whatever reason, Kevin’s airbag was slow to deploy on impact, meaning that his chest hit the steering column and buckled, breaking ribs and collapsing a lung. His head sailed over top, likely colliding briefly with the windshield, based on the lacerations and cracked skull, before the airbag finally reacted and sent him careening back with some severe whiplash. The whiplash was likely to blame for his neck fracture, and his tongue being bitten nearly in two, but either hit could have been responsible for the brain bleed that left him comatose. I won’t make assumptions where such important credit is concerned. 

He was on my rounds list the morning after the crash. I call it a crash rather than an accident, because driving drunk without a seatbelt feels more akin to a deliberate act of hubris than something accidental. Anyway, he was on my list. The name startled me when I saw it, but I didn’t tell anyone. I should have, but I was far too tantalized to worry about the possible but unlikely repercussions. 

Before Kevin was a vegetable, he must have been some form of popular, because he’s been here for months and still receives visitors commonly. The nurses hate it, but I find it interesting to get a better sense of his world, the one he used to hide from me. I’ve met a few of his coworkers, old friends, his sister, and both of his parents.   

His mother is here today, I’m not surprised, she’s here often. She sits in her usual seat, the appropriately beige visitor’s chair in the corner, and looks up at me as I walk into the room. I can tell that her blue eyes have recently been crying, based on the puffy skin at their borders, and the red spider veins that snake their way through the whites. But she seems to have pulled herself together now, for which I am grateful. 

I am no good at emotions. Other people’s tears make me uncomfortable. They usually remind me that I would very much like to be crying myself, which then makes me angry, which then makes me feel guilty, and then I want to cry again. I find it hard enough to wrangle my own moods, let alone someone else’s. 

“Oh, Jenna.” Kevin’s mother says. Sniffling. Sigh. “I wasn’t expecting you today.”

I usually only round on the long term annex Tuesdays and Fridays, unless there’s an issue. Today is Thursday, so the nervous edge to her voice means she assumes that there is indeed an issue. I don’t assuage this concern right away. 

The room is dark when I enter. The curtains are drawn and only one bank of lights has been turned on. The various machines to which Kevin is attached glow ominously with blinking lights and neon lines that move in predictable patterns. He wants them to stay predictable, I however, am indifferent. 

A symphony of conflicting beeps and high pitched hums announce Kevin’s various functions of life; heart beat, pulse, oxygen saturation. I’ve found that if you sit in a hospital room long enough, your subconscious will usually start to pick out a melody through all that noise. One that only you can hear, one that will only make sense to you. Kevin liked jazz. So I like to imagine that his rotting brain is still filtering in hard bop riffs that don’t actually exist, but still repeat in endless, maddening chaos. I find this idea soothing.

“I don’t usually stop by on Thursday.” I tell Kevin’s mother, finally. Cheerily, and unhelpfully. I turn on the second two banks of lights and she squints violently against the fluorescent wave. “Sorry.” I offer, gesturing to the plastic clipboard in my hands, “I couldn’t see my notes.” 

“Oh, of course! Oh, please, don’t be sorry.” She says this with such genuine kindness that it makes my stomach sag. 

Mrs. Knieds looks like her son. The same deep-set eyes, the same sandy blonde hair, strong nose and fat lips. She must have been beautiful once. She looks like a woman who was once beautiful, before time had had its way with her, and turned her skin to age spots and crepe. She still carries herself like a beautiful woman. Genteel in the way that beauty can afford. Kevin was beautiful too, once. 

“Is there a problem?” She asks me nervously. 

“No, Mrs. Knieds.” I say brightly, begrudgingly retracting my claws. “There’s no problem, I’m just taking tomorrow off for a trip, and I wanted to make sure my complicated cases were ready for the dietitian who’s filling in for me.” 

Mrs. Knieds’ chest visibly deflates as she lets out a sigh of relief. “Oh, good. Thank you.”

“You’re welcome.”

I stroll over to the side of Kevin’s bed, where his bag of formula hangs on a pump connected to a metal stand. I check to make sure that it's still running as I’ve prescribed. That the water flushes are set to the proper intervals, and the hospitalist interns haven’t done anything inexplicable. I take shallow breaths as I do this, because Kevin stinks. Badly. 

He used to smell clean, like Bleu by Channel, and musky like Marlboro lights, but now he’s sour. Like his use by date has passed and he’s turned. Like stale wounds and unsettled death. Like perhaps the nurses have left him marinating in his own shit again. I smile mildly at that thought. 

He would look almost peaceful, lying there, if not for the intubation tube taped in his mouth, which I know is running thick down the back of his throat. His face is gaunt, where it was once full and dynamic and sharp. His skin is waxy and yellowed, or perhaps simply just so pale that it’s reflecting the harsh flood from the overhead lights. This makes me think of buttercups beneath the chins of summer children. Then it makes me think of jaundice, and I wonder if his liver is finally starting to give out. 

“He lost another pound this week.” Mrs. Knieds’ timid voice sounds at my back.

I bristle. Unfairly.

She isn't speaking with complaint or criticism, though her bashful expression tells me she’s worried she might be coming off that way. Rather, her question is simply one of unmitigated bewilderment, with perhaps a smidge of desperation. It's a mother, who has become powerless. A woman, who recognizes that she is, once again, powerless. 

She knows nothing of MRIs or Complete Metabolic Panels. She doesn’t know the right questions to ask or what she can do to help her son, but she knows he’s looking thinner. She knows how to read a scale. And because I am the keeper of that scale, she has no choice but to reclaim a tiny scrap of her power by annoying me; another woman who is well familiar with feeling powerless. 

“That’s to be expected, Mrs. Knieds.” I say gently. My body is currently blocking her view of the various tubes and wires connected to her son, so I reclaim a bit of my power by nonchalantly resting against the IV that drapes down the side of his bed. I press my weight steadily into it, so that it tugs against the needle stuck beneath Kevin’s skin. This would hurt if he could feel it, and though I doubt he can, the idea that he might allows my voice to remain sweet. “His muscles are probably just atrophying due to the length of inactivity, which would show up as continuing weight loss.” I flash her a reassuring smile, to which she nods, and then I return to my work.

“Where are you going?” She asks me warmly, while I scan Kevin for any new physical symptoms that might be nutritionally relevant.

“What?” I return dismissively. I heard her, clearly, but I’m hoping the need to repeat herself will discourage her interest in this piece of small talk, which I’m quite certain she doesn’t actually care about.  

“Where are you going?” She repeats, then clarifies, “for your days off.”

I’ve apparently underestimated her pathological need for pleasantries. I repress a groan, then paint a coat of bubblegum pink over my irritation, and answer impassively, “Santa Barbara, my mother lives there.” She didn't need this last detail, and I am horrified that I’ve allowed it to slip out.

“Well that should be fun!” She says, then continues to ramble on about her own visits to Santa Barbara. The restaurants she likes, Stearn's Wharf, the gardens, the beaches. 

Each word makes me dig my pen into my notes a little harder, makes my muscles tense and tears beg at my throat. Each word reminds me that I’ve just divulged a piece of myself that I wanted to keep. That she’s taking something from me. That she has her son’s eyes and his distinct cadence, and she is taking something from me. As inconsequential a thing as it is. 

“I need to check the condition of his G-tube, Mrs. Knieds.” I say very suddenly, cutting her off mid-sentence. 

I turn back to face her, and find her wide eyes blinking at me stupidly. She is obviously taken aback, and confused.

“I’m sorry, it's just that most family members don’t like to see the, um, the technical stuff.” I explain. “They don’t enjoy seeing their loved ones exposed that way.” I say this with a subtly pointed accusation, as though suggesting that she would enjoy seeing these things.

I want her to leave, and I want her to feel uncomfortable if she doesn’t. 

My ploy seems to work. Mrs. Knieds turns the color of August poppies, and begins to visibly fluster. There is a quick pang of guilt as I watch her collect her purse, but a brief glance back at her son allows me to suppress that feeling quickly. 

“I’ll just wait out in the lobby.” Mrs. Knieds says, her voice still quivering with the reedy adrenaline of shame. “Will you come let me know when you're finished?”

“Of course.” I reply, with a smile so sugary sweet it makes my teeth rot.

I don’t know if I will actually do this, but you aren’t allowed to tell grieving mothers no. You have to lie to them, with syrupy grins, and then do what you want.  

She gives me a painfully grateful nod, then disappears out into the hall. 

I watch the door fall shut, then turn back to Kevin. “Alone at last.” I slide, and then realize what an unbelievable miscreant I am, and resist the urge to drive my pen into my forearm. 

I suppose it’s very lucky that most people seem to find me conventionally attractive, or I’d have probably ended up in some form of societal exile by this point. Set to drift on an ice flow somewhere with all the other creeps and degenerates who didn’t inherit a genetic fortune. 

I shake my head to clear a bit of the revulsion I’ve just stirred up, and then move on to the task at hand. Which, I’m realizing now, is perhaps even more creepy, given the circumstances, but at least it’s professionally sanctioned, so I try to think of Kevin as just another patient. Moreover, I try to think of Kevin as just another patient who is basically meat at this point. Then I roll down the bedding, and gently lift up the hem of his hospital gown.

His body looks foreign and hostile. Like an alien landscape upon which I have been marooned without sustenance. Cold and desolate. Cruel. 

I can see his breath now, rising and falling at the command of machines, cradled in the hands of their whirring mercy. The concave pocket in his chest has always been there, but it’s sunk deeper now. As though something has been removed. As though it had once been the place where his life resided but no longer does. His soul plucked from his center, his spirit, his essence. 

He used to be formidable. I used to live in fear of the strength that now lays crumpled before me. He was still solid when he first came in, broken from the crash, but solid with muscle besides. Strategic rippling and bulging definition that he worked hard to cultivate, all of which has long since melted away. Like sealing wax. Now he's just flesh. Empty, sagging flesh. His bones still remain, hidden. Lost somewhere beneath the layers. But I can just make out the slight smile of an ilium ridge beginning to peek through, revealed by the slow starvation I inflict. I take a bit too much pleasure in that. I take a bit too much pleasure in the diaper sagging beneath his hips as well. I begin to feel like a creep again, so I move on. 

Checking the condition of a G-tube technically falls within the purview of the surgical team, but most surgeons are unremarkable white men, and very often arrogant. They tend to believe that their time is too precious to waste on anything besides cutting, and seldom follow-up with patients more than once, so I’ve gotten in the habit of just monitoring feeding tubes myself. Kevin’s looks good. As good as a plastic tube sewn into human skin can look, in any case. The site is clean, and there are no obvious signs of infection or leakage. I’m satisfied. 

I replace the hospital gown, and then the blanket, and then I just stand there for a moment. I pretend to make notes on my clipboard, but really, I’m just scribbling my name, over and over. The room is essentially empty, so I don’t actually know for whom I feel the need to pretend. Kevin? Someone who might happen to walk in? Myself? 

I pretend to make notes, but really, I am just taking in the sight of him, just like this. I’m studying how very helpless he looks. How very small. I’m letting that notion filter in through all the darkness that collects in my mind like smog. I’m trying to sate some of the slobbering madness. Tossing pleasing images to the beasts to bribe them back behind their gates. 

I stand there until I realize that my pen has stopped moving, and spotty warmth has replaced enough of the chill. Then I give Kevin a quick flick to his forehead, just because I can, and then I leave to go track down his mother. 

I will relent, I suppose. Though I still sigh. I will force myself to be the kind woman I know is still buried here somewhere, and I will go fetch stupid, teary Mrs. Knieds. I will do this because I don’t feel quite so heavy anymore. I will do it because suddenly, I am feeling much, much better.