Last Breath

Carl considered the 12 hour shifts part of his life. Arriving at 8 AM to the home of someone dying a slow death required a very early rise plus the travel time to get there. Once he arrived and did the transfer briefing with the home care aid finishing the shift, he spent a long day mostly sitting and watching. Carl was a hospice aid.

This occupation fell naturally to Carl. As a young boy, his aged Nanna had lived in the smallest room of the apartment with his mother and sister. Carl would often sit with Nanna just watching her dozing in front of the small TV that endlessly played the soaps. The tiny room was filled with crucifixes of Jesus on the Cross, St Peter and various other icons plus one photo of President Kennedy. Nanna often explained that the puzzles and questions of this life would be answered when she was in the arms of Jesus; that is, after she died. She was okay with that. Why Carl’s father disappeared; why her husband had died young; why the family struggled with the problems of each day. All these and more would be resolved when she left this mortal coil.

When she finally did die, Carl was 13 years old and saw the peace in her face as prepared by the undertaker. He too felt okay with her passing.

Now, 20 years later, Carl’s job consisted of attending to the needs of someone in the final days of life. Usually it was a person of advanced age who’s body was failing one organ at a time until the last breath was drawn. In the mean time, that person deserved to be made as comfortable as possible with palliative medicine, usually some form of morphine derivative. Carl would keep them as comfortable as possible with sponge baths and administrations of medicine while making sure the oxygen flowed under their nose. That is, most needed the oxygen to help them breath without distress. This lowered their stress level, but did not necessarily keep them alive.

The final decisions had been made, the next step had been chosen. The only question was ’how soon’. That was the primary question posed by the family in attendance. For the fortunate ones, there was a group of family and friends speaking in somber tones until the patient perked up upon hearing the voices nearby. A remarkable, last revival often occurs that inspires the family and energizes the patient. Carl was always struck by the energy that flows from the family directly into the patient. Occasionally, the revival is so strong, the patient recovers to the extent that Carl’s services are not needed for a few days or weeks. But that is rare and only temporary; soon he is called back to tend and watch.

As the patient becomes less and less responsive, the 12 hour shifts seemingly become longer and longer. The company Carl works for requires he keep his laptop computer on and open with a near-continuous stream of questions and interactions Carl must respond to as proof he has not fallen asleep. 

It would seem the temptation to nap was tremendous. But for Carl, his senses would sharpened as he wanted to be there and hear the last wheezed breath. This would likely happen at a time there was no family in the room as if the patient could sense the absence and choose this time to pass. The drone of the oxygen pump was like white noise and there would be the background sound coming from a TV in the room. The breaths would become longer with extended gaps between each of them. No panic, just peaceful inhale, pause, exhale, longer pause, then inhale again. Carl would watch in anticipation to see if IT would happen again. 

****

Today, Carl was at the home of Salvador Aldo. Sal was 89 years old and suffering from a number of terminal ailments that made him an ideal candidate for hospice care. He was ensconced in a hospital bed in the middle of the living room as getting upstairs to the bedrooms was out of the question. The bed was arranged so he could see his beloved garden in the back yard as well as the TV hanging on the wall. There was a Classic Movie channel playing continuously with the sound at a low volume. The furniture in the home was perfect for this couple: Provincial style that probably dated back to the early days of their 65 year marriage. This was the third day Carl had been with Sal and was positioned on an uncomfortable chair behind Sal’s bed. His wife, Marie, was in excellent health and a coterie of her friends had been coming and going over those days. Sal was clearly failing and Marie had sent them away. She had tearfully explained that their son was stationed overseas and was unable to be with her. 

Sitting and doing almost nothing day after day was truly exhausting. Marie said, “Do you think I can lie down for a quick nap? I am totally drained.” 

“Of course, you need to keep your strength. I will be here.” Carl thought that the end was nearing for Sal, but said nothing about that as Marie left the room and trudged up the stairs. Sal, apparently sensing her absence, slowed his breathing. Carl noticed this and paid strict attention to see if the end was actually near. It was important for him to hear the last breath. Thoughts of waking Marie for this fled his head.

Finally, Sal exhaled, his jaw slackened and breathed no more. And yes, IT was happening again! Carl saw the bed creak and instead of simply lying in repose, Sal began to vibrate. Suddenly, there seemed to be a separation within Sal and soon a version of Sal was sitting on the edge of the bed looking at Carl. Now the body of Sal was still and quiet just as he was after taking that last breath.

Sal’s apparition appeared a bit confused and said ‘Who are you?” in a language that sounded like Italian, but Carl spoke no Italian.

However he understood every word and responded softly in English “My name is Carl.”

“Why are you in my house?”

“To help you in your last days,” Carl said and swallowed hard to keep his composure. This had only happened once before and he had been so freaked by the event that he ran out of the room leaving the apparition behind. By the time he returned, it was gone. This time, Carl wanted to learn more. “Marie is napping upstairs, do you want to see her?”

“No, we said our goodbyes already. I guess I am on my own now.” He turned and looked out the window sighing, “I see my garden is not looking so good right now. I haven’t been keeping it up...”

Carl interrupted him, “You do see you’re not Sal anymore. Sal is lying on the bed.”

The apparition turned the other way and contemplated Sal’s body without alarm, “Well, you’re right about that. So what am I?”

“Damned if I know. If I had to guess, you are Sal’s ghost...,” then Carl muttered, “whatever that means.” Brightening, Carl asked, “What does it feel like to be a ghost? Are you in pain? Do you feel anger or remorse?”

“No, no pain. No feelings. I guess it feels like nothing.”

“But you commented on the condition of your garden.”

“I did say that, but it just felt like something to say. In fact, I used to hate that garden, it was like a slave driver that got me out of the house away from Marie. Now, I just don’t care about it.”

Carl was wondering if there was anything to learn from this ghost, “Hey, how about telling me where the cash you must have is stashed. There must be some secrets from beyond the grave.”

Sal’s ghost gave a sly smile, “Not really, Marie knows our finances. But there is about two grand in cash under the old watering can in my greenhouse. That’s my mad money that I never spent. I have no secrets... Well there was that time I had a little fling with a waitress in Rome when I was on a business trip back in ‘84. Never did tell Marie about that. Just as well, she wouldn’t have taken it well.”

“OK, that’s interesting. What about regrets, you lived a long life. What do you regret?”

This time with a sheepish smile, “My big regret is not buying Microsoft stock in 1986 at $21. Boy that would have been something. Other than that, I lived my life. It’s over now.”

Carl tried another tack, “So you have led a good life. That’s great. Do you see Jesus or God or anybody like that? Maybe St Peter?”

“Nope. Just you. And you are starting to get a bit fuzzy around the edges.”

“Tell me, is there anything you feel strongly about?”

A shake of the head, “Nope. I do wonder what’s going to happen next. Fact is, I am getting kind of tired. I think I will lay down for a bit”

Carl watched as the apparition rolled over as Sal’s body started vibrating again. The ghost just shimmered into the body and disappeared. Carl simply stared.

He was jolted by the alarm sound coming from his laptop. He had missed one of the mandatory activity sessions. Still staring at Sal’s body, his cell phone rang. The dispatcher was following up on the failed activity session. Answering the call Carl said, “Sal passed about 10 minutes ago. I was just about to call you. I will need a medical sign-off on the time of death. I am going to wake his wife from her nap.”

An hour later, Carl and the Nurse Practitioner were consoling the remarkably calm Marie. She initially was very upset to be asleep when Sal died, but seemed to understand that Sal wanted to be alone at that moment. It was comforting to her that Carl had been there with him, “Did he say anything before he died?” 

“No, it was very peaceful. He took a last breath and passed away,” Carl said with no intention of adding what had happened after that. 

****

A month went by and Carl had helped a few families say goodby to a loved one. Most had passed when Carl was not there. When he was, IT had not happened again. 

He received a thank you note from Marie Aldo. It was common to hear from the families he helped, but this note was different. Marie thanked him for his care but especially for the note he passed her just before leaving the house. The greenhouse money had been a life saver to help with the funeral expenses. She did not ask how he knew about it.

Carl was becoming convinced that the dead folks have no more clue about what is happening than the alive folks. He had doubts that Nanna got her answers. There are mysteries just not meant to be known.

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