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Dedication

This book is dedicated to the memory of John Kirk Farrar. He called himself Johnny K. I called him Johnny K. of the Milky Way. I guess that’s where he really does live now. More or less.

Once, I was writing an article about what things make the best Christmas presents. So I called John and asked him, “What’s the best present you’ve ever been given?” He thought for a while, and then he said, “You know how cats sometimes run sideways?” I said yes. He said, “That’s one.”

That’s how he was. That’s why I miss him. So many do.

ACKNOWLEDGMENTS

Well, of course I want to thank my agent, Lisa Bankoff, who handles my business affairs with such grace and integrity. And style. Many thanks as well to her assistant, Patrick Price, who gets things done, and done well. He is a man who can be trusted, no small thing.

I also want to thank my editor, Emily Bestler, for believing in this book and for stepping up to the plate in cowgirl boots to prove it. Thanks too to her assistant, Kip Hakala, for the many favors he does for me and for making our business dealings such fun. Whenever he calls, I feel like something good has just come on TV.

I am fortunate to have two daughters, Julie and Jennifer, who enrich my life beyond all measure. And I have the love of a good man, Bill Young, to provide a foundation I cannot be without. His affection is returned.

My dog, Toblance Floyd Ripken, king of the golden retrievers, deserves his own paragraph for the way he is a constant source of comfort and joy. Here you go, Toby.

This book could not have been written without the spiritual instruction I received at the hands of the many patients I cared for when I worked as a registered nurse. I thanked them then and I thank them again now. I thank them most of all.

The world breaks everyone and afterwards many are strong at the broken places.

—ERNEST HEMINGWAY
from A Farewell to Arms

PROLOGUE

The Tuesday before it happened was a perfect summer day. Driving through town on my way home, I saw two young girls holding hands as they tried to cross a street against the light. They would start to cross, then stop; start again, stop. Finally, all the traffic sighed and halted; and the girls bolted to the other side of the street and began to laugh and push each other, exhilarated by their survival.

Next I saw an old woman sitting at a bus stop, eating an ice cream cone with the neat precision of a cat. She wore a yellow print house-dress and white, orthopedic-style sandals, and her purse sat on the bench a slight distance from her, as though it were her companion. One leg was crossed over the other, and her foot swung rhythmically. She stared straight ahead, seemingly lost in memories.

I passed a very small child walking delicately along a stone wall, holding onto her mother’s hand. It was a graceful pas de deux; love lay strung along the length of their joined extremities, love and pleasure. And heartbreaking certainty.

I drove by two boys about eleven years old, riding the hell out of their bicycles as young boys do, their real manhood still so frustratingly far off. You could see their sweet toughness in the straining cords of their necks. Each kept passing the other, shouting roughly, shouting insults; but each always looked back to make sure the other was coming.

Two blocks from home, I went past the library and I knew I could go into the children’s room and sit in a chair and watch, enjoying every damp curl, every dimpled elbow, every throaty question, every pair of eyes turned upward toward a parent—the wholeness of that trust! I could press my own hands over the children’s small prints on the walls of the hamster cage, trying to see what they saw, as they saw it. I could turn the pages of a book that one of them had looked at, then left behind. The question: Why was this not taken?

Yes, and I could stay for pajama story hour, as I often had, and watch the children who gathered on the carpet with their matted, sleep-scented stuffed animals. I could enjoy the children’s unashamed eagerness—yanking their thumbs out of their mouths and rising up on their knees to see the pictures, resting their hands unselfconsciously on those ahead of them so that they would not lose their balance.

I suppose I might then have gone upstairs to the reference room, pulled down a weighty text, and searched for some wondrous fact I had never known. I might once again have sat at a wooden table, my own purse on the chair beside me, waiting for words to offer their touchless embrace.

I did not do these things. I headed home, toward what I had come to believe was my destiny.

Chapter 1

You know people like me. I’m the one who sat on a folding chair out in the hall with a cigar box on my lap, selling tickets to the prom, but never going—even though in the late sixties only nerds went to proms. But I would have gone. I would have happily gone; I would have been so happy. I wanted the phone call with the rough voice asking “Would you …?” I wanted to finger row after row of pastel dresses in silks and chiffons—their sweetheart necks, their wide ribbon ties. I wanted to have some shoes dyed; I thought it was a miracle they could do it. I wanted to put a wrist corsage in my refrigerator, lock the bathroom door, and bathe in perfumed water with rollers in my hair and the transistor at the edge of the sink blaring “Sugar Pie, Honey Bunch.” I wanted to allow an hour for the application of all my new Maybelline, suffer the flash-bulbs of my parents’ eager camera, stay out all night, and eat breakfast before I came home, bleary-eyed and in the know.

I didn’t get asked. I never once got asked. Not to proms, not to lesser dances, not to movies, not to parties, not for shopping with the girls.

I would get talked to, though. I mean beyond the “Hi!”s in the hall, beyond the preoccupied chatter in the lunchroom. I got talked to a lot. They would call me on the phone, the pretty girls. They would call and talk to me about things that were serious: their parents’ alcoholism. Their hidden scoliosis. Their possible pregnancies. They talked to me because I knew how to listen, and I gave good advice. I didn’t have a lot of personal experience, but I knew things, because I read and I watched. That is what there was for me. Those girls talked to me—and a boy, once, too—because they knew I would never betray them. Of course they betrayed me constantly. But they didn’t really mean to. Probably they didn’t know. They didn’t think about it that much.

I’m the one everybody liked, Myra Lipinski, oh yeah, Myra, she’s nice, the one that everybody liked and no one wanted to be with. The odd shape. The socks, those socks—well, her parents had accents. The face, unfortunate, with its too small eyes, its too wide mouth. The hair mousy brown, too thin and straight, greasy after half a day, no matter what. Even as a five-year-old: the aunt and uncle who once came to visit, sitting with my mother at the kitchen table, chatting quietly in Polish, and smiling over at me. “What are they saying?” I asked my mother, coming over to stretch myself out across her lap and shyly smiling back at them. “What are they saying about me?” And my mother finally breaking into English to tell me, “They say you look like … your father. And now we are not anymore talking about you.” I lay still in her lap, contemplating the yellow-and-orange pattern of her apron and forbidding myself my thumb, until she crossed her legs and dislodged me.

So. I sold the tickets and I decorated the gym and I helped win the volleyball games and I sang a good alto in the choir and I lent my notes to anyone who asked; and if people wanted to copy from my test paper, I let them do that, too. I did not become bitter. I don’t know why. Maybe I didn’t think I had the right.

After graduation, I stayed here in Ashton, venturing no further than the twenty-two miles necessary to get to Boston College, where I earned my BSN. I went to nursing school because I knew it would be a way for people to love me. And for me to love them, too. This happens in illness. The sad plates of armor separate; the light comes in.

At first, I worked in the intensive care unit. I wanted the challenge and the prestige of working in the hardest place. You’re eating lunch in the cafeteria, wearing your scrubs, your high-tech stethoscope around your neck, a hemostat clipped onto you somewhere, tourniquets tied onto it. You know a long list of lab values cold; you could intubate if you had to; you can rate heart murmurs and evaluate lung status and draw blood and start IVs better than most of the attending physicians. You see a burst of ventricular tachycardia race across a monitor screen and you save the patient and let the doctor know about it when you get around to it. You can give a lot of drugs that nurses on other floors can’t. You can decide when to get certain kinds of tests performed. When you call down to any other department in the hospital and say, “This is ICU,” they pay attention. You come first. When you say stat, it gets done stat.

So you’re eating lunch and a code is called over the loudspeaker, and you get up and run back to the unit. It’s likely you’ll be needed, no matter where in the hospital the arrest occurred. The other people in the cafeteria watch you leave your bowl of soup sitting there, and they nod at you as you pass by. In the army of nurses, you wear four stars.

The pay is pretty good, too, especially for a single woman with no obligations—only child with no children, parents dead. I bought a little two-bedroom house a couple of blocks from the center of town. I bought a Porsche Carrera 911, too. Black, tan leather interior. Incredible sound system. The boys look when I pull up next to them; then look away. I beat them off the line, every time.

The problem with intensive care is that the patients usually can’t speak. They’re on respirators. Or they’re unconscious. Or they have such messed up chemistry that they’re confused. Or they stay just until they’re stabilized, and then they’re out of there and another train wreck comes in. That’s what the bad cases are called: train wrecks. It doesn’t mean what it sounds like. What it means is: right now, I can’t get close to you, you’re halfway to death. And anyway, I don’t have time.

So there’s no opportunity, in the unit, to sit at the side of the bed and shoot the breeze with patients. To get to know them. To admire pictures of their children, to style their hair, to slowly help them eat. Not that many of them eat. Tubes. I know a nurse who works in the unit precisely because the patients don’t eat. “I didn’t go to four years of nursing school to load mashed potatoes onto a fork,” she says. But I like feeding people. It doesn’t feel demeaning. It feels like high privilege.

The best day I had in the unit came when we had a boarder, someone who couldn’t get put onto the floor where she belonged; it was full. She ate. She sat up in a chair. She was oriented to time, place, and person. She dug in her purse for lipstick after her bath. The unit was light that day; she was my only patient. She told me she had a crush on her doctor—no surprise, everyone had a crush on Dr. LaGuardia, with his dark, South American looks—so I told her I’d curl her hair, and she’d look beautiful when he came to visit her. We used 4 × 4 gauze pads to make rag rollers, and she did look beautiful when he came. I stopped him outside her cubicle, told him to be sure he noticed her hairdo. He’s a good guy, Dr. LaGuardia. He walked in the room and stopped dead in his tracks. “Where was the beauty contest?” he asked, in the accent you could feel in your knees. “Where’s the trophy?” Then he told her she could transfer to her floor now, there was a bed available; and twenty minutes later I was taking care of a gray-faced man with multisystem failure.

I stayed working in the unit for a long time. I mixed drugs, counted drops, monitored machines, resuscitated people who arrested, then resuscitated them again when they arrested half an hour later. I rarely had enough time to talk to their distraught family members. I had to walk away from their sad, worried clusters; I had to go and milk chest tubes while they wept and talked in church-quiet voices.

Oftentimes, I worked in my dreams. I heard the beep-beep of the IV telling me the infusion was completed, the rhythmic sighs of the ventilator, the dull bong of the alarm on the heart monitor. I changed dressings in my sleep, emptied urine and bile and drainage from wounds into toilets, sent polyps and kidney stones and spinal fluid to the pathology lab. I tested feces for blood, tested urine for blood, tested vomit for blood, kept track of each ounce that went into a patient and each ounce that came out, monitored levels of consciousness, listened to lungs, to hearts, to various levels of activity in the four quadrants of the abdomen. I awakened after those nights feeling exhausted, feeling like I’d just put in eight hours at the hospital after having just put in eight hours at the hospital. Or nine. Or sixteen.

These days I work for a Boston agency called Protemp, as a visiting nurse. When I was hired, I asked for easy patients; I was tired of high acuity levels. Now that I’ve been there for ten years, I don’t think I could hear a heart murmur if it were as loud as sandpaper on sandpaper. But I’m happy. And when I sleep now, I am back to dreaming only gauzy mysteries.

I have some clients I see daily: Rose Banovitz, who lives in a seedy area on Commonwealth Avenue and needs her morning dose of insulin, and who often sings to me in her high, quivery voice. Fitz Walters lives in Chinatown and needs me to check his blood pressure and his wildly erratic heartbeat in order to determine his dose of Nitropaste. He goes to strip clubs every night, Fitz, though he is blind. The Schwartzes live in the heart of Brookline and need weekly visits to supervise their medications and to keep them from killing each other. Another once-a-weeker, a black woman in Dorchester appropriately named Marvelous, I will keep on seeing even after I’m no longer paid to help her with her colostomy. I also see one DeWitt Washington, because nobody else will put up with the combination of his personality and his neighborhood in Roxbury. I have to go every afternoon and change the dressing on his gunshot wound.

I give eyedrops daily to a rich woman in Back Bay, Ann Peters, who can’t see to do it herself and whose family can’t be bothered. And since last week, I’ve been going to Allston to see a fifteen-year-old girl named Grace to help her with the baby she just had. I gave her my home number, and she leaves me messages at least once a day. Things like, “Okay. His shit looks exactly like scrambled eggs. No way is this normal. All I do is fuck up, and he don’t even cry. Can you call me? Sorry for the swears, can you please call?”

You know the boy who once called me in high school? That was Chip Reardon. He called because he knew I had been talking to his girlfriend, Diann Briedenbach. They were having trouble. He wanted advice, some inside information. He felt comfortable asking me—we’d had a lot of classes together and he knew how carefully I observed things. Once, in fact, after an essay of mine had been read aloud in English, he stopped me after class to compliment me on my perceptiveness. I treasured that small event, carried the memory of it home from school like a wrapped gift. I even decided, foolishly, that had the bell not rung, that conversation might have led to something more. I remember getting home and looking at myself in my parents’ full-length mirror, wondering if I’d finally worn something right, something that would make a boy like him really see a girl like me. I’d worn the same outfit a week later, down to the same color tie to hold my hair back, but of course nothing happened.

Anyway, when he called that night I told him only that he shouldn’t worry, Diann loved him, I knew that for certain. He thanked me, though it seemed to me that his relief was not so great. But then I decided I was only making that up, trying to make him less invested in her than he really was. After we hung up, I put my fingers to the place his voice had come from.

As there is one of me in every high school, there is one of Chip Reardon, too. Other end of the spectrum. Every girl’s dream boy. The handsome star athlete with a good head on his shoulders, too. And a genuinely nice guy. Everyone fighting over him for college.

He went west. That’s what he said, to keep from bragging about Stanford—nobody from Ashton High had ever gotten in there. But now he’s back here. I know because I got a message from my agency, asking if I could possibly fit in another client. A man called Chip Reardon. Fifty-one years old. Brain tumor, end stage, apparently; not too much to do. Probably home to die—he’d only need comfort measures.

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