Reflections on Life and Death

by Kristine Kathryn Rusch

“No,” Sarah’s mother said, her voice barely more than a whisper around the tubes. “You can’t. They kill people in there.”

Sarah held her mother’s good hand—the one without the IV. Small chips dotted her mother’s face and body, each scanning vital signs. It made her look as if she had chickenpox.

The doctor was watching Sarah. The doctor was a thin thirtyish woman with nut-brown eyes and light brown skin. Her hair, a delicate blonde, was shoulder length and covered with a nearly invisible clean-net so no strands fell free.

“Sarah?” the doctor said, and it made Sarah wonder how a woman ten years younger than herself managed to sound make one word so condescending.

“Sarah—” her mother said again. “You can’t.”

“You can’t go home,” Sarah said.

“But you could take me.”

Sarah closed her eyes. One more thing. It had taken all of her strength to get to the hospital each day before visiting hours closed. She had lost a day of work to be here this afternoon. Her secretarial job was rare, precious, and difficult. It also only paid a quarter of what she really needed. Besides, the children were doubled up in one room in her two-bedroom apartment. If her mother came to stay, someone would have to sleep on the couch.

Her mother’s hand clutched, the bones cutting off the circulation in Sarah’s fingers. Sarah opened her eyes. Her mother’s skin was chalk-white; her lips almost blue.

“Please,” she said.

“You didn’t take Gram,” Sarah said, and then bit her tongue.

“I don’t think you need me any longer,” the doctor said. “Page me, Sarah, when you reach a decision.”

“It’s not her decision to make,” her mother said.

“What do you want to do, Mrs. Chomley?” the doctor asked, addressing Sarah’s mother for the first time.

“I want to go home,” her mother said.

“That’s not possible,” the doctor said.

“Then I want to go with Sarah.”

The doctor looked at Sarah. Sarah looked away. How come the doctor, who usually ignored her mother, used a respectful title when she finally addressed her?

“Do you have other family?” the doctor asked.

“No,” Sarah said.

“Then it looks, my dear,” the doctor said, “as if it’s up to you.”

1986: Gram’s backyard. Icicles hanging off winter trees, sleet making the air a grayish mist. The streetlights burned white, and the cold was so deep that Sarah could see her breath.

She couldn’t move in her snowsuit and mittens. Gram sat beside her on the ice-crusted snow. They were going to make angels, but Gram had started crying. Sarah had never seen Gram cry.

“I don’t see nothing burning,” Sarah said, looking skyward. She’d seen the images all day. The happy astronauts waving as they carried their cases into the shuttle. The liftoff, and then the speck, exploding in the sky. She knew that when she threw something in the air, it came down. The higher she threw it, the longer it took. And Gram had said the shuttle was really high when it blew up.

“You won’t, hon,” Gram said. She had her arms wrapped around her knees. The tears made her eyelashes clump together. “The pieces have landed already. Far away. In Florida.”

“Floor-e-da,” Sarah repeated. “How come you are crying? Did you know them people?”

Gram shook her head. Then she tilted it back. “You can’t even see the moon tonight,” she said.

“There’s a man in the moon,” Sarah said.

“No, honey,” Gram said. “But once upon a time, there was a man on the moon.”

“Did you know him?” Sarah asked.

“No,” Gram said. “But it sure felt as if I did.”

The Martin Luther Extended Care Facility covered one city block near the old Dane County airport terminal. Sarah remembered when the entire area had been fields that were filled with the richest brown dirt she had ever seen. The MLECF was a new facility for middle- to low-income elderly. It covered the city block in small buildings, each stacked on top of each other, making the place a maze. The brochure said the design maximized available space. Sarah thought it maximized confusion.

It had been decades since she had been in a place like this. Not since she was a teenager, when nursing homes were still called nursing homes, and the places smelled of pee and antiseptic. MLECF smelled like roses. Nanotech hadn’t met the technological promises made by its proponents in the early nineties, but it had achieved a sort of olfactory victory: Perfume companies had discovered a way to make good odors eat bad ones. It was an expensive but satisfying service, one that made life in the late twenties much more bearable than life in the nineties.

The hospital had given her a twenty-four hour reprieve. It was not charity: the reprieve was required by law for anyone who requested it. It snapped all the social services into action. A social worker had been waiting for her by the front door of MLECF.

The tour was scripted: she saw the rehab rooms, the private suites, the entertainment center, and the kitchen. Mobile residents could cook their own meals on small counters in special suites. The place was as lovely as its brochure, but she knew this part of the facility was designed to put her at ease.

Except she wasn’t. She had seen no elderly.

“Where is everyone?” she asked the social worker when he brought her back to the front desk. He was a small man with graying hair and long, fashionable sideburns. His hands were the smallest trying about him—a child’s hands really—soft and square and delicate.

“Privacy laws,” he said. “We’re not allowed to let outsiders see the residents without their permission.”

“So when I visit my mother, will I be able to go to her room?” she asked.

“If you sign non-disclosure forms.”

“And if I were to sign them today?” she asked. “Could I see the rest of the facility?”

His smile was small, tolerant, distant. “We don’t have short-term forms,” he said.

“I’m not making a short-term decision,” she said. “This is my mother’s life.”

His gaze darted to her, then, and he sighed. “Come to my office, Ms. Chomley,” he said. He went around the front desk through a narrow corridor and into a small cubicle with no windows. His desk was built into the wall, the computer screen larger than normal and rather old. Its component parts hummed, something she associated with the computers of her childhood.

He sat in the chair behind the desk, and she took the only other one, a wire seat with an arched back. It was not made for comfort. She perched on the edge of it, waiting for him to go on.

“Your mother was diagnosed with old age, am I right?” he asked.

“They said you didn’t need to know,” she said, “not unless I decided.”

He shrugged. “It’s logical. People with hope of recovery don’t come here,” he said.

“But you have rehabilitation rooms,” she said. “What are they for then?”

He folded his small hands and rested them on the desktop. “They are for the handful of people who come here after surgeries, long illnesses, or comas. Not for people diagnosed as old.”

“Then why do old people come here?” she asked.

“Make their last years as comfortable as possible,” he said.

“Is that possible here?” she asked. “In one room?”

“One eighth of a room, Ms. Chomley,” he said. “We don’t have private rooms.”

“But the suites—”

“Are for rehabilitation patients.” He tugged on his sideburn, leaned forward, and whispered, “Do you love your mother, Ms. Chomley?”

“Of course,” she said automatically, even though she wasn’t sure it was true.

“Then take her home,” he whispered. “Take her home.”

1998: Hazlet’s gym. A private club, converted from a row of seventies apartments by a local developer, designed for his tenants, but later opened to paying memberships. Nights and afternoons belonged to the students. Mornings from five A.M. belonged to the seniors.

“Gram,” Sarah said, holding a five-pound weight against her chest. “I don’t need this. I jog.”

“Women need strength,” Gram said. She was wearing gray sweats and had her long gray hair tied back with a red scarf. She was on her back, pressing thirty-five pounds, another elderly woman spotting her as she worked. “Jogging keeps the weight down, but it doesn’t give you strength.” “I had self-defense in school,” Sarah said.

“I’m not talking self-defense,” Gram said. “I’m talking strength. To carry a box, to lift a carton. To be independent.”

Sarah laughed. “I am independent,” she said.

“Now,” Gram said. “Wait fifty years. Independence is something you won’t take for granted then.”

The pizza box was lukewarm by the time Sarah got it to the apartment. The heating chip had burned out a mile away from home, leaving the pizza inside to cool. She pulled the apartment door open, tossed the box on the counter, and threw her coat over a chair.

Janie, her oldest, was studying, squinting at her palmtop. She wasn’t supposed to use such a small screen, but Sarah couldn’t afford anything larger. She knew it meant upgraded lenses for Janie’s bad eyes, but the lenses were in the future. The computer expense was part of the present.

Her son, Keith, whom her daughters had nicknamed Scooter, was taking apart the motorized car she had given him for Christmas. The car had cost half a week’s salary; she hoped he could reassemble it. He was humming along to a radio chip, the telltale cord—required of all in-ear objects—trailing down the side of his head like an errant strand of hair.

Trina, her youngest, was already in the kitchen, standing on a stool as she begged the cereal cabinet to release its lock. She hadn’t figured out the new code yet. It would only be a matter of days. She generally figured out cupboard codes by day five.

“I called,” Sarah said. “I told you I’d be late.”

“House screen’s out,” Scooter said.

“Yeah,” Trina said. “He took out the sound chip for his car.”

Sarah suppressed a sigh. “Scoot,” she said. “We don’t own the house screens. Why didn’t you use your radio chip?”

“ ’Cause I need that,” he said. He stretched out one bare foot, scraping car parts against the hardwood floor.

“Well, see what you can do with the heater on this box,” she said. “I don’t want to pay for microwave time if I can help it.”

“It burn out again?” Janie asked, setting her palmtop aside. “You gotta stop going there.”

“I gotta stop ordering the special,” Sarah said. “They always put it in the oldest boxes.”

Scooter put the car parts beside the baseboard, then got up, brushed himself off, and came into the kitchen. He slid the box off the counter, and stuck a finger in the cardboard. Sarah pulled Trina off her chair and set her on the floor.

“Guys,” she said. “I have a question. Can we make room for your grandmother here?”

“I thought you didn’t like her,” Janie said.

“Yeah,” Scooter said. “Why should we make room for her when she didn’t make room for her mother?”

“Does she know the cupboard codes?” Trina asked.

Sarah bit her lower lip. She hadn’t realized she had put those thoughts in her children’s brains. “I went to that center today. The social worker advised me to bring her home.”

“Why?” Janie set her palmtop on the end table.

“Shut it off, please,” Sarah said, and Janie did. Behind her, cardboard ripped and Scooter cursed. Sarah ignored him.

“Why are you supposed to bring her home?” Janie asked again.

“Because she’d be in a room with seven others,” Sarah said. “Because it’s no place to spend the rest of your life.”

“What do you care?” Scooter asked. “She never did anything for you.”

Sarah sat down. She was shaking. “She raised me,” Sarah said.

“Yeah, but she didn’t want to,” Trina said. Sarah looked at her daughter. She didn’t remember telling Trina why her mother had left Sarah with Gram at various points in her life.

“You always said she was too busy living her life to care about someone else’s,” Scooter said.

“She’s my mother,” Sarah said, feeling defensive.

“So?” Janie asked. “That doesn’t mean you have to take care of her.”

“I know,” Sarah said, and sighed.

2003: Her mother’s living room. Sarah was standing; her mother was sitting on the white, pink, and blue couch bought at an auction the year before.

“I’ll take care of her, Mom. Instead of paying some home, give me room, board and some pocket change. That way she can stay home.”

Her mother, small and delicate, still wore her hair long. It reached the middle of her back, a gray and black wave as chaotic as her mother could be. The black hairs were straight. The gray was coming in curly.

“Have you ever watched anyone die of cancer?” her mother asked.

“No, but—”

“I have. When I was married to Jack.” Jack. Husband number two. The rich one. The one who died on her, and left all his money to his son, a man two years older than Sarah’s mother. Jack had achieved perfection before he died. The men after that had no hope of catching up. “I did volunteer work at the hospital.”

As if Sarah didn’t know. Her mother was proud of the volunteer work, prouder of that than of her paid work. The volunteer work meant she had time on her hands, time to give away. The paid work—done to support her daughter from her ill-advised rebound of a third marriage—never measured up.

“They used to have fans on in the cancer ward to keep the stink down.” Her mother wrinkled her small nose as if she could still smell the memory.

“Mom, that was in the seventies.”

“It hasn’t gotten any prettier,” her mother said. “And you don’t have the stamina for it. Better that Gram goes where people can take care of her. Better to let her die with dignity, on clean comfortable sheets, in a clean comfortable room.”

“Shouldn’t she have her family with her?”

“She’ll have her family with her,” her mother said, staring past Sarah at something on the street. “We’ll visit her every day.”

“I’m going to take care of her,” Sarah said.

Her mother shook her head. “It’s your choice,” her mother said. “It’s not something I would do.”

“I know,” Sarah said. “You always did what was convenient for you.”

“Not fair, Sarah.”

“But true,” Sarah said.

Sarah clutched the entrance documents in her right hand. As she entered her mother’s hospital room, her fingers tightened, crumpling the pages. Her mother was asleep. The skin stretched across her tiny face, revealing the angles and hollows. Through the translucent surface, Sarah thought she could actually see bone.

—Her strength is failing, the first doctor had said. The pneumonia was just a stage. We can cure the stages, but they will continue. We can stop any disease she gets except the one that’s going to kill her. She’s got old age. No one recovers from that.

—Old age isn’t a disease, Sarah said.

—Oh, but it is, the doctor said. For a reason we don’t understand, the cells fail to regenerate. Or they regenerate improperly. We can stimulate regeneration, but only in certain parts of the body. We can’t touch the brain cells. And no matter what we do, some parts always fail. The heart muscle atrophies. It’s as if total degeneration is built into the system. Your mother’s degeneration has started. We can do nothing to end it except—end it.

—She’s not that bad, is she?

The doctor shrugged.—I’ve been secondary approving physician on cases less advanced than hers. Once it reaches this stage, the future is certain. Death.

—The future is certain now, Sarah said. You’ll die. I’ll die.

The doctor shook his head. That’s not certain. There is research in Sweden that shows degeneration can be prevented.

—Then why can’t we use that treatment on Mother?

The doctor’s look was withering.

—Because she can’t afford it? Sarah asked.

The doctor took a step back, as if Sarah’s tone startled him.—Because it’s experimental. And even if it weren’t, she’s not a candidate. Degeneration is advanced in her. The Swedish treatments begin before the internal organs show advanced signs of wear. For some, that’s age twenty. For others, that’s forty-five. For no one is it seventy. No one at all.

—So you’re saying kill her, Sarah said.

The doctor didn’t meet her gaze. What’s more humane? Letting her die now, with all her faculties in place, or waiting until she shuts down, part by part?

—Isn’t that what death is? Sarah asked.

—Death, the doctor had said as if he were quoting a textbook, is the cessation of life.

“Mom?” Sarah said. She sat beside the bed, and put the papers in her lap. “Mom, wake up. It’s me.”

Her mother’s eyes opened. They were yellowish, bloodshot, exhausted. “Sarah?” she whispered.

Sarah nodded. “I brought papers here from the extended care center.”

“Papers?” Her mother’s voice was stronger now. She dug her hands into the mattress and pushed herself up. “What kind of papers?”

“Entrance agreements. They have the regular agreements there on computer. I told them you weren’t linked here.”

Her mother frowned. “Have you read them?”

“Yes,” she said. “They seem fine. All they ask is that you agree to the rules of the center.”

“And what are those rules?” her mother asked.

“They’re listed in the regular document,” Sarah said.

Her mother crossed her arms over her sunken chest. “I won’t sign,” she said.

“If you don’t sign, you can’t go,” Sarah said. “The hospital has the legal right to put you on the street.”

“I’ll go home,” her mother said.

“Mom.” Sarah had been dreading this moment. “They rented your apartment. I had to put your stuff in storage.”

“I pay my bills,” her mother said.

“No, Mom,” Sarah said. “Your weekly allowance has been coming here, for the deductible.”

“You didn’t pay my rent?”

“I can’t afford my rent.”

“But you can afford storage.”

“It’s cheaper than rent,” Sarah said.

Her mother’s lower lip trembled. “They’ll kill me in that center.”

“People die there, yes, Mom, but the officials don’t kill anyone.”

“Read the forms,” her mother said.

“Mom, they have to have ways of dealing with the critically ill.”

“I’m not critically ill,” her mother said.

“Your doctor says you’re dying,” Sarah said.

“My doctor’s wrong.” Sarah’s mother raised her chin, a slight gesture of defiance.

“That’s denial, Mom.”

“No, Sarah,” her mother said. “I’m alive, and I like breathing. And I’m not afraid of what the future holds. I want to see each phase through, the way God intended.”

Sarah shook her head. Her mother didn’t understand. She couldn’t. If she did, she wouldn’t want to die, bit by bit, piece by piece. “Gram—”

“Your grandmother was a coward,” her mother said.

“Gram was thinking of us,” Sarah said.

Her mother’s eyes narrowed. “Was she? Was she really?”

2003: Gram’s house. An EMS truck was parked in the driveway. Sarah’s mother stood in front of the door, arms crossed. Her hair was falling out of its ponytail and her right cheek was streaked with blood.

Sarah parked her car across the street, and ran to her mother. Her mother held out one blood-stained hand.

“You can’t go in,” her mother said.

“But you called—”

“I did,” her mother said. “Before I knew. Gram’s in the truck.”

“Then she’s all right?” Sarah started for it, but her mother grabbed her arm.

“No,” her mother said, her voice oddly calm.

“I want to see her.”

“No,” her mother said.

“What happened?” Sarah asked, panic eating at the edges of her stomach. “She used your grandfather’s handgun. She always said she would. Dramatic to the end.” Her mother shook her head slightly, as if she couldn’t quite believe it. “She called to say good-bye, and not to worry. That’s when I called you. That’s when I came here. The neighbors heard the shots. They’d already called 911.”

“But she’s all right,” Sarah said.

Her mother’s eyes met Sarah’s. “She’s gone.”

Sarah frowned. “But I told her I’d take care of her. Yesterday. I told her I’d be here, and we’d get through it.”

Her mother blinked hard and wiped at her nose. “Your grandmother said to tell you that she didn’t want you to waste your life.”

“But I wanted to help,” Sarah said.

“I know.” Her mother put her arm around Sarah, not noticing as the blood on her hand stained Sarah’s white sleeve. “But you can’t any more. And now we have to get through this. Together.”

Sarah sat at her desk and scanned the documents the social worker had e-mailed her from MLECF. Her hand was shaking as she scrolled, her brain overloading from the legalese.

She would have found nothing if the social worker hadn’t highlighted two sections for her.

1. Patient grants MLECF power of attorney in all matters pertaining to health.

and

50. Patient agrees to allow doctors and social workers to determine, in tandem, when resources allotted exceed gains returned.

She printed up both and handed them to her cubicle mate, Lars. He scanned them. “So?” he asked.

“What do they mean to you?” she asked.

“They mean the facility has the. right to put a patient to sleep if they can no longer afford treatment.”

“That’s legal?”

“Sure,” he said. “Has been for as long as I can remember.”

“And it doesn’t shock you?” she asked.

“Why should it?” he said. “These places have been doing it for years.”

“I didn’t realize,” Sarah said.

“Not many people do,” Lars said. “It’s just an efficient way of dealing with a burden on society.” He handed the hard copy back to her. “Why’d you ask?”

“For my mother,” she said.

“Oh,” Lars answered, and had the grace to flush.

1990: Spring thaw, Lake Wingra. First meeting of the Wingra Seniors’ Polar Bear Club. Sarah wore her down jacket, unzipped, and a pair of fleece-lined boots. Her mittens dangled from strings, and the sweater her mother had made her wear that morning was too hot. But her face was cold. An icy mist was falling, making it feel as if the air were spitting.

Near the water’s edge, four old men wearing rubber boots stomped away the last of the ice. A doctor stood beside the men, shaking his head as he watched.

Gram was beside Sarah. She wore a heavy car coat over her sweats. In her arms, she clutched a fluffy towel, still warm from the dryer.

“You’re nuts, Gram,” Sarah said.

“I’m living, baby doll,” Gram said. She handed Sarah the towel, then peeled off her car coat, and her sweatshirt, revealing a one-piece suit underneath.

“That water’s cold, Gram. What if you get a heart attack? What if you get sick?” Sarah lowered her voice. “What if you die?”

“Then I’ll go out happy,” Gram said. She shucked off her shoes and her sweatpants. Sarah took those too.

“Life’s one big adventure, Sarah. You gotta live it the best way you can,” Gram said, and ran for the frigid water.

Sarah stood at the door of her mother’s hospital room and watched her mother sleep.

Old age.

It was going to kill her, and no matter what the doctor said, it would probably kill all of them eventually.

It didn’t matter how you died, Gram used to say. What mattered was how you lived.

And how had she lived these last few years? Like her mother. Selfish and focused and angry at the hand life had dealt her. Ever since Greg left— Greg. She hadn’t let herself think his name since he walked out, leaving her with three children and an apartment she couldn’t afford on her own. No one had one-caretaker apartments any more, and she had been struggling against that for years, angry at Greg, angry at the world.

Not proud of herself like Gram would have been.

Proud for beating the system.

Sarah swallowed. “Mom?” She came closer to the bed. “Mom, wake up.”

Her mother smiled. The dots on her cheeks moved as she did. “I was awake. I was watching you.”

Sarah started. She hadn’t expected the same scrutiny she was giving her mother.

“Children grow away from you, you know,” her mother said.

“I know,” Sarah said. She’d been watching hers do that every day.

“From the minute they leave the womb, they’re not yours any more. They’re strangers.”

Sarah approached her mother. “Are we strangers, Mom?”

Tears floated in her mother’s eyes.

She touched her mother’s arm. She had lived inside this body once. It had been her first home. How could she let someone else discard it, as if it had never been? “I’m going to bring you to my place,” Sarah said.

Her mother blinked, but her cheeks remained dry. “I’m not going to be noble like your grandmother was.”

Sarah smiled. It was against her mother’s nature to be noble. She squeezed her mother’s arm. Gram’s suicide had been awful.

“Nobility’s overrated,” Sarah said.

1986: Gram’s backyard. Sarah put her pudgy arms around her Gram’s neck and wiped her tears with one grimy mitten. “How come you’re crying for the people in that shuttle if you didn’t know them?” she asked.

Gram shook her head, then buried her face in Sarah’s hair. “I don’t know,” she said. “Sometimes lives and dreams are so mixed up together, and you don’t realize it until it’s too late.”

Gram was holding her too tight Sarah squirmed. Gram let go. Sarah sat on Gram’s knee.

Gram smiled at her. “You don’t know what I’m talking about, do you?” Sarah shook her head. Sometimes big people said kinds of stuff she didn’t understand.

“It’s okay,” Gram said. “You’ll figure it out soon enough.”

The hide-a-bed cost half a month’s salary, but Sarah figured she could afford it, with her mother’s allowance going toward rent. The living room was crammed with knick-knacks Sarah had once hoped she would never have to live with again. Her mother’s heavy, ancient television set with its curved screen sat in the hallway, waiting to be carried to the back bedroom. The bedroom had been Sarah’s. From that night on, it would be her mother’s.

And, surprisingly, Sarah didn’t mind. This was the chance she had missed with Gram. This was the chance she needed with her own mother. Too many people watched life’s beginning and shied away from its end.

“I still don’t get it,” Janie said as she carried in the last box from storage. “Why doesn’t she get her own apartment?”

“They don’t make new leases with people over seventy, stupid,” Scooter said. He was rummaging through the previous box, seeing if there were any old chips. Sarah reached into an open one beside her and brought out an old attachable house sound system. She handed it to Scooter. He squealed with delight and looked for the chip.

“I don’t see why she has to come here,” Janie said again.

“Because I asked her,” Sarah said.

“You don’t even like her, Mom,” Trina said. She was bouncing on the hide-a-bed, testing its springs.

Sarah took Trina’s arm, and gently stopped her bouncing. Trina let her, almost as if she had been expecting it. After three children, Sarah knew how to parent.

But her mother had only had one. Sarah had been an accident, unplanned. Sarah’s children were planned, but being raised the same way. By one woman alone.

“I don’t know her any more,” Sarah said. “I don’t know if I like her or not.”

“Then why bring her here?” Janie asked, sitting beside Trina.

Sarah looked at her daughters, and wondered how they would feel after their grandmother was gone.

When their own mother was dying.

The law said they weren’t responsible, any more than she was.

“I’m bringing her here,” Sarah said, “because life’s an adventure.”

She had forgotten that. All these years, she’d forgotten it. It had taken her mother, of all people, to remind her.

“An adventure?” Janie asked, as if she had never heard that before.

“An adventure,” Sarah said. “I’d just forgotten, until now.”

Content

Reflections on Life and Death
by Kristine Kathryn Rusch