It’s easy to get lost in the hospital. Even though you know it like the tiles of the bathroom floor under your bare feet. Still you lose track of exactly where you are—what unit, what floor, what time it is, what day it is.
I was vaguely aware that I was on the fifth floor when I was called to pronounce the patient dead. Although I’d never met her before, it had been clear from the beginning of my shift, early in the night, that she was getting close. A 73-year-old woman with advanced dementia and aggressive bladder cancer—I had called her daughter, Marissa, soon after I arrived, to let her know that her mother seemed to have taken a turn toward what we call “actively dying.”
It was an unusual place for a patient to die: 5-D, the low-acuity “med-surg” unit on the fifth floor, the top floor of the hospital. These rooms were mostly filled with patients recovering from cholecystectomies, appendectomies. The patient had been moved here earlier in the day from the ICU, after signing a do-not-resuscitate form.
I was just finishing a post-operative note on a young man who had had a routine gallbladder surgery, when the nurse approached me. “Doctor, the patient in Bed 32.”
I didn’t look up; the bed number meant nothing to me. “Mm-hmm? What about her?”
It was the exact middle of the night—the strange, confusing hour that is neither today nor tomorrow, when the zeroes line up on the nursing charts, and outside dark night becomes dark morning, while inside the fluorescent bulbs keep burning their bizarre, timeless energy, reflecting off the cold linoleum floor.
I found Marissa standing at her mother’s bedside, weeping quietly. She was a forty-ish African American woman, heavyset, in a black track suit with pink piping on the sleeves. She wore her hair in tiny braided ringlets around her face, pinned back at the temples with ladybug bobby pins, like a little girl. Her husband, a sinewy man on crutches with a speckle of grey in his beard, hovered quietly in the background. The room was dark; the TV was turned to a choir singing hymns.
The patient lay still in the bed, looking much like she had when I’d seen her a few hours ago, waxy lips parted, thin gray hair combed back neatly from her face. I leaned down to place my stethoscope on her chest and saw the details of her body up close: the hairs scattered on her upper lip and chin, the black pores on the fleshy tip of her nose, the sticky tears still glistening in the corners of her eyes. On the other side of the stethoscope: the pronounced stillness, roaring silence, a sound I’d never actually heard before. One by one I parted the eyelids and shined my light into the glassy, blank eyes—glimpsing for a moment the depths of the ocean caught in that tiny beam.
When I let go, the eyelids stayed half open, and in an awkward, clichéd gesture, I tugged them back down with my fingertips, hoping they wouldn’t pop open again when I let go, like the eyes of some plastic doll.
Rising, I reached for Marissa’s hand and said, “I’m sorry.” Then, remembering what I was here to do, I said firmly, “She’s died.”
Nodding and biting her lip, Marissa whispered (somewhat melodramatically, I thought), “One thirty-one.”
The time of death.
We were silent for a moment. I held onto her hand. Then abruptly, she said, “I need help taking her ring off.” Eyes squeezed tight, face crumpling, “I don’t want to be the one to pull it off her finger.”
I thought I saw her husband roll his eyes and shift his weight on his crutches.
In my bravest voice, I offered, “Would you like me to take it off for you?”
She nodded, eyes still closed, head bowed.
I pulled the covers back and gently lifted the thin hand, still warm and alive-feeling. The fingers were curled loosely as though they’d been clutching something. It occurred to me that it would be a rather morbid picture if, now that I’d volunteered, I could not straighten out the fingers and pull off the ring. I resolved not to be timid. But the fingers were pliable in mine, and I loosened the fist easily. The hand was empty. The ring was a thin gold band with a blue stone. With a firm, slow pull, it slid over the knuckle, scraping along with it a thin layer of something slightly wet—dried skin cells maybe, sweat, lotion.
I held the ring out to Marissa, who took it and clasped it to her chest.
“Thank you,” she whispered. “Thank you for calling me when you did.”
Papers to sign, notes to write. Disposition: Expired. I went to the stairwell and headed up, my footsteps echoing off the cement walls. I turned to the doorway of the next floor—stopping short, startled.
A locked door: LEVEL 6—ROOF.
I had forgotten that I was already on the highest floor of the hospital. There was nothing else here.
Disconcerted, tired, I turned and hurried back down the stairs. The night went on.