Terminally Ill Read online

  Strange.

  Ryan had sent me a quick message that he’d gotten home okay, so I answered it and sent him a link to the news article. I wasn’t sure if he’d like it or not, but if he was hanging around me, he’d have to get used to it.

  Or not. If I moved to Ottawa and stayed indoors after 5 p.m., except when I was on call.

  I also forwarded the link to Tucker. I figured he’d be royally skeeved once he figured out that not only had I taken over the case, but I’d brought Ryan along for good measure. So I just said, FYI.

  Then I washed my hands and grabbed my sandwich from the residents’ fridge. Cream cheese again, since peanut butter is verboten at a hospital, and I hadn’t had a chance to grocery shop. At least tonight I was on call, so I’d get a free hot meal out of it. I chewed dolefully, taking swigs of my water, while the rest of the crew watched Law & Order and played around with their phones. Then I decided to head up early to palliative care.

  Instead of the usual skeleton crew at lunchtime, I pushed open the door at the top of the staircase and noticed a little cluster of people at the nursing station bent over the central computer. Ricky, the clerk, turned to smile at Karen, one of the nurses.

  I paused, watching them. The palliative ward is a lot more cheery than you might think, but this felt more like a party. I detoured around the soiled linen cart and headed over to see whassup. As I approached, Dr. Huot gestured me over, and the crowd parted to reveal the nucleus of the cluster, Peter the Preacher.

  Peter smiled at me. “Dr. Sze, I’m sorry you couldn’t make it to the service on Sunday. If you’re interested, I’ve uploaded a video of the service to my YouTube channel.”

  Eek on a few counts. Watching a video church service was party time on the palliative ward? Take me away now. Also, Peter the Preacher had a YouTube channel? I know this shouldn’t surprise me, but I guess I still kind of expected older people to…well, not exactly make the sign of the cross in front of the computer, but mostly they just seemed to forward bad jokes on e-mail (“Fw: Fw: Fw: Fw: Funny! Must read!”) and set up Facebook accounts so they could coo publicly over their grandchildren and share memes about getting old vs. the foolishness of young people nowadays.

  So a YouTube video seemed relatively advanced, and truthfully, even though I wasn’t that interested, it’s kind of like someone showing off their new baby or new car. You can’t just say, “Nah, I’m good.” So I peered politely at the computer monitor, along with everyone else. I was just in time for a hymn.

  The slightly shaky camera panned the audience as they sang slowly and ponderously along with a pre-recorded backup chorus. I didn’t know the song, of course, but I was startled to see Mrs. Bérubé, sitting up very straight in the first row, silver hair pinned in a neat chignon, singing and holding her husband’s hand. He was slouched in a wheelchair, but his eyes were open and he seemed to nod a little in time with the music. It was the most alert I’d ever seen him, and I was glad. Good for them, for getting out of the room and into a church service.

  Even with the relatively bad sound quality, I detected one superior singer. In my limited experience with church, under Ryan’s tutelage, there’s always at least one non-choir singer who’s good. She knows it, and she’s belting it out behind you. The Voice didn’t match Mrs. Bérubé’s lips, but she looked like she was enjoying herself.

  The camera panned right, showing a group of maybe twenty people, including some who looked vaguely familiar. I thought I recognized the pharmaceutical company guy, either taking a break from the emerg or he’d managed to get his mother upstairs at last, bribe or no bribe. Yep, that was his mother, looking jaundiced, even on a pixelated screen. Her eyes were closed and the skin sagged off her skinny face. She looked more frail than Mr. Bérubé, so I guessed the chemo was taking a lot out of her.

  My head jerked up as I spotted a teenager in one of the folding chairs in the second row. Like I said, we don’t get a whole lot of youths at St. Joe’s. There’s no pediatric program, even though we have obstetrics, so you might spot a few newborns, but it seems like most of the patients are over seventy.

  The camera paused, jiggling a little before it came back into focus, and the breath hissed out between my teeth. That wasn’t any child. That was the crazy kid from the FMC clinic. Kameron. She didn’t bother to sing along or even mouth the words. She just sat in her metal folding chair, looking like she’d rather eat her own toenails than endure a second longer of this mess. So what was she doing there?

  The man beside her also didn’t fit the usual St. Joe’s senior’s program. For one thing, I’d peg him in his forties or fifties, tops. He still had all his dark hair, although it was starting to recede at the temples, and it was hard to make out his features behind his full-on moustache and beard, although it looked like his nose had been broken a few times. His eyes tracked around the room like he was searching for escape routes. His broad shoulders barely seemed to fit inside his beat-up leather jacket.

  Peter the Preacher sure seemed to attract an odd mix to his sermons. I’d expected all white-haired old ladies, but at least three generations had showed up. I gave him bonus points for that.

  The camera lifted and zoomed in on a skinny woman in blue scrubs at the back of the room. She looked familiar, too, but I couldn’t place her. The reason the camera was paying such loving attention to her, though, was because she was the source of The Voice.

  She had a soft, thin, but very sweet voice, much prettier than the wavering singing that surrounded it. Her voice wove with Peter’s. She even did a little counterpoint descant, that thing where you do your own riff on top of the melody.

  I listened to the end of the song, just so I could hear her sing. Sometimes I shy away from full-blown, overwrought, American Idol grandstanding, but her voice soothed me.

  When the song ended, the circle of nurses broke into spontaneous, scattered applause. Dr. Huot looked like she’d personally received a text message from the big guy upstairs when she said, “Peter, I enjoyed your sermon, and Rosie’s singing lit up the room.”

  “That’s for sure,” said Ricky.

  “She should have her own YouTube video!” exclaimed a young nurse. I’d never caught her name.

  A broad-hipped, middle-aged préposée (orderly) named Toni shook her head. “Can you imagine? She’d probably just die.”

  “Where is Rosie, anyway?” said Karen.

  Peter clicked his YouTube window closed. “She’s working. I think I saw her at the end of the hall.”

  “Aw, we should have waited for her,” said Ricky.

  “We’ll just watch it again!” said the young nurse.

  Peter smiled and opened the YouTube window again. “I’ll bookmark it so you can show it to her.”

  “Oh, here she is. Rosie!” Karen beckoned down the hall at the thin brunette wheeling her cart stocked with mops, buckets and cleaning products. As she came closer, I mostly noticed Rosie’s enormous eyes, like a child, but her face was lined, and the exhausted light in her eyes and the slump of her shoulders didn’t look young at all. She stiffened when the group started cheering. She stopped her cart.

  “Rosie, we need you!”

  Rosie made her way to the desk, and they replayed the song. Instead of relishing the attention, she flinched when she recognized the scene. When the camera focused on her image, she paled and started turn away in real life.

  “No, Rosie, this is the best part!” Toni tried to do the descant and massacred it. Everyone laughed.

  Rosie flinched like the nurse had struck her. I knew they meant well, but suddenly I felt like I was in high school, picking on one of the other kids, even though we weren’t ganging up on her at all.

  Peter stepped forward and turned to face us so that he was shoulder to shoulder with Rosie. “Thank you for your singing. I know this is difficult for you. I appreciate your modesty. ‘Do not let your adorning be external—the braiding of hair and the putting on of gold jewelry, or the clothing you wear—but let your adorning be
the hidden person of the heart with the imperishable beauty of a gentle and quiet spirit, which in God’s sight is very precious.’”

  Rosie’s head dipped, and her cheeks reddened. She muttered something to Peter, and he nodded. “We should all go back to work. Thank you again for your voice and for attending the service.”

  Rosie flapped her hand and beat it back to her cart.

  Peter cocked his head. “I feel a sermon on humility coming on. ‘God opposes the proud but gives grace to the humble. Humble yourselves, therefore, under the mighty hand of God so that at the proper time he may exalt you.’”

  Between Rosie’s poor reception and Peter’s proselytizing, the party atmosphere dimmed considerably, even before we heard the sobbing coming from down the hallway.

  Dr. Huot and I exchanged a look before I hustled out of the nursing station, taking a right down the hall, past the stairs, toward the cries. I had a bad feeling about this even before I stopped in the doorway of room 5656.

  Mrs. Bérubé whirled to face me. She was still clinging to her husband’s left hand.

  I checked Mr. Bérubé’s face, which was white and very still, before I met Mrs. Bérubé’s gaze again.

  She shook her head. Her body vibrated with the effort to hold back the sobs, but she managed to say, “He’s gone.”

  I nodded, silenced by her grief.

  She burst into fresh tears. Karen entered the room, moving toward the head of the bed. She nodded at Mr. Bérubé and smoothed the covers under his arms, since his skinny arms were outside the covers. Then Karen put her arm around Mrs. Bérubé’s shoulders, even though the new widow was slightly taller than her.

  Mrs. Bérubé shook her shoulders like she was trying to shake off water.

  Karen dropped her arm back to her side, but still stood close. “It’s hard. It’s very hard.”

  Dr. Huot had entered the room, moving to the side of the bed near the window, opposite Karen and Mrs. B, while I hovered at the foot of the bed. Dr. Huot was smiling which seemed even more incongruous than usual, but she murmured to me, “Grieving is a normal and healthy part of the process.”

  Karen handed Mrs. Bérubé the little box of cheap hospital tissues from the bedside table. Mrs. Bérubé ripped one out of the box and said to me, “I can’t find his silver dollar anywhere.”

  Dr. Huot continued beaming, but I felt compelled to explain to her, “His lucky silver dollar.” I turned back to Mrs. B. “It disappeared?”

  Mrs. Bérubé nodded. “I stepped out. He was feeling better. He wanted to eat some dolmades—you know, feuilles de vigne? He’s always loved those.”

  She was talking to me like there was nobody else in the room. I nodded. I knew those treats: rice wrapped in grape leaves.

  “I thought, maybe because his sodium was better, maybe that’s why he was getting his appetite back. So I went to get him some dolmades.”

  Dr. Huot nodded her approval. She’d already explained to me that palliative patients often lack an appetite, and that we can prescribe appetite stimulants, but really, eating should be for pleasure. It’s the family members who worry about the lack of appetite rather than the patients themselves.

  “I don’t understand it,” she said. “George was getting stronger. He was standing up. He tried to go to the toilet by himself yesterday!”

  “That happens sometimes,” I said. People can get a burst of energy or clarity before dying. Dr. Huot and the nurses had all mentioned it.

  “But he was talking again. He reminded me about my silver dollar and how I used to carry it around in a knotted handkerchief in my pocket, because I was so proud of it.”

  “Uh huh,” I said, trying to sound soothing.

  She threw up her free hand. “It was like God had returned my husband to me. I bought eight dolmades, because that was his favourite number, and I knew he’d want to share. I got some baklava, too, for the nurses. I shouldn’t have taken so long, but I had to stop at a bank machine. And now he’s gone!” Tears spilled from her eyes again, but she swiped them away with her tissue.

  “He knew how much you loved him. Everyone knew that,” said Karen, touching Mrs. Bérubé’s right hand.

  Mrs. Bérubé didn’t move away, although she kept her body very stiff as she ripped a few more tissues out of the box.

  I shifted a little from foot to foot, unsure what I should do. Karen had taken over the comforting role, and Dr. Huot was issuing words of wisdom, so I was neither fish nor fowl, as always. Mrs. Bérubé covered her face and cried for a few more minutes before she said to me, “Are you here to verify his death?”

  “Yes,” I said, secretly quaking in my sneakers.

  “And to provide comfort to yourself and any other family members,” added Dr. Huot smoothly.

  Mrs. Bérubé sniffed. “I’ll have to call our children. Our daughter, our youngest, she was supposed to fly in tomorrow…”

  “We can help you talk to your family members, if that’s easier,” said Karen.

  Dr. Huot nodded at me, so I approached the bed from her side, the one nearest the window. Mr. Huot’s eyelids were mostly closed, but not 100 percent, which is always a little creepy, even before I noticed that his white-haired head was arched back on the pillow with the chin pointed toward the ceiling.

  “He never sleeps like that. He likes to sleep with his blanket right up to his chin and his hands folded on his chest.” Mrs. Bérubé’s voice trembled, but she held it firm until she said, “He must have been looking for me—”

  “There, there,” said Karen. “I was right down the hall, and I checked on him not half an hour ago. He wanted to take a nap. The two of us helped him from the chair to the bed and he went right to sleep.”

  I understood that Mrs. Bérubé was feeling guilty. I would, too, if my husband had died alone. On the other hand, she was 84 years old. She couldn’t maintain a vigil 24/7 without exhausting herself. That was the whole point of admitting him, to give both of them a break. But I didn’t know what to say, so I just nodded in agreement with Karen.

  Mr. Bérubé’s hands were flexed by his side, pinning the blanket to his chest, so I had to tug it downward and then pull his pajama top up to check for breath sounds. His skinny chest looked even worse than usual because the breastbone was concave. I knew it was called pectus excavatum, a congenital deformity, but I’d only seen it once or twice before in real life.

  Mrs. Bérubé gave a watery chuckle. “He was so vain, he would never take his shirt off in public. Even when he was swimming, he’d make an excuse about why he had to wear a shirt. I didn’t know about his chest until after I’d married him, and then I teased him that he’d lured me in by wearing a stiff uniform where I couldn’t see what was underneath it. But after I saw how much it hurt his feelings, I ended up making him an apple pie and telling him of course it didn’t matter to me. I probably shouldn’t say all this, but how embarrassed he’d be, to have three women staring at his naked chest like this!”

  If you’ve never seen pectus excavatum before, it can be pretty startling. It looked like a crater in the middle of his chest, as if a meteor had left a souvenir. I could see why he was self-conscious, and I actually thought it was kind of mean to tease a war hero about it. On the other hand, it was better than her crying. So I smiled a little, going along with the joke, as Dr. Huot chuckled softly.

  I listened for heart sounds and breath sounds in his chest, carefully moving my stethoscope around the edges of the crater.

  I didn’t hear anything, even though I listened for a good sixty seconds. His chest didn’t rise or fall. So that seemed like a pretty good clue. But patients who are dying can go a long while without breathing and then suddenly gasp, not to mention irregular breathing like “Cheyne-Stokesing,” so you have to observe for a while.

  I didn’t flex his arms or legs, because rigor mortis sets in after three or four hours and doesn’t get maximal until twelve hours, and there was no way Mrs. Bérubé or Karen would have left him alone that long. Anyway, I’d alre
ady moved his arms a little to adjust his blanket and they were pretty flexible. I covered up his poor chest again with his pajamas and then his blanket, thinking, There you go, sir.

  “I’ll move on to the eyes now, Madame Bérubé,” I said, trying to sound calm and grown-up. I pulled the ophthalmoscope off the hook on the wall and pulled up his half-closed eyelids to shine the light into his eyes.

  I caught my breath. His pupils were fixed and dilated. That wasn’t the problem. But he also had little dark red, smeary dots—petechial hemorrhages—scattered over the sclerae, or white parts, of both eyes.

  We see subconjuctival hemorrhages all the time. My own mother freaked out over the phone at me a few months ago when she found one. It’s really a bruise, or burst blood vessel, in the eye. Looks horrible, and takes a few weeks to re-absorb, but it’s no more significant than a bruise on your knee.

  In this case, though, Mr. Bérubé had at least eight tiny spots in both eyes. And in my forensic pathology class, they’d mentioned this as pathognomonic (a relatively sure sign) of death by smothering.

  Chapter 22

  Mrs. Bérubé gasped. “What happened to his eyes?”

  I swallowed hard and let go of his eyelids. Mr. Bérubé’s eyelids sagged back down a few degrees, but I could still spot at least two hemorrhages in each eyeball. I tried to stay calm. One of the medical sayings I’d often heard is, “When you hear hoof beats, think of horses, not zebras.” In other words, common things are common. Don’t leap to wild and wacky conclusions.

  Just because I’d run into two murderers thus far at St. Joseph’s didn’t mean I had to meet a third.

  Mrs. Bérubé raised her voice. “He didn’t look like that an hour ago. What happened to him?”

  “Those are…petechiae,” I said slowly, using the medical term. That’s one thing I learned from my radiology rotation. When in doubt, just describe what you’re seeing. You don’t have to hazard a diagnosis right away. “Little blood vessels in his eyes have burst.”

  “But why?” she demanded.