The Helicopter Patients

IIn the evening of our third day on with little more to do than play games of cat and mouse with Lonnie, the old janitor, Jeffrey, the other CNA, and I took to harassing Martha the nurse. In the night, anyway, there were few emergencies in Palliative—it was only a mausoleum for the decrepit little husks on the DNR list, and there was a collective death rattle that blended terribly with the overtones of country radio. There were the occasional bleeding delinquents who were transferred from the ER, victims of massive heart attacks or car wrecks. And sometimes a poor hopeless case from Oncology whose body had nearly given up was rushed into the Palliative Care unit on an expedited basis, suddenly, inexplicably, often the product of a bureaucratic oversight wherein the patient had been dying in the wrong place. Working in Palliative was about being a witness to a continuous losing battle. It was as Lonnie had spouted to us in one of his many religious adages—death is certain; life is not. Though I think that it was an oversimplification of the Biblical prose.

It was on this night, the final one in our rotation, as I was emptying the catheter bag of a Hodgkin’s Lymphoma patient, that they wheeled old Thaddeus in. He came with an entire legion of country folks. You see them often—crawling out of Oldsmobiles, big ambling men wearing denim worn to a patchwork of near confetti. And Thaddeus came with an army of family, barking and bellowing their way down the hall.

“Look at this old whip,” Jeffrey said, nudging me in the arm. I recognized the alkaline smell on his breath: morphine. “This guy probably fought in the Civil War.”

“Can you please help get him admitted?” Martha barked at us. She was being barraged with questions from the dozen or so family members who had come in with the old man. They were mostly acrimonious questions about next of kin.

We had just hours ago moved the corpse of a leukemia patient from the room in the southeast corner, with the view of the creek, and this is the room we wheeled Thaddeus into, breaking the stillness of the death as we spread out his tubes and got him catheterized. He smiled slightly when we got the tube in, his lips dry little creek beds on a hatchet-cut face.

“I ain’t even know why they brought me in here,” he said, his knuckles like wooden beads beneath his skin, groping at the wads of sheet. Evidently he was entirely blind, but somehow he managed to look me in the eyes with his milky, roving pupils. “Jesus already tried to get me once and he couldn’t because they moved me. Did they tell you all that?”

“We’re well aware, buddy,” Jeffrey said, chewing on a paper clip. He was texting someone—who, I could not imagine, especially at this hour. It wasn’t until nurse Martha entered the room that Jeffrey snapped to attention, preparing the old man’s veins for IV morphine.

“Are you comfortable, Mr. Murray?” Nurse Martha practically shouted down into his face. “We’re here to ensure that you feel absolutely comfortable. If there’s anything you need—”

“Keep the roof open,” the old man barked suddenly, causing her to jump back. “Jesus is coming down and fixing to get me in a helicopter. You better keep the roof clear. He’s coming to get me in a big old helicopter and we’re going up together. You’ll see. He already tried to get me once before they brought me here.”

As he said it he looked upwards through the bizarre perforations of ceiling material, through the paste of the fluorescent lights, as if signaling to the celestial pilot with his own eyes. And then he went quiet, those roving eyes falling on some inscrutably far object, as the morphine took its place in his veins. Morphine lived like a ghost in the hospital, trailing its wild perfume and twirling her dress hems on the sanitized hallways that Lonnie cleaned.

It wasn’t until returning to the lobby that I learned the extent of the drama unfolding. Thaddeus’s relatives seemed to have multiplied on themselves during the five minutes that I had looked away.

“He ain’t even want to be here,” said a man named George, who I believed was Thaddeus’s son, who I later learned was in fact his grandson. He seemed preternaturally cranky, which was understandable since it was nearing midnight and the family had just been saddled with a bill. “He was up and ready to pass at Oncology but they told him he had to come here. We stole him away from his proper time and he ain’t even fitter’n a swaddling child.”

“You ain’t even spoke to him in quarter century,” shouted an already cadaverous, emaciated blonde woman wearing flannel pajama pants, who seemed to be twirling a phantom cigarette in her fingers. “You ain’t even know what he do or don’t want.”

“She just want him around because he ain’t got sense enough send her out back to the bowling alley where she got fired from.”

“And who has Mr. Murray appointed as power of attorney?” asked Nurse Martha sweetly, her voice petal-soft within the overture room of barking voices.

“Well I’m his wife,” shouted a woman in the corner, who had up until now been silent. “So I’m next of kin.”

“She ain’t his wife,” the young man named George bellowed. “She’s barely even his ex-wife.”

“Excuse me for a moment,” Nurse Martha said, picking up the phone, dialing the doctor on call. She whispered into the phone: “you might want to come see this.”

Fifteen minutes later the doctor, a red-faced mumbler named Andrews, barged into the patient’s room, beaming, no doubt dreading something beyond his interpersonal competence and likely work-intensive.

“What seems to be the problem?” he said sweetly, smiling at no one in particular.

IIThaddeus was a Korean War vet from Tobaccoville whose contraction of colon cancer had somehow reunified an entire family that was otherwise scattered as marbles across the folding blankets of those foothills. It was not uncommon for us to administer to patients who could claim a number of grandchildren in the high double or even triple digits. Thaddeus was, like some heliocentric power center, able to pull all of them out of the hills, those same people who were in the early morning populating our clinic, roaring in their ongoing shouting match, debating over DNR and inheritance. There were factions within factions, including one particularly adamant grandson named Elton and his family who were of the firmest conviction that Thaddeus was going to be able to go home again—that somehow his colon would mend itself if they, as a team, concentrated their prayers.

It was a particular source of amusement for Doctor Andrews, who, stirring coffee in the break room, imitated their accents, thicker than syrup.

“He gon-na trynna wheel his-self home in that hel-ee-copter,” the cherubic Doctor Andrews would say, chuckling. And then, in his normal voice, the doctor said, “I don’t care how he’s getting home, just as long as someone foots the bill. Helicopter or not, that morphine’s gonna cost.”

Doctor Andrews had just bought a ninety-thousand dollar German sedan. He was, perhaps, not a believer in the Lord’s mercy. Besides, if Jesus were to steal this patient away then it would be impossible to bill a level three admission for an enduring and moderate drip of morphine, and this profitable stasis between life and death would be shattered.

On the mid-shift break I sat beside Jeffrey on the bed of his pickup truck, watching the sun rise in the parking light, cutting long shadows out of all the litter. The mall, a quarter mile away, was visible in its low blue wattage, slowly coming to life. There was a small forest separating us, and I took comfort in it being there.

I watched Jeffrey fumbling with the cigarettes in his hand, struggling to maintain grip. I knew the feeling, from when I used to do the same thing—coming down off the stolen painkillers would have me feeling pessimistic, self-destructive. I think he had recently taken to vending them too. Someone in inventory must have been getting a cut.

“I’m thinking about going to nursing school,” I told him.

“What would you do that for?”

“To become a nurse.”

Jeffrey had been the debate team captain when we were in high school together, though his deductive reasoning seemed to be only spent in crafting innuendos about Nurse Martha and conniving to obtain painkillers. The sun caught the blonde filaments of his eyelashes in a way that made me remember how handsome he looked on prom night.

“Are you worried about the shame?” Jeffrey asked me.

“What shame?”

“Of being a male nurse.”

“I’m just worried that I’m going to end up like one of our patients,” I said. “Leaving my family behind with nothing but debt.”

“You think being a nurse is going to help that?” he said, flicking his cigarette into the parking lot. “Shit, it’ll probably just make you more depressed than you are already. Seeing all this death. Nothing but death and no way to fix it.”

Doctors and nurses never got involved in palliative care because it was lucrative, but because it afforded the infinite luxury of a week on, week off schedule. For us, it was the experience of never having to connect. Everyone checked out within a month. It was the experience of watching life fall through our hands, one season at a time, the morphine ghost a gentle debutante with her fingers intertwined in our own.

“Y’all know the parking lot ain’t goin’ nowhere!” Lonnie shouted through the open window. “You ain’t gotta watch it. Y’all been on break five minutes over!”

Lonnie, the janitor, had been at the hospital longer than anyone could remember. It was his hospital in some ways. He was nearing eighty but had immaculate skin. He had probably met many of the deceased of our county at one point or another. The old janitor watched and waited as I threw my cigarette down and stubbed it out with the heel of my rubber clog.

“It’s amazing that you let him boss you around,” Jeffrey said. “Some black janitor.”

“At least he’s an honest man,” I said.

“What’s that supposed to mean?”

“He’s not selling painkillers.”

Jeffrey snorted, put another cigarette in his mouth. Someone in pharmacy must have been getting a cut, and then someone above pharmacy must have been getting a bigger cut. It all came down from the top of the pyramid. The hospital was a giant power structure in which the patients, the wellsprings of cash, existed at the base, and the morphine flowed downwards and the money flowed up.

We put up the gate of the truck bed and, because it was six in the morning, Doctor Andrews was getting ready to go home. I waved to him as he opened the door to his sedan.

“Hello cowboy,” he shouted to me, forgetting my name. “Some night, huh?”

“Sure was,” I said.

“Fucking hypocrite,” Jeffrey muttered, after the Doctor had closed the door.

Doctor Andrews was probably getting a cut too.

IIIThe average life span of a patient in Palliative Care is ten days. The critical ones don’t make it more than two. Only in the rarest cases does anyone ever go back home. One time a brave young ex-cop with sepsis had managed to combat the infection, and walked himself home with the barbaric metal still in his gut. We still told stories about him. Otherwise, we carried almost everyone else out in a plastic bag.

The state could deem an autopsy necessary in the case of wrongful death, but, otherwise, there was rarely any mystery as to what our residents died of. At a certain point your body will let go — it doesn’t matter whether the injury is internal, external, neurological, cardiological. The human body is a carefully calibrated circuit board, an entire colony, if you will, and collapse becomes imminent in the most telltale ways.

They bloat, they rot, they wither, they starve, they decompose before the last breath has even left. Death usually comes on in a quiet, dark, phantasmic way. Sometimes the patient’s hand is in yours. It’s the final drip of morphine that usually does it.

The two most common ways of ending a patient’s care are through sedation and extubation. Extubation is the process in which life support mechanisms are removed from the body, depriving the patient of oxygen. When you extubate the patient the heat gradually subsides into something ashen, crossing the threshold into memory. The other method, which the nurse administers, is the process in which we give them enough morphine to stop their vital organs. Assisted suicide is not legal in our state but we do it occasionally, implicitly, for the poor, broken families who put their loved one’s name on the DNR list, as much as Doctor Andrews has despised letting anyone check out early.

The state could deem an autopsy necessary in the case of wrongful death, but rarely is there maliciousness or injustice in Palliative Care, nothing more than the collective exhaling of life. One time a twenty-nine year-old cerebral palsy patient experienced a brain hemorrhage and was in our care for a week before he finally let go. The state initiated an autopsy, suspecting the young man had, in infancy, experienced shaken baby syndrome. Shaken baby syndrome is a condition in which a baby is violently shaken — often because a frustrated parent does not know how to make it stop crying—and the whiplash has deleterious effect on its malleable brain and skull. They tried to prosecute the mother but she had already fled to Missouri, according to some cousin or another.

In the case of Thaddeus—a ninety-eight-year-old with a nonfunctional colon, we had projected no more than a day and a half. “Don’t buy him any green bananas,” Nurse Martha had joked the night before.

It was surprising, therefore, on the fourth day of the rotation, eighteen hours after admitting him, when I walked into his room to empty his catheter bag only to find him sitting up, raptly watching the college football game with the remote in his hand.

“I don’t want it,” he said to me, bluntly, when I was fastening the hose into the drip.

“It’s your family’s wishes,” I said, trying to reassure him. It was necessary to keep him on a moderate dosage until they finalized the M.O.S.T. forms — Medical Orders for Scope of Treatment. “They don’t want to see you in pain.”

“Jesus ain’t gonna take me if I can’t find him,” he said. His arms, thin and frail, were softer than cottage cheese.

I wondered if this was the moment when Jesus would be landing on the roof in the helicopter. There was something so clear in his eyes, and though he was long unresponsive, I could not help but feel that he was, somehow, more aware of the currents in the air than I was.

One of his relatives, a young woman named Karen, walked into the room and told him that he should be taking his meds that the kind man is giving him. Then there was a wiry man in coveralls, stomping in behind her, who interjected.

“He ain’t no man,” said the relative. “You see what he’s wearing?”

I forgot that I had chosen to wear my Snoopy and Woodstock scrubs to work. When I returned to the break room I noticed the small river of blood running down Jeffrey’s nose. Some sort of circuitry must have burst. He smiled at me as he continued polishing the scalpel in his hand.

IVThe Dixie Classic Fair approached. One of my finer friends named Davis was a broker for the R.J.R. tobacco conglomerate, who kindly appropriated Jeffrey and I two tickets to the fair in exchange for all the morphine we stole him earlier in the summer. It was not as if we could not afford to go, but it felt suddenly like a crime not to.

After following the strands of lights long enough we found our way to the ferris wheel, a slowly spinning ride wherein we were the only non-couple. The worker was a man in a vest who clasped the metal gate down on our lap and laughed about it. “Have fun,” he said, because in this part of the country homophobia was still thick as pollen.

“We’re just here scouting for talent,” Jeffrey said. “Don’t get the wrong idea, buddy.”

“Sure,” he said, coughing. “Have fun.”

It rose slowly and suddenly the comical smallness of the fair became apparent. The alleyways of men and women receding behind the airbrush station. I looked for the graffiti where I had inscribed my girlfriend’s initials—HG—from a fiery autumn during high school. But the panel of the seat was plain yellow metal and I recognized none of the initials inscribed on it.

At the top of the arc Jeffrey pointed to the R.J.R. banking building, which glowed like some strange cucumber on the dark nether of downtown.

“I banged a girl who worked there once,” he said. “She’s married now.”

“Do you want to get some food?” I asked. “There’s good brisket this year.”

“I’m glad that Martha didn’t decide to press charges.”

He was referring to a regrettable incident from the summer, which he now took to blaming on the influence of the substances he had been on. Regardless, we all had our jobs still, and I was doing my best to stay focused on the far-off tinsel of our banking towers, where the man who I had loved also spent his days.

I insisted on eating when we got back down. Jeffrey repeated his story about the woman from the bank loud enough for the worker to hear but the worker gave him not even a passing glance, fixated instead at the wrist of a teenage girl waiting in line.

The barbecue tent served us a bizarre amalgamation of overly-fried steaks and toasted starches bathed in butter — these were the foods that had seemed savory years ago, when I still believed that the South was a vital and wondrous place. This was before I worked a job in which I seemed to be writing my own eulogy everyday. We were sitting at a picnic table on the hard dusty ground eating fritters with fried sugar. Down the dirt walkway was a string band dressed in shining vests and bowties, their hair slicked back over their angular faces. The singer, a facsimile of the nineteenth century, was singing a song about lamenting losing his horse in a bad card game.

“I’d like to go somewhere this time of year,” Jeffrey said. “This is about the time of year that I get really down. You know what I mean?”

“Do you feel like more people die when it’s cold out?”

“There are definitely more people coming in,” he said. “I mean, why give up in the middle of summer?”

We walked through the throngs of people, some familiar, some strangers from the country. There was a causeway of perfume that flowed into my face instigating familiar sensations from past lovers, and I turned my eyes on the strangers whose scents were catalyzing that upsurge of affection.

“Davis is having a party tonight,” Jeffrey said to me. “There are a few customers who I want to connect with too.”

By customers he meant people who wanted painkillers. I had no choice but to go—it was his truck, after all.

We walked through the fair. The crowns of the pine trees rose high into the silhouetted purple foothills. A well-dressed man was standing in a booth promoting his book. It was a novel about moonshiners and Appalachia. It didn’t occur to me until after we walked away that he used to be one of us.

VWe tried to find Davis and his party but must have taken a left on the wrong Tobaccoville road. Who knew. There were no signs once you got far enough from the nucleus of our town. We got lost on a strange road that seemed to run parallel to the powerline cut. We could see it as a great swath of moonlight seemed to fill in the empty cold air where there were no trees.

“It should be around here,” Jeffrey said, turning the wheel hard again, downshifting such that the torque of the rear wheels threw all sorts of gravel out behind us. “Goddamn Davis.”

We had managed to get lost in a place where they used to do ceremonies—this is before the men in white robes used to burn crosses, even. This was the stomping ground where they used to come out by the dozen and speak in languages that were not quite English, worshipping things that were not quite God or Devil. It was all a matter of where your icons were from. You could see the strange hatchet markings in the trees where the illiterate folks had sent sparks upwards into the sky. Where they consumed hot freshly slain flesh.

There were certain things that never made it into novels about Appalachia—for some reason we had chosen to entomb the garrulous moonshiners and immortalize the nineteenth century love stories about runaway slaves. There was an insistence on the New South—we saw it as we drove past the billboard on the two-lane road that said Sunshine: A New Energy Drink for a New South.

“How long do you think old Thaddeus has?” I asked Jeffrey, as he gripped the wheel harder, squinting through the windshield in vain, hoping to recognize any of the barren signposts.

“Who?”

“The old timer with the huge family. The one who thinks that Jesus is going to carry him out on a helicopter.”

“That guy ain’t got more than two days. Hell, I’d be surprised if he was there when we came back on shift.”

We were on day two of our three days off. I usually didn’t start missing patients until the afternoon of the third day off.

“I think we’re lost,” I told him.

“We’re not lost,” he said. “I know these woods like the back of my hand.”

“Do you know them well enough to know when we’re lost?”

“If I knew we were lost then I wouldn’t tell you,” he said. “But we’re not lost.”

I watched the big billboard for Sunshine flash by us a second time. A New Energy Drink for a New South. We were on a two lane road again with the bright yellow lines between us unraveling like a tape measure, and the occasional mammal leaping across the celestial road in small parabolas.

“We’re back where we started,” I told him.

“We’re not,” he said. “Those billboards are everywhere. We’re getting closer.”

He wiped the slow stream of blood from his upper lip. I recognized the chalky scent of his breath—he must have been chewing pills again.

Then the blue gumball lights exploded behind us. I looked at the speedometer—we were going twenty over, as absurd as it seemed on this relatively dark road without landmarks, without lights. Jeffrey tossed the bag of pills—I was correct—beneath his seat. We waited as Officer Cody, a former stellar center from our high school basketball team, approached the window, standing two heads above the roof.

“Hello Cody,” Jeffrey said, handing him his license. “Slow night?”

“Just wait in the car,” the cop said, making his way back to the police vehicle.

It was devilishly cold for what should have been, strangely, an Indian summer. That was what everyone had told us. We had twenty-four hours before we were supposed to be back to the hospital.

“You go to the fair tonight, Cody?” Jeffrey asked the officer when he returned. “We were at the fair earlier.”

“You crossed the yellow line,” Officer Cody said, stoically. “You know the drill.”

“You’re going to actually test me?” Jeffrey said. “You realize everyone crosses that line. I mean, follow someone long enough and they’ll cross that line. It doesn’t matter whether they’re sober or not. Whether they’re drinking or not.”

“Go ahead and step out,” he said.

“Is this because of the whole Martha situation?”

“Go ahead and step out of the car,” Officer Cody said.

I watched in the rearview mirror as the officer shepherded Jeffrey down the yellow line for what was neither the first nor last tightrope walk of his life. The Martha situation seemed suddenly palpable, a toxin that had needled its way into the night air.

I had long since given up on believing in miracles, but, suddenly, I began praying again as the angelic blue lights of a German sedan spirited towards us, an inline five roaring with great promontory gusto, the hacksaw of diesel…God it was this sublime feeling and I wished I could have simply latched on my fingers and caught it, caught onto wherever they were going.

But the car ripped by Jeffrey, honking and laughing, as he walked down the line. I watched the car until it was gone over the hill, watched those pretty teenagers with great luminous teeth and long blonde hair, drunkenly cooing to Jeffrey as he teetered down the line. I watched those caustic red taillights disappear over the crest of the road.

Jeffrey returned to the car, triumphantly, his chest swelling against the chambray shirt, his eyes filled with a renewed light.

“Breathalyzer came up zero,” Jeffrey said, his words slurred. “He thought I’d been drinking.”

There was no way you could detect painkillers short of a blood or urine test. We continued our journey down the undulating country road, passing the Sunshine billboard for what seemed like the hundredth time. We never found Davis or his party, but, as we crested the summit and the waterfall beside the road was illuminated, I could hear the bizarre thrush making its warble in the woods, and I knew that something would have to change.

VIMy three days off were nothing more than a neurotic, obsessive, restless period spent dreaming about old Thaddeus, and I had these painful hallucinations of Doctor Andrews driving a Mercedes sedan, filling his gas tank with morphine drip. I had a vision of the Thaddeus family—this anthill of semi-toothless relatives living in blackened, iron-smoked hovels in the hills, the stacks of bills and overdue notices piling up in the other boxes of junk mail. An entire tree of vitality split asunder by this axe of capitalism. Somehow we had managed to capitalize on the death of their patriarch, and we had sold them the fabulous helicopter ride to the heavens, accepting a role as the spiritual escort of this old pilot’s soul.

The three days off had never gone by so slowly, and I returned to work for my shift fifteen minutes early, the parking lot filling with light, the Mercedes glazed in a honey-colored warmth and Lonnie’s truck sitting there with dents and crevices. I was beelining for the old man’s room when Lonnie pulled me aside in the hallway, his mop balanced in the crook of his elbow.

“You’re going to want to see something,” he said. “Go to ER.”

Jeffrey had been admitted overnight, his skull fractured, two ribs broken by the steering column of his truck, having driven off the road. It was half an hour before the EMTs found him. Luckily, he was not in pain.

“I did a stupid thing,” he said, slowly. He was reclined in the hospital bed, half of his head bandaged. He was clearly short on fluids. “I know you’re going to laugh.”

“Good lord,” I said. “I was with you just two nights ago.”

“Isn’t it ironic?” he laughed. “They’ve got me on painkillers.”

“You’re going to pull through,” I told him.

“I just want to die. I should have died.”

“One inch to the left and you would have.”

He looked so young again, in his hospital gown, his tired eye slinking left and right in the room, surveying me, looking up and down at the blinking machinery on the wall behind me. At the television. It had been a long time since I had seen him sober, and even though the painkillers were still inside his veins, there was a look of sacrosanct defeat in his eyes bordering on piety.

“We’ll get you out of here soon,” I told him, my hand on his shoulder. “You’re going to be fine. You’re going to bounce back.”

“And then what?” he said, his eye wetting again. “I mean, why did God even spare me? I’m going to get out of the hospital and then what—go back to working at the hospital? I wish a helicopter would come for me.”

“It ain’t coming anytime soon.”

The cicadas and the crickets were undeterred and the chaos of the Dixie Classic Fair, having blown away, was replaced by this almost retrograde solace, as if somehow we were closer to August than we were to October, closer to the ocean and the glittering lake shores.

This was the summer that I had fallen in love with a man named James—he was also late in life to come to terms with it—and it felt like a great weight had been lifted as we prowled around in the undergrowth by the bodies of water, the rallying cries of hatred in this town suddenly deflated by the sheer relief of lifting the weight from my shoulders. When you get a high like that there’s nothing the citizens or family can do to negate it.

This was the summer that Jeffrey had stayed an extra shift on his third night—when he should have gone home—when he sat on the bent fender of the truck with Nurse Martha at three in the morning, and she, at least according to him, was an open faucet about her marital discord. She had been married too long to the kind officer Cody with whom she was once enamored, our senior year. It was a fragile love that had been stomped on like the dogwood flowers, something that, according to her, had become petty and incongruous with the spoils of life. There was a certain high—believe me—about attending to the needs of the dying that seemed to reorient the scope of the other relations in your life. I had felt it too.

I had seen them come and go, the bickering rambunctious families, the ex-wives and ex-brothers bound by no more than gossamers of memory, struggling for some last minute power of attorney, grappling for some place on the will. I had seen those who still resided in town and those who moved away, banished like dandelion molt, speaking as if with prescience of death, as if channeling the voice of the unresponsive dying member of the family. And I had seen Doctor Andrews, with his big bright ties and his steel-silver hair, preying on all of them like a great mantis, his claws in the softest places of the family unit, prying away where the connective tissue was weak. There was always a good day for morphine on Doctor Andrew’s watch. The M.O.S.T. forms were populated with his optimistic, intensive care regimens for keeping this place as close to a living mausoleum as possible.

I had seen him drive away in the sweet sedan, a piece of engineering hardly emblematic of life-saving. I had watched Lonnie, patiently emptying trash cans, who had guarded this place for decades without ever so much of a hint as trying to escape.

It was on this day, that Jeffrey was admitted to the ER, no doubt at a price more astronomical than he could conceive of paying, that I decided to send Thaddeus to the roof. He had been a wellspring of capital for too long, had been kept away from his final ride for too long. I knew that I couldn’t be a witness any longer.

But when I opened his room door I found only an empty bed, the flowers and the framed portraits all moved, the strange aviation memorabilia gone.

“Where is he?” I asked.

“You didn’t hear?” Nurse Martha said. “He went home yesterday. The clotting took hold in his colon. You should have seen it—he literally walked himself out of bed on his own.”

“That’s…extraordinary,” I said, looking up through the ceiling, as if I could somehow hear those big blades cutting through the air through all of the insulation and hospital walls.

VIIAt the end of the third day on I walked into the ER and I signed the release form for Jeffrey. He slung his arm around my shoulders and I helped him through the door, as he swore the entire time about almost everything—the institution, health insurance, paid vacation, the police force. Nurse Martha saw us coming and just rolled her eyes—me in scrubs, he in hospital-issued gowns. They had disposed of his clothes because they were soaked in blood.

It was one of those hot Indian summer days when I could say to hell with all of the bickering and all of the congestions of the world. We rode in my truck away from the hospital, past the blue wattage of the mall, to the place in the road where it starts to undulate, rolling high and low through these valleys of pine. And the sunlight came through like tinsel on the side of his unshaven face.

“Did Thaddeus go?” he asked me.

“Yes,” I said. “He finally did.”

“He die peacefully?”

“He didn’t die. He left…Lonnie thinks that they’re going to kick him out of heaven when he does end up getting there though.”

“What for?”

“Complaining too much.”

Jeffrey laughed about this. It was some time before we came to Lake James and all of its spectacular crests and the diamonds of light playing on those waves.

“I used to want to go up there too,” Jeffrey said. “But the funniest thing happened when I was in ER. This angel came down in a helicopter and told me to sit on her lap. And she looked just like Martha.”

“Are you serious?”

“I’m joking,” he said, laughing.

He began reaching into his pockets, but I made him watch as I threw all of his medication into the lake. And when he protested I threw him in too, and I threw myself in after, and everything, for a brief moment, was quiet. When I came up for air I saw his face, dripping wet, and the strangest thing was I could see the shapes of my own family on the waves. We had gone on too long being numbed, and I think I suddenly understood why the old janitor gleefully pushed the mop everyday—it was all simply a matter of life before death.

Thrashing in the water, Jeffrey asked me to pull him ashore. I waited until he realized that it was shallow enough that he could stand up.

Michael Mount is a graduate of Brown University. His work has appeared on NPR. He is a MacDowell Colony fellow, finishing his first novel: And Then There Is Using Everything. He is a native of North Carolina.