"Yes, one son. Donny. He owns a restaurant in Honolulu. I don't see him much, but next week he'll be here- a business trip to New York. And he taught me how to use e-mail." She pointed at a turquoise laptop sitting on her night table.
Pretty lonely, he couldn't help thinking, and tried to come up with something else to say. "Do you know the hospital chaplain, Jimmy Fitzpatrick?"
Her eyes beamed. "Father Jimmy? Of course. He's wonderful. Always says just the right thing to pick up a person's spirits."
Oh, does he now? Earl thought, still shaken by the hiding he'd received.
"Cracking jokes the way he does is wonderful," she continued, "but he can be serious when he wants to be."
"Tell me which you like best about him, jokes or serious." Maybe she could give him some pointers about the man's technique with the patients here.
"That's easy. He never wastes my time. No rubbish about doctors all at once finding a cure or me somehow getting better through a miracle. There's a relief in hearing a person tell bad news honestly and make no bones about what can't be done. It leaves him free to help me in ways he can."
"What are those?"
"Listening, talking about ordinary things, keeping me interested in the world- you know, making me feel I matter to him. Not that he's got a lot of time to do it in. There are so many others who depend on him as well."
Earl started to thank her, not much the wiser about specifics that made Jimmy so great at his job, but she laid a hand on his arm. "Know what's his real secret, now that I think about it?"
Earl waited.
"It's the way he looks you in the eye and says, 'I'm sorry you're going through this.' Twenty seconds face-to-face like that, and I feel he's given me twenty minutes."
The next dozen visits went a little quicker, but he found them no easier. Patients raised questions he couldn't answer and expressed fears he didn't know how to console.
"Why me?" some asked when he inquired about their pain.
"I'm afraid to die," others said.
Not that he hadn't heard those words thousands of times in ER. But there the confused hurly-burly of a resuscitation or the rush to line and intubate whomever he was working on allowed him to get away with brief reassurances. Here people looked him in the eye and expected his undivided attention along with a detailed response.
"I don't know what to say," he repeated over and over, bowing to a growing sense that on this ward, bullshit would be even less forgivable than his ineptness with words. "But I'm sorry for your ordeal."
Still, he pushed on with the rounds. Despite the emotional suffering he'd discovered, he began to wonder if Jimmy hadn't exaggerated his claim about patients being undermedicated, as most seemed free of physical discomfort.
Then they approached the nearest of a string of rooms where the nurses had closed the doors. The sounds he'd heard earlier emanated from here.
He quickly scanned the chart of the patient they were about to see.
Elizabeth Matthews, fifty-eight, terminal cancer of the ovary.
What had sounded like whimpering turned out to be a continuous high-pitched cry once they were inside. The lights were off and the blinds were closed, so he could barely make out her form on the bed. But he could smell the acrid, sour aroma of her sweat.
Swallowing, he drew closer, and his eyes adjusted to the dark. She lay on her side clutching her knees, curled around the point where the tumor, grown from what had once been the source of her seed, would have maximally eaten through the contents of her lower abdomen and into her pelvis. She rocked back and forth, as if her belly were a cradle to the malignancy and her hideous keening could lull its ravages to sleep.
"Mrs. Matthews?"
The piercing sound from her throat never wavered.
A movement in the corner of the room startled him. "Doctor?" a man's voice said.
Earl turned to see a tall, asthenic figure rise from a lounge chair set well back from the bed.
"I'm Elizabeth's husband." He held out his hand. "Thank you for coming."
Earl took it, touched by the simple dignity of the gesture. Either the man had nerves of steel to remain so composed in the face of his wife's suffering, or witnessing it had left him numb. "Mr. Matthews, I'm so sorry."
"Nothing's helped, Doctor. She's been this way for the last two days. The residents tell me they're giving her the maximum amounts of morphine possible…"
As he talked, Earl flipped to the medication sheet and looked at the orders.
Morphine sulfate, 5 mg sc q 4 hrs prn.
Maximum, his ass. A medical student must have written it, copying word for word from the Physicians' Desk Reference, the bible of medications and their standard dosages. But Elizabeth Matthews didn't have standard pain.
He immediately felt back on his turf. "Get me ten milligrams of midazolam," he said to Yablonsky. This kind of suffering he could dispatch in seconds.
"But-"
"Now!"
One of her younger assistants darted out the door.
"When did she get her last dose of morphine?" he asked, walking over to check that Elizabeth Matthews's IV line remained functional. He opened the valve full, and it ran fine.
Yablonsky flipped to the nurses' notes. "At three this afternoon," she said, "during our usual medication rounds."
"And it's now nearly eight, five hours later. Her order says every four hours, as needed. I think we agree she needs it."
"Well, yes…"
"And you gave her only five milligrams?"
"Subcutaneous, as prescribed."
"You didn't request her doctor raise the dose, even though you could easily see she required more?"
"More is not what's on the chart, Doctor. Besides, we don't want her to get used to it so the drug no longer has an effect-"
"You call this an effect, Mrs. Yablonsky?" He gestured to the crumpled shape on the bed.
She fidgeted with the chart, fuming at being confronted. "No, but I-"
"What do you say we give her ten, then? And if that doesn't work, make it fifteen." He grabbed the file out of her hand and wrote the order, scrawling his signature with an angry flourish. "And once we find out how much is enough, we'll make it an IV infusion. Even street junkies know that popping narcotics under the skin doesn't hold a candle to mainlining."
Yablonsky turned scarlet all the way to the tips of her ears. "Really, Dr. Garnet, her oncologist says she could linger like this for months. She wi//grow tolerant to morphine, and-"
"Then we'll sedate her, just as I'm about to do now."
As if on cue, the young nurse who'd gone to fetch the midazolam returned and handed him a syringeful of the fast-acting sedative. He swiped the rubber portal at the side of Elizabeth's IV line with an alcohol swab, jabbed in the needle, and slowly pushed on the plunger. "Whatever it takes to make her comfortable," he continued, "especially if she's got months. My God, is that your policy, the longer a patient has, the longer they don't get sufficient morphine?"
Yablonsky's younger colleagues, standing behind her back, nodded tellingly.
Yablonsky snapped her head high and threw back her ample shoulders. "Of course not."
Earl wondered if she had once been an army nurse.
Elizabeth's cries lessened as he slowly injected the contents of the needle, keeping a sharp eye on the rise and fall of her chest.
Mr. Matthews walked over to the other side of the bed, leaned over, and stroked his wife's head. "It will be better now, Elizabeth. You'll get some rest." The fatigue in his voice weighted the words like rocks, but they must have fallen as gently as tears on her ears. She smiled, released her hold on her knees, and reached up to pat his hand.