The End is a series about end-of-life issues.
In a Venn diagram of tending helpless people at the extremes of life, the circle of caring for a dying person overlaps almost completely with the one for caring for a baby. Both are repetitive, intimate, often gross, sometimes funny, weirdly frantic even as they’re crushingly tedious, and a total act of devotion. In the nonoverlapping part of the end-of-life circle, there’s pain, grief, despair and a dreadful fading. There is movement not forward, toward consciousness, but backward, away from it. And for all of your endless patience there is nothing at the end. Just death, and your only job is a kind of mothering right up to the lip of the abyss.
Many people already know this, but I didn’t. Ali, my 47-year-old best friend of 44 years, was dying of ovarian cancer in a Coney Island hospice, and I was a death novice. I could flip through my mental scrapbook of our lives together — past stitching the last-minute buttons to her wedding dress, past teenage afternoons in Postermat on Eighth Street, past even the fold-and-seal letters from camp, all the way back to our Snoopy stuffed toys, who were often sick and had to be bandaged in Kleenex and fed bits of gingersnap, their feverish, grimy plush cooled with ice cubes while we watched afternoon reruns of “Emergency!”. But as a grown-up, I hadn’t really been through it.
It was hard even before it got worse than we could have imagined, back when we thought it was as hard as it could get. Back then, Ali was in the hospital still. It was the beginning of the end, and she was in so much pain. She needed to be massaged and held and to eat cold chunks of watermelon by the quartful. She had a horrible, leaking tube that emptied the contents of her stomach into a bag and left behind a deadly thirst. The more she drank, the more the tube drained away, and the thirstier she became. It was mythological. For a while she craved a particular kind of German mineral water, then strawberry Popsicles, then San Pellegrino grapefruit soda. Since my babies were the kind that nursed every 20 minutes, this was familiar to me — the constant guzzling, as well as the constant thrum of doing that often drowns out the bigger existential story.
I’d announce that I was going out for a minute of fresh air, only I never would — there was never time — even though time passed so excruciatingly slowly. When you’re pregnant you hear that your baby will sleep for 20 hours of every day, but then somehow the minutes never clump together into any meaningful stretches. It was like that with Ali. She needed dry pajamas, fresh sheets, more ice, a bite of yogurt. She needed a new drainage bag, a clean lap pad. She needed blood drawn and potassium injected and Ativan added to one of her half-dozen drips. It took an hour for her husband, David, and me and a nurse to get her into a chair by the cracked window so she could see the sunset, feel the breeze, only by the time we got her there she needed to return to bed. David and I made dirty jokes about Ali’s thigh-high medical compression stockings, and she laughed. We cried in each other’s arms and also were bored.
The hospice was better, but also, of course, worse. I couldn’t stop myself from looking into all the open rooms, the dying people so grayly flat in their beds they were already like ghosts. There was a baby, too, dying across the hall in a crib. It was unspeakable.
Ali had vases and vases of flowers along her windowsill and I devoted myself to culling and rearranging them. I borrowed surgical scissors, spread out a towel, dragged over the trash can, and turned 15 vases of decaying roses and hydrangeas into five vases of gorgeous ones. It reminded me of sitting captive beneath a napping baby, clipping my fingernails simply because I could reach the nail clippers and it was something to pass the time.
Oh, but it got so bad. There was the night I slept on the foldout couch, when Ali cried in my arms because her little son was sick at home with his dad, and she was not there to care for him — would, impossibly, never again be there to care for him — while she drank and drank. She drank raspberry-apple juice and a beige protein shake. “My heart is breaking,” she cried, gulping from a quart of blue Gatorade, after which she said, through her tears, shrugging, “That was actually really good.” We laughed because the lofty and the base can come into such absurd proximity.
But this was not nearly as bad as it got later. Later, when words failed her, Ali squeezed my hand and, eyebrows and shoulders raised in alarm, studied my face. My kids did this too, when they were small — looked into my eyes to see if they were safe. I remember an elevator trip, the doors opening to a brick wall between floors, two little faces swiveling up to ask, wordlessly, “Are we safe?” We are safe, I beamed back at them, because we were in it together, what did it really matter? You are safe, I beamed at Ali now, smiling and smiling, nodding in my maternal way.
“You’re good, you’re perfect,” I said all the time. “You’re doing everything right.” And we weren’t in it together, and it didn’t mean anything meaningful, but she would grin and her eyebrows and shoulders would drop down again. It was like a trust fall, and also it was life and death.
The big, cheerful doctor came by daily — the one who looked exactly like a yarmulked James Gandolfini, and whom we called, behind his back, Dr. Soprano — and my friend talked to him like the child she was becoming. She had wanted to go away one last time — first, ambitiously, to Florida, and then, less ambitiously, to a hotel on the Upper West Side — and when he finally said no, it wasn’t possible, the trip would be a nightmarish disaster at best, she was crestfallen.
“Why?” she said to him, said to me after he left. “I don’t understand. Why can’t I?” I thought of my kids, small still, watching the rides being taken apart before they’d even realized the carnival had come to town. Why?
Ali fell to the floor once in the middle of the night, and I had to sit with my fainting head between my spineless knees while the nurse and Ali’s braver friend Amanda did the heavy lifting. Years ago, when my son knocked his two front teeth out, I muttered consolingly and mopped up blood and filled a bag with ice and then, when his father got home, knelt on the bathroom floor with my forehead on the tiles. All my petty cowardices!
O death be not proud. Also, be not so messy and exhausting. Live as if you’re dying would be a better sentiment if dying weren’t so awful.
But just as you are too busy diapering the baby and mopping up curdles to feel the constant radiant ecstasy of your gratitude, you cannot sustain the high note of tragedy, even though everything else feels frivolous. On Ali’s second to last living night, she wouldn’t close her eyes. David was home, caring for their children, and her parents and brother had returned to their apartments, but sometimes she imagined they were all there. She was like a kid who didn’t want to miss anything — convinced that the Monopoly board and jelly beans were going to come out the minute she was asleep. Or like a person who didn’t want to die.
“Close your eyes!” I said, Amanda said. We wanted her to sleep. We were so tired! We filled and refilled her drinks. She pointed to them one after the other — six glasses on her tray, more broken underfoot since she was too weak to hold them, but refused to drink from plastic — and we named them while she nodded approvingly, rattled her ice. A few months later while I was walking on the beach, a lodged shard of glass from that night would finally come out of my heel and I would be spared at least that particular walking-around pain.
“What’s the name of the guy. . . with the hoog?” Ali wondered. “Hoog? Woozy.” We didn’t know. “You two. . . work in a bar together?” she asked near dawn, and we laughed. She craved sweets, wanted her cracking lips smeared with balm, needed a dry nightie. She was so cold. Her teeth were huge, her hair sparse. She had become a cross between a baby and a million-year-old woman. “Is there any champagne?” she asked, as the sun rose over the Atlantic, and Amanda sighed like a weary mother. “It’s 6 in the morning, Ali. There is no champagne.” “Tell me that’s not the last thing I said to her,” she said to me at the funeral, and we laughed like crazy people.
After I had my firstborn, I was stunned by the basic fact of birth. “That person!” I would say, clutching my husband’s sleeve, “That person, that one, all of those people, every one of them was born!” I was not exaggerating my wonder at this fact. Every living human represented a pregnancy, a birth, a groaning hook-or-crook launch into the world! The universal can be so startling.
I had a similarly banal revelation after Ali died. “You and you and you,” I thought, on the Amtrak train. The teenager on his iPhone, the woman with her sandwich. My old parents, me, even my own children. Everybody was going to die, with or without six different drinks in front of them. You already know this, but I hadn’t understood it. I hadn’t understood that you’re stuck loving only hearts that could stop beating, that will. You love them with your own stretched and scarred organ, the one that might pound on long after, like a dumb animal. Like it didn’t get the memo about the heart and what the heart can take.
Catherine Newman is the author of the forthcoming memoir “Catastrophic Happiness.”