Dinner Stories: Emergency Room

by W. Scott Olsen

Prologue

Here is a truth that crosses every border. Dinner is a time for stories.

There is something magical about the meal. Or, to be more precise, there is something magical about the occasion. We don’t often tell breakfast stories. We have to get going. The stories we tell over lunch are brief, summaries at best. But dinner stories can be long. They hold drama and nuance. They hold backstory and foreshadowing. They have an arc that reveals something deeper than just what happened.

Gather a group of friends at an evening table and we share stories that nourish the soul as well as the spleen.

The Chef

My friend Eric Watson is a chef. Talented, imaginative and creative, he owns a restaurant in Moorhead, Minnesota, called Rustica. What if, I asked Eric, we gathered just one person, someone with an interesting job, and asked them to tell stories? Could you come up with a menu to provoke those stories? Could you come up with a menu that was based on or inspired by the work they do?

Eric paused, but only for a moment. “Yes” he said. “I think I could.”

The Guest

Warren Hintz. Emergency Room Physician. Sanford Hospital. Fargo, North Dakota

The Menu

Wood Roasted Manilla Clams

Preserved Meyer Lemon, Garlic, Basil, Caper, Olive & Sweet Tomato

Ginger Miso Glazed Cauliflower

Edamame, Tofu, Sweet Potato & Sticky Black Rice

Scallop Crudo with Toasted Coriander

Fresh Orange, Shaved Fennel & Asparagus

Flash Seared Beef Tenderloin Medallion

Cumin Scented Quinoa, Black Beans, & Carrot Tahini Puree

Caramelized Pear

Coconut Milk, Ginger & Almond

Eric and I sit at the bar at Rustica, going over the menu he wants to serve.

Is there a connection between food and profession?

“That’s what I’m shooting for,” Eric says. “We have an Emergency Room doctor. So I am trying to keep it healthy. A lot of the ingredients on here—I just feel like certain ingredients hit my stomach and make my stomach feel better. Healing food. So like miso, or things that are umami driven, really savory. When I eat salmon roe for example, it makes my body feel better. It’s personal to me. Everything on here seems, to me, fresh, vibrant, healing. Something that’s good for the body.

“I tried to create a menu based around things that are going to cook really quick,” he says. “When I think of the emergency room I think fast, speed, so I wanted things that were quick. Like the beef medallions, for example. We can flash sear them really quick and they’re done. The caramelized pear requires very little cooking time. Everything on here requires very little, if any cooking time.

“I start light and work toward things that are heavier. The clams are super light, super clean. Manilla clams are petite and tender. The cauliflower—I just wanted to keep it healthy, so anything kind of along the vegan lines, health conscious, plant-based. The pear? Just wanted to keep it as free of animal fats as I could.”

I smile, looking at the piece of paper that holds his notes, imagining the evening.

“Should we tell him?” I ask.

“This is the Emergency Room,” he says. “I think it’s kind of fun to let him be surprised.”

Dinner Stories

Dinner is at 5:00 p.m. on a warm clear April evening. Warren and I arrive at nearly the same time. Grey hair and a closely trimmed grey beard, the man radiates calm. He moves quietly. His voice is soft.

Eric has reserved the best seat in the house, a table in the front window overlooking the intersection of Main Avenue and 4^th Street South. Cars and trucks, the occasional motorcycle, people out for a stroll go by. Walkers peer in the restaurant windows as they pass, all of them looking at the food on the tables more than the faces of the diners. A happy, curious young woman named Madi appears at our table and pours water, then takes our order for drinks. She knows this is an occasion. Be right back, she promises.

Warren and I smile, then start with beginnings.

“I was working for an engineering consulting company in Bismarck,” he says.

“Remember those aptitude tests we all used to take? They said I would be good at engineering, so that’s what I went into. With nothing else to do I thought ok, they’re smart, I’ll do that.

“Anyway, I was sitting in my office three years into it, after graduation, and I happened to look across the hallway to my bosses’ offices. They were both behind their desks. I realized at that moment, even though there was probably a little wanderlust happening before then, that these guys were forty-two years old and I was twenty-six. I was doing the exact same thing they were doing. And I said, do I really want to do this when I’m forty-two? Do I want to do this when I’m forty-five? The answer turned out to be no.

“So then it was a matter of what are you going to do if you’re not going to do this? I toyed with going into law school for a little while but there was a movie that came out in the late 70s called And Justice for All. Al Pacino. It was a great movie. It was really a spectacular movie. But it was horrible in the message it was offering. The message, and one of the lines I remember, was Al Pacino saying ‘There is no truth. Truth in law is only what you can get people to believe.’ I realized I don’t believe that. I couldn’t do that. So I started processing other things.”

Warren takes a sip of his water and begins a smile.

“I had a recollection of a girl I was dating during college and she had mentioned I should go to medical school,” he says.

Then he waits.

“Because?” I ask.

“She thought I’d look good in white.”

We laugh.

“Why not interrupt my whole life and my career path and everything else in the world I had at that moment because I would look good in white?”

Madi shows up with red wine for me, a gin and tonic for Warren. Her timing, I think, is perfect. Warren and I take that first sip of our drinks and survey the room. Other people are arriving and the room is filling with laughter. One couple, at a table a bit distant from our own, is clearly on a date. Perhaps a first date. Obvious, awkward eagerness.

“To be serious,” Warren says, “it was during this same time that I would ride my bicycle all over North Dakota and I was out riding one evening after dark. I was right down by the Holiday Inn in Bismarck, just about to go underneath the Memorial Bridge, and I heard this horrible screeching and scratching and crash. A car crash. This was obviously before cell phones. I ran up to the middle of the bridge. There was this car with four young girls in it. High school age. And then the other car, the notorious drunk driver. And these young girls kept saying, ‘Help me. Help me. Help us. Help us.’ There wasn’t anything I could do. I didn’t know anything. There wasn’t a thing I could do other than just try and reassure them, encourage them to stay calm. At least I knew enough that they shouldn’t move around too much. Another person came up after that, backed up, went somewhere and made the phone call to 9-1-1. I was able to stay there with them. And it was that evening, night, next morning that I said I would never be in a position where I don’t know what to do. So within two weeks I signed up for an EMS course. Joined an ambulance squad. Went to medical school.

“I am firm believer that everyone has a calling at some time in their life, he says. And we always look at things we like to do and might want to do. That night I found mine.”

Starters

Madi shows up again. Right behind her, Eric appears, deep plates in each hand. He sets them in front of us.

“Oh, my heavens,” I say, then make introductions.

“We’re starting out with a wood-fired, roasted clam,” Eric says, “with a sweet tomato broth, olives, capers, basil, a little garlic, chicken stock, a touch of butter and olive oil.”

I understand plating as an art form, I think to myself, but I am always amazed by the beauty of well-presented food on a plate.

“This came to be,” Eric says, “with the idea of trying to pair it with an ER doctor, at least the best I can. Just fast. Things that are flash cooked. I was just thinking speed. I picture an ER doctor moving quick. Or at least thinking fast. Nutritious. Good for the soul. Not a lot of saturated fat. But a lot of color. A lot of vibrancy. That’s where I was starting and where I was heading.”

“This smells grand,” Warren says.

Warren smiles at me after he takes his first bite. Behind us, the sounds have changed to forks and spoons and knives put to work. A dozen variations on the way to say “hmm” that means “this is really good.”

“I will confess,” I say, “I am afraid every time I get a meal like this. Shells and such. Do I really know how to eat this? But I’m also old enough to know I really don’t care.”

“Indeed,” Warren says.

I take my own first bite. Oh lord, I think.

“You’ve seen a lot of water under the bridge,” I say. I already know he is the second most senior physician in the ER. More than thirty years waiting for disaster.

“It’s remarkably changed,” he says.

“The technology has changed,” I say. “Has practice changed?”

“Skills,” he says. “Skills relative to procedures that you do to either save lives or make things more comfortable for people. Whether it’s lines, IV lines, or intubating, or something else, the skills have certainly followed the technology. Better equipment. Better techniques. Procedures have changed. Patient population has changed too, to some degree. Initially the patient population was truly emergency medicine people. Then it started falling into urgent care, walk-in clinic types of things. Now it’s all of that, plus. The only thing we don’t do is preventative care. And only because the setting isn’t right for preventative care. But whether it’s psychiatry, whether it’s chronic medical care, whether it’s urgent care, whether it’s emergent care, it’s kind of the full gamut of everything.”

“I had not thought of emergency psychiatry coming to your room,” I say. “Other places, yes. But not the ER.”

“Most of that, unfortunately,” he says, then pauses, “is despair. It’s an incredible social, cultural type of issue. Despair issues run the gamut of suicidal, whether it’s just thinking about it or actual attempts, to alcohol and drug related issues, overdose issues, intentional or otherwise. And just some health issues. Certainly we know that physiologically and medically people get sick from their stress. They get sick when they are in despair. Even if they are not using things. Even if they are not suicidal. Just physiologically they would get sick.”

Warren and I sit quietly for a moment, take bites of our meal. I’m coming to understand his pauses are a consideration of options. His life is based on getting it right.

“It’s curious,” he says, “that you ask what would bring people to the emergency department for even routine things, like a cold, or a child who has a fever, when there are walk-in clinics available. I used to ask myself that a lot. But then I learned.

“I think it’s been—I’m just going to guess on the timing of this—ten years ago? It was in the middle of the night. About 2:30 in the morning. Even ten years ago we weren’t overly busy overnight. Ten people, maybe twelve. Maybe even five? From 10:00 p.m. until about 6:00 a.m. it was not a grand crowd. This one particular morning, I was in our sleeping room, study room, whatever, and I got a call there was a patient to see me. I came out to see him and here’s this eighty-seven-year old little guy, nicely dressed, looking healthy, and his primary complaint was fatigue. At 2:30 in the morning. And I wondered, I wondered what he was thinking.

“So, fatigue. I went through the whole gamut of what could cause a little old man to have fatigue. He hadn’t fallen or been dizzy or anything. As I was interviewing him, and then examining him, I was asking him—what do you mean by fatigue? Tell me what you’re experiencing. What has changed recently?

“He had more energy than I did! He was telling me that twice a week he would go down to the Eagles club and dance until they closed at midnight. He was telling me stories about little old ladies. ‘They just won’t let me alone,’ he says. ‘There’re more old women than there are old men there, so I don’t have to worry about not being able to dance,’ he said. ‘In fact, sometimes I just wish I could just sit and chat for a little while.’

“And I thought, so you dance all night, once or twice a week, and he says yes, I do. And then he said he hikes miles a day! So I ask—has anything changed? He said, not really. So I’m still processing, how does a little eighty-seven year old man, nicely dressed, 2:30 in the morning, come into my department saying he’s fatigued? I did some diabetes checks, some anemia checks, whatever else I could come up with for fatigue. And I came back half an hour later and I said you know, everything looks good. I don’t have an explanation for what you’re experiencing. He said, it’s okay. I’m not necessarily fatigued. I’m just sad.

“And I said, what are you sad about? He said, ‘Well, in the middle of the dance night tonight, I got a phone call that my last best friend died. And I just wanted somebody to talk to.’

“Since then, I realized that everybody comes to see me, comes to see us, for a reason. And whether that reason is something I understand, whether that reason is something I agree with, whether it’s a reasonable reason or they just needed somebody to talk to, at 2:30 in the morning, I’m there. I’m serving a function. And so I kind of vowed that I will never ask again, in my mind let alone out loud, if they should be there. Sometimes I do ask What are you here for? because I just don’t understand their whole process, and that does clarify a lot of things. Sometimes it still just doesn’t make sense, but at least most of the time it clears things up. But at least I vowed I would never be angry or frustrated with somebody who’s there that I don’t think needs to be there.”

“Have you been able to keep that vow,” I ask?

“I think for the most part yeah,” he says. “I have. I was so impressed with that little old man.”

Second Course

Madi arrives, smiling. “Can I take this first course out of the way?”

“It was wonderful,” I say.

“I think I devastated it,” Warren says. “Thank you.”

Eric arrives right behind her.

“So what do we have?” he says. “This is a pan seared cauliflower medallion with a ginger miso glaze. We got a little tofu, a marinated tofu with a little splash of tamari. Same thing with the edamame —it’s got a little splash of tamari as well. And a sweet potato puree and a black sticky Tai rice.”

“Oh my, Eric,” I say. “Where did this idea come from?”

“You give me too much credit for ideas,” he says, laughing. “No, it’s just I like the color scheme, I like the textures and flavors together, so yeah, that’s really where it’s born from. Just kind of going all vegetarian, vegan on this dish actually, so again just trying to keep it clean, healthy, small portions.”

We invite him to linger but Eric says he cannot. Other customers. Other patients.

Warren starts to talk about diagnostics and protocols. He tells me about ABC—airways, breathing, circulation. But then he takes a bite, stops and points at his plate, at the presentation of the food. All he says is “mmmm.”

“I wish I had Eric’s imagination,” I say.

“That sweet potato puree is just absolutely breathtaking,” Warren says.

We are suddenly in that comfortable silence of good food. A shared, atmospheric joy. Something shared even before language. Something ancient.

“I marvel at creative people,” Warren says.

“Don’t let anyone know,” I say, “but I actually like the tofu.”

“I’m there with you, too,” Warren laughs.

“I’m always amazed when people can bring out a flavor in cauliflower,” he says. “Something that is so”—he pauses, then just smiles.

We pay attention to the food, sip our drinks.

“Tell me about diagnostics,” I say. “It seems to me, from the outsider’s perspective, that you, your department, has to have the fastest diagnostic skills in the world. The range of things you could be presented with is everything.”

“I think that’s accurate,” he says. “You have to have at least a pretty clear picture of what the possibilities are. We use the term differential diagnosis relative to whatever complaint they have. So you came in with belly pain—what are the possibilities? You came in with chest pain—what are the possibilities? You came in unresponsive—what are the possibilities?”

“What information do you have before you see a patient?” I ask.

“It certainly varies,” he says. “A critical patient is really the only type of patient I hear about before I generally go in to see them. For the most part, all of the patients we see have a chief complaint or a primary complaint. And maybe a little bit of details from the nursing staff.”

“So usually you’re just looking at the chart hanging on the door as you go in?”

“Right. Whereas critical patients, the staff are exceptional in letting us know there’s somebody critical coming in in ten minutes, fifteen minutes, and this is what we know. Sometimes it’s we know they’re not breathing well, some of it is blood pressure is low, some of it’s that they’re unresponsive. And some of it they’re not doing well. I hesitate to use the term routine patients, but their vital signs may not be there when I walk into the room. But anyone that has something that’s pretty dramatic, we’ll know.”

“So you’re already thinking as you walk down the hall,” I say.

                                                                                                

“Correct. And probably the first thing I think about is ‘is this person sick or is this person ok?’”

“How do you…” I ask, then retreat. “Wait. Is a broken arm sick? Is that what you mean?” I ask.

“No. Sick meaning are they, unless I do something quick, going to deteriorate? Or are they already deteriorating? And that’s a relatively quick assessment. You get just this general gestalt of what you’re seeing. Pale. Sweaty. Heartrate of 230. Minimally responsive. Those things you can just boom. You can have a big picture. Or at least a focused picture. And that’s where the ABC comes in.

“And when I say okay,” he continues, “when they look okay, or they look ill but their vital signs are okay, and everything else is working okay, at least I have a little bit of time to process. I don’t have to do anything immediately to manage something that’s life threatening.”

“How essential is the interview?” I ask. “You have the machines to tell you what the body’s doing. How essential is the talk to you?”

“It’s vital. Mostly because it gives you a clearer picture of what direction to go. By the time you’re done with the interview and an examination, things should be narrowed down pretty close to two or three potential items. And then it’s just a matter of the process of doing the investigation work that helps support those two or three items you’re thinking about.

“Things are not so much different here than they are anywhere else in the country,” he says, “in Boston, in inner-city New York. The quantity of trauma, quantity of violent trauma, is certainly different. But the general flow, the general what you do, the patient population, all of those things are pretty uniform all across the country. Right, wrong or otherwise, medicine has evolved into a clinic practice that is maintenance of things which have already been identified as problems. Walk-in clinics, urgent care clinics, and emergency departments are I have something new. Or, something old is now broken. My blood pressure is now, suddenly, too high. It’s difficult the way medicine is setup now. You can’t call up your doctor and say your blood pressure is now 210, you have a little bit of a headache, you’re having some problems with vision, and expect that he will drop two other patients in the next half hour to see you and try to manage that. So we see you. We have all the tools to manage that. And especially if it ends up getting worse.”

“Tell me about a particularly difficult diagnosis,” I say. “Is there a patient or whatever that particularly confounded you? Or one that you just nailed?”

Third Course

We are interrupted when Eric arrives again.

“Eric,” I say, “these are all beautiful dishes. Oh, that smells so good.”

“Probably one of my favorite ones,” he says. “We have a little scallop crudo, just keeping it raw and fresh. Quickly marinated and served immediately. That way the citrus doesn’t start to cook it. In this case, a nice, fresh, sea scallop. Came in fresh. We drizzled a mixture of orange juice and fresh lemon juice over the top. We got toasted ground coriander seed sprinkled over there, we got fennel, shaved fennel, red onion on the bottom with some shaved asparagus. That’s it. And fresh orange on top.”

We all look at each other, and I suddenly wonder if chefs and physicians don’t often get the same looks. Gratitude for the ineffable. We stop talking. Eating is its own pleasure.

“I think the most memorable patients,” Warren begins, finally, then pauses again. “It’s interesting because when you think of the world memorable you think of something that touched your heart, that maybe has a bright spot in the back or in the forefront of your mind. These are memorable in the opposite direction. They certainly have impacted my heart. They certainly have impacted my perception of life. But I’m not fond of remembering them. Those are abused children.”

We pause.

“It always amazes me,” he says, then pauses again.

“As an aside,” he says, “this is exceptional. Holy Moly! I just had my first bite and I go Oh Man… This has touched me. This is exceptional. Man, I like fennel, but I am not sure I’ve ever had fennel that’s this good.”

We pause again. Talking about pain in the midst of joy. The restaurant crowd. Laughter and love at the other tables. The happy noises. Somehow good food gives permission.

“The thing about child abuse,” he says. “I’m always amazed. I can certainly come up with sad. Anger. But every time I would see a child that’s been abused, either physically or sexually, and thank goodness it’s not often, I’m always amazed anybody could do that to a child.

“The other thing I’m always amazed at is the demeanor of the assailant.”

“Do you see them?” I ask, amazed. “Is it the parents who bring them in?”

“Sometimes the parents,” he says. “Sometimes the boyfriend of the mom. Sometimes a relative. Most of the time it’s somebody they know. And all the time I’ve experienced it, it is somebody they know.”

“And that somebody is standing in the room with you as you’re…,” I say.

“Yeah,” he says.

“Have you punched anybody?” I ask.

“No,” he says.

“You can almost always tell who the perpetrator is,” he says. “Because they’re removed. They seem concerned…”

“Concerned about evidence of their own guilt?” I interrupt. “Or concerned about the child?”

“Concerned about the child, he says. At least you get that impression. But there’s almost a sense of laisse faire intermixed among some of the other things. This is serious, and initially you think they don’t understand the seriousness, the seriousness of the injury, the seriousness of whatever is going on. And even if they’re engaged enough, that disconnect always comes through someplace.”

“How often does the child point a finger at someone and say that’s where my injury came from?” I ask. “Ever?”

Warren looks at his plate for what seems like a very long time.

“I’ve had very few abused children who are in a position to point the finger. The ones I see are toddlers, at best.”

“What about trauma,” I ask. “Not just car wreck trauma. But knives, bullets, beat-ups? Do you see a fair amount of that? I saw something today about an increase in the homicide rate.”

“I think there was a three percent increase in the homicide rate,” he says. “No, he says, it was a thirty percent increase. Which means we’ve had six.”

“So we’re not a violent town, in terms of your office,” I ask.

“No, we are,” he says. “There’s no question. But we’re still the knife club. Not the knife and gun club. Lots of stabbings. Lots of knife violence.”

Madi shows up again, to check on our drinks. I can tell she wants to know what’s going on.

“How does this look from your perspective?” I ask her. “Is any of this on the menu?”

“No,” she says. “I don’t even know what any of it is. I don’t even know what Chef is bringing out because he’s been preparing it all. I haven’t got a clue. But I heard that you guys are writing a book?”

“Yes,” I say.

“And the courses are meant to go along with the story?”

“He’s an Emergency room doctor,” I say, pointing at Warren. “Eric has to come up with a menu to match his profession.”

“Oh boy, that’s a tough one,” Madi says, then continues. “I’m going to be studying nursing.”

“That’s good for you,” Warren says, genuinely.

“I’m excited to get into it,” she says. “I’m going to start this fall.”

“Is medicine still attractive to eighteen-year olds?” I ask when she walks away.

“It seems like it,” he says.

I look around the restaurant. Every seat is filled. Food arrives and conversation stops to allow eyes and noses their own vocabulary. The first date couple is gone, their seats replaced by two middle aged couples. I silently wish them all well.

We go back to knife and gun club talk.

“We do have firearm injuries,” he says. “But the majority of those are self-inflicted.”

“What about somebody just beating up somebody else?” I ask.

“We see a lot of that. It’s been that way for a while. Ten, fifteen years.”

“Stupid bar fights?” I ask.

“Stupid bar fights. Domestics. For the last ten years, twelve years, I work strictly days. I gave up shift work.”

“The benefits of age,” I say.

“Or the agonies of age,” he says. “I couldn’t do shift work anymore. So I don’t see as much of the violence as people who work the evenings and especially the overnights. Nothing good happens after midnight.”

“What’s the most common complaint during the day shift,” I ask.

“Chest pain,” he says.

“How many of them are ER necessary?” I ask.

He pauses, takes a bite and says “I go back, he says, to everybody who comes to see me believes it’s necessary in some way or another.”

The evening light outside our window has shifted into the golden hour. There is saxophone jazz in the background. Crowd noise.

“I have a strong—that’s a reasonable adjective—concept of the value of life,” he says. “The last twenty, twenty-five years, I’ve gotten even more understanding of the value of anybody and everybody, whether they’re a chronic drunk or whether they’re a psychotic on stimulants, whether they’re somebody who comes to see us too often. Whether it’s somebody who has chest pain that is obviously not life threatening. I think the simple answer is that I truly just appreciate the value of every living being.”

“Did that come from you’re your time in ER” I ask. “Before medicine? From family? I ask. Religion?”

“Certainly it is family,” he says. “My mom and dad had a strong influence on me. They had an intense sense of the worth of people. They came from little or nothing, but gave to people who needed it. I’m also the product of a world war two veteran and they have a tendency of touching people’s hearts. My dad was in the infantry in the South Pacific. I don’t have stories that he would share—about anything. Except being sick with malaria and yellow fever. His platoon was devastated, twice, and he survived. A man I admired all my life. He certainly had his struggles with depression, though fortunately not substance abuse. He was in a psychiatric ward a couple times in his life. And it certainly gave me an incredible understanding of those people who are struggling. And most people are. Whether they’re coming in for a heart attack, belly pain, or a bad headache. At that moment they’re struggling with life.”

Fourth Course

Eric presents the next dish.

That last one, we say, has to go on the menu.

“It might go on a special,” he says, smiling.

We stopped the conversation for that one, we say. It was terrific.

“So here we go,” he says. “Fourth course, I believe. Flash seared beef tenderloin medallion on top of a carrot tahini puree. Some brown rice quinoa with black beans. A little dust of toasted ground cumin seed. And then just the natural pan sauce drizzled over that.

“I started with the carrot and tahini,” he says. “I’ve liked that flavor for a while. Then things fall into line with that. The black beans. The quinoa and then the cumin. Beef tenderloin. Small cut. Low fat.”

Here, I think, is the center of the meal. At least for me. It looks so pretty on the plate, we hesitate to cut. But then we do.

“Tell me a story,” I ask Warren. “Walk me through a typical case?”

“This one wasn’t a difficult diagnosis,” he says. “It was a difficult situation. And I hesitate just a little bit because it’s to some degree well-known.

“Emotionally it was difficult,” he says. “Mechanically it was difficult, too. I was the physician for a woman who was in an auto accident. And one of my partners was the physician for her child. Her child died. And so, mechanically the difficulty was how do I do what I needed to do, to make sure that this woman is okay? And how do I provide whatever she might need from a trauma standpoint, and still allow the time for her to hold and grieve for her child?”

He continues talking, but seems to wait between every phrase.

“And…so, from a process standpoint, I chose to…. She was doing okay, and I was watching certain parameters…so even though with trauma patients we like to have things in order, ready to go for whatever investigating things we need to have done, within the first ten or fifteen minutes of them arriving…it took me an hour to identify the things I definitely needed to do, and in order to get them done…I chose to take that time.”

I want to know more, I think. But I also do not want to open a wound.

“Do you ever learn to give bad news?” I ask.

“I think so,” he says. “Early in my career,” he says, “and I have no idea why I thought this, but I thought I had to give an explanation of the process. And then give the bad news. Fortunately, that didn’t last very long, a year or two, maybe three years. But I began to realize they really don’t care about the process. It’s nice for them to hear the process before you give them the bad news because then they know. Once you give them the bad news it doesn’t make any difference what the process was and what actually happened. Some people ask, but very rarely.”

“So any more,” he says. “Obviously I introduce myself, I find out who are family members and who are friends, and who is the person I direct my comments to. And I usually just say I’m sorry, there wasn’t anything we could do.”

“How many times a week do you do that?” I ask.

“Every other week, maybe,” he says.

I would have thought it would be more often. Aging population and then add motorcycles.

“The ninety-year old,” he says, “is more difficult. You have to know, in a relatively brief amount of time, their whole medical history. You need to know what they’ve dragged along with them on this particular day. So even if they are not on death’s door, but they have something that’s potentially life-threatening, the information if vital. Fifty-year olds, sixty-year olds, seventy-year olds, even maybe eighty-year olds, with a heart attack, there is no question about what you do. Call a cardiologist. They go to the cath lab. They get stents. Whatever else they do. But a ninety-five-year old with dementia, diabetes, kidneys that aren’t working perfectly well. They come in with a heart attack. Now what do you do? The angiogram even by itself can damage the kidneys even more. Would the person really understand what’s going on?”

Dessert

Madi clears our plates and sets new silverware for dessert.

“How many different sets of silverware did we go through,” I ask.

“You guys are getting special treatment,” she says.

“My wife really likes these,” Warren says, “so I’ve been storing them in my pocket.”

“Oh, I know,” she says. “We’ve been counting.”

When she walks away, Warren continues. “We see a fair amount of people who…There’s a husband/wife team in Princeton who coined this term Deaths of Despair. They’re looking at demographics. Profound increases in suicide. Certain groups in that category. Late teens to early twenties. And the other group that’s really increased in incidence is the middle-aged white male. So, suicide. Drug overdose. And indirect deaths due to substances. Alcohol or drugs or whatever the case may be.”

“Not Corvettes and motorcycles,” I say.

“Not Corvettes and motorcycles.”

“That was the category they looked at,” he continues. “And in my mind the term Deaths of Despair is an incredible term. And it speaks specifically to what we see day in and day out.”

Eric arrives. Caramelized pears, sliced standing upright on the plate. A balancing act to carry across the restaurant.

“So final course here,” he says. “Ohh!” A pear tips, but he recovers.

“Caramelized pear,” he says. “With a little sugar in the raw to help it caramelize. We got natural pan drippings around the outside and a sauce in the middle. We got coconut milk and almonds over the top.”

“Any reason why you chose this as the finish?” I ask.

“Because I love pears,” he laughs.

“Honestly,” he says, “I just love the presentation. I like the way they slice and present. It just seemed like a nice grand finale.”

He has a meeting at 7 p.m., he says. We all shake hands, say thank you, try to express admiration and astonishment, and then he dashes off.

The pears are very good.

“If I get annoyed at anything,” Warren says, after a moment, “it’s chaos.”

“How so?” I ask.

“Chaos is out of control,” he says.

“But when the ambulance pulls up and the door goes up, that’s what you’ve got,” I say. “That’s who you are. You’re the emergency room.”

“But it doesn’t need to be,” he says, “if everybody who’s there does what they’re supposed to do. That’s where training comes in. That’s where protocols come in. Even in the most dramatic cases, it doesn’t need to be chaos.”

I ask about mass casualty drills. Airplane crashes. Train derailments. Chemical explosions in town. Suddenly hundreds of people heading for the emergency room. The hospital does participate with the police and fire department in regular training. But in-hospital care, he says, is much different than pre-hospital care. “The EMTs,” he says, “they have a whole specific role they need to do and they’re very good at it.”

“Is there a most chaos-filled, most dramatic story?”

He pauses for a long time.

“This particular instance was a young lady, early thirties probably, and she came in without the ability to breathe. Because of something that was going on in her throat.

“Fortunately, this doesn’t happen very often,” he says. “Most of the time airway management is reasonably routine. You might have a hiccup or two, but even with the hiccup you’re usually successful.”

“There was already a tube in?” I ask.

“No,” he says.

“Ok,” I say. “She brought herself in?”

“She came by ambulance,” he says. “But as she was doing somewhat okay, the paramedics are usually pretty judicial. I mean if they need to, they do. But if they don’t need to within the next ten minutes, they wait for us. It’s just that much easier. Because you’re in, to some degree, a controlled environment. You have everything you need and all the people around you. The respiratory therapists, everybody else that’s there. For the paramedics, you’re in somebody’s home. The light’s not good. Or they’re in the ambulance, bouncing down the road. So if they can wait for a better, more controlled environment, they usually do. And she was holding her own for a while. But it was obvious that wasn’t going to last for very long.

“And this was one of those airway managements that was more than a hiccup. Multiple tries by myself, even with anesthesia, even by our ear/nose/throat doctors, were unsuccessful. We were able to ventilate her a little bit, without the airway, but obviously that wasn’t going to last for very long. So we wound up doing a surgical airway in the operating room. And even that was more difficult than usual. It turned out that she had the airway about the size of a child. Maybe a ten-year old’s. Maybe eight.”

“Just a condition?” I ask.

“Exactly.”

“And it was not only the size,” he says, “but it was floppy. So instead of this hose that stays open, when she was not breathing it would collapse. Multiple tries but we finally got enough of a temporary air way she could be moved to the operating room for a definitive airway.”

“And nothing in her history,” I say.

“No.”

“You could have done some real damage if you continued to try to stuff an adult sized tube down her throat,” I say.

“Some of it was, you couldn’t even see,” he says. “Just the anatomy she had in her hypopharynx you couldn’t see enough even to attempt. Multiple attempts by multiple people. You just couldn’t see. Even fiber optic scopes were unsuccessful.”

Warren takes a bite of his dessert. “That was probably the most harrowing and chaotic thing I ever did.”

Madi clears the plates. So much more to ask and say.

Behind us, the restaurant has grown quieter.  Many people have left, heading out to other rooms, other places, for deeper comfort or rest.  Some people linger over their knives and glasses, this place what they need.

But the evening is not late. Madi and the other servers ready the tables for new customers.  Eric is gone, but another chef readies the kitchen for whatever orders may come.

Warren surveys the room.  “Remarkable,” he says, quietly.

W. Scott Olsen is a writer, photographer, and professor of English at Concordia College, Moorhead, MN. The author of eleven books, editor of several anthologies, and formerly the long-time editor of the national literary magazine, Ascent, Olsen has published individual essays, articles, and stories in a number of literary publications including Alaska Quarterly Review, Albany Review, Huffington Post, Kansas Quarterly, Kenyon Review, Mid-American Review, North American Review, North Dakota Quarterly, Northwest Review, Red River Journal, River Teeth, South Dakota Review, Tampa Review, Third Coast, Weber Studies, Willow Springs and others as well as commercial publications in magazines such as The Forum, Flying Magazine, AOPA Pilot, Flight Training and others. His most recent book, A Moment with Strangers, was published by North Dakota State University Press. All of his books are available for purchase online.

Never Turn Away

by Christine Holmstrom

          “Come here, Marilyn, let’s look in this window.” Wedged between an untrimmed bush and the home’s front wall, I’d motioned to my friend, inviting her to join me. Pressing my face against the glass, I peered inside.

Drat. It was the kitchen.

          From what I’d read in the LA Herald Examiner a few days ago, a man had murdered his wife, then his four children as they slept, right here in our placid suburban enclave. Afterwards, he’d killed himself.

          “What’s there?” Marilyn whispered, glancing backwards to see if any of the neighbors had noticed us.

“Just a messy table.” It sat in the middle of the kitchen, a butter dish near the edge, the contents slumping onto scuffed wood, victim of the valley’s summer heat.

No blood here.

We’d have to find the bedrooms where the kids were stabbed.

Marilyn and I were both twelve. Curious. Or maybe it was mostly me. Did I believe that viewing the crime scene would answer the unspoken question—why? The question had taunted me from when I could first read newspaper stories about strangled starlets, missing children, and trussed bodies found in steamer trunks.

Horrible as these neighborhood murders were, they provided the most excitement we’d known in quiet Canoga Park. If we’d thought to examine our motives, Marilyn and I likely would’ve recalled how drivers slow and stare, braking to look across the highway at smashed vehicles, the corpses—covered in blankets—lying on a sloping hillside.

“The bedrooms must be in the back.” Freeing myself from the clasp of the unruly shrub, I’d surveyed our surroundings. A tall wood fence encircled the sides and back of the home—a locked gate the only access.

“Wait, what’s that?” Marilyn pointed to the large rust-red stain that blossomed over the asphalt driveway leading to the two-car garage.

Could it be blood? I stopped, transfixed. Was this where the father committed suicide?

I always wanted to know more. Maybe that curiosity is part of the reason that I’d ended up as a correctional officer— a prison guard—at San Quentin decades later.

After walking through the heavy iron gates into the prison yard, I witnessed things that can never be erased from memory. There is no turning away.

As a “fish cop”—a new correctional officer—I was frightened yet mesmerized by stories of staff murders. During new officer orientation, Sgt. “Flip” Fernandez recounted how he’d been the first to find the body of Officer Richard Ochoa in the prison laundry back in ’76. “You couldn’t even recognize him. He didn’t have no face—it was hamburger.”

“So why would someone kill him?” I wanted to know.

“Not sure. Ochoa was well liked.”

“What happened?”

“Well, my guess is that Ochoa stumbled onto a drug deal.” Fernandez frowned. “The convicts must’ve panicked. Grabbed a weightlifting bar and…”

I held my breath, trying not to imagine a man without a face, the torn and battered flesh, the splintered nose, bits of pink tissue splattering his khaki uniform shirt, the pooling blood…

It could be any of us; could be me. Being a good cop wouldn’t save you.

During my first years at San Quentin, the prison was a war zone. Alarms screeching, whistles blaring daily. Shouts of “shots on the yard” as gun rail officers fired warning rounds or tried to stop a knife-wielding assailant with a bullet. Then the piercing wail of an ambulance racing down Sir Francis Drake Blvd to deliver the wounded and dying to Marin General.

Once, stepping out of the housing unit to respond to the blare of whistles, I’d flattened myself against the wall as four officers ran past, a badly injured prisoner on their gurney—his forehead split open, brain matter exposed.

Try as I might, I cannot erase certain scenes. Like this one: It was late morning—a cold day. There’d been another stabbing. I needed to ID the victim and sign the Warden’s Check-out Order prior to transport. The inmate lay naked, except for his boxer shorts, in the prison’s battered old ambulance. His pale belly heaved; his breath labored. Thin crimson stripes pierced his abdomen—the marks left by repeated stab wounds. Unaware of me, his eyes remained fixed on the vehicle’s gray metal ceiling. He was my age, handsome—no tattoos or gang symbols on his bare skin. Except for his longish hair, he reminded me of a man I’d once dated. I examined the ID photo that the gate officer had handed me, verified the match. Would the prisoner ever need it again?

There are many ways to die in prison besides assault—accidental deaths from bad “pruno” laced with wood alcohol or a suicide gesture gone wrong.

Or miscalculation. Like the two inmates in Badger Section.

Walking through the sally port—the prison’s double-gated entry—I’d nearly bumped into a lieutenant from the Investigations Unit. In his hand he’d held a few eight by ten photos. The bright colors drew my eyes.

“What are those?” Curious, I’d pointed.

“Evidence.” He fanned the glossies like playing cards. “Remember the cell fire last week?”

I’d heard about it. Late one night two prisoners had set fire to a blanket tied on the bars of their shared cell. Nothing especially unusual, although most convicts simply pushed a pile of burning garbage onto the tier. Inmates started tier fires when they were angry or drunk or just for the hell of it. The gun rail officer yelled at them to put out the fire. They’d ignored him. By the time another cop got to the cell with a fire extinguisher, the flames had spread. Their TV, also attached to the bars, ignited, exploding in a shower of sparks shooting across the cell. Decades of paint began to burn, the walls a flaming oven. By then the convicts were screaming, hurling water at the conflagration, plunging their heads into the toilet bowl. Some cops unfurled the unit fire hose from its red painted box and lugged it up two flights of stairs then dragged it down the tier towards the cell. It proved too short. Other cops were already on the tier, aiming fire extinguishers at the blaze without success. Intense heat had expanded the cell door, jamming it shut.

“No way could we unlock the door,” one of the cops later said. “It was the frickin’ Towering Inferno.”

I held out my hand for the photos. At first, I thought I was looking at an enlarged shot of two overcooked hot dogs—the pink skin splitting sideways—tattooed with charcoal bits. Then I noticed the blackened bunk bed and realized what I was seeing.

There was no pleasure in these sights—only a slight salve for the curiosity that had been itching since my childhood.

Friends sometimes asked why I kept working at the prison. Many reasons—the adrenaline high, the glory and notoriety of being a female correctional officer, the pay, promotional opportunities…

Although I could never erase what I witnessed during my time at San Quentin, I’d chosen not to turn away either.

There was too much to see.

Christine Holmstrom’s work has been published in Bernie Siegel’s book, Faith, Hope, and Healing. Her nonfiction has been published or is forthcoming in Dime Show Review, Gulf Stream, The Gravel, Jet Fuel Review, The MacGuffin, The Penmen Review, Rougarou,Streetlight Magazine, Switchback, Stonecoast Review, Summerset Review, Two Cities Review, and others. After surviving riots, an armed escape and a death threat while working at San Quentin prison, she finally had the good sense to retire. Christine is now working on a memoir about her prison years.

Colonus

by John Donaghy

After Father died, Mother did not pine away; hers was not that kind of desolation. She lived for twenty-four more years. During that quarter century she elaborated a glittering vision of her marriage and fixed it in a set of canonical anecdotes which she told us over and over. We were to understand that she and Father enjoyed a passion that could only have developed long ago among people who were more vital and closer to the source of life than our own anemic generation with its provisional, little loves.

On her kitchen table she kept a pile of old letters in tattered and yellowing envelopes: they were all the letters she and my father had exchanged from their courtship onwards. "I don't know what to do with all these,” she would always say, “I don't know who would be interested in them," and I always said, who knows why, “I'd love to take care of them for you.” And she: "I don't know. There's awfully personal stuff in here. Some of these are the letters of a man who is totally gone on a woman. Maybe I'll have them cremated with me. And yet I hate to do that, someone might find them very interesting.”

           Within that pile of letters there was a smaller bundle bound with a purple ribbon. These were the letters that chronicled The Argument. The Argument was the central story in the canon, the one that she told us more often than any other: She had been head of pediatric nursing at the Mass General. He was doing his residency there. They had been going together for months. She did not drink and flirt like the other girls. He was crazy about her, and she was crazy about him. He would call her every night at ten. When he was away, he would write to her every day. Sometimes twice. He had to go away for three weeks. He was resting; he had been overworking. But he missed her. He had to give a lecture in Montreal. He had arranged to take her with him; he had arranged for them to share a hotel room. He had acted as though it were a fait accompli. He had assumed and had not asked. Well, she was furious. She wanted to know if this was his habit. She wanted to know if he thought she was like other girls. She would most certainly not go with him to Montreal or anywhere else for that matter. He was hurt. He behaved as though he were angry. She would have none of that. She would not listen to him. They were estranged for days, oh, it might have been two weeks; she heard not one word. Then one night at ten o’clock, the phone call came. She had won. It was a glorious love affair. It lasted a lifetime.

In advanced old age when the multiplying frailties of nature send most people collapsing into themselves, Mother’s vigor seemed divorced from her flesh. In her eighties and nineties she became tiny, bowed, seamed with wrinkles, dry as a cricket, but she stacked her own wood and pushed her own reel mower and took as many trips to the landfill as she could. She amazed people with her wit and her activity, and she took so much pride in their amazement that she developed a kind of geriatric bravado. At ninety-three she stood on the very top of her step ladder—the “This Is Not A Step” step—in order to prune her lilacs. The ladder was on uneven ground and it began to tip, “It was going to take me through the kitchen window,” she said, “So I jumped.” She hit the ground and rolled, breaking nothing but straining her coccyx. She refused the doctor. It only hurt, she said, whenever she tried to lift something heavier than thirty pounds.

I could not help thinking that she might grow in energy as she shriveled in mass until eventually, a century from now perhaps, she’d whirl up into the hungry vortex of herself and disappear. But at the age of ninety-seven she began to fail. Her eyesight grew worse; her hearing began to go; her gait became unsteady; her driving became lethal. She tore out the undercarriage of her car by driving, at speed, into a ditch. She emerged from that accident unscathed, angry and, she claimed, blameless. It would never have happened had the town made that ditch more visible. As soon as the car was fixed, she visited my brother’s law offices for a quick consultation. Leaving his parking lot, she stomped on the accelerator rather than the brake. She shot across the road, over the sidewalk and down a stretch of lawn before coming to rest wedged under someone’s front porch. Again she was unhurt though this time she conceded that the incident had quite taken her breath away. Still, it was the sort of thing that could happen to anyone.

My brother appropriated her car keys. One of her neighbors, an extraordinarily kind woman, offered to drive her whenever she needed a ride. But Mother did not want to be driven. She did not like the neighbor who seemed to want to become a friend. She had gone so far as to send a birthday card. God. Mother was not going to saddle herself with that bit of inanity. Her errands were her own damned business, and she could do them herself. She discovered a spare set of car keys, and after a few weeks, when the car had been repaired from its collision with the porch, she drove it to the grocery store.

She left early in the morning so that she would arrive while the parking lot was still empty. She did not like parking lots. When they were busy, they confused her, and because she feared that by the time she was ready to leave, the store lot would be swarming with other vehicles, she parked strategically—nose up to a short, ornamental hedge beyond which she could see, reassuringly, the sidewalk and the street. It was clever of her to do so, she told us later, for when she emerged with her groceries, the parking lot had become a madhouse. Cars were pulling into spaces and pulling out of spaces and driving around looking for spaces, bumper to bumper like salmon in a stream. There were people everywhere walking as though they hadn’t a care in the world right where she had to drive. She didn’t think it would be quite safe to back out into all that confusion. Instead, she put the car in drive and bulled her way through the shrubbery, across the sidewalk, and into two cars which were parallel parked in the street. These were an unexpected impediment. They had not been there when she had chosen her parking space, but she found that if she applied the gas, she could push them slowly outward, and so force her way between them and gain the open road and freedom and, eventually, home.

She suspected that some busybody might have seen her and assumed she was breaking the law. She was preemptive. She called the grocery store. “Hello,” she said, “This is Frances Donaghy. I’m afraid I may have damaged some of your lovely plantings as I was leaving your parking lot.” When the police showed up on Horn of the Moon, she was a very fragile, very old lady. “The officer was a woman and she was very nice. She asked if she could bring my car keys to anyone who might keep them for me. I didn’t want to argue, and I won’t go into it now, but apparently I did more damage than I had thought. I told her that it was all right and that I wouldn’t drive again.”

She never did. She stopped going out. She had no friends to visit and none who would visit her. Occasionally my brother drove her to the doctor, but otherwise she occupied herself at home as she always had when we were young—reading, listening to the CBC, cleaning the house, and brooding on her children. We were the mediators of her image and the guardians of her legacy, and yet, she knew, we were not true believers. She tried and tried to set us straight. She explained to each one of us, many, many times, that we were Superior People because everything she had ever done had been for us. Our childhood had been an idyll, really, the rococo dream of Watteau or Fragonard. She painted it for us. She put herself in the foreground as a set of allegorical figures: Wisdom, Discipline, and Benignity in stately dance, draperies billowing under a sky piled high with summer clouds. Her children were two happy little shepherds and two happy little shepherdesses piping on a distant hillside. We, the perfect offspring of a perfect union, had enjoyed a perfect upbringing.

The hardest point to revise was my sister Peigi. Mother had scrubbed and scrubbed her conscience, but some shadow of Peigi’s childhood years—years of unbroken rancor and derision, of slaps and blows and hair-pulling and starvation—returned and returned like Lady M’s damned spot. Part of the problem was that Peigi, who now lived far away in Oregon, had become very gracious. She had kept in touch. She called regularly. She did her best to see that Mother was as comfortable as she could be, that she was on the right amount of the right medications, that she would be able, if she chose, to die in her own home. Whenever she visited the east coast, Peigi stayed for a day or two on the Horn of the Moon even though the proximity of all those childhood artifacts could give her spells of dizziness and nausea which made Mother worry that she might be in ill health. Mother couldn’t understand it. Peigi had always been such a robust child. In fact, we all had been ridiculously healthy. We were never sick at all.

 “Well,” Mother said to me one day, “your sister is just a fantastic mother, and she has worked very, very hard. Her boys are doing well; she has a great reputation where she works. Wherever she’s worked. She’s really done something with her life.” This was delivered earnestly, reproachfully, as though she suspected I wanted to accuse Peigi of sloth and bad parenting. “I know,” I said. She was silent for a moment of dramatic consideration and then: “You know, I think she must have been bi-polar when she was in high school.”

It did no good to point out that bi-polar disorder is not like mono or that Peigi is essentially the same person she always was. “Oh, come on. She is absolutely not the same person. She is completely different. No one could have predicted how she would turn out. She needed a very firm hand. She calls me every day. I don’t know why. I suspect it’s good for her.”

This Grand Revision was somewhat undermined by the way she sought, as her widowhood advanced, to reclaim her ancient powers of command. Increasing frailty gave her a leverage she had not enjoyed for decades. She called us more and more frequently asking us to drive up to Horn of the Moon and help her with one thing or another.

We always went, and when we arrived, we discovered that help consisted not so much in accomplishing anything practical as in doing exactly what we were told. She was particular and insistent. She could take over a minute explaining exactly how to empty a barrel of weeds over the pasture fence. We were to do what we were asked and not one thing more; we were absolutely not to freelance. One late August day, after I had stacked a couple of cords of wood for her, I noticed that the catch on her wood stove door had rusted and seized up over the summer. I got a hammer and was just about to tap it free when she came into the room and asked, “What are you doing?” in a tone that suggested she had caught me with my hand in the till.

“I’m fixing your stove,” I said.

“That’s Pede’s job.”

“I’m right here. It’ll take less than a second.”

“You will not touch my stove with that hammer. You’ll shatter the whole damned thing.”

“Fuck you,” I thought graciously and tapped it anyway. Immediately the catch released and the handle was freed.

“See?” I said. “All better.”

“Thank-you,” she said crisply.

Gradually we became specialists, performing only those tasks she suspected we found most irksome. For me it was driving her places, especially to her hairdresser who lived forty minutes away and who, as he worked on her wisps, flattered her so relentlessly that she was compelled to disavow every unctuous word of it with breathless, elaborately artificial modesty all the way home. For Pede she reserved requests that were irritatingly vague or burdensomely trivial or which frustrated action. She might call him late at night to inform him that she thought she was having a medical emergency but that she didn’t want to go to the hospital; he was not to worry, and could be bring her more hand cream in the morning? But it was Betsy who stirred up Mother’s old blood lust. Betsy had always been the most responsible of us, the most easily moved to guilt; her vulnerability made her irresistible.

Mother wanted Betsy to touch her, to bathe her, to drive up to Vermont from Massachusetts to wash her hair. I once arrived at the Horn of the Moon unannounced in the middle of one of these shampooing sessions. Mother was standing at the kitchen sink and Betsy stood over her, gently massaging suds into her scalp, a pitcher of lukewarm water at her elbow. It sounded as though Mother were directing her own waterboarding. She groaned and spluttered, nothing Betsy did was right: she was being too rough; she was missing places; she wasn’t getting all the soap out; she wasn’t using enough water; she was using too much water; couldn’t she see she was getting soap in her eyes? Did Betsy think Mother had asked her to come all this way to drown her in her own sink?

Betsy looked at me over the top of Mother’s head and rolled her eyes. Mother did not immediately notice me; she was too lost in whatever was going on between the two of them. It wasn’t until Betsy was gently patting her hair dry with a towel, that she saw me, and then she lifted her head and stared like a lioness disturbed on a carcass. “Now,” she said to Betsy, “Upstairs for a bath.”

Mother’s hunger for attention was terrible. She could not find nourishment in the world as it is. She wanted us near her all the time, but as soon as we got close, she erased us. She could eat only the promise-crammed air of her own fantasies. She conjured an illusory empire out of darkness visible: Pandæmonium, palace and city, seat of power to rival the towers of Heaven, the trickster kingdom of narcissism, the old fabric of wind and shadow and wish and denial.

It is a week before Thanksgiving 2012. Mother is ninety-eight years old. It is early in the morning and the sun has not yet risen. The month has been unseasonably warm, but today is raw and windy up in the hills on Horn of the Moon. Overnight the ruts have frozen in the narrow road that runs by her place and gusts of snow sweep down the mountain, through the stunted upland orchards and over her little farmhouse. Today she is paying her bills. She works at the little kitchen table under a dim lamp writing checks and addressing envelopes in her quivery hand. She has boiled a sauce pan of coffee for herself on the woodstove, the door of which she leaves precariously open because she “likes to keep an eye on it”. A tinkling mound of coals throws a red warmth across the cobbled hearth and up the back of her chair. By the time the sun has come up she is ready to go to the mailbox down at the end of the drive. She does not bother with her overcoat or her blackthorn stick because they are a bother and because the stick makes her look like a crone.

She goes out the back door because both the heavy front door and the glass storm door stick. She has been having dizzy spells recently. Something the doctor has put her on, something that was intended to keep her heart from racing, makes the damned thing stutter and stop instead. When it stops, she faints. It always gets going again, but when it does, she generally finds herself on the ground. She is crossing through the woodshed with its uneven gravel floor when she loses consciousness, pitches forward and lands hard. When she comes to, she knows she has broken something and she appears to be bleeding from deep cuts on her forearms. Her knees too feel sticky with blood. She gathers the bills from where they have scattered, crawls to the woodpile, hauls herself upright and keeps going. Bleeding, in pain, with the world and its snow whirling around her, she makes her way down the driveway through the brown and blowing weeds to her mailbox. “They were bills”, she explained later, “I was going to mail them.”

A neighbor is driving up the hill in his pickup truck. When he sees her, he slows. She’s not dressed warmly enough; she appears to be staggering, and the sleeves of her sweat shirt are soaked with blood. He stops. He puts her in the warm cab, goes inside and gets a jacket for her and then takes her to the hospital. She has a broken pelvis and extensive lacerations on her arms and legs.

Within a few days she is in a rehabilitation facility. It’s actually quite a nice place. It does not smell like a nursing home. It’s quiet, with broad corridors and large, sunny rooms. When I drop in to see her, she is alone. It is odd to see her name plate on the door like a secret that should not be exposed: “Frances Donaghy.” She is lying on her bed before a big window; she looks as though she has been dropped there by a careless hand. Her head is thrown back, canted off to one side. Her mouth is open and dark, the upper lip drawn back from long, ochre teeth. I have never seen this woman before. That scant nimbus of gray hair. That small, high-shouldered bone-cage of torso. The arms loose jointed and thin like the arms of a child or a marionette, the palms upward, a final shrug. The old feeing again; it is not her, it is something else, it is uncanny, it’s a doll, a fetish; it is feathers and bones and leather and baboon-blood paste and teeth of old cowrie shells. “Mom”, I say, and then louder, “Mom.” Incredibly she stirs, shifts. Her sleep has been deep and she is confused, “Pete?” she asks. “No,” I say. “John”. “Oh,” she says, “John.” She struggles into a sitting position and finds her glasses.

She looks at me, and fills up with herself. “I’m glad I have lived so long,” she says even before she is all the way back, as though she were taking up a conversation we had been having when she nodded off. “It has given me a chance to review my life.” I wait and say nothing. “I’ve always been frugal. I’ve never asked for a thing. I never even asked for a job. I would never have asked for a job, but they wanted to give me one. And then my nursing classmates made me a class officer. Well, I was no more interested in that kind of thing than in . . . ” she pauses, unable to think of anything in which she could have comparably little interest. “Even with your father. I never pursued him. I was crazy about him of course but I never pursued. He pursued me. I count myself very lucky. And here. My God, any little thing I happen to say they think is the height of cleverness. The nurses, of course. And the psychologist was in here the other day testing my cognitive function. He gave me three words at the beginning of our conversation and told me to remember them because at the end he was going to ask me what they were—I remembered all but one, and that one I recalled immediately with a hint. He seemed to think that was extraordinary. Well, afterwards, he was no sooner gone than he was back again. ‘I forgot my clipboard,’ he said. ‘Ah,’ I said, ‘forgot.’ Well, he laughed and he said, ‘Give me a high-five. I guess there are no problems here.’”

          I have reviewed my life and discovered that from the day I was born everybody has loved me, wanted me. An offering from Pandæmonium; an exact untruth.  

Thus Mother announces herself to herself, standing at the entrance to the shack she imagines, in her terrible weakness and her terrible strength, is a palace. She is a plucky five-year-old in outsized livery—knee breaches with silk stockings, a frogged and brocaded coat, a cocked hat that comes down over her eyes. “Her most high and puissant majesty,” she declaims “Empress of Life, Queen of all Knowledge and of all Virtue; Singular and Flawless, Tower of Ivory,” and she ushers in something dark and bent, something with crooked little horns, with shit in its burlap pants and lice crawling under its blackened scales.

She died at the age of one hundred and one. When she went into hospice, I found myself afflicted with a kind of tenderness for what had never been. I wanted to read to her. I needed to read to her—a compulsive return, perhaps, to the best part of childhood, to the only intimacy that had not been dangerous. I found one of her favorite books—Cider with Rosie—a too-charming-to be-quite-true account of a rural English childhood by the poet Laurie Lee. I thought it might turn her mind fondly backwards. I tried to read to her several times, but she would have none of it. “What?” she’d say. “I can’t make heads nor tails of what you’re saying.” Why did she resist? That she could have listened if she chose is certain. After she died, when we were clearing out her room, the nurse—a big, gentle man with a full beard—came to me and said, “I want you to know how much I enjoyed taking care of your mother. Such an extraordinary woman. You know, I read to her almost every evening. It was so peaceful. She’d listen very carefully and say the most intelligent things.”

In her last two months she began to pass in and out of a terrible dementia that whittled her all the way down to her essential hunger. It was a madness that came upon her in fits. When she was in its grip, she’d call us from her hospice room. She wanted us to come visit. It did no good to remind her that one of us had been there earlier in the day or to reassure her that another of us would be there tomorrow; she lived only in the starving now. She saw no reason we could not sit by her in shifts, one after another for twenty-four hours every day. She wanted us to bring her things: Kleenex because “They told me here that they will charge me more if they supply it,” shampoo because “the stuff here makes my hair fall out,” clocks with extra-large numerals because “nothing you’ve given me is large enough.” She could be wheedling and tearful in one moment and choking with fury in the next. Sometimes she would fall into the very center of herself. Then she would believe, as I have always believed in my heart, that someone was missing. She did not know who it was. She was desperate to know, and she wanted us to find out. At the peak of these fits the calls would come every three minutes for an hour or more until the facility, at our request, replaced her room phone with one that had no keypad.

Two days before Mother slipped into her final coma, Pede and I visited her. Her thoughts lay, like Ozymandias, in blocky ruins that communicated a message she did not intend. Pede had brought her a new talking clock, a small box that spoke the time when you pushed a button on top of it. She had broken the old one in her palsied impatience; the new one was bigger and easier to operate; the button on top was so big and so red that it looked like it might launch missiles.

"What's this?" Mother asked when she saw it.

"It's your new talking clock," Pede said.

"Where's the old one?"

"It's broken."

"Oh, it's broken?" she looked at the new clock as if it were a large spider. “Then why give it to me?”

"No, the old one is broken."

"But this isn't the old one."

"No".

"Well where is the old one?"

"I took it. It was broken. I threw it out"

"It's in my bag."

"No, I took it," Pede said. "It didn't work. I tried to get you one just like it, but the Society for the Blind doesn't have them anymore. They have these instead. They’re better."

"My bag is on the floor,” she said “It’s in there. Get it for me."

“I took it home and threw it out. It’s not there.”

We are all silent for a moment and then with an angry bounce she said, "Just get me my goddamned bag!"

There was no clock in the bag, and her anger had exhausted her. “Wait a moment,” she said, “I have to catch my breath. I can’t be talking all the time although I know it’s good for you.” Pede and I looked at one another and kept still.

At last she said, “That other grandmother was quite a foul-mouthed old lady.”

“What other grandmother?” I asked.

“You know. Annie’s mother. Tay. That’s what I heard. I hope I may never stoop to such a low expediency.”

Another long silence while we all considered this. Pede grinned at me. Anne’s mother, Tay, was widely acknowledged as a kind of saint. At last Mother said, “I was always a leader.”

 “A leader of what?” I ask.

“A leader of mankind,” she said and fell asleep as though someone had hit a switch. When she woke up some twenty minutes later, she said, “I am about to deliver my last sermon. I will be dead in this many weeks,” she held up three fingers and looked first at Pede and then at me over the top of her glasses. “Then I will be alone, alone, alone—flat on my back, staring into the sky with open eyes, seeing nothing. Strangers will walk by me all day long.”

One night a few weeks before her one hundredth birthday Mother was seized by twelve violent hours of vomiting and diarrhea. She soiled her nightgown, her bedding, her bedroom carpet. She staggered to the bathroom where she lay until dawn, cold, filthy and wet, huddled on the floor next to the toilet. When the sun rose, she called my brother and asked him to come. She told him it was very important, but she did not tell him exactly what the problem was. When he was done cleaning up, he bought her a new nightgown and some new sheets and blankets, and when he put her to bed, she enjoined secrecy on him. He must tell no one, especially not his wife. Then she called Peigi to complain. No one has ever passed such a night. She had been dizzy; she had had no control of her bowels; she had been in pain; she had been dying. Peigi must not tell a soul.

Betsy, hearing of the episode from Peigi, drove up from Massachusetts the next afternoon to see how Mother was doing. She noticed the wood box was empty and offered to fill it. “No. Just leave it,” Mother said.

“Why?” Betsy asked, “It’s going to get cold again. You need it filled and I’m not sure you can manage it yet. I’m here and happy to do it.”

“Ne-ver mind. I have my reasons. You are not to touch a stick of that wood.”

When Betsy had gone, Mother called me. She told me that she felt fantastic. She had just awoken from the longest sleep of her life—almost eighteen hours. She asked me to come and fill her wood box for her. I was concerned. She had always taken great pride in filling the wood box by herself, but now she told me that, curiously, she seemed to have lost the strength of her hands. I imagined she was far worse off than she was letting me know. I imagined she feared the approaching cold snap, that she had no stove wood in the kitchen and no strength to fetch it from the shed. I imagined she was nearing the end.

But when, on the following day, I got to her house, I saw that she had not weakened in the least. There was a heavy, dark, antique bureau in her kitchen full of linens and old silver and candles and papers and photographs. It weighed considerably more than she did, but she had dragged it across the lumpy friction of braided rugs in order to get at the dust underneath it and in order to remove a heavy picture that had hung on the wall behind it. I saw that she had removed another large picture as well from an awkward spot over the sink, and she appeared to have carried them both off to some other room to dust them under better light. I was impressed: Stonehenge, the pyramids, the mysterious power of the ancients.

“Hello?” I called, doubting that she could hear me, but she emerged from the dim interior of the house, swaying stiff-legged into the kitchen doorway. She was very upright, barely five feet tall, and weighing considerably less than one hundred pounds. She was wearing black trousers and a short woolen coat with brass buttons that gave her a tin-soldier, military look. I thought of Hoffmann’s nutcracker.

          “Who’s that?” she said.

          “It’s me,” I said.

          “Who? John? You’re early.”

          “Did you move the bureau by yourself?” I asked.

          “Yes,” she said. “It wasn’t much. It was harder getting those pictures down.”

          “Good Lord” I said, “Like an ant carrying a cricket’s carcass. For all your faults you’re the strongest damned centenarian that ever lived.”

          “For all my what?” she asked. She was deaf, but she also feigned deafness.

          “Faults,” I said.

          “What?”

          “I said, faults.”

          “Oh, faults”. She assumed the arch expression that signaled she was about to make a serious joke. “I have no faults.”

          When I had filled the wood box and rehung the pictures and moved the bureau back against the wall, she said, “Okay, now. For God’s sake sit down and talk to me.” I removed a copy of the Times from a chair and sat at the table. She had something particular to say, and she wasted no time in saying it:

          “Your father and I always took such delight in you,” she says. “And we were proud of you. You never had to go to medical school, you know.”

          This again. “Mother, please,” I said, “drop it.”

          But she would not drop it. “You said such funny things when you were small and you were such a character all through high school. You made us laugh and whether you believe it or not we were proud of you.”

          A one-hundred-year old great-grandmother gaslighting a sixty-year old grandfather about events from forty-five years ago. There was something utterly unclean in the way she so relentlessly pried, though more and more weakly, at the heavy stonework of what was and is. And there was something utterly infantile and hopeless in the rage and exhaustion I felt when she did it.

           Let it go, I told myself. But I said, “You didn’t seem all that proud. Do you remember not going to my high school graduation because I wasn’t valedictorian? Do you remember asking, ‘How did it feel to sit among the idiots?’ when I got home?”

          “You didn’t need us to keep telling you we were proud of you did you?” she pursued. And when I didn’t answer, she tried a new line of attack—“You gave up an awful lot for Jesus.”

 “Well, I should get home,” I said and stood up.

           “Are you going so soon?” she said. And immediately she was no longer confiding and superior. She may have been acting, and she may not have been, but she seemed frightened. She did not want to be left alone. “Wait a minute,” she said, “there’s something else I’d like you to do for me. These things are driving me crazy.” She held up her thumbs; the nails were long and broken and notched. “They keep snagging on things,” she said, “I have an appointment next week with a podiatrist who will cut all my nails, but I can’t wait that long with these.” Her neediness felt like cobwebs in my hair.

She had no nail clippers and so I went into the pantry where she kept her first aid kit in a dim corner under some cupboards and next to an old-fashioned breadbox. I carried it to the window and rummaged through the bandages and rolls of gauze and antibacterial creams and discovered the same small, curved pair of scissors with which, when I was a child, she had cut my nails. She moved a standing lamp over next to the rocker on the hearth. “Do it over here,” she said, “where there is light.”

I would have rather not. I did not want to touch her, but I sat next to her. Through the window I could see the falling snow turning the afternoon to twilight. The woods were growing invisible along the far edges of the fields, and the old house was fading into its hillside. We were an aging man and an ancient woman bending our heads together under the yellow light of a small lamp. We were on opposite sides of the same void; we were infiltrated by the same dread. Her hand was small and parched, spotted and bruised, wrinkled as a sparrow’s claw. It was very strange, that dying flesh—twisted, stained,, halfway to mummification. But when I held her hand against my knee to suppress its tremor, there was a sudden bustling far off in the back of my mind—doors opening and closing, running footfalls in the corridors, hurried whispers, heads craning over the banister to see who it was who had returned after all those years.

Her flesh was full of many voices calling to me from many places: memories beyond memory, ghosts of the ancient needs and terrors too faint for words. There in that dim kitchen was the dark stream, the lustral basin, the brazen threshold and the downward stair. Mother wanted me to take her nails down as far as I could, but she feared I would cut her. She was on blood thinners and would not be able to stop bleeding. With each snip she flinched and hissed as though I were hurting her, but when I was done, she kept finding rough places and asking me to cut more. I insisted that I’d taken her nails down to the quick and could not safely go any further, but she did not want me to stop touching her. And when at last, desperate for the upper air, I stood and put the scissors away and shrugged on my coat she asked, “When will you be back?”

“Not for a couple of weeks,” I said.

“No,” she said, “You’ll come back sooner. You cannot get away so easily.”

John Donaghy spent twelve years teaching and coaching at a secondary school and twenty-six more serving as an adjunct in both the English Department and Institute for Writing and Rhetoric at Dartmouth College before he mustered the courage to drop it all and become a writer. At the age of sixty-seven he received his MFA from the Rainier Writers Workshop in Tacoma, WA. He lives in New Hampshire with his wife who is also a writer.

Dinner 1959

by Robert D. Kirvel

Dinner is at 6 p.m. sharp. That doesn’t mean 6:05.

Having your dinner requires sitting at the big table in your designated chair. Otherwise no food until tomorrow morning. Period.

Table rules are few but firm. Eat your vegetables. Clean          your    plate.

Sit                still               until              you               are               excused.

No one says anything when Mother cooks liver and onions for dinner. No one likes liver and onions, but Mother says a doctor tells in a magazine how liver and onions are good for you, so hush and eat what’s on your plate.

Anyone still having questions about dinner rules, go read that Reader’s Digest® article on benefits—for young’uns (sic) especially—when American Families eat together at the table. Unless you have something against family unity, sticking to a schedule, manners, improved communication, and greater respect for others? Very well then.

No one is worried when Mother first announces Aunt Cee-Cee, regarded as the toughest nut in the family tree, will be arriving for dinner. At least no one says out loud he or she is upset because, looking on the bright side, it’s a chance for everybody to work on improved communication with an elder, isn’t it? Cee-Cee is driving all the way from Chicago by herself and will be spending a few days and nights, so everybody just relax.

One person is uncomfortable after realizing Aunt Cee-Cee and Uncle Walter—who drives his big, new car about ninety miles an hour on back roads and often shows up for dinner just in the nick of time—will likely be sharing a meal at the same table tonight. The two have not spoken to one another for “eons.” So, we’ll just have to see.

If Cee-Cee is a tough nut, her opinion of brother Walter is hard to fault. She thinks Walter is a loud and obnoxious jerk who is uninformed to the point of ignorance and is also a sexist, arrogant, egotistical, bigoted womanizer. Cee-Cee is sometimes wrong, but not always.

Yes, Aunt Cee-Cee and Uncle Walter both make it to the table in time for dinner. They take their chairs but do not look at one another. Bad sign.

At least one person at the dinner table is uncomfortable when Uncle Walter starts in on “them boogies” again at dinnertime, describing for the umpteenth time how those people is always sucking on cigarettes and slurping sickening-sweet bottles of coca cola through straws for lunch at the lunch counter during lunch break at the factory where Uncle Walter works as a security guard. Uncle Walter does not consider cigarettes and cokes a proper lunch for people, and he wishes there were a law, but then them boogies aren’t normal people, so ….

One person at the table, the youngest family member who adores his fourth-grade teacher, wonders what his teacher, an articulate black woman in her forties, would say if she were present at the family dinner table tonight and heard Uncle Walter talk about “boogies” in 1959 America.

Two people at the dinner table squirm when Uncle Walter tells his two young nephews at the table how he intends to teach them how to “walk like an Indian” through the woods. Walking silently on the forest floor out back behind the house, he means, so as not to scare animals away you want to hunt. Like an Indian. Because Uncle Walter claims he is descended from silent-walking Indians, though no one in the family other than Uncle Walter wants to hunt or has ever heard anything about, or makes claims to, Native American lineage resulting in a predisposition to slip silently through the woods. Still, Uncle Walter swears loudly he is one-seventh Indian. Not one fourth or one eighth. One seventh.

Three people at the dinner table become fretful when Aunt Cee-Cee directs a question to her brother, Uncle Walter, a question that changes the subject. “Are you still humping that spic squaw?” This is a triple-loaded question calculated to get a reaction because it is pregnant with not-so-subtle references to Walter’s life-long promiscuity, problematic claim to Indian blood, and racism directed at persons with ancestry other than his own, but especially at people of color, other than Native Americans, whom Walter has never thought of as people of color.

Many adults at the table are afraid Uncle Walter will answer Aunt Cee-Cee by bringing up one of several whispered-about facts concerning her lifestyle. This is fertile territory. For instance, Cee-Cee sells illegal but highly profitable French postcards (you know, porn, some whisper) from behind the counter of her smoke-shop cubicle on a high-traffic downtown Chicago street corner located in a high-crime neighborhood. Also, her shop is the only one on the street that has never been robbed, a remarkable immunity to crime that is not luck but owing to the watchful eyes of Men in Blue with whom Cee-Cee is on the most familiar personal terms and to whom she regularly makes “cash donations.”

No one in the family brings up Sputnik. No one brings up Cee-Cee’s “mobster” boyfriend connections, or Walter’s crazy driving habits in his brand-new, green, Pontiac Bonneville coup, which will not remain pristine for long plus he can’t afford it on his piddling salary, but don’t ask, or how Dad gets peevish after spending time around Uncle Walter or Aunt Cee-Cee, let alone both, or Mother’s inclinations to strictly Biblical (nonmetaphorical) interpretations of Jonah and the Whale and The Last Supper.

All at the table, kids included, are relieved when Mother stands up before Uncle Walter or Aunt Cee-Cee can say another word and announces, “That’s enough!” while excusing the young ones from the dinner table even before dessert is served, though the kids will get their dessert later. Dessert is a chocolate-frosted, triple-layer, made-from-scratch, marble cake over which Uncle Walter, remaining at the table, will ladle cold gravy while eyeing Cee-Cee and claiming he loves gravy on cake—always has—just to get Cee-Cee’s goat.

Robert D. Kirvel is a Pushcart Prize (twice) and Best of the Net nominee for fiction. Awards include the Chautauqua 2017 Editor’s Prize, the 2016 Fulton Prize for the Short Story, and a 2015 ArtPrize for creative nonfiction. He has published in England, Ireland, Canada, New Zealand, and Germany; in translation and anthologies; and in dozens of U.S. literary journals. His novel, Shooting the Wire, was published in August 2019 by Eyewear Publishing Ltd., London. Most of his literary publications are linked on https://twitter.com/Rkirvel.