Prize Winners 1999
Pain Management
The roaches scurried along the wall above his bed as if beckoned by some all-knowing life-form which was leading them not into temptation but into the salvation of another meal. These were not roaches of which horror movies are made; in fact, to the contrary, in every abode in the world these small creatures exist as peacably as can be expected, for amongst them humans go about their daily routines with only disdain for them. So, when the Roach Motel awaited them at the end of their journey up the wall, into a small crevice at the upper molding of the dining room wall, through the cracked ducts that in a bygone era spouted air conditioning, into the kitchen by way of the cabinets that now held nothing but stale Fruit Loops and two-year old packets of Canel’s gum, and under the refrigerator past remnants of what three weeks ago may have constituted a nourishing meal, it was to no surprise. No worries among the survivors. We breed faster than these mortals can ever imagine. We’ll be back.
“Uuuuuuuuggggggghhh…,” groaned Mahoney. The exquisite detail of his pain was embodied in this one utterance. His speech was becoming more unintelligible every day, but no one seemed to care. He was becoming a burden to them all. Hour after hour problems would arise. “It’s not my turn to change his diaper.” “Come on mom, I ain’t getting near that bed, that’s some serious stank.” “Goddamn Julius, what the fuck did you put on that man, some shit or something. I told you the Silvadine, goddammit.”
“Uuuuuggggghhhh…Moooooorrrr paa,” he repeated. From the front yard of their coachhouse a grimy, yet glowingly pretty thirty-two year old Charlotte Luther came running to see what troubled her father. Because she had been trained as a nurse’s assistant, the duties of caring for him in these last days of his life fell firmly on her shoulders. Not that she had any time to use that training to actually make any money to help support her family. Between being pregnant and caring for the six children, well, seven if you counted Mahoney, she had forgotten what hospital life was like. “Oh, I see, it’s time for your next dose of morphine.” Charlotte was used to the routine by now; after all, he had been lying in this bed for the past four months. Lying there, in a hospital bed, in the middle of the dining room, waiting to die. Actually, she too was quite repulsed by the physical presence of his body merely existing in the center of her house. It reminded her of when he returned from Vietnam in 1972. He had lost his left leg to a vicious infection and appeared to her to be a scared man. Always a glazed look on his face, somehow distant, never affectionate. She was six when he returned and never remembered him otherwise. This incomplete man was supposed to be her father?
Charlotte learned, years later via correspondence, from her mother who had left the children with Mahoney and his new “squeeze” in the late seventies that what he returned from Vietnam with was a newfound devotion to heroin – a religious addiction which would only serve to worsen his health problems. A smoker from age eleven, Mahoney never needed much encouragement to try something new: reefers, moonshine, cigarettes, heroin. When he up and moved Charlotte, her four sisters and one brother, and their new “momma” north to Chicago in the early eighties she never thought things would be different but she had hope. That hope was squashed when the diabetes and the lung cancer were diagnosed at the VA. Mahoney delved deeper into depression and drugs, hookers and smack. Now look at him.
“Mommy, mommy, the white mens is coming.” The doorbell rang and Charlotte hurdled the children watching TV in the living room to answer the door. “Good morning doctors, please come in.” The “white mens” were actually Mahoney’s hospice doctor and two medical students. All of them seemed to care deeply every time they came to care for him. Charlotte knew better though, as she felt their disdain for her way of life. The four of them entered the dining room and she felt each remaining drop of pride ooze from her being as she too watched the roaches, both small and large, scurry from the packages of gauze and hide in teh nether regions of the carpet. “Do the roaches know something about these men? They don’t scurry from us, Charlotte thought. A perverse sense of revenge came over her as the doctors seemed to feel uncomfortable and cringed.
All of their speaking was directed towards Charlotte. She never referred to them by name but continuously they addressed her as “Charlotte” while all the while looking and speaking at Mahoney. “do they know that I’m a nurse? Well, nurses aide, at least,” Charlotte wondered. They asked about “Mahoney’s pain” and “symptom control.” She showed them the log of escalating morphine doses, insulin injections, and meals. As she opened the log, a small roach, maybe one and a half centimeters of very light, almost translucent, brown jumped onto the floor, landing firmly on the ccarpet at the foot of one of the medical students, and fleetingly basked in the sliver of light entering the room from the southern window. “Oh shit,” the medical student exclaimed and promptly squashed it under his jet black Dr. Martens. “Well, you guys have one less now,” he said with a smirk on his face. The doctors checked the patient up and down – inspecting the bed sores which appear much improved, listening to his ever-failing heart, palpating the abdomen filled with cirrhotic liver and almost certainly mets to somewhere, and finally asked Mahoney to breathe deeply while all three placed their shiny stethoscopes on his sweaty, smelly back. “I hear breath sounds on the left,” one said as they played a game of Twister trying to switch stethoscope positions before Mahoney ceases to follow their instructions to breath deeply. Charlotte looked on in amazement. “They really care about him, don’t they,” she thought.
“It seems to us that his pain is under good control and he is not having much difficulty breathing at least when he is not excited,” explained one of them. Charlotte had heard this speech hundreds of times before, two, perhaps three times a week ever since they decided to enter Mahoney into hospice care. After all, this is what he had said that he wanted. After the seventh hospital admission last year the VA doctors presented Mahoney and her with all of the options but stressed “there is nothing left for us to do.” What had they ever done? The years since his diagnosis had been a living hell. In and out of the hospital, surgeries, chemotherapy, radiation. Her father had become a human guinea pig. She thought that after years of this continuous medical investigation they should have some sort of answer, some sort of plan. But they did not. Repeated tests, more drugs, another tube into his body. She had heard their snide comments “They all get what they deserve.” “Look at what all those drugs can do to your body.” “How many times has this poor sunabitch come in here, what a gomer.” “Just put him out of his misery already, lady.” She always tried to ask questions and allowed Mahoney to call all the shots, but it was not so easy. The doctors’ biased commentary always led to only one logical conclusion. But Mahoney was happy, they always gave him a choice. He felt empowered through his medical adventures, the only time in his life that this was so.
Hospice was the logical culmination of this adventure. In and out of Rehab, hanging on to his remaining lower extremity, insulin twice a day in the ass, other meds too numerous to mention. Charlotte was a nurse, well, nurse’s aide, adn even she didn’t know what they all were for. Biopsy, Lobectomy, Radiation. When the kind Doctors presented Mahoney and Charlotte with the option of pain control and symptom management, they both were intrigued by the concept and signed on with nary a worry, even though it meant, according to Mahoney’s oncologist, “Giving Up.” The hospice workers were all kindly white folks who seemed far removed from previous experiences in hospitals. Always a smile on their faces, albeit they were always muted smiles. Caring, soft tones of voice. A hug here and there, always touching them. But now, after months of their visits, Charlotte was tiring of them, tiring of their caring. Was the decision she and Mahoney made a decision at all? The way it had been presente to them, hospice was a liberating experience. “The patient has power over his own Death.” “Comfortable and at home.” Well, the “home” had deteriorated to the point that it now resembled a shanty and comfortable was the antithesis of living under one roof with six children and a smelly, incontinent, rotting corpse of a man Charlotte called father. Was this really their decision?
Escorting the Doctors to the front door meant ccrawling over the children lying on the floor in the living room watching transvestite brothers attack their prostitute sisters on The Jerry Springer Show. Charlotte opened the door at the exact moment that a pink and purple low-rider Ford F-150 truck rode by with its Chicano passengers glarign at her while they bounced to the sounds of a bass-heavy technodance remix of “Bella Maria de Mi Alma.” “My how this neighborhood has changed,” Charlotte apologized to the Doctors. They nodded in condescending agreement, left with her a plastic bag filled with saline, gauze, and two bottles of MS Contin tablets, said they would stop in at the end of the week, and wished her well. As they walked away, she swore she heard one of the medical students say, “He’s going to die by then, isn’t he?”
The walk through the living room into the dining room was saddening as always. The roaches did not scurry, they merely watched as if in agreement of all that had transpired in the room thus far this day. By now it was 12:35 in the afternoon, time to give Mahoney some food, the little of it he could swallow. First, however, she realized that the White Sox were playing that afternoon. Charlotte remembered how her Father loved sitting on the porch with his brothers, listening to the south-siders, and smoking a reefer. Quickly she sent her youngest son, Marque, 6, out to find Julius, her eldest. Then she put the small transistor radio on the window sill where the small sliver of light entered the room and fidgete with it to ensure proper reception. While doing this, however, the window shade released and winded up instantaneously so that streaming sunlight blanketed the bed and its occupant. Mahoney opened his eyes with enthusiasm and looked right at Charlotte. “Let me Live…Die…” The first intelligible words he had spoken in nearly two months. Julius, 18, entered in a fine black and gold Karl Kani overall ensemble asking his mother what she wanted. “You got any chronic Julius?” “Yo, moms, you surely can’t be serious,” as he reached into a seemingly bottomless pocket to pull out a dime bag of marijuana and some rolling paper. Charlotte rolled the small faded green buds and crumbled leaves into a joint and lit it as her children looked on in amazement. After a deep toke, she placed her lips on Mahoney’s and puffed gently.
For the first time in months, Mahoney was breathing calmly, peaceably, without his patented groans of anguish. His eyes were closed and he seemed to be happy. Around him were gathered in a half-circle of family, Charlotte, her six chidren (together for the first time in weeks), and three or four nameless “Aunts” that came by only in times of celebration. They were all silent while Charlotte recited a poem that she had been working on for years, something she had written on scrops of paper every since they lived in Alabama:
Julius of all people, the hardened gangster of the family, was the one who first noticed that Mahoney had stopped breathing. There he lay, eyes closed, a small smile on his face, and for the first time in months, there seemed to be no odor in the room. Also missing were the roaches that traditionally dotted the walls and littered the bookshelf and cabinet in the room. One of the Aunts suggested that Charlotte cover the body and say a prayer for him before calling the hospice operators who were always ready to forward the message of another successful Death to the necessary people. Charlotte repeated the poem as the Family came together, hand in hand, in a closed circle immediately surrounding the body. By the third stanza, the call-and-response traditions of their ancestors took over and “Let Me Live/Free” was repeated gloriously, louder and louder until the shades once again flew up, all but blinding the family members. One of the Aunts then went to get the hospice number and phone, quickly returned to the dining room, and handed them to Charlotte. “No, I don’t think so. From now on, We can make the Decisions. And there’s lots of Decisions to be made.”
Eric M. Spratford
University of Illinois at Chicago College of Medicine
First Prize