Some readers may find this article too graphic, yet it is as courageous as it is raw. When Maureen Stanton sent us her unflinching look at the demise of a loved one (names have been changed), she wrote, “I believe that many people don’t really have a notion about the process of dying. . . . I kept the story simple. I did not want to clutter the actual event with philosophy. I strived to show the tension in the room, the fear, the pain, but also the love.”
I had known all week that Keith would die that weekend. I knew he wanted me there when he died, not at work, or waiting at a red light, or picking up bread or milk, or waiting in line at the bank. He waited for me.
We had moved from our small apartment to his parents’ house the week before. Keith had returned to his childhood home to die.
His younger sister went to an amusement park in Ohio for the weekend. She knew, too.
I knew all day Saturday that Keith would die that day. It wasn’t just my intuition, nor the fact that I knew every inch of his lanky body. We functioned as one unit. Eighteen months ago, when doctors told Keith he had two months to live, we were separate — he with cancer, me helping him fight it. But six months before he died, he quit the fight, and quietly resigned to dying. This is the point at which we became inseparable.
I felt how the bones in his knees bore on each other as he lay sideways in bed, and I put a feather pillow between his knees to prevent this small discomfort. I knew exactly how to cook his eggs, removing the blotch in the white before stirring them up to batter French toast. I knew the pattern of his breathing, the slow, steady breaths, a second of silence, then the slow, steady breaths again. It’s natural I knew the day of his death.
It wasn’t just my guts that told me. Months before, the hospice nurse had given me a list of clues. A checklist for dying, like going on a vacation and making sure you packed everything. A checklist. This made me think of young men being drafted into the army. No allergies, no flat feet, no psychological imbalances. You made it. Congratulations, you can go to war. Keith was being drafted into God’s army. That’s what his mother believed.
The checklist included these signs:
An increase in blood pressure to 140. Keith’s blood pressure had been a steady 120 in the month before he died. He slept ten to twelve hours a day, and rose only to use the bathroom, or to move from the couch to the recliner to the bed. Yet his heart was pumping furiously, like a runner, putting it all into the last stretch. He was a quiet, motionless runner, speeding toward the end.
Cheyne-Stokes respiration. Who was this Cheyne-Stokes guy anyway, whose namesake is the irregular, interrupted breathing of a dying person? I still don’t know. After Keith died, I moved into a small house, and was haunted by the old refrigerator. The refrigerator would give a huge shudder, then be completely silent. A low humming would develop, get louder and more strained, intensify, and then release a shudder. And the cycle would repeat, just like the final breaths of Keith’s life.
Clammy skin was a sign, like all the clichés. His skin was cool and moist, like basement walls on a humid summer day. Despite this coolness, Keith was thirsty, desperately thirsty, all evening the night he died. We were giving him juice over crushed ice. His mother couldn’t get it right. She’d bring a drink with big chunks of ice and he would send it back. “Too big,” he said. “Pulverize it.” It was funny, his mother in the kitchen pulverizing ice. We smiled at the sound of the blender. His thirst couldn’t be satisfied, though. I went to the nearest store and bought a large blueberry slush. He drank this, and his lips and tongue turned blue.
Bluish extremities. Keith’s feet had been purplish for weeks, and his toes had a slightly blue tone. Little pieces of skin were peeling off his feet. It made me think of grated Romano cheese. It had the same texture and smell.
Incoherency and hallucinations. A few nights before he died, when we were lying in bed, Keith said, “What’s that noise?”
I said, “What noise?”
“Listen,” he said, “it sounds like someone turning pages.”
“I can’t hear it, Keith. Do this, Keith,” I said. “Put your finger on my leg. When you hear the noise, tap your finger.”
A few seconds passed, he touched my thigh, then tapped again, and a third time. “I can’t hear it.” I became scared, and I tried to listen harder for any noise as he pressed his finger on my skin, but I just couldn’t hear a thing in the dark night.
On the night he died, after I laid him in bed, he asked, “Who’s frying something?”
“Nobody,” I said.
“I smell something frying.”
“I don’t know what it is, Keith.”
“What’s frying?” he asked again.
These were the signs. At eleven o’clock his parents went to their room next to ours to go to bed, his mother without her glasses, bags under her eyes, blinking, in her daintily flowered nightgown that came to her toes, and his father still in his work clothes, an old pair of jeans that sagged to expose the cleavage of his behind, and allowed his belly to hang over his belt. If you want to know what your husband will be like, take a look at his father, my mother always warned me.
I helped Keith up from his favorite chair, a brown Lazy-Boy recliner, to the bed. I fixed five pillows around him: one under his head; one between his skinny legs to keep his knees from jabbing into each other; one that he hugged to his chest; and two behind his back to keep him in the sideways position that allowed sleep. Sleep had become a major part of his life ever since he found out he had cancer. Toward the end, he was sleeping most of the day and night, waking every three or four hours for a short while to smoke a cigarette, have some juice, flick from channel to channel on the television.
Keith was restless in bed. He wanted to go back to the recliner. I helped him up, but halfway there his legs gave out and he collapsed. I carried him the few remaining steps to the chair. Keith was six-feet-one. At that time, he weighed about as much as I did, a hundred and twenty pounds. As Keith shed pounds the last months of his life, I gained. I cooked and baked his favorite food. Peanut-butter oatmeal cookies, apple crisp, pancakes, mashed potatoes and gravy. I ate my food, his food when he couldn’t finish it, and the food left in the pot. I ate an entire pan of Rice Krispies squares once, except for the one Keith ate. And when he wanted another one, I made another batch, gave him one, and ate the rest.
Perhaps this food gave me strength. Some strength from somewhere helped me carry Keith to the chair.
When his knees buckled, I cried out, “Oh, Keith.” I remember this clearly. His parents came running into the room, wrapping their robes around them.
“I think he’s dying,” I said.
Keith called out, “Mom. Dad.”
“We’re here, honey,” his mother said.
He closed his eyes.
I was jealous about that for a long time. Why didn’t he call out my name? I decided he didn’t call my name because he knew I was there, as I always was, during the sickness, day and night, and before that, as his lover.
I bent to his ear and whispered, “Keith, I love you. Goodbye Keith, I love you.” I felt like I was arming him with ruby slippers, that no matter where he was going, he could always come back to me because I loved him. I kissed him and he squeezed my finger.
He began to cry a little, moan softly. He complained his stomach hurt. He hadn’t eaten in more than two weeks. He hadn’t had a bowel movement for three weeks. He was connected to a morphine drip. A needle was planted in his thigh, the only place where he still had much flesh. I gave him an extra shot of morphine by pressing a button on his IV unit. But the unit was programmed to give him no more than one extra dose per hour — a bolus, the nurses called it. At first, I thought they were saying bonus. If I could have, I would have sent it all down the tube into his vein.
His pain became intense. He held his abdomen and moaned, louder and louder. Then he said, “I think I shit my pants.” I looked and saw black fluid, thick like menstrual blood, coming out of his rectum. I massaged his abdomen. He moaned and moaned, until his breathing became moaning, and each exhale was a loud wail, a long, low moan. A baying, like an animal dying, so loud in that small house.
“Get me some warm washcloths,” I ordered his father. I took off Keith’s underwear. His cousin had given him blue and red and yellow polka-dot boxer shorts when he first went into the hospital, a year and a half ago. He had been wearing them for the last two weeks. They were loose, and comfortable, and there seemed to be no point in changing each day. It was trouble to bathe. It hurt him. His teeth were gray and coated. He wouldn’t let me bathe or clean him anymore. I understood. Why bother primping for the occasion? Might as well go into the ground dirty, earthy. That pair of polka-dot underwear stayed in the top drawer of my dresser along with my underwear for almost three years after he died. And even then I didn’t throw them away. I put them in a box with letters and pictures and a curl of his hair and a cassette of his voice. Our voices. A fight we had taped long ago, before the cancer, to see who was twisting whose words around.
I placed a pad, like a diaper, under him. The nurses called these pads “chux.” Black liquid, the color of old car oil, continued to pour out of him. The smell wasn’t overwhelming, as waste usually smells. It smelled like guts, like cow livers, like internal organs. As fast as it was coming out, I was trying to clean him up, but it was coming too fast. I asked his father to get me a cup to catch it, and a bucket to dump it in. His mother was rinsing washcloths and keeping me supplied with clean, warm towels. Keith’s eyes were rolling back into their sockets. He was still moaning loudly and steadily, almost rhythmically.
His father returned from the kitchen with a styrofoam cup. I tried to place it under Keith to catch the black shit pouring out. The cup broke. Keith’s mother said, “For God’s sake, Phil, get something that won’t break.” He left and returned with a small flowered teacup. She looked at him in disgust. I took the cup anyway. It worked.
The black fluid was slowing down now. But just about the time we got him cleaned up, wiped his sweaty face, wrapped him in another diaper, the black came out again. There was so much. Each time it stopped we thought surely that was the end. But it kept coming. It was like the sins of his life, thirty-one years of sins, pouring out of his body.
His moaning was still loud and regular. I took a syringe with Valium in it, which he took four times a day. He wasn’t due for a shot but I gave it to him anyway. His mother didn’t want me to. She had read the fine print on the bottles, where it warned that an overdose could lead to heart failure, could prove fatal. She worried that Keith was going to die of a heart attack.
“That would be a blessing,” I said.
I poked the needle into the vial of Valium, and sucked the drug into the syringe. I jabbed the needle into a port in the tubing in Keith’s leg and gave him not one but two shots of Valium. His breathing suddenly changed. It grew raspy and quick, and I thought, “His mother’s right. I’ve killed him.”
But he continued breathing, and the moaning subsided to low, steady bursts of noise that sounded like a foghorn whose steady booming has slowed and become faint as its generator runs down. Keith’s father was making coffee and drinking it out of a beat-up green metal thermos as he always did, generously adding whiskey. His mother began filling syringes with valium. She neatly arranged a supply sufficient for the next four days.
Keith was still moaning and holding his abdomen. I thought that he must be stopped up and that was causing him pain. It had happened before. I put on surgical rubber gloves that I had on hand for giving Keith enemas and changing dressings. I stuck two fingers up his rectum. I felt a blockage.
His mother looked at me and said, “I don’t know how you can do that.”
She sat by Keith’s side and wiped his brow. I began to pull out hard masses of thick black sludge. More black liquid followed. I pulled out more hard balls of shit and massaged Keith’s abdomen vigorously. His mother thought I was hurting him. Keith’s moaning softened, the flow of black liquid waned, then stopped altogether.
He was breathing restfully, shallowly, softly. I wiped his face, cleaned him up, and hoped we would sleep a bit. His mother was picking up towels and cleaning the mess. His dad lit a cigar, coughed up phlegm, and spit into his handkerchief.
Keith was in his Lazy-Boy chair, clean, diapered, draped in a blanket, and resting his head on his favorite feather pillow. I gave him that feather pillow. I sat on the bed. It was 5:02 a.m. I looked around the room. It was a mess still. There were half-filled glasses on the night table beside the bed, and plastic wrappers from the chux and the rubber gloves and syringes on the floor. The carpet was aqua-green. I breathed, and looked at Keith. His eyes were shut. He looked like he was resting peacefully. But I noticed a strangeness, an absence of movement. His bony ribs were not rising or falling. He’s dead, I thought. I felt for his pulse, first on his wrist, and then by pressing my index finger and thumb hard to his jugular. Still. I called Keith’s mom and dad. “Come in here,” I said. “He’s dead,” I said. I put my ear to his chest. There was no sound, even faintly. “Get a mirror,” I said. His mother brought one. I put it under his nose. No mist appeared. I fell to my knees and began to cry. Keith’s father said, “Son of a bitch,” then he punched the wall. His knuckles began to bleed, and he wept. His mother cried into a towel, and then we hugged.
For five hours, Keith died. Five hours, but really only one second, because he was actually alive, his heart beating, until that one second, that second I looked away, when I rested my eyes. He left without me after all.