Do Not Resuscitate by Reverend Cynthia Cain

Cynthia is this month’s winner of $502.50 for her story about the complexities of family and end-of-life care.

Bio: Cynthia Cain is a Unitarian Universalist minister, a South Jersey native who now lives in Kentucky on her farm, Innisfree, with her family and a Golden Retriever named Whiskey. She completed an MFA in fiction at Naslund-Mann Graduate School of Writing (formerly Spalding University) in Louisville. She's written three novels, a collection of short stories, and a nonfiction book of interviews with the elders of her local Black community. Some of her writing can be found at:

https://www.ajerseygirlinkentucky.blogspot.com

and

https://www.thespringfieldproject.blogspot.com

Without further ado, “Do Not Resuscitate” by Reverend Cynthia Cain.

Ruthie was like a discarded outfit on the hospital bed. She’d always been thin, and two months in a nursing home had whittled away any flesh. I tried to look unshocked.

“Hello, my old friend.” This voice came from the dark bed.

“Ruthie, it’s me, Connie.”

“I know it’s you. Now tell me what’s up with this place and why they’ve got me here.”

“They called me. They said you have pneumonia.”

“Well, that’s not so bad now, is it?”

I sat beside my aunt on the bed, feeling as if my weight would roll the frail woman into my lap. “I don’t know. We’ll see.”

“Oh, I don’t think I’m ready to die.” Ruthie’s eyes closed.

Then opened again. “Where have you been?”

“I live in Virginia. It’s a four-hour drive.”

“I don’t know why. You had that perfectly nice husband. Wes.”

“I’m married to Hank now. We have a baby girl. You saw her, remember?”

 She kept right on. “That beautiful house, that big porch. I miss it so.”

“I’m sorry, Aunt Ruthie.”

A nurse came in and lifted the sheet that covered Ruthie’s bony frame. I got up and slipped out the door into the hallway. This hospital was like all of the hospitals I’d been in, full of people waiting to celebrate or mourn. Everyone looked weary and worried. In the waiting room down the hall, pale sunlight tried to make its way through dusty windows, and a fat man slept, covered by a coat. He was snoring. I sat on a small couch and smiled at a serene-looking older woman who offered me a section of her newspaper. The room smelled like stale coffee.

“No, thanks, I’ve been driving since five AM. I’m too tired to read.”

“Oh. Where did you drive from?” She folded her paper, like she had been waiting for someone to talk to.

“Virginia. Little city called Winchester. But this is home.”

“I’ve lived here all my seventy-seven years. Been married to my husband for almost sixty.” She leaned toward me, and I could smell her perfume. It reminded me of the women in church, when I used to go as a young child.

“That’s nice.” I wanted to close my eyes, but I felt compelled to know this woman. She made me feel comforted somehow.

“Is your husband. I mean, is he the patient?”

“Yes, dear, I am afraid so. He’s been in a nursing home for two years now, with Parkinson’s. He’s gotten pneumonia again. Second time this winter.”

“My aunt has pneumonia, too. They called me during the night, and said she may not make it.”

“Are you her only family?” I wasn’t. But how to tell this decent woman that Ruthie’s other niece, my cousin Patty, was probably either in jail or rehab, again, and that my brother, her nephew, couldn’t be bothered?

“I kind of take care of her. She never married. My mother - her sister - died when I was pretty young and she’s always been around.”

 “She became like a mother to you.”

 I smiled at that. “Not exactly.”

“Have they done a tracheotomy?”

“No. Do you think they would do that?”

“Only as a last resort. Only if you say they should. It would mean, of course, a respirator.”

It hadn’t occurred to me that there’d be decisions to make. I was the one. I had power of attorney and paid all of her bills. In fact, I’d made decisions already, hadn’t I?

“Is your husband - will he have a tube?” Then I added, “I hope you don’t mind me asking.”

“Not at all. No, he has a big “Do Not Resuscitate” on his chart. As far as his disease has progressed, it would be cruel to keep him alive artificially. But, you know, they call pneumonia the old folks’ friend. It can take them rather swiftly. Or could, before they came up with all of these ways to hook them up to machines.”

“It doesn’t sound very comfortable, the tracheotomy and all.”

“My dear, it’s for the family, to avoid guilt. Almost no one comes off those things. It’s a slow death sentence. Especially for the old and frail.”

I nodded at her and went into the hall. It was dim and narrow. Its pale-yellow cinder block walls reminded me of the depressing grim halls of my middle school. The bathroom that was provided for visitors was cramped and dirty. I washed my hands with hot water, as if I were terrified of the germs all around me. As if the sadness was contagious.      

Back in my aunt’s room, I stood just inside the door and listened while the nurses tried to converse with her.

“Time for me to change your IV, Miss Patton.”

“Ohhhhh… please leave me ‘lone!”

“As soon as we turn you and fix you up a little. You’ve got a nasty sore spot, must be from the nursing home bed. You need to let them turn you more often, move you around when you go back.”

“It hurts me so, now just go on then and get it over.”

“Is there anything you need, Miss Patton?”

“I want a cigarette.”

“I’m afraid that won’t be possible. You’re here with pneumonia, do you remember that? You’ve barely been able to catch your breath a few times. The folks over at the Manor thought they’d lost you last night. I don’t think a cigarette would help us keep you alive.”

“My car. I’ve been thinking about my car. Do you know where it is?”

“Let’s see. What’s it look like?” The girl was poking around her arm again, looking for a vein that would hold up. I caught a glimpse of it from where I stood. The skin hung like the cloth draped over the cross at Easter, all purple with dingy bruises.

“It’s blue. I had it, oh, not too long ago. I just don’t know what they did with it.”

“Good news, Miss Patton. Your niece is here.”

“Patty? My niece Patty? What did she say? Ask her how my little boy Jimmy is. Oh, I miss that baby.”

“No, Miss Patton, this woman’s name is Connie. Is she your niece?”

“Oh, that one. Where is she?”

“She’s right here. Do you remember?”

“Won’t you tell her hurry? Hurry and bring some cigarettes.”

“You rest now, Miss Patton”.

I thought about the last time I visited Ruthie. The nursing home that was covered by her Medicare looked reasonably clean and pleasant. We’d sat in a courtyard and watched Ruthie smoke cigarette after cigarette. She couldn't get them there but we'd brought several packs. Hank and the baby were with me; the boys were with their father. Ruthie offered to baby sit Marisa, as soon as she got out, like she used to do the boys, and Hank and I laughed about that not long after. It wasn’t the fact that we lived four hours away so much as the ludicrous notion that we’d leave the baby in her care that humored us.

“When you went to the bathroom, she asked me where her car was,” Hank smiled.

“Her car?”

“She thinks she could still drive.”

“Did you tell her that her loser niece Patty and her addict husband probably sold the car for a Ziploc of drugs?”

“No, honey, I told her I’d check into it.” Hank was a resident in psychiatry. We’d met when I was still trying to finish my Ph.D. He had accommodated my sons, the baby, and the move from New Jersey to Virginia, without complaint. I envied his adaptability.

“They steal the cigarettes we leave her, don’t they?”

“The place isn’t as bad as you’d expect.”

“Hank, she wants to come live with us.”

“I know.”

“She can’t, Hank. She chain smokes, it would kill the baby. I’d kill Ruthie.”

“At least she doesn’t inhale.” Ruthie had always boasted about this.

“Yeah, her and Clinton! Do you know how much more second-hand smoke there is when somebody puffs it all out? She might be healthier, but everybody else is asphyxiated,” I said.

“We’ll look for a good place near us in Virginia.”

“With what money? I’ve been looking. Patty ripped her off so thoroughly while we were away at school. Shit. I should have never left her there with Patty and George around. That’s elder abuse.”

“Why is this all on you, Connie?”

“Hank. She’s my mother’s sister. You don’t know the history. It’s the way that family is. Every single one of them an alcoholic or the caretaker for one. She never turned her back on anybody. Look at how she let Patty run all over her. She’s the world’s flattest, dirtiest door mat.”

“So, Con, you don’t have to be a doormat.” Hank’s voice was soft and sympathetic. That was Hank, Mr. Understanding. For a moment, I saw myself as Hank must see me. A cushiony person, too easy on my sons, giving too much of myself away. But it was okay when it was given to him.

“I’m not!”

“It will work out.”

I sat back down on the bed. Ruthie reached for my hand and grabbed it with alarming strength.

“I’m breathing a little better today, Patty.”

“I’m Connie.”

She started to cough and wheeze. Her tiny body convulsed with the effort.

I looked at the door, uncertain about whether to run for help. She grabbed at my hand, flailing for it, when I took it away. The gasping subsided after a few minutes. Ruthie spoke, a whisper.

“Glory, this pain in my chest. This coughing is making me so weary. Why can’t they give me something to make it better? Patty?”

She seemed to be falling into a light slumber.

I felt as if maybe I should sing, one of the old hymns she used to sing us to sleep with after our mother died. All I could think of was “The Old Rugged Cross.” I sang the words in a whisper: High on a hill, there’s an old rugged cross, the emblem of suffering and shame. How I love that old cross, da de dum, da de dah…. And exchange it someday for a crown.”

I stopped. What a thing to sing to a little kid. Suffering and shame?

A few years earlier, I bought tickets to a circus at a nearby community college. I took the boys and Ruthie, sure that my old aunt would love it. Circuses and parades were her delight. It was something that hadn’t changed, something that would bring back a memory, and memories were what she lived for. Partway through the second act, just as the trapeze performance began, Ruthie got up to go to the ladies’ room. I went along, letting Ruthie cling to my arm all the way there. The boys stayed in the bleachers. But, coming back from the restroom, Ruthie started to dig into her ratty pocketbook for cigarettes.

“I’m not going outside now,” I said. “The boys are alone. And you can’t smoke in here."

“Just a few minutes. One cigarette!” She was like a child when she pleaded.

“Go by yourself, then,” I said.

I had turned then, headed toward the gymnasium, when I’d sensed a commotion. In the hallway between me and the door, Ruthie lay crumpled against the wall. Two teenage boys, running, shoving, too old to care about the circus, had collided with her and knocked her to the floor. I grabbed my sons from the audience and sat next to Ruthie while we waited for an ambulance. Even then, I thought as she lay beside me, her shallow breathing a testament to the body’s refusal to be easily killed, I hadn’t spent enough time with her at the hospital.

She never regained her health after the circus. She fell and broke the hip again a year later, but by then Hank and I were married and Marisa was on the way. There was a good residency program in Northern Virginia. Wes said the boys could move with me. The nursing home had been the only realistic option.

I remembered then how unkind, how impatient I was sometimes with Ruthie. I became exasperated with her: the treasured photo albums, the same stories over and over, the sour-smelling leftovers in her kitchen covered by little shower caps, the cats, the chain-smoking. I felt as much disdain as loyalty for my mother’s old maid sister, and aversion mingled with loyalty in a cocktail, bitter to drink but warming. It made me feel satisfied and sick at the same time.

It was as if she wasn’t a whole person but just an extension of other people. Her constant theme was family, and all of her dreams were dreams of the past, with childish faith that if she wished hard enough it might come back. She’d wake up, and there would be her parents and her siblings, and it would be one of the six happy days they’d ever had.

 The question just below the surface, never articulated, but behind all of my condescension toward Ruthie, was just what was her purpose in living?

Hadn’t I secretly wished that my aunt would hurry up and die?

Did I want to make her suffer or should I tell a lie that would kill her?

After the accident at the circus, I went to see a personal injury lawyer. He took down all of the information about the fall in his office, a storefront with fake pine paneling.

“Because this event was hosted by the community college, both they and the circus are liable. Sounds like there might be some money coming to her if we can convince them her safety was disregarded.”

“Those boys should not have been running. Someone should have been watching that hallway.”

“Just what do you and your aunt want?” He was looking at me with complete indifference, weighing nothing but his chance to make some easy money.

“Well, she doesn’t have anything except her pension and social security. I thought maybe if there was some compensation, she could do some traveling, put some away for extras, that sort of thing.”

“It will most likely be a settlement with the insurance companies. The amount will be based on her age and earning potential, so naturally, since she’s almost eighty, and finished working, there’s not as much compensation as there might be otherwise. You’re probably looking at twenty-five, thirty thousand dollars, tops.”

“That would be a lot to her.”

“Bear in mind that my fees, since I am taking the case without retainer, will be twenty-five percent of any reward. If there’s no compensation, there’s no fee.”

I agreed. The suit was settled easily, with no court appearance.

Several months later, I deposited a check for seventeen thousand dollars in Ruthie’s bank account. What I had failed to take into account was how little it would mean to Ruthie, who didn’t even want to shop for new clothes. What Patty and George didn’t clean her out of had to be spent quickly so that she could qualify for the nursing home. The lawsuit had been an empty gesture born of remorse.

I walked out into the hall and stood by the door. A nurse, writing in charts on a ledge that folded out from the wall, glanced at me.

“May I help you?”

“No, I’m fine.” She went on writing.

“I’m just wondering…” The nurse looked up again. She looked a bit annoyed. Her words didn’t match her impatient gestures.

“Yes?”

“Is there something I need to do, or… sign, about whether or not, I mean, I was talking to the woman down the hall, and she said something about a tracheotomy. I don’t think Miss Patton would want anything like that.”

“Are you the responsible party for Miss Patton?”

“I’m the only one. I have a power of attorney. Is that enough?”

“Has Miss Patton left any advanced directives that you know about?”

“Advanced directives? She has a will.”

“I’m talking about directives for end-of-life care, intervention. What we used to call a Living Will.”

“No, nothing like that.”

“Unless we have orders otherwise, we’ll do everything we can to maintain life. You may want to discuss it with her if you are able.”

I went back into the room. How could I ask my aunt, who didn’t even remember who I was, for permission to let her die?