March 2009 Archives

At 10 PM I push against the bedroom door, cursing its hollowness and creaks.  Light floods upon the playing field, the center, the action.  Marlou.  She groans.  She's cranked up in bed, and this attitude has become more or less permanent because of her frequent vomiting.  Linda, longtime friend and the night's volunteer nurse, follows me into the room.  She walks to Marlou's bedside and announces the nightly medications.  What, Marlou asks?  I can hear her bitter, dismissive tone.  I can hear trouble brewing.  What?

It's time for your pills, I say.  And what then, asks Marlou?  In her enfeebled state, this question is either profound or delirious or both.  Indeed, what next?  I stall.  What do you mean, I ask?  What is going to happen after the...pills?  Marlou slurs and can barely utter the final word.  Surely her strength cannot ebb further, but I have been wrong throughout this saga.  What happens next?  

What happens next is what has been happening within me throughout.  It is that, for the first time in my life, I truly know what to do.  I know not to discuss what happens next or to argue, and I know not to concern myself with whether my words will succeed or fail, for they are the right words.  And there is no success possible now.

I love you very much, I say.  It's time for pills.  And the next thing for us is bed.  We are going to cuddle.  Then we are going to sleep.  And tomorrow we will wake up and face another day.  

Of all the things I have said, the last seems the most like a lie.  But it has come to me, the appropriately sober and credible word.  Face.  We will face it.  

Okay, Marlou whispers.  I say nothing, just whisk about the room while Linda gets the medication into her patient's system.  By way of distraction I burble on about the state of the lettuce in the garden.  There is this kind and that kind, and the netting my brother put in place works quite splendidly, and Linda is opening the new ointment.  Marlou's vomiting is so intense that her pills have been ground into a paste, mixed with a hand cream.  Linda dons the prescribed glove and works the pharmaceutical ointment into Marlou's forearm.  All the jokes about people taking, or not taking, their meds flutter about my head like bats.

I am so shot full of weariness that I fear for my balance, and in the end, ask Linda to help me get my legs under the sheet.  I sink into slumber.  Every few hours, Marlou emits a gasp, then a telltale bubbling sound and I yell for Linda.  One of us hits the 'up' button on the electric bed, the retching begins, then the wiping and the toweling, and the lowering of the bed and the return to sleep.  I know this isn't as bad as sleeping in a foxhole at the Somme, but it's a good first step.

The nursing assistant who arrives in the morning keeps telling Marlou that her stethoscope is cold.  Sorry, she says, again and again.  Marlou's belly is distended.  Cancer, if one thinks about it, is utterly purposeless and self defeating.  It kills its host, just as mistletoe kills the tree, but the latter manages to cast off a few seeds, and cancer casts off nothing.  Watching the nurse, considering this appeal to cellular reason, I have the fantasy that one can get through to the cancer cells, talk to them, maybe all of us work with a counselor.  The nurse is raising her head, looking to one side, now considers something and motions me outside the bedroom.  She shuts the door.

I ask her what she has heard in Marlou's belly.  Nothing, she explains.  That is the problem.  The normal sounds of digestion, even the very faint sounds of the weak and infirm, are absent.  She suspects that Marlou's digestive system is now totally blocked.  It's like a Colorado River dam with no spillway.  Everything is backing up.  That's why Marlou is vomiting so often.  What happens now, I ask?  The nurse asks me to bear with her, places her laptop on our dining room table, taps away, opens her mobile phone and chats with someone.  I lie down next to Marlou, Linda raises my feet to the bed.  I wonder if the nurse can order a few meds for me.  Anything will do.  Pastel pills with colors that don't clash, maybe in a dispenser with a shaker top.  I fall asleep.  The phone rings, and Linda in the kitchen answers.  I fall asleep again.

Waking, I remember a moment from summer camp, at least 50 years ago.  A counselor, a college biology student, stood in the summer heat examining a beetle.  It was a large bug, one of the common black variety, but the kids had found an odd specimen.  The beetle had been lying on its back, twitching.  Its front legs waved faintly in the air.  Its back legs did not exist.  The creature's abdomen had disappeared.  Half of the thorax had been hollowed out, nothing but the shell left around its posterior.  Ants might have eaten half of it away, the counselor speculated.  Somehow, the front portion remained alive.  How could this be?  Well, the counselor said, it was true that the legs moved a bit.  But was this insect truly alive?  He prodded at the beetle's front limbs, watching how they faintly flexed, seemingly fascinated by his own question.

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Leviticus, Torah scholars will tell you, may seem about as interesting as a GE dishwasher manual, but there's more than meets the eye.  True, the text goes on about ritual slaughter at mindnumbing length, but the priests saw something in the observed death of animals.  They saw life.  In studying the agony and the mystery at the conclusion of existence, they learned something about its start.  Which, I am thinking, does explain one of the small miracles unfolding around me.

People keep returning to help Marlou.  Most eventually suffer some sort of burnout, but that is to be expected.  New ones keep taking their place.  The last film Marlou saw was 'The Man Who Came to Dinner', from the classic play.  An irascible Broadway columnist on lecture tour slips on ice and convalesces in a Midwest family's home.  He can't seem to leave.  The family can't get rid of him.  And so it is with our helpers.  They come from some distance.  They see a friend in great distress and pain, and though the hours and days must be emotionally exhausting, no one seems to reject the experience.  All keep coming back until they no longer can.  And why?  It is hard to say, but like the ritual priests and their slaughter, everyone seems to be getting closer to life.

Liz has returned from Los Angeles, replacing Linda.  In a spontaneous moment, I ask her about getting this dying thing under control.  What does she think about assisted suicide?  Liz, like everyone else who has flocked to Marlou's bedside, does not bat an eye.  It's a logical question, she says.  Something to think about, naturally.  As for Marlou, she would not go for it, Liz is almost certain.  And what about me?  Would I?

The package arrives late, via special courier, and I have to sign for it about a dozen times.  The carton sits in the dining room.  Marlou's parents eyeball the thing, note the 'must refrigerate' lettering on the side and worry if we shouldn't shove the entire box in the fridge.  I ignore this and retreat to my office.  

Within a few moments I will issue a general edict that everyone in our home must be refrigerated for several hours before anything else can transpire.  I laugh privately and heartily for a good 10 seconds before the reality of bodies and refrigeration hits me.  And where is the fucking nurse?

He arrives at 11 PM full of apologies and wanting any real explanation.  He opens the carton and goes about assembling the morphine pump.  It takes half an hour for the thing to finally be up and beeping.  The nurse places the pump switch in Marlou's hand.  I place my own hand on her hand.  Liz hits the light switch, and another day has ended.  By dawn, having slept and not rested, another nurse is on the scene.  She has been eyeballing Marlou's nocturnal button pushing, correlating that data with the machine's setting for the release of morphine, and has a question.  Would Marlou like to up the dose?

In the morning warmth, for spring has arrived, Marlou listens.  She says 'no' to the nurse.  I roll my wheelchair into the office and shut the door.  The nurse follows.  She is a young woman, but not averse to hanging out with death and dying, so I suspend my judgment and bite my tongue.  I tell her, in as diplomatic terms as I can manage, that when I see my wife lying on her side recovering from another bout of vomiting, I don't like what emanates from her eyes.  It is something beyond sadness, even resignation.  It is that look of life knowledge that one sees in the eyes of concentration camp victims.  And there is more, I tell the nurse.  Marlou's breathing has changed overnight.  She gasps, sucks in air in desperate gulps.  

Marlou is not in pain, the nurse tells me.  You are in pain, she adds, but not your wife.

I let the nurse tend to Marlou, head outside to check on the lettuce seedlings and find that the latter have moved to lettuce adolescence.  The sun splashes against my face.  I need a mission.  I decide to roll to the bank.  Incredibly, scores of local constituents are rolling my way, clutching steaming cups of Peet's.  Sure enough, the coffee place has reopened.  Huge fans whir inside.  One of my neighbors tells me that the place had a close call.  The entire building almost went up in smoke, but now it's in business again.  The air conditioning system has shut down, and there's no heat.  But the fans will keep the air moving.  It's an improvisation, but Peet's is moving and I am moving and everything will keep moving until it stops.

Opera, Marlou is fond of saying, teaches us that we haven't lived enough.  Whether they're pushed off castle towers, drowned in the Rhine, strangled by husbands or stabbed on the way home from the cigarette factory, lyric heroines have a particularly tough go of it.  The going gets toughest in the mad scenes.  Blood pushes Lady Macbeth over the edge, Lucia goes nuts trying to spell 'Lammermoor', and on it goes.  While in real life men go mad with at least as much frequency, only women get these scenes in opera.  

It's late afternoon.  I roll to Marlou's side of the bed for a few routine moments.  We don't do much talking, because speech has become so difficult for her.  Most of the time in bed or beside it I stroke Marlou's hand, rub her arm, tell her she's beautiful, let time pass.  She has wakeful moments, but she's mostly drowsy or asleep.  But now she's awake in her heavy lidded way.  She reaches for my arm with what in current circumstance amounts to strength.  This is it, she tells me.  Not much later our friend Laurel takes a peek at Marlou, grows alarmed and summons her mother.  Her father comes too.  We all stand around her bed.

I enjoy telling stories and don't mind if people listen.  Marlou does not like being the center of attention, which she is right now with everyone around her bed.  Laurel continues dispensing early evening medication.  Her patient turns to those assembled and manages to get out, with minimal brain-tumor mangling, 'Has everyone gathered to watch me take a pill'?  

Now I'm thinking that despite Marlou's sudden pallor, she retains remarkable health.  We call the hospice nurse just to make sure.  He speeds over.  Her blood pressure may have dropped, he tells us, but Marlou's cardiac performance is back to normal.  The nurse packs his bag and heads home.  I head for bed.

1:00 AM and Marlou is talking.  She has had it, she says.  Why can't we pull the plug?  She wants to talk to Laurel.  I yell to the front room.  Laurel appears, takes in Marlou's question and without batting an eye, explains that there is no plug to pull.  Marlou is not plugged into anything.  This is a natural process, dying.  It's a process that's bigger than Marlou or Laurel or any of us.  I tell Marlou, now in Laurel's presence, that I know she has to die and this is okay and I'm okay and people will take care of me.  And Marlou can let go.  I want Laurel to hear this, because the words are not mine but those of the Multidisciplinary and Ecumenical Committee for the Dying of Paul's Wife, a cast now numbering in the hundreds, with open auditions daily.  

These words of hospice advice, 'let go', are not proven and defy proof.  But I say them anyway, and despite her aplomb Laurel later reassures me that she feels as lost as I.  No one really knows what to do, including the person at the center of it all.  And this is the only message, the one thing I can tell my dying wife with any certainty.  That she really is the center of everything.  

At times, I understand why someone invented hospitals.  There is an
efficiency of scale in medicating, cleaning and hydrating multiple human bodies at one time.  But Marlou doesn't want to die in hospital.  And this seems entirely right.  She connects too deeply with people heart-to-heart, and she is too sensitive.  Even in her semiconscious state, this afternoon Marlou picked up on a strange voice in the house, two closed doors away...a physiotherapist whispering about my wrist.  For those of us who know Marlou, the image of her in the beeping, hallway-rumbling, bedpan-clanging, world of Stanford Hospital borders on the comical.  And there's her need for order.  Marlou stares at my shirt collar and with her last ounce of strength tries to tell me that the garment is frayed and, she gasps, out of fashion.  I want to tell her that I am too.  Marlou was born to array beautiful things around her.

With her middle-of-the-night medication, Marlou ceases discussing death or anything and drifts off to sleep.  I stare at the ceiling until 4 AM, then do the same.  But 4:30 AM finds Marlou sitting up in bed.  This is something she hasn't done, and hasn't been able to do without the mechanism of our electric bed.  But somehow she has raised herself with her own abdominal muscles.  Seated on the edge of the bed, wobbly but upright, she throws an arm to one side, turns and says to me, 'I want to go to the hospital'.

The hospital?  I stare at Marlou.  No one on the Vast Hospice Advisory Committee has prepared me for this.  It is like mid-Atlantic on the Queen Mary, deciding that you've had it with this oceanic bullshit and want to fly.  Well, I say, the hospital doesn't sound like such a good thing.  I am a bit worried at Marlou's wobbling on the edge of the bed.  

'Why am I sick, and not you'?  I fumble around, in what is left of my own mind, for Marlou's deeper meaning.  I say, well that's quite a poser.  We should talk to Laurel.  A Vast Stupidity has sucked me into its maw.

Within minutes Laurel staggers into our 5 AM bedroom.  She has a capacity for either exuding or feigning calmness.  In fact, Laurel could stand under the exploding Hindenburg, quietly note the appearance of flame and suggest that observers might want to increase their distance vis-à-vis the Grim Reaper.  

In any event, Laurel is taking all this in, Marlou sitting, Marlou gesturing and, now, Marlou yelling.  She wants the hospital, dammit.  She wants to go to the fucking hospital.  She has, in fact, 75% recovered within the last few minutes.  Now, she asks us both, why is she sick and I healthy.  She wants the poison center.  She wants me to hand her the phone so that she can talk to the poison center.  Marlou wobbles at the edge of the bed, reaches in the direction of the phone.  We are trying to kill her, she says.  She has had it.  There is even more, but the narrative is hitting me too hard, disorienting me too much, and I now expect Marlou to turn her head 360° as in 'The Exorcist'.  I flick the wheelchair control to high and exit for the kitchen.  I shut the door and call the 24-hour hospice line.  The nurse comes on remarkably quickly.  I run through my account of things.  The nurse listens.  I tell her Marlou seems uncontrollable.  A silence.  I have run out of words.  

Perhaps, the nurse asks, Marlou has accused you of stealing her money?  I haven't mentioned this part, and the question seems downright clairvoyant.  Yes, I say.  Something shifts.  Morphine, the nurse says, coupled with the other drugs, a brain tumor, and the general drift toward death often add up to temporary dementia.  The stealing-the-money thing is the most common, she says.  Will she come over, I ask?  No, she says.  A stranger in the house would be a bad idea.  What am I supposed to do, I ask?  Wait, she says.  This won't last long.

I hang up and, sure enough, sounds from the bedroom tell me that the mad scene is over.  It has ended not with an opera curtain descending, but in the way of cancer, with vomiting.  Marlou's parents are in the bedroom now.  Soon her father is in the kitchen asking me to come back to bed.  Marlou wants you, he says.  She is sleeping, barely breathing.  Lying on her side.  I am pulsing with anger and pity.  And something else.  A strong desire to run away.

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Familiar Peet's morning customers stand in the carpark, looking slightly lost, carrying on conversations.  I recognize two baristas in the park across the street.  No one is quite milling or quite moving, and the plate glass windows of the coffee salon are covered in plastic.  There appears to be no one inside.  Yet the public has assembled.  Nothing seems to be happening here.  Everything has stopped.  We know a civic emergency when we see one.  And while this unknown thing filters about our tiny suburban center, just look around.  Unaccountably, spring has blown into town.  The trees are blooming.  The daffodils are past their peak.

Friday evening and my friend Arnie produces two plates containing my Oakland cousin's Mediterranean chicken stew, a salad, some bread.  He works unobtrusively, producing food in what can only be called a presentation.  When dinner is over he will whisk things away, magically wash them and ask what else he can do.  But for now he's doing what is best, sitting down at the dinner table with me.  It has been a long time since Marlou and I did this and, of course, we will not do it again.  So here we are, two guys, enjoying each other's company and aware of the change.  This instant and unwilling reversion to bachelorhood should not seem so crushingly sad, yet for the moment it does.  Gamely, I produce a Web document, 'Jewish Mourning and Funeral Customs for Interfaith Families' and regret that I still do not have the concentration to read this or anything else.  Arnie promises to return early in the morning.  I say goodnight, and as soon as he is gone all psychic hell breaks loose.

It's quite remarkable that Marlou with her half-paralyzed body manages to get clear around the bed so that she is sitting up on my side.  Our night help, a timid Filipina woman, has alerted me.  And sure enough, there Marlou is, insisting that she wants the telephone.  She wants her oncologist to pay a visit.  This request has the ring of the rational about it, except that Marlou is essentially beyond oncologists.  There is no more treatment, just pain management.  

Marlou is furious with me.  I expect her to die on schedule, she says.  She wants her parents to come downstairs.  Her parents arrive, and she wants to call her friend Liz in Los Angeles.  I tell her she has every right to be angry.  I retreat to my office and guiltily pick up my mobile phone.  The night nurse and I have a chat.  Nothing is illuminated, and this time I stay away from the nightly mad scene until the vomiting concludes.  I angrily slide into bed.

I will sign up for a six-week tour of Saturn's rings, with an optional day excursion to Jupiter, before taking another ounce of death-and-dying advice from any expert.  No one knows anything.  My advice to Marlou that she can let go, and I am okay, all this has done nothing but agitate her.  She is refusing her newly prescribed tranquilizer, because she doesn't trust me, she says.  Perhaps she fears that she will take the pill and never wake up.  Perhaps what parents experience with their firstborn, nights of crying and no sleep, the scent of bodily byproducts, wafting about the house...maybe death comes the same way.  We return to our unpolished core, make a mess and keep everyone up at night.

One thing is for sure.  Marlou is no longer the good girl, pleasing everyone, ignoring her own needs.  She is saying what she wants.  And what she wants is impossible.  Maybe if you have the consciousness to sense your own potential, you also suffer the curse of the unfulfilled.  Marlou's spirit is emerging, and it is not always pretty, but it is always honest.  I cannot help her during her night madness, physically or psychically.  This evening when Marlou was at her highest pitch of lunacy, as she sat on my side of the bed, misdialing phone numbers and ignoring the advice of her parents...be calm...take a pill...I put the hospice nurse on hold, put the receiver down and briefly rolled into the bedroom.  You have every right to be angry, Marlou, I said.  Too bad, she said, she wasn't dying on schedule.  You have every right to be angry, I repeated, rolling out of the room.  I wasn't saying this for her, but for me.

Someone advised me to help Marlou hold her space.  We are fond of psychobabble in California.  We give space.  We share space.  Our spaces are good or bad.  And with everyone so spatial, it's very easy not to listen.  But I remembered my first real job, as a science writer.  Theoretical physicists devote their lives to space, whether it can be folded or is elliptical.  Now, holding space, the emptiness and source of creation, seems the only thing to do.

In the late afternoon, which afternoon I cannot say, for these slow days of Marlou's end-of-life agony have lost all form, the two of us talk.  A light rain is falling outside, an event of note in arid California.  My brother and his wife are visiting, if that is the word for taking over the vigil for the next few days.  They converse with Marlou's parents in the front room, while the two of us spend the evening in the bedroom.  I have parked my wheelchair close to Marlou and hold her hand.  I tell her one of my early recollections of Berkeley campus life.  From time to time I would wander into the geology building and have a look at the seismographs.  The machines came in all sensitivities.  Some could withstand an earthquake on the campus fault, others picked up temblors from Japan to Kamchatka.  There was nothing wrong with being sensitive, the instruments seemed to say.

Marlou takes this in.  She says that she sees her life as a lantern box.  She says that her light was meant to shine through others.  It has shined through me.  She says that she was destined to find love, and unselfish love.  And she was destined to lose it.

Her words render me mute, without thought.  Except for one thought.  My life began in an unhappy family, orbiting about an unhappy marriage.  I have found a happy marriage.  Where humans in their intimacy hurt each other, and then heal each other.  Where there is teamwork...until tomorrow or next week.

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I'm on one of my brief forays to the outside world and dash about Trader Joe's in search of superfluities.  Actually, I am killing time while Walgreen's puts together the hospice's prescription for mindnumbing drugs.  The current dose isn't keeping Marlou calm and anxiety-free, which explains my state of advanced fatigue.  Still, taking care not to drive into one of the shop's columns, I spot a kid sitting in a shopping cart.  He may be two years old, and we recognize each other.  My wheels have a primal appeal to little boys.  His mother is gazing hard at organic olive oils, so I brazenly give the kid a wave.  Inexpert at waving, he pumps his hand up and down, smiles broadly, and my work is done.  I don't know what my work is.  I'm running on no sleep, fight-or-flight adrenaline and dim hope.  Within moments, I'm through the check out and hurtling for Walgreens, then home.

It's not losing sleep over it.  I ponder the expression, consider its merit, then discard it.  I do not believe that Marlou's late-night conversations, however superficially incoherent, are devoid of meaning.  At 1 AM last night, she began discussing the children.  Exhausted and desperate for literal meaning, I suggested that she meant Avery, our six-year-old neighbor.  No, Marlou said with a voice heavy with paralysis and barely intelligible, she meant all the children.  First, she wanted to know how young the children would be at her funeral service.  They must be at least eight years old, she said.  Six years old was too young.  As for Avery, he would never forgive us.  He would never trust anyone again after her death.  There was no reassuring her.  She was, and is, somewhere else.

Someone must take care of the younger children, she said.  Death, though she did not use this word, would be too much for them.  I wonder if Marlou's struggles, described in a very understated way, amount to loss of innocence.  Perhaps now she knows life's savageries so well that she is seeking protection, wishing to warn others...one cannot say.  In any case, on it goes, resurging at 3 AM, then at 5 AM, this concern about the children.  They children are very real to her, and they are numerous.  I think of the kids Marlou, and I, have never had.  An early-morning pill puts her to sleep, but nothing puts her to rest.  She is working on something, working out something, churning and restive.  And, yes, it's the drugs and the swelling brain and doubtless the collapse of her organs.  But it's her.  It's what I have.  And I prefer to see and believe in her story.

When the helicopters began circling I barely noticed.  They are ever present, flying to and fro with what I had once assumed to be burn victims or prenatal babies.  We are so close to Stanford Medical Center, I even hear them on the ground, whooshing and stomping at the hospital heliport.  Much of the romance wore off when I learned, from a reliable source, that most of the helicopter traffic has to do with organs, their donors and recipients.  I am too old to come to grips with the fact that lots of what goes on at Stanford has to do with money, and that Stanford has been left in the moneygrubbing dust by places like Berkeley.  So I tuned out the helicopters this morning, until it dawned on me that they were flying around in circles.

What they were circling hardly surprised me, everything throbbing with meaning these days, and the apocalyptic so prominent in both personal and public spheres.  There was a fire, a rather large fire on the urban scale, in central Menlo Park.  And I did not bat an eye when my father-in-law returned from a personal reconnaissance stroll and reported the news.  Peet's was on fire.  The blaze had gotten to the urban planners above, and from their offices it had spread to the roof.  The town was awash in firetrucks, several from regional suburbs.  Streets had closed off.  And during it all I sat on my recumbent exercycle, hearing the reports, trying not to make banal jokes about dark roast.

After all, we had had a better night, Marlou and I.  My twin fears, being absent when Marlou dies and being present, seemed to fade.  I slept soundly for about six hours.  I'm getting adjusted to things.  Those shepherding birth and death seem to lose a lot of sleep.  Nothing to worry about.  In fact, when one of the hospice nurses called this afternoon, we had the briefest of chats, and she told me the simplest of solutions.  Roll into the bedroom, turn off the wheelchair, lean over the bed and tell Marlou what you want.  Prior notification regarding passing.  And a sort of FYI on the fear.  A.k.a., I am afraid you will die without me.  Marlou listened to this, shrugged her shoulders and told me it wasn't necessary, this husband-wife bedside dying thing.  Go catch a film, she was almost saying.  And the dying timetable?  She patted my hand.

As for fear of death, I find myself revisiting the June night in 1968 when I bumped into three leering kids with a gun.  I got a close look at the gun but a better look at the street pavement and a long gaze at the blank mystery of mortality and a terrifying lack of completeness.  That I would never do what had to be done.  That I would lose life without valuing it.

It's the hands, Marlou says.  I have wedged my wheelchair in close to her bedside.  She lies back, hollow cheeked on her pillow.  Her eyes are mostly closed, but she speaks.  Some of the outer layers of personality have gotten sanded down in this process.  And the morphine creates a sort of solvent, making thoughts and moments flow in and out of each other.  Marlou has not had an easy time saying what she wants in much of her life.  But in this part, despite the word-robbing brain tumor, she makes herself quite clear.  If you don't understand me, she slurs, say you don't understand me.  I don't understand you, I say.  She says for the second time, it's the hands.

It is, of course, and from my perspective the hands belong to Marlou.  I'm sure she is thinking of someone else's, but I only notice hers.  In the afternoons now I lie on my side, unabashedly asking assistance for body positioning.  Whoever is around props a pillow under my butt so I can tilt toward Marlou.  Face-to-face now, we can hold hands, stroke arms and maintain some physical connection.  This phase of things, when Marlou's pain finally drowned in morphine and her nausea disappeared with the collapse of her digestive system, has blossomed unexpectedly.  

At night in bed only a few days ago, I expected something more querulous when I gave her hand a good night pat.  Instead, she worked her torso onto its side, a grand effort these days that rivals my own.  Marlou reached out her hand, first one, then the other.  She wanted to hold my head.  She has such an exquisite grace and delicacy that she can manage these things, weakness or not.  A friend has noticed that Marlou's right leg is not only half-paralyzed, but twitching in a familiar neurological way.  Her body isn't cooperating, but look at what's happening, her fingers, slender and long and now bony from loss of flesh, are drifting over my hair, descending around my ear and resting on my temple.  The other hand finds its way to my forehead.  And we have found our way to this moment, and maybe this is all there is.

At lunchtime my friend Alan and I sit on a park bench watching the local fire brigade have a go at what is left of Peet's.  They're awfully good, I can tell.  Charred bits of wood come tumbling out of the inside, new beams arrive as temporary supports.  The fire crew begins removing yellow crime-scene tape, starts rolling their massive ladders down from the blackened roof.  A lane of traffic reopens.  Just another disaster.  The helicopter has long departed, having gotten its film-at-11 moments for the TV news.  I ask Alan if his wife wants to stop by and say goodbye to Marlou.  He wants to know if I'm asking this on behalf of her or of me.  The question brings tears to my eyes.  This is time for direct talk.  Me, I tell him.  Okay, he says.

The soil in my raised beds exceeds all expectations.  I had planned to dig a few transplanted California poppies into place with a trowel, but no tool is necessary.  Thanks to my ceaseless attentions and brilliant grasp of California clay, the garden has composted and mulched itself into organic heaven.  The soil particles are actually dancing, holding hands in a sort of molecular maypole dance, worms diving in and out of the center.  Things are so loose that the poppy roots all but jump to the soil surface on command.  They transplant as easily as puppy dogs.  I will toss them some bone meal.

Nevermind that Marlou's birdfeeder crashed to the terrace today.  Marlou had found the thing somewhere, squirrel-proof and receptive to goldfinches.  The arrival of a new or odd bird rarely escaped her notice.  That the birdfeeder loosed its bonds and hurtled to the brick terrace on this particular day means nothing.  It is not portentous.  Never mind Peet's.  You can only open your eyes so much, and then you have to close them.

Marlou wakes in the late afternoon.  She is propped up in bed, and the propping is done by an electric motor which raises and lowers each half of our queen-size in the hospital style.  We bought the bed at the urging of my prescient brother and sister-in-law.  And now we're set up and Marlou is propped up and if she would just stop throwing up, conditions for comfortable death could be said to be perfect.

At times the agony of this seems to border on the irresponsible.  I have the conviction, quite certain, that malfeasance or malpractice or malevolence lie at the heart of Marlou's protracted misery.  I'm going to sue.  

At other times, Marlou's slow death seems to be squeezing out truth after truth, revelation after revelation.  Her outbursts of anger, some have advised, may derive from the same brain tumor that is squeezing off her power of speech.  I prefer my own explanation, that at this late moment all pretense has dropped and she is simply, unabashedly, furious.  Conditioned by my mother's volatile anger, I flinch at the earliest warning signs of female attack...but there's no time for that right now.  I have to see things in perspective, and quickly.  Marlou forgets half the things she says.  She has lost track of days, thinking yesterday's visitor was here this morning.  So she erupts, I erupt, and now the whole thing has to be over in five minutes, because we may not have ten.

My current team of psychological and spiritual advisers has swelled to such proportions that I am urging them all to form a union.  Pay their dues, gather at the hall, then go out on strike.  I'll provide the signs.  There are too many people offering me advice and personal growth these days.  And there are not enough.  In the evenings, after a long day of bedside living, my visiting sister and I try to go out for an hour's escape.  Marlou's parents stay behind.  I worry every moment I am gone.  I fear that I will miss the final moment.  And what is there to fear?  What will happen at the very end?  And don't I fear the very end more than I fear missing it?  There's no escape.  Everything orbits about the central event that has yet to occur.

Sitting up in in our levered bed, early evening advancing, Marlou looks at me.  She is the victim of an ordeal, drained and not entirely here some of the time, yet still occasionally quite lucid and specific in her thinking.  At this moment, she stares at me with the blackness of the unseeing.  There is no expression about her face.  Her eyes register mine, unguarded in the openly uninterested way of strangers.  Like everything else, I must not take this personally.  Marlou is going away.

And yet the moment I go away from her bedside, she whispers, barely intelligibly, to any available nurse or friend...take care of Paul.  I'm not sure what care she means, nor am I certain what part I play in this.  Several of the hospice team has suggested that I should reassure her of my wellbeing and prospects for continuance.  Surely Marlou knows I am made of sterner stuff.  But do I know?  What really will happen after I have spoken at the redwood chapel, driven to the Monterey coast as instructed, and released what is left Marlou to the Pacific breeze?

Because the future is a blank, I try to fill in pieces of the past.  I am glad that on several occasions, not many and not enough, we danced, in our fashion.  A birthday, hers or mine, New Years, and now and then just a moment, I would stand, hold onto her for support and lean in a rhythmic sort of way.  Earlier in my disability, I had the neuromuscular wherewithal to actually move around and managed something of a step.  But now, my balance is gone, so I rock to and fro.  What overwhelms such moments is not the physical challenge, but the poignancy.  The intensity of what I have lost always rises in me, but so does Marlou's smile, all encouragement and enjoyment.  For my hand is in the small of Marlou's back, her eyes are on mine, and everything about her tells me that I am her man, that I will do, and this will do.  The man leads.  I can feel how that is.  And so can Marlou, and so this thing is built and shared until, stamina being what it is, we reach the end.  The end of some little number by Bill Evans, who long ago reached his.  "When I Fall in Love."  Love is ended before it's begun.  But there is the music, and the two of us have captured it, even if I'm soon back in the battery-driven mundanity of my clicking wheelchair.

Recently, our medical life had achieved a twisted normalcy.  Our friend Laurel who introduced us in Sacramento a decade ago, stays a few days.  This is followed by my brother Richard and his wife Debbie, Marlou's friend Liz who is miraculously an RN, then my sister Susie.  Then through next week Laurel, Liz, my brother and sister-in-law promise to repeat the pattern...all of this reassuringly plotted in my calendar book.  Together, we have even witnessed progress of a sort.  The toing and froing of hospice nurses, our insistent reports and the occasional wheelchair dash to Walgreens seem to finally have quelled Marlou's nausea.  She sleeps all night.  Sometimes, I come close.  Until this morning.

Marlou wants you, my sister told me over breakfast.  I rolled towards her cluttered, wheelchair-inaccessible bedside.  I told my sister I couldn't stand the situation, finally insisted that chair and commode and electric heater give way for me.  My sister, who is gifted with a penetrating gentleness, put her hand on my shoulder and spoke the pathetically obvious: this is your wife, this is your home.  And so I rolled close to Marlou, instead of lying beside her in bed and exchanging sideways glances, now staring face-to-face.  She was in the midst of reaching for her water glass.  

I have come to accept the preposterous fact of cancer from the abdomen blossoming in the brain, and years of rehabilitation clinics and hospitals have inured me to the varieties of paralysis.  So there's nothing surprising to me in the way Marlou turns her head, trains her eye to the left and directs a hand to a small water glass with straw.  An inveterate muscular dystrophy person will do much the same, shoving the vital hand with a waning shoulder toward its target.  What strikes me is Marlou's extraordinary grace.  She is so new to this, yet she has adapted naturally, with serenity, and, yes, she has made it to the water glass.  She moves the drink toward her mouth.  It slips from her fingers, crashing against the wooden bedside table.  Her eyes close in exasperated pain.  Honey, I tell her, me, it's okay.  Here.  She waves away the straw.  All this is happening to her, but it feels far too much like me.

The drink can wait, she seems to be saying.  Her speech is so soft and garbled that conversation exasperates both of us.  Still she is clear on this point, that recently she has had a sinking feeling.  She sinks and sinks, goes down and down, and wants me by her bedside.  I tell her she is beautiful.  She is my love.  She is my wife.  Yet now something opens in me that is terrifyingly hollow and would weaken me at the knees if I was standing.  It's bad enough sitting, and I lean forward resting my head on her hand as though this move is affectionate.  It's not.  I'm simply collapsing.  Outside, I hear someone approaching the front door, Marlou's mother opening it.  Arnie.  It's my friend Arnie.  I call out his name, now there are three of us, and there is a hand on my shoulder.  

Think I'll stretch out, I say as nonchalantly as possible.  Sliding from my side of the bed to Marlou's is a protracted physiotherapy exercise, so I don't even pretend.  I ask Arnie to swing my legs into position, shove my torso toward her.  He does this, then gives Marlou a hug.  Him too, she says, meaning me.  We all laugh, Arnie rubs me with his beard.  And Marlou and her humor are still there.

I try to tell her that she will still be there after she is gone.  This is supposed to help Marlou let go, and although dutily I have said these words, I am not sure what they mean.  Except perhaps in moments.  It was back in the last era, the Age of Carpeting, two weeks ago, that Marlou took a post-nausea-pill nap and I sneaked out of our hotel for an afternoon matinee of "Slum Dog Millionaire."  The film meant nothing to me.  It seemed slight, but I was hardly in a fine mood.  But the scenes at the Taj Mahal ring clear as a bell.  If you love a woman, and you lose her, and you have the bucks and you get the zoning permits, what else are you going to do but build fountains and domes and towers and reflecting pools?  

And only two days ago, at a point too late in the afternoon when Marlou's father and I had gotten to Peet's for a double espresso, and had finished discussing the particulars of funeral arrangements, I rolled up to the counter to purchase teabags.  The clerk had that haggard, end-of-shift look that comes of a day of caffeinating Silicon Valley's most avid.  She also had flashing eyelids, high cheekbones and a ready warmth.  She remembered my name, smiled, wearily recommended a green tea and did everything to reassure me while I fumbled with my MasterCard, that for this mercantile moment she was mine and I was hers.  I wanted to tell her, and the words were half out of my mouth, how lovely she was.  And I knew immediately that this impulse comes from Marlou.  That in ten years of marriage, fear of women had given way to love of women.  And love is love, and male love is naturally a little indiscriminate, and that's okay.

Maybe it's all okay.  Sickening and sad and infuriating.  But indisputably life.

I am awake hours before our 8:40 AM appointment with the oncologist and start working on waking Marlou before 7:00.  She sits up reluctantly, gripping the mattress edge for balance and stares puzzled at the hotel carpet.  Now she rises slowly and wavers as though uncertain where she is.  Staggering, knocking against the wall she heads to the toilet, vomits.  She returns to bed.  Twenty minutes later she is up again, and somehow, we are out the door on time.  Marlou lurches through the crisp morning, holding the handles of my wheelchair.  She really needs one of her own, but never mind.  We are making progress.  

And within the hour Dr. Mata flings open the door of an examining room, slides a chair close to Marlou and positions herself, all in one fluid motion.  She asks Marlou how she is.  The answer couldn't be clearer: garlic.  Does the room smell of garlic, Marlou asks, and isn't it coming from Paul?  And if he just left the room for a moment wouldn't we know?  Actually, I wonder if Dr. Mata hasn't been hitting the vindaloo curry pretty hard herself.  Okay, I say, I will leave the room.

The room I will leave it is a sterile, windowless cube, cut off from everything, including sound.  The examining table sighs.  Dr. Mata pats my knee.  Her other hand is rising, fingers moving up Marlou's cheek.  She is touching both of us now, but looking at only one.  You have mounted a brave effort, she tells Marlou.  And now it's time for something else.  Marlou needs no more treatment.  Her decline has been swift, the doctor says.  The only goal now is comfort.  Dr. Mata has a hospice service in mind, an excellent team that can keep Marlou at home, in her own bed.  Dr. Mata, holds Marlou's fingers in her left hand and continues to hold her face with the other.  She keeps her hand on Marlou's cheek, tears streaming down it.  Time, seconds or minutes, I cannot say, passes.  Marlou, you have been very courageous, she says.  Maybe it's time to let go.

Dr. Mata has left a molecular biology laboratory at Berkeley for this, clinical work with patients.  God knows why.  But as though reading my thoughts, she tells us now.  I have learned much from both of you, she says.  Dr. Mata has recently had a baby, and the infant's picture stares at me across a jar of cotton balls.  I stare back.  Marlou is crying and I am crying, and everything has been leading to this.  And now all the world's possibilities are in this room.  A silent class of second graders has risen, tiny hands holding the backs of chairs, and they are staring at us.  All are present, no tardies, no absences.  They know what is happening to the adults.  They are waiting.

In our hotel room Marlou stares at this morning's room service fruit plate.  She gathers a few items from the bathroom.  I do the same.  She stretches out on the bed.  I want to call the bellman and ask for help with packing.  Marlou sits up.  She goes about the gathering and arranging and packing of things.  When is checkout time, she asks?  Still 11 a.m., I tell her.  Sarcasm has me in its grip.

Marlou does not want to go home.  She wants to go to a healing service at Menlo Park's Episcopal church.  I am very tired, but one doesn't argue with such requests.  Before I know it, I am parked and sitting in a redwood chapel, and the English rector is asking if I want to take part.  No, I tell her, and there is no time for explaining.  I try to smile as warmly as I can.  This woman has come to our home, talked to Marlou in privacy, and the least we can do is turn up here, it seems.  I watch the ceremony.  The Eucharist, I learn, is not a church object, but the communion ceremony.  I want to ask the British minister about the article.  After all, it's not 'the Christmas' or 'the lent,' so why is it 'the Eucharist?'  But this is no time for questions, and all I can do is thank her.  Marlou is not a churchgoer, and now she is here in this woman's chapel, and she is welcome.  And she is dying.

Marlou enters our apartment, eyeballs the scene and pronounces the new carpet too light.  She had thought it would go better with the furniture.  She falls heavily asleep on her bed.  The hospice nurse phones to announce she is on her way.  Within the hour, she is at Marlou's bedside, getting her patient under the sheets, pasting stickers with the hospice number on every phone she can find.  She is Irish, miniature and voluble.  I can tell her narrative is driving Marlou nuts.  By the end of the afternoon, another nurse, a trainee, has joined her.  Also, a social worker.  Everyone is trying to get the lay of the medical land, sense the psychological environment.  And chat.  Marlou is not a chatter even when she is well.  I lie beside her on the bed.  You have to get these people out of here, she tells me.  I assure her they will be gone soon.  This is a lie, but it will do.

Marlou can barely speak.  One side of her face is losing feeling, she says.  Also one arm.  A leg is weakening.  Can you feel in this one, I ask, stroking the arm nearest to me?  Yes.  There is nothing to do now but lightly rub Marlou's forearm.  I know that human limbs can lose feeling.  My left hand, the only one that moves, hasn't registered tactile reality for more than 40 years.  But I can feel the warmth of Marlou's skin.  A soft womanly glow passes from her to me.  It has been passing for years, and I have barely considered it.  Now, it is all there is and seems to have always been, everything to me.  Marlou and her hypersensitivity and her quality of heart and now, yes, her anger and always her unflinching sincerity, all this is now emerging from her right wrist.  

I lean toward her, a major neuromuscular event, getting my torso on its side so that I can rest my cheek on her palm.  Marlou's hand on the side of my head sends me into the usual swoon.  In these moments, I am utterly secure, loved and nearly amniotic.  People are arriving soon.  The next day will bring more nurses, friends have announced their visits and Marlou's parents will spend no more than a few days in their Oahu home before boarding the next plane for San Francisco.  My brother and sister, families in tow, will arrive next.  I can see at all, Gianni Schicchi with a house full of wailing, but no one laughing and no Puccini.  I can take it.  What I cannot take, at least not now, is the certainty that this very hand beneath my head will soon grow cold.

'What's brown and smelly and comes backwards out of cows?'  British schoolboys, several eras ago, knew the naughty answer was the Isle of Wight ferry leaving the harbor at Cowes, and and why this occurs to me backing out of my California apartment is anyone's guess.  Except that I'm going in reverse, and now I'm not going at all.  To close the door, I need to grab a cord tied to the door knob.  There's no other way.  I cannot lean forward far enough to reach beyond the footrests of my wheelchair, but with my landlord's old shoelace tied to the knob, I can back, pull the door shut, and all is splendid.

'I have had this since Vietnam,' my landlord told me 12 years ago when he tied his old boot lace to the brass doorknob.  

It's gone now.  Crews of movers and carpenters, not to mention a small battalion of personal assistants, have been coming and going from our apartment.  And someone grabbed the boot lace, yanked it off the door while we were gone.  Vietnam, the use of the word "our" losing its appropriateness, backing out the door...everything has acquired layers of meaning, two, sometimes three.  This has been the longest week of my life.  No, the first week of June, 1968, when I was shot, that was long too.  But this one has been close.

It began with the ocean.  The Pacific, rolling and vast and stretching from the harbor at Valparaiso, to the Marianas Trench, to the San Diego sewage outflow to Half Moon Bay.  I wanted to spend a few days at the latter.  Marlou said we needed a hotel with room service.  There's one at Half Moon Bay.  More important, there's a bay at Half Moon Bay.  And I was into baying.  At the moon, at the front desk, I didn't care.  I was at my wit's end.

The carpet, or more precisely, the choosing of the carpet had stretched well beyond anything in the great Pacific basin.  Marlou had spent two months, more or less, going over colors, calling the decorator, inspecting samples from as far away as India.  This was too much of this, too little of that, and on and on it went.  We are running out of time, I told her as gently as I could.  Marlou does not like to be rushed.

When I fully grasped that to install the carpet we would have to uninstall ourselves for at least three nights, something in me swooned.  My life has had enough upheavals.  Since her oncologist pulled the plug on treatment, Marlou's cancer has been a runaway train.  It has sailed off down the tracks, rumbling out of sight, but always within earshot.  And now my terminal wife, having finally settled for the wool/synthetic blend with the ridged texture, has set dates with the movers, and the installers, and God knows who else.  And, no, we are not going to spend three days by the sea, by the vast, blue rolling mother of destiny.  Never mind that Half Moon Bay is only 30 minutes away, and there's not a fucking thing we can do while the carpet crew has a go at our place.  Marlou is set on staying in town.  Close to the action.  Where?  Right on El Camino Real, the north-south main drag of the Peninsula suburbs, in the Palo Alto Westin.  This will be like staying in one of those motels composed of old boxcars.  We might as well be sleeping in the Queen Mary drydocked at Long Beach.  The idea is as mad as it is expensive.  Oh well, Marlou assures me, at least it's close to the Palo Alto Medical Clinic.

It's unfortunate in one sense that the Vietnam era has ended, for there was a draft in place, and conscription is what it takes to get a quadriplegic and a weakening cancer patient packed.  Movers move.  Packers pack.  Marlou does her best to fill boxes, but the strength is draining from her.  She collapses on the sofa in the middle of packing.  We've hired one helper, but we really need another.  The helper phones a friend.  At the end of the day, one angry cripple and one very ill woman drive the mile to the hotel.  I wave away the parking valet, and dock my enormous Ford van in the disabled space.

The Westin is sold out.  I got a room here, only because someone canceled at the last minute.  The tone of the place is silly and pretentious, haute executive.  Businessmen are coming in from their evening jog, and a man in the lobby welcomes each, asking how the run went, and would monsieur like a bottle of water?  Marlou is already in the room, having stepped out of the van at the front door.  I collapse on the bed, stare at the ceiling and wonder about dinner.  Why is it called dinner?  It sounds thinner than diner.  If you order some diner, you'll put on a few pounds.  But not some dinner.  Backwards out of Cowes.  We head for the restaurant.  

There's only one.  No one in his right mind would eat in a restaurant in a hotel like this one.  But no one in his right mind would undertake carpeting, propped up like Evita.  The restaurant is true to character, French provincial stuffy.  The place is rather empty.  The waiter ushers us to our table with great fanfare.  The menu is overpriced and over sauced, but there's no kidding ourselves.  We have no other option.  Marlou walked here with some difficulty, a little over 100 m from room to table.  She looks weak.  We quickly order.  Marlou's appetite has waned.  What she orders is more or less an hors d'oeuvres.  I go for the swordfish.  While I'm waiting for the entrée, I demolish the bread and garlic spread.  The latter is quite wonderful.  

Our plates arrive.  I tuck into the fish.  Marlou has a shrimp.  Sorry, she says, see you back at the room.  She grabs a napkin, positions it over her mouth and rushes away.  I stare at my plate.  I don't know why we aren't home.  Home is where you live.  It's where you die.  We need to do both right now.  I am, like all the other traveling executives in the dining room, alone at my table.  Most of my companions are reading.  The waiter keeps coming by to ask if everything is okay.  I sign the evening over to room 54, add a tip and point my wheelchair toward sleep.  Back in the room, Marlou is throwing up.  

'I think she's doing this carpeting for you,' a neighbor explained.  Marlou has learned that wheelchairs get better traction on certain tightly woven carpets, and this has become her obsession.  I nodded to the neighbor thanked her, and wondered if there maybe was a God of Floor Coverings who, with enough prayer, travel allowance and dental package, would intervene.

In the morning, it was hard to get Marlou awake.  She finally rose to use the bathroom, threw up again, and returned to bed.  I wanted to call her doctor.  She rolled her eyes.  Could we call the clinic nurse in oncology, I asked?  Marlou said she had an appointment in five days, and that would do.  She was tired, she said, of taking care of my anxiety.  And would I change my sweater?  I smelled like a Mediterranean soup kitchen.  Marlou fell asleep.  

At my wits end, exhausted from a bad night, I stretched out for a morning nap.  I fell asleep.  When I woke, it was after 10 AM, and Marlou wanted to check on the movers.  Was the furniture out?  Were the carpet guys already at work?  Groggy, I drove the one mile to our apartment.  Marlou stepped out of my van and made her way, wavering and sinuous, to the stairs.  While she visited her parents in our upstairs, I had lunch with a friend.  Later, in the apartment parking lot, Dick and Joan, Marlou's parents said hello.  We stood in the late winter sun, watching battered remnants of the old carpet pad emerge from our downstairs place.  Paul smells like a Mediterranean soup kitchen, Marlou said.

We head back to the hotel.  Even in traffic, the ride takes all of four minutes, barely long enough for me to feign spontaneity and surprise.  You know, I say, why don't we just pull into the clinic?  Maybe we can grab a nurse and have a little chat about how things are going.  Marlou says okay.  She seems weak, beaten down, defeated.  A nurse wanders out to the waiting room of the clinic.  She kneels before Marlou.  My wife's speech seems to grow more slurred by the moment.  The two speak quietly.  I want to know what is being said, but Marlou needs what in California we still call space.  Marlou needs to go to Urgent Care, the nurse says to both of us.  We set out for the short walk to the elevator.  Marlou slips into the women's toilet.  I can hear vomiting.  The oncology nurse appears beside me.  Your wife may need to go to the hospital, she says.  The nurse takes Marlou's hand.  They stand together in the elevator, still holding hands.  This is one of those moments when human kindness and connection strike like a torpedo.  I'm trying hard, very hard, not to cry.

Marlou is given a bed, a succession of intravenous bags containing much needed fluids, a dash of electrolytes and another nausea medication.  I have another dinner alone.  Our domesticity became a pleasure over the years and now it is over.  And there is this, fluorescent restaurant lights and chicken enchiladas and the brink of solitary living in middle-age.  

By the time I return to Urgent Care, matters are no longer urgent.  The doctor discharges Marlou and squeezes her in for an early morning appointment in Oncology.  We head back to the hotel.  It's only a two minute walk, for the Westin is right next door, as Marlou pointed out when I booked.  I understand now.  I understand everything.  And I know nothing.  I want this day to end.  Marlou walks slowly, holding onto one of the handles of my wheelchair.  Leaving the vast clinic, there are two footpaths.  I head down the low one, and Marlou wants the upper.  There's no traffic light, she says.  I hesitate.  Marlou says I never listen to her, never value her opinion.  I take the upper path.

In the room, we quickly undress.  No, that is overstating it.  No quadriplegic quickly undresses.  While I take my one-handed time about it, Marlou tells me I have got to get rid of my sweater.  I smell like a soup kitchen, a Mediterranean one, of course.  If that is the case, I tell her, stay away from me.  Marlou tries to help me unbuckle my leg brace, a nightly ritual for years.  Forget it, I tell her.  She bursts into tears.  Don't push me away, she says.  Please.  

Her pain cuts to the soul, and whether her soul or mine, I cannot say.  I am an achey old man with a wheelchair and one poorly functioning hand, and the day has been full of rejections and humiliations, and Marlou seems to be behind it all.  She is crying, or trying to.  But in reality she is too weak to cry.  I am a cruel person.  And this is the truth.  And this is the end.  Marlou slips into bed.  Her eyes shut.  I know she will be asleep in seconds.  I sit on the edge of the bed.  There are certain things to say at such moments, and I know about these things, having read a book about them.  

I sit on the edge of the bed.  I touch her face.  Please forgive me, I say.  This has been very hard for me.  Marlou, too tired to even open her eyes, her speech even more slurred than when the day began, pats my hand.  It's okay, she says.  We have other things to worry about.  I love you, I say.  There are some other things to say in these extreme moments, according to the book, but they elude me now.