I had taken care of Mrs. Huff for as long as I had been practicing medicine – twelve years. She was eighty five years old, and it was the first time I had ever made a house call for her. I like to think that I would have done it even if she weren’t dying, but the truth is I probably wouldn’t have. I didn’t even know where she lived until her daughter, recently arrived from out of state, called and asked if I could stop by and check on her mother. The daughter, Mary I think her name was, had essentially moved in once her mother had gotten to the point she could no longer care for herself. Someone had to do the feeding, cooking, cleaning - the diaper changing - the staying up all night so Mom wouldn’t walk into the street and get run over by a truck during her nightly episode of confusion. But that was early on. She didn’t walk anywhere anymore. Her son lived with her. I knew that. He used to bring her into the office for her visits. But the fact that sons are usually not very good at taking care of sick parents is an unavoidable truth. The daughters always do a much better job. “Thank God I have a daughter.” I think for the millionth time.
I had no idea that her house was less than a mile from mine. “I could have walked.” I think as I pull onto the long, paved driveway. It was one of those beautiful, late summer days when you can just begin to feel that fall is near. The character of the air was different. The heat was present, but it too was changed…more tolerable. And the smells in the air were beginning to subtly evolve. The powerful scent of car exhaust, sweat and freshly cut grass was giving way to faint hints of the unique, dry smell of field corn being harvested.
There are four cars in the driveway – all with plates from different states. As I get out of my car I take a covert, deep breath. “I hate this.” I think. It is no fun visiting a patient who is dying. It is rewarding, but no fun – kind of like exercise I guess. This one will be even harder since aside from the one son I don’t know any of her family at all. Mrs. Huff and her son had lived by themselves until the colon cancer had spread to her liver. She was too old and frail for chemotherapy, or anymore surgery, and she was too weak and too dependent to continue on under her current living arrangements. As soon as the words “nursing home” had been warily uttered, the family tumbled into town like puppies out of a cardboard box.
Right away I notice the beauty of the home and, particularly, the landscaping. There are stately willow oaks standing watch in the back - peeking over the roof to see who may be coming. The front is filled with elaborate flower beds and beautiful ornamental trees, topped off by a gorgeous magnolia. I can just make out through the gate leading to the back yard a vegetable garden – tomatoes, squash and okra seem to be holding on. It is overrun with weeds. “That looks out of place.” I think. I’m not sure why I think that. My own garden is always weedy. But it seems to me that for this home, a weed-ridden garden is an unusual state of affairs. Forgetting about the vegetable patch, I round the gentle curve onto the winding sidewalk that leads to the front door, and I notice more incongruities. The flower beds are elaborate, but a total mess. From a distance the lawn looks like pure, rich fescue. But here I see
Bermuda grass. Not the “intentional” Bermuda grass that some folks seed their lawns with. No. This is scraggly – the wild stuff. I have heard it said that rats and roaches will survive all out nuclear war. I believe Bermuda grass will live right alongside them. It sneaked in here unwanted. The Bermuda has sent its long, hungry tentacles stretching across the sidewalk and into the forbidden flowerbeds. They look like a series of slender, greenish-brown rope bridges over which the Bermuda troops will pour and overpower the flowers. My eyes follow the grassy bridges and I see the attack is already well-advanced. The beds are full of crabgrass, dandelions and various unidentifiable invaders. Someone had once worked very hard to establish and maintain this yard and landscape, but the work has been abandoned…and I know right away that this is somehow important. At first I think this is the first time I have seen it, but something in my subconscious tells me that it is always like this – for the dying – only I never before truly noticed.
The red brick front steps lead up to a wide front porch supported by beautiful white columns. The porch is constructed from brick-red pavers oriented in a herring-bone pattern. I let my eyes climb up the columns and there it is again. Cobwebs filled with dead flies and moths are everywhere. They cluster in the corners and spring out to entangle themselves in the grand central porch light. The light is littered with dead bug stuff.
I turn my attention back to the front door and I notice I can see myself clearly in the glass. I’m carrying my doctor bag. I always wonder if this looks odd, and my reflection does look a little like a kid trying to play doctor.
I wait less than five seconds after ringing the bell before she comes to the door.
“Hello. Are you Dr. Bryant?” She asks.
“Yes I am. How are you?”
“Fine, my name is Mary. Thank you for coming by. It is awfully nice of you.”
“Oh no, it’s my pleasure.” It’s only a fraction of a lie.
“Mom is back here – in the living room.”
As I follow Mary, I am led through the kitchen. Here is where they have gathered. There are four of them, not counting the son I know, all sitting at the kitchen table. They are completely silent. I notice one of them is smoking and I simultaneously wonder if anyone has ever smoked in Mrs. Huff’s house before and if smoking in front of a doctor makes him feel awkward - from the look on his face, evidently not.
Compared to the newly neglected exterior, the inside of the house is immaculate. The carpets have been recently vacuumed. The vacuum tracks give it away, and the kitchen is spotless – no dishes in the sink and there is a smell of bleach and pine-sol in the air mixed with some menthol arthritis ointment Mrs. Huff must be using.
I see at once that her situation is pretty much the same as all who are dying and know it. The family has constructed a makeshift hospital room right in the living room. Her oversized lift-chair is positioned right in front of the television. TV is always somehow more important than a view of the outside world. There is a gaggle of medicine bottles scattered across her bedside table – along with used tissues, a blood pressure cuff and a Bible. I see a walker in the corner. “That’s no longer needed.” I think. In order to reach her side, I have to navigate the bedside toilet and wheelchair. She has been very well attended to. She is clean. Her hair is done and she is wearing a fresh, clean nightgown. The bed linens are crisp and freshly laundered. There is a conspicuous lack of the usual odors of the dying – urine, stool and a hint of body odor with bad breath thrown in. Someone has been working very hard to keep her in such a fine state. The six-o’clock news plays quietly on the TV…as if Mrs. Huff cares what is happening in the world she is about to leave.
“Hello Dr. Bryant.” She says weakly. I am a little surprised she remembers me. I had been told that she was quite confused most of the time.
“Hello Mrs. Huff. How are you feeling?”
“Not too good.” She says falteringly. “I’m having trouble breathing, my spine hurts terribly, my legs are swollen and I can’t sleep.”
Her symptoms immediately tell me she likely has metastasis of her cancer to her lungs, spine and liver. “Is she eating?” I ask Mary. And as I turn I notice the rest of the family has assembled behind her, eyeing me warily.
“No.” Mary says. “She hasn’t eaten since I have been here. I try to feed her, but she either just holds it in her mouth or, if she tries to swallow, she gags and coughs.”
“What about fluids? Is she drinking?”
“Very little,” one standing behind her says. I notice it is the smoker speaking. His prodigious mustache is smoke-stained.
“Does your pain medicine help?”
“A little.” She says. It always surprises me how patients think that saying a medicine isn’t working will somehow offend me.
“Well, we can make sure you don’t have pain.” I say, truthfully, as I pat her on the leg. I can see the family nodding their approval.
“That is the most important thing…her comfort.” One I don’t know says.
A brief examination of Mrs. Huff tells the rest of the tale. Her lungs are clearly fluid laden; twin air sponges saturated with fluid. Her skin is parchment thin, gray and bruised with sores on the pressure bearing areas. The swelling in her ankles and lower legs is immense – a combination of a liver hard as a stone and malnutrition.
I explain to Mary, who seems to be the family leader and spokesperson, how to adjust her medication in order to keep her mother comfortable, “and call me if you have any questions.” I add.
“Goodbye Mrs. Huff. I will come back to see you in a few days.” I say it out loud, but I don’t believe it. People who don’t eat or drink – and have widespread cancer – don’t tend to live very long, and the amount of fluid in her lungs is a grave finding.
Mary leads me back through the kitchen and I notice one of the men is cooking a meal – bacon and eggs. I wonder if they will eat in here, shielded from the sight of the one who used to cook the bacon and eggs for them in this very kitchen. The family cook has removed his shirt. That alone is odd enough, but the fact that he has such an impressively large gut makes it even more peculiar. Apparently he is not vain…at all. Everyone has left Mrs. Huff in the living room and gathered in the kitchen. “Apparently this is the waiting room.” I think. I linger for a few minutes and answer their questions. They are predictable.
“How much longer will it be?”
“Will she know what’s happening?”
“Will she be in pain?”
“How will we know when the end is near?”
I answer their questions. They don’t understand that there is no way I can answer them with anything bordering on certainty, but I answer anyway and they seem grateful. Their suspicion of me has subsided. People always appreciate a house call. It is viewed by most as some sort of tremendous personal sacrifice on the part of the physician. Forty years ago it was expected.
I tell Mary goodbye at the door and answer a few final questions before I leave. I again notice the peculiarly neglected state of things as compared to the interior of the home and Mrs. Huff herself. On the short drive back to my house, it strikes me. Before her death was imminent, the most important “thing” was inside the house…namely, Mrs. Huff, but no one realized it. She was neglected relative to the yard. Someone, perhaps the son only, or the son and some help, or before that, the son and Mrs. Huff slaved for a manicured lawn. Regardless of the players involved, the yard was a priority. It had to be perfect. The family has come back now, but where were they before? I don’t mean to condemn them – heaven knows that we are all pretty much the same. But I am struck by the irony. When Mom was healthy and vibrant, how many hours were “wasted” on the lawn? And now that Mom is dying, the lawn is left to die too. It really seems ridiculous. It seems upside-down. When Mom was available to enjoy, and to be enjoyed by her family, the lawn and silly flower beds were important. Now, when Mom is dying, attention is lavished on her, and the lawn dies. Mom dies and the lawn dies. Mom lives and the lawn lives, but at the price of relationship.
As I drive, I notice all of the manicured landscapes in my neighborhood…including mine. “How much useless energy is spent on this?” I ask myself. “How much time that could be spent with friends and family?” There will be a time when we all live with Mrs. Huff. When that inevitably comes to pass, the lawn will not matter. The idea of shame and embarrassment at what the neighbors think will seem ludicrous and petty. The lawn will die. So will Mom. But then it is too late. That which we love…which we should have nurtured and cultivated will lie dying. We will spend the final few weeks trying to revive, renew and recapture. But it is impossible…like trying to rescue a marigold that has been hacked by the weed-eater. It is too late.
The day after Mrs. Huff’s funeral, I drive by the house and I notice Mary standing on the front porch. Acting on impulse, I pull into the drive. I don’t know why I feel that it is okay to intrude on her, but I do.
“Hello Mary,” I exclaim. “How are you and your family doing?”
“As fine as can be expected.” She replies. “I was just out here looking at the old house. I grew up here – me and my brothers.”
“It’s a beautiful place.”
“Yes, we were always working the house and lawn.”
“I can tell.”
After a few minutes I leave her forever and head back to the car. On the way, I notice the cook – the guy with the big belly – is working on the lawn mower.
“How are you?” I ask.
“Okay – trying to whip the yard back into shape before I leave.”
“Good luck,” I offer as I walk away.
As I drive off the house is a mausoleum. And I wonder why cemetery ground is always well tended, and why we are angered when it isn’t. “What in the world does it matter?” I think. I hope wherever I am buried that no one will spend a moment sewing grass seed or planting flowers. Let them stay home and spend that time with their living, who - although alive now - are certainly dying all the same.
William “Cully” Bryant is a family physician and author. His medical practice is located in rural southeast Missouri, and most of his writing is inspired by his experiences growing up, living and working in the rural mid-south. In addition to writing featured in CLAPBOARD HOUSE, other works of fiction and poetry are forthcoming in THE DEAD MULE SCHOOL OF SOUTHERN LITERATURE, LOCUST, THE JOURNAL OF TRUTH AND CONSEQUENCE and UNDERGROUND VOICES. William writes across many genres and his first fantasy-fiction novel, “Messages”, will be available in 2009. William can be reached for correspondence at firstname.lastname@example.org