What We Hold

We had a woman on the list yesterday. First case after lunch. Just a colonoscopy. Nothing in the chart to set it apart from any other case on any other November day that passes under the OR lights. I wheeled her in from preop and parked the stretcher beside the OR bed. She was small in the way people get small when the gown is on and their clothes and jewelry have been taken from them. Her hair was flattened at the back from the pillow, a gray hearing aid clipped above her ear. She lay quiet, watching. We moved around her with the established choreography. Cuff around the arm. Pulse oximeter on the finger. Leads on the chest where the faded green gown parted like a curtain. The stretcher creaked. Somewhere a vacuum line hissed in the wall. She watched all this with the gaze of someone already half a step removed from themselves. Then she said, God bless y’all. I don’t know how you do this. Her voice was calm. Just a statement offered to the air between us. I was taping down the IV line on the back of her hand. I looked up at her. Well, what do you do, I said. She blinked slow, as if deciding whether to trouble herself with the answer. I’m a mortician, she said. I work on assignments only. Oregon and Washington. I couldn’t work with the living. They terrify me. The nurse stopped for half a second with the blood pressure cuff in her hand. Then went on. I thought maybe she was trying to make a joke of it. People do that sometimes when they’re lying under the light and all the machines are watching them. You messing with us, I said. No, she said. She turned her eyes toward the ceiling. Couple of days ago they called me for a kid, she said. Thirty-one. Went through a tree on a winding highway. Half his face missing. Nobody spoke. You could hear the faint echo of a voice calling for someone down the hall and then the quiet again. Took thirty-one hours to put him back together, she said. She said it the way someone might tell the time or the weather. Every little piece, she said. Every bone no bigger than a seed. His whole face. In the corner the monitor began its steady beeping as the cuff cycled, numbers climbing, then falling. Oxygen saturation in the blue digits. The small relentless accounting of a human body that still drew breath. I thought about what it meant to spend that long with the dead. Piece by piece, bone by bone, returning a face to the world that would only see it once more and briefly, in a room gone quiet and overbright with lilies. To labor that long for something that would not speak again. You’re afraid of the living, I said. She nodded. Her eyes came back to mine. The dead don’t ask questions, she said. They don’t look at you like they still want something. She fell silent. The nurse went on checking the suction, the endoscope screen waking into blue light. The GI doc was talking to someone outside the door about a ballgame, his laughter distant. I drew up the propofol, the milky white swirl in the syringe. I pushed a little through the port to clear the line, the plunger moving under my thumb. You will slowly drift asleep. Pick out a nice dream, let’s go on vacation, I said. Let’s go to Hawaii. She gave a small breath that might have been a laugh. Sleep’s all right, she said. It’s the waking up that’s hard. There was a moment where she seemed to be listening for something only she could hear. Then her gaze slipped away, down some corridor inside herself where no one could follow. The beeping on the monitor stayed the same. The numbers obedient. Heart, pressure, oxygen. All the measures of a life passing through one more anonymous procedure. In anesthesiology we spend our days on that narrow border, asked to pull the living away from pain and danger by taking them, briefly, out of themselves. We watch the numbers and titrate the drugs, but what we are really managing is this passage between terror and trust, between the fear of waking and the fear of never waking again. Our work is measured in vital signs and discharge notes, but it is these small, unexpected confessions at the bedside that remind me what they have given us to hold. I watched her drift under, the mortician afraid of the living, and it occurred to me that somewhere in some other room there was a table where she stood with her own white light overhead and someone else on it, broken, waiting. Bone by bone, piece by piece. And that between us there ran a thin and unbending thread, drawn through the living and the dead alike, and none of us knew who would next be standing at which end of it. The GI doc came in, pulling on his gloves. Ready? he said. I nodded and turned back to the syringe.