On Tuesday, the social worker is late to work and has to park on the top level of the garage. Instead of the elevator, she takes the stairs down to the bridge which crosses into the hospital and regrets it. She’s feeling fat and old, neither of which are true, but her knees and ankles are already telling her that the heels are a mistake. She has flats in her office, but before she even goes down there, she has to see a few people. The tearful drug addict who needs rehab. The man with no family who needs help at home (that should really be a case management issue). And Manuel.. She’s not thinking about Manuel, not until she has to see him. She has to talk to Manuel’s wife, Alicia. She hasn’t been in yet. Does she even know?
Two hours later, she needs a cigarette and a few excedrin. And a nap. She needs to go boxing. In addition to everything else, she’s had to council two patients trying to leave against medical advice and one of them threatened to hit her. Again sir, she said, I’m just doing my job. I’m required to talk to you, just to make sure you understand the ramifications of leaving.
I’ll give you ramifications, the man yelled, and the social worker left the room. Ostensibly she’s not paid to be abused, but some days, really, she is. And she’s not paid enough, either.
“Am I a terrible person if I hate him for that?” she asks one of the nurses. “Don’t answer that.” She’s still got to see Manuel, but she calls Fiona and they walk across the street to get coffee.
She leans against a warm brick wall in the sunshine. She doesn’t smoke, not offically, but every once in a blue moon, a patient twists her kindness into shrapnel and cuts her and she needs a drag. She thinks about Manuel.
“Jesus, Fiona,” she says. “Some people have all the luck. I mean, this kid left his country, fought in Libya, and he came home alive. Fine. He got married, he’s going to school and now he’s got cancer.”
Fiona drops her cigarette and looks at her watch. In their line of work, exceptional tragedies are everyday realities. “What kind of cancer?” she says.
“I don’t know. I don’t think the docs know,” the social worker says. “The nurses say he screamed when he found out. I mean here is this kid, so tough and so composed and he’s screaming.”
“Why isn’t he on the oncology floor?”
“I don’t know. I’m going to try to move him there today.” She looks up at the sky. “Time to go.”
But when she gets to Manuel’s floor, he’s not there. The bad news is that he’s been moved to the ICU. The even worse news is that it’s her ICU. Somebody hates me, she thinks. Somebody really hates me.
She goes in to meet Alicia.
The social worker is good at what she does. She’s not afraid of verbal abuse, of tense family meetings, of emotional catharsis. She’s probably too good, because she carries these things with her wherever she goes. She once went hiking (that was a bad date) to a place where the ground was all smooth rock, but filled with thin, deep, fissures, and it seemed to her, if one was strong enough, canny enough, one could wrench open those fissure and the earth’s secrets would spill out. People are like that to her. She can find their fissures, open them up. She knows denial, anticipatory grieving, dysfunctional coping, and when she opens a person, like a book, like a crack in the earth, she can help them. She helps them more than they’ll admit and more than she knows. But she can’t crack Alicia.
Manuel’s wife is standing at his bedside, staring down impassively. Manuel himself is beyond caring. A ventilator regulates his breathing and a sedative drips into his veins. Metastatic carcinoma of unknown origin. It’s not testicular and probably not from the colon. An exposure in the military? Or something he’s been keeping, like a dirty secret, a remnant of his impoverished childhood in the slums of San Salvador. Radon-rich groundwater or contaminated air breathed in 15 years ago, manifesting itself today as an orphan maker.
In the stroller, the baby kicks and smiles at the social worker. The social worker cannot help herself. She is delighted. She smiles back. She introduces herself to the baby, whose name by all rights, should be Sunny. She talks to Alicia.
She does all the right things. Introduction, open ended questions, non-judgmental attitude. Leading statements. Alicia answers only yes or no and sometimes she does not answer at all. She’s a well dressed, good looking young woman and she keeps staring at the social worker, as if she’s wondering why the profession exists. As if she’s saying, this is my tragedy. What right to do you have to lay claim to it? Finally, Jessica picks up the baby and turns her back. The interview is over.
Alicia watches the social worker close the door and then rub alcohol gel on her hands. What the hell does she know about Manuel? She allows herself to scowl at the woman’s back. That perfectly thin woman with her life together and her good job, coming to work every day to dissect human agony. Probably eats sorrow for dinner and grief for dessert. When she’s done, crumbs of hopelessness remain on her plate.
Sunny giggles at one of her toys, and chews thoughtfully on her hands. Jessica touches Manuel’s arm. It’s already not the arm, not the body of the man she married. He feels unstable and unanchored, like a strong wind could whisk him off to heaven any moment now. This is what she’ll do. See him as a different person. As the twin he never had.
She won’t see him as the veteran who cried about the children in Soyapango, or the shy boy who proposed to her by whispering in her ear during a late night, half-drunk slow dance when they’d only been dating for two months. She won’t think of him as a frustrated student, struggling with some of the English words, and laughing at himself when he said (his words, not hers) that he sounded like an immigrant.
This man laying in bed, this sick and bloated remnant of a person is not her husband. He’s a brother. She’s looking in on him while Manuel is visiting his mother.
Manuel is 26. He’s getting chemo, but he’s already critically ill. He’s going to die and Alicia is going to lose her husband and the father of her beautiful baby. She sets her face like a flint. She is not going to crack.
Over the next few days, Manuel gets worse. The social worker has a lot of other patients to see, but she always checks in with Alicia. She’s persistent, if not effective. I’m here for you, she says. Alicia smiles that tight little smile. Sunny smiles with her whole body, kicking her legs and laughing.
“My god,” she tells Fiona. “That boy is going to die. He’s going to die and the baby isn’t going to have a father and is Alicia even going to cry? This woman is like made of steel or something. I can’t imagine. I just don’t get it.”
But she does imagine. She imagines Sunny without a father and she feels tears prick the corners of her eyes. It isn’t fair. She gives up smoking again, and goes to boxing. She punches cancer in the face, again and again, but cancer won’t die. Cancer won’t be defeated. It roars back.
In the waiting room, Sunny charms. Other families smile at her and talk to her. They use her as a buffer for their own sorrow, looking into her eyes forgetting for a moment that the world has teeth and it can bite. Alicia doesn’t mind. She’s glad to share. Glad for the distraction. It means she can avoid the pity.
It’s more than the social worker. She’s seeing pity in the eyes of the nurses, the oncologists and she swears the parking garage guy is in the know. All these people wanting to reach out and comfort, so they can forget their own snarled lives and smelly entanglements. She’s just a convenience for them; her tragedy is the gristle of their dinnertime conversation and the meat of their self-avoidance. They can feel bad for her, reach out to her, but she’s not going to help them.
Down the hall, Manuel has taken a turn for the worse. The nurses have asked her to leave for a little bit. There’s blood coming out of his lungs. Alicia stands in the warmth of a sunny window and pushes the stroller back and forth. She needs to find a baby-sitter.
Two weeks after he has been admitted to the ICU and five weeks after he has been diagnosed with cancer, after 25 blood product transfusions, four thousand dollars worth of chemo and several hundred hours of nursing care, Manuel dies. The social worker watches the doctor talk to Alicia and hears the words between them, even though she’s not close enough. She sees Alicia nod, sees her eyes close for a minute and sees the grief etched on her face. For a moment, Alicia cracks.
At the bedside, in a room full of machines and beeps, the nurse sets down a syringe of morphine. This is to help him, she tells Alicia. He’s going to feel like he can’t breathe, and the morphine will help.
Alicia stands in the corner. She knows there’s nothing more they can do, she’s known it for a few days now and she’s not ready for this, but what’s the point in waiting. She’s trying to stay out of the way, but really, she’s scared out of her mind. She tries to put the fear in a box, push it away as the respiratory therapist removes the breathing tube and the nurse turns off the IV pumps and gives the morphine. They seem to certain. How can you be so sure, Alicia screams inside her head. She’s on thin ice, barely intact over a dark and chilly river of doubt.
Manuel jerks. He coughs and his face turns a horrible color. The nurse turns. She is crying.
“Come hold his hand,” she says. “Come be with him.”
Alicia does. She does not think, does not feel. She takes her mind away to a cold gray place where no smiles or tears exist. She stands biting her lips so hard they bleed while the life slips out of her husband. Manuel coughs and then his breathing slows. There are no last words, no final gaze. This is not how it is on TV.
The social worker sees the nurse come out of the room and close the door. They stand at the desk and watch the monitor as Manuel’s heart slows and stops. She has never seen this nurse cry before, but they are both thinking about Sunny. Who will teach her to ride a bike or walk her down the aisle?
“Why do we do this?” the social worker asks. She does not expect an answer.
The nurse wipes her eyes and blows her nose. “Who else should?” she says. “We did everything. I mean, we couldn’t have done more.”
The social worker nods. She’s going to take this one home; they both will. But they’ve done everything they can. There’s nothing more.
“We all failed,” the social worker says. She thinks of all the failures, and Alicia, standing, cold and remote at her husband’s bedside.
The nurse wants to tell the social worker that she didn’t fail, helping Alicia get childcare and locating Manuel’s long lost mother. But the nurse’s voice is full of tears and she says nothing.
Alicia leaves. She pulls out of the parking garage and gets on the highway. She makes it to the first exit before the first spasm wrack her body. By the time she reaches an empty parking lot, she barely has control of the car. She jams it into park and curls up in a ball of anguish. She wails. It’s like being possessed by a hurricane. There isn’t enough space in her body for the volume of grief trying to fill it, and yet it grows and grows, this loss this desolation, this utter agony. How can the human heart hold so much pain and go on beating? This is why the Sioux women cut themselves, to bleed out the pain. She wants to slip into a hole and never be seen again. She wants to drive for hours until she reaches the ocean and drive in. She wants to be alone forever. She grips the steering wheel, beats it, rests her head on it, and grieves.
Sometimes there are no good answers. There aren’t any lights at the end of the tunnel, or happy endings to smile at. Fate is capricious and tragedy is real and cruel and I can testify to this. I was that nurse who stopped the drips and pushed the morphine and told Alicia to hold his hand. I sat in the back room afterward and cried. In telling Alicia’s story, I want a moral to it, something good to hang onto, but there is nothing. This is what happened. It was not an everyday tragedy; it was extraordinary, and yet Alicia, the social worker and I, we bear no scars. Maybe I am feeding off her grief, thanking God that it is not my own. The social worker and the doctors and I see so many cases where illness and tragedy could have been forestalled if a person had been more careful or come to follow up appointments, but here, nothing could have been changed. It happened and its ending was foretold as soon as it began.