The baja sauce zings my tastebuds with fire from the ancho chili peppers. The light, flaky sauteed mahi mahi and fresh guacamole with lime make for fish taco perfection. Digging my toes deeper into the sand, I take another bite – a Chronic Taco party in my mouth. Gary and I sit on the warm sand and watch the waves crash onto the beach.
We see Bryson and Karl throwing the baseball back and forth. Faint voices on the wind.
“What do you think was in that baja sauce?” Gary asks as he puts his soiled napkin in the bag. We banter back and forth trying to guess the ingredients.
Gary points out a little bird that walks rapidly down the beach. The bird suddenly stops and looks around. He has a black belly, face, and legs, checkered wings, and a white crown, nape and undertail.
“Black-bellied plover.” Gary identifies the bird.
Gary flew in last night to join us for a long weekend and doesn’t yet have the lay of the land.
“Tons of birds here,” I say. “There’s an ecological reserve, up the coast a few miles at the Bolsa Chica part of Huntington Beach.”
He takes in my comment and looks around for more birds. I think my vision must not be as good as his because I can’t discern details like he can.
“How are Greg and Lisa doing?” I ask. Greg was just diagnosed with Stage IV Prostate Cancer.
“About as well as can be expected,” Gary says. Opaque. Doctor. Response.
“Do you think he’ll do chemo?” I ask and take a sip of my watered-down lemonade.
“I don’t know,” he says as he smacks sand dust off his pants.
Gary can say no more. Personal confidences and HIPPA violations blockade any further questions. Annoying. He unrolls the cuff of his pant leg and releases the trapped sand back to the beach.
Greg is also a physician, board certified in emergency medicine, internal medicine and rheumatology. I wonder what he will choose to do.
“Doctors often die differently,” Gary says.
“What do you mean by that?” I ask, assuming it’s because doctors–and their families–are treated well by their peers and co-workers. I’ve been the fortunate recipient of same-day appointments with specialists.
“Most know the choices of treatment and they know the consequences.” He picks up a hand full of sand and lets it slip through his fingers cascading over his toes. “They rarely initiate life support because they understand the healthcare system.”
I take another sip of my drink and watch the gulls ride the thermals above.
“Do they choose quality of life over quantity?” I ask.
“Usually,” he says and looks down focusing on burying his feet deep into the sand.
I’m curious if he knows exactly where the liminal line of quality of life is for him.
After a moment Gary says, “Most don’t want a Hail Mary. They want to go ‘gently into that good night.’” Grains of sand reposition on the surface, a ripple effect of Gary scrunching his toes below.
I sift granules through my fingertips and process aloud, “Why don’t they want to ‘rage against the dying of the light’?”
“They know the course of the disease. Their decisions are data-driven,” Gary says and pulls his feet from the beneath the sand. He stretches his legs out long and leans forward. He inspects his feet and rubs the sand out from between his ginormous great toe and the next one.
“Okay, so they’ve got the knowledge to determine the best course of action. If you don’t, how do you know who to trust?” I ask.
Waves inch closer to us as the tide comes in.
“How did you know who to trust?” Gary rests his elbow on his knee and creates a cradle in his hand, for his chin. I sense the intensity of his question as his eyes pierce me.
“I didn’t really have any choices to make during those critical moments. I witnessed it all unfold and trusted he was getting the help he needed. Frankly, I was just grateful for it.” I shrug.
Down the beach, an older couple works together to fly a green two-line parafoil kite in the wind.
“How did you know who to trust after Rob died?” Gary asks.
I’m mesmerized by the couple’s dancing kite and can’t turn away. I answer Gary and my hair gets caught in my mouth. “You already know,” I say as I tuck the strands behind my ear. Gary wants me to repeat the story. He’s leading me to make a point. I continue, “Six months before Rob died, he came into the kitchen and told me to put down my phone and pay attention. He said if anything ever happened to him, I could trust the Reebs to help me clean up his business. I asked him why he was telling me this. He said, ‘Cycling is the most dangerous thing I do.’” I pause, remembering Rob’s earnestness. Did he have a premonition? If so, I’d tell him to get off the freaking bike and find another hobby. I laugh – it sounds strained, maybe even repellant. “And I thought driving his convertible Porsche was the most dangerous thing he did.” I shake my head disbelieving the course of our lives.
“You had the Reebs,” Gary says. “Who else did you trust?”
“My parents, Zaharis’, Lesueur’s, Kerr’s?”
“Why?” he asks.
He is using his version of the Socratic Method of questioning, dialing in to get to the meat. I dig my feet into the sand up to my ankles.
“They’re people I love, and they wanted what’s best for me.”
“And?” He probes.
I look down and make sweeping motions, sand angels with my hands. Gary is good at digging for what he calls the “nut-check” reason, the golden nugget – why.
“They didn’t need anything from me. They already had their own kingdoms. They didn’t need mine.” I pull my legs out of their granulated holes and rest them atop the sand.
“Exactly. No ulterior motives,” Gary says. “I’m not sure you realize how fortunate you are.” The shirt tails of Gary’s button-down flap in the breeze. A thick wall of gray fog, on the horizon, rolls toward the beach.
“I am. It was a scary time of vultures circling. I was vulnerable. I know my family thought I was neglecting my kids, but I had to make sure our financial fortifications were secure – you know, to protect us.” The breeze is stronger. The boys are no longer throwing the baseball back and forth. They’ve stretched their arms out to their sides, ready to take flight. Their shirts ripple in the wind. I scooch closer to Gary to hear him better.
“I don’t often see many patients in my practice as prepared as you and Rob were,” he says. Gary’s accompanying facial expression, is flat, professional. Distanced.
I know he’s referring to our legal documents: Advance Care Directive, Medical Power of Attorney Will, Executor, Trust, and Life Insurance.
And I didn’t feel prepared.
I still vacillate between being grateful I didn’t have to experience the death of a spouse in gradations and wishing we’d had time to say goodbye.
I think Gary knows the exact neural pathway my thoughts went down, because he says, “Advanced illness patients are often preyed upon by ‘do-gooder sharks.’”
I look out at the ocean and think, the water’s not clear, there’s no way I’m getting in past my waist this week. I shouldn’t watch Shark Week – it feeds my fears. My imagination is pulling me away from being present. I shake myself of distracting thoughts and ask, “What do you mean by ‘do-gooder sharks’?”
“People who’ve read articles or spoken with a friend of a friend or have heard about different miraculous holistic treatments, like shamans, or MLM’s (Multi-Level-Marketing), that sort of ilk – the ‘cash-only’ treatments.” He shakes his head.
“I don’t understand why they’d fall for that? Seems so foolish and naïve,” I say without empathy as I cling to Gary’s warmth.
“The dying are desperate. They want to trust the people they shouldn’t. Much of the time concern for the patient is coming from a place with good intentions, but it isn’t in the best interest of the patient,” he says.
“What’s the most absurd thing you’ve seen?” I ask.
The sky begins to spit moisture at us. Gary looks toward the waves crashing on the shore and erupts into laughter.
“This happened in my own extended family.” He grins and can’t stop laughing. “A family member was suffering with chronic pain and someone got a hold of a new treatment. They had ‘the in’ with a new start-up company.”
Somebody always has “the in,” and I would have fallen for it too. I would have done anything to save Rob.
“Turns out the product was filled with bacteria.” Gary belly laughs and tears run down through his crinkles. Amidst snickers, he manages to say, “Bacteria?” again for emphasis. He can’t stop laughing.
I throw back my head and laugh. “Oh, bless their heart.”
“As my cardio-thoracic surgeon friend says, ‘There’s no pill for stupid.’” Gary wipes the tears from his crinkles and dries his hands on his pants.
We laugh and laugh. I don’t ask who. I don’t want to know. It’s easier for me to love people when their cluelessness has not been identified and confirmed.
Gary gets ahold of himself and says, “I’ve seen some really sad things too.”
“Like what?” I think my brain always wants to know the worst-case scenario.
“People dumping their 401K’s or getting seconds on their houses for snake oil.”
I can only shake my head. I’m sick thinking of the MLM’s, I know, pushing sales through church congregations.
“There was a patient who wanted these new, ‘cutting edge,’” he scoffs, “very expensive herbal treatments, so he took out a HELOC (Home Equity Line of Credit) on his house. His house that was close to being paid off! Then, he died, and his wife was left behind to sell the house she could no longer afford. He left her destitute. Selfish.”
Sometimes I forget Gary sees the really ugly side of human nature too.
I’m cold from the descending dampness of the misting sky. I snuggle in closer to Gary and he wraps an arm around me.
“You also have these weird situations where family members want their loved one to stay alive at all costs because they’re benefitting from social security or a pension.”
I wrinkle my nose, confirming the behavior is abhorrent.
“We should go, it’s cold,” I say.
“Let’s wait until the boys are finished,” he says as he pulls me in tighter. His hair is mussy. I breathe in his scent, salt water and the cologne Ansel gave to him, cologne in a Cuban cigar-shaped bottle.
I’m forgetting Rob’s scent. I begin to ruminate on pieces of his clothing I have in storage bins in the attic. Wondering if they still smell like him.
I take a close look at a single strand of Gary’s graying hair. I follow the strand with my fingers.
How long have I been down this hole of wondering about Rob’s scent?
It’s unfair to Gary that my mental tug of war pulls me from being present with him. Rob will have to understand that I love him, and I need to focus on Gary and cultivating my love for him.
“How do you help patients navigate?” I ask.
“I ask what their Goals of Care are: Do they want to be intubated? Resuscitated? These things should be discussed before times of crisis. I suggest they make decisions on their own terms, when they have a rational mind. And I emphasize that they only delegate power to the people they trust the most.”
“You know what would’ve been helpful?” I say.
Gary waits for me to answer my own question.
“If Rob had mentioned, just once, what he would have liked done for a funeral, or where he wanted to be buried, or what he wanted his obituary to say. Or even what his thoughts were on me remarrying? Anything would have been helpful.”
I no longer feel as chilled. My chest feels warm as I realize I’m getting riled up.
“Once, I told Rob if I died, he’d be remarried within a few months and you know what he said?”
I look directly into Gary’s eyes for emphasis.
“All he said was, ‘Yup.’ That’s it! That’s it! All I got was a ‘Yup!’”
I crescendo and discover my hands are in the air talking. I decide to dial down my potent emotions.
Gary’s still. Listening.
“We had four kids together. We were married for twenty years. Twenty years! And he never said a thing. Not one thing.”
I’m mad sad. Hurts. The sand is cold and wet, and the darkness grows as the fog envelopes us.
“How am I supposed to know what he wanted? What did he want for me? Did he care? What did he want for our children? I mean, yeah, we had documents in place. We had transparency. But we didn’t have enough. And I don’t know if I could’ve gotten any answers from him, anyway. Frustrating. We never think we’ll die, do we? Gary?”
He waits to see if I will dismount my soapbox and let him speak. A tingling shame-wave washes over me. I want to retract what I’ve hung out there in my moment of pain. I cannot.
“Coming to terms with our mortality is a challenge all will face,” Gary says.
The phrase sounds too concise. Truth polished. Honed to exactness.
I remind myself this is Gary’s delicate specialty – palliative care: helping patients live the rest of their lives on their own terms. Balancing between terminal disease and end-of-life care. I wonder how many times Gary has used these same guiding words with his patients. I’m damp and cold. I stand and stretch my arms out to help Gary up out of the sand.
“I get it. It’s hard to know who to trust,” he says.
“You’ve got to be on the lookout for the vultures and their side-kicks, the bottom feeders.” I’m nauseous thinking of men who “offered” to help me with Rob’s business.
“You can spot ‘em from a distance and still, they always surprise me,” Gary says as he stands and continues to hold my hand. He waves the boys over with his free hand.
“That’s ‘cause you try to think the best of others.” I think of a bloodsucker we both know. “Remember that guy from the Sundance Ski Shop?” I ask.
“Who could forget? I’ve seen a lot of things and that’s a whole new level. He asked me how much life insurance you got.” Gary’s jaw is slack. “I still can’t believe it.”
“Slime,” I say as Karl and Bryson join us, a little flock on the sand in the rain. “Let’s go guys!”
“Are you talking about me?” Karl asks and gives me a damp-shirt hug.
I say no and tell him while Gary and I were dating, this guy asked Gary if I got any life insurance and how much.
“Really?” Karl says disbelieving.
“Yes, really,” I say. “Foul buzzard. C’mon, I’m freezing.” We tromp through the sand toward the coastal highway. “We steered you guys away from their schmoozy ‘fun’ family.”
Karl and Bryson pester, wanting to know his identity. They guess and I’m pleased they are perceptive of the disingenuous. I warn them to be wary in future dealings.
“Is that necessary or nice?” Gary asks.
I tell him I am teaching our boys the traits of predators. Soon they will spot the vultures themselves.
A deluge of rain bursts down upon us and there’s no place to run for shelter. All we can do is keep walking.
Gary grabs my hand and pulls me to him. “When my time is up, there’s just one thing I want you to remember.”
“Okay.” I brace myself.
“You need to know I’ve made an oath with Nancy Trapnell.”
My skin is riddled with goose bumps from the blowing wind.
“Mm-hmmm” I say bracing myself for his disclosure, wondering what sort of commitment he’s made with Nancy, an older hospice nurse he has worked with for years. She is now in her eighties.
I look at him, his eyes sparkle with delight.
“We had an agreement. You will know when it’s time and you will know what to do.” He chuckles.