IT MUST BE A dream. How could she not have felt the earthquake? Still, the ER staff were saying it had been the big one. She heard sirens approaching the emergency room.
“Ambulance alert!” screamed a ward clerk. “Six hundred AIDS patients on their way, all critically injured. ETA five minutes.”
In moments, they would be awash in infected blood. Men in white plastic jumpsuits walked through the hallways fumigating doctors and nurses in preparation for the onslaught. Covered with oily disinfectant, damp hair stuck to her neck, she waited. The sirens kept howling but didn’t come closer.
Waking in the dark, Gwen realized the telephone was ringing. Her digital clock showed five a.m.
She picked up the receiver and mumbled, “Hello.”
“Dr. Howard, it’s the answering service. I have a Terrell Hunt on the line. He says your patient, Ed Greames, is dying. I told him he should call an ambulance, but he insists Mr. Greames told him not to.”
Gwen remembered the two prescriptions she had written and sat upright, wide awake.
“Connect me please.”
Gwen had met Ed Greames’ boy lover once in clinic. She thought his name was Timmy, perhaps because he looked like the child actor who shared top billing with Lassie in her favorite girlhood television show. Allegedly nineteen years old, Terrell acted the part of a devoted son or nephew.
She heard the operator say, “Dr. Howard is on the line.”
A pleading voice, punctuated by static from the tenuous phone connection, said, “I don’t…to do. How…know when he’s dead?”
“Slow down, Terrell. Tell me what happened.”
“Ed took the death cocktail.”
“Is he breathing?”
“Sort of…stops and starts.”
“Terrell, find the pill bottles and see if they’re empty.”
“What difference…” he shouted. “Are the police…arrest me? Do I need to get out of here?”
“Don’t go anywhere, Terrell! Give me your address. I’ll be there in half an hour.”
Her mind raced as she sped across the Bay Bridge. This was the first time she had intentionally given a patient the means to end his life. She hadn’t thought through how it might play out. What if Greames didn’t swallow all the pills or couldn’t keep them down, and then Terrell called an ambulance? Would Terrell, or Ed, if he woke up, tell the ER doc that Gwen had written the fatal prescriptions? Would that trigger a criminal investigation? Or if Ed did die at home, would people from the coroner’s office come and find empty morphine and phenobarbital bottles that had her name printed on them as the prescribing physician? Would they call the police? How could she honor Ed Greames’ wishes without losing her medical license and facing manslaughter charges?
A band of orange light rose above the East Bay hills as she descended into Eureka Valley. It was spreading across the sky when she found the address, a second floor Victorian flat off Castro Street. She rang the bell. The door promptly buzzed open.
Gwen climbed a dark stairway and entered a high-ceiling living room decorated with splendid millwork. Ed Greames lay on a couch. He didn’t respond to her shouting his name or rubbing his collarbone. He was breathing, intermittently, and had faint heart sounds. She couldn’t feel a pulse.
From behind her, Terrell asked, “Is he dead yet?”
“No,” she answered, thinking minutes, an hour at most.
Then she reconsidered. What if his phenobarbital levels had already peaked? God, what is the half-life of that drug? It’s long, isn’t it?
She turned to the boy and said, “Timmy, I mean Terrell, what did he take? Which medications?”
“I don’t know”
“Think hard. It’s important.”
“He told me he was going to take the death cocktail, but I didn’t see him do it.”
“When did he take it?”
“Probably when he went to sleep, maybe two in the morning.”
Gwen demanded he show her all of Ed’s pill bottles. Terrell led her into the kitchen where medication containers littered the breakfast table. She inspected each bottle, several times. None were labeled morphine or phenobarbital.
“Are you sure this is everything?”
“I don’t know,” he answered defensively. “I just fed him and cleaned him. I didn’t deal with his pills.”
Gwen couldn’t remember the precise words of their conversation, but she had seen Ed write down the names of the drugs and the number of pills. She studied the boy. Nineteen might be pushing it a year or two. Gwen chose to believe him. Ed must have taken the pills four hours ago. In his terminal state, he would absorb the medication slowly. That meant his blood morphine levels should be peaking now, possibly the phenobarbital as well.
Terrell twitched. His eyebrows knitted. Gwen saw a frightened kid, only a few years older than Eva. She was appalled by the questions she had just asked him, the tone she had used. This had to stop being about what she was risking and start being about what he had already lost.
“Terrell, you did the right thing. No one is going to accuse you of a crime. OK?”
He looked doubtfully at her.
“We have to wait until he goes. It won’t be long. Are you OK with that?”
“Like I have some other choice? If I leave now, you can tell the police I killed him.”
“As soon as he dies, I’ll call the coroner. They’ll send people to take the body away. I’ll do the talking. There won’t be any police.”
Terrell crouched on a stool with the posture of a dog about to be struck.
“Look, they’ll see evidence that someone else has been living here. They just need to see you here, so it won’t look like we’re hiding anything. OK?”
He reluctantly acceded then slipped away to the bedroom.
Gwen sat next to Ed Greames. She watched him breathe in crescendo-decrescendo cycles, each ending in a protracted period of no movement. Then his airflow would fitfully recover and his respirations mount again in depth and frequency.
It had been over a year since Gwen’s last death vigil. She’d done it many times during her training and again in the first months after City Hospital opened a special AIDS ward. Gwen believed being present at a death was a great privilege. As an intern, she had hoped witnessing the transition from warm, pulsatile life into cold, motionless death might give her insight into the mystery of her own being, of all life. She would hold patients’ wrists, feel their pulse stop, their skin temperature drop, their bodies transform from a volitional creatures into inanimate objects. There was a disconnect, like the reversal between figure and ground in an optical illusion, but there was never an epiphany. The only revelation was how unfathomable the mystery remained.
Ed’s gasping was more forlorn than desperate. He was tired out, ready to quit. Gwen concentrated on the rise and fall of his chest, which calmed her. After another half an hour, Ed paused at the end of a cycle. Five minutes later, he still hadn’t taken a breath. Gwen placed her stethoscope over his heart. There was no sound. His skin was distinctly cooler. She covered him with a blanket.
Gwen dialed information and asked the operator to connect her to the coroner. While listening to the rings, she again worried the coroner’s staff would search the apartment. What if they found the two pill bottles she had missed—the ones with her name on the label? Would Terrell say something indiscreet?
On the twelfth ring, there was a click.
“Coroner’s office,” a gruff voice said.
“This is Dr. Gwen Howard from City Hospital. I’m on a home visit. I have a death to report.”