Authors: Theodore Roszak
Beth was not the first patient Julia had lost to resignation. Still, seeing someone so vibrant and life-affirming surrender was worse than watching her die. The experience forced Julia to ask a troubling question. Was it possible she had the psychology of aging all wrong? What if the strain of growing old is rooted so deeply in us that it can never be plucked out, never outflanked and eluded? Do a few years, a few months one way or the other make any real difference? Should we — especially doctors — act as if they do? Perhaps that was all that the best medicine came down to: deciding when to let the inevitable happen. Everything in the universe ages. Stars, galaxies, brute matter. Forests, oceans, glaciers. Humans, the machines they make, the buildings they build. Whether of bone or stone, time takes its toll. If there were no decay, no depletion, no death, there would be no time. Time is the trajectory of order diminishing, energy dissipating. That amounted to saying that living things are no exception to the law of entropy, which sounded like good, tough science.
Yet how odd it was, that gerontology, the branch of medicine that worked closest to entropy, should be so painfully aware of the gap that divided the sciences. All scientists study the same nature, apply the same basic laws. But for physicists, entropy is simply a statistic, nothing more: the chaotic play of infinitesimal bits and pieces, dead particles that career through the void, growing colder, moving slower, sinking toward absolute zero. But entropy as Julia observed it in Beth Soames, in her mother, in her patients, was a mind going dark, losing all that it had still to give, whether an artistic masterpiece or simply a friendly greeting. A soul flickering out, vanishing forever from the universe, taking its memories of love and joy and sorrow down into the abyss. What remained, scattered physical parts, dying vibrations, was not at all the equivalent of what had been there before — a whole and original being. That was a loss that broke the heart in ways that allowed no calculation. Could this be the same phenomenon chemists calibrated in a test tube or engineers in a machine? If so, then medicine must resign to a counsel of despair.
Julia was not ready for that. Perhaps that was why she had never done well at the various non-human sciences she studied in college. She could not accept the continuity between the quick and the dead. Entropy may rule, but she believed in fighting against it, if only for one hour more. Though it might be futile, that act of defiance was what divided living flesh from dead matter. Secretly she clung to a principle that had no scientific status. If there were laws for the conservation of matter and energy, then there had to be a law for the conservation of human consciousness. A law that gave life a special momentum in the face of all that thermodynamics taught about inert nature.
Please don’t bother, my dear
. “Why not, Beth?” In her thoughts she had asked the question countless times. “Why are you giving up the fight?” She knew what Beth might have answered. “Because there’s too little to gain for all the work. Save your efforts for those who have more time.” More time. Beth was over ninety; how much longer could she last? At twenty we can assume we have another twenty years ahead of us. At thirty, another thirty years. But at fifty and sixty, we cannot assume we have double the number of years yet to go. And at ninety … After a certain point, expectation fades; the horizon of hope shortens with each passing day. Fatalism sets in, soon to become the balm of surrender. In their final years people stop wanting more time because they have had their share. Staying alive becomes hard work, the strain becomes too great. It is almost as if nature has built submission into the deep psyche, the last consolation of the doomed. Once it is triggered, the struggle is over. And when it became clear that her patients were ready to submit, Julia, though reluctantly, acquiesced, letting them find peace in their final days.
But now a remarkable possibility had entered her life. A senile
child
. The boy who had now become her youngest patient knew he had a right to another fifty or sixty years of healthy life. With her help, he might be willing to fight for those years. If anybody had ever been old before his time, Aaron Lacey was that person. Surely that certainty would give him the will to fight. That was what made him important. Though cursed with age, he might not be burdened with resignation.
***
Julia made a point of visiting Aaron every night, the last patient on her rounds before she left for home. She used the occasion to make a few notes on his condition, but this was mainly a chance to mother the lonely boy a bit. She sat at his bedside and talked about anything that interested him. Sometimes they talked about the games, reviewing the strategies he had chosen. Invariably he asked how she thought he was progressing. “Am I getting better?” he would ask. And she would be as reassuring as she could be without actually lying. Sometimes she would read to him from a favorite book, a chapter from
The Lord of the Rings
perhaps, a book he was struggling through with his dimmed eyesight. Above all she tried to find excuses to touch him, to hold his hand, feel his brow, stroke his cheek. She was a great believer in the therapeutic laying on of hands. And finally she would tuck him in and brush a kiss to his forehead, sometimes waiting, with his hand in hers, until he dozed off.
These became precious moments for Aaron. Each time Julia settled down beside him he studied her face, finding it more and more beautiful, even when she came to him with her hair mussed and wearing no makeup. He grew used to her odor, a mixture of medicinal aromas mixed with the heat of her body. Touching became especially important to him. Where her fingers brushed against him, he felt a pleasure that was more like a forbidden thrill than friendly warmth. And when she bent over him to adjust his covers and kiss him good-night, he flushed with joy to know her breasts were there, just a few inches from him. He wanted to reach up and take hold of her, to press her against him, but he knew that would be wrong. This was not the feeling he had for his mother, but something more intense and troubling. It came over him whenever Julia was with him during the day, a pang of longing.
Stay
, he wanted to say.
Hold me.
One night, after she checked to see if he was asleep, she turned off the lights and moved to the other side of the room. Ready to leave for the day, she had brought a change of clothes with her, a fresh blouse, a skirt to replace the slacks she wore at the clinic. In the far corner, she removed her smock and the clothes she had worn through the day. In his bed, Aaron was not asleep. By the dim light from the window, he could see her making the quick change. He could see her bared back, crossed by her brassiere straps.
Turn
, he was saying to himself.
Turn
, though he knew he should not want that. He was just a kid; she was his doctor. There was a memory that was blending with what he saw. Before he came to the clinic, he had once had a sitter, a college girl who minded him a few days each week. Sal was her name, a pleasant young woman and very pretty Aaron thought. One day, he caught sight of Sal as she was changing clothes in the bathroom. He saw her bare to the waist. When she noticed him peeking in at the door, she hitched her bra on, and covered up quickly. “Well,” she said, with a small embarrassed smile, “I’ll bet that’s your first lesson in sex education.” He had not known what she meant by that, but he remembered how excited he had been in that brief moment. A wave of heat passed through him, a delicious euphoria. He felt that way now, watching Julia in the darkened room.
Was this what it meant to love somebody, he wondered. To want them close, to want their skin against yours? But love was for grown-up people. It led to holding and kissing — like in HyperionQuest where, more than once now, he and Julia had embraced and kissed in their roles as the princess and her knight, their digital surrogates. Why was he feeling like that? Why was he wanting something he could never have? Perhaps because he would never grow up to be an adult, to have a girl friend, to kiss the way grown-up people did. He wanted this feeling that he could never have. Wanted it, craved it, knowing that it was wrong in every possible way.
Wrong, wrong, wrong.
It was not the first time it had happened. Julia woke to find her hand on the phone before she had consciously registered a ring. She believed it was a capacity doctors developed over the years, a form of second sight that tells them they are needed. She waited. And then the phone beneath her hand rang.
“It’s Aaron,” the voice on the other end of the line said. It was Hal Prentiss, the doctor on duty that night at the clinic. “I think it’s a stroke. We’re getting him to the ER.” Abrupt and to the point, the way worried doctors communicate.
An hour later Julia was at Aaron’s side in the emergency room at Mount Zion. The boy lay in a coma, his vital signs barely registering. Doctors were treating him for stroke, though Aaron’s EKG did not confirm that diagnosis. “We’re moving him into intensive care,” the physician in charge told her. “We have him scheduled for a CAT scan and other tests.” He did not look hopeful.
“How was he when you put him to bed?” Hal Prentiss asked.
“He was fine,” Julia said. “There was even some improvement over the last few days.”
“About 2 AM he rang for the nurse,” Prentiss told her. “When she got to him, he was comatose. We got him through that, but then his vitals dropped like off the edge of a cliff. We stabilized him, but he hasn’t come round.”
Prentiss had brought Aaron’s file with her. The ER doctor skimmed through it. “Never dealt with a case of progeria before,” he said. “This is one sick little boy.”
“He actually seemed to be making progress over the past few months,” Julia said. But the ER doctor looked even more doubtful.
“I’ve had a few elderly patients who finished like this,” he said. “They simply collapse all over at once like the wonderful one-horse shay. I’d say Aaron got too old to live.”
“We don’t think that way any more in my field,” Julia answered sharply. “Old people die of something that kills other people too. They don’t die of old age.”
The doctor gave her a two-plus-two-equals-four shrug. “When you’re as far gone as he was, does it matter which system failed first?”
Twelve hours later, there was nothing new to report. Aaron, his body infested with a maze of tubes and wires, was unresponsive. His brain activity was incoherent, suggesting the possibility of serious damage. Julia cleared her schedule to stay with him. At his bedside, she whispered at his ear several times every hour, hoping some part of his beleaguered brain would hear her words. “I’m here, Aaron. I’m waiting for you. Speak to me.” There was not the least tremor of awareness. He had folded himself into a tight ball in his bed and lay as unmoving as a statue.
I’ve lost him,
Julia said to herself. She was going dead inside as if she wanted to share her patient’s fate. It was not simply sorrow she felt; she was ashamed to have raised his hopes, to have promised him life when she could not provide it. She had used hope to keep him concentrated and striving. The will to live was there, but she had found no way to transform hope into healthy tissue, durable organs. She had nothing more to offer except her grieving presence.
It was time to phone the Laceys.
Encouraged by Julia’s early success, Aaron’s parents had relocated to Marin County where they both had found jobs. Only an hour’s drive away across the bridge from the clinic, they had become frequent visitors. At Julia’s urging they were taking a more active part in Aaron’s treatment, arranging field trips and at-home sleep-overs. Delighted with their son’s progress, their trust in Julia seemed to know no bounds. Now she was about to tell them that Aaron might not survive until morning. Julia had called many times to report a turn for the worse or to announce a death to a patient’s family; but she had never found it so difficult to state the medical facts of a case as now. The admission of failure was there from the first word she spoke. At the other end of the line Todd Lacey rapidly ran the gamut from shock to fear to anger. Julia found herself facing a barrage of parental rage and more questions than she could answer. How could Aaron have suffered a stroke? They had never been informed of that possibility. Hadn’t she seen that coming? Why had she been sending them such encouraging reports if he was this fragile? What sort of “quack treatments” had she been using that might have damaged his heart? Julia realized that the more she sought to calm his fears and defend herself, the more suspicious he became. Clearly his trust in her had crumbled.
“We’re not sure it was a stroke,” Julia told him. “We have no idea why this happened. You should feel free to call in other doctors if you wish, though he is receiving excellent care.”
“We’ll be there in an hour,” Todd snapped and abruptly hung up. When he and Louise arrived at the ER, Julia was forced to endure the dressing down she expected. The same questions again and again. Why, why, why?
Louise Lacey, though severely disappointed, was more restrained. “I’m sure you did all you could. But, God! this really hurts. We’d gotten our hopes up.”
As gently as she could, Julia reminded both the parents that Aaron wasn’t dead. “You mean he might hang on for a few more hours,” Todd snarled.
But Aaron lingered longer than that. A day, another day, another. A week later, though he was still comatose, his vital signs were stabilizing and his brain activity had returned to normal. When he at last woke on his sixth day in intensive care, Julia was at his side, where she had been spending her nights. She heard him let out a loud groan and was beside him at once before her head had cleared. “Aaron,” she called out in a loud voice, trying to shock him into consciousness. “Aaron, I’m here.” She pressed the call button to bring a nurse, then wrapped him in her arms. He was struggling to free himself of the tubes and wires that enveloped him. “No,” she said, “you need to stay calm.” But he was in a mounting panic.
“What’s wrong with me?” he barked, his voice frail and foggy.
“You went into a coma. But you’ve come out of it. You’ll be all right.”
He refused to stay quiet. “You told me I was getting better,” he shouted. “Why am I back in the hospital?” Julia tried to hold him tighter, but he slapped her hand away. “You told me I was going to be healthy. You lied to me.”
Before she could say a word, the room was filled with doctors and nurses laboring to prevent him from yanking the IVs from his body. “She lied to me,” he kept repeating as he fought to leave the bed. “I don’t belong here. I want to go, to go!” Doctors were shouting at him to cooperate, but he insisted on struggling against them. At last, a nurse arrived with a syringe. The sedative took effect quickly. He fell back across the bed muttering, “What’s the point? What’s the God-damned point?”
***
I’m dying. I know it. The brightness isn’t helping me, it’s killing me, burning me up. It’s all over me, all around me like fever, hotter than fever. My skin is on fire. I keep seeing things from the game, like I can’t stop being in the game.
Who’s that
— there in the corner? The man in the hood, I can’t remember.
Get him out of here!
I’m dying and it’s her fault. She let me down. She told me she was going to save me and she couldn’t. I was never anything but a guinea pig for her to try all her stupid ideas on. She feeds me bad things, things that turn my stomach. As soon as I had the chance, I wrote this so she would know. Dr. Stein, you are a fake and a liar!!! I’m going to write this down tonight before I die. You’re a rotten fake. And I hate you!!! You said I was getting better. But I’m not. I’m worse than ever. I’m going to die. The brightness is setting me on fire. I’m melting. I’m a snowflake and I’m melting. I’m back in the hospital with tubes in every part of me. All these nurses and doctors. Think I don’t know what that means? It means I’m dying. I was in a coma for six days!!! I want to get as far away from you as I can before I die. And when I die, the last thought in my mind will be how much I hate you.
***
“It will take weeks to bring him back from this,” Julia lamented to her husband the next morning at breakfast. Jake found her at the kitchen table sitting over a cup of coffee, looking battle-worn after a night at Aaron’s bedside. It was the first time she had been home in the morning since Aaron was taken to the hospital. She and Jake rarely talked at breakfast, but seeing her so bedraggled he felt moved to give her a sympathetic word.
“But he will pull through, you think?”
“Yes. Fortunately, there’s been no physical damage to his brain or heart.”
“I thought you said there was brain damage.”
“We all thought so. There was every indication. But he’s showing signs of remarkable vigor. The hospital staff had trouble holding him down.” She paused, a long pause that left a sense of tension in the air. Jake looked up. She was frowning out the window. “He didn’t want to see me.”
“Maybe he’s just pretty fatigued.”
“No, I mean the way he said it. ‘I don’t want to see her. Tell her to go away.’ He was angry, hurt. Disappointed in me. I’m sure his morale has taken a beating.”
“Sounds like a good sign,” Jake said, tossing off the remark. He was flipping through a stack of papers, already becoming more absorbed in his legal briefs than in anything Julia had to tell him. It was not usual for him to spare even that much of a comment on her work.
“Why do you say that?” she asked, wondering if he had misunderstood what she said.
“This is the kid who was so feeble when he first came to you? The pro … ”
“The progeric, yes.”
Jake raised his eyebrows, as if to imply nothing could be more obvious. “If they’re having trouble holding him down, maybe he’s getting better.”
He made the comment as a lawyer would — catching a witness out on a contradiction. But he phrased the remark dismissively. That was typical of Jake, who was inclined to regard his wife as a benign quack. But he could be right, Julia realized. She had seen Aaron fighting like a little demon with his nurses. She thanked Jake for the insight, then smiled to herself at how formal and remote they had become. She had thanked him the way she might thank a stranger for giving her street directions.
Brief as the exchange had been, it was the most they had said to one another about their work in weeks. They had fallen into the habit of speaking as if words were rationed, each assuming the other preferred terse bulletins. At first, as their relationship cooled, they had tried to remain curious about their careers. It was something to talk about, a safe topic. They spoke not at all about feelings; instead, she asked about his cases, he asked about her patients and they made as much of that as they could. In reality, he had no more interest in geriatric medicine than she had in corporation law. In time they talked less and less about anything they had not come across in the newspaper. Their jobs were eroding their marriage, giving them too many occasions to travel, to stay away late, to seek the company of others. In time, they asked less and less about one another’s work, perhaps because success was the rival both faced.
Sometimes, with no more than idle curiosity, she wondered where Jake’s sexuality had gone. She could not imagine he had turned celibate, an affable, well-liked, and successful man in the active middle of his life. Perhaps he was seeing other women. From time to time he mentioned the women he worked with, often remarking on their attractiveness before he got round to crediting them with brains or ability. At parties his habit was to immerse himself in conversation with one or another of the younger women in the room, a kind of innocuous and discreet flirting. He never told Julia afterwards what they had been talking about so intently. “Nothing much,” he would answer if she asked, or perhaps he would say they had talked about a movie or a book. Women often phoned asking for him. Partners, he said they were — or clients. He had ample opportunity to cheat, but then so did she. It would not take much for either of them to pull it off. A few lies, maybe not even that, so rarely did they any longer ask about what the other did when they were apart. She gave Jake the benefit of the doubt, mainly because confirming any suspicions she had about his fidelity would have put her to more trouble than it was worth. She preferred to grant him innocence until he proved himself guilty — a good legal principle.
But did Jake ever wonder about her desires? Did he care? Sometimes in the night she composed scenarios of possible love affairs and how she might manage them. If she told Jake she was off to a conference for the weekend, he never asked where or why. “Leave a number on the fridge.” That was all he might say. She could have had all the lovers she wished, but bedtime fantasies were as far she went. Her sexuality was in indefinite cold storage. She was almost proud of how easily she had made that transition — seemingly without regret, without resentment. A mature adjustment. Men — those she worked with, those she met in the course of her practice — saw her as frigidly professional. Or at least that was what she assumed. She preferred that; it made her feel safe, self-contained, in charge. Or had she simply lost the ability to recognize a sexual advance when it was made? Yes, that was a possibility. But it worked out the same in the end, didn’t it?
***
When she came today, I refused to see her. The nurse who came to tell me she was waiting said, “She’s been waiting all morning.”
I said, “She can wait forever. She can wait until hell freezes over. Why should I want to see the doctor who almost killed me?” The nurse told me that wasn’t fair, but I told her I didn’t care about what was fair. I was in no mood to be friendly. I said, “Look at me! Has life been fair to me?” Instead of seeing Dr. Stein, I showed the nurse the note I’d written the night before. The note that let Dr. Stein know what a fake she was, and what a liar, and how much I hated her. “Give her this,” I said. The nurse scowled at me. “You’re being a brat,” she said, but she said she’d deliver the note.
A few minutes later, Dr. Stein came to my room anyway, as if it didn’t matter what I wanted. She simply walked right in, the bitch! Why didn’t I notice before how bossy she is, how pushy, especially when she thinks she’s dealing with a child? Since I was tied down with feeding tubes and IVs, I couldn’t get away from her. I turned away and wouldn’t speak.