Forced Expiration
a short story by Shanna Germain
    

His wife has been here for forty days. The machines make her heart beat and her lungs whoosh, a steady metronome of blood and air. You could try to count the future out, minutes on the rise of her chest, hours on the fall of it.

I know that’s what he’s doing, counting, the way he keeps the flat of his palm on the flat of her chest, halfway between lung and heart. The way his gray sky eyes watch the back of his hand rise and fall, rise and fall.

He is here every morning. Evenings too. Sitting in that plastic hospital chair in the same pair of jeans, that same gray cable-knit sweater that matches his eyes. His wife, with her dark hair tucked behind her ears and flat brown eyes staring upward, almost looks more alive than he does. Even the long-dead flowers behind him, their golden petals dark and stained, still reach skyward.

I’ve asked the regular nurses if he goes home at night and although they would like to pretend I am not here, would like to rip my white scrubs right off and press them to black beneath their nurse’s shoes, they answer me, as they must. Yes, he goes somewhere.

But I don’t believe it. They tell me lies sometimes, in the hope that I will not be needed and that I will go away.  

If someone is taking him at night—sister, buddy, son—then they need to start feeding him—his cheekbones, the point of his chin, show sharp through his brown stubble, the dirty sweater slides farther and farther off his thinning shoulders.

When I step into the room with him, I do it with strong shoes against squeaky floors, loud enough so he can hear me coming, quiet enough that I don’t mess up his count. He almost looks at me as I near the bed, but really he just raises his chin. What’s left of 30 years of good manners in a time like this.

I slide my stethoscope off my neck, press the metal diaphragm of it against my palm to warm it. 

“I’m just going to check her vitals,” I say. Really, I don’t need to. This many machines in a person and you can read their whole life story in the blips: BP 80 over nothing, pulse thready, even with the machine, future flat.  

But I will check her anyway. I am supposed to keep my hands on my patients. That’s my job. Well, that’s my pseudo-job. That’s what the hospital administrators will tell you if you ask them. The other nurses too, although if you caught them three martinis down and offered anonymity, then who knows?  

Most of the time, the hospitals wish I didn’t exist. The nurses too—I know they think it’s blasphemous that I wear white scrubs, like a pregnant woman going down the aisle all in white. But when things start to fall apart, I am the one they call.

My patients are not the wives on life support or the preemies in neonatal. Yes, I am a nurse, and, I believe, a good one. But not to this woman. My patients are the people sitting in these plastic chairs counting heartbeats and breaths. My patients are the Loved Ones. Or as we called them back in med school, the Lo's.  

My job is to keep the Lo’s sane, to keep them alive however I can while they’re sitting here, counting on dying. One of the ways I do this is by letting them see my hands taking care. I make the motions of checking his wife’s BP, roll her eyelids up and shine my light on her dark brown centers. Pupils, dilated, non-responsive. I put two fingers against her pulse, wrap my hands around her wrist. But I don’t count. There is nothing here worth counting on.   

While I take care with my hands, I take stock of my patient, my real patient, with my eyes. His vitals are: Sweater gray, energy gray, eyes gray. The hand just above his wife’s feeding tube, gray. More gray than his wife’s skin. More gray than the hospital sheets before they are bleached back to nearly white.

He moves his eyes to my hands when I peel back the tape inside his wife’s elbow, check the skin where the silver IV needle sits. The flesh is cool and slightly purple beneath my fingers. Already her skin is falling down into itself, plummy and cell-less.

Sometimes, I can turn a light on in a Lo’s eyes or have them lean forward to ask a question, if I’m rough enough. But not this one. His eyes are clouds torn by wind. Lighting might kill him. 

Instead, I stroke the inside of her elbow and watch for a reaction. But his hand stays on her chest, trapped between white sheet and air, counting the rise, the fall. 

Unlike the other nurses, I don’t ask Lo’s how they are doing or how they feel. They’ll say, “fine,” or “okay” if they say anything at all. To say or think otherwise would admit defeat. Instead, I ask something calculable, something with numbers and a rhythm. What’s your home phone number? What is your insurance company? How old is she? On what date did you first notice the symptoms?

For him, I will ask, “How many?” But not yet, not until I’m sure he doesn’t know.

~

 

When I come back the next morning, I am sure. He has both hands on her chest and doesn’t even lift his chin when I stand next to the bed. Where his thin arms poke from the sweater sleeves, his skin is rippled with goose bumps. He is doubling-up his count, sure that soon she is going to recover or she is going to die. He is preparing himself for these possibilities. Rise or fall.

He does not yet understand that there is a third option, the one her body has chosen, the one that is so long he will never be able to count on it. He is the only one who doesn’t understand that she is not, never, coming out of it.

This is what patients in vegetative states do. Like mermaids with land legs, they convince their loved ones that they’re not drowning, no, they’re swimming up and up. Just hang on to them, just hold their hands and follow their breathing—they will take you to the surface. The truth is they’re just floating half-way between bottom and surface, holding their loved ones down with them for as long as possible. It’s not the patients’ fault; they don’t know they’re doing it. Like the mermaids, their beauty captures the Lo’s, holds captive. It is my job to break them free. 

I put my hand next to his on the sheet without touching him. I’ve heard photographers say that when they’re setting up for a shoot, they exhale and click the photo right at the moment their lungs are empty. It makes their shots steadier.

For Lo’s who are counting, I wait until the patient inhales, because the inhale takes longer, because it doesn’t mess up their count.  

Her breath, the mechanical suck of it, in and in.

“How many?” I ask.

He doesn’t lift his gray eyes. Below our hands, the body of his wife exhales. Inhales.

He runs the dry tip of his tongue across the skin of his top lip. It makes the sound of a dead leaf on the sidewalk. Hiss. Suck.  

“Today,” he says. Whoever’s taking him home at night isn’t making him talk. His voice scrapes out, rusty. He doesn’t clear his throat. Another inhale. “Three hundred and sixty two.” 

I slide my hand across the sheet, across the waves that are the ribs of his wife, until my pinky finger touches the side of his. His knuckle is split open down the side, a recent wound not cared for, the edges of it sharp against my skin.

Matching his wife, I take my own inhale. The air is heavy with discarded pieces of body and breath.      

“How many more?” I ask.

He doesn’t know. He thinks the number is still calculable, that there is an equation in his head that he must figure out.  

His pinky twitches against mine, a dry twig. I know he would pull his hands back if he could, but he can’t. He cannot miss a breath, a count. He thinks he is almost to the end.

I press my pinky tighter to his skin, to that wound.

“How many?”

This time, his finger stays steady against mine. His eyes are back on his hands, gray on gray on white. He is counting inside his mouth, 364, 365... I have lost him. 

How many more? If I could answer for him, I would. I would say Pi more. I would say irrational number more. I would say forever more.

Instead, I take my hand away and unwrap my stethoscope from its home around my neck. For now, all I can do is let him see me taking care.

 

~

 

The next morning, I tell the day nurse in charge that we need to schedule surgery for his wife. Coming from me, she knows what this means. Transport the patient somewhere else for a few hours so I can work. It doesn’t mean she likes it. She pulls a pencil from her gray and black ponytail, looks at me hard for a few seconds, her blue eyes like steel.

“When?” she says.

I run my fingers over the tools in my pocket—circle and square. “This morning would be great.”

She cradles the black handset between her cheek and shoulder. “This morning?”

I know it’s asking a lot. I also know she’ll do it.

“Thanks,” I say. Even though I don’t have to. Even though she says nothing back.

This morning, he is the same. Thinner maybe. Grayer inside his sweater if that’s possible.

“Daniel,” I plucked his name from his chart on the way in. I don’t usually do that, get involved in a name kind of way. It’s like kissing on the lips. But sometimes you have to do what you can to bring them back.

I walk around to his side of the bed. Stand beside him without touching him. I explain to him what’s going to happen.

His eyes, dead on his hands. His wife, dead, not dead through machines. He is not hearing this, not a word of it. He is counting. But I have to say it—hospital regulations. The hospital could get sued for the work I do here, although if it came to that, they’d feed me to the dogs, say they didn’t know the type of work I did. It doesn’t matter. No one ever sues.

I slide the small needle out of my scrub pocket and pull off the protective cap. When the silver enters the vein in his neck, his skin makes a small pop. He doesn’t flinch, not even when the sedative goes in, though I know this one stings through the veins like jellyfish. Still, nothing. I raise my fingers to the crew outside the door, telling them to wait. One breath, two.     

Like Ritalin on hyperactive children, the sedative will actually do the opposite in a few minutes. But right now, he is all rag doll, limp as those big cats they capture on TV. I wait until his hands begin their inevitable slide down the ribcage of his wife’s body before I signal the crew in to take away his wife.

“Daniel, we’re going to get you cleaned up,” I say.

His eyes are closed. I have less than five minutes to get him where I need him. I lean down and put his arm around my shoulder. I know enough not to inhale, but still I get his sour milk scent on my tongue.

“Up we go,” I say.

I am strong—I have to be—and he is nothing but bones and breath. I almost overshoot my strength and send us both toppling. But I right myself, and navigate us through the door and down the hall to the cleaning room. All the way, patients look at us funny—Daniel’s left arm sticks straight out, his hand flat like it’s been for months. It makes him look like he’s trying to fly.

I get Daniel inside the cleaning room, slide him into the chair in front of the large, three-headed shower. The sed kicks in just as I slide the deadbolt into the lock. For the first time, his eyes actually see me, see the space around him. Now, his eyes are blue, not gray.

“Where…” Again the throat that doesn’t work. I turn on one of the showerheads. “Where am I?”

When all three showerheads are spraying behind him, I kneel in front of his chair. The scent of dirt and urine is everywhere in his jeans.

“You’re in the hospital. Your wife—”

When I say wife, his eyes go wide and deeper blue. His hands fumble to get him up.  

“Where is she?”

I put one hand on his jeaned knee, try to hold him in the chair with what I can tell him.

“Your wife needed a procedure.” I don’t say surgery. Surgery gives them hope, one way or the other. “You couldn’t be with her.”

Something lets go inside his eyes, blue sky to gray. He lets his head fall to his chest. His hands go flat on his knees. Inside his mouth, he is counting her breaths, letting his own chest rise and fall at the speed he remembers them. He is nearly exact in his timing.

I wait for his inhale.

“You need to start thinking of yourself now,” I say. “Get undressed, take a shower.”

Exhale, inhale. I need to break him of the habit, but I need to get him into the shower more.

“You can keep counting,” I say.

It doesn’t matter. He doesn’t want any part of this. He will sit in the chair and count until someone brings him back to his wife, and then he will sit in another chair and count until one of them dies.

I slip a pair of rubber gloves from my scrubs pocket and slide them over my fingers. Then I bend down further, untie his sneakers. The smell of his socks as I pull them off makes me gag and I rise too quick, feeling my head spin. 

“Stand up,” I say, and I pick him up a second time. He doesn’t fight me—he is keeping time. Counting breaths is all that matters. He is showing his wife how much he loves her by keeping the beat of her breath inside his mouth.

I pull my trauma sheers out of my pocket, slice through the bulky front of the sweater and the dirty t-shirt inside it. The fabric opens against his body and falls away. His chest is sunk to hollow, his bones everywhere inside his skin.   

I put one hand on the button of his jeans.

“Don’t make me cut you out of your pants too,” I say. He does not hear. Goose bumps break out on his thighs when I pull his dirty jeans down to his feet. His boxers come down easily, too loose now for his waist.

Still in my scrubs, I take his hand and lead him into the showers. When I soap him down, he becomes less gray, takes on the appearance of near human again. My scrubs stick wet to me, turning gray from the dirt and water. Even my gloves are turning a yellow gray, like the sky before a thunderstorm.    

I turn him around. Both of his hands are over his heart. I run the bar of soap down his chest, feel his breath in and out. His beat is off now, a little slower than the rhythm the ventilator gives his wife. Still he counts behind the fence of his teeth.  

When I reach his belly button, I squat down and start at his feet, work up to his knees. While I take care with my hands, I take stock of my patient with my eyes. Beneath the spray of the hot water, the skin of his shoulders and chest has turned an angry red. It is a good red. An alive red.

I rub the soap over his hips. His penis is still flaccid and tiny. Still gray. Gray penis, gray eyes, gray matter—the last three parts of him to come back to life. The water is in my shoes; they push out gray suds with every step.     

I soap up my gloved hand and run it along the inside of his thighs, cup it against the underside of his balls. He makes a sound somewhere in his throat, somewhere in his chest. My soapy fingers reach the base of his penis, circle it, draw long and slow down its soft sides.

This is where it gets tricky: guilt, fear, there are many reasons a Lo’s freaks out at this point. I have to move slowly enough that he isn’t fully aware of what I’m asking of him, quickly enough that by the time he’s aware, it’s too late. And I can’t speak. To exhale breath with sound would remind him that I am not his wife doing these things, that I am not supposed to be here.

I let his penis fall back against his thigh. It’s still gray, but there is some firmness to it now. Then I re-soap my hands and slide the bar into the red Sharps container on the wall. I wrap one gloved hand around the base of his penis, pull in soft, short tugs with the other. Beneath my hands, everything lengthens and hardens. Everything begins to turn pink.

He doesn’t want this. He doesn’t want to feel this. His body, awake and asking for something, anything to stay alive, is betraying him.

“No,” he says. “No, no, no…” but it is more moan than words. The sound of someone who has already fallen.

I watch the rhythm of his chest, the numbers that are almost visible behind the gate of his teeth, and go opposite. Short then long. Stroke, stroke, stop. Anything to get him off the rhythm of his wife’s chest. Anything to make him stop counting. Anything to break the hold of the infinite numbers and keep him alive.

I keep my fist moving, back and forth in a rhythm with no pattern, something so humanly erred that no machine could follow. Something that is impossible to count. He still tries, though. I can see it in his teeth, gnashed together to keep everything inside. I stop stroking, cup my hand again beneath his balls. I wait, one beat, two, two and a half. And then I pick up the rhythm again, fast fast against his reddening skin. So fast he could not count it if he tried.

Now he is leaning back against the wall of the shower. His palms are flat against the tile. His eyes are closed. He pumps his hips forward and back, forward and back. It is a rhythm, but it is not the rhythm of his wife’s breath. It is his own rhythm. It is the beat of his own life, returning. He has let go of the mermaid’s hand and begun to kick toward surface.

When he comes in my hands, he is crying. I strip off my gloves with their palms full of gray fluid, and drop them into the Sharps container. Then I lean in and put my arms around him. The water washes over us in its fierce rhythm, rinsing him clean, driving the gray further into the fabric of my scrubs.

Right now, he lets me hold him because he lost the only thing he had to hold on to and I seem something like the surface he is looking for. In a few hours, when he sees his wife again and he tries to put his clean hands on her chest, he will remember it was me who took her away. And years from now, when his wife has been here for so long that her breaths are more numerous than the stars, and he has gone on with his life, he might try to find me. He might try to thank me. But I’ll be long gone, on to other places where they count on me to take care.

  

© 2006 Shanna Germain

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