ONE My best buddy, Earl Haynes, was the first to arrive for the dinner party. Earl looked like the college lineman who is just a little out of shape. He was a jovial type who appealed to women who like cuddly, teddy-bear physiques. Having a flattened abdomen was something he desired, but watching workout tapes while eating never produced recognizable results. His slightly crooked nose, a souvenir from his high-school wrestling days, rescued him from the banality of a classic pretty-boy face. Realizing she was late, Karen had dressed quickly, and raced down the stairs. She was not prone to hysteria and tantrums, but she got stressed when running behind schedule. Karen refused to own a blow-dryer – it would just frizz up her natural waves, she claimed. I could still see where her long, damp hair had left dark wet spots on the shoulders of her jade-colored linen blouse. Quietly by-passing our guests, she went directly to the kitchen to get the hummus and tabouleh she had prepared earlier. She noisily set the bowls on the dining room table, unintentionally creating a clatter that guaranteed her entrance would not go unnoticed. TWO If there is one thing a medical education has unintentionally taught me, it’s that rapid advances in modern medicine generally outpace our ability to reach a consensus on how to deal with the ethical, legal, and natural repercussions. For years I tried to find reasons why I shouldn’t accept that lesson as fact. But idealism, in opposition to reality, demanded ignorance and an innocence that is now irretrievably lost. The sleep shattering noise that came from downstairs demanded our immediate attention. It left no time to complete a dream which was having a bad ending anyway. Clanging and thuds would not seem unexpected in a house full of inebriated people, yet there was something peculiarly unnerving about that sound. For a second, I wondered if part of an airplane had broken off and hit the house, but then rationalized the improbability of that happening. Karen and I sat bolt upright. Iko, our German Shepherd, was seated at attention in front of our bedroom’s closed door, ears cocked, and eyes focused on the knob. THREE The events that followed are almost picture perfect in my memory. Grant freaked out because he couldn’t feel a pulse. I started chest compressions. He gave rescue breaths. Karen called the 911 dispatcher.
Other than his rustic attire, he had adapted to the big city remarkably well, given that the water tower was the tallest structure in his hometown of Reform, Alabama. Reform was so small, he’d tell us, that people only gave out the last four digits of their phone numbers because the first three digits were the same for everyone. He left the place a decade ago to attend medical school, but retained a slight southern drawl, and much of the town’s character. The thing about Earl was that it didn’t matter where he was. Wherever he was, he felt at home. It’s a quality I envied.
You wouldn’t have even noticed his accent much except for the fact that his whole body emitted southern culture. Not the style of the courtly, southern gentleman. Rather, a tough rugged guy who drove a red pick-up truck, and listened to Lynyrd Skynyrd and the Allman Brothers - that sort of thing. He believed the three most important years in American history were 1492, 1776, and 2001 (not because of September 11, but for the loss of Dale Earnhardt on the last lap of the Daytona 500 that year). Be that as it may, to oversimplify Earl would mistakenly veil an astonishingly complex mind.
I was glad Earl came ahead of the other guests. We hadn’t seen each other since he passed out at my house two weeks prior to the dinner party. On that occasion, we required a taxi to haul us home from a downtown bar to my place. When we got home, he had made his wobbly way over to my baby grand to ogle one of the carelessly framed photos on top of the seldom played piano. “Hey, Karen has always been a good looking girl in my eyes,” he said, “but these pictures make her look totally great.” At which point I swore at him and explained he was actually looking at a picture of my mother taken two decades ago. “Well, is she still married?” he asked, not missing a beat.
“She’s an aging widow on the verge of losing her marbles. If one more difficult life circumstance emerges, she might just transform into one of those crazy ladies who collects every stray cat in the neighborhood. Stay away from her.”
Earl always arrived at his host’s home carting a twelve-pack of McTarnahans Ale. Actually, he arrived just about anywhere carrying McTarnahans Ale. He was not an alcoholic, but certainly drank to a greater degree than the average person. He claimed that he didn’t drink to relax, but rather to make other people more interesting. Our colleagues at the hospital joked that Earl rarely made a diagnosis of alcoholism because patients could only be diagnosed as alcoholics if they were heavier drinkers than their doctor. He knew the health risks of alcohol, but like most physicians he found ways to justify his hang-ups. It’s true alcohol kills brain cells, but only the wimpy ones, he’d profess.
Earl’s stellar reputation as a compassionate, brilliant oncologist hadn’t led to a case of high self-regard. Among friends he sometimes despaired that his job was to poison already dying patients. When medical breakthroughs arrive that will eventually make chemotherapy obsolete, it will be a relief to him, even if it means being out of a job. Like most people, he desired respect, but Earl never cared what venue that respect came in. Whether he was a happy hour hero, or oncologist to the elite, it didn’t matter to him.
As usual, Earl had left all remnants of his professional demeanor at the hospital. He carried the ale into the kitchen and began describing some long-legged girl he saw at the convenience store on the way to my house.
“Maaa-an, you should have seen her. I felt like dropping protein right on that there spot.”
Luckily the doorbell rang, sparing me from hearing further details. Our friend Roy stood on the porch, shifting from one foot to the other.
Roy’s sandy blond hair hung just below his shoulders. He was a nerdy guy, and it never bothered him. Being a software programmer surrounded him with fellow unabashed geeks who repelled cool. Sci-fi books, comics, and classic rock were his passions. He arrived wearing green corduroy pants and a blue t-shirt with a red and yellow Superman symbol on the chest.
Roy sat down on the couch and immediately started fidgeting with his hands and rambling about the craziness of his day.
“It all started this morning. Well, actually it started last night. I went camping at the coast with my buddy, Potter. We woke up after a night of rain, and discovered we were basically sleeping in a frozen puddle,” said
“That’s no way to greet the new day,” I acknowledged.
“Yeah, well that was just the start of it. We decided to pack up and head for the car. When we got to the car, we both realized we didn’t bring a change of clothes. Man, we were soaked.”
“Bummer,” I said halfheartedly.
“Yeah, so we decided to strip and headed back to
“Nothing like feeling dry,” I said, thinking that was the end of the story. Somewhat fruity, but understandable given the circumstances they were in.
“Yeah, and we drove back pretty fast. We passed this slow Chevrolet on the road. Wouldn’t you know it, a mile later we’re at a stop sign in Tillamook and the damn Chevrolet rear ends us.”
“Oh gosh,” I mumbled, hoping my intonation sounded like one of concern, rather than one of amusement. In truth, I was internally grinning, just sitting back, amused by
“Yeah, so Potter and I got out of the car to get our soaked clothes from the trunk. But, wouldn’t you know it, the Chevrolet had smashed in our trunk and it wouldn’t open.”
Earl and I chuckled.
“Twenty minutes later we were sitting with towels around our waists in the Tillamook police station. The cop was acting like a real jerk. One of the first things he did when he arrested us was take our watches. He put them in a desk drawer filled with tons of other watches. You know, I never got my watch back.”
Earl guffawed. Beer came out his nose. “You two gone and got yourselves in quite the predicament,” he said.
Roy, recognizing he had enthralled his audience with the hilarity of it all, continued. “I was scared shitless. Seriously, I really had to go to the bathroom. The cop eventually let me use the restroom. No kidding man, I ended up clogging the toilet. It was the biggest and smelliest crap-out I’ve ever had. Luckily, Potter had paid the fine on his credit card while I was in the bathroom. When I got out of the bathroom I was just about to tell the cop about the toilet, when he told me I was free to go. Knowing there was only one cop car in town and that it was at the police station, we bolted out of town like bats out of hell – still only wrapped with towels around our waists.”
I became concerned. Not about
Roy may not have been done with his story, but by that time Grant and his girlfriend, Tarini, had arrived. Tarini was a lovely half-Hindu, half-American doctor of internal medicine whom Grant had met shortly after divorcing his wife. I was happy to see they made it to our house; earlier that morning, Grant had telephoned to say he might be coming down with the flu. The germ of his disease turned out to be his secretary. She had negligently brewed decaffeinated coffee for his mandatory morning cup, causing his soul to remain in hibernation until his observant nurse discovered the empty decaf bag in the waste basket.
I had met Grant a few years ago, soon after I arrived in the city to join Portland Premier Health Partners. His medical practice rented space in the same office building as my group. Right off, he invited me to his wife’s (now ex-wife’s) birthday party. They would be celebrating at a “topless” bar, he told me. I was keyed up at the prospect because it seemed I was the only guy on earth who by age thirty-four hadn’t been to a strip-club. In anticipation, I went to the bank to get fifty dollars in singles. What a letdown when I got to the party and realized we were at a “tapas” bar. The tasty array of Spanish “small-plates” was no consolation prize. Not to mention the embarrassment of using forty-three single dollars to pay for my portion of the bill.
I often stared at Karen. She probably took it as endearing while others may have considered it creepy. In truth, I only occasionally stared at her in lust. Usually, I was just wondering why she was still with me, and when she would eventually lose interest. There was no question she could get a better looking man. Like my previous girlfriends, maybe she would make her escape on short notice. There were times that if I’d had the opportunity to escape from myself, I’d have done it.
“Hey Karen, what’s up?” Tarini asked, as she followed her into the kitchen. I walked in behind both of them to get some more ice.
“Same old thing. I’m just waking up from a nap. I had the worst migraine today,” Karen replied. She massaged the side of her head and her wavy curls bounced along with the movement of her hand.
“Isn’t that the worst? I’ve also been getting tons of headaches lately,” said Tarini. As a physician, Tarini couldn’t abstain from giving medical advice. Her sincerity, something I’ve noticed to be common among Hindu women, made her appear so compassionate towards friends and patients. “It’s important you get it checked out to make sure it’s nothing serious. Did you know women get three times as many headaches as men?” Her right eye twitched involuntarily as she spoke, a tic which I had only recently noticed.
“That doesn’t surprise me. It’s men that cause them,” Karen answered, hoisting herself onto a counter stool. Karen maneuvered like the tomboy she once was, more adept at climbing trees than pirouetting around the room. But this lack of physical gracefulness made her more human in my eyes, since everything else about her seemed perfect. The exceptions included her annoying habit of pressing the snooze alarm six times each morning instead of setting the alarm for an hour later. She also insisted that every location in
Grant had followed us into the kitchen. Usually a reliable defender of the male cause, he stopped listening once he spied the Jelly Bellies on the table. Instead, he began devouring them, oblivious to all conversation around him. “These jelly beans are awesome. I mean they could seriously replace fruit.”
“You’ve never had Jelly Bellies before?” Karen inquired, happy for a distracting light topic that would help her forget her headache.
“I’ve had jelly beans before, but not like these. These are great.”
“Well, you sound as if you’d never had one before,” Karen went on, “where were you during the Reagan years?” she asked, referring to the famous big jar the president always kept on his desk.
Grant replied defensively, “College, that’s where. It’s not like I was in
Another peculiarity was Grant’s tendency to correlate, at random, his own insecurities with the topic at hand. “People often ask me if I’m Asian, but I’m not. My mom drank a lot when she was pregnant with me.” That’s a classic problem with doctors. They often think every anatomical variation they encounter is a reflection of some disease process. The inferred connection between his mother drinking and him looking Asian baffled Karen, because Grant did not have the kind of slanted eyes that characterize babies with fetal alcohol syndrome. But I had become skilled in following Grant’s warped logic.
Back in the living room and over our drinks Earl soon had us in stitches as he related how he had recovered from his typical neurosis of health professionals. Late one night during his second year of med school, he had noticed a nodular three millimeter lesion on his genitals. After scanning every textbook of venereal disease he could find on his crammed bookshelf, he narrowed his self-diagnosis down to one of two rare diseases -- either Lymphogranuloma Venereum or Chancroid. It didn’t matter to him that these rarely occurred in
Dr. Stover recognized him as a medical student. Not the least bit fazed she took one look at the lesion and, without saying a word, grabbed the nodule between her thumb and index finger and gave a firm squeeze. A small amount of white pus came out of the nodule. Clearly, whatever he had must have been quite serious. He felt the blood drain from his face. Dr. Stover, still silent, took off her gloves and threw them in the trash. She proceeded to wash and dry her hands for another twenty seconds, and opened the door to leave the room. Then she turned and congratulated a red-faced Earl for having the biggest pimple on a penis she had ever seen. She advised him to go home and study the manifestations and treatments of acne.
Inevitably, they still run into each other on hospital shifts. Earl masks his embarrassment by pitching tasteless pick-up lines at her. “You should see me without the pimple.”
As a hardened ER doctor, Dr. Stover holds her own with piercing wit. “Earl, without the pimple, there would be nothing there.”
I had invited Dr. Stover to our dinner party, but she declined, stating that her ER shift ended at 10 p.m. If she had the energy after work, she would consider stopping by for a late night drink, she said, but it didn’t happen. Either she lacked the energy, or Earl genuinely repulsed her. Most likely, it was the latter.
We have tried reconstructing the details of the event that changed all our lives. None of us remember exactly what was said during our marathon-of-a-dinner, but we had laughed a lot and philosophized a little and told some good stories. We ate and drank well into the night.
Rather than face the diminished visibility of the roads due to
The clock said 4:06 a.m. Had we been asleep a few minutes or a few hours?
“What was that?” Karen whispered. She had the same uneasy look that surfaced a few weeks prior, when I had returned from the hardware store with a how-to book -- Electrical Wiring Made Easy.
“I don’t know. Probably Earl tripping over something.” I figured a quip about the big guy would relieve the tense situation. It didn’t. Karen took my remark at face value.
“Earl is sleeping in the basement on the futon. That sound did not come all the way from the basement.”
Earlier that night we had all washed away our tensions with liquor. Trying to ignore the consequential headache, I slowly made my way across the bedroom and reluctantly opened the door. One hundred pounds of canine galloped past me, and raced down the stairs. I followed her to the kitchen - unknowingly leaving behind my unseasoned view of life. Sometimes I wonder if that crash was God’s way of trying to get my attention.
By the time I got to the kitchen, Iko was barking aggressively in front of the pantry door. She was in a rage, ready to lunge at whatever lurked inside.
I didn’t try to quiet her. The dog was not the over-reactive, excitable type. Someone was behind that door. The only time Iko ever acted that crazy was on Tuesday mornings, when she was convinced the garbage men had once again returned to steal our stuff from the driveway. I grabbed a dirty knife that had been left on the cutting board, hoping it would protect me from whatever was hiding in that walk-in pantry. Grant and Earl came up behind me, and fixated on Iko. Earl was clad only in underwear.
“Who’s in there?” I yelled.
No answer.
“If anyone is in there you should know that my dog was trained-to-kill in
Grant, and then Earl, grabbed knives from the Wusthof set I had given Karen for her birthday.
Earl noticed that the butcher knife was missing.
“Oh, Jesus…” I whispered. If you want to see what somebody is truly made of, watch what they say and do under pressure. Some, like Abe Lincoln or Washington, were inspired by challenges and displayed genuine greatness. I took a moment to think, and then remarked, “…this unconditionally sucks.”
My thoughts momentarily flashed from whether a guy in the pantry had a butcher knife to how I had always wanted a gun, an idea Karen rejected vehemently. How many times had she warned me that every hour in the
Karen peeked in from the adjacent dining room, and whispered that she thought she had put the butcher knife in the dishwasher. The tone of her voice did not reassure us. The dishwasher was located about two feet from the pantry’s doorknob. No one wanted to risk getting that close to the pantry.
Roy made his way into the kitchen. His hands quivered slightly, which was not unusual for him when he was nervous. There was still no sound from the pantry. We hand-signaled each other to retreat to the dining room and formulate a plan. Iko began to snarl and whine, clearly annoyed at my reluctance to take action. Her disapproving demeanor brought to mind a recent encounter with my malcontented, vegetarian neighbor at the annual barbecue block party.
“Should I call the police?” Karen asked me in a barely audible voice.
“Go for it,” uttered
“It’s four in the morning. We can’t be sure there is someone in there. Do we really want to wake the whole neighborhood? It might just be a mouse that knocked over a bunch of soup cans.” I knew that wasn’t the case. We’d had mice before. Mice wouldn’t be strong enough to knock over a single soup can, let alone cause the loud crash we all heard. Iko might have barked once or twice at a mouse. She wouldn’t try to tear the door down over one.
Roy spoke up again. “All our cars are in the driveway. Do you think a burglar would really choose to rob a house with that many cars out front?” The hippy geek did make some sense, but none of us paid much attention.
“Where’s Tarini?” Karen asked. She was good at asking pertinent questions.
Grant said, “I fell asleep in your basement guest room. I don’t think she ever came down to join me. Our car is still out front.”
I told the dog to shut up. She quieted down but remained in attack position in front of the pantry door.
“Are you in there, Tarini?” Grant screamed at the door.
No answer. Was Tarini being held hostage behind the door?
Grant walked over, opened the pantry door about 6 inches and backed off. We should all have been feeling terribly hung over, I thought to myself, but a heightened consciousness kindled by fear overcame the lingering intoxication.
Iko saw her cue. She rushed into the pantry, flinging the door open with her strong body, and barked with more frenzy than before. I flipped on the pantry light. There was Tarini immobile on the floor amid cans of refried beans, soup, and a pool of salsa from an adjacent broken jar. I felt her image burn into my retina, and knew it would remain there with the same permanence as a brand on a bull. I rushed to her side. Grant and Earl looked at each other in disbelief, then after a moment of startled hesitation, joined me at her side. There were no cuts on her. No signs of trauma, but she wasn’t breathing.
Tarini didn’t feel cold, but she didn’t feel warm either. Her petite body was naked under a long white shirt. Her lips were blue, and her hands and feet appeared mottled. The pupils of her once beautiful emerald green eyes were dilated and fixed. If the eyes are the windows to the soul, as some say, then her soul seemed to have departed. When the brain isn’t getting oxygen, it starts dying after four minutes. We had wasted precious time being idiots outside the pantry door. Was she not breathing that entire time? As a critical-care physician, I knew the grim statistics for surviving an out-of-hospital cardiac arrest, but the thought of not generating a successful resuscitation didn’t cross my mind, nor apparently the minds of any of my friends.
The world seemed to me to be divided primarily into two groups of people. Those who credit a puppet-master in the sky for pulling all the strings, and those who believe we’re on our own. Then there are confused folks like me who are on both sides of the aisle theologically. I wasn’t naïve enough to think Tarini’s heart would start on its own by divine intervention, but if God wanted to assist in the matter, I was all for the help.
None of it felt real. We had participated in plenty of CODE BLUE cardiac arrests, but always in the hospital where the environment was controllable, and personnel back-up, drugs, and defibrillators were plentiful. Usually there was a degree of separation between the doctors and the patients that allowed for clear and logical thinking. Our personal feelings about Tarini bred an intensely intimate and visceral response. Panic never helps a resuscitation effort, and we were all panicked. People watch heroic CPR on television where the victim wakes up with Pamela Anderson or another Baywatch beauty pressed against his lips, and assume it always works that way in real life. But, this wasn’t television. There were no dramatized characters saying, “Come on man, you’ve got to make it. Don’t you die on me now!”
We were all trying to stay focused on getting the job done for Tarini. Consistent with the statistics, we were not reviving her despite our best efforts. In the background, Karen was screaming at the 911 operator to get help to us faster. We momentarily gained composure and then got back into sequence. Perspiration born from raw exasperation dripped out of every skin pore. Every few minutes or so, I felt another one of Tarini’s ribs fracture during my chest compressions, as is the usual case in prolonged CPR. Whether or not Tarini felt anything was impossible to discern. She wasn’t displaying any signs of suffering. A grimace or a moan would have been gratifying in a situation so desperate.
Patients who have pulled out of a close brush with death have told me that the dying process paradoxically made them feel more alive than ever before. Not only on a psychological level of being able to understand completely what’s important and what they will miss, but on a physical level as well. They cherish each palpitation of blood in their vessels. Each breath becomes so monumental that they can’t imagine how most days proceeded without them ever thinking about breathing.
We only die once, and each experience is intimate and unique. Death is something we don’t usually schedule into our lives, but the disease of mortality is an affliction we all encounter, eventually. As a frequent observer of the process, it’s something I’ve thought a lot about, but that experience complicated everything.
When performing CPR, it’s essential to allow for a brief pause in chest compressions to feel for a pulse every couple of minutes. If the heart starts beating you don’t want to continue traumatizing the chest. My fingers pressed into Tarini’s neck in an attempt to detect blood flow in her carotid artery. For a second I thought there was a pulse, but then realized my panic had caused an amateurish error. My own pulse was pounding so hard in my fingertips that I had attributed it to Tarini’s heart. When I palpated my own carotid artery with my other hand, the pulses in both hands were unambiguously synchronous with each other.
The paramedics finally arrived. They hooked up the heart monitor, and we scrutinized the dreadful flat rhythm of asystole. Tarini’s heart did not contain even a slight trace of electricity to shock it back to life. I mustered up the courage to look at Grant. He stood silently, staring at the monitor. I fixated on his small chin scar that he once claimed was from a tumble in kindergarten due to an untied shoelace. Then he turned his head downward, buried his chin in his chest, and began to sob convulsively.
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