Yesterday's Last Flower

It wasn’t until the slight scraping of a flower filled vase sliding across a fake wooden table that I realized someone was there. My hands were busy swabbing a tracheostomy stoma site with a mixture of hydrogen peroxide and saline water and the best I could do was give a nod to acknowledge his presence. He nodded back.

“I’m almost done,” I said pushing the cleaning tray out of the way. “Then I’ll be out of your hair.”

“It’s fine.” There was a hint of sadness, but also the familiar ring of not wanting to be here. It was a tone that ran through most of the family members who were veterans of this place. A mixture of guilt, regret, burdens, and unanswered closure that came from watching someone with unimaginable potential being struck down and muted. Survivors some would call these patients but for the family members entering here it wasn’t. It was something worse. It was purgatory. The place between life and death and I was just one of the many who cared for those lost souls that now found themselves stuck in the in-between.

My hands went behind the neck and gently lifted her head while also pushing locks of hair aside. I ran a cushioned velvet strap from one end to the other and threaded the plastic Velcro pieces into place that would limit the tracheostomy tube from being able to come out. This triggered a cruel cough that raised the young lady’s body violently up and down. Reflexes triggered; I slid a suction tube to catch the pale-yellow phlegm that was bubbling to the top. Pushing a new gauze into place, I gave a last cursory examination to make sure everything was perfect and bright.

She was much like the others in the Neurological care unit. Her tree brown eyes never looked but instead peered far and distant as if looking for a distant visitor to crest a hill that wasn’t there. The arms and legs were atrophied. It was a consequence of neurological devastation that we called posturing. Arms and legs would contract into unnatural contortions and lock into place never to bend naturally ever again. The best we could do was place hands, fingers, feet, and toes into hard white braces and straighten them from the stiffing seizure that comes from the affliction of a massive brain injury.

A machine ran air into and out of her lungs with a distinct audible hiss using positive pressure which is the very opposite of how we normally breathe. The circuit also bypasses the natural humidity and heat of the normal human body and thus filters or heated wires are used to replace it. All of this had a grinding unnatural affect that lent our patients susceptible to pneumonia and furthering lung damage. The only way we could get the unending tireless production of mucus was to manually use a tube to go into the lungs and suction it out.

There was a plastic jug filled with nutritional liquid hung up high. A tan life-giving fluid circled a path directly through a peg tube that was placed in the belly of her stomach. There was no normal eating, swallowing, or chewing. The entire esophagus was bypassed. The unnatural musty sickening sweet scent of the feeding fluid was pervasive and filled every nook and cranny of the hospital unit. It was the welcoming greeting you received the moment entered through the doors. I had never gotten used to that smell and thinking on it now I can tell you I never would.

Even the very act of washing had been replaced with something akin to a manufacturing plant. The nurse’s aides would come, my patient would be loaded onto a flat meshed cart, and then hauled to a room where she would be hosed off and dried with clean white towels. Dressed in a new hospital gown, she would then be taken back to her bed where she would wait till her time on the shower schedule came up again.

Little to no sunlight reached into these rooms nor were the patients ever taken outside. Just a never-ending persistence of florescent lamps casting their glow day and night. It gave my patients a pale unnatural waxy sheen that for anyone unprepared would shock and haunt them to their core. The man behind me was a veteran though. He had been in this room and this hall at least a hundred times. Though I had yet to ever meet him, I doubted if anything here could shock or distress him now.

“I’m James,” I introduced myself as I went to the sink and washed my hands. “I’m Mrs. Caballero’s Respiratory Therapist. If you need anything, anything at all, please let me know.”

He shrugged, grabbed the small vase of Yellow Marigold flowers, and took them to the nightstand. “Her names Esmeralda. Would you mind calling her that for me?”

I didn’t answer.

Like most of the patients in this neurological care unit, the family had stopped visiting except for an occasional holiday visit. Today was Mother’s Day. I was sure there would be more people like him. Ones that felt obligated to see a loved one that dimly resembled the one they loved when they were fully alive.

There was a progression that flowed like clockwork here with every arrival. The constant stream of visitors would come nearly every day with the belief that their circumstances would be different. This would inevitably turn to dismay and tears. A blanket realization under the denial would creep to the surface and then the pleading and begging to the God above would cross slowly into anger. Finally, acceptance would sink in, the visiting stream would become a trickle, and then a drought. The creek bed would dry up except for when the occasional holiday storm would send a deluge of family members flooding back in to reminisce on days gone by.

Today was one of those days.

He stared at me and then said, “You know, she was my cousin’s girlfriend’s sister, man. I walked into that room and there she was. An Aztec Goddess, bro. Lit the entire room up. Boom! Hair exactly as it is now. Long, wavy, and floated around her shoulders like a cloud. And when she danced… I never seen anything like it. It entranced me. I was love hypnotized. God, she could move. You know, I got out of gang banging because of Ezzie. She wouldn’t have anything to do with me till I swore on my mom’s life that I would have nothing to do with it. Now, look at her stuck in this bed. If you knew her, you would understand. She was so beautiful. Now, look at her?” He stared at his wife, his onetime lover, and the mother of his child. “You act like she isn’t even real, bro. I watched you. Going through the motions, right? That’s my wife, man. That’s my wife.”

There wasn’t much for me to say. It was true. Everything was routine. I had twenty patients and all of them were the same. “I’m sorry if it seems that way. I have a bunch of other patients, but I have read their charts and I have gone through all of their medical history. I can’t imagine going through what you did. Losing your wife and then having a new baby too. It would wreck me," I acknowledged. "I’m sorry that it looks like I don’t care but I do. It bothers me."

“Yeah, man. Yeah.” He ran his fingers through his hair. “We were supposed to be a family. None of this was supposed to happen. I was there in the room. We were having a baby and I was happy. So, happy, and excited, bro. One minute she is breathing and pushing and the next she’s not. Just lying there and I’m being dragged out of the room and all those people rushing in. Nobody telling me what was going on. It was messed up.”

It didn't take much for me to imagine what happened. She had a stroke giving birth that had left her brain damaged. It didn’t happen often, but it happened enough so that it wasn’t unheard of. Now, her husband was here reliving that moment every time he came in.

“Her family hates me, bro. They hate me. They try to guilt me into coming here all the time but that isn’t her.” He pointed at his wife. “That isn’t her. My wife was funny. She would play jokes and everything. All this… It’s just a reminder of what could be. I can’t do this anymore. You know what I’m saying? I can’t do it anymore. Come here as if it matters, bring my son, and act like nothing has changed. Everything has changed. It isn’t right.”

I didn’t know what to say or do so instead I walked up to him and put my hand on his shoulder. “She’s cared for,” I said. I'm not sure I meant it though.

“Thanks. I guess there’s that right? All I know is I can’t bring my son here anymore. He’s getting older and trying to tell him that this is his mom... That isn’t normal, you know. My son deserves a real mom and screw her parents if they don’t like it. It will mess him up just like me and I can’t do that to him.”

A ventilator alarm in another room began going off. It screamed for my attention. “I have to go take care of that, but I can come back if you want to talk?”

“Naaa, you do you, man. I know they keep you hopping. It’s all good.”

As I walked out, a woman and a four-year-old child walked in. The resemblance of the woman and the one laying in the bed was uncanny. They could have almost been twins. On her left index finger shined a ring with sapphires and diamonds that sparkled brilliantly in the florescent light. The child was bouncing and bobbing around her hips and was jabbering saying, “Mommy, I want some candy.”

“We’ll get some ice cream after this. We have to visit Ezzie first,” she replied.

The next day, the vase of sun-colored Marigolds was sitting in the office where we gave report. Its bright yellow flowers fluttered with the breeze coming from above. I dipped my head around the corner and peered into the room where the vase should have been. The bright florescent lights had all been switched off. It was a message we all had grown accustomed with. One we had seen dozens of times. Yet, this time a cold chill wrapped itself into the deepest portion of my chest.

Esmeralda Caballero was gone.

The one who had taken over for me said, “She started going downhill about an hour after her family left.”

“But she was fine.”

“Tell him the crazy part,” another Respiratory Therapist said.

“Well, you see after the husband left…” She stopped for a second and slightly shut the door. “You saw him, right? He brought in their boy and the woman.”

“Yeah, I talked with him a bit. Why?”

“Well, after they left...”

“Yeah?”

“She was crying.”