Early one morning, in February of 2011, we carried pieces of her to a lawyer's office in Newark, New Jersey: a sweater she'd liked, which she wore two sizes too small on her already small frame; a set of car keys, for a car she drove too fast; a picture of her smiling, head leaning slightly to the right, full of imperfections, from shiny forehead to dimpled chin, only she would notice; cell phone records of the last conversations she'd had, mostly with the boyfriend she’d lived with; the autopsy report. We were her mother, her father, and her two older sisters. We knew her. But we also knew enough about the halls in which we stood that we had to have something to help us remember what to say about her to a stranger. The stranger introduced himself and asked forgiveness for his casual look—khaki slacks and polo shirt—for he was in-between moving offices, and since it wasn't a court day, he felt he could shed the suit. He apologized anyway because a good lawyer, he said, should always be professional in a suit and all that. We smiled our forgiveness, pointing out our own casual attire. And we all—slacks, polo shirts, jeans, day dresses—shook hands.
I am the older sister of the deceased, the eldest of three. I wore her sweater. On my taller, narrower frame, it was still two sizes too small, but when I put it on that morning, I felt I’d entered one of my sister’s secrets about clothing: that a close fit could hold you secure and help even out your breathing. We were all tense, but the tight hold of a sweater, comfy swing chairs, a solid desk, loose blank paper, and pencils for all, made it look like a room where fair business could happen.
He shuffled a stack of papers in front of him and gave us his condolences, looking directly at my mother. She was sitting closest to him and had placed a picture of my sister on the desk in front of her. It was a picture from the day they’d spent together on my sister’s birthday the month before she died. They’d shopped and eaten at their favorite Thai restaurant. My mother said she could still smell the perfume she bought for her that day. She’d chosen it because it was citrus and sweet and reminded her of the fresh oranges she squeezed for us every morning when we were children. The smell used to linger all day on her fingertips. These days it mingled with the last smell she’d had of my sister, the smell of something rotting, unattended. Together they filled up her lungs every time she inhaled. It was a constant heavy, sharp pain. She held it there all day, she told me, even though it threatened to break open her chest. She had two daughters still alive, but the one she’d been closest to was now this thing sitting on her chest.
“I know it's here somewhere. I read it just last night. All of it. I can't seem to find it right this minute, but I remember it clearly.”
The lawyer continued to shuffle papers as he spoke. The it was the autopsy report. He brushed away my mother's offer of her copy, and after a few seconds, triumphantly produced his.
“Here it is. Thanks, but I know I had it. Let's see. Much of this is very routine, unfortunately. As someone with some medical knowledge, I can tell you these things do happen during surgery. They shouldn't, of course, but they do happen.”
He moved a finger slowly beneath an underlined section of the report: Autopsy findings: Cause of death: sepsis due to acute peritonitis due to status post laparoscopic procedure for the treatment of endometriosis.
“In lay terms,” he explained, “the doctor erroneously punctured the patient during surgery, and left untreated, the patient developed and succumbed to a fatal internal infection.”
He paused and looked around the room. He knew this wasn’t news.
“That's horrendous,” he continued, “but my job is to prove that it all happened outside of the norm. One of my first questions is, was there proper procedural care after the operation was complete to make sure, for instance, that there was no excessive bleeding or anything to worry a competent doctor?”
There was no doctor to answer his question there in the room that day, but my sister, the middle child, thought she knew the answer to that one. She had called me a few days after our sister died, while shock was still our only way of reckoning with the world around us, and told me she'd googled the doctor's name and discovered she'd had two malpractice cases settled in the past five years. For her, this was a clear indication that she could have been careless with our sister's operation. But she was aware that guilt, though easily determined from the internet (credible doctor-monitoring site and all), might not be easily transferred from the internet to the room we were in. She repeated her findings to the lawyer, but there were other non-internet considerations.
She had shared the same living space with our sister in our parents’ home during the ten days she’d lived following surgery. She’d cleaned her navel—the site of entry for the laparoscopy—twice a day, and fed her the watery meals that had been her only sustenance, for too long, perhaps. And it didn't help that fresh in her mind was the last conversation she'd had with our sister's doctor. She'd called the doctor nine days after the operation, nine days of watching her swallow small amounts of food and then collect the automatic return in the bucket that had been a fixture at her side. She'd told the doctor about that and asked if she should take her to an emergency room. The doctor told her no, bring her to her office in the morning, after all, she explained, the wait in the emergency room would be long and she probably wouldn't get the right care anyway.
The hospital where our sister was finally taken by ambulance was the one nearest our parents' home in New Jersey. I had given birth there twice. For me, there was only one way to enter the hospital, one sight I looked forward to every time I entered or exited: the sight of pregnant women, and women who had just given birth, families gathered in the lounge, a bundled infant in someone's arms. Most times there were balloons to announce to the world the arrival of healthy new life.
Mid-morning on the 5th of October in 2010, my mother called me. I was settling down to an unhurried second cup of coffee after taking my kids to school, and was irritated at the interruption. I had tried explaining that it was the perfect time of day for me to get any writing done, but she still complained often about me not answering her calls, so I picked up the phone. The conversation had been brief.
“It's only me. Your sister was throwing up something dark this morning, and if you’re not doing anything, could you come over? Don't rush, but come anyway.”
“You called 911, right?” I’d asked.
“Yes, they're on the way. Take your time. Don't panic.”
So I hadn't, stifling the instinct to do so at her strange-sounding insistence that I should come anyway.
Day 1: The navel seems just the place for a way in to correct the womb.
I’d seen my sister three days before the day my mother called. She hadn’t said much, which I had noted, but brushed away because she was recovering from a painful operation. She was tired the entire time I was there, but she sat with us in the living room for a short while, during which I’d allowed myself to imagine we were having a conversation. The conversation consisted of me joking about how she looked like I had looked when I had my babies, like someone had dragged something heavy and alive out of her body, something that hadn’t really wanted to leave. She’d uttered a few words, which at the time I’d formed into a coherent sentence, but it was a sentence I could no longer remember. I’d given her that sentence and explained away how terrible she looked because I knew if she was in real danger, someone in the room would notice and do something to fix it. I was in the room and I’d explained her away in that manner. On the phone, I hadn’t insisted that my mother explain things clearly to me. She and I were not in the habit of long, fully wrought conversations anyway. I knew whatever was going on at the house, I’d have to figure out for myself when I arrived there.
Day 2: She’d had her navel pierced through, and was in a crouch, unable to straighten her back against the pull forward.
The things my mother couldn't tell me then: that the vomiting of dark stuff—blood, always a bad sign—had taken place the night before; that my sister had also passed blood through other orifices the night before; that two hours prior to calling me, she had been surprised at how heavy and almost helpless my sister had been, as she helped her get ready for her first post-op visit with the doctor; that when she had finally gotten her dressed, my sister had struggled into a sitting position, and immediately collapsed in her arms; that she had screamed for help and somehow she and my father had called the paramedics and watched numbly as they worked unsuccessfully to get her to breathe; that they'd taken her to the hospital, a suburban procession of police, fire engine, and EMT vehicle, with my middle sister seated in front, afraid to turn around, hoping that the sounds of air rushing in and out of medical equipment behind her meant our baby sister was fighting hard.
When I finally arrived at my parents' home, shock had settled quietly over everything. My parents were sitting in their living room. They hardly spoke. I thought maybe my sisters were upstairs, and hurried to check. Neither of my parents stopped me. In front of the bedroom, where I had last seen my recovering sister alive, was a small pool of blood, deep dark red. I retreated back down the stairs and asked, “Where are they?”
My father had answered: “They tried for a long time then they took her away, but they said don't be too hopeful.”
An hour or so later, my parents sat and listened as I spoke on the phone with my sister who had traveled along in the ambulance. Our conversation confirmed the paramedics' warning.
And that's how I discovered another way to enter the hospital. It was smaller than the other entrance, less welcoming, no balloons, quiet. My parents and I huddled there just inside looking for someone who could tell us where to go. Finally, the awkward question to a woman behind a desk: “My sister was brought here today. She had an emergency. We got a call that she didn't make it...”
The woman was sympathetic and walked with us through automated doors to another desk.
“What's your sister's name?”--another kind face.
“Oh I'm so sorry. They did all they could, but— She's in room one. Take all the time you want. Do you want us to call the Chaplain? Do you want tea, coffee, water?”
None of us wanted anything.
She had lain there, breathing tube still in her open mouth, eyes slightly open, her body covered with white sheets. One hand, perfectly manicured nails, visible. My mother closed her eyes and we pulled chairs around the bed and sat in them, aware that plans had to be made, though we were unsure what exactly. We sat for hours, sometimes whispering indecipherable things, taking turns holding the exposed hand. It was warm.
Day 3: Pain pills ground to a fine powder numb the womb.
“The other question important to this case (besides the question as to whether or not there was proper procedural care after the operation was completed), is did the doctor have knowledge that something went wrong once the patient was discharged and left for home?”
He shuffled less and less of the stack of papers as he zeroed in on the autopsy report again: The large intestine reveals a 1''x ½'' perforation over the anterior aspect of the rectum. The margins of this perforation reveal extensive necrosis, greenish/black discoloration, and thinning of the mucosa and serosa… He frowned as he read.
“She had to have been in a lot of pain based on this. Was she complaining a lot about pain?”
My father closed his eyes, and folded his arms. He knew what was coming next and waited for my mother to tell the generational female story about high tolerance for pain and suffering. It was a history of tolerance, his closed eyes and folded arms seemed to hope, would be mindful of where we were, in a lawyer's office seeking compensation for evidence of pain and suffering. This was no place to talk about tolerance for pain. My mother, nevertheless, dove into her family history, beginning (mercifully, only two generations back) with my grandmother, who raised five children, on her own mostly, while her husband did everything he could to make himself unemployable, despite his brilliance.
“And he beat her,” my mother said, as she looked at my sister and me for confirmation, “but she never complained as she sewed day and night for a living. She also never complained when she was in her fifties and arthritic, working long hours in a nursing home here in the United States to send money home to us in Guyana. And she never complained to anyone when she was an amputee in her eighties and dependent on us in ways she'd never ever wanted to be.”
My sister and I nodded confirmation of a tale we’d heard several times with more or less of the details our mother was now offering the lawyer.
I watched my father squeeze his eyes shut tighter as my mother moved on to her own story of suffering silently through an unjust regime in Guyana and through “marital difficulties” of her own. I too noted with some relief that she chose to limit her description of her marriage to “marital difficulties,” rather than tell the full version of how forgiving and patient she had been to ensure their many years of bliss. She ended that section of the story, and picked up the picture of my sister.
Day 4: When the womb is numbed, she notices that her niece, who had been a calm, murmuring baby a few months ago, is now an impatient little girl.
“She had highs and lows like anybody else,” she began, looking again at me and my sister for confirmation.
We joined in to help, but we mostly let her tell the lawyer the story she wanted to tell. Our versions of our sister’s story would have to wait. The story we helped her tell the lawyer was of a young woman who bore through the physical and emotional pain of endometriosis, and of the first surgery she'd had ten years earlier when we had seen the before and after pictures of her blood-splattered, scarred uterus, and of the years afterwards of efforts to control the returning splatter and scarring, in hopes that she'd be able to conceive and carry a baby to full term.
“She never complained,” my mother said, “because she confessed to me that all she wanted was one child, one child of her own, some day.”
My father said nothing. His eyes remained closed. And I wondered if like us, he wanted to remember her this way too, as a kind of victim of unfortunate circumstances, not how we knew she really was: a very decisive woman who refused to believe that the boyfriend she'd had for over ten years did not want to have children, and most likely wanted her to have the complete hysterectomy that would cure her painful disease for good. I knew my father had heard us trying to reason with her over the years to leave him and give herself a chance at motherhood, as the splatter returned and her scars hardened, sealing her fate. At any other time, he might have interrupted us with reminders of the parts we were excluding, but perhaps he felt (as I did) that though she had been stubborn in love and insistent about how she wanted to live, in this lawyer's office, her heart was not under assessment.
My father had kept his eyes closed too when we had gathered, this group plus the boyfriend, at the funeral home to make burial plans. That day we all wanted to shut out my sister’s boyfriend's ready answers to questions about her favorite color, the clothes she would be buried in, the names of her friends, the last title she held in her career as a Financial Analyst, where she played tennis on the weekends. They were all questions only he and my mother could answer. It was very apparent that we (me, my middle sister, and my father) hadn't known her that well for a long time. But we had put together a funeral service that included much of what had been familiar to us: tributes from childhood friends of hers, and from the principal of the high school she had attended in Guyana; a group of her former schoolmates singing their school hymn; my uncle singing a favorite hymn.
Day 5: She can’t digest watery soup.
I had written the eulogy, upon my mother’s request, and I had taken it on as I would any request to write something explanatory about a subject. I’d had enough experience as a writer and teacher to sense the things that would soothe the people I knew would fill the church and the funeral home, in disbelief at how suddenly my healthy, 39-year-old sister had died. Most of them had been unaware she’d had surgery ten days before she died. So I had chosen words I hoped would help them understand and make peace with their loss. I wrote about the way she’d played hard to win at everything, even at card and board games. I wrote about the way she danced and sang, as high-pitched and fierce and off-beat as she played those games with us. I wrote about career goals she’d set and attained and the steady sure pace at which she kept aiming higher. I wrote about how generous she had been with the money she earned. I used lines from Guyanese poet, Martin Carter, about measuring the stretch of years we share with loved ones. I wrote to make them laugh. I wrote to make them cry. I wrote to give them something memorable to carry back to their homes and the lives they would continue to live. But as I heard the words being read the day of her funeral, I realized I hadn’t written about my loss. I hadn’t written for me.
Day 6: She asks that her powered medicine be increased.
The lawyer picked up a fresh sharpened pencil and underlined a section of the paper in front of him. He had been nodding sympathetically as we spoke, and seized the mood to tell stories of his own.
“I know lawyers aren't supposed to talk about their cases, but without naming names, I have two cases that might help put this one in some perspective. One is the case of a neurosurgeon, in his early forties, highly regarded in his field, husband and father. He gets run over by an out-of-control car as he's standing in his driveway and dies after an hour or so of suffering from his injuries. Now figuring out the financial worth of that hour or so of pain and suffering made his wife and children and his lawyers very happy. Multimillion happy, I can tell you. And then there's the case of the elderly man, whose death had clearly been at the hands of a careless doctor, and whose survivors were offered only one million dollars in a settlement. His age and condition had dictated the amount of the settlement. He was in his seventies and not in the best health. My job, and the dictates of the court system in cases like this, would be to figure out where, between these two scenarios, your daughter's case would fit.”
He still only addressed our parents.
Day 7: She hears laughter and feels her sister’s kiss on her forehead. She knows her lips must register the shock of damp, cold, skin.
If he had asked me, I might have encouraged him to consider further. He looked encourageable, so to speak. His thick, blond curls were set far back on his head, creating a rather pleasant high forehead, rather than the early stages of balding that it most likely was. He had apologized for his manner of dressing, but he appeared neat and approachable, his body lean and relaxed in what he wore. I wondered if he thought race had any additional or maybe even primary sway in how the settlements in each case were decided. I wondered what he wasn't saying, but probably thinking, about my sister's race. She was a black woman who never looked like what she was. At 5' 5” and petite, she would probably never have struck him, or many people, to be fair, as someone who earned a six-figure income as an executive at one of New Jersey’s major financial institutions. She'd complained often about having to fight to be taken seriously by people who only saw her color before and sometimes even after they read her résumé. I wondered what he wasn’t saying about the value of my unmarried, childless, non-white sister's 39 years, 15 or so dedicated to a very successful career, and all of them dedicated to being an important part of a circle of family and friends. I sought for words to encourage him to compare my sister’s pain and suffering out loud (in wrongful death settlement figures) with that of the white male neurosurgeon with wife and kids, or with that of the elderly white male, also with wife and kids. What would be the comparative worth if all—male neurosurgeon with dependents, elderly man with dependents, female executive—were white? What would be the comparative worth if all three were black, or belonged to some other non-white (American-categorized) group? The court's number system is not blind to age, occupation, or marital status, so one has to suppose it also isn’t blind to race and gender. I couldn’t find the words to encourage him to give us those comparisons, and he didn’t offer them. But that day, as we, black immigrant family, sat around the civil table that was a representation of the American justice system, and listened to the lawyer's presentation, we knew, though race and gender were not included in his story about numbers and pain and suffering, they hovered over unsatisfyingly.
The lawyer intently circled and re-circled three items in front of him. He dotted them with his pencil as he spoke.
“These three phone calls she made to the doctor, and the one someone else made to the doctor on her behalf the day before she died, may or may not be enough to convince a judge or jury that she was reaching out to her doctor, that she was in lots of pain and wanted the doctor to be aware of it.”
The three phone calls, which added up to about 15 minutes of reaching out to the doctor, were other numbers to be considered in the analysis of pain and suffering.
“Why,” he wanted to know, “weren't there more calls to the doctor? Why wasn't there a trip to the emergency room? See those are the questions an impartial judge or jury may well ask.”
His questions resounded unanswered in the room.
Day 8: She tries calling her doctor to ask about the heaviness.
Our meeting with him ended shortly afterward, and he promised to send us a letter with his decision whether or not to take the case.
We gathered outside in the parking lot, uncertain. My mother ventured a timid positive spin on things.
“He was friendly and seemed concerned, wasn't he?”
My father promptly reminded her of the painfully obvious unanswered question: “You sure you brought all the phone records you had?”
“Don't worry,” my sister was eager to see things positively too, “He knows what he's doing. That's the way he has to play it, you know-- ask the tough questions in preparation for what the doctor and her side will say or ask. She'll probably say she didn't get any call that sounded serious enough to think it was an emergency situation.”
We hugged and went our separate ways to wait for the lawyer’s letter.
Day 9: As her sister cleans her navel, she asks her to pray with her.
In “How to Tell a True War Story,” (The Things They Carried), Tim O’Brien tells the story of a buddy in Vietnam who wrote a letter to the sister of his dead friend. In the letter, the grieving man puts together a portrait of a man who was brave and adventurous, and a man he loved like a soulmate. He mailed the letter and waited two months, we’re told, before he realized the “dumb cooze” wasn’t going to write back. Out of the horror of sudden death, frustration, and loss, the man had built a portrait that was complex and complete with pathos and ethos, a tribute to a loved one that had gone unappreciated, unrecognized by someone he thought would care. Like all the war stories in The Things They Carried, this story is emotionally raw and deliberate in its layering, and additionally tells of the tortured shooting of a baby buffalo to death by the bereaved friend, and O’Brien’s public reading of the story, after which a woman tells him it made her sad, and advises him to put it all behind him, find new stories to tell. He insists though, that it wasn’t a war story; it was a love story, and in the end, a true war story is never about war; it’s about love and memory and sorrow, and about sisters who never write back and people who never listen. Of all the stories I’d read and taught over the years, that story from The Things They Carried haunted the days I waited for the lawyer’s letter.
Two weeks after we met with him, my mother received a letter from the lawyer. She waited a full day before she opened and read it. She called me shortly after reading it to talk about my sister’s estate—her house, her bank accounts and investments, her car, her walk-in closet full of clothes and shoes—and what she planned to do with it all. She’d had two weeks to think about it, she said, and it was time to move on. I asked her to read the letter, and she read what had been written for me, for her, for my sister, and for my father. The lawyer had efficiently identified the persons he felt should be held responsible for the unchecked flow of emptying that had occurred, once my sister’s body had been punctured.
I'm sorry for the delay in contacting you about the case. I met with you, your daughters and husband in our office after we had received and reviewed the records concerning your daughter’s death, and the autopsy disclosed that the deceased suffered a perforated rectum that appears to have been the cause of her passing. One of the key questions we had to answer when evaluating our possible chances of success was whether we could prove that the doctor knew or should have known about the perforation. Based upon our experience in such matters, the central question is not the fact that the perforation occurred—that is not an issue of negligence / malpractice in this type of surgery—but rather the real question is whether the discovery of the perforation and its consequences was in a prompt and timely fashion. What we learned is that once the deceased was discharged in apparently good condition we have no proof at all that the doctor was aware of an ongoing problem until it was too late. We would have to prove that the doctor was negligent in not acting reasonably when faced with complaints or problems after the surgery. We do not see that proof in any record nor can anyone provide details about the conversations with the doctor’s office. We know there were brief calls made to the office number but have no clear knowledge or proof that the doctor was actually on the phone, who was spoken with or even what was said. It is our burden to prove our case, not the burden of the defense to disprove our allegations. Without some strong proof of the doctor’s negligence, we will not invest our resources of time and money in a case in which the risk of loss is great.
The lawyer’s words, his version of things, were dismissive and decisive and they were being added to the things we would have to carry for the rest of our lives, whether or not we wanted to. The story, the version I knew I had to write, this one, would have to help me make peace with indecision and inattentiveness. It would have to help me learn to carry those things with some ease.
Day 10: She tells her sister she would not be there when she returned home from her errands. She needs her mother’s help to get fully dressed for where she’s going. She tells her mother not to forget deodorant, thirty-five times under each arm.
My mother told me this about what happened when she showed my father the letter. She said he skimmed its contents without bothering to turn off the TV. She remembered that Clint Eastwood’s voice was steady and intimidating as he read the letter. Once he was done reading, he turned off the TV and told her to come take a ride with him. She was surprised but got dressed and her heartbeat quickened when he pulled up outside the local flower shop. He went inside and came back with three dozen roses, yellow, white, and pink. At my sister’s gravesite, they didn’t speak much, but took their time shedding yellow and pink petals. She said when she reached for the last white dozen, he stopped her and said, “I’m not sure it’s the right color, but I chose white for you, for companionship.”
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