By Timothy Yang
In the evening, my parents took Tommy and Charlie home for dinner. They left quietly, looking at their crooked steps and dragging their feet in the way tired little children do as I walked them to the entrance and buzzed them out with my staff card. At the anteroom, they de-gowned and pulled off their disposable caps, no longer laughing at their hat hair or splashing water at each other as they once did. I thanked my waiting parents for their help and support and imagined as much as they wanted to stay, they were glad to leave.
Grief was exhausting.
They disappeared through the Intensive Care Unit's doors and I stood a while, watching as the doors swung shut behind them, suddenly overcome with fatigue. Go have a drink first, or a bite, she would have said. You can't take care of others if you don't take care of yourself.
I caught myself slouching and felt her hand lightly on the small of my back. Straightened and took a deep breath. I could eat and drink later, because right now, every moment was precious. I turned around and walked back through the ICU, past the dozens of critically ill patients. I knew each of them, admitted some myself. Intubated them, put the lines in. The bed in the corner where the sickest patient in the unit lay was surrounded by display panels that monitored every vital sign. Heart rate, blood pressure, mean arterial blood pressure, oxygen saturation, cardiac rhythm, end-tidal carbon dioxide. On and on. The parade of constantly fluctuating numbers had bewildered and boggled her parents and mine, but to me they were my mother tongue.
They say some intensive care doctors have god complexes, acting as the gatekeepers and arbiters of life and death. I had no such illusions. I felt more like Charon, the boatman on the river Styx, escorting the dying to their final destination. In a good week, I'd watch one or two people die. On the bad weeks —
No one lives forever.
My wife's thin, pale form slumbered under a tangle of tubes and wires that kept her alive. There were lines for giving medication and fluid, lines for nutrients, for dialysis, for urine. And the biggest lines of all, as thick as my thumb, the extracorporeal membrane oxygenation (ECMO) circuit. The pump hummed at the foot of her bed, receiving her blood, blending oxygen into it and pumping it back into her body. The line shuddered like my voice had when I had tried to explain it to our family. An artificial heart and lung, one of the greatest medical breakthroughs, was a double-edged sword. With it, we could keep her alive despite the massive heart failure, but at an ever-increasing risk of bleeding due to the blood thinners required to prevent clots in the machine, and the number one killer in ICU, infection.
Don't break my heart, she'd joke. It's fragile. I would roll my eyes. Heard it all before.
I sat in the plastic chair next to her bed and held her hand. The nurses gave me a considerate amount of space, going about their tasks quietly. The most recent news had been grave. Although my wife was near the top of the transplant list, there was no guarantee that she would be the right match, or if there would even be a heart available. Time was slipping through our fingers, faster and faster the harder we held onto it. And we were gripping on for dear life. For now she remained a prisoner in her trapped flesh, in a state of suspended animation, her eyes closed peacefully in a propofol dream. I wondered what she dreamt about.
I dreamt about an ocean, and waves that lapped at my feet as I sat on a secluded beach. The sand ran through my clenched fist and the wind whipped up the fine grains and dragged them inland, over the trees that lined the shore. A kite soared high over me, a shimmering, multicoloured phoenix across the blue sky. It dipped suddenly, disappeared into some trees. An exclamation of disappointment drifted across the wind. A girl stood under a tree, looking up at her kite tangled in the branches, out of her reach. She was luminous in her summer dress and glowed with sweat, her face flushed, breathing hard.
She pouted as I approached. The wind stopped.
I climbed up to free the kite. I admired it as I got closer. It was homemade, beautifully crafted, a painted, fragile thing of paper and bent bamboo, looking like it would shatter under the slightest stress. It was sheer luck that it was still in one piece. I carefully worked it free, untangled the kite string, and made my way down to the girl who would become my wife.
Did you make this yourself, I asked. It's gorgeous.
She blushed and held out the kite to me. I'm a little tired, she said, and a bit out of breath.
Could you fly it for me?
I took it from her. I've never flown a kite before.
It's easy, I'll teach you how to.
The funeral was well attended. We followed the plans she had made in advance, used the colourful crepe-paper flowers she had crafted herself in those last weeks as she laid in the hospital bed. Before she got truly sick. Before she went into ICU. Over 200 people turned up. Family, friends, colleagues, church friends. People I had never met, from the parent-teacher association in Tommy and Charlie's kindergarten. Old friends flew in from out of town by the bus-load. Everyone wore white or colourful wear, as she had specified. In front of a rainbow backdrop, the church band played a selection of her favourite worship songs, lively and uptempo. People took turns to go up and share stories of how she had touched their lives in small, real ways. The queue stretched to the back of the church. The refugee ladies she was working with at the centre cooked up a storm, an international feast of curries and naans and briyani and fried noodles. Her friends made a video tribute to her, stitching together the best videos and photos gleaned from her social media. Some of the moments were so funny, they made me laugh so hard that I wanted to cry.
I was exhausted from playing host, running around making sure everyone was fed and comfortable, my hand numb from shaking hands, face numb from the smile plastered to my face. Playing host was more her thing. She would have enjoyed it.
For a while after the funeral, her parents and mine were always over at our place. It was as if they didn't want to leave us to bear our pain alone, but perhaps I was being selfish in thinking that it was all for me and the boys to bear. After all, they shed as many tears as we had, and her parents knew her much longer than I did. So I welcomed them in, grateful for the hustle and bustle of guests, the facsimile of life they brought into our home.
Perhaps being in our house, her home, was soothing to them, being surrounded by the things she had touched. The people she loved. Her indelible presence through her paintings, her impeccable taste in decor, the craft flowers, the stuffed toys she sewed.
When our parents came over, we always talked about everything except her, as if our patter could fill the vacant seat next to mine at the dining table. We would talk about their vacations, recent and upcoming, our neighbours, my job, my colleagues. After I put the boys to sleep, we would continue our orbit around the periphery of polite conversation. The economy, the political unrest, the protests, the property prices. But like the inexorable pull of gravity, like a star that collapsed and left behind a black hole, she would draw us in. Someone would slip and we would eventually end up talking about her in the end. Our memories of her. Our projections of her, what she would have said, or liked, or done. Then we'd look at the empty chair at the dining table, and the conversation would trickle away. Someone would excuse themselves to go to the bathroom. Eyes would redden. Then they would leave as quickly as they came, suddenly overwhelmed by her conspicuous absence.
In those quiet, hollow moments after everyone had left the apartment, I could hear Tommy sob in his room. I slumped against the wall outside his room, sitting in the corridor, listening to the quiet sobbing. Charlie was just three and from time to time would still ask when Mummy was coming back. But Tommy was almost six. He would remember, he understood. I desperately wanted to go in and hug him like I had done in the early days. But I hung back now, knowing from experience that our sorrow would just feed off each other's, resonate and grow stronger and more keening, until we'd both still be weeping when the sun rose. My wife and I had both spoken to him at length about death and grieving, together and separately. He knew the theory, but putting it to practice was a different beast. There was nothing more I could say to make him feel better, to process it. Only time would smoothen those jagged edges.
Absolutely not, I had said. It's far too dangerous. I didn't even want to think about having a child. But she was adamant. Stubborn in that persistent, persevering way.
I listed the complications of childbirth. Clots in her legs and lungs. Infections. Massive blood loss. I got to how the deranged physiology might affect her heart, make her condition worse, cause cardiomegaly.
You mean my heart might get even bigger?
That's not a good thing, I reminded her. It's irreversible. You could die. Call me selfish, but I want to keep you alive for myself.
I'm not afraid of death.
She stroked the hair out of my face. I want to make something from our love. To build something from the tissue of our relationship.
She had wanted to craft life within her and she knew the risks.
And I knew the risks of loving her.
Her laughter was a warm spring rain. Besides, that's why I married a doctor, I get the best healthcare.
We would run realistic simulations in the ICU, using mannequins, practising for the crisis scenarios. In the same way, I had imagined her death so many times in my mind I felt numb. Empty. A husk, drained and bereft of any emotion, going through the motions and the days. I thought I might feel a sense of relief if she died — but I caught those selfish thoughts, strangled them in the cradle. I thought I would be ready when the time came.
My wife had sat with the boys, doing craft together after their homework. Finger painting and fruit painting for Charlie, while she taught Tommy how to use the scissors, guiding his hands, cutting, pasting, folding. A paper globe, a carefully folded sphere of paper, sat on the mantle shelf in the living room, below the framed phoenix kite. It had been their last project together, before she got admitted to the hospital. Next to the globe was the urn that cupped her ashes in its unassuming whiteness. Tommy insisted we put the urn there. Mommy was my world, he said.
Nothing prepared me for the surgeon's frantic voice on the phone, asking me to rush into the operating theatre. When I arrived in the OT, the surgeons were closing her chest already, tugging her sternum together with wire — an action that looked all too violent and rough, out of place in the delicate precision that was heart surgery. The anaesthesiologist stood by, silently giving me space to crouch beside the head of the bed, cradling my wife's icy cold head next to mine, her eyes taped shut. My tears streamed down my face and dripped onto hers. I felt myself sobbing and heaving and for a long time I couldn't find the strength in my legs to stand.
A week before she died, they extubated her on my request. It was a selfish one, even though the ECMO was providing enough oxygen, she'd be in pain, breathless and suffering off the ventilator.
Just for a few minutes, I said. Please. It may be the last time I ever talk to her.
They weaned her off the sedation overnight and in the morning she woke up, as if she was waking from a deep sleep. I held her hand as she regained consciousness, felt her stir.
She smiled at me and for a moment it seemed like she was well again. Like she wasn't in ICU, like she wasn't dying. That it was all just a dream. It was just the two of us, but now there was no one to correct my memory if I remembered wrongly.
Good morning, I said. I love you.
I love you, too, she said. Where are the boys?
I was feeling selfish, I wanted you to myself.
She closed her eyes and took a painful breath. When I die, I want you to scatter my ashes at sea. I want to be free.
The machines bleeped around her, filling the silence between us. The tubes and wires across her bed suddenly looked like tenuous restraints holding her luminosity to the dirt.
I shook my head. You're not going to die. You'll be just fine.
She smiled again, weakly. Liar. Then she gripped my hand, as tight as she could. It'll be okay. It'll always be okay in the end. No one lives forever.
We had been together six months, longer than she had been with any other boy and I had been with any girl, when she told me, in my college dorm room. I was practising for my final medical school clinical exams and she agreed to be a mock patient. Using the engraved stethoscope she had given me, I auscultated her heart and heard an ominous whooshing instead of the reassuring thumps. A ticking time bomb of suffering. Seeing the concern on my face, she unbuttoned the top few buttons of her blouse to show me the mound of keloid on her chest, a story of multiple cardiac operations. I didn't need imaging to tell me that her heart was a mass of scar tissue, an operative minefield fraught with risk. A visual reminder of her expiry date.
Tears welled up in her eyes. She wouldn't blame me if I left, and of all the boys she had dated, I would have best understood the price I would have to pay for loving her.
I drew her in tight and closed the blouse over her scar, like a curtain over the show. She was right, of course. I understood the agonising calculus better than anyone. I was also the most equipped to deal with it. It would become my job.
We got married six months later.
When my wife was first admitted into the ICU I worked at, I promised my boss I wouldn't treat her. I would let them do their job and wouldn't get in the way. It was an easy decision for me because I didn't want to be her doctor, I wanted to be her husband. My boss put her hand on my shoulder and squeezed. Don't take it on yourself to explain everything to your family. Let us do it, she said.
I was grateful for that arrangement, standing mutely to the side as my colleague explained to my family that there was a clot in the ECMO circuit. At any point of time it could dislodge and travel to other organs, causing a stroke, an ischemic limb that might need to be amputated. Ischemic means dead, I said. No blood. Their plan was to increase the dose of heparin, an anticoagulant, in a bid to dissolve the clot. But that would increase the risk of bleeding, he said.
Not a day later, my wife's blood pressure dropped precipitously. She started bleeding around the heart, along the raw surfaces where they had operated. A pericardial tamponade. The blood was collecting in the sac that holds the heart and like a fist it was squeezing the heart and stopping it from pumping properly. The surgeon told us they were going to bring her into the operating theatre again to try and stop the bleeding and drain the blood around the heart. She looked grave as she explained the risks to us.
Then she paused. One alternative, she said hesitantly, would be to let her go in peace. We may be at the end of the line here.
I was not a novice — I knew that hesitation meant they were almost certain this was it. But they also knew who I was, and who she was to me. And they were extending this hand for my sake. I touched my wife's cheek. This was a calculation I had simulated in my mind many times over. Wondered what my wife would have wanted — then remembered that she had made a choice to marry me, to give birth to the boys, to craft something out of the tissues of her life, despite the risks.
Hope, like the wind, can be an awful thing.
I lifted up the boys and held them to give her a kiss on the cheek. They were angels, so careful not to dislodge any of the many tubes. See you very soon, mummy, they said. Get well soon.
Like pallbearers, the three of us followed the small procession of porters, nurses and doctors who carefully escorted my wife through the ICU and across the corridor to the operating theatre. We stood waving at the nurses and doctors and my wife as the operating theatre doors slid shut behind her.
She unwrapped the anniversary present and looked surprised, then thanked me carefully.
I must have looked a little hurt because she immediately softened and said, it's the thought that counts.
You don't like it?
A kite should belong in the sky, not framed up.
I looked at the tattered kite, its wings patched over, frame replaced by new bamboo. It'll eventually break irreparably. The colours will fade. And what if we lose it?
Then we make a new one.
But this one is special. It's sentimental.
She touched my hand. Only as much as we attribute to it. She brought my hand to her heart.
The real kite will always be in here.
We hung the framed kite on the wall. Told stories about it when we hosted guests.
Peeling off the scrubs in the locker room through tear-blurred eyes was like a dam crumbling down. A wave of emotion surged through me and through my fists. In the maelstrom I identified sadness, anger, helplessness — amongst others that I had tamped down for too long while I played the good soldier and good husband and good father. For a moment, I didn't want to be good anymore. I screamed and punched and kicked, a mad-man denting the locker doors, angry at God, angry at her for leaving, angry at myself for my selfishness, my weakness, for — I didn't know what for. I still don't. I imagined what she would have said if she saw me in this state. She would have been aghast. I looked at my bloody fists, and the carnage and property damage I had wrought, then I just felt enraged at myself for losing control, ashamed even.
A month after she died, I transferred out of the ICU and found a training post in psychiatry. I would have to start all over from the beginning but the hours would let me spend more time with the boys.
That's a big change, my boss said, as she signed my papers at the nursing station.
That's the point, I said, looking at the bed in the corner. There was another patient in it. Nurses buzzed around them, flies over a carcass. You need to have a certain cynicism about death to be a good intensivist, to be able to make clear-headed decisions about resource allocation. Like how a woman with an essentially terminal diagnosis and multiple previous heart operations should never even have been on ECMO in the first place, should never had those re-operations. It had been selfish of me. I couldn't be Charon any more.
I found myself staring at the urn sitting on the mantle shelf, semi-regretting not keeping her wish. But I didn't have the heart to tell Tommy, not yet. I had confided with our parents her last wish, then immediately regretted that I had brought it up. They baulked. Had so many reservations. It didn't seem right, to them, to let her memory go like that. Discarded like trash, tossed away. Fluttering across the sea, a free kite in the wind. It was hard to explain to them. That letting her go didn't mean losing her. That even without her ashes sitting on the shelf, she would never let us go, either. I wished I had someone else to explain it for me, that they didn't look to me as the authority on grieving her. In the end, I decided to let it be for now. The boys, Tommy especially, needed her more than she needed to be free. She might hate it, but she would understand.
I was free on the weekend. I should bring the boys to fly kites.QLRS Vol. 21 No. 1 Jan 2022