By Elizabeth Hanson

Non-fiction Award Winner

The Past:  An Intro to The Beginning.

“We can’t allow more than two people in,” she says.  “And you can only be inside for thirty minutes.  That’s the absolute most.  It’s the policy for the radiation rooms.  Only family is allowed inside.”

I look nervously at Dad as we follow the nurse down the narrow hallway until we reach a door with a “No Visitors” sign.

“I’m his son-in-law, and she’s his granddaughter,” Dad says. 

“Mmhmm, yes, I know,” the nurse replies.  She opens the door.  Inside I see Poppa resting in bed under a pile of white hospital sheets.  “He had his radiation pellets placed yesterday and there’s a small drain coming out of his left leg.  Please don’t touch it.  If you’re not out in thirty minutes someone will come get you.  It’s the policy, you know.”  She leaves.

“Poppa!”  He opens his eyes and the corners of his mouth turn up in a smile.  I wonder if he knows who I am, I think.  Mom said some days he remembers and some days he doesn’t.  Because of the medicines and the dementia. 

“Hi Dad!” my dad says.  “We brought pictures!  You remember Beth, right?  She’s about to start high school in a few months!”  Poppa winks at me but doesn’t say anything.  He doesn’t remember me today, I think.  Dad opens his laptop and clicks the “April 2007” folder.  We scroll through photos, reminding Poppa of names that match the faces, sharing bits of joy we have had this spring while he has been isolated, waiting for the radiation pellets to destroy the tumor in his thigh.  

After exactly thirty minutes the nurse knocks sharply.  “Your time is up.  We cannot allow extra time in the radiation rooms.  It’s the policy, you know.”  

We nod, kiss Poppa goodbye, and then drive home in the dark, our cheerful chatter blanketed by the somber silence between us.

*          *          *

The Present:  Day 1.

At 3:45 a.m. on December 16^th, 2019 my alarm goes off.  It’s the first day of my ICU rotation and despite being an emergency medicine resident I feel unprepared.  I fumble with my phone, trying to silence the annoying chimes but this only makes it worse.  Gahhh why won’t it stop?!  I somehow find the right combination of buttons and my bedroom is quiet again.  The cold air that meets my skin when I slide my legs out from under the covers makes me cringe.  I stumble through the dark until I find a pair of scrubs.

 The moon is shining brightly when I enter the ICU workroom at 4:15 a.m.  It’s empty.  Night team must be napping in the call room, I think.  I log on to a computer and open the patient list.  I don’t know who I’ll be assigned to so I click on the first chart.  I unscrew the top of my coffee mug, burning my tongue when I take a sip.  The first drops of caffeine warm the receptors in my brain and by 4:19 a.m. I have officially started my day.

*          *          *

The Past:  The Beginning.

It’s hot on the field, even though it’s November.  Beads of sweat drip down my neck, turning my jersey from blue to navy.  My teammate makes a run down the far side of the field.  I sprint down the sideline, jostling elbows with a defender.  I veer toward the goal as our midfielder drills the ball to my feet.  In two quick taps I pass it to another teammate who lines it up for a shot.  With a loud smack! her cleat makes contact, and it soars toward the upper corner of the goal, slamming into the back of the net.  For a moment the field is silent.  The sweat rolling down my back freezes in time.  The referee’s whistle cuts through the air.  We realize we have won and there is an eruption of cheers.

Afterwards, we shake hands.  We hold a plaque that reads, “2007 North Carolina State Cup Champions.”  Our parents force us into neat rows for pictures.  My mom, however, is strangely absent.  I escape the photo mob and find her a short distance away, with her cell phone to her ear.  She hangs up when I approach and immediately I know something is wrong.  Oh no, who died? 

She wipes her eyes on her sleeve.  “It’s Poppa,” she says.  “They had to amputate his leg.”

*          *          *

The Present:  The Remainder of Day 1.

The night residents come into the workroom at 6:50 a.m.  “You’re here early,” the tall male says.  

“Yeah,” I reply.  “First day, thought I’d need extra time to chart review and figure out how things work.”

“Oh gotcha.” He yawns, rubbing gunk from his eyes.  “You can take Reeves, Stiles, and Landon.  Reeves has kidney disease and got admitted for hyperkalemia.  We treated it.  She’s transferring out today.  Stiles has a history of GI bleeds and came in with another one.  He’s stable, getting a scope later.  Landon is this 71 year old guy with chronic pulmonary disease who’s been here for almost a week because he keeps taking off his bipap and desatting so he’s never stable enough to go to the floor.”

“Sounds good!” I say.  I scour the charts of my patients, trying to understand why they are sick, which meds they take, how we will fix them. 

I stop by Mrs. Reeves’ and Mr. Stiles’ rooms first.  They were stable overnight, and their nurses have nothing to report.  I introduce myself and move on.  Mr. Landon’s room is the last of the row.  I peer through his glass window.  For some reason I had imagined Mr. Landon as a thin, frail old man, with a scraggly white beard.  Instead what I see is a large round man with a bald head and beady black eyes.  A bipap mask is strapped to his face and there are soft wrist restraints hanging loosely from the bedrails.  He is naked from the waist up and his unbuttoned hospital gown is pooled in his lap.  Sweat glistens on his chest.  His swollen feet stick out from his blanket at the end of the bed and his sausage fingers are wrapped tightly around the bed rails, almost as if he is holding back from attacking.  Why does he look so angry? I wonder.  He turns his gaze toward me like I am his prey, like he is some kind of caged animal preparing to pounce. 

“He’s had it on for two hours.”  

I whirl around, startled by the nurse who has snuck up behind me.  “I’m sorry?”  I say. 

“The bipap mask.”  She places her hand on her hip.  “Aren’t you the resident taking care of him?”

“Yes.  Sorry.  First day.”

“Hmm,” she says.  “Well he’s supposed to wear it all night but he takes it off and I have to go in there and tell him to put it back on.  Then he refuses, his oxygen drops, and he gets hypoxic and lethargic and that’s basically the only way I can get it back on.  It’s a cycle.  Good luck.”  She walks away.

I face Mr. Landon.  He huffs into his bipap mask and grips the bed rails tighter, eyes drilling holes through the glass.  First day is always the roughest, I pep talk myself.  I step into his room.

*          *          *

The Past:  The Remainder of the Beginning.

“Grandma found him,” Mom says when we are safe in the privacy of our car after the game, “earlier today, when she got home from church.  He was on the ground so she called 9-1-1.  She said the doctors told her his femoral artery burst.  They think the radiation earlier this year weakened it.”

This isn’t real, I think. “So is he okay?  You said they had to amputate his leg.  Does that mean his whole leg?”

“Yes,” mom replies. “I guess by the time Grandma found him he had bled too much.  They couldn’t save it.”  She sniffs. 

He’ll never walk again, I think.  Pine trees fly by my window but the only thing I see is a scene in which Poppa is lying on the floor turning pale, waiting helplessly for someone to come.  We have three hours left, so I close my eyes and hope that the image will erase itself by the time we arrive home.

*          *          *

The Present:  Day 12.

His nurse is right, I think, getting him to wear his bipap consistently is impossible.  It is my twelfth day with Mr. Landon and we haven’t made any progress.  His oxygen is too low, his carbon dioxide is too high.  Just as I am about to sip my coffee a nurse shoves open the workroom door.  “You!” she shouts.  “Mr. Landon took off his mask again.  He’s at 80%.  You need to do something!”  Why can’t you talk him off his ledge? I think bitterly. 

“Have you tried talking to him?” I ask.

“Yes but he won’t listen!”

“You have to bargain with him.  It doesn’t make sense but it works sometimes,” I reply, thinking about how Mr. Landon had put his mask on last week after I agreed to personally bring him an orange juice. 

“Just do something!”  The door slams before I can respond. 

Perfect.  I set my mug back down, not bothering to replace the lid, and walk to Mr. Landon’s room.  Sure enough the bipap mask is on his rotund lap and he is staring at the nurse who had aggressively yelled at me to fix a seemingly unfixable problem.  I inhale deeply.  This is, unfortunately, not an unfamiliar sight.  This scene has been on replay almost every morning.  I don’t have time for this.  I sigh out the breath I have been holding.  Be patient, it’ll be fine.  

“Mr. Landon, why did you take the mask off?” I ask in the least confrontational tone I can render.

“Because!”  He leans forward, the volume in his voice increasing.  “I don’t want to wear the stupid thing!”

“Is there a reason why you don’t want to?”  Why do I have to ask you this every single day?

“Because!  I don’t need it!  You people –” he sputters, gasps, “ – you people!”

I wait for him to finish but he doesn’t.  Instead, he points one fat finger at me and shakes it.  

“Ha!” he yells.  His eyes roam wildly between me and the nurse.  Do they look darker today?

“Sir your oxygen is very low.  We need you to wear that mask to help your oxygen level.”

“No!  I don’t need it!  There’s nothing wrong with me!” he yells.  The monitor starts beeping loudly.  The oxygen saturation blinks yellow.  80%…79%…78%.  “I won’t put it on!”

“Mr. Landon, it’s very important.  Can I please help you with it?” I am exasperated but I plead with him anyway.  The monitor beeps.  Oxygen hisses out of the mask on his lap. 

“No!” he yells back.  “You don’t even know what you’re doing!  You’re too young!  You’re probably not even a doctor!”

It strikes me like a blow to the gut.  I feel so belittled, and then so angry.  My eyes narrow.  I don’t have to help you, I think.  Heat burns in my chest.

“Tell me this,” he says, “why do you say my oxygen is low?  Prove it to me!”

I inhale again, trying to stop the anger from growing into rage.  I point to the flashing 78%.  “Because sir, this number shows us your oxygen and it’s dangerously low.” 

“I don’t believe you!  You…can’t…prove it!” he huffs, spittle flying from his giant mouth.  I am tired of this game, this ritual, this argument.  I am tired of trying to prove science to someone who accuses me of knowing nothing.  Fine! I think.  If you won’t leave it on you’re just going to die and it will be your own fault!   I regret the thought immediately.  The sparks inside me dwindle.  My shoulders hunch.  I give in to his fight.

“Mr. Landon.  Please,” I beg.  “I know you don’t think it’s important.  But it is.  I don’t know how else to convince you. Please.  I’m trying to help.”

“Fine!” he snaps.  “But turn my bed toward the monitor so I can see it better.  I still don’t believe you!”  Where has your mind gone? I wonder, strapping on his mask.  Hypoxia induced confusion or have you left and been replaced with this beast of a man?  78%…79%…80%…I wait until the number reaches 93% and then I leave, knowing that we’ll do this all over again tomorrow.  I feel so defeated.  Only eleven hours left today.  I sit down at my computer and pick up my mug.  This time when I take a sip it doesn’t burn.

*          *          *

The Past:  The Middle.

“There are no eggs hidden beyond Grandma and Poppa’s backyard bushes.  There will be no stealing anyone else’s eggs.  There will be no re-locating other teams’ eggs.  There will be–”

“I have a question,” cousin Mark raises his hand interrupting Uncle Jack who is doing the annual “Reading of the Rules” before our 2008 Family Easter Egg Hunt.  Mark’s Easter basket is upside down on his head.  “Can you just clarify which bushes are the ones we can’t go past?”

 “Mark!” we whine.  “Stop being a dummy, we’ll never start!”

“The bushes with the pointy leaves.”  Uncle Jack continues, “Lastly.  There will be no crying.  If you have a problem take it up with Aunt Amy.  Ready?  Go!”

We sprint down the stairs into the backyard.  Our Aunts and Uncles stand with Grandma on the deck, laughing at how silly we look diving under shrubs to find our eggs.  Poppa is in his wheelchair next to them smiling at the chaos below.  I wonder if he remembers how he used to hide the eggs, I think, snatching one from the bird bath.  I wonder which memories he has, which ones the dementia hasn’t taken yet. 

“Who do you think will be the first to start crying about something being unfair?” Aunt Amy jokes from above.  

“Oh Amy!” Grandma giggles, and then she pushes Poppa back inside. 

An hour later my cousins and I are piled on top of each other on the couch in the living room.  The adults are in the kitchen warming up green beans and slicing the ham we’re about to eat.  Except for Poppa.  Poppa has joined us.  He sits a few feet away in his wheelchair.  One leg swings over the ground.  The other is an invisible stump beneath his shorts.  He watches without speaking.  Even before the dementia and amputation Poppa was a quiet man.  He never had many words.  Most often he said what he needed to with his sweet smiles, soft blue eyes, and notorious wink.  In this moment, however, his face is blank.  I wonder if he thinks we’re his children in the living room where they grew up.  Like déjà vu, only a reality for him.  Maybe he–

“Let me try!” Mark reaches for the Rubix cube that I am mindlessly turning in my hand and I jerk it away.  He scrambles over Courtney, who has wiggled her way between us.  

“Ooof,” Courtney grunts.

“No, Mark, wait!” I shield my face with my free arm as he dives on top of me.

“Hey!  HEY!  Get off of her!”  Poppa’s voice, stern and loud, slices through the air and we are thrown into silence.  Even the clattering of pots and pans from the kitchen ceases.

Poppa has wheeled himself closer to the couch.  One hand is outstretched, pointing at us.  The blank stare is gone and his blue eyes are burning, firing beams into Mark.  He never yells like that, I think.  He’s quiet, even when he’s angry.  Where did this come from?  Who is this man?  His accusing finger hangs in the air and an image floats across my mind:  Poppa, downstairs in the basement by the window, sitting across from his easel, holding out a thin brown paintbrush, feet planted, back straight, rays of sunlight across his lap, examining his canvas.  There is a National Geographic Magazine and a watercolor pallet on the table beside him.  The magazine is open to a picture of a lion and he has sketched an identical image on his canvas.  He brushes paint gently back and forth, smooth and steady.  I watch him as his lion comes to life.

“It’s okay Poppa,” Courtney’s voice brings me back.  “He didn’t hurt us.  He was just playing.”

Someone turns on the sink in the kitchen.  A spoon clinks on the counter.  The oven opens, then closes.  Mark crawls back to the corner seat.  Poppa relaxes back into his wheelchair.  His trembling hand falls to his lap.  The intensity sizzles out of his eyes.  They dull beneath his lids.  The blank stare returns.  The sticky smell of honey glazed ham drifts into the room, and then we are all sitting around a long table and I am wondering where Poppa has gone in his mind, and marveling at how we are passing sweet potatoes and green beans and ham to and fro like nothing ever happened.

*          *          *

The Present:  Day 17.

My alarm shrieks and I open my eyes on New Year’s Day thinking about how Mr. Landon has probably already started plotting against me.  I sigh.  There’s a text message notification from my mom.  I miss her.  I miss all of my family.  For the first time in 26 years I didn’t spend the holidays with them.  I’m sure her text says something about how they miss me too, but I don’t even have the energy to read it.  I swipe the notification away. 

The walk from the parking lot to the hospital entrance feels colder than usual, and I realize it has been days since I’ve seen the sun.  Arrive before the sun comes up, leave after it goes down.  I just want this day to end already.  Go back home, sleep.  Start over.  Wake up to a good day for once.  I enter the ICU.

Instead of waiting for his nurse to frantically come find me, I go straight to Mr. Landon’s room.  Might as well get it over with.  To my surprise he is sitting calmly in his bed, leaning against the pillow behind him.  His gown is unbuttoned and, as usual, has slid down his massive chest.  But this morning he isn’t gripping the bed rails, and there is no one else in the room to yell at.  He has a nasal cannula in place.  He isn’t even attempting to pull it out.  Tame today, I think.  Maybe it won’t be as bad as I thought.  I approach the glass door and he gradually turns his head until his dark eyes meet mine.  An eerie feeling seeps into my skin.  It’s like he knows something I don’t.

“Good morning Mr. Landon,” I say, sliding open his door.  “How are you feeling?”

“Oh you know,” he says.  He slows his speech, intentionally enunciating each word.  “Same as you, really.  Just as bad as yesterday.”  

I am taken aback.  I don’t know what to say.  He stares deeper into my eyes before I can divert them away.  I am paralyzed.  Can he see it on my face?  Is it that obvious?  I swallow the lump in my throat.  My legs quiver.  I don’t know how to break his trance so I reach for my stethoscope and cautiously place it on his chest with a shaky hand.  His heart is thumping.  Or maybe that’s mine, I think.  How does he know?  I feel like I am going to melt, like the anger and stress and exhaustion that have been holding me upright will leak through my pores and my body will sink to the floor.  The frustration I have been carrying all week fades, leaving a void that is filled by a strange sense of pity – pity for the way Mr. Landon can’t function without a mask attached to his face, pity for the way he has replaced his distress with bitterly harsh words, pity for the way he looks like a big bulky giant confined to a crib, and pity because if he feels the way I do then I know exactly what he feels and how heavy the weight on his heart must be.

“I…I’m sorry you’re feeling bad,” I stammer.  He doesn’t respond, just stares me down until I finally turn to leave.  He read me like a book, I think on my way out.  I walk through the rest of my day in a fog, wondering how the one person with whom I have been fighting for 17 days has somehow seen right into my tired soul, plucked out and exposed my deepest emotions through which we seem to share a connection.

*          *          *

The Past:  The Remainder of the Middle.

Poppa is leaning against the kitchen sink on his one leg when I come downstairs.  Mom and Grandma are at the kitchen table reading the October 10^th, 2008 Wilson Daily Times newspaper.

“Well good morning,” Mom says.  

“Good morning,” I announce.  Poppa twists his head around, smiles and winks.  

“They’ve got you washing dishes even on vacation?” I say to Poppa.  

Grandma laughs, “Oh yes.  Same deal we’ve always had.  I cook, Poppa cleans.”

“Grandma and Poppa are leaving at noon,” Mom says. “Will you be around?”

“Of course,” I say, shoveling cereal into my mouth.  “Have homework, but I’ll come back down to say goodbye.”  I drink the milk from the bowl and return to my room.  Biology book is on top, guess I’ll start there, I sigh.  There was a time when I looked forward to learning new things.  But lately the work seems to add weight to my already heavy shoulders.  I don’t find joy in it.  I don’t really find joy in anything anymore.  It’s the same thing every day.  Everything feels so…pointless.  Why would anyone want to live like this?  I can’t quite lay a finger on why I’ve been down recently.  But I know that sometimes it feels like I’m carrying a brick in my chest, and that sometimes it feels like I have been dropped into a hole with walls too tall to climb, and that many times I feel like giving up.  

The trunk thuds shut in the driveway.  They must be packed.  I walk outside.  Grandma has just finished saying goodbye to Mom and after I hug her I walk to the passenger side where Poppa is waiting in the front seat.  “Bye Poppa!” I say, hugging him as best I can through the open door.  He might not remember me at all next time I see him, I think.  “I love you!” I say as I hug him a little harder.  When I finally let go and start to step away Poppa grabs my hand and squeezes it firmly.  Confused and slightly surprised, I look up into his blue eyes. 

“You hang in there,” he says.  He winks.  I am speechless.  My throat tightens.  My eyes well.  No one else has said anything to me.  No one has asked why my eyes are red and glassy with dark circles beneath them, why I look at the ground when I walk, why I stopped speaking in class or why I can’t sleep at night.  No one has asked if I am okay.  He feels it though, I think.  He senses it.  He knows.

“All set!” Grandma chirps.  Poppa releases my hand and I clear my throat and wipe my eyes.  He gives me one last smile and a wink.  Oh Poppa, I think, I’ll try.  I wave until their car turns the corner down the street.

*          *          *

The Present:  Day 98.

The woman who walks into Room 5 is thin and frail.  Her wrinkles and white hair suggest old age.  Must be his wife, I think.  Maybe she can tell me why they brought him here.  Since finishing my ICU rotation months ago I have been working in the emergency department, my residency home per se.  The cold has broken and I feel the slightest bit lighter, like things aren’t as bad, like everything might be okay.

I enter Room 5.  “Excuse me, ma’am?  Are you family?”

She leans over and kisses the forehead of the pale man lying there.  “Yes.  I’m his mother.”

This comes as a surprise.  The man in the bed is bald and emaciated, curled onto his side with a pillow between his knobby knees to cushion them.  His face is covered with as many wrinkles and age spots as the woman’s is and his lips are dry and cracked.  His hip bones protrude through the waistband of his baggy pajama pants and his gnarled fingers are clasped together near his chest.  He is too weak to move, too weak to speak.  How can this be her son?

“I was wondering, ma’am, would you be able to give me a little more history?” I ask.  “He wasn’t able to tell me much about his medical conditions or why the ambulance brought him here.”  

“Oh, yes.  Yes I can,” she says.   “Well, we’re from another state, originally.  But then he got sick.  He has brain cancer, and bone and kidney cancer.  Or maybe its liver cancer.”  She rambles.  “Actually I think it’s metastatic.  I’m sorry, it’s so much to remember.  Wait, I have everything somewhere.”  She drops her large handbag onto the chair next to the bed and starts rummaging through it.  “I’m sorry, just give me a minute.”  I look at her son who has yet to say anything.  His eyelids close heavily, then slowly open every minute or so.  

For a moment I wonder where his mind has gone, and I have flashbacks of Mr. Landon and Poppa and the way they would sometimes get lost in another world.  I think of how, even though they seemed far away, they could be so keenly aware of those around them.  Hang in there, Poppa had said.  Same as you really, Mr. Landon had said, just as bad as yesterday.  

“Here, look I found them.”  She turns, flustered, and holds out a thick stack of papers bound by a rubber band.  Oh boy. “These are his records.”    

“Well, he had chemotherapy.  Or radiation maybe?  He was getting treated at so many different places.  There was a surgery too, I think.”

“He looks very dehydrated and weak.  I’ll have to read through these records more, but I think we’ll need to do labs and admit him to the hospital.  We can contact our cancer doctors, but at the very least I think he will need pain control and rehydration.”

“Thank you,” she says.  “Doctor, there’s something else too.”  I place the records on the chair.  “The other hospitals, they told me there was nothing else they could do.”  Her eyes fall upon the withering man.  “I, well, I called 9-1-1 to have him brought here for another opinion.  I thought maybe you could try something different, to cure him.  He’s my son.”  Her chin drops and she lifts her hands to her eyes.  “I’m not ready to give up on him yet.”  Her voice cracks and her body slumps as she folds into herself and then into my embrace.  Her shoulders bounce up and down and her tears dampen my scrub top where she has buried her face in my shoulder.  

 “I know this must be hard,” I say.  “I can’t even imagine what you must be going through.  We’ll take the best care of him that we can.”  My voice softens and I choke back tears of my own.  “Ma’am.  You hang in there.”  I squeeze her a little tighter.

*          *          *

The End.

In the end, there are funerals.  I am told, many months later, that Mr. Landon had made it out of the ICU, but had been made comfort care and had died shortly after.  Poppa, too, passes away.  It happens in January on a cool Tuesday evening.  He is cremated, as was written in his will, so that when Grandma dies his ashes can be placed in her coffin at her feet, to keep them warm for eternity.  His funeral is attended by many.  We share memories of his success, of the bird houses he built and the paintings he created.  We reminisce about his quiet demeanor and the way he would wink at us from across the room.  We speak of how he sometimes just knew.  Dad carries his ashes down the aisle when the service is over.  He says the box is heavy, that the weight a man is greater when his body has housed so much kindness.

Sometimes I see pieces of Poppa in those with gentle smiles or sea blue eyes and soft voices.  Mr. Landon swirls in my memories too.  I don’t feel the burden of anger, frustration, or sadness anymore, but I remember the way Poppa had grabbed my hand saying Hang in there, and the way Mr. Landon had seen right through me, stating Same as you really…Just as bad as yesterday.  I carry them both with me, Poppa especially – his words, his spirit, his resilience.   I wake each day with the hope that I will always remember that which they have shared:  the gift of glimpsing through a window in search of a connection that is buried somewhere deep within the human soul.  

---

Elizabeth Hanson, M.D., is a 2022 graduate of the UAMS Emergency Medicine residency program.

By J. Stephen Nix

Fiction Award Winner

First the cats went fat. Then Esther asked for a bird feeder to set off the front porch, and Francis bought the kind that hung from a metal pole so the squirrels couldn’t get at the seed. There were good birds that came. Cardinals, blue jays, your run-of-the-mill sparrows—those were fine, too. Jesus took care of the sparrows as he did us. It wasn’t until Francis found his wife feeding the cats late at night that he thought something was wrong. She sat on the hardwood cross-legged, petting the cats with one hand and scooping brown pebbles onto a pile like a mudslide with the other. She looked at him and smiled. She smiled in a way that said nothing was wrong, Francis. Nothing was wrong at all. But that spooked him, and three weeks later a doctor diagnosed her with dementia. 

In the front yard, Esther’s bony frame sunk into a camouflage folding chair. A bag of birdfeed slumped at her feet, and she threw handfuls of seed onto the grass for the squirrels. There were at least four squirrels living about the yard now. The bird feeder dangled empty— that was because Esther liked to feed animals from her hands. She didn’t talk anymore, but she had the same smile she had that night years before with the cats in the kitchen in the dark. 

“Time to come in, honey.” Francis gently took her arm, and she followed him, smiling. He guided her through the screen door and into the kitchen, where she sat and patted his hand like a cat.

Francis had long since remodeled the kitchen into a pantry prison with each speck of food under padlock. The refrigerator as well had a chain wrapped around it like a belt. He had to do it or else she’d empty the whole food stores in a single afternoon. She just about did it once. Francis came home from church and found her in the front yard dumping cans of Spam and tomato sauce into a pile of slop for the squirrels who weren’t eating any of it. After that, he bought the chains and locks from the hardware store. He thought about getting a bolt for the bedroom door to keep her safe. It hadn’t felt right though, to shut his wife up like that. She wandered sometimes—that was true—but she never went far and there wasn’t much out there that could hurt her. Sometimes feral hogs passed through, and there were snakes in the pond. But mostly Esther just circled the hay fields, and there wasn’t anything worth mentioning in the hay fields. Still, Francis bought a dog tracker GPS collar and fastened it around her ankle. That hadn’t felt right either, but it was better than locking her in the bedroom. 

Dementia was irreversible. That’s what the doctor said, but she didn’t need to tell Francis that. Francis knew that when the mind rolled downhill there was nobody to push it back up again. Esther’s mother died of dementia in a nursing home. She couldn’t feed herself in the end, he remembered, couldn’t talk, couldn’t bathe, couldn’t go to the bathroom in a toilet. Esther and Francis talked about it then. Esther said she’d rather die than end up that way. Francis agreed. But it was one thing to talk about it when you were healthy. It was another when it was your wife sitting at the kitchen table smiling past you. 

And she wasn’t suffering. She was always pleasant and smiling, feeding her animals and feeding herself. She’d talked for a while, too, and sometimes she talked about something they’d done together like the time they drove to the boats in Shreveport and she won five hundred dollars at a slot machine. They bought a hotel room and stayed the night instead of driving back. Stories like that gave Francis hope that she was still in there. But watching his wife was like watching a fishing bobber in high winds—no matter the dance or the jig there was nothing biting. Now she was like a fishing bobber lying on its side, still floating but nothing underneath.

Francis left his wife sitting at the kitchen table and drove to town. The Snakeskin Gun and Pawn bordered the train tracks and was built out of gray aluminum siding like a backyard toolshed. Next to it was the bowling alley that burned down three times before the owner called it quits and left the blackened frame to burrow down into a grave of its own making. The soil was sandy in those parts. 

The door closed behind him with a ring, and Francis walked to the gun counter where a skinny man in a Wrangler denim shirt read a hunting magazine. A terrarium stood on display with glass chalk scrawled across the upper right-hand corner, “Snakeskin Sam.” Under the name and in smaller writing was the price, seventy-five dollars. Snakeskin Sam rested his head on his own back and stared at Francis, tongue flicking. Francis wondered if his wife would ever feed an animal as horrible as that scaly thing.

The skinny man tossed the magazine and grinned. From behind the counter, he produced a black, hard-plastic box with a handwritten price tag. He opened the box and removed the operations manual to reveal a black handgun and accompanying clips. The gun was a Glock 22, a .40 caliber pistol with a magazine that held thirteen rounds. Francis said it was for home protection, the gun. The man—his name was also Sam—told Francis that he couldn’t do better than a Glock 22. It was easy to use, easy to clean, and with no safety it was easy to shoot if the need should arise. The .40 caliber rounds were the best choice because they’d stop about anything. Sam didn’t say they’d stop a wild hog, but really a rifle was better for that. For home protection, you couldn’t beat a Glock 22 for reliability, ease of use, and price. It was what the police carried, after all. 

Francis picked up the gun, light in his hand, and placed it back in the case. He had never owned a gun and never thought he’d own one either. He knew how to shoot—everyone did here where the 4-H club was the next biggest thing to high school football. He just never had a use for a gun, not even a hunting shotgun. This fact made no difference to Sam. Home defense was an act of patriotism, a celebration of the Constitution, and plain common sense in today’s troubled times. Sam would sell him a holster (barely used) for a steal, just in case Francis found the need to open carry on his own private lands or elsewhere for that matter. The cartridges sold full price. 

Francis drove home with the gun, the holster, and the bullets bundled in a plastic sack under the passenger seat. He’d thought a lot on if he could do it, and he wasn’t sure if he could. 

He knew Esther wasn’t coming back, and it was a mercy but whether it was right or not he didn’t know. He read the Bible, and there was nothing in there about the merciful ending of a loved one. There was killing in the Bible. King David killed thousands in the name of Jehovah, but they were enemy soldiers, heretics, and blasphemers. His wife was a good Christian and went to church almost every Sunday like he did. Like he used to, at least. Now they watched a preacher on television. 

One time, Francis was driving when a minister on the Christian radio station was talking about suicide. The minister said the Catholics believed suicide was an unforgivable sin, and if a man killed himself he wouldn’t go to heaven. Now Francis wasn’t Catholic and wasn’t rightfully sure if Catholics went to heaven in the first place, but the thought stuck with him. It stuck with him so strongly that he knew he wouldn’t turn the gun on himself afterward—what he’d originally planned—but that he’d have to live with what he did. And that brought on another set of considerations. 

If he did it, he’d have to lay her to rest in a way that was fitting to a Christian burial. The first idea was simply to bury her in the woods, but that was no good. The land was sandy in that part of the state and didn’t hold well. Francis worked in the city manager’s office in his youth and remembered the calls from folks living near the public cemetery after a hard rain. They’d call and say that dead people juice was washing up their stoops, and Francis believed them, too. 

One of the men who mowed the cemetery told Francis that the ground was so sandy the blades of the mower clipped bones off fingers reaching up through the grass after a rain. He said in Louisiana they put concrete over the graves and that they should do that here, too. That’s how Francis got his second idea. 

You could buy fifty pounds of fast set concrete mix at just about any hardware store in town. All you needed was water, and it sets. Francis had already bought the concrete. The bag lay against the wall in the garage next to where he parked the pickup truck. 

Francis didn’t do it that night or the night after. He kept the gun loaded and carried it on his hip when he took Esther outside to feed the squirrels or walk the fields. Their walks about the property stretched longer and longer each day. First, they followed the dirt driveway through the hay fields, and then they ventured down to the fishing pond. A derelict wooden dock jutted into murky water. Beyond the embankment, a copse of pine trees sprouted. That was the spot. He realized it when he received the sign from the Lord, a sign that came in the form of ducks. 

Francis knew nothing of the ducks as they walked to the pond. She saw them first. While he straggled behind Esther with his hand on the gun, she veered toward the shore and dropped to her knees. A paddle of mallards quacked along the warm, dark water. Esther uprooted a tussock sedge at the edge of the bank and tossed the chaff onto the ripples one handful at a time. Though the ducks didn’t eat the sedge, they didn’t fly away either. The next time Francis walked his wife to the pond he brought a bag of cracked corn from the feed store. The mallards waddled onto the bank just beside the pines and ate the corn his wife threw. It was nothing short of a sign from the Lord. 

The copse of pine trees lay beautiful and peaceful and undisturbed, mostly hidden on one side by the pond’s embankment and on the other by a cow-trodden hill. The only place where someone could get a good look at that patch of pines was from the house, and Francis knew no one would be up there when he did it. He hauled the wheelbarrow with the fast set concrete mix down to the spot after much prayer and consideration. His wife he took next. 

But he didn’t do it then either. The ducks made habit of watching for Esther, and they saw her coming and shook water and marched uphill toward the house and even cleared the barbed wire fence separating the hay fields from the cow pastures, a good fifty yards from the pond. His wife dumped the corn in the weeds while Francis struggled with the latch on the rusted gate. After that, he carried the cracked corn himself, leading his wife and the waddling ducks to the embankment like an Arkansas Pied Piper. 

There was one time that he even drew the gun. Esther squatted and outstretched her hand to a green-headed drake. Francis eased the gun from the leather holster and aimed at her back. 

His hand shook like a top water buzz bait. Then he remembered he hadn’t put one in the chamber and pulled the slide and snapped in a round. Esther glanced back at the sound with that smile she had while feeding animals, but this time it looked like the smile she used to have when he told her that he loved her and she told him back. The mallard was eating out of her hand for the first time. Esther hadn’t made a sound in God knew how long, but Francis swore he heard her laugh at that yellow bill pecking away at the corn in her hand. He lowered the gun against his jeans. 

It rained for three days after that, he and Esther cooped up inside the house with the cats and the rain beating heavy on the windowpanes. Francis watched golf while Esther paced floorboards, trying kitchen cabinet locks, walking away, and trying them again. He kept the front door locked, too, so she wouldn’t wander out and try feeding the squirrels in the rain. 

Francis did let her feed the cats their breakfast, lunch, and dinner every day, and they trailed Esther big and fat as throw pillows. The vet told Francis that if he didn’t feed the cats less, they’d get diabetes like people. Francis bought an expensive weight reduction pet food because he didn’t have the heart to cut the portions Esther could give them. 

Francis worried the ducks would be gone after those long days of rain. But on the third day the rain finally left, and he put on his black rubber boots and squished mud down to the pond where the ducks were waiting. The Lord had once again given him a sign. 

The next day, the countryside broiled under a clear blue sky. Francis held his wife’s hand and carried the cracked corn. Though the gun jabbed his side with every step, he didn’t let go of his wife to adjust the holster. Today was the day he’d do it. 

The ducks quacked at his feet as he unlatched the utility gate. He rested the bag of cracked corn on the fence post so that neither the ducks nor his wife could get to it while he closed the gate behind him. He intended to do it by the pond. That way he’d be near the pine trees and the wheelbarrow. He hoped the fast set concrete mix had stayed dry inside the black trash bag in which he’d wrapped it. If only he’d checked before, he’d have known if it hadn’t spoiled in the damp. It was too late though. Dry or not, he would do it today. 

He handed the feed to his wife and guided her to the pond’s bank. She fished cracked corn from the plastic bag and threw it before her like a flower girl at a wedding. Francis, in the meantime, hiked down to the wheelbarrow where he untied the garbage bag and felt the wrapping inside. It was dry. 

He drew the gun and pulled the slide. The bullet clacked in the chamber. There was no safety on a Glock 22. All he had to do was squeeze the trigger. It was a reliable gun. Reliable and easy to use. What the police used. 

His boots dug grass as he climbed the embankment to reach his wife. That’s when he saw the cottonmouth. 

The stubby, brown snake coiled tight on the dirt, and its mouth gaped wide and white. Straightened out, the snake would have measured near the height of Esther—Francis was sure of it. He scrambled up the last length of incline and dropped to a knee and aimed. 

No shot rang out. His wife was too close, and she knelt calmly as if in prayer before the tensed serpent. And even more calmly her right hand reached inside the plastic bag for the cracked corn. Francis couldn’t see her face, but he imagined she was smiling that smile she had when feeding animals. She extended her hand and uncurled her fingers. 

Francis never saw the snake strike. In an instant, it was hanging from her hand, the jaw sawing back and forth on his wife’s flesh. Esther’s screamed. Francis charged and fumbled for the snake, trying to grip its belly in his free hand, but he couldn’t hold it the way it twisted and lurched. Francis pointed the gun and fired. 

The cottonmouth’s body spasmed and went limp. Francis shot again, this time missing completely. Esther held her arm up as if shielding herself from the beating sun overhead, the snake hanging heavy from her hand. Francis pressed the barrel point blank against the snake and pulled the trigger. It shuddered. He shot again and again, but the snake would not release. The weight of the snake dragged Esther’s arm to the dirt, and only then did Francis realize the cottonmouth was dead. 

Esther no longer screamed. She stared blankly at the pond bank, the cottonmouth still gripping her hand. Francis dropped the gun and carefully grasped the snake’s neck. He’d heard stories as a boy about decapitated snakes still being able to bite and poison. He squeezed and twisted to loosen snake’s grip on his wife. 

Suddenly, the jaw released Esther’s arm and snapped wildly in the air. Francis startled backward and flung the cottonmouth over the sedge grass where it splashed and sank into the muddy water.

Francis dropped to his knees and crawled to his wife and held her head to his shoulder. He told her that he was with her, and the Lord was with her, too. He realized the Lord had sent an angel in the form of a cottonmouth to take Esther home so he wouldn’t have to do it. 

Francis rocked Esther slowly, determined to catch his wife’s last breath in this world. Then her arm was around his back. She was holding him. And in that moment, it felt like she was the Esther of years past, her mind no longer nothing but a hollow smile. Francis was crying now. He brushed her hair with his fingernails and whispered that he loved her, and he thought he heard her say it back.

In the emergency department, the young doctor identified the snake from description as a water moccasin and gave Esther antivenom. The damage to the hand was bad, he said, and there were other concerns, such as tetanus and swelling. He put Esther in a room with glass walls and a nurse outside at a computer and assured Francis that they were just being cautious and that Esther would soon be moved to a regular room. 

Francis stood vigil by Esther through the long beeping night, and in the morning, they moved to a different floor where more doctors and nurses and students came to ask the same questions. Esther responded not a single word. Over and over, Francis told the story. He told about the snake and the dementia and how she started feeding animals. He told about how he wanted to take her home. 

At dinnertime, a man brought a tray of country ham and sides. Francis watched his wife pick up the cornbread. She was smiling and staring past him into the corner of the hospital room. 

Then she crumbled the cornbread into her palm and tossed it to the floor. 

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J. Stephen Nix is a neuropathologist raised in Southern Arkansas on watermelon and the American naturalism of Jack London. His previous works have been published in The Examined Life and Closler, and he is currently enrolled in the Johns Hopkins Master of Arts in Writing program. When not studying neuropathologic disease or writing, Stephen enjoys spending time with his wife and son, Fabiola and James, family, friends, and many pets.