I passed this good news on to the ambulance guys, and with Margaret strapped and wired up to the monitors, lights flashing, we crept through the streets of Valhalla and swung onto the Taconic Parkway, which was absolutely deserted—even the snowplows weren’t out yet. I was sitting in front next to the driver, and I could only see Margaret by turning my head around until the muscles in my neck hurt. Her eyes were shut. The other member of the crew sat next to her on a folding seat, checking her vitals on the monitors and talking to her soothingly. These guys were pros, I could see.
I could hardly even make out the side of the road or the guardrails. Apart from the occasional mild skid we progressed at a fairly steady pace, although it was as dark as night. Every once in a while we passed a snowplow as we headed north, but most of the time the parkway ahead was as pristine as a ski slope, no tire tracks on it at all. The snowplows pulled over to let us pass at the sight of the flashing lights coming up behind them. The driver kept both hands firmly on the wheel, and a gentle foot for the brake and accelerator. Up in our part of the country a gift for driving in the snow is not only useful, but much admired—Margaret’s ability to get back and forth from our farm to Rhinebeck to have her nails done driving her Porsche 911 in even the heaviest of snowstorms won her as much admiration locally as her horsemanship—more, in fact. “You’re good at this,” I said.
“I was a driver in the Tenth Mountain Division.”
I nodded. “Up at Fort Drum?”
He gave me a brief look. “It snows six months a year up there, over ten feet a year.” I said I knew, that’s why they put the mountain division up there in the first place.
“You’re a veteran?” he asked.
“Well, yes, I suppose so, but not here. I was in the Royal Air Force, a lifetime ago.” It’s one of those odd things about American life, military service of any kind generates a degree of respect not found anywhere else. Nobody in England would have asked the question, or cared about the answer one way or the other. “My buddy back there was in the Air Force,” the driver said, and explained to the EMT in the back over the intercom that I had been an airman too. The EMT gave me a thumbs-up. The storm was much worse now, all traces of the roadway obliterated, and I would not have been surprised if the driver had pulled off the parkway to wait it out, but now that my status as a veteran had been established, he appeared determined to go on. You don’t let a fellow veteran down.
Just before the exit to Interstate 84 I could see the blue and red flashing lights of a police car, a four-wheel drive vehicle of some kind, which pulled out and led us all the way to the Rhinebeck exit, just as promised. For a moment I was completely disoriented—this was not the direction from which I usually approached Rhinebeck, and the snow made everything seem ghostly and unfamiliar, like the winter scene in Dr. Zhivago. I wondered if we had come this far only to get lost, but before I could ask whether he knew the way, we had pulled into the emergency room dock. Two nurses were waiting to move Margaret with a gurney. I had thought she was asleep or sedated, but apparently not. She looked at the snow and shook her head. “Way to go, guys,” she said quite clearly, before the nurses wheeled her away. “She drives a Porsche 911 in the snow?” the EMT said. “Gutsy lady.” Evidently she had been talking to the EMT. I said she was indeed, gave them each a hundred-dollar bill. We shook hands solemnly, and I followed Margaret into the building carrying the Vuitton bag that had accompanied her all over the world.
Her room looked out over snow-covered fields. It was cheery, airy, decorated in soothing colors, quiet, almost serene. She was already in bed. On one wall was a whiteboard showing the schedule for the next week, every day already filled up with speech, physical, and occupational therapy. On the night table beside the bed was a telephone, a welcome sign of normality, since patients in the Neuro-ICU did not get a telephone—they were mostly in no state to use one.
I emailed Alain to tell him we had arrived safely, and he emailed back, “Wonderful news! Bravo.” Her internist, Dr. Adam, emailed from New York City, “Please know Margaret is in our prayers.” People complain about the indifference of doctors in these days when every practice is becoming part of a larger medical entity, but Margaret’s doctors took as warm an interest in her as her friends. While she dozed, I caught up on my emails, and replied to one from Lynn Nesbit, my best friend and agent for over forty years and my number-one morale-booster: “Ghastly journey by ambulance up the Taconic through a blizzard. I hope she will be more comfortable [here] and perhaps come home in about ten days to two weeks. Outlook hard to say. Probably chemo for melanoma, a whole new treatment but with very risky side effects. Surgery and radiation have gone about as far as they can go.”
Margaret settled down quickly into the routine at the Paul Rosenthal Rehabilitation Center. She didn’t want visitors, except for Colleen—she was embarrassed about the way she looked—but she began to take telephone calls from Megan and from Miguel, and to reconnect with news about the farm. Her anxiety level dropped as long as she was kept busy. Each landmark meant a lot to her. Five days after her arrival, her sutures were removed; the next day her hair was washed, what little she still had of it. Not surprisingly, she longed to be home.
Except for breakfast, about which I could do nothing because visiting hours didn’t begin until eleven a.m., I took care of food. At noon, I stopped at Ray’s deli on the way over to Rhinebeck and bought her an egg-salad sandwich and an order of crisp bacon for lunch, and a Reese’s peanut butter cookie for tea. In the evening, I asked Rob to bring in either the crab cake appetizer from the Tavern at the Beekman Arms, a pizza margherita from Gigi’s, or fried baby artichokes with garlic mayonnaise from Terrapin—Rhinebeck probably has more (and more varied) restaurants per head of population than any other small town in New York State—or whatever else I thought she might like. Eating was still difficult for her, everything had to be cut up into minuscule pieces (I carried a sharp knife in a scabbard on my belt for just that purpose), and her appetite remained very poor; still, at least she was eating something.
Her leftovers were usually enough for my own dinner, and I took to bringing in a screw-top jar full of white wine marked with Margaret’s name on a piece of white surgical tape and put it with the urine samples in the refrigerator outside the room. I wasn’t too sure how the nurses would react to a bottle of Cloudy Bay New Zealand Chardonnay there, but the jar didn’t attract any attention.
She was still frightened and lonely, but a deluge of emails from friends kept her interested, although her spirits plummeted on Sunday, when there was no therapy. “The hospital at Rhinebeck is fine,” I emailed Linda, “much better than Burke or WMC, only ten patients, but she is going stir-crazy.” She loved messages that reconnected her with her world, like one from Carol Kozlowski, who had just been made president of the United States Eventing Association (the governing body of Margaret’s sport). Carol had been seated next to the great British Olympic gold medalist William Fox-Pitt, MBE at the annual meeting. He told Carol about his terrible fall in 2015 that put him in a coma for two weeks, and said he still suffered from memory loss and would burst into tears for no reason. Carol went off to deal with the paperwork that would make her presidency official and realized too late that she had slipped Fox-Pitt’s notes for his speech into her briefcase just as he was starting to speak. “In a brief deer-in-the-headlights moment, I had visions of William coming to a halt in his speech and bursting into tears . . . I thought to myself, ‘Good God, I’ve been President for 5 minutes and I’ve already torpedoed William Fox-Pitt!’”
When she read that it was the first time I had heard Margaret laugh for many weeks, a good, hearty belly laugh as she imagined the scene—how she would have liked to been there!—but there was still no way she could reply except to dictate to me, the fingers of her right hand were useless.
Margaret’s occupational therapy concentrated on getting her fingers to work again. This was perhaps the tensest hour of her day, as she tried to pick up square pegs and pu
t them in square holes and the round ones in round holes, her face a study of concentration—and all too often, frustration—as the piece fell from her fingers or she was unable to put them in the right holes. Physical therapy, as usual, went well, speech therapy much less well, but we also spent at least a couple of hours a day walking around the hospital, Margaret using her walker. I dressed her twice a day for her walks. Once, as I put her running shoes on, I said, “I haven’t tied the laces on anybody else’s shoes since Chris was a little boy. I’m learning how to tie your laces at about the same time in my life as I’m forgetting how to tie my own!”
Northern Dutchess is small, as hospitals go (eighty-four beds), but once we left the rehabilitation center and turned right, the corridors wound on for what seemed like miles, intersecting with each other so that it was easy to get lost. From time to time we would confront a locked door to an operating room or radiation and have to backtrack, but in time we began to recognize enough landmarks to guide us back and to give us a good idea of how far we had been walking. There were occasional sitting areas, or banks of potted palms, and at one point a window that gave a good view toward the snow-covered Catskills. Soon some of the patients and staff began to recognize us, Margaret in the baseball cap she wore to events with a message embroidered on the front that read “Born to Cowboy,” a pair of old worn blue jeans that hung loosely on her because she had lost so much weight, and a navy-blue hoodie with her “Team Stonegate Farm” logo. There was something gallant and determined about her as she walked through the maze of hospital corridors. Patients who saw her from their beds gave her a thumbs-up as she passed, and so did the nurses and doctors along the way. When she got back to her room she was exhausted, but movement buoyed her spirits—there was no way she could lie in bed and watch television, she never turned it on once.
I was already making plans for her to repeat her rehabilitation exercises at MidHudson Hospital, and to arrange for Chris Dayger to be her physical therapist again. Alain had set her next MRI for six weeks away and we had made another appointment for her to see Dr. Jason Rubin, which Margaret was already sorry she had agreed to.
Exactly two weeks after she had arrived at Northern Dutchess Hospital Margaret was discharged. I reported to Alain that the doctor had been very impressed by the amount of progress she had made, but warned her sternly that she should not ride or drive for several months because of the risk of a seizure. I pointed out to Alain that it would be hard to keep her off a horse, and probably unkind.
He also warned Margaret she should not drink. Margaret was not a big drinker, I pointed out, but one weakish vodka tonic before dinner was a comforting part of her routine. Alain replied promptly that these were standard recommendations after brain surgery, but added: “I tend to individualize my recommendations. As I am not really worried that Margaret is going to finish off an entire bottle of vodka, I do not think we should deprive her of her vodka tonic before a meal, especially if it helps to stimulate her appetite!” A doctor after my own heart!
Margaret’s return home was uneventful. She visited her horses, pushing her walker through the snow, but making it upstairs in the house was more difficult than ever, even with me coming behind her to make sure she didn’t fall. I had clipped an ad for a stair lift from a magazine, and made a mental note to see about putting one in. Margaret would certainly resist making such a major alteration to the house, but we might still have to do it, I decided. I had purchased a bath lift, so that if or when we needed it we would be able to put it in.
But once again I had underestimated the speed at which the disease moves.
12.
SEEING MARGARET RIDE every morning again gave me the impression that she was back to normal, but that was an illusion. Of course she was riding within a week, not for long rides, just walking the horse, but still, back in the saddle. She loved riding in the snow, and there was plenty of it. Our paint horse Monty liked it too, he would have seen plenty of snow growing up in Montana.
Taking her daily walk was a more difficult proposition, since there were big snowbanks on both sides of the roads and it was discouragingly cold; cars came hurtling down the narrow road, so you constantly had to worry about one of them skidding on a patch of ice and running into you. It was my assistant Dawn who suggested we try the Galleria, the big shopping mall on Route 9 in Poughkeepsie, as a place to walk indoors.
I am not much of a mall person myself, but Margaret could spend an hour or two there shopping quite happily. If I went with her I usually brought the New York Times with me and sat reading it and drinking a cappuccino while she shopped.
Margaret took to walking in the Galleria at once. After we had ridden I would drive her there in the morning, park the car at the northern end of the mall outside Macy’s—at eleven in the morning the parking lot was virtually empty, as was the mall itself—then walk all the way through the mall to the southern far end, as far as you could go down the aisles of cookware and toys at Target. To avoid boredom, we sometimes took the escalator up to the second floor for the walk back. At a rough guess a complete circuit added up to a little less than a mile, if we added a swing through the endless aisles of sports clothes in Dick’s Sporting Goods, and it took Margaret about half an hour using her walker, a little less once she had graduated to a cane. I could judge our progress by the counters or shops we passed. Once we had passed the Macy’s perfume counter we were in the long aisle of the mall proper; the halfway point was Aéropostale, and at the far end of the toy counters in Target there was a wall where we turned around and headed for home.
The mall always reminded me in width and length of airstrips I had flown from in the Second Tactical Air Force of the British Army of the Rhine, except for the terrazzo and faux-marble flooring and the kiosks selling pretzels or offering while-you-wait cell phone repair. On the upper floor Bare Essentials was our halfway point, and Francesca’s Collections meant that we were approaching Macy’s again, where we took the escalator down and walked through the store past the women’s underwear and stockings to the exit at the far end, where we were parked. Within a few days we were recognized as regulars. There were people who jogged every morning in the mall during the winter, and of course people opening the shops and setting up the counters. The young man baking his first batch of pretzels of the day always gave us a cheery greeting, but most of the indoor joggers were too self-involved to bother, or perhaps frightened by the sight of somebody using a walker. People exercising always want to believe that fitness will spare them from this kind of thing. By now I knew better.
We came to believe that the mall belonged to us. It was cavernous and almost empty first thing in the morning, with the smell of things cooking in the food court and everything looking bright and clean. As the days went by, Margaret increased the distance and the speed. She was determined that I time us and write down the results every day, as if she were training for an Olympic event, so I carried a little notebook and a pencil in my pocket for that purpose. She was cramming a lot into every day—riding, her walk in the Galleria, physical and speech therapy—not so surprisingly by teatime she was exhausted. Climbing the stairs for her bath wiped her out, the bath itself was still an ordeal for both of us. She managed to come downstairs in her bathrobe for her drink and dinner, but she did not eat much.
After the second week of walking in the mall I began to notice that very slowly, day by day, Margaret was beginning to list ever so slightly to her right, so I occasionally had to take her arm to support her. It did not slow her down, she did not even seem to be aware she was doing it, but then one morning, quite suddenly, on the way back to Macy’s, she fell to her right, and for an instant I thought she was going to crash through the plate-glass window of Bath & Body Works. I managed to catch her just in time. She had a hard time getting up again, but a total stranger rushed over and took her other arm, and together we put her back on her feet again. She was unsteady and disoriented.
“Can you walk back to the car?” I asked. She shook
her head. We were near a side entrance, so I asked the man if we could get her seated in the Macy’s shoe department, would he mind staying with her while I brought the car around? He said he would be happy to, so I ran through Macy’s, got the car, and left it parked as close as I could to the side exit with the engine running, and together we carried her to the car, put her in, and fastened her seat belt.
Sitting in an idling car in the parking lot of a shopping mall is not the ideal place to talk about dying, but then what place is?
“Is this the beginning of the end?” she asked calmly.
“It’s not a good sign.”
“Was it a seizure, do you think? Dr. Rubin mentioned seizures.”
Margaret’s consultation with Dr. Rubin had gone smoothly enough, although he mentioned that Mayo Clinic tests on the specimen harvested by Dr. Alain from the older tumor had failed to identify a BRAF mutation that might have made treatment for advanced melanoma possible. That was not good news, though I’m not sure it sank in. Both of us liked Dr. Rubin, he had a certain low-key authority disguised by a gentle manner, as if he were saying, Look, I’m sorry, but this is the way it is. Those were not his exact words, but that was the message conveyed.
Further radiation was unlikely to help; chemotherapy would be ineffective against the brain tumors; immunotherapy, whether at Yale–New Haven or elsewhere, was the next step, the only step. But Margaret did not want to become “a pincushion,” as she put it, meaning to become a patient in a trial of experimental drugs, in and out of emergency rooms and living with side effects. Dr. Rubin was not about to give us a timetable for the progression of the disease, nor did we expect one. Margaret respected him, but all her instincts were against following his advice. I had mixed feelings. If it were me, I would probably have chosen to try a more aggressive treatment, but at the same time I understood and respected Margaret’s feelings—after all, she was the one with brain cancer, not me. I anticipated that I would feel guilty about not pushing her harder, but my guilt feelings were my problem, not hers.
Passing Page 16
