What Remains

by Radziwill, Carole

  It’s six at night, and my thoughts are panicky. Has something gone wrong? Did we forget to check in this morning?

  “Where’s the doctor?” I ask him. I force myself to sound calm.

  “I don’t know. I think he left.”

  He is alone, thin and pale. I am struck by how helpless he looks, the empty room. I take it in cautiously. “I’m confused. Have you been sitting here all afternoon?”

  “The nurses are waiting on something from the lab.” He is anxious. He tells me no one has checked on him.

  “Where the hell is everyone?” I am trying to keep my voice steady.

  “They’re waiting on my blood work.”

  “When did they take it?”

  “A while ago, I guess. Don’t make a scene, Carole. They’re just busy.”

  I know when I hear him call me by my name to be careful. He has said this before, Don’t make a scene. As a patient, he does not want attention called to him. He thinks there must be patients who are worse off, and they are getting treated first. After all, he thinks, he’s going to get better, and these other sicker patients might not. But it’s no longer true. Now he is sometimes the sickest patient in the unit. I am not the sort of person to make scenes, I think, though it turns out I just need the right set of circumstances.

  This is my Terms of Endearment– Shirley MacLaine moment. It’s in all the movies in which someone dies—the moment when you understand, when you get it. This is all just a charade. The doctors have moved on to other patients and you’re left screaming for help at the nurses’ station. Anthony is not so much a patient anymore but a guest who has overstayed his welcome.

  “I just got to my husband’s room, and he’s been sitting here all day waiting for the chemo,” I say on the phone to the lab. “I left this morning, and he’s been sitting here all day—why is he still sitting here?” The last three words are tight, clenched.

  “I’m sorry, Mrs. Radziwill. Someone should have called. We’re waiting to hear from his doctor. We need a dispensation from his doctor before we can release the drugs.”

  “Why? His doctor already ordered the treatment.”

  “His blood work came back, and his creatinine level is a little high.”

  The creatinine level indicates how the kidneys are functioning; it is monitored closely because kidney damage is a possible side effect of ifosfamide. A healthy creatinine level is 1. One is perfect. It means you’re walking, eating, drinking, and everything is running smoothly. Ten, on the other hand, is total kidney failure.

  Anthony’s creatinine level is approaching 2, they tell me, and yes, they have called Dr. Best of the Best. He has okayed the chemo but asked for a modified version: slightly reducing the ifosfamide to compensate for the kidney concern. But the lab hasn’t sent up the drugs yet. “We have another call in to the doctor. We’re waiting to hear back.”

  His doctor ordered it, I think. If he says give it to him, then give it to him! His creatinine level is elevated, but still it’s only at 2, and kidneys don’t fail until 10. Or so I thought.

  “What is going on?” I ask the doctor when I reach him on his home phone. “Anthony’s been waiting in his room all day.”

  “What are you talking about? I ordered the drugs,” he says. When I repeat what the lab has told me about the creatinine level, he answers me testily. He’s aware of the problem, he says, and has already addressed it.

  Dr. Best of the Best sounds impatient. I’m sure I am not welcome, calling him here. “I ordered the fucking drugs. I told them to send up the drugs this morning. Hours ago.”

  The fucking startles me. I have not heard a doctor curse. Best of the Best is angry with the lab.

  I switch the phone to my other ear and glance at Anthony. He is staring at a wall. His arms look thin but heavy. As if they have dropped there at his sides and he can’t lift them back up. I look past him out the window at the commuters—people leaving offices to drive to houses in the suburbs. Warm food and garlic smells hugging them as they walk through familiar doors.

  I don’t know whom to turn to. I need to trust the doctor, to put my faith in him completely. I’m lost if I can’t. He’s my compass. I need to trust that he is right and that the lab is responsible for the delay. A simple miscommunication. This is not the time, in the fifth round of chemo, almost at the end, that I am eager to question Anthony’s doctor.

  In the early rounds I did the research. I combed the Internet for new drugs, new treatments, and studied their side effects. I brought it all to Best of the Best’s office. He listened quietly while I read from articles and World News Tonight transcripts and then gave me his opinion. After the third round he didn’t respond. I named the drug, and he wrote the prescription without even looking up. He gave me a triplicate prescription for Marinol, the “pot” drug, which I filled and then took myself to get to sleep. When Anthony asked how long he would live if he didn’t finish the five cycles, Best of the Best replied, without missing a beat, “Oh, I hate it when my patients ask me that.” In the beginning, yes, I would question, but now I don’t have that kind of time.

  Twenty minutes after we hang up, the lab brings up the drugs.

  I am pleased with myself, a little. I have taken charge and taken care of something, I think. I help Anthony get comfortable; then I find a supply room and go inside and shut the door. I sit down on a step stool, next to boxes of surgical masks and bedpans and a stack of white blankets, and cry.

  He does the chemo drip for three days around the clock, and after seventy-two hours I have forgotten about the lab and the cursing. We are back on course, pushing ahead. I move it away from everything else on my mind.

  2

  It is two weeks after the fifth cycle of chemo, and Anthony has not regained his strength. Best of the Best told us it might take a little longer to recover; the last cycle is always the most difficult. He has been home but unable to go to work.

  No one knows what goes on in our secret lives. We guzzle NyQuil to sleep. We get up in the night to change the sheets, which are soaked in perspiration. Anthony sleeps upright so he can breathe easier. If I hear him struggling, I nudge him to wake him up. He is always, it seems, up during the night. I take his temperature every hour. I cry in the shower so he cannot hear me.

  He has had a fever for days, and we are biding it. But this night seems worse. It is four in the morning, and he is running a 103-degree fever and is filling the crescent moon–shaped bowls they gave us at the hospital with bile, so we agree on the cab.

  “Columbia Presbyterian, emergency room,” I tell the driver calmly.

  We are used to going to hospitals in cabs. In New York this is what you do.

  There are things I know how to do, regardless of how crazy it all seems. I am serious, efficient. Following my own made-up directions. I am unable, still, to say I can’t do this by myself. And no one suggests that I get help. There is such a fuzzy line between sick and rush to the hospital, and we keep moving it. Hailing cabs at four in the morning. Keep moving. It will be worse if you stop.

  This is the second trip to the ER in as many weeks. But this time, before I finish checking him into the hospital the emergency room doctor says, “I think you should call his mother,” as he puts an oxygen mask on Anthony and hooks up a saline IV.

  We have been in hospitals for years, but now I am worried. It is the expression on the doctor’s face. The stark change, it seems, in Anthony from the door of our apartment to here. I have a fleeting thought of him dying right here in the ER, but that can’t be possible. Can it?

  The ER doctor is serious and direct. He is disheveled, sweaty, and he’s talking fast. He has no time for careful meetings. He tells me Anthony is fighting a massive infection. They won’t be sure what it is until the blood tests and cultures come back from the lab. The doctor starts an IV for Vancomycin, the antibiotic of last resort. “It’s not good,” he is saying. “His immune system is so compromised from the chemo, he’s having difficulty fighting back. There is very lit
tle we can do except wait.” I don’t respond. “The first twenty-four hours are the most important. If his condition doesn’t improve, well, that’s not good either.” Mrs. Radziwill, he is trying to tell me, I think your husband is going to die.

  Carolyn comes in the morning. Lee arrives with Hamilton. Herbert calls from Los Angeles. Friends start showing up in the afternoon. There are people who haven’t seen Anthony in the hospital before, who don’t know what this is like, and Carolyn won’t let me reassure them. She is worried about me. She grabs my hand in the waiting room and makes it clear she will take care of me, and the others will have to manage this on their own.

  After Anthony is situated in the ICU, I book one of the McKeen Pavilion’s guest rooms, and Carolyn and I spend the night. She is afraid to leave me now. Afraid that if Anthony dies during the night, I will be here all alone. I wake up early the next morning and call the ICU.

  “How is he?”

  “He’s the same,” the voice says flatly. “Unchanged.” The nurse says it slowly, without inflection, like a recording.

  “What does that mean?”

  “We were hoping for some progress.”

  Carolyn is sitting on the bed next to me, and I won’t talk to her. I put the phone down and cry. She brings me juice and a muffin and runs the shower for me. When I get out, I see that she has laid out the clothes she brought for me. I get dressed and sit down in the bathroom and she blow-dries my hair.

  I suddenly realize I’m not prepared for him to die. I’m not ready for this. Not yet.

  I’ll just sleep, I think. I’ll wake up and he’ll be coming out of it. Close one, I will tell him. He’ll smile and squeeze my hand. But I wake up and his condition is the same and I can’t look at anyone.

  Carolyn and I walk silently to the ICU. John is there already. Caroline comes in with Ed, Holly with Pete and Joan. Marc and Lori are sitting in the waiting room outside. Anthony’s sister Tina, here with her boyfriend, is visibly shaken. It looks as if Anthony is hooked to every machine they have. His resistance is breaking down, his kidneys are failing, his circulation system is going, his white blood cell count is skyrocketing, his red blood count is too low, his respiratory system is shutting down—it appears to be irreversible.

  John comes back late that night in his tuxedo, straight from an event. It is nearly midnight, and Carolyn and I are waiting for him. He is the one who can save us somehow. The one we count on. The one who brings magic dust and sparkle, and we hold our breath each time, hoping he can still do it. We are hoping, Carolyn and I, that he can somehow pull this off.

  He kisses her, gives me a quick hug, and walks over to Anthony’s bed. We have been standing here for hours, watching him drift in and out of consciousness.

  “Tonypro,” he says quietly and grabs Anthony’s hand. John’s shoes are black and shiny. His bow tie is undone. His tuxedo looks comical in the yellow lights of the ICU.

  He begins humming, and then there are words. We can barely hear him, but Anthony does, and he smiles. His eyes are still closed, but they seem more relaxed when he smiles, and then his mouth starts to move along with John’s.

  If you go down to the woods today,

  You’re sure of a big surprise.

  If you go down to the woods today,

  You’d better go in disguise.

  For every bear that ever there was

  Will gather there for certain because

  Today’s the day the teddy bears have their picnic.

  They sing together softly, this children’s song, with their hands clasped like little boys. They sing it over and over, John holding tightly on to Anthony’s hand. They are in a place that no one else has ever been or could ever go, singing a song that John’s mother used to sing to the two of them. The boys who laughed and played and sang silly songs are all grown up now—John in a tuxedo, Anthony in a hospital gown.

  The doctors think Anthony will die tonight, and John takes him to the safest place he knows.

  3

  It’s day four in the ICU. Anthony’s immune system is helpless. He is at the mercy of every kind of infection, vulnerable to everything. His body has a septic infection and his organs are systematically shutting down, one by one. Each day that he holds on increases his chances of surviving. Each day they can keep him stable increases the likelihood he will pull through. But some systems won’t be able to recover.

  As if the ICU isn’t gloomy enough by itself, there is a run of spinal meningitis while we’re here. Bodies are wheeled by under white sheets. The first time I see this, the white sheet draped over a stretcher, I don’t know what it is. By the second time it is clear.

  None of us says anything to Anthony. No one talks about death in a hospital; it seems like bad luck.

  I am following his creatinine level, because I think this is something I know about. It is rising steadily each day—four to five to six. It stops around six and a half, and I am relieved. Thank God, I think, it’s not kidney failure.

  The interns make their rounds every morning with their charts—clipboards with the numbers of Anthony’s life: blood pressure, cell counts, hematocrit levels, culture reports, and creatinine levels. The ER doctor stops by to check on his patient. He is amazed that Anthony has survived. He looks at the chart and takes the time to explain it.

  “This is what’s going on with his kidneys,” he tells me, showing me the charts and reports from the chemo. He shows me the creatinine levels rising: 1.5 after the third round, 1.9 after the fourth. Anthony’s kidneys were beginning to fail long before our 4 a.m. cab ride to the ER, and the doctor is explaining to me how it happened, and that we can’t do anything about it. He stops and waits for me to catch up, to understand that Anthony’s kidneys will never recover.

  What I don’t understand before talking to the doctor is that at a creatinine level of 2 his kidneys are functioning at 50 percent. He essentially has one working kidney. You would think, or at least I thought, that 5 is 50 percent, not 2. The range is 1 to 10. And because I thought this, I didn’t panic when his level was 2. I thought we had room. Even if it gets to 5, I thought, 5 is okay. You can live at 50 percent, I thought, on one kidney. But I’m wrong. This doctor is telling me that a level of 2 is as far, really, as he can go.

  I can’t believe what I’m hearing. I feel a quick and dizzying whirl of emotions: fury, devastation, hatred, as if I’m a windup toy and he has just pulled the string. And then I stop. I am too stunned to feel anything.

  Later that day Dr. Best of the Best stops by in his pressed white lab coat. He is standing at the nurses’ station checking Anthony’s chart and I ask him what happened. Cancer patients, he says, are always at risk for infections after having chemo. “As for the kidneys,” he adds, “there’s no way to know exactly what caused it. It could well have been the thalidomide.” It is the last time I ever see him.

  When I get home that night I find a copy of Elle Decor in our mailbox. The cover reads, “Big Ideas for Small Spaces.” Anthony and I are on page 198, “Paradise on Park.” There is a full-page photo, taken eight months ago, before his last thoracotomy in March. We’re walking arm in arm on the sidewalk in front of our apartment, Anthony, in a grey cashmere sweater and slacks, gazing down at me. Both of us smiling, a portrait of carefree lives. We look as if we have it all. There is a three-page photo spread of the apartment packed with the antiques, the furnishings, the subtle reincarnations of Anthony’s history that I raced to put together. A past and a future assembled from our precarious present.

  Diane’s husband, Mike, comes to the ICU every day at 1 p.m. with a bag of cookies and sandwiches that he passes out to all the nurses. He is an old family friend of Anthony’s and John’s. We’re all friends—he was at our wedding, we see each other at get-togethers, and I work with Diane—but I haven’t really gotten to know him well until now.

  He sits with me in the ICU, and if Anthony is awake, the three of us talk. If he is asleep, Mike and I talk, or sometimes we don’t. He understands the awkwar
d rhythm of hospital days, of having to entertain in a strange place, of feeling obligated to host. He comes in and sits down in the chair without hesitation, as if he’s been coming here for ten years and is just now running into us. Mike distrusts doctors, so when the interns come around and discuss Anthony’s condition among themselves as though he is deaf or dead, I have someone to look at across the room. While they tick off the succession of things that are going wrong, I have someone to hate them with.

  It is very stressful, this stay, because we are in New York, and Anthony is narrowly cheating death. Word spreads quickly, and soon everyone comes, and I don’t know what to say. I don’t want to see anyone, but I feel guilty turning them away. I don’t want this to seem like a viewing, a stream of people parading in to pay respects. The phone rings all day. You tell me, when do you think I can come see him? I don’t want these calls. I don’t want to schedule. I don’t want them to come, but when they do sometimes it’s nice. I don’t want to be involved in it. Mike never calls. He shows up. He doesn’t make me decide. He is a comfort to me during this stay.

  After seven days in the ICU Anthony is stable enough to move to a room. We get the Sunny von Bülow room, informally named after the heiress who lived here in a coma for so many years.

  She haunts the room, the penthouse suite at Columbia Presbyterian. There is a story told that she started whistling one day while an intern was changing her feeding tube. Whistling, out of nowhere, after years of lying mute. Of all the hospital rooms, this is my favorite. It has full-length windows and a beautiful view. The picture window looks as if it was framed right around the George Washington Bridge. It is bigger than the ones in other rooms and has cream-colored curtains with a pattern of light-blue flowers. A city hospital room done in country chic. The bedspread and the shower curtain are made from the same fabric, and on a hook behind the door is a small table that unfolds to hold dinner for two. I sleep on a cot I make up with crisp white hospital sheets. I set it up between Anthony’s bed and the window so I can stare out at the lights. The magic dots moving on the bridge. People coming and going with their stories—to the theater, in cocktail dresses, to apartments, to concerts, to dinners, to celebrate. It’s enchanting, this view. The first thing people notice when they come. This is nice for Anthony, because it makes him the second thing. Most of the people who visit us are shocked. They don’t realize we are this far along. We have managed a good front until now, and I can see it in their stretched smiles, their round eyes. Oh, my God, what happened?