DISCLAIMER: This is an original work of fiction. It is not an Uber story. So, there is nothing else to write here.

WARNING: There is no sex or violence or bondage or bad language. However, it is a sad tale. If the absence of the former and the presence of the later bother you then you may want to read something different.

POETRY ALERT: The poem at the beginning is not mine and is used with the express permission of the author. Needless to say, it should not be copied without her permission.

WHY: Sometimes, I just need an excuse to cry.

THE CONSULT

by phair

neglect

the man I forgot to wrap

is leaving

he’s come loose

he’s falling out of my life

never to return,

unable to reemerge,

leaving so much unfinished business

now, not needing completion

giving me time that I lacked

to do what I could have

to make him stay

by Marguerite Mullaney, 1997

used with permission

"Somebody beeped me."

"Dr. O’Grady?" The ER nurse gulped a mouthful of doughnut, "Howie is suppose to be on until change of shift."

"I am acutely aware of the schedule seeing as I’m the one to draw it up each month," the weary department head huffed. "Dr. Howard’s wife went into labor an hour ago so you’re stuck with me. Which attending called?"

The nurse’s shoulders sagged under the psychiatrist’s penetrating stare. It was a running joke at the hospital that the intensely professional specialist could look straight into the psyche with those deep blue eyes and see mental illness. The other part of the joke was Dr. O’Grady’s frigid personality froze the sickness right out of her patients.

"Okay," the nurse decided to save time and confess, "I called."

"You can’t do that," the doctor stated flatly. "Only attendings can call in a referral. Psychiatry is very expensive and most of our patients are under insured for mental health benefits. Attendings need to ration in-hospital treatment units on an "urgent necessity" basis. Everybody else can obtain services in the outpatient department," O’Grady saw the nurse was unimpressed with the logical management of resources. "I don’t have time to explain policy to you. Who’s the patient’s attending?"

"She’s not a patient. She’s a family member of a patient," the nurse took another bite of her doughnut.

"Look," Dr. O’Grady was losing her temper and straightened to her full, imposing height, "if she’s tearing up the place, get security. If she decompensated then get the chaplain. You should know better than to bother me with a non-billable issue. In fact," the doctor squinted at the powdered sugar speckled name tag, "Betsy, you are way out of line here. I should report you for this."

"Give me one minute to explain and then report me," Betsy brushed back her graying hair with a casual flip.

"Make it good," the doctor realized the use her four inch height advantage for leverage in the conversation was lost on the veteran nurse.

"The guy in trauma two is dead; DOA. Bullfinch’s students are getting to practice with the paddles on him and have been doing so for the last fifteen minutes...,"

"We are a teaching hospital," O’Grady defended.

"Ya, well, his sister is in the Family Room; one door down. She can hear all of it. Ordinarily, I’d send her for coffee but these two are frequent fliers. I know she won’t leave him. It was all I could do to get her to wait in a separate room. He’s status post head injury times twenty years," she nodded at the psychiatrist’s shocked expression at the exceptional survival number. "It gets better. His kid sister has been taking care of him, at home, for the last...,"

"Twenty years?" O’Grady winced at the nurse’s affirmative nod. "How bad was he?"

"No movement, no speech, great smile," the nurse rubbed away a tear absently. "I like them. We all do. They’re good people. And now, she’s sitting there alone and I just know, she knows he’s gone."

The doctor thought for a moment. Somewhere behind her somebody yelled "clear" again. The bang that followed was louder than the doctor ever remembered it being before.

"What do you expect me to do?" It was asked as a legitimate question without sarcasm.

"Make sure she’s okay. Their older brother is coming in from the western part of the state but it will take a while to get here even at this hour of the morning."

"I’ll give you fifteen minutes, my coffee break," the doctor flashed a smug grin, "and you’re buying the coffee."

"Thanks," the nurse was relieved she was able to pull a freebie out of a budget obsessed manager.

* * *

"Hello, I’m Dr. O’Grady," she extended her hand to the weeping woman.

"Is he...?" The woman went to rise from her chair but the doctor signaled for her to sit.

"No, I’m here to see if you need anything."

The woman settled back in her chair. O’Grady’s well practiced observational technique noted the defensive posturing which followed; eyes scanning the intruder, arms crossed, feet planted firmly on the ground preparing to escape. It was the level just below the obvious that intrigued the psychiatrist. The woman’s blood shot eyes were ringed with swollen, red skin from crying but they appeared remarkably focused on their task of assessing the doctor. Back teeth ground stiff to hold her countenance steady. Her face, paled from the adrenaline rush, appeared child like framed by a mass of unbrushed, brown hair. A small hint of gray on the left suggested she was older than she looked. The woman was battling to maintain a stoic presentation in the wake of her unbearable grief.

"Would you like some coffee, Ms. ...,"

"Elisabeth, just call me Elisabeth, and no thanks to the coffee."

"May I sit?" The doctor accepted the woman’s shrug for yes, "It has been a difficult night for you."

Nothing but another shrug.

"What happened?" With only eleven minutes to go, O’Grady abandoned her usual round about interview technique and went straight for the heart of the matter.

"Woke up and he was gone," the woman responded in kind.

"He’s been ill...," the doctor immediately recognized direct questions would not penetrate Elisabeth’s well practiced poise. "She’s learned evasion from the best; doctors," O’Grady thought.

"Over the summer, he had a few pneumonia’s but last night he seemed fine," a smile traced across her bloodless lips.

"He was happy...," the doctor made a guess.

"Oh, very happy," Elisabeth looking up at the doctor with a flash of innocence twinkling in her eyes, "we got a new cable system. Digital or something like that. Three hundred channels. Thom was psyched."

"Thom liked tv...," O’Grady smiled thinly at the woman’s infectious laugh.

"That’s an understatement. It was all he had left. He stopped being able to eat a year or so ago and they stuck a tube in him."

"He wanted the tube...,"

"We talked about, you know," Elisabeth shook her head at the memory. "The muscles just didn’t work anymore. I told him without the tube he would get a really big pneumonia that would take him out. And, if he was done with all this, if he was too tired to go on nobody would think less of him. But if he was still enjoying his life then dying over food was stupid."

"He chose the tube...,"

"I think," the tears broke loose again but Elizabeth ignored them, "I think, he knew I wasn’t ready for him to leave. It was just too soon."

Dr. O’Grady was momentarily stunned. The woman before her, no more than thirty five, had spent the last twenty years caring for a totally dependent sibling. Her entire adult life lost to keeping somebody else alive. Yet, she claimed, she was not ready to lose him.

O’Grady lived in a world of institutions. Care and confinement for the aged, infirmed, and insane were as much part of the daily landscape as the sun at dawn. The concept of home care was a stretch for her imagination. The idea a healthy adult could get real, emotional gratification from dispensing that kind of care twenty four hours a day, seven days a week was a completely alien concept to her.

"You weren’t ready?" The doctor did not like the surprise resonating in her question but was unable to restrain it.

"I already lost him once. It is too much to ask of a person to lose the same brother twice."

"Tell me about the first time," O’Grady moved to the edge of her seat, "please."

Elisabeth sighed. It was the weight of a hundred thousand retellings that forced out her reserve air. For an instant, she looked younger somehow to the doctor. It was as if the question brought her back to the beginning again; to the day her childhood abruptly ended.

"He was a an unrestrained passenger in a car hit by a drunk driver...,"

"No, tell me about you during the first loss."

"Me?" Elisabeth’s usual defenses were shattered by the novelty of the question. Nobody had ever cared to ask before, "I was, I, I was just a kid."

"And Thom was...," O’Grady leaned her elbows on her knees to close the distance between them.

"My big brother; college boy, married, smart, and," tears were dried with a sweat shirt sleeve, "he loved me. He was my best friend. There were alot of us, brothers and sisters, but he took care of me."

"Losing him then was...,"

"Agony. It was worse than just death. In spite of his injuries, there was hope that he would come back."

"But he didn’t...,"

"Oh, he came back but it was a different Thom. He was physically ruined and his intellect was restricted to adolescence but...,

"He still loved you," Dr. O’Grady finished quietly as a long suppressed emptiness in her own life whispered hello.

"Unconditionally," Elisabeth chuckled. "Thom would hang on every word out of my mouth. I’d tell him about school or work and I’d be right even if I was wrong. He always had a look on his face like, ‘I taught her everything she knows.’"

"He was proud of you," the doctor had never experienced a similar moment personally.

"You shouldn’t have to lose that twice in the same lifetime," Elisabeth looked pleadingly at the doctor.

"No," the doctor could only agree, "you shouldn’t"

A small commotion outside the open door distracted Elisabeth. Several blue scrub suit clad doctors swarmed the entrance like a gathering of vultures. The older man in the center of the group pushed forward into the room.

"I’m Dr. Bullfinch," the balding man entered with bluster and a small woman resident carrying an enormous chart scampering at his side, "Your brother, Tim, no, Thomas, yes, was denied oxygen for a considerable period of time. I got his heart restarted. However, he is on a respirator at present. His condition is very poor."

"Poor." Elisabeth repeated.

"Yes, he is unable to move or talk," the pompous doctor looked over his glasses to drive the severity of his statement home.

Dr. O’Grady saw Elisabeth stiffen. Resignation at the stupidity of anonymous medicine ghosted across her face. She maintained her most patient face for the doctors but her eyes narrowed with silent annoyance.

"That would be his baseline, sir. Can you tell me what else he isn’t doing?"

Bullfinch snatched the chart from his little helper and furiously turned pages. His cheeks reddened with each passing moment until he found the needed information.

"Pupils are fixed, none responsive to pain, unable to breath on his own...,"

"You want permission to unplug," Elisabeth cut to the chase.

"It would be in his best...,"

"I just want to wait for Matt, our older brother. He’ll be here soon. I’ll sign anything you need after that."

"Oh, you have Power of Attorney?"

"Better, I’m the guardian. My paperwork is in his chart," her chin jutted to the massive volume in his hands. "If you bothered to look in there then you’d seen it’s the first page."

"Fine," Bullfinch ignored the cutting remark, "tell the nurse when your brother gets here so we can finish this up. Dr. O’Grady, I’m surprised to see you so early in the morning," he turned his full attention to his colleague dismissing the presence of the grieving family member.

"Yes, Dr. Howard was called out. I’m covering," she politely avoided his unspoken question.

"And you’re here exactly why?" His fluffy, silver eyebrows arched.

"My coffee break," O’Grady smiled sweetly. "Betsy brews the best."

"You’re kidding," the clueless resident interjected, "the stuff she gives us tastes like her cat pissed in it."

"Enough Mason," Bullfinch shoved the chart back into the resident’s chest before dragging her out of the room.

O’Grady smiled broadly at Elisabeth who was quietly laughing.

"Mason’s right. Betsy makes the worst coffee," the woman looked at the ceiling. "So, why are you here, Doc?"

"Seems Thom and you have friends on the nursing staff," O’Grady leveled with the woman. "They were worried about you."

"Should have told me they sent you, I would have been nicer. Sorry," it was sincere. "You get kind of jaded around the health care system. Every day since Thom’s accident some medical giant told me he was gonna die."

"They wanted to prepare you," O’Grady was surprised the woman’s comment threatened her.

"Ya, well, I must be an imbecile ‘cause today was the day and I was still stunned."

O’Grady could not contain her laugh at the Elisabeth’s comic delivery of a tragic sentiment. Humor echoed in the room and in Elisabeth’s voice.

"You know, Doc, if you tell somebody everyday they are going to die then you’ll eventually be right. Life’s a terminal condition."

"You’re right." The doctor decided it was time for the tough question, "Elisabeth, can you tell me about losing him the second time?"

The woman looked out the window at the coming dawn. A tremor rattled her body. Drawing her legs upon the chair, she wrapped her arms around them as the sobs tore from her throat. O’Grady wanted to take her question back but it was too late; the damage was done. Elisabeth’s fragile struggle against despair was over. She surrendered to the dark memory.

"We watched a movie until ten," she choked out. "I did some work and kissed his forehead goodnight at midnight. He was snoring. He never budged. I went to my bedroom with the dog and fell asleep," a long pause to steady her breathing. "At five, I woke up, don’t know why, just did," she was losing it, "my dog, Dov, was still asleep which is weird. Dov always woke me if Thom was awake. I went out to check on him and Thom was, he wasn’t, well, he was dead."

"What is dead?" The doctor desperately needed to tell her it was a mistaken assumption and death occurred at the hospital. If not for the woman’s sake then for her own.

"It’s cold and stiff and all the blood pooling toward gravity and twisted, painful features frozen moments after the body gives up the struggle to take one last, fleeting breath to steal one more instant of life."

"You’ve seen it before," the doctor acknowledged her own foolish attempt to rewrite Elisabeth’s life.

"Most people think it’s a sanitary, dignified process but they are naive. The body fights for life to the bitter end. It’s messy and painful and eyes rolling back in the head nightmare time," her breath came in anguished gasps, "and I should have been with him to hold him and tell him not to leave me again and he could stay a while more...,"

"But he needed to leave," the voice at the doorway startled both women. "Honeybunch, you helped him stay as long as he could," a man, ten or so years older than Elisabeth, smiled proudly at her and the doctor felt a twinge of jealousy, "you were his saint. If you don’t go to Heaven then nobody will."

The man moved with a grace that defied his age and stumpy frame. He scooped up Elisabeth as she dissolved beneath a flood of unstoppable tears. Her body was as limp as a rag doll in his arms. He cradled her with a gentle swaying motion and soft words.

"I got you, I got you, I got you, I got you, I got you," the man repeated the mantra over and over.

Dr. O’Grady left the pair without another word. She had to admit to herself she envied them in spite of all their pain. Or, perhaps, it was because of it. After all, unconditional love is not a risk free venture.

"Well, Dr. O’Grady, what did you think?" A worried Betsy intercepted the fleeing doctor’s retreat.

"I think Elisabeth is a very lucky woman and I learned alot from her." Stopping but not turning back, the doctor spoke over her shoulder, "Thanks for calling me, Betsy. I’ll buy the coffee next time."

The End

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