This fictional short story was published in Secrets from the Black Bag (Royal College of General Practitioners Publications; London, December, 2005).
Some patients will do anything we tell them. Others obey their spouses blindly. Ambrose O’Sullivan did as his wife directed. It killed her.
“Divina won’t be needing that toe massage now,” I said gently, glancing over my shoulder at the foot of the conjugal bed one frosty, winter morning. Joan Baez sang “Old Blue” from a tape player near the bed.
The big man sighed. “Aye, but she always used to like it. It’s the last thing I can do for her,” he said, reverently releasing the lifeless digit. “I should have called the ambulance.”
I closed the dead woman’s eyes and started to pull the cotton sheet with dainty, pink-and-yellow flowers over her head, which the large woman had preferred to bold stripes and practical polyester.
“Not yet, doctor, if you don’t mind,” Ambrose said, coming to my side to say his last goodbyes.
We were alone in the room. Ambrose had sent the numerous O’Sullivan children out back to play with the dog. He knelt adoringly by his Divina’s deathbed, his features unfinished as if his Maker had got tired or bored and left the job incomplete. Ambrose’s nose was broad and flat, barely more than two nostrils. His ears wandered halfheartedly into his head. His eyes held the look I had seen so many times before in this situation.
“I should have called the ambulance,” he repeated brokenly.
“Your wife stopped you acting, Ambrose,” I said quietly.
Divina had completely dominated her husband. I knew that. Heart disease had plagued Divina for years. I knew that too. Given both factors, should I have counselled Ambrose to ignore her likely protestations and ring for an ambulance in case of trouble?
“Yes, that’s right. Look at the trouble I got into when I tried to run the place,” Ambrose said, leaning forward. His eyebrows, short, dark, little slashes, descended sharply towards his nose. They stopped halfway back across his brow bone, where his eyes began, forming a triangle. Nothing tight or pinched inhabited Ambrose’s face. Even the lines around his mouth meandered from nose to jaw.
Did you ever read The Secret Life of Walter Mitty? The protagonist had many guises and schemes, all of them totally hopeless. As a miniature Mitty, Ambrose’s judgment and critical faculties were as lost as his physical finesse. Better still to think of him as the dreamer in Lennon’s “Imagine.” In his own way he tried to spread harmony and love, but it smeared more like hardened marmalade with Divina.
One day he decided to rear calves out the back and sell the fatted-up results. He loosed five enthusiastic, young heifers in his backyard. That did not do his garden much good. Not only did they shit all over the place but also their hooves tore up everything. It became a badly run farmyard. Every kid in the district came to pat his calves. The vet then appeared and pronounced ringworm, so Ambrose had to pay for 120 children with ringworm. Picture all these kids running around town painted blue! The government condemned and shot every last calf. Ambrose lost his backyard, his calves, and his wife’s affections. The neighbors did not see him as a roaring success.
Another time Ambrose ruled as the local chicken king. Day-old chicks were a great seller, because when they finish laying you eat them. Hence the need for new ones. He invested in all the gear and had the things coming out of his ears. Then one day the state government announced that the egg board had a monopoly on the provision of eggs. Anybody who kept more than one chicken had to register and pay a fee. Ambrose’s empire disappeared overnight. I have always wondered what he did with his stock, but that is a secret he still guards. The good man went on to a number of other schemes over the years, all of which were complete disasters. His wife finally took over ruling the roost and had henpecked him for the last twenty years.
Divina’s domineering nature killed her. She had a coronary in the bedroom. “Ahh!! I’ve got severe indigestion,” she cried, sitting up in bed and clutching her middle.
“I’ll get the ambulance, dear,” said Ambrose, heading for the phone. Contrary to appearances he wasn’t a total fool. He could recognize a lady having a heart attack.
“No! I’ve only got indigestion.”
“But Mum—” protested the children, who had all gathered around.
Divina let neither husband nor any of their brood leave her side. The family sat transfixed for two hours, until eventually she keeled over and the spell was broken.
“I should have called the ambulance,” Ambrose said.
“Perhaps she wanted to die at home, Ambrose. It’s quite difficult with a very dominant partner,” I replied, hoping to provide some comfort. I did not add that it takes courage to break that bond of control. It can be very difficult to persuade people they are dying. The wife, often against her better judgment, does not call the ambulance in accordance with her husband’s wishes. My theory, with which my colleagues may disagree—I know my husband, Wayne, certainly does—is that during a heart attack the heart’s output to the brain starts to drop and the oxygen level in the brain falls. The frontal lobe of the brain ceases to function at 95 or 96 percent oxygen. It needs that 100 percent pure, quality stuff in order to change a decision. Consequently, if one decides this is only indigestion, even though it gets worse as the heart output and oxygenation fall, one cannot change that decision. Somebody else has to step in and change it. Ambrose may once have had the courage required to break that bond of control, but his wife wore him down long ago. On the other hand, hypoxia may not have hampered Divina O’Sullivan. She may have known precisely what she was doing and wanted to die at home in her own nest, in her own cotton, floral sheets, surrounded by family.
Into the silence around Divina’s deathbed burst one of the O’Sullivan children. A large, friendly Labrador lapped at his heels.
“Dad, Blue’s in the house!”
Ambrose transferred his hands from wife to canine, ecstatic to be inside again after so many years.
“Let him stay, son, if it makes you happy,” Ambrose said with uncontested authority, and smiled sadly. “We can breed llamas now.”
SUSAN WOLDENBERG BUTLER was born in Lafayette, Louisiana. She has published fiction and non-fiction in the U.S., U.K., and Australia, including Secrets from the Black Bag (Royal College of General Practitioners Publications), which is on the recommended reading lists of the Association of Course Organizers in the U.K. and General Practice Training in Tasmania. Black Bag Moon, her second book of doctor stories, is under consideration with a U.K. publisher. She lives with her epidemiologist husband, Colin, in Tasmania and Canberra, Australia. In 1989, Colin and Susan founded Benevolent Organization for Development, Health & Insight (BODHI), a non-profit organization that works in the areas of health, education and micro-credit in developing countries. For more information about Susan, please visit her website: www.susanbutler.com.au.