Lynn Dion
New York City, New York, USA

Mr. Hemphill appeared to be in his late sixties, but he was considerably younger. He was in the end stage of alcoholic cirrhosis of the liver, and except for the tight, distended belly of liver damage, was emaciated, pale, and paper thin in the white bed. I could pick up the skin on the backs of his hands an inch or more, thin as the skin that floats on boiled milk. His eyes were an indeterminate blue or gray, filmy, and discolored. He was short of breath and could not move more than a few feet at a time, so he leaned on me when I walked him from the wheelchair to the bed. The only thing about him that looked like it was clinging to life was his incongruously thick white hair.

He had left his small town somewhere in Northern Ireland in his mid-twenties. Long before coming to this country, he had lost any control over his drinking, but he had made a reasonable life for himself: steadily employed, married, later divorced. No children. He was fairly educated and quiet, and he worked in the print industry as a typesetter. For my part, I was a music student at the local state college, the “black sheep” daughter of a long line of nurses. My sister, a surgical nurse, had finagled the night-shift nurse’s aide job for me, for the freedom it lent my complicated schedule of classes and rehearsals.

I had just admitted Mr. Hemphill from the emergency department to the medical unit I reported to nightly. I took a brief history and vital signs, put him to bed, and propped him securely at a half-sitting angle to aid his breathing. After explaining the patient call light, filling his water jug, and turning the over-bed lamp down low, I bid him good night. I had every reason to expect that Mr. Hemphill would have a peaceful night, as he and the white bed together seemed almost to be floating there, pallid and benign against the shadows and the dark window curtains.

I had almost reached the door when he erupted without warning behind me, and my ears and nose relayed the awful story even before I saw it. I heard a deep gurgle and the rasp of stomach contents tearing past an exhausted larynx, then the flat slap of it hitting the footboard of the bed and flying over it onto the floor. At once an overwhelming smell filled the room: a sour odor of stomach, combined with the blunt, metallic halitus of blood.

My fledgling training did not hold, and I could repress neither the horror nor the incredulous fascination that seized me when I turned back to him. He was covered with a mass of half-digested clots and matter that resembled coffee grounds, just below his nose to the end of the bed. In the low lamplight it had the look of some expressionist theater piece: white, black, and numerous shades of red, from scarlet to brick to old crumbling leather. A rapt disbelief did indeed shield me from full perception, but it also immobilized me.

Mr. Hemphill himself came to my rescue. He looked up and saw me seeing him: a staggered kid with a new white uniform, and skinny ankles, who had never witnessed anything so appalling, and who was now struggling to pull herself together and act. And because he was a gentleman, with a good deal of diffident gallantry left in him, he roused himself to help me.

“Ah, girlie,” he said, spitting a mouthful of dark blood, “I’m so sorry for you seein’ that. And the nice clean bed and all.” Evidently this was no new experience for him, and he was aware of what he looked like. I saw genuine pity in his eyes that had nothing to do with his own condition. It was more than I could bear, that he should regret heaving his guts out because I was there to see it.

I moved quickly enough to fetch a basin, run water, swab out his mouth and begin mopping the ghastly smears off his face and hands. Soon, I fairly covered myself in the tarry mess as well. While I unsnapped the sleeves of his sodden johnny and rolled it down from his chest, I joked lamely about the mess—and if he was Irish why wasn’t it green?—to which he answered, through a faint, bloody grin, that it used to be but he feared he’d been in America too long. By then others had come to help bathe him and change the linens.

The name of the charge nurse was Jackie, but behind her back we called her the Captain. She was one of those shrewd Army nurses who had served in Korea. As far as she was concerned, the incident was close enough to battle conditions for a youngster like me, and she judged that I must be traumatized. After I had washed, almost from head to foot, she took me aside to debrief me on what I had just seen. She told me, briskly and kindly, that in chronic alcoholics with profound liver damage the esophageal vessels become varicose and may bleed into the stomach, which then yields to an emptying reflex, with virtually no warning—the gut-wringing, flying purge I’d heard fouling the white tiles of the floor.

She paused to peer at me keenly, frowning. Then she cracked open a sterile square and a new bottle of peroxide and wiped the outer corner of my right eyebrow. I glimpsed the small, tarry smear and cringed as she briefly examined my eye for any traces.

Jackie did not push me any further that night, but left me alone with a squeeze on the shoulder. “It takes time,” she said. I remained in the chilly utility room a while longer, scrubbing and scrubbing at the ruined uniform, which would not come clean and which I would never bring myself to wear again.

Mr. Hemphill did not experience another “bleed” in my presence, but he did repeat the performance once on the day shift, and his condition went perilously low. For two more nights he was assigned to me. Since he slept on and off around the clock, he was awake at eleven when I clocked in, and at two in the morning, and again around five. At any of those times, he would be waiting for me to come around; and though he himself was far too spent to talk, he clearly wanted the company. He would greet me whispering, “There’s the girlie,” ask a word or two about my day, and then sit motionless in the elevated bed, listening, while I told him about my flatmate or my doings at school. He could not hold his head up for more than a few seconds, but struggled nonetheless to meet my eye. It seemed to matter greatly to him. I devised a way to prop his neck and shoulders with a soft towel roll, so we could visit face to face for ten minutes or so, and he would faintly nod his approval until he nodded himself to sleep again.

On the fourth night he was gone. The unit had already been cleaned and readied for another admission by the time I came in at eleven. It was unthinkable, sick as he was, that he could have been discharged to home or extended care, and I knew he must have died. I never asked when or how. Death came to him in one of a likely handful of ways, miserable and stripped of dignity, and I had no desire to find out more.

But I kept thinking about the bond that had formed between me and my dying new friend. I reflected about his clear ruination and his simple decency, his capacity to go on reaching for human contact, not passively but as an equal, knowing there was help to offer as well as comfort to take. I believe he had simply decided he was going to live and to keep it in the here and now, until there wasn’t a drop left and if there were someone to share the last drop with, that was all the time in the world, and he wouldn’t say no to it.