It came on suddenly on Wednesday afternoon, and by the evening my fever was 103°. Feeling just truly awful, I called my mom to complain and was told by both her and our longtime family friend Alison that I should go to urgent care, and then once we realized urgent care was closed, the emergency room. Alison â tall, uncompromising, fiercely loving, stubborn as hell -- had spent the last two years being treated for metastatic lung cancer, but was calling the fight. My mom was spending a few nights with her in the lead up to her âfinal exitâ on Saturday when she would end her life via a fatal dose of prescribed medication thanks to Washington's Death with Dignity Act.
My mom, Alison, and her beloved daughter Alyssia making frittata in our old house (2010)
Despite being a nurse and therefore a person who had spent her life ministering to the needs of strangers, Alison had refused to hire a caregiver. She hated the idea of a stranger in her house messing things up, and much preferred the idea of her friends and family doing the messing. And her loved ones had stepped up, caring for her in shifts all the way to the end, despite the fact that all along there had been the means to hire help. Many people wouldnât have the guts to test their friends like this, especially at the end, but Alison was brave like that.
Sometimes my dad and I challenge each other to imagine what it might be like to be dead forever, and thereâs this vertiginous drop and then a feeling of waking up and I know I have failed. We move on to other topics. My dad has told me that even though he has terminal cancer he canât really fathom the fact that he will die much more than I can. Itâs basically impossible to understand the concept of being dead forever. As Joseph Campbell said, âEternity isnât some later time. Eternity isnât even a long time. Eternity has nothing to do with time.â It would be like a fetus trying to understand what it is to be born.Â
Something else thatâs non-linear is fever. 103° is uncomfortably hot. Itâs the point that you start putting towels dipped in ice water on your body even though this too feels awful because youâre achy and somehow also freezing. Itâs only three degrees hotter than 100° but thatâs a lot if you consider thereâs only like seven degrees between fine and dead.Â
I didnât know which hospitals in the city took my extremely âboutiqueâ kinda-Cigna-kinda-not PPO plan and attempts to log in to my âprovider finderâ kept coming back with a wrong username or password message. I was feeling bad enough that I knew if I didnât do this right now, I would just lie down and hope for the best, so I picked the nearest ER and called an Uber.Â
It was an unseasonably warm night, and the waiting room was crowded but hushed. The ED experience itself was truly not bad, and I spent most of the four hours I was there in my own watching Nightmare on Elm Street. Everyone was extremely friendly. The doctor even made me feel like I wasnât an idiot for coming in, saying sheâd had several strong women, ER nurses even, felled similarly by what turned out to be the virus that causes the common cold. Our immune systems over-reacting after several years of coddling. By midnight my temperature was down to 99°, and I was ready to go. Hours later, it had climbed back to 103°. It cycled like that for the next 36 hours.
On Friday, my mom told me that Alison had looked at her and said in awe and not quite belief, âThis is my last day on Earth,â which rocked me more than learning the news of her death the next day would. Probably I could comprehend the concept of her last day on Earth, but not her actually dying. You think when it happens you will understand it to be true, but then itâs just like everything else: not what you hoped for or despaired over and in fact something else entirely.Â
Speaking of courage in the face of extreme adversity, I mustered the strength to call my insurance and find out if the hospital I went to was in network. The call is answered by Christopher, who refers to himself as a concierge. He assures me that no, the hospital I went to is not covered. When I sputter that other hospitals in the same hospital chain are covered, he explains that just because two hospitals are part of the same organization does not mean they take the same insurance since each individual site apparently contracts with insurance based on its own personal preferences. You can be sure this is the case because if itâs asinine, opaque, and cruel itâs the American healthcare system.Â
I started to cry imagining how many thousands of dollars my little sojourn had cost me and for what? Nothing had really been done (there was also not really anything to be done). I hadnât needed medical care so much as medical assurance that I wasnât going to die. But at 9 oâclock at night, the ER must serve both functions (and many more). It hadnât turned out to be an emergency but thatâs the thing about emergencies: if you wait too long to find out if it is one, it will end one way or another, and you might not like âanotherâ and you might like âone wayâ even less.Â
As soon as I started crying something changed in Christopher and he went from being a haughty mansplainer to just a man, ie terrified of womenâs tears. âNo no no no no no you donât need to cry. Oh please donât cryâŚâ he said. I blubbered that it was âjust so complicated,â by which I meant the American Healthcare System, but he thought I meant Life.Â
And again Christopher cycled, becoming not just a man but the saddest man on Earth. âRamona itâs going to be ok. I understand that life is really hard. Believe me. I cry every day. My friends are like, âChristopher, are you ok?â And I tell them, âEvery morning I wake up is a win.â The thing is, it could be over likethat, and Iâd rather have a hard life than a short one.âÂ
He went on like this for 10 minutes, and although he clearly knew he was on a recorded line, at one point saying, âWeâre your health insurance company. We want you to get the most out of your benefits,â I actually did feel better when the call was over. This might have had something to do with learning I âonlyâ had to pay 30% on out of network ER visits (after the $1000 deductible), but it was also his earnest reminder that these days, no matter how dumb and twisted, are in no way guaranteed. It could and one day will be otherwise.Â
He ended the call by giving me his extension and telling me to call when I got the bill and also if I needed anything in general, âIf you just need to cry thatâs fine. Iâve helped members order pizza, find a lawyer. As long as it isnât illegal, unethical or immoral I will do what I can to help you.â At this point, it was clear that Christopher was not a man terrified by womenâs tears, but a man who loved tears of all kinds, and in fact required them as payment for his services.Â
On Saturday morning I was feeling well enough to get out, and took a long walk north into Fishtown. At some point Cathy called and we chatted while I stood on the sunny sidewalk eating a free cupcake. We talked about Alison, who at that point had an hour and 15 minutes left until she was dead forever, and the Phillies, and whether we would get brunch next weekend. Itâs psychotic that anyone could speak of such things â could speak period â when someone they know is about to die, but then you do it and you see how it can happen. Does happen. Everyday. How we keep living even while people die forever.Â
Cathy had just come back from a trip to Seattle where she had stayed with my dad while my mom came to visit me in Philadelphia. She said it was a highlight of her year. Spending time with my dad has always been good for that, but more generally being in the company of people who are seriously ill is often a surprisingly life-giving experience. You trip back over the threshold, relieved. The sun is out. A store that sells $40 candles is opening down the block.Â
Eternity unreels, but not yet for me.Â