The Hospital

The Keeper of Hours

Chapter 28: The Hospital

The fever started on a Sunday.

She had been, in the three weeks since the fall, managing. The hip had quieted. The shoulder had quieted. Yvonne had been in the house full-time since the tenth of September. Tiana had come every morning. Carl had come every afternoon. The grab bar had been installed. The rails along the hallway had been added to. The small light over the stove had stayed on around the clock. The careful perimeter a household draws around a woman in her last months had been drawn, and Mama Tate had been, within the perimeter, reasonably well.

Until Sunday night.

She had gone to bed at eight-thirty, which was early even for her, and she had not, in the hour before bed, mentioned to Yvonne that the cough she had been managing all afternoon had deepened. She had not mentioned, either, that the small warm feeling in her chest that had started at lunch had not gone away with supper. She had said only, Yvonne baby, I am tired. I am going to bed. Yvonne had walked her back. Yvonne had not, at that moment, noticed anything more than ordinary tiredness.

At ten-forty Yvonne, who was on the couch in the front room watching the late news with Carl, heard through the wall the small sound of her mother coughing hard.

She got up. She went to the bedroom.

Mama Tate was in the bed. The quilt was down at her feet. Her face was flushed. Her hand, when Yvonne touched it, was hot.

"Mama."

"Yvonne. I — baby, I do not feel right."

"Mama. You are burning up."

"I know, baby. It came up fast. I was all right at supper."

"Mama, let me take your temperature."

Yvonne got the thermometer. She took the temperature. It read one hundred and two point six.

She did not, for a moment, speak.

Then she went to the front room. She called Tobi. She called Tobi at ten forty-five on a Sunday night on the cell phone Tobi had given her in April and had told her to call at any hour for any reason. Tobi answered on the second ring.

Tobi said, after Yvonne had described the fever and the cough and the sudden rise: "Yvonne. Take her in tonight. Not tomorrow. Tonight. I will call the ER at Methodist. I will meet you there. This sounds like a pneumonia coming up fast. In her condition it cannot wait till morning."

Yvonne nodded. Yvonne said, "Yes, Tobi."

She hung up. She told Carl. She told Tiana on the phone. She got her mother up slowly, into the car. Mama Tate did not, on the short walk from the bedroom to the car, protest. She was not, this night, a woman in a position to protest. She let Yvonne put her into the passenger seat. She let Carl put the small overnight bag — the same bag, which had been refreshed last week — in the back seat. She let Yvonne drive.

Tiana met them at the hospital entrance at eleven forty-seven.

The admission went fast.

Tobi had called ahead. The ER was expecting them. Mama Tate was triaged in eleven minutes. The chest X-ray came back in twenty. The right lower lobe had the small clear cloud that meant pneumonia. They started the IV antibiotics at one in the morning. They admitted her at two. They moved her to a room on the fifth floor at two-forty.

The room was a single.

Tobi had arranged it.

Yvonne stayed the first night. Tiana stayed the second. Carl stayed the third. On the fourth night Marcus flew in from Atlanta and took his turn. The rotation was the rotation of a family that had been practicing rotation for six months and was now executing under pressure.

Mama Tate slept hard the first two nights. She was less clear on the third. On the fourth — which was the Wednesday — she had a long stretch of not knowing where she was, during which she called Tiana by Yvonne's name twice and asked, quietly, with small dignity, baby, is your father coming tonight, to which Tiana had replied, Yes, Grandma. Daddy is coming at dinner. Mama Tate had nodded and had slept.

On Thursday she was clearer.

On Thursday morning Tobi came in at seven-thirty.

Tobi was in the white coat over a navy blouse. She had the small leather portfolio she had been carrying since April. She closed the door behind her. Yvonne was in the chair at the window. Tiana was at the foot of the bed. Marcus had flown in the night before and was sitting in the small second chair across from the bed.

Tobi sat on the edge of the bed. She put her hand on Mama Tate's.

"Mama Tate."

"Tobi."

"I want to talk to you about where we are."

"Yes, baby."

"The antibiotics have worked. The infection is clearing. The lung sounds are better than Monday. You are going to be able to go home on Saturday. Probably Saturday. Possibly Sunday."

"Yes, baby."

"Mama Tate. I need to tell you what else this episode means. I am going to tell you the way I would tell my own grandmother. I am not going to soften it for you, because softening is not what you have ever asked for, and not what you have wanted for a month now. Is that all right?"

"Tell me, Tobi."

"This is an aspiration pneumonia. Your swallow has been changing. We have all seen it — Tiana, Yvonne, myself. We did not say it to you because we were watching. The swallow will continue to change. That is the shape of this disease in its later stages. You are going to get pneumonias. Every few months. Each one takes a little more from the body than the last one left. The body will, at some pneumonia, not come back. I do not know which one. Nobody does. I am telling you what the shape is."

Mama Tate did not, for a moment, speak.

Then she said, slowly: "Tobi."

"Yes, Mama Tate."

"You are telling me that we are, now, in the last stretch."

"I am telling you that we are in it. Not the last weeks. Possibly not the last month. But we are no longer in the slow middle. We are in the stretch where the body is beginning to let go. I would guess — and I am speaking now as the daughter of my father, not as a physician — I would guess you have three to five months. It could be more. It could be less. I want you to know, from me, the honest number, because you are a woman who has been planning her own going for two years and who is going to want the data to finish planning."

Mama Tate closed her eyes.

She did not, for a long moment, open them.

When she did, she said: "Tobi. Thank you for telling me."

"You are welcome, Mama Tate."

"I have a thing to say now."

"I am listening, ma'am."

"I am not coming back to this hospital."

Tobi did not, at first, speak.

Yvonne, in the chair at the window, did not move.

Tiana, at the foot of the bed, put her hand to her mouth.

Marcus looked down at his hands.

"Tobi. I am not coming back to this hospital. If I get another pneumonia, it will be managed at home. I want hospice. I want Rosa, if she is available. I want to die in my own bed. I want to die on Eldridge's side of the bed, which is where I have been sleeping since the eleventh of September. I want to die in the small brick house on Park Avenue. I do not want more machines. I do not want more IVs. I do not want more antibiotics after this one unless the antibiotics are oral and I can take them at home in a pill. I am asking you to tell me, plainly, whether that is allowed."

Tobi breathed.

"Mama Tate. It is allowed. It is more than allowed. I can arrange it. I will arrange it. Rosa is with a different patient right now but will be available within the month. I can bring her by the house in the second week of November for the intake. We can have in-home hospice from then on. When the next pneumonia comes — or the one after it — we will manage it with comfort care. You will not be moved to the hospital unless you explicitly ask. You will be allowed to die at home, in your own bed, in your own time."

"Yes, baby."

"Mama Tate."

"Yes, Tobi."

"I need to ask you something. You have been talking about this with Yvonne. You have been talking about this with Tiana. I need to know it in my charting. Do you have — do you have any advance directive on file?"

"I do, baby. I filed one in 2012. Yvonne has a copy. It has been on the door of my refrigerator behind the magnet since 2014. It is titled Mama's Directives. Yvonne will bring it to the office tomorrow."

Tobi nodded.

"Thank you, ma'am."

Mama Tate looked at her.

"Tobi. Can I ask you a thing?"

"Ask, Mama Tate."

"Will you be with me when I go?"

Tobi did not, for a long moment, breathe.

Then she said, quietly: "Mama Tate. I will be. If I am in town. I will be. You call me. You tell Yvonne to call me. You tell Tiana. I will come. I will sit with you. I will be the doctor at the door. Rosa will be the nurse in the room. Yvonne will be on your right hand. Tiana will be on your left. Marcus will be at the foot, the way Curtis was at Mother Wells's foot. The room will be full. The Lord will be there. You will not be alone."

"Yes, baby."

"I will be there, Mama Tate."

Tobi bent — slowly, the way she had bent the first time, on a third Saturday in May — and she kissed Mama Tate on the cheek.

Then she rose, smoothed her coat, said she would be by on rounds at four, and left the room.

The room was, for a long minute, quiet.

Yvonne came over from the window.

"Mama."

"Yes, baby."

"You all right?"

"I am all right, Yvonne. I am tired. I am also clear. The clear is good. The Lord has given me the clear this morning for the conversation. I was not sure I would have the clear. The Lord arranged it."

"Yes, Mama."

"Come over here, babies. All of you."

Tiana came. Marcus came. They gathered around the bed. Yvonne sat on the edge of the bed where Tobi had been sitting. Tiana sat on the other side. Marcus stood at the foot.

Mama Tate looked at them.

"Babies. We are going to go home on Saturday. Saturday or Sunday. We are going to settle the house into its hospice shape over the next month. Rosa will come in November. We are going to have, Tobi says, between three and five months. We are going to spend the time well. We are going to have the people over. We are going to have Thanksgiving. We are going to have Christmas if the Lord gives it. We are going to have Naomi's fifth birthday, which is in February, if the Lord gives that. We are not going to waste the time. We are also not going to hurry the time. We will do what there is to do. We will not do what there is not to do."

"Yes, Mama."

"Marcus."

"Yes, Mama."

"You fly home to Atlanta tomorrow. You work your job. You come back in two weeks. You bring Naomi over. You stay on the weekends for the rest of the fall. When I go into the harder part of the months — you will know when — you take the leave your boss told you about in July. You move here for the last several weeks. You do not quit your job. You take leave. The Lord has arranged the leave already. You use it."

"Yes, Mama."

"Yvonne."

"Yes, Mama."

"You keep the school thing the way you have been keeping it. You do two or three days in person. You do the rest from the kitchen. You tell the school on Monday. They have been ready for this conversation since September. They will support it. You will be all right."

"Yes, Mama."

"Tiana."

"Yes, Grandma."

"You keep your work at the unit. You do not — Tiana, you do not take leave until I am in the last week. I know you will want to. I am telling you now, with the clear the Lord has given me, that I do not want you to. Your work on the unit is your keeping. You do not set down the keeping to be with me full-time. You come before and after shifts, the way you have been coming. Your patients on the unit need you as much as I do. You care for them. You come home and care for me. The Lord will hold both. He has been holding both for six months. He will continue."

"Yes, Grandma."

"And one more thing, babies."

"Yes, Mama," they said.

"The book. The book has not stopped. The book will not stop. Tiana, you keep reading every morning. Yvonne, you keep reading the legacy pages on Saturdays. Carl, you keep being on the couch on Saturdays. Marcus, when you are here on weekends, you sit on the couch the way you sat in June. Naomi, when she is over, will be on the couch with whoever is there. I will, for as long as I can, sit in the chair. When I cannot, I will lie in my bed and you will bring the book in and read by me. The keeping continues. The fall — the fall of my body — does not stop the keeping. The keeping is in the house. The keeping is in the hands. The keeping is not in my hip or in my swallow. Do you hear me?"

"Yes, Mama," they said.

"Say it back to me, babies."

Tiana said: "Grandma. The keeping is not in your hip. The keeping is in our hands. The keeping continues."

Yvonne said: "Mama. The book does not stop."

Marcus said: "Mama Tate. I will be on the couch when I am home, and in my own way in Atlanta. The keeping continues."

Mama Tate closed her eyes.

She nodded.

She said: "Good, babies. Good."

Saturday afternoon she came home.

Carl drove the Toyota up to the hospital entrance. Marcus had flown home to Atlanta on Friday because Mama Tate had been firm about it, but had texted Yvonne every two hours through Saturday. Yvonne helped her mother into the passenger seat. Tiana followed in her own car with the small bag of medications from the pharmacy.

The ride home took twelve minutes.

The house was the house. Yvonne had, during the week, been home for a few hours each afternoon to manage things. The living room was the living room. The front room had a few small additions — a small portable commode behind a folded screen in the corner, the small oxygen concentrator Rosa had left from Mother Wells's time which Tobi had arranged for delivery, a small adjustable table beside Eldridge's chair.

Mama Tate walked in slowly with Yvonne's hand under her elbow.

She stood for a moment in the front room.

She looked at Eldridge's chair.

The chair had not moved. The side table had not moved. The pecan tree, through the window, was beginning to turn — the small green hands that Naomi had counted in July were now, some of them, yellow at the edges.

Mama Tate, standing in the doorway, said quietly: "Home."

"Yes, Mama."

"Walk me to the chair."

Yvonne walked her. She sat. Her hip complained. She acknowledged it. Yvonne pulled the small quilt over her knees. Tiana brought the prayer book and the new composition book and the green book and set them — the small stack they had been — on the side table.

Carl went to the kitchen to make tea.

Mama Tate sat for a moment with her hand on the stack of books.

She closed her eyes.

Lord. I am home. Thank You. You have given me the time to come home. You have given me a doctor who understood and a daughter who arranged and a granddaughter who said yes and a son-in-law who drove and a grandson who will fly in two weeks. You have given me Mother Wells's nurse coming in November. You have given me Naomi's fifth birthday in February if I live that long. You have given me the book. You have given me the family. You have given me more than any keeper has the right to ask for. I am — Lord, I am tired. I am grateful. I am tired and grateful. I am going to sit in this chair for a while. I am going to eat a small supper. I am going to sleep in my own bed tonight. I am going to do the morning tomorrow on the couch while Tiana reads, and I am going to live the next few months the way You arrange them. I am Yours. The keeping is Yours. The going, when it comes, is Yours. I trust You with the going.

She opened her eyes.

Yvonne was sitting across from her on the couch.

"Mama."

"Yes, baby."

"You are home."

"I am home, Yvonne."

"You want me to read you anything?"

"Not yet, baby. I want to sit. I want to look at the tree. I want Carl to bring me tea. I want to feel the house hold me for an hour. That is what I want this afternoon."

"Yes, Mama."

She sat for the rest of the afternoon.

The tea came. Carl brought it. He sat in the small wooden chair by the door and did not, for a long time, speak. Tiana, at some point, came and sat on the floor by Mama Tate's chair the way Marcus had sat on the porch boards in May, and she put her head against her grandmother's knee, and Mama Tate put her hand on Tiana's head, and the three of them — Yvonne on the couch, Tiana on the floor, Carl at the door, Mama Tate in Eldridge's chair — stayed that way for what might have been an hour.

The pecan tree turned yellower in the late light.

The October sun came through the window at its fall angle.

Down the block a car went past. Miss Renita's grandbabies were already in school by now — they had gone back in mid-August — and the block was, on a Saturday afternoon in October, quieter than it had been in July.

Mama Tate did not, in the long quiet hour, speak.

Neither did the others.

They were home. She was home. The body had begun its last part of the trajectory. The house had received her for what everyone in the room understood was the last long stretch.

In the last small amber of the October afternoon, Yvonne rose from the couch, gently, and crossed to her mother.

"Mama. Let me help you to the kitchen. Tiana made soup."

"Yes, baby."

"Can you walk?"

"With your arm."

Yvonne gave her arm. They walked slowly to the kitchen. The table was set. The soup was warm. The bread was on the board. The family sat down — Yvonne, Tiana, Carl, Mama Tate — and they ate. Mama Tate ate a small portion. The portion was all she had. The family accepted the portion. They did not press.

After supper she slept in her bed for twelve hours.

The house held her.

The next morning — Sunday, the eleventh of October — Tiana came at four, and the reading began, and the keeping continued, and the long evening moved, in a small clear turn, from its middle hour into its late one.

Mama Tate was home.