Joan Didion: The Year of Magical Thinking

John was talking, then he wasn’t.

At one point in the seconds or minute before he stopped talking he had asked me if I had used single-malt Scotch for his second drink. I had said no, I used the same Scotch I had used for his first drink. “Good,” he had said. “I don’t know why but I don’t think you should mix them.” At another point in those seconds or that minute he had been talking about why World War One was the critical event from which the entire rest of the twentieth century flowed.

I have no idea which subject we were on, the Scotch or World War One, at the instant he stopped talking.

I only remember looking up. His left hand was raised and he was slumped motionless. At first I thought he was making a failed joke, an attempt to make the difficulty of the day seem manageable.

I remember saying Don’t do that.

When he did not respond my first thought was that he had started to eat and choked. I remember trying to lift him far enough from the back of the chair to give him the Heimlich. I remember the sense of his weight as he fell forward, first against the table, then to the floor. In the kitchen by the telephone I had taped a card with the New York — Presbyterian ambulance numbers. I had not taped the numbers by the telephone because I anticipated a moment like this. I had taped the numbers by the telephone in case someone in the building needed an ambulance.

Someone else.

I called one of the numbers. A dispatcher asked if he was breathing. I said Just come. When the paramedics came I tried to tell them what had happened but before I could finish they had transformed the part of the living room where John lay into an emergency department. One of them (there were three, maybe four, even an hour later I could not have said) was talking to the hospital about the electrocardiogram they seemed already to be transmitting. Another was opening the first or second of what would be many syringes for injection. (Epinephrine? Lidocaine? Procainamide? The names came to mind but I had no idea from where.) I remember saying that he might have choked. This was dismissed with a finger swipe: the airway was clear. They seemed now to be using defibrillating paddles, an attempt to restore a rhythm. They got something that could have been a normal heartbeat (or I thought they did, we had all been silent, there was a sharp jump), then lost it, and started again.

“He’s still fibbing,” I remember the one on the telephone saying.

“ V- fibbing,” John’s cardiologist said the next morning when he called from Nantucket. “They would have said ‘ V- fibbing.’ V for ventricular.”

Maybe they said “V-fibbing” and maybe they did not. Atrial fibrillation did not immediately or necessarily cause cardiac arrest. Ventricular did. Maybe ventricular was the given.

I remember trying to straighten out in my mind what would happen next. Since there was an ambulance crew in the living room, the next logical step would be going to the hospital. It occurred to me that the crew could decide very suddenly to go to the hospital and I would not be ready. I would not have in hand what I needed to take. I would waste time, get left behind. I found my handbag and a set of keys and a summary John’s doctor had made of his medical history. When I got back to the living room the paramedics were watching the computer monitor they had set up on the floor. I could not see the monitor so I watched their faces. I remember one glancing at the others. When the decision was made to move it happened very fast. I followed them to the elevator and asked if I could go with them. They said they were taking the gurney down first, I could go in the second ambulance. One of them waited with me for the elevator to come back up. By the time he and I got into the second ambulance the ambulance carrying the gurney was pulling away from the front of the building. The distance from our building to the part of New York — Presbyterian that used to be New York Hospital is six crosstown blocks. I have no memory of sirens. I have no memory of traffic. When we arrived at the emergency entrance to the hospital the gurney was already disappearing into the building. A man was waiting in the driveway. Everyone else in sight was wearing scrubs. He was not. “Is this the wife,” he said to the driver, then turned to me. “I’m your social worker,” he said, and I guess that is when I must have known.

“Iopened the door and I seen the man in the dress greens and I knew. I immediately knew.” This was what the mother of a nineteen-year-old killed by a bomb in Kirkuk said on an HBO documentary quoted by Bob Herbert in The New York Times on the morning of November 12, 2004. “But I thought that if, as long as I didn’t let him in, he couldn’t tell me. And then it — none of that would’ve happened. So he kept saying, ‘Ma’am, I need to come in.’ And I kept telling him, ‘I’m sorry, but you can’t come in.’”

When I read this at breakfast almost eleven months after the night with the ambulance and the social worker I recognized the thinking as my own.

Inside the emergency room I could see the gurney being pushed into a cubicle, propelled by more people in scrubs. Someone told me to wait in the reception area. I did. There was a line for admittance paperwork. Waiting in the line seemed the constructive thing to do. Waiting in the line said that there was still time to deal with this, I had copies of the insurance cards in my handbag, this was not a hospital I had ever negotiated — New York Hospital was the Cornell part of New York — Presbyterian, the part I knew was the Columbia part, Columbia-Presbyterian, at 168th and Broadway, twenty minutes away at best, too far in this kind of emergency — but I could make this unfamiliar hospital work, I could be useful, I could arrange the transfer to Columbia-Presbyterian once he was stabilized. I was fixed on the details of this imminent transfer to Columbia (he would need a bed with telemetry, eventually I could also get Quintana transferred to Columbia, the night she was admitted to Beth Israel North I had written on a card the beeper numbers of several Columbia doctors, one or another of them could make all this happen) when the social worker reappeared and guided me from the paperwork line into an empty room off the reception area. “You can wait here,” he said. I waited. The room was cold, or I was. I wondered how much time had passed between the time I called the ambulance and the arrival of the paramedics. It had seemed no time at all ( a mote in the eye of God was the phrase that came to me in the room off the reception area) but it must have been at the minimum several minutes.

I used to have on a bulletin board in my office, for reasons having to do with a plot point in a movie, a pink index card on which I had typed a sentence from The Merck Manual about how long the brain can be deprived of oxygen. The image of the pink index card was coming back to me in the room off the reception area: “Tissue anoxia for > 4 to 6 min. can result in irreversible brain damage or death.” I was telling myself that I must be misremembering the sentence when the social worker reappeared. He had with him a man he introduced as “your husband’s doctor.” There was a silence. “He’s dead, isn’t he,” I heard myself say to the doctor. The doctor looked at the social worker. “It’s okay,” the social worker said. “She’s a pretty cool customer.” They took me into the curtained cubicle where John lay, alone now. They asked if I wanted a priest. I said yes. A priest appeared and said the words. I thanked him. They gave me the silver clip in which John kept his driver’s license and credit cards. They gave me the cash that had been in his pocket. They gave me his watch. They gave me his cell phone. They gave me a plastic bag in which they said I would find his clothes. I thanked them. The social worker asked if he could do anything more for me. I said he could put me in a taxi. He did. I thanked him. “Do you have money for the fare,” he asked. I said I did, the cool customer. When I walked into the apartment and saw John’s jacket and scarf still lying on the chair where he had dropped them when we came in from seeing Quintana at Beth Israel North (the red cashmere scarf, the Patagonia windbreaker that had been the crew jacket on Up Close & Personal ) I wondered what an uncool customer would be allowed to do. Break down? Require sedation? Scream?