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“ SI NG . . . S I NG,” S H E m o u ths. Marlene wants to say sing to me, my darling ch i l d re n , you have the voices of ange l s. The most she can muster are simple charades. To a s s i st her bre a thing, she sits with knees pulled to her chest and sways in time to her daughte rs’ qu i et harmonizing. She fo l l ows the outline of thin legs th rough th e sheer mate rial of her pyjamas. When did I get so skinny? she th i n ks. Once she l o n ged to be slimmer, especially after her stomach and hips th i c kened with each p re g n a n c y. She smiles, re m e m b e ring her moth e r’s homespun advice: be care f u l Now that Marlene grows we a ke r, her mother ente rs her thoughts more fre- qu e n t ly. Last night she awo ke to watch her mother approach the end of the hos- p i tal bed. She picked up Marl e n e’s chart, scanned it and nodded her head. Ro l f wheezed and twitched in the corner of the room, slumped aw k wa rd ly in a re c l i n- “Mom?” Marlene was te mpted to wa ke Rolf but knew the apparition wo u l d n’t l a st. None of them did. I t’s the drugs, and tri cks of the mind, she told herself. The m e m o ry remains while Marlene sways to the music of her childre n .
Blue Moon, you saw me standing alone, Her daughte rs don’t watch her as th ey sing, perched on the edge of the bed.
I n stead, Kayla, seve n teen, twists the hem of Marl e n e’s pyjama sleeve, and Emily, fo u rteen, looks towa rd the window. Kayla has already moved onto the ve rge of a d u l thood, now even more with her additional responsibilities around the house.
E m i ly is the angry one, incensed that Marlene is abandoning the fa m i ly. Eye c o n tact with her has grown imp o s s i b l e .
D e s p i te the morphine haze, Marlene knows these are her last days. To d ay she re qu e sts a reduction in the drugs. She wants to see—with clari t y — the outline of her daughte rs’ faces, the cornsilk hair she once possessed and the bluish white s of their eyes, although late ly re d - rimmed. Until now, Rolf has been her rock as well as her link to the outside wo rl d .
To d ay he comes apart and looks worn. He weeps silently in the corner with his s we a t s h i rt bunched around his shoulders, his wide face unshaven and shadowe d .
Since he’s seldom left her room in the last few days —has it been days or we e ks? M a rlene wo n d e rs—he hasn’t washed his hair. Re st rictions to visiting hours are n o n ex i stent on this wa rd, and families are never asked to leave. He sways to the a c a p p e l l a of his daughte rs’ voices. To d ay it is their children who show st re n g th. E ven without the morphine, she feels a veneer of floating marvel despite th e building grip of pain with each st ru g gle to inhale. Most people are n’t gra n ted th e l u x u ry of knowing their end, she realizes. Some are launched hars h ly from th e i r bodies by errant dri ve rs. The unpaid hy d ro bill tucked inside a flung purse is fo r- g ot ten; the fresh pasta planned for supper and the litre of 2% milk for eve n i n g cappuccino is splatte red curbside; the kids miss their te eth cleaning and the dog fo regoes her grooming. Those depart u res are both untimely and unscheduled.
O th e rs are seized by fa st-acting st ro kes that enter without knocking, save th e “Ed, someth i n g ’s wrong. I only see . . . half of yo u ,” Marl e n e’s mother told her fa ther when the st ro ke made its rapid assault. One moment she sat on the to i l et , flipping th rough the late st issue of C h a te l a i n e and debating bet ween aspara g u s w i th avocado or candied yams for Thanksgiving dinner. The next, her vision shut d own like an old-fashioned te l evision, slowly reducing to a concluding dot of light.
The only other time Marlene felt this grip so inte n s e ly was on her wedding day when the minister spoke of man not separating what God has joined to geth e r.
Fat te a rs rolled down Ro l f’s cheeks during the cere m o ny, which happened to be the fi rst time she’d seen him cry. And, of course, on the fl awless births of both d a u g h te rs. Make that th ree times in total. The grip is making its full circle and Marlene feels both honoured and con- qu e red by its powe r. Her fear has changed to acceptance. This recognition is m o re real than the smiling sad faces of nurses and docto rs who, on a daily basis, advise Marlene: “Don’t give up hope.” To d ay the chant is useless. Now that she th i n ks of it, none have mentioned the wo rd “hope” for seve ral we e ks. Marl e n e decides to abandon false optimism so her fa m i ly can move on with their live s .
Wi th the significance of letting go comes a wave of relief. Her mind is cleare r than it has been in months, possibly clearer than befo re her diagnosis.
“It doesn’t make sense,” Rolf yelled from their kitchen table half a year earl i e r, “and it’s not bloody fa i r. Old smoke rs with bad diets get esophageal cancer! It s ays right here in this booklet. It doesn’t say any thing about fo rt y- ye a r-old wo m e n who drink wheat grass and jog four clicks a day . . . it’s not bloody fa i r.” Ro l f’s voice trailed off. Pe rhaps the impact of the docto r’s news burrowed into his heart .
Pe rhaps he thought of planning a funeral, of raising two te e n a ge daughte rs on his own, of living without a part n e r.
Blue Moon, you knew just what I was there fo r, You heard me saying a pray ’r fo r Someone I re a l ly could care fo r. The purity of the moment makes Marlene smile. Emily stops singing, mista k- “Mom, are you having trouble bre a thing? Do you need more medication?” She reaches for the call cord but Marlene is surp ri s i n gly quick and catches her “ No pain, keep singing,” Marlene ge st u res with her index fi n ge r, as in “keep it ro l l i n g ,” befo re releasing the pre s s u re on Emily ’s arm. Both girls look st ri c ke n , wounded, and Marlene notices how her sickness has made eve ryone close to her ill. For months, all she has focused on has been her own energy and suffe r- ing. And her details. Marlene has left defi n i te inst ructions concerning what she She began to clean house menta l ly after the initial diagnosis, a diagnosis th a t should have been st rep th roat, any curable condition with a few we e ks’ wo rth of a n t i b i otics. Or acid re flux, like the doctor at the wa l k-in clinic fi rst sugge sted. He m u st have perused the same Inte r n et site, the site advising innocents th a t h e a l thy, youngish women ra re ly get this type of cancer. Instead of grad dre s s shopping with Kayla, she typed out cry ptic notes in bold upper case: DO NOT “What the hell is this?” Rolf said when he found the inst ructions, two clean copies left next to his morning coffee. “How can you be so morbid? Chri st, yo u’re acting like it’s all ove r. It’s not over yet, damn it.” Marlene said nothing but ro s e f rom her chair and stood behind him, placing her arms on his shoulders. She re sted aga i n st him and kissed the visible scalp th rough his thinning hair th a t “The chemo will wo rk, yo u’ll see,” he said and took a fa st mouthful of black c o ffee. By the way he clamped his te eth and squeezed his lips, Marlene could te l l he had burned his tongue. Considering his wife was about to undergo surge ry and then endure the baptism of life - s aving poisons, he could hard ly comp l a i n about a scalded mouth. Nor could he swa l l ow his fru st ration, or his helplessness, “I’m not being morbid, Ro l f ,” she whispered, unable to speak louder than a rasp. “These are my wishes in the event . . . you know. And I’ve always wa n ted to be cre m a ted, even befo re I got sick.” Rolf took her hand and felt the noticeable dwindling of her flesh. He hoped s h e’d stay behind him because at that moment he couldn’t bear to see her eye s , eyes collapsing inwa rds as food became impossible to accept .
“I read it’s hard on the soul to be cre m a ted too qu i c k ly.” If Marlene had been healthy and if th ey ’d been planning their wills to geth e r, much like couples who plan upcoming holidays and reunions, Rolf might have t ra n s formed it into a joke. “Then ta ke off your shoes if it’s so hard on your s o l e,” he would say. Marlene would laugh and insta n t ly grasp how foolish her plan sounded when spoken aloud. Her notes would be cru mpled into a ball and That was then, when humour was still a daily player and when separa t i n g f rom the ones she loves was inconceivable. Now she can concentra te on her fa m i ly. Amazing, what a hit of reality can do to a pers o n, she th i n ks from her fl a n n e l et te sheets, delive red fresh daily from her daughte rs .
And then there suddenly appeared befo re me The only one my arms will ever hold. I heard somebody whisper, “Please adore me,” And when I looked the moon had turned to gold! Fu n ny, the song th ey ’ve chosen. It’s such an oldie, one more suited to her m oth e r. Marlene would ra ther listen to disco. She re m e m b e rs when Rolf bought her a “Super Hits” compilation of Earth, Wind & Fi re for one of her birth d ays .
When he borrowed the CD for his own Discman, she eave s d ropped on his off - key M a rlene pulled out one of his ear buds and said, “Honey, the wo rds are ‘sing a song, it’ll make your day,’ not ‘it’ll make you dead’! Yo u’re so silly,” and she kissed his pers p i ring fo rehead befo re re i n s e rting the ear bud. “Blue Moon” was from Kayl a’s school play. Marlene can’t recall the name of the play, or when the drama club performed it, or much beyond the vague mem- o ry of Po l a roid pictures Rolf brought back from the production. She had oth e r m a t te rs to contend with: nausea, vomiting and vicious mouth sore s .
S h e’ll always remember the song because Kayla sang, hummed and whist l e d it for we e ks. No one realized how that song became her daughte r’s mantra to stay st rong while her mother underwent chemo. “Hair to d ay, gone to m o rrow,” Marlene whispered when the girls fi rst saw her turbaned head. She pulled off the wrap and insisted th ey touch her smooth scalp, as if introducing them to a st ra n ge animal. “Have you ever seen such a gorge o u s s kull?” she asked, wo rking hard to open her eyes with feigned enthusiasm. Their eyes looked more hollow than Marl e n e’s .
Blue Moon, now I’m no longer alone By dying young, Marlene knows she’ll stay faultless in the minds of her daugh- te rs and husband. C ra z y, she th i n ks, h ow people tra n s fo rm to saintly pro p o rt i o n s a fter they ’ve died. Eve ryone fo rgets the petty squabbles or annoying traits and re m e m b e rs only the achievements, the jokes, the laughte r. Kayla wo n’t ever bri n g up how, at sixteen, she yelled “Bitch!” after Marlene called her a slut for coming home late, reeking of pot and cove red with purplish bruises on her neck. Inste a d , th ey’ll speak of the countless joys ex p e rienced as a fa m i ly, focusing on memo- rable celebrations and trips. One sto ry will fe a t u re the ride on Space Mountain at D i s n ey Wo rld where Marlene was intimidated by the warning signs dire c ted at those with heart and bladder pro b l e m s .
“What if I have a bladder problem without knowing?” Marlene said while th e four wa i ted in a snaking line. They ’d fl own to Florida for spring bre a k, using th e M a rch birth d ays of the girls as an excuse for a va c a t i o n .
“Yo u’ll know soon enough,” Kayla said, fo l l owed by the nervous giggles of Emily. T h ey’ll also laugh at how the girls accused each other of letting out high- pitched squeals on the roller coaster until discove ring it was their fa ther who s c reamed. And how th ey snicke red at their tour guide for eye-burning body odour when it was Rolf who re e ke d .
“ H ey, I’m on holidays ,” was his defence. “I shouldn’t have to wear B-O-dera n t “Dad, appare n t ly your pits don’t know yo u’re on holidays ,” and Kayla plugge d E m i ly props a folded note aga i n st the phone on the bedside cupboard when she gets up to leave the hospital with Kayla. They promise to return in an hour, a fter th ey ’ve changed their clothes and found th e m s e lves some supper.
“Can we bring you back any thing, Mom?” Kayla asks. Marlene pretends to think about the qu e stion for a moment befo re shaking her head “no.” What she’s done, instead, is study her daughte r, tracing Kayl a’s heart-shaped face with her eyes. She has to be furt i ve with her glances or the girls break down and sob.
T h ey look for signs to indicate their mother is ready to say goodbye, yet neve r want the signs to appear. T h ey’ll be a great comfo rt to each ot h e r, Marl e n e th i n ks. H ow lucky I’ve had two ch i l d ren. Two good ch i l d re n . B oth girls kiss their moth e r’s fo rehead and walk backwa rds th rough the door, b l owing kisses that Marlene pretends to catch. The ivy- b o rd e red note is one from Marl e n e’s sta t i o n e ry drawe r. It reads: Mom—I’ll never be alone because yo u’ll always be the dream in my heart. Promise yo u’ll try to contact me l i ke they do on Crossing Ove r. Remember our code O rd i n a ri ly, Marlene would save a ke e p s a ke like this in a special Ru b b e r m a i d c o n ta i n e r. She’s ke pt eve ry card, poem and Moth e r’s Day art wo rk that fl owe d f rom their chubby crayon-wielding fi n ge rs. Now it is Ro l f’s turn. He watches te a rs st ream down Marl e n e’s cheeks, cheeks cove red with inv i s i- ble kisses. Marlene holds up her hand when he sta rts to rise from his chair. He stays sitting and watches with a quizzical ex p ression. The note will be a surp ri s e to him as well since Emily has always been a ske ptic when it comes to the para- normal, shielding her ears when anyone spoke of supernatural ex p e ri e n c e s .
“I don’t want to hear th i s ,” she’d say and sto mp towa rd the door. “You know I get bad dreams when you talk about this st u ff. It’s way too cre e py.” To d ay she is the brave one who admits that Marl e n e’s time is almost up. M a rlene squints and tries to remember her fa m i ly exa c t ly as th ey are at th i s moment. Instead, she notices that Ro l f’s hair is ove rdue for a cut. It hasn’t been this long and scra g gly since th ey met in unive rs i t y, in their fi rst - year philosophy c o u rse. Then she considers the iro ny of having a phone next to her bed when “ Rolf?” she says by tapping on her tray. “I’ll have that morphine now,” she signals with a make - b e l i eve needle held to her arm. “Blue Moon” music by Richard Ro d ge rs & wo rds by Lorenz Hart, 19 34 .

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Additional Information Juan Bustillo, M.D. Professor of Psychiatry and Neurosciences Director, Schizophrenia Research Program Medical Director Spanish Speaking Clinic Attending Psychiatrist, Clozapine Clinic Research Mentor NIH, Scientific Review Group ITVA (Interventions Committee for Adult Disorders). Member: 6/2011 to 2/2014 Exemplary Psychiatrist Award, National Alliance on Mental Il

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