“Seriously, Matt. I forgot. I just plain forgot.”

He tries to put his arm around my shoulder, but I push him away.

“Sorry, sorry,” I say. “I don’t need to start crying.”

“Nothing wrong with that.”

“Not now. Not here.”

“Here” is the harshly lit Critical Care Unit, a place designed for observation and expediency, not privacy. I ask why he’s chasing after me. He says he was in the hospital anyway. There’d been a little problem with one of his admissions to the psych unit. I thank him for taking the time to check on me, tell him he shouldn’t have bothered. He should go back to the psych ward, the kid’s problems seem more important.

“No. Not more important, just more emergent,” he says.

Little does he know.

“Why did you cancel?” I ask.

“I told you. I need to go out of town. It was unexpected.”

“Where are you going?”

“ Washington.”

“Why?”

He’s clearly uncomfortable being questioned.

“We can talk about that when I get back. If it’s necessary.”

“I think it’s necessary.”

“It may not be.”

“Is it an emergency?”

“No. It’s not an emergency.”

“Then why couldn’t you have planned ahead?” I’m surprised by how shrill I sound. “You know you’ve violated the cancellation policy, don’t you? Payment in full for cancellations with less than forty-eight hours’ notice. I’m enforcing it. It’s only fair. Here’s my price. You have to tell me why you’re going. Tell me what’s so-how did you say it?-important but not emergent. You cancelled too late. Now you have to pay.”

“Andy, I gave you plenty of notice and tried to reschedule.”

“I’m a very busy man, Matt. Can’t you see that? Take a look around. You think I don’t have anything better to do than sit around and watch the monitors? Hey, nurse, what’s a flat line mean? Well, maybe you’re right. Maybe I don’t have anything better to do. That doesn’t mean I’m not very busy.”

This time he forces me to accept the arm around my shoulder.

“Come on,” he says. “I can take a later flight.”

He knows the shortest route to the nondenominational chapel where the anxious can seek comfort in the Crucifix, the Star of David, or the Crescent Moon. Hindus are shit out of luck. The room is spartan and austere and feels about as devotional as an interfaith public service announcement on late-night television.

“Thanks for coming today,” I say.

“Sure.”

“You still owe me, though.”

“Come on, Andy.”

“I’m not letting you off the hook.”

“Technically I am off the hook. But because I’ve inconvenienced you, I’m waiving the fee for this session.”

“I’ll pay. Now tell me.”

“Look Andy, it’s a bit premature. There’s no point discussing it until, no, unless and until, it’s necessary. I don’t want to risk upsetting you for no reason.”

I don’t like the sound of this.

“Now you really have to tell me.”

“I’m in discussions with Georgetown. They’ve made me an offer. They need an answer by next week. I’m meeting other members of the department tomorrow, then dinner with the chair and the dean and the president of the hospital. I don’t know if we’ll be able to come to an agreement.”

This is perfect. Just what I need. Probably what I deserve. The final, gratuitous kick in the stomach. You fucker. Three weeks ago I was ready to walk out the door. Adios, amigo. These boots were made for walkin’. Up and over. Out from under. I would have ended it in a heartbeat if you hadn’t duped me with your silver tongue, hadn’t pacified me with your fucking case study. I see your agenda now.

Can’t take being rejected, huh? Keep me dangling a few more weeks, just long enough for you to be the one who walks away.

Fucking priest.

“Congratulations” is all I say.

“Like I said, Andy, it’s a little premature.”

I stand up quickly and extend my hand. “Well, good luck.”

“Andy, sit down. We were going to talk.”

“Matt, I have to go. I really do. My sister’s waiting for me. I’m late.”

I find the closest toilet, bolt the door, and vomit. I try lifting my head, but I’m dizzy, too dizzy to stand. I thought I could at least count on him. I thought I could at least rely on paying someone to keep me from being completely alone. Everything’s collapsing around me. Even my money’s no good anymore.

Regina is furious. She looks at her watch and hisses. She doesn’t understand why the unit is freezing. It’s like a meat locker in here, she says. What do you expect, I want to ask, where do you think you are? Don’t you see all these limp bodies, all these lives hovering just above the baseline, a weak pulse the only line of defense against the onset of bloat and rot? Face facts, kiddo, you’re in an abattoir.

Good morning, folks.

The army is descending on the Critical Care Unit. They’ve come to hear the announcement of my final decision.

Do not resuscitate.

DNR.

They’re sensitive to the palpable tension.

Pardon me, Mr. Nocera, Mrs. Gallagher? Are you in agreement? We like to have consensus within the family. Of course, Mr. Nocera, you have the power of attorney. The law says the decision is yours. However, it’s our experience that it’s better if everyone’s in agreement.

The pulmonologist has determined my mother is to be transferred from critical care. Other patients, ones with some hope of survival, deserve this bed. All of this expertise, this attention, cannot be wasted on comfort care. The hospice unit is perfectly capable of ensuring she feels no pain. The hospital has summoned the troops. They’ve been kind enough to provide us with our very own social worker, right out of Central Casting. She’s thin, tremulous, horse-faced. Why is her lower lip quivering? It’s not her mother lying there with her face covered by a thick plastic breathing cup. She oozes empathy and compassion, compensating for the let’s-get-on-with-it demeanor of the pulmonologist.

Regina and I retire to a small waiting room. We’ve been through this twenty times in the past week. She knows I won’t change my mind. She knows my mother’s last wishes. So she fixates on the oncologist, accusing her of having an attitude. She mistakes the good doctor’s dog-tiredness for lack of concern and impatience. I tell her she’s not being fair, that the woman could have chosen the safety and distance of communication by telephone line instead of a face-to-face confrontation with the consequences of the failure of the transplant.

My bone marrow has been swept away by an avalanche of white blood cells.

All further treatment to be limited to keeping her comfortable.

Do not resuscitate.

No mechanical respiration.

No tube feeding or invasive form of nutrition or hydration.

No blood or blood products.

No form of surgery nor any invasive diagnostic procedures.

No kidney dialysis.

No antibiotics.

No codes.

No extraordinary efforts to sustain life.

Do whatever you like, my sister shrieks, running out of the room, battered and defeated, only to reappear seconds later. She insists on a feeding tube. Memories of National Geographic and the bloated babies of sub-Saharan Africa haunt her. She can’t bear the thought of our mother starving to death. I agree and put my arms around her, letting her sob into my chest. I can always change my mind later, if this misguided act of mercy prolongs the agony.

The oncologist hugs me when I tell her our decision. She doesn’t offer any bromides, no it’s-for-the-best, it’s-what-she-would-have-wanted. She leaves that for the social worker. I thank her for being here, tell her it means a lot to us. She wishes she could have done more. She lets me comfort her, knowing the soothing effect my own kind words have on me.

The social worker says my mother should be settled in her new room in an hour. She suggests we get something to eat, we need to keep up our strength. My sister and I trudge down to the cafeteria and forage the steam tables. We carry our plastic trays, scratched and pocked from a thousand forks and knives, and find a table where we sit, silently. I squeeze a dry scoop of mashed potatoes through the prongs of my fork. My sister watches, disgusted. She drinks bottomless cups of black coffee and plays with the salt shaker. Then she starts tapping the table-top with her lacquered fingernails. She knows the rat-a-tat-tat is driving me crazy. I push my plate away from me and set down the fork. She stops drumming the table.