“There’s always the urge to see somebody dead that isn’t you.” Stephen King

I drove into Sacre Coeur Cemetery that rainy Saturday morning, relieved it wasn’t me in that box, going down into that hole, buried under a personalized marble monument. I could never understand the hubris of elaborately marking where bodies are buried, reinforcing people’s misguided hopes for immortality. Gone now to heaven, they say. But my agnostic definition of hell is where one is placed in a coffin, then inside a concrete grave liner – to prevent the ground and the funeral directors’ income from sinking – then covered with tons of dirt so even a single atom can’t be freed, that it might escape and unite with other forms in the universe.

I parked my car in the visitors’ lot and strode a path through a well-tended lawn, not a blade out of place. Orderly rows of headstones were backed in the distance by the opulent statuary of the wealthier inhabitants, denoting their final places of residence, and it was there I headed toward the black canopy sheltering her mourners.

Family and friends avoided gaping at the deep hole behind her packaged body, ready to be interred and, eventually, one day forgotten. She hadn’t wanted this kind of sendoff, but her family defaulted to their own wishes, she no longer being in a position to argue her preference. Take a lesson, friend: Make your wants known widely, loudly. Those I’ve chosen will cremate me and spread my ashes in the sea. Simple, low-cost, and my cremains will be released to roam, even more than I have in life.

I probably sound like a morbid voyeur, gathering converts along my way through life, toward death. I’m not, though I’ve had my moments. She gave me one of them. Until hers, I’d never before witnessed an actual human death.

I exchanged glances and serious nods with those around the gravesite that I recognized from her descriptions of them. I was just in time to hear the minister drone her platitudes, expecting her worn words to make the mourners on the sidelines feel better, when in fact they likely fell on numb ears. “She’s in a better place” made it sound like she’s comfy and cozy, instead of trapped in that container poised before us. “It was God’s will” might remind them that their deity designed the process of life to close on a dreaded dead-end path for all. A verbal sendoff, poorly designed to console the grieving, but death leaves a space nothing can fill, especially not with cliches. 

As for me, I find such rituals a form of entertainment. I stood there observing how we dance around death, with or without a dirge, or to one of the dear departed’s favorite tunes. Hers was any of the chant-like melodies by Beirut, an unconventional gypsy sort of band that reflected her style. I smiled faintly, imagining the reactions of the sedate black-clad mourners if one of their songs suddenly blared through speakers in the damp cemetery air.

We went around the circle, and those who wished to said a few words about her. Most were as stale as the minister’s: 

“She gave so much to others, and took so little in return.” 

“Her love gave me strength.”

“She lived like there was no tomorrow.”

Only the last echoed what I knew of her.

~

They didn’t know her as I did. I was sure they saw only her exterior, her long thin black braids with beaded ends, tied back to show off inquisitive eyes set in her seriously attractive honey-brown face, her thoroughbred gait, her drab but artful bohemian wardrobe accompanied by the worn leather messenger bag she toted everywhere. They must have feared secret jealousy to be like her, lest they come to the same end. But we can only be ourselves, and she was a unique self. I know. I was her last confidant, her final confessor, her psychiatrist. 

She came to me hurting, physically and emotionally, seeking to distance herself not merely from her pain, but from life itself.

“You must help me end it,” she said, spilling out her words, not long into our first session. “Everyone else I’ve approached has turned me down, and I’m not brave enough to bring about my own demise. I’ve read their books, and their online chats, and their advice springs only from professional observations. I don’t trust them.”

“So why are you here? How, why, do you think I differ?”

“I’ve read your columns and papers on death and dying, and you profess to be a truth seeker on the afterlife, even if only to prove its nonexistence. You have the clinical skills, and you didn’t pack away your curiosity with your diploma. Those were the things I chose you for in seeking a doctor who might help me.”

So, she’d discovered reams of my commentary on the rituals of dying and death. I’d read Agee’s A Death in the Family when I was in my early teens, and it gave me a life-long hunger for minutiae on the topic. I’ve given talks on Mitford’s The American Way of Death – where even the poor can take their last ride in a Cadillac hearse – and shared the resolve it inspired in me to opt-out of a conventional burial. In my spare time I’ve consoled bereavement groups, helping the ones left behind explore their own meanings of life and death, and furthering my own. I’ve prowled burial grounds from Monument Valley to Savannah, Boston to Paris, and even roamed the infamous Coon Dog Cemetery near Huntsville, Alabama, seeking ephemeral clues, finding, as always, only mortal shrines. She’d read that I sought the link between life and death, a metaphorical death canal, the correspondent to birth. 

Her gaze roamed around my office, taking in my framed credentials and book-bound interests. Few patients took such an interest in me beyond my questions and guarded remarks, remaining absorbed in their own reasons for visiting a shrink. I was pleased.

“I believe you’re asking me to break the law, to ignore my own professional code,” I replied. Not that I hadn’t before, but it was the proper thing to say. “I understand your need, and your reluctance to fulfill it yourself,” I went on, trained to rephrase her words, “and I’m prepared to help you move beyond your pain. We can plan a course of treatment that serves that end, and you can decide if it meets your purpose.”

“An interesting comeback, Doctor. You didn’t say yes, and you didn’t say no.” She paused and smiled. I became aware of her musky scent, like that of a free-range animal. “Perhaps together we can bend some rules,” she said. “Let’s give each other a try.”

Her response surprised me with its playfulness, with her willingness to put her desperation for death at arm’s length, even for a moment. My immediate reaction was even more so. I began to feel like Moliere’s Tartuffe, ready to rectify an evil action with the purity of our mutual intentions.

She related the backstory of her pain. She’d been in a horrible road accident this past year, and while most of the physical damage to her body was not visible to others, she assured me it had been extensive. She’d had multiple surgeries and saw no end to those still to come. She wore a flesh-colored glove on her right hand, hardly noticeable while she kept it resting on her lap, and during our second session she pulled it off to reveal the hand had only two digits, thumb and index, grayish, rigid. 

“They saved what they could,” she said, watching my reaction, which remained passive, as she held it up. “I preserved the others. If only they could have saved my child as well.”

Now we were getting somewhere. With each session I learned more about her and her tragedies – and about myself as well, in responding to them. She was a chameleon, revealing different skins at different moments. I got to touch her pinkish feminine layer, which could turn purple and then black in a blink. Not literally of course, but I regularly imagined it happening as her moods changed in my presence. I wondered which she donned when contemplating her own looking-glass. 

She’d researched many ways to exit this world. Pills, jumping, drowning, others. I was impressed by her thoroughness, her courage, but it made me wonder if she was going down a speculative rabbit hole. She made me realize that until then I’d explored death from a limited perspective, from that of one who wanted to live. Her drive for release seemed immediate, shoving her from the inside with a need she could not suppress, eager to leave this world, hoping against hope she might join her child in what might be the next. She sought my aid from the perspective of one who wanted to die. 

How was I to help her without killing her, or rather helping her kill herself? And were the actions, the motives, not one and the same?

I saw her weekly at first, Mondays at 2 pm. She sat across from me in the comfortable rose-colored wing chair for the entire hour, instead of the usual fifty minutes. I immediately rearranged the standing appointment following hers for 3:30 so I could allow my time with her to run over, and then have a few minutes to reflect after she departed. Following her second visit, I realized she’d left behind a set of keys in the wing chair. When I phoned to tell her, assuming she’d need them, she said they were the keys to the car she’d demolished. She’d left them as relics of her pain and didn’t want to see them ever again. Were they a gift? Proof? Why had she held on to them until now? 

~

She told me she was a freelance writer, said she earned her living in the marketplace of words, and she was in fact a most articulate patient. I suggested she try to write her way through her pain. I asked her to keep a daily diary and share it with me, to capture her thoughts and dreams to further our discussions.

“No, it’s too much to ask. I don’t want to go there, and neither do you.”

“I do. The more you share with me, the more I can …”

“I have no need to write about this drama for myself or for others, even for you. My soul has died. Yet it’s still trapped in my living body. The two are in such conflict. At night I dream of running through the streets screaming and throwing myself in front of a bus, of ingesting one pill after another with one shot of booze after another, until I am no more. But then I wake up, unsuccessful, sad that I have to force myself through the motions of another day.”

I sat across from her, the prop of a pad and pen resting in my lap. My interest in her was like that of any patient, but my curiosity about her path drew me closer to her dramatic plight. Dare I use my resources to fulfill her desperate request? If I steered her one way, would she willfully take the other fork on that road? We took several detours into her past, to times when life seemed worth living, but those memories only strengthened her resolve. 

She became impatient with our slow progress, accepting it was due to her own lack of complicity. After a month of sessions we added Thursday visits to her calendar. Her time was her own, she was losing interest in her work, so she welcomed a deeper dive into her misery. But the cost of her accelerated treatment was becoming another matter. I had my own criteria for doing pro bono work, and she did not meet them. Open about her finances, she approached me with a fairly standard offer.

“I’m spending down my modest means, Doctor. It’s fueling my sense of urgency, forcing me to make a move. But I’m not there yet.”

“And?”

“And, I wonder if you’d be willing to barter for further services.” 

Her face presented no clues to her intent. Did she want to trade sex, or was she offering to update the pages on my website for me? Bartering is still practiced in the medical profession these days, even if most of it stays between doctor, patient, and accountant. I suppose some rural doctors still trade chicken casseroles for their treatments, and city doctors are not immune to their patients’ financial plights either. How far would I go to help her?

“What do you have in mind? You do understand we have no definitive end to your psychiatric treatment and, more importantly, I’m not able to put a price on where or when your life is saved or ended.”

“My body for your time. Until you or I decide the ‘when’. I think you might find it interesting.”

Well I might, I thought, but I had other interests in her treatment, personal and clinical. To comprehend her desire for death, I had to understand far more about her life. She was asking me to cross yet another line, and I decided to keep us on the course that most interested me. Besides, if I took advantage of every patient who made that proposition, I’d be oversexed and underfunded. 

“I’m not making light of your offer. But since your life has so little value to you, how do you think I should value it? I mean… as a professional, not as a lover. You are not a whore, and I am not your client. What does interest me is how we can get you past your pain. What I do value is your willingness to explore your intentions and your options, seeing whether you will go on living your life, or end it.”

“Thank you for your candor, Doctor. Have you any recommendations for how I can go on financing your services? Or should I just drive my car into a wall on my way home? Or, perhaps, you might prescribe the magic pill that will give me the sleep of angels?”

“You’ve already survived one tragic accident. I would not advise believing another would provide your desired outcome. You might lose more than some nonvital organs and a few fingers, and still have enough functioning parts left to survive.” I chose my next words carefully. “As for magic pills, I can provide a sleep aid for you but, taken as directed, it will only send you to bed, not to heaven. Is that what you’d like?”

“Are you suggesting I might choose to overdo the sleeping pills before I run out of money?”

“Absolutely not! I suggest nothing of the kind. A series of sound sleeps will calm and clear your mind, improve your receptiveness to treatment. We can work out a financing plan for your office visits. And I can cut my rate for the next several months, let’s say six months. Will that work for you?”

“I suppose so. For now.” I couldn’t tell if she was pleased or disappointed. 

I scrawled out the prescription and handed it to her. “These work rather quickly, so only take them when you have nothing else to do the rest of the day. Don’t drive, or spend time over the stove. Do not consume any alcohol for four to six hours before a dose, and even then, if you must, sparingly. 

We both knew she’d finally gotten what she came for.

That visit she left behind an envelope with my name on it, propped up on the sink in the restroom next to my office. It contained a gruesome 8” x 10” black and white photo of a wrecked sports car, too damaged to identify the make and model. Was she shedding her past, and transferring it to me? I was relieved I found the piece, and not my next patient. I put the envelope in the file with the car’s keys.

~

Having given her access to pharmaceuticals, I feared I might not see her again. I sign up for a google alert on all my patients, right after their first visits, and the service forwards a link to any online mention of their names. I’ve gotten good news and bad news over the years, even long after one of them has moved on from my practice. I checked each morning for her name, and finding nothing on her was good news.

On her next visit she was almost radiant, more animated, loosely gesturing as she spoke, and she sat back as though molded into the comfortable wing chair, seeming relaxed and relieved. “Sound sleep was just what the doctor ordered,” she said.

She was exhibiting a classic sign of coming to peace with suicide. After emotionally and psychologically struggling with the decision, once it’s been made, either way, the internal struggle is over and relief sets in.

“You do look well rested,” I said, alert to every nuance of her speech and movement. “More than I’ve ever seen you. Tell me, does it mirror how you feel?”

“What an odd way to put it – mirror how I feel. I did sit before a mirror yesterday for quite some time, having my braids redone by my hairdresser. It was a long process, and expensive, too. I justified it as part of my therapy. It was so relaxing to watch someone undo my messy grown-out hair, feel them massage my scalp, take such care to make me look clean and neat.”

“Special occasion coming up?”

“I used to go to the salon more regularly, but I’ve let myself go since… well, no, I just thought it was time to take better care of myself again, get back in the groove, as they say. I even submitted a piece of work for publication this morning, the first one in ages. I have you to thank for that, Doctor.”

I sometimes, as now, moved into a zone of professional uncertainty, between satisfaction that I may have helped a patient tremendously or fear that I’ve failed them miserably. There’s no knowing which is true until time and the patient have revealed the result, one way or the other. I had no sense yet which way this would go.

Before she left we confirmed her next appointment. Afterward, I sat at my desk and updated my notes in her file. We’d mutually agreed not to record her treatment sessions, but now I wished I’d pressed her for permission. I’d said nothing incriminating, and I would’ve liked to hear her actual words again, the inflections in her voice, any clues that would help me be a better therapist, employ those clues the next time I get a similar patient, if there ever is a next time.

~

It was me the first responders called because she’d listed me as the ICE contact on her phone, In Case of Emergency. She’d driven her car into a bridge abutment on I64, not far from the picturesque Gateway Arch. Apparently at very high speed. They told me some kind of gypsy music was still blaring from the car’s CD player when they found her. Again she’d survived, as I’d warned. Badly damaged, as I’d predicted. 

I spent her final couple of hours at her bedside. It wasn’t the visible process I’d hoped to see while watching someone depart from life. I hovered over her bruised face and tangled braids, whispering questions I’d harbored for decades about the path toward the end, but they went unanswered. Heavily sedated, her breath slowed, became intermittent as my eyes moved from her face to the heart monitor and back, then stopped. Her death was a disappointing moment for me. A triumph for her. She’d owned it, gotten control over it, given it a date and a time and a place.

The next day I paid a service to do a complete background check on her. She’d never had a child, but possibly been pregnant. I’ll never know. But the first auto crash really did damage her body, and perhaps her mind. I also learned she’d published a large body of acclaimed fiction under a pseudonym. I didn’t recognize the name, but you might. She’d been quite good at fictionalizing her life, too. I’m professionally ashamed to admit I hadn’t caught her in any of her lies. She’d left me still in that zone of uncertainty. Had I helped her? Or failed her?

~

I’ll probably miss her visits for a little while. The fullness of her mortal absence hadn’t yet sunk in and yet there I was, at her grave, spending precious minutes of my life on someone I’ll never again see or hear or smell or engage with. I’d tried to make her office visits about her, and not about what I wanted to learn from her. Death has ended those possibilities, leaving me still with a gaping hole in my knowledge of its abstract mysteries.

Anyway, the real reason I came here was to return one of the final mementos she left for me. As I pulled the shriveled article from my pocket, my hand relaxed after gripping it so tightly during the graveside service. While everyone was praying their last words, eyes closed, I dropped it into the gaping hole. It was one of her fingers, only one, preserved from her first auto accident. I found all three of the digits wrapped in black tissue in a small gift box, on the floor under the wing chair after her last visit. I’ve decided to keep the other two.

---

Patricia Ann Bowen is the author of a medical time travel series about a cure for Alzheimer’s, and Unintended Consequences, a collection of short stories about strong women of all ages in challenging circumstances. Her stories have also appeared in the Table for Two and Stories of Southern Humor and Southern Crime anthologies. She has taught short story writing, and she leads a critique group of short story writers for the Atlanta Writer’s Club. You can connect with her at www.patriciabowen.com.

---