It is the waning hours of the noctis shift, the time just before dawn shimmers gold through the bay fog. Over the public address, a female voice practiced in just-the-facts: “Code blue, ICU six-two-seven, code blue, ICU six-two-seven.”

Awakened patients in semi-dark rooms groan, adjust themselves, try to get back to sleep. One patient bumps the IV in the back of his hand, curses, then closes his eyes.

Four pairs of feet pound down gleaming tiles to room 627—sensible nurse shoes and candy-colored clogs squeaking when taking the corner. Now comes the urgent rattling of a crash cart.

In 627, a nurse is pumping a bag valve mask clamped on a woman’s face. The nurse has raised the woman’s bed into a reclining position; the patient is limp with her jaw slack.

The nurse, still pumping, says, “I came in on rounds and found her unconscious and not breathing. I hit the alarm and started bagging her.”

A white-coated doctor with red hair sticking up, jarred from a nap on his office sofa: “How long in arrest?”

“I don’t know. Maybe since the end of the last round.”

“Pull the bag. Let’s suction her throat.”

The in-wall suction unit makes a shook-shook-shook sound.

“Clear,” the doctor says. “Continue bagging. Crank the O2 to one hundred percent. You stay as airway manager.” The doctor snaps a glance at the beeping patient monitor. “Hypoxemia and tachycardia. Get the ventilator online.”

Wordlessly, two nurses shove visitor chairs into corners, while a third yanks the privacy curtain fully out of the way, then powers on the ventilator sitting on its cart.

The bagging nurse, still pumping, says, “I see cyanosis on her lips.”

“Her lungs were roasted to begin with. Let’s intubate.”

The doctor leans into the woman’s left ear. He notices her unlined, creamy skin. Hair grown back powderpuff-fluffy between chemo rounds. “Angela?” he says loudly—emergency responder voice. “It’s Dr. Reilly. We’re going to put you on a machine to help you breathe. I’ll be sliding a tube into your mouth and down into your trachea, but first I’m going to give you something, so you won’t feel it.”

The doctor glances at the monitor again, watches the ventilator screen as it boots up.

“Point one five of etomidate into her IV, please. Not that it matters,” he says more quietly. “She’s comatose. But, just in case.”

I can hear you.
The tube hurts. I wouldn’t feel it, you said.
Roasted?

Next day, midday visiting hours. A new shift on duty. A man arrives on the ICU floor. His blue eyes are bloodshot, making them look aflame. He has grocery store flowers wrapped in pink paper. He turns into 627.

A veteran nurse seated at the central station looks up, sees him go in. She wears a white smock patterned with smiling yellow suns. “Sir? Sir!” To her younger colleague: “Shit! I wanted to catch him and warn him, damn it.” She quicksteps around the counter, enters the room.

The man is standing with his mouth open. The flowers are on the floor where they slipped from his hand.

“Mr. Armistead?” He doesn’t answer. He stares. His wife reclines, semi-elevated, eyes closed, an accordion hose running from the ventilator to her open mouth, sealed with white tape. IVs trail from both bruised arms. A third hangs from her neck, unused, residual from last night’s emergency.

The ventilator goes hiss, thump, thump . . . hiss, thump, thump . . . its internal conductor keeping slow, infallible time. Her body jerks just a little with each machine breath.

“Mr. Armistead?” She grazes his forearm with her fingertips. His head snaps toward her, his face like one startled from sleep: “The hell happened here?”

“We tried to call you last night, but your cell kept disconnecting.”

“I forgot to charge it. My head is mush. I don’t sleep.”

“Well, anyway, we saw she was having a little trouble breathing, so we put her on this ventilator to breathe for her. Let me get Dr. Ross. She can fill you in.”

The ventilator screeches an alarm. He jumps, looks back and forth from his wife to the machine. The nurse steps over, taps a few buttons and the conductor inside the machine again takes up his baton: hiss, thump, thump . . .

“It’s fine,” the nurse says.

No, it’s not. Unbind me. My heart flutters like a leaf.

They stand at the end of the bed, Dr. Ross and the husband. He is a tall man and towers over her.

“What got her moved to us in the ICU from oncology was pneumonitis, which is a general inflammation of the lungs that makes breathing difficult. What we have now is ARDS—acute respiratory distress syndrome—where the inflammation is causing her body’s immune system to respond dramatically and escalate the inflammation exponentially. Essentially, her lung tissue is being destroyed. Steroids can help—we have her on a course of them—but at this stage of severity, really all we can do is use the vent to keep her breathing.”

“Is that from the chemo and radiation?”

“That’s a question for the oncologists. I’m a pulmonologist.”

“Can she get better?”

The doctor pinches her chin, studies her patient. “It’s not likely, and with her blood oxygen as low as it is, considerable brain damage is inevitable, and likely already in motion.”

He looks at his wife, the face of a decade together. His lips tremble as her body does its little jerk in time with the ventilator.

He clears his throat. Swallows. “Can she hear us?”

“Possibly.”

He glares down at the doctor. “Then maybe we should speak privately?” He bobs his head toward the door. She follows him into the corridor. He stoops to hear her better.

“Honestly, in my examination this morning, between vent breaths, I saw Cheyne-Stokes respirations, which we see when someone is near death. I administered a paralytic, which will keep her from doing something called bucking the vent, so the machine can do all the work for her. I have her heavily sedated, just in case, but as things stand, she’s not going to wake up.” Dr. Ross glances at the tablet she carries. “I see that you are her healthcare proxy?”

“Are you telling me I might have a decision to make?”

“Will other relatives visit soon?”

“They’re trying, but they all live back East and that blizzard . . .”

“If they can come, I think it would be a good idea if they did. What you’re seeing in there is life support.”

The doctor walks away and leaves him standing, staring after her, while medical personnel bustle by. A food service worker rolls past, pushing a cart loaded with cups of green Jell-O. Other visitors creep along the corridor as if trying not to make noise, peering into rooms, feeling their way, faces creased with worry.

The nurse in smiling yellow suns watches him, knows the look of bad, very bad news. “Goddamn Ross,” she mutters to her desk mate. “She has the bedside manner of a robot.”

The husband makes eye contact with her. She busies herself at the desk. He drops into a stray wheelchair and raps his shin on the footrest without noticing. His insides tumble, then settle. He gets up and goes into the room, rummages through a plastic drawstring bag marked Patient’s Belongings, finds his wife’s glasses, cleans them with his shirttail. He puts them on her face. She is hopelessly nearsighted without them. This way, when she wakes up, she won’t see the world as if through a waterfall.

He pulls a chair upholstered in cheap aqua vinyl next to her bed and takes her hand. It’s soft, like always, but cold, like never.

“Angela,” he says. “Squeeze my hand if you can hear me.”

Nothing. He has forgotten about the paralytic.

The flowers stay where they have fallen.

Roasted, roasted. I am so roasted. Ah, Bill. I’m so sorry. You’ve been a good man. This is going to be rough on you and Mom.

Now I am a blind woman going deaf, straining to hear. I have been cheated of time. It isn’t fair; all this suffering just to become a ghost.

The husband takes the grungy parking garage elevator to his car to make a call. He sits in the gloom holding his now-charged phone, massages his temple with two fingertips, sighs, taps in his mother-in-law’s number.

“Barbara. It’s Bill.”

“What’s going on out there?”

He closes his eyes, recites what he knows. Omits Angela’s slate-blue lips and fingertips. Omits the empty urinary drainage bag, which Dr. Ross said is a sign of her kidneys shutting down. Omits the lead-white face like a medieval portrait.

“I have to get out there,” Barbara says. She is sobbing. “I don’t care what they say. Or you. I’ll step in!”

“Barbara, with the snow and the airport situation back there . . . I hate to be blunt, but I don’t think you’d make it in time.”

“Damn you! Why did you have to move her way the hell out there?”

“We went where there was work,” he says quietly. “You know that.”

“God damn you!” She is sobbing louder. “That’s my daughter!”

“That’s my wife,” he whispers.

“She could have done so much better!”

“I’ll keep you posted, Barbara. If anything changes, I’ll call. Or call me whenever you want.”

In a high-pitched yowl, like a cat in pain: “You son of a bitch!”

He taps the disconnect button and puts the phone in his shirt pocket. He sits for a moment, staring ahead blankly, then drives his fist into the dashboard with such force that it smashes the radio. His knuckles bleed. He does not notice.

Pain and fear have been mine for months upon months, like walking through a bitter headwind. I am exhausted from the trek. The wind has stopped, yet my heart beats as if it would leave my chest.

I was ambitious, but I see now nothing will happen except this. I should be angry. Or scared. I am neither. I would just like to sleep in my own bed.

The husband sits in the chair watching his wife. Hears the machine breathing for her, watches the little jerk of her body. He holds a paperback book, folded over his index finger.

The noctis shift is coming on; he hears the exchange of information at the desk just outside. An announcement over the public address system: visiting hours end in ten minutes.

He sits up and leans forward, grips the armrests, unsure if he can stand. He gets to his feet, gathers his jacket. Feels the pocket for his keys. Nurse sunshine enters with her relief. They confer at the ventilator, jot down some notes.

The night nurse turns toward him: “You don’t have to leave,” she says in a voice rich with the Caribbean. Sunshine nods in agreement.

“No?”

“No. You can stay the night if you’d like. That chair over there is a recliner.”

Sunshine leaves, returns with a blanket, pillow, and a small plastic bag of hospital-issue toiletries. He takes them, thanks her. Dr. Reilly pops his head in, beckons to the nurses, and they file out. The husband drags the recliner out, fluffs the pillow, and lies down. The night nurse returns, dims the lights.

“Were you going to watch TV?”

“No, no thank you.”

She switches on the television to the “Comfort Channel”—a scenic slideshow backed by soft, classical music. She puts the TV controller with its small speaker on the pillow next to Angela’s head.

“In case she can hear, this is calming—better than hearing hospital sounds. Have you been talking to her?”

“Yes. I was reading to her, actually.”

“Good. But try to rest as best you can.”

He looks at Angela. “My wife is dying,” he says. His voice sounds spectral, as if it came from a far corner of the room.

“She has some very sick lungs,” the night nurse says. She leans over to look at the empty urine collection bag, frowns, starts to say something, checks herself.

“Try to rest,” she says. “I’ll look in on her a little later.”

He goes into the patient restroom, dry heaves, rinses his mouth with bleachy-tasting water, returns to his chair. She is still there, the monitor softly beating with her heart.

He can’t sleep but pretends to when the nurse comes on rounds, fusses with this or that, and goes. He avoids the comfort slide show, watches the patient monitor instead. The numbers mean nothing to him, except the rising heart rate. Periodically, he reaches over to squeeze his wife’s chilly hand and stroke her face, tells her he is there.

I am shedding my shape, myself, slowly, moving in a slow river flowing to I know not where, but I know I am approaching the cusp of something ancient. I hear voices I haven’t heard since childhood, asking the gods to show me what lies beyond the rudiments of time.

Morning, three days later. Nurse sunshine comes on duty, conducts her relief, enters Room 627. The husband sits close to the bed, holding his wife’s hand. He looks like he has been up for days. The ventilator screeches; sunshine quiets it. He doesn’t look up. The machine has sounded alarms all night, every night.

Dr. Ross comes in, checks the vent, examines the patient, studies the vitals on the monitor. The husband looks up at Ross, raises his eyebrows.

“Sir,” she says. “See the heart rate?” She taps the monitor with her pen, as if instructing a class. “One hundred fifty-five. Her brain stem is commanding her heart to pump what little oxygenated blood she has to her organs, to try to keep them alive. Her heart has been racing like this for eighteen hours. The next thing that will happen is she’s going to have a heart attack. Then we’ll have to resuscitate her, if we can, which isn’t likely.”

“Can’t you do a . . . what do you call it . . . a tracheotomy for the vent, while I arrange for a long-term facility?”

Ross squats down before him, rests her hands on her thighs. “We could, but you have to think of quality of life. Her lungs will not heal. They’re too far gone. Her brain has been oxygen-starved for days. Her kidneys have shut down, and toxins are flooding her system. I’ve conferred with my colleagues and we all agree. Even if something miraculous happens and she keeps going, you’re looking at a vegetative state.” She glances down at the floor, thinking, looks up, moves the hair from her eyes. “I’m very sorry, but you need to think of end of life.”

Ross stands, leaves.

He looks at his wife, leans in. “Did you hear all that?” he says. “Angie. What do I do?”

I lie curled in a hollow in a patch of warm morning sunshine, resting in a field of thousands of wildflowers: red, yellow, blue, white. Black butterflies flutter and whirl in my heart. I rise and walk to a wood where the buzz-saw sound of a million unseen cicadas announces me to the trees.

I traverse a broad gully, sure-footed, guided somehow up and over a ridge of aspen and scrub oak. Distant things shimmer in a forenoon now glimmering with heat, and the sound is of summer insects. I feel pinkish warm as I move through sweet, waist-high ferns to a dry swale, cross, climb to a plateau. There a sweat-stained old man plows a field with twin mules, like a sepia image of my Yankee great-grandfather. I strain to see his face. He whoas the mules, raises his battered fedora in greeting, then uses it to point. My eyes follow and there, just below, is a calm sea.

Ross and sunshine come in, stand quietly. He looks from one to the other. “Okay,” he says.

“I’m going to give her more morphine,” Ross says. “She will feel no pain.”

His mind flashes back to when they had to put down their ancient, sick dog. “She will feel no pain,” the veterinarian said. He cradles his throbbing head in his hands.

Sunshine taps on the patient monitor. The vital signs disappear. The word comfort floats across the screen. Two other nurses appear, carrying a basin of water and washcloths, shift Angela here and there as they bathe her, then comb her hair.

“God forgive me, I hope I’m doing the right thing,” he says, quietly, not to them.

“You are,” all four say in chorus.

“Why don’t you step out for just a sec,” Sunshine says, gently. “I’ll come get you in a minute.”

Sunshine brings him back in and the ventilator, IV lines, and other life support paraphernalia are gone. He kneels next to his wife. Sunshine pulls the privacy curtain closed and leaves.

I come to the shore of this flat blue sea. A ship awaits and somehow, I know it’s for me. I board and step forward to the bow, where there is a brass binnacle and compass, its needle pointing dead ahead. I hear the footsteps of others boarding behind me, but I cannot turn my head to see them. Forward in the distance is a brilliant green shore, a continent, and I know that is where we will go.

As the boat begins to move, swiftly, the breaking rush of the bow wake makes a sound that swaddles us in comfort. We begin to sing, in a perfect otherworldly harmony.

Dr. Ross enters, wearing a stethoscope. She lays the diaphragm against her patient’s carotid arteries, listens, then does the same at the chest and ankles. She does it twice, then checks her watch: “4:27 pm,” she says.

The husband looks at her, bewildered. “Why would I want to remember that?” he asks.

“I’ll give you some time with her,” she says, and leaves.

The husband struggles to his feet, yanks open the window curtains, tearing one, filling the room with golden California sunshine. A while later, he comes out of the room, closes the door. The day shift is at the central station, Ross, and sunshine included, all tapping into computers.

“Thank you,” he says, flatly. He is glassy-eyed. “All of you. I know you did your best.” He walks away toward the elevator, staggering a bit. His wife’s glasses dangle from his fingertips.

Nurse sunshine follows him, catches up.

“I’m so sorry for this,” she says. “You’ve been very brave.”

“Me?” he says, incredulous.

“Yes, you. I’ve been doing this a long time, and you don’t know how many times I’ve seen people come once, and then never again because they can’t handle it.”

“Who would do such a thing?” he says. He presses the button, steps into the elevator and disappears.

Sunshine starts her car in the tomblike parking garage. She lights and deep drags a cigarette. “Leave it at work,” she whispers thrice, like a mantra, blue smoke tumbling from her mouth as she forms the words.

A nurse from pediatrics walking past sees her, playfully wags a finger—no smoking on campus. Sunshine bobs her head and shrugs. “Three years until retirement,” she says. She flicks the cigarette out the window. It sparks on the concrete for all to see. She puts the car in gear, rolls to the exit.

From his car, the husband calls a funeral home, tells them where to find her. Then he taps out his mother-in-law’s phone number, stops, puts the phone away. He pulls out of the garage, squints in the sudden light, drives in a trance. When he stops, he finds himself in the parking lot near the summit of Mount Diablo, a place he’s never visited. He jogs the trail to the summit, setting off miniature rockslides of sharp-edged Franciscan chert the color of dried blood.

Sweating and breathless, he looks west over honey-colored hills of wild oat grass dotted with green oak. The breeze smells of baked sage and vanilla. In the distance is the shimmering bay, with the Golden Gate Bridge outlined as if made of matchsticks and black string. Beyond the bridge, the Farallon Islands float on the horizon. The sun blinds him as it sinks into the Pacific. Here, at the end of the world, he begs it not to go.

In her office, Dr. Ross puts her head down on her desk. Her hair fans out over her forearms like a veil. Silently, she weeps.