READ LOCAL First represents Utah’s most comprehensive collection of celebrated and promising writers of fiction, poetry, literary nonfiction, and memoir. This week we bring you Joni Hemond, M.D., who has been a practicing pediatrician for 20 years. Much of her professional life has focused on providing care to medically underserved populations, and she is continually touched by the struggles, sorrows, and joys of her patients and their families. Her book “Coyote Sky” was born from writing fictionalized accounts of her experiences. It won first place in the 2017 Utah Original Writing Competition, Book-Length Collection of Stories Category, judged by Becky Bradway. Joni lives with her husband and three children in Salt Lake City where she is an academic pediatrician at the University of Utah School of Medicine.
Upstate New York
58 beats per minute.
The view, out the window, was beautiful; there was no place more enchanting than rural New York in the spring. Mom’s room was in the back of the hospital, and her window looked out to where the land swept upward to a hill that rolled toward the plum-colored mountains of the horizon. The trees’ branches were springy in the April air, alight with buds and new leaves, the sky a crystal blue and touched here and there with wispy horizontal clouds. Though he couldn’t smell it from inside, Jackson knew the air was thick with the scents of his childhood: of soil and mineral and bark and wildflowers.
He opened his mouth to talk to Mom, to ask her the name of that fragrant purple flower that grew along their fence, but stopped. It was a question that, until last week, she would have easily answered—not just the common name but the genus and species, too. Epilobium ciliatum she would have said in her high, breathy voice. Now, all she could do was sleep. She hadn’t spoken a word in two days.
A girl walked into the room. Well, she looked like a girl, but Jackson knew she was a medical student by her short white coat and name tag. He wondered what she was doing all the way up here, in this tiny town with its tiny local hospital—there were no academic trailblazers in Collingsworth that he knew of. Her lashes clumped together with dark bits of make-up, and her clear blue eyes were wide and round with youth. She held a clipboard and scribbled with her pen at uneven intervals.
Jackson had a million questions to ask her, as he had just made a final decision the week before to apply to medical school: Who should he ask for recommendations? With his free summer weeks, should he do basic science research or volunteer at a homeless shelter? How did she study for the MCAT? How was med school so far? (Had it been worth it?)
Instead he stood up and studied Mom’s monitor.
56 beats per minute.
He swallowed his other questions and asked, instead, “That’s her heart rate, right?” The girl—Michelle—nodded. “Is it slow, being in the 50s?” He began to pace around the room.
Michelle nodded again. “Yes, it is.” She looked down at her clipboard, looked up again, set it on the counter, opened her mouth to say more, seemed to think better of it, and closed it. She busied herself first with retying her ponytail, then with adjusting the oxygen tubing.
Jackson stopped his pacing and sat down next to Mom, right on her bed so he could feel the warmth of her. He put his hand around her tiny-boned wrist, as light and thin as a little bird’s wing. Her hands were deceptively delicate in the way they lay against the bed, so pale that the blue of her veins was visible like rivers just beneath her skin. But he knew, once flipped over, those hands would reveal the calluses of a life that wasn’t easy, would reveal the hard core of a woman who on first look might appear fragile and slight.
“I’ll be back,” said Michelle.
He wished he had the courage to talk to Michelle about Mom. To tell her what Ginny Chris was really like, so there was someone else in the world who had an image of her in their mind before she was gone. Mom’s eyelids fluttered. Jackson studied her face. Once it had been round and shining with a smile that never failed to warm his insides. That smile had always been there, unwavering, at the end of a long day, after scraped knees, after being teased about his too-short pants and disorderly hair. Now, there was no smile. He could see the outline of all the bones in her skull. Her facial skin was the color of an old dishrag and dented where the oxygen tubing pressed against it.
She was a fourth grade teacher, and Jackson had been forced to have her as his own teacher since there was only one class per grade. He had spent that year slinking down at his desk, feeling the tips of his ears burn when he saw the way the other kids laughed behind their hands at Mrs. Chris’s scrubby flannel shirts that she often chose to pair with striped or polka-dotted pants.
“It’s okay to dress nice, Jacksie, don’t get me wrong,” she was famous for saying. “But when it’s the focus of a person, then other, more important things get missed out on.” And then she would turn to another tangential, obscure topic. “The bees, for example. Did you know that without them, we wouldn’t be able to enjoy innumerable types of foods? Like cucumbers, pumpkins, cherries, and apples. Those tiny bodies, against incredible odds, collect the pollen that fuels the earth. One out of every three bites of food we eat is because of those pollinators. My son, do you know what Einstein said? That brilliant man prophesized that if the bees disappeared from the surface of the earth, humankind would have no more than four years to live. Us humans should have heeded his warning long ago, but alas, we did not. The bee population is in sharp decline, a detriment to the soil crust and mineral content and the very food we nourish ourselves with. When a worry like that exists, how can one pay any mind to the right hairstyle or the latest fashion?”
In addition to her shapeless, mismatched clothes, from his earliest memories she always wore her hair the same way: in two long braids that framed the sides of her face. It was a light brown color, and only in the last few years had a few gray hairs sprung up. Just last month she was still climbing trees and tending to the chickens and shoveling snow and scrambling up to the roof to make repairs. Jackson had grown up believing there was not a thing his mother couldn’t do. She must have been exhausted after days of teaching, evenings spent in the yard, and the hours before bed consumed with grading and planning, but she never showed it. In fact, her favorite catch phrase was a cheerful: “There’s nothing to do but get it done.” If someone had asked Jackson a year ago whether he ever worried she would get sick, he would have been affronted. He didn’t have a single recollection of her even having the sniffles.
51 beats per minute.
He had seen some apples in the cafeteria yesterday, and suddenly he was consumed with the idea that he needed to bring one to Mom. He knew she couldn’t eat it, but he didn’t care. He wanted to see her hand closed around one. Just one last time.
“Hey, Mom,” he whispered into her ear. “I’ll be back in a jiffy.”
The hall was empty. Silent. There was no sign of Michelle, nor of Angie, the heavyset nurse who wore a multi-colored turban and had been Mom’s main caregiver three days in a row. Angie was so kind, and self-assured—one of those people who always seemed to know just the right thing to say. He wished she had been there keeping watch even for his brief outing, but he knew Mom’s monitors would alert the main nursing station if anything changed.
Jackson chose to take the stairs down the three flights to the cafeteria. It was an off time, at close to four in the afternoon, but there were plenty of people lining up to get fries and pizza and sandwiches. Illness didn’t run by a clock, as he had learned since Mom got her diagnosis. It spun in uneven circles around the twenty-four hours in a day.
“I have pancreatic cancer,” she told him abruptly over the phone three months ago. He was in his college dorm room getting ready to watch his roommate’s hockey game.
“Oh, my God. Mom.” He had gotten so dizzy he had to sit on the bed, and her words whirred and spun inside of his head like the cogs inside their grandfather clock. “Pancreatic cancer? This is unbelievable. Mom, what did they tell you? Is it really bad?”
“Well, bad is one way to put it. But ever since I’ve known, the world has become intensely beautiful. I’ve been able to see individual blades of grass that I never noticed. I saw a rainbow inside a cloud last night. It was remarkable. And afterward, I went out in the rainstorm. The way the water hit my face felt like a soft caress. I had never felt the rain that way before, you know?”
“Jesus, Mom. This is serious stuff, and you’re talking about the rain?”
“The rain is serious, Jacksie. That’s what I’m trying to say. Because I know I’m feeling it. I’m aware of my existence. I can understand my place in the workings of the earth. That my molecules are the same types of molecules that compose the rain and earth, all bouncing around and rearranging. Last week, I thought I knew. I could have told you all the same things. But I didn’t really, truly understand.”
Jackson’s breaths came in short gasps, as did his words. “That’s all fine, Mom, but what’s the plan? The treatment? Is it chemo? Will you get sick? Do I need to come home? Will there be surgeries? I just started the term—should I tell them what’s going on and get a refund on my classes?”
“Shhhh,” she’d said, in a way that made the hairs on his neck stand up. At a time like this, she was shushing him? “No need to get all worked up, son. I’m having a fair amount of pain, so they’re going to do a little procedure and then start some chemotherapy. But they have made it relatively clear that the treatment is only to help me feel better. To give me some quality before it’s over.”
“Oh, Mom. No, no, no. I can’t believe it. This can’t be happening. You’re only forty-one.”
“Some people get quality, some people get quantity, Jackson. Most get neither, and only a lucky few get both.”
He couldn’t listen anymore. He had put the phone down in his lap and vaguely heard her voice calling out to him. It was just the two of them. And now it was going to be just the one of him. The prospect was so lonely, so sad, so desperate: the phrase “just the one of him” wasn’t even a phrase at all.
In the end, Jackson had withdrawn from all of his classes but one, physiology, which was a follow up to the anatomy class Mom had encouraged him to take last semester. Since he had started as an English major, and his schedule of literary theory and Shakespeare classes did not meet a single pre-med requirement, he would have had to spend at least one extra semester taking chem, organic, and physics anyway. No matter how untraditional his path, he was certain now, more than ever, that med school would be there at the end.
He headed directly for the fruit stand at the cafeteria. There were bananas and oranges and even a few pears. But no apples. There had been at least a few of them yesterday, he could swear it. His eyes welled with tears, which he swiped at angrily. After everything, he was going to cry about a piece of fruit?
On his way back toward the elevators, he saw Michelle, who looked anxious. “We’ve been looking for you,” she said a little breathlessly. “You should come back upstairs.”
47 beats per minute.
Mom didn’t look much different. Same sallow cheeks, same shallow breathing. He settled in next to her again, and pressed the orange he had bought into her hand. The sun was shining from the window over the head of her bed.
“Hey, Mom. I brought you something. I know it’s not the same. But it’s round, and it fits into your hand.”
“Jackson?” Angie laid a hand against his back. He turned toward her. “Dr. O’Malley wants to be here when…”
“About how much time?” he asked her, but it was Michelle who answered from the shadows.
“Her breathing has become more irregular and her oxygen levels are starting to go down. Her heart rate continues to slow. I really don’t think it will be long.” Angie nodded. Jackson wanted to yell at both of them for that horribly vague answer. Did “long” mean seconds or minutes or hours? But he didn’t press for more details, giving only a muted: “Thanks.” Mom’s hand moved, and he swore that her thumb rubbed against the orange in a way that said she knew it was there. Knew he was there. He closed his eyes, and just like always, the memory that first popped up was of Mom in the branches of an apple tree.
Fall had always been her favorite season. “It’s such a reminder that we can endure change. That because fall comes, and then winter, then so can spring. It tells us that aging is not a bad thing, but the most beautiful gift. At the same time the leaves of a tree get wrinkled, they also become more vibrant and colorful than at any other time in their lives.”
Rossi’s orchard was not even a mile down the road from their house, and every autumn Saturday they’d head over with their baskets. Jackson knew Mom could climb those trees without a ladder, knew that her deceptively thin arms had incredible strength; but she always indulged old Mr. Rossi and used one. Once he was out of sight and she was inside the branches, she would fly from limb to limb, laughing as she grabbed apples and aimed them for the basket Jackson held, his feet firmly planted on one of the ladder’s lower steps.
“Ooh, you know I love what comes of all this picking!” she’d shout from above him. “Pies and cobbler and applesauce! I’m so glad I’ve taught you how to make all of it, Jacksie. Granny is smiling down from Heaven to see a boy in the kitchen.” Not a season went by without a repeated lecture on apples, on how they went from seed to tree to fruit and back again. Mom was an extension of those trees—he envied the way she was so comfortable in her own skin, a quality that had been elusive for him since the day he was born. Always too tall with hands that were big and clumsy, and with long, lumbering feet that did him no justice in hockey or basketball, the sports Mom insisted that he play.
She never seemed to notice that Jackson was the one to let the goals in, or get the ball stolen, or finish the season without ever scoring. She cheered for him at the top of her lungs from the side of the rink or the court. When he was younger, he had smiled and waved to her while he played, running or skating so slowly that he trailed everyone else; later he had wished with all his might that she would just be quiet. He was never so thankful to reach middle school, when he had to try out for a team in order to play; and it was around that time they discovered bowling.
A new alley had opened up on Main Street, and Mom begged him to check it out. He was about thirteen, and gawkier than ever, with no real sense of where his arms and legs began and ended. A recent growth spurt had left him tripping over his feet multiple times a day.
“I don’t want to bowl, Mom. I thought I’d finally freed myself from sports forever.”
“Oh, I wouldn’t think of it as a sport, exactly. Just an activity. We’ll try it, we’ll chat. I’ll order us a pizza.”
He had gone reluctantly, attempting—without success—to hide when a group of Mom’s former students came running over. “Mrs. Chris! It’s so nice to see you. I hope you’re doing well. This must be Jackson. Wow, he was so little when we had you in fourth grade!”
He’d had to try multiple balls until he finally found one that fit, because his hands were already so big his fingers got stuck in the holes. It seemed so huge and heavy at first, bending his whole hand back with its weight. His first few tries he watched without surprise as the ball slid into the gutters. But around the sixth frame, it just clicked. He finished his first game ever with a 137, and throughout middle school and his high school years he continued to improve—his name was still plastered all over the walls at the alley for holding most of its records.
“I knew you’d be good at it. I just knew,” Mom often said, beaming at him with her freckled face. She never missed a single one of his tournaments.
42 beats per minute.
The freckles were still there, sprinkled across her nose and cheeks. Jackson listened to her breathing, which grew rougher with each passing moment. She moaned every few minutes and if she appeared agitated Angie would dose her with more morphine. Sometimes her feet rustled under the blankets, making a sound like the scratch of the branches against the second floor windowpanes of their house. He felt a pang of guilt: Mom should have died there. At home. It’s what she wanted, and she had told him that. But the thought of having to return there after it happened, of being forced to sit in whichever room she had taken her last breath in, was unbearable. Jackson wanted to eat his cereal at the kitchen table and have a vision of Mom puttering at the stove. He wanted to lay back on the couch near the old fireplace and hear, in his mind, her muttering over something in the Collingsworth Gazette. He wanted to smell the earthen scent she brought in with her through the back door. If she died there, he was afraid that would be all he would remember instead.
Their house was a homestead cabin built in the 1800s. It was full of creaks and cracks, and leaned so far to one side that if you put a marble on the eastern end of the floor it would roll to the western side. It had a large living area with a window that looked out over a meadow, and big soft couches covered in the afghans that Mom knitted herself, in wretched greens and oranges and gaudy blues. Every wall was made of maple wood and the whole house smelled faintly of syrup. There were only two bedrooms upstairs, one of which Jackson had slept in for the majority of his life.
Thinking of it now, of his decision to bring her here, to this stiff hospital room that carried an odor of antiseptic and plastic bottles, seemed so selfish. He had so been bent on keeping their house unspoiled—in order for him to return there and live free from the agony of her final days—that he had stolen her wish. Only in this moment did he realize what a farce it had been to think he would ever live free of her death, no matter where it occurred.
“I’m sorry, Mom. For so very, very much.”
35 beats per minute.
He placed his hand against her chest where her heartbeat thrummed gently. He had just finished up the unit on the heart in physiology. It was such a beautiful, strong, miraculous muscle. There were channels in the cell membranes of cardiac tissue that opened and closed for the passage of calcium, creating a charge gradient and contracting the muscle. In and out. Squeeze and relax. Not unlike the relentless crashing of the waves against a beach—forward, back. Forward, back. Every person, every animal on the earth only got a chance to keep living because those tiny molecules moved in an unending wave across those cardiac cells.
“It’s not your brain that will take you places, Jacksie, though Lord knows you’ve been blessed with a bright mind. It’s not your muscles or your mouth or your hands either. It’s your heart. If you are kind, if you are able to slide yourself into someone else’s eyes, even for a moment, you will succeed. And you know I’m not talking about money or power or fame. You know I’m talking about a life lived in the right way. That, my dear son, is the only real accomplishment there is.”
24 beats per minute.
It was no longer the beats he could hear, but the space between them, growing longer and longer. In that gap of time, from one thump to the next, her life hung in the balance. But wasn’t it the same for him, too? And for Angie and Michelle and everyone else? In that space between was the reality that there would come a point for everyone when that next beat would not arrive.
17 beats per minute.
The sun was setting now. It was a splendid display of pink and mauve, blanketing the hills and the distant mountains and the trees, even touching the tips each blade of grass.
“Mom, can you hear me? Mom, it’s so beautiful outside. And I know what you meant. I see the blades of grass, too.” He paused. “I remember how you told me, when I was around ten years old, about the science of a sunset. You said that when beams of sunlight strike the molecules in our atmosphere, the light scatters. It sends off its wavelengths in different directions.
“The main components of the air are oxygen and nitrogen, two very tiny molecules compared to the big waves of light that the sun pounds against them. During daytime hours, when the sun is closest to our eyes, we can only see the smallest wavelengths, the only ones that those little molecules have time to scatter before the light reaches us. Those short wavelengths are the blues and purples. But at sunset, when the sun is further away, the blues and purples have long since dispersed. What’s left are those wavelengths of light that can travel a longer distance…the reds and oranges and pinks.”
He paused and looked down at her.
“There’s something else you told me, too. That every single one of those vibrant colors are there in the sky, all the time. It’s just that our eyes can only see them from just the right angle.” He rubbed the side of her face. “See, Mom. I listened.”
Her hand moved. It raised up and she laid it on his chest. She never opened her eyes, but whispered two words so softly he may have imagined them: “My heart.”
9 beats per minute.
A bluish tint crept into her skin and there was no more breath. The sun was cut in half by the edge of the earth. Mom’s two braids lay on either side of her face, just like always. Jackson still clutched her hand.
0 beats per minute.
And in that unending space from a single beat to the one that never came, it was “just the one of him.”
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