Comfort box

Ben Metrikin
Medical Student, Kaiser Permanente School of Medicine

When my grandfather was in hospice care, we received a box of medications from one of his nurses. She left it at the front door. It contained medications like alprazolam, morphine, and haloperidol in little pill boxes. Opening the box revealed a curt set of instructions listed on a piece of paper, detailing when and how to give the medications. If the patient appears uncomfortable, give haloperidol.
I read somewhere about the archeology of language – like cities built around the ruins of older cities. Like Rome. Like those little eggs my mom would get us, the ones that we poured water over and scraped at until we found the little plastic toy hidden inside. Like she knew that words come into being as accidents, constrained by and created out of the histories that surround them. Words congealed like cold butter.
Many people think English is the hardest language to learn. I wouldn’t have known (I took French in high school and promptly forgot it). So many words that sound similarly but mean differently. Vice versa, too. What a nightmare.
I’m not convinced that English is the hardest language to learn; I think it’s medicine. Even with Latin, there are rules to the game. Many of those rules are similar. With medicine, it’s different. You learn to break the body apart, piece by piece, until the constituent parts no longer look like a coherent whole. Like doing a puzzle where the picture is already on the box – a different kind of game.
The comfort box instructions consisted of a numbered list, as if to provide order to the jumbled contents.
My grandpa’s pills, in their bottles, in the comfort box, in the fridge – we knew their mechanism of action, their biochemistry. But it was their mythology which we struggled to understand the most, the lives that they lived beyond the pill bottle. My grandmother didn’t know why morphine was in the box, why we (of all the however-many-billion-people in the world) were expected to keep my grandfather’s death drug in our freezer. Sometimes we weren’t sure if the medications were for him or for us. For us, perhaps, so we didn’t have to see – immediately, apparently – his tossing and turning. He never told us how he wished to die.
For secretions in the mouth or throat, use atropine.
When my grandfather was discharged from the hospital the first time, the plan was for him to come in to see the doctor every few weeks for radiation and chemotherapy, donning a mask and gloves. Without any help from any of us, he waded out into the streets, hopped in a car, and went into the oncologist’s office for treatment.
Look again, closely, two weeks later: there were only 12 red steps separating his apartment from the street, but they had become insurmountable. His legs were getting weaker and could no longer support him. He was still himself – tall, strong, sturdy – but had to drape an arm around my shoulder, now, to get up and down those stairs.
Why did doctors feel the need to name diseases after themselves? As if to conquer some specific biochemical process, to plant their flag in a medical aberration. As if to say: this part, right here, is mine. It might be part of your body, but it’s mine! To me, at least, it seems like an unwelcome intimacy.
During those few weeks, while my grandfather got sicker and sicker, we walked up and down those stairs in tandem. Some neurological effects of the chemotherapy, maybe, or just the cancer spreading? My body slowly took on the weight of his as his legs began to fail him. At first, I merely let him push down on my shoulders while he grabbed onto the railing, letting him lean against a wall to catch his breath once we reached the bottom of the stairs. Days later, I was pushing him up each red stair, holding onto his body for fear that he would fall.
It was a strange kind of intimacy: as I grasped his torso on either side to propel him up those stairs, I felt each rib as they slid underneath skin. When I wedged my shoulder underneath his legs to stop him from falling, I felt the atrophying muscles tightening with the massive effort each step took. Even so, we were masked and gloved, sanitized before and after — our spheres as separate as we could possibly make them while my body took on the functions of his.
If the patient appears agitated, use lorazepam.
The comfort box sat in the freezer, largely untouched. Towards the end, we argued endlessly about which medications to give. Two doctors in the room (my dad and my uncle) and still no clarity, no formulaic certainty about what kind of comfort we ought to provide. To be fair: what is the difference between discomfort and agitation, when the patient can’t provide any spoken clarity?
The hospice doctor called before the oncologist did; we could hear it in his voice, even if he never said it. Upon reflection, no one ever said it; or maybe there was no “it” to say. Maybe “lymphoma” was enough, even if “lymphoma” didn’t normally move so quickly. Maybe no name was better than having one.
For me the noise of Time is not sad: I love bells, clocks, watches — and I recall that at first the photographic implements were related to techniques of cabinetmaking and the machinery of precision…¹
When the funeral home took the body, at 7:30am, right as the sun was rising, we hardly had a word to say.
There was a small café right outside the apartment where I grew up in New York. Despite the rickety wooden bench that sat outside of it, the café recalled a French patisserie. There was always a cake in the front window, crafted graciously and exquisitely, but not extravagantly. Each year, right around when summer would turn into fall, my grandfather would sit my brother and I down on that bench, in front of a different cake, and take our picture. There is a series of those photos, all the way from when I was two years old until I left for college. In each photo, you can see my brother and I sitting next to each other, smiling at the camera, slowly growing older.

(1) Barthes, Roland. “Camera Lucida”. Hill & Wang, 2010.

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