The call comes in the early morning. I jump, and the tea I’m drinking spills into the saucer. It’s my sister’s wife, JP.
“Lizzie’s in the E.R.”
My heart plummets. “Again? I can get on a plane this morning. Should I come?”
“No. It’ll probably be like last time. I’ll call you as soon as I have any news. I have to get off the phone. They’re not allowed in here.”
“JP, I—” But the line’s dead. When I pick up my tea, my hand is trembling.
Twelve months ago, I received a different phone call that set me shaking. Lizzie told me she’d been diagnosed with FSGS: Focal Segmental Glomerulosclerosis.
“What the heck is that?”
“It’s a form of kidney disease.”
I was stupefied. Lizzie was the picture of health, constantly eating the healthiest foods and working out regularly. But she hadn’t always been. Before she left California, she was a drunk: plowing her car into the neighbor’s front yard, getting fired for constant tardiness, slurring on the phone. She sobered up when she moved to Philadelphia, but was it too late?
“I thought alcohol affected the liver, not the kidneys.”
“It’s not connected to the drinking. They don’t know why I have it.”
“How serious is it?” I asked.
“It’s a chronic disease. It could ultimately lead to kidney failure, but—”
“Oh my God! What can I do?” I was ready to jump on the next plane and donate an organ, if that was what she needed.
“Calm down, Ash.” Lizzie’s voice was soft and reassuring. “It could lead to kidney failure way into the future, but Doctor Marshall thinks he caught it early enough. With treatment I should be asymptomatic for years.”
“If you don’t have any symptoms, why were you even seeing the doctor?”
“Routine blood tests. They spotted a pattern they’d never noticed before.”
“You mean you’ve had it for years?” I had so many questions, I didn’t even know where to start. “Should I come visit? I could get off work…”
“No. I have JP. She’s going to take very good care of me. Not that there’s anything to do now, anyway.”
I sighed. I sometimes felt as if JP and I were in competition when it came to Lizzie. I could picture JP standing in the background shaking her head at my offer to visit.
“I’ll be praying for you, sis. I’m going to put you on the prayer list at church too, so everyone can pray for you.”
“That’s sweet, Ash, but don’t get overdramatic. It’s not cancer or anything.”
“I can’t help it. You’re my baby sister. I don’t want anything to happen to you, ever.”
She laughed. “I know. You’re the best big sister anyone could have. But don’t worry. I lead a great life and have a wonderful partner. Nothing’s going to happen to me.”
But something has happened, and it’s not the first time. Last month Lizzie was hospitalized overnight because of dizziness and nausea. They discharged her the next day with a clean bill of health, and we all breathed a sigh of relief.
Now she’s back in the E.R. again. Should I ignore JP’s advice and head out to Philly? I’m her big sister. I should be there to protect her. But JP’s her wife, and I know she’ll move heaven and earth to make sure Lizzie’s well taken care of.
I have to get ready for work, but figuring out what to wear is the last thing on my mind. I pull a grey, wool dress off the hanger and slip into black pumps. When I check my hair in the mirror, the figure staring back at me looks like she’s dressed for a funeral. I tear the dress off and shrug on a bright red one instead. She’ll be fine. Just like last time.
The drive to my job at Grace Covenant School is a short one. This time of year I usually keep an eye out for late-lying snow or early almond blossoms, but today I see nothing. Once at work, I stay in my office as much as possible and try to catch up on emails, avoiding kids who might want to interact with me. But I can’t concentrate. I feel so powerless. By lunchtime, I make an excuse and skip out early.
At home, I sit on the sofa, clasp my hands together, and offer up silent prayers.
“Superstitious hogwash, Ash.” I can hear Lizzie’s voice as clearly as if she were sitting by my side. “Religious mumbo-jumbo.”
It’s amazing how she went from one extreme to the other with her faith. She was the one who recruited high school students to take a virginity pledge. The one who said her goal in life was to marry a good man and have lots of kids. Once she met JP, all that went out the window. She didn’t just abandon her church, she actively despised it.
For me, it’s more complicated. Sometimes I do feel confined by my religion, but I worry that without it, I’d have nothing. After our parents died, I felt so alone. Activities like singing in the church choir and serving meals at the shelter keep me grounded and give me a sense of family, especially now that Lizzie lives so far away.
The phone rings and I almost drop it in my anxiety to grab onto it.
“JP?” I ask, even though I can see the caller ID. “Is Lizzie doing better?”
“No.” I wait for more information, but none is forthcoming.
“How bad is it?”
“She’s going downhill fast.”
“Downhill? Dear God, what’s going on?” I push the words out with all the force I can muster, thinking they will come out as an almighty roar, but all that comes out is a high-pitched squeak.
“Her kidneys have shut down.” Her voice sounds muffled as if she may be trying not to cry. “If you want to see her, you better get on a plane tonight.”
I feel as if I’ve been punched in the gut. “Tonight? But surely…” I trail off, waiting for JP to soften the blow. She says nothing.
That’s when I know for sure what she’s telling me: my beloved baby sister Lizzie, who celebrated her thirty-third birthday barely six months ago, is dying.
The red-eye flight is grueling, especially since it involves a layover. I try to read The Shack, which I grabbed from the shelf on my way out the door, but I can’t concentrate. Older sisters are meant to protect their siblings, and I’d do anything to save Lizzie. I don’t understand how the doctors could have said she was fine, and a month later, her kidneys have shut down.
I should have jumped on a plane this morning. Why did I listen to JP? Ever since our parents died, I’ve been second-guessing myself: What’s best for Lizzie? How can I keep her safe? The guilt that’s never far away, settles on my shoulders like a hundred pound barbell.
I need to sleep, but when I close my eyes, my mind conjures up endless images of Lizzie and me together: playing hopscotch in front of Gran’s house, driving her to the prom when she wore that ridiculous lime taffeta, shoving piles of her clothes into the trunk of my car when she finally left Kurt.
Those pictures get superimposed on that dreadful day we lost our parents, and I have to pull my thoughts away because I can’t bear to remember the funeral and the aftermath. When I steer my memory in a different direction, it takes me to that first meeting with JP, the mistake I made, and how I feel as if I’ve been apologizing ever since.
I still can’t believe Lizzie could be dying. Maybe I’ll arrive and learn that it was all a mistake, her kidneys have recovered, or she’s received a transplant. Surely they’ll tell me that she’s on the mend and will be out of the hospital in a week or so.
In the Philadelphia airport I text JP and hurry to the bathroom to brush my teeth and apply some makeup. There are dark shadows under my eyes, and my skin is even whiter than usual. My mousy hair looks dank, as if it hasn’t been washed in a week. I pull back stray strands of hair that have come loose and shove them back into my ponytail.
“You have such lovely hair, why do you restrain it?” Lizzie used to ask, until she gave up trying to get me to change.
“I have to keep it under control.” I believe my hair mirrors my state of being. Sometimes I wish I could let go of things more—my hair, my eating habits, the religious strictures I impose on myself—but I’m scared that if I do, everything will fall apart. So I keep my hair tightly pulled back, and I wear clothes that fit my angular body without emphasizing any part of it. Nothing too tight and nothing loose or free flowing. I’ve never cared about fashion trends, as long as I look neat and tidy. I was one of those kids who was sorry to stop wearing a uniform when I got to high school, and if I could still wear a white short-sleeved blouse with blue shorts every day, I’d be happy.
People say Lizzie and I look alike. We’re both average height, long-waisted, and our legs are muscled from running. We have Mom’s blue eyes and a cleft in our chin from Dad. The similarities end there though. Lizzie’s silky, chestnut hair falls in waves around her face, her cheekbones are soft, and she has a little snub nose. My cheekbones are high, my noise too pointy, and my thin lips make me look severe, even when I smile. Does my appearance reflect my personality or is it vice versa? If I looked more like Lizzie, would I have softened up like her? If only I could find a way to loosen up, but still hold everything together.
This morning my gaunt face appears more austere than ever. I methodically apply eye shadow to my eyelids. I know it’s crazy, but it’s a habit. I’ve always presented myself to Lizzie and the world as well put together, and I’m not going to change now. What if she doesn’t know how dire her situation is? My not wearing makeup would say it all.
JP is leaning against her pickup truck in the arrivals zone, looking impatient. Her hair is so short she seems almost bald. A shapeless plaid shirt hangs from her shoulders, and her baggy cargo shorts have settled loosely below her hips. She’s lost weight since I saw her a couple of years ago. If I didn’t know better, I’d think she was the one with the medical disorder.
“You texted five minutes ago. The security guys were trying to move me on.”
“I’m sorry.” I throw my overnight bag onto the jump seat of the pickup. As usual, I’m starting out by apologizing to JP. I settle into the passenger seat, and she pulls away from the curb.
She doesn’t ask how the flight was, so I break the silence. “Tell me again what the doctors are saying.”
“There’s not much to tell. They don’t know why she deteriorated so suddenly.” She stares directly ahead of her and steers the pickup onto the freeway. JP has never been chatty, but her silence is frustrating. I try again. “Last year she told me this form of kidney disease would be totally manageable. So what happened?” I swivel in my seat and pull my safety belt to the side so I can look right at her.
“Your guess is as good as mine. Did the doctors mess up? After all, they missed her condition for years. All those times she went to the doctor because of blood in her urine, they insisted it coincided with her period. The fact that her protein levels were high? They brushed it off.”
“Maybe we shouldn’t have put such faith in their optimism and researched it ourselves.”
JP keeps her gaze on the road. “We could’ve gone crazy researching on the Internet, but when all the doctors tell you not to worry, you don’t. Especially if you’re Lizzie.”
I nod. Lizzie was never one to make a fuss. Over the past year I’ve tried to ask her whether she thought her doctor was negligent in not picking up on the FSGS sooner, but she wouldn’t go there with me.
“Okay, I’ll level with you. She brought it on herself,” JP says.
“What?” I swivel back around to face JP. Her gaze doesn’t stray from the road.
“The docs think it was the alcohol that caused the kidney failure.”
“But why now? Lizzie is ten years sober.”
“I’m sorry to break this to you, Ash, but she wasn’t. In the last year, she kept having slips, some worse than others.”
“Slips?” Surely Lizzie would have told me if she’d fallen off the wagon. She’d been so upfront with me, once she recognized her addiction. “She never said anything.”
JP shrugs. “She looked up to you. She didn’t want to disappoint you. There were all kinds of things she didn’t share with you.”
JP doesn’t answer. She maneuvers the pickup off the freeway.
We’re in an area I’m not familiar with, nowhere near center city. Somehow I’d assumed she’d be at one of the prestigious city hospitals.
I’m still struggling with the idea that my sister had slips. “I don’t believe Lizzie would have compromised her sobriety.”
“It wasn’t the first time. She had a slip a year ago, when she was first diagnosed. The other night when I brought her into the E.R., she had come home completely smashed.”
“A year ago? Two nights ago…are you sure?”
“Jesus, Ashley, ask Paula about last year if you don’t believe me.” Paula is Lizzie’s best friend. “As for this time around, ask the doctors or nurses. They’ll confirm what I said.”
I sit back in silence, gazing out the window, seeing nothing.
It’s hard to imagine Lizzie not telling me that she had a slip, even harder to believe she was drunk when she was admitted to the hospital. But JP has no reason to lie. Maybe Lizzie didn’t confide in me; maybe she thought I’d find fault. After she gave up her faith, she kept trying to show me how my beliefs made me judge others. She said I was a good person. She said I had to start thinking for myself.
JP pulls into the driveway of a large, old-fashioned, brick building, nothing like the modern glass- and-steel structures hospitals tend to be nowadays.
“Why don’t I drop you here and go park? She’s on the second floor. I told them you’d be coming.”
I run through the double doors and follow the signs to the elevators. A desultory group of people is waiting, and now that I’m so close, I’m too desperate to see Lizzie to wait. I push open the small door next to the elevators and take the stairs two at a time, vaguely registering the plain white concrete steps, the paint peeling off the walls. I pull open the heavy door onto the second floor and head toward the nurse’s station.
A plump, middle-aged woman, whose Afro frames her face like a halo, asks how she can help me. When I tell her who I am, she looks relieved and hurries me down the hall.
Inside Lizzie’s room, it’s hard to believe the woman propped up in the hospital bed is my sister. Her skin is yellow and she’s so bloated she reminds me of one of those blimps that hover in the sky, encouraging me to buy their brand of beer or insurance. An oxygen mask covers her nose and mouth and an IV snakes itself around her arm. Her eyes are closed.
I tiptoe over and stand at the bedside.
“Lizzie?” I whisper and stroke her swollen fingers. “Lizzie?”
I don’t know if she can hear me, so I take a chance and say loudly, “It’s me, Ash, your sister.”
Her lids flutter and for a moment she opens her eyes. Her gaze is blank, and she closes her eyes again. Through the plastic of the oxygen mask, the corner of her mouth turns upward as if she’s trying to smile. I squeeze her hand and she grimaces.
“I love you,” I say, “darling, darling sister. I love you so much.” I clench my throat tight to hold back a sob trying to make its way out.
My hand is in hers and she tries to lift it. I’m not sure if she wants to kiss my fingers. The effort is too much and her hand falls back. I lean forward and kiss her forehead. Maybe she wants to say something. I move the oxygen mask away from her face. She opens her mouth, but no sound comes out. She swallows and tries again, gasping for air. I lean forward to replace the oxygen mask, but she shakes her head.
“JP,” she whispers, and I feel my heart constrict. I thought she’d be happy to see me. Apparently, the only person she wants next to her is her wife.
“She’s coming. She’s parking the truck.”
She shakes her head with surprising vehemence and opens her eyes. They’re no longer glazed or blank, only full of agitation. She’s trying to get a sentence out, but it’s barely a mumble and there are only a couple of words I can catch. “JP…affair…Jim…”
“JP had an affair with a guy called Jim?” It’s about the most unlikely thing she could tell me, and I wonder what drugs they have her on. I stroke her hand, her forehead, any part of her I can touch. “Whatever happened, we don’t need to talk about that now, honey, it doesn’t matter.”
“No…me.” She gasps, then continues. “JP…mad.”
Is this a deathbed confession? While I can’t believe JP would have an affair with a guy, it’s hard to imagine loyal, dependable Lizzie having an affair with anyone, female or male.
“Sweetheart, none of it matters. We’re both here for you. We love you. She’s parking the truck, she’s not mad at you.”
“Not now, then…she…” She sucks in all the air she can then forces out a string of words, mumbling and incoherent. “I told her…Hell and…in the water…no energy…drink…Jim…but I wasn’t…”
“Lizzie, honey, I don’t understand what you’re trying to tell me. I’m sure it doesn’t matter now.” She’s clearly exhausted, fighting for breath. I put the oxygen mask back over her nose and mouth.
Did I hear her say the word Hell? Is she saying she’s going to Hell? I know she gave up her faith, but now that she’s dying, is she clinging to it?
I wonder if there’s a chaplain or pastor here. Even though Lizzie says she’s no longer a Christian, she might want someone to pray with her and help her go home to God. I want to ask her, and yet she’s already so upset and agitated, I don’t want to make things worse. Does she understand how serious her condition is?
“Shall we pray together?” I stroke her hand. With a strength I would never have expected, she rips the mask off her face.
“Ash!” Her eyes, so empty a few moments ago, are burning fiercely.
“Yes, my sweet sister, I’m—” She cuts me off.
I turn, thinking JP is by the door or has come in. She hasn’t. Lizzie’s eyes grow wide and frantic. “Jim…” Again, something I can’t make out, and then a word that sounds like prison.
“Jim is in prison?”
She shakes her head and pushes out the word one more time. It still sounds like she’s saying prison, yet I know it’s not quite that. Her mouth moves but nothing happens. All of a sudden she slumps. Her eyes roll backwards, and all the machines she’s attached to start beeping frantically.
A nurse yells, “Code blue!” and there’s flurry of activity. I know it’s too late. I’ve watched enough TV to know what it means when the machines show flat lines. Lizzie’s chest is no longer rising and falling, and I can feel death in the air.
“Lizzie!” I spin around. JP stands in the doorway, stunned. She rushes into the room but Lizzie is now surrounded by medical professionals pumping on her chest, blowing some sort of balloon into her mouth, and JP can’t get near her.
There is silence while the medical team works on Lizzie, and I hear the words, “Time of death…”
JP looks around in bewilderment, chokes up, and bursts into tears. She slides down onto the floor and I slide next to her. All I can think is that my sister is gone forever. I’m completely alone in the world. How can this have happened? How can my beloved sister, so healthy until last month, be dead?
Lizzie’s last words echo over and over in my brain: Jim. Prison. All of a sudden, in the midst of my grief, the word comes unbidden into the forefront of my brain.
She wasn’t saying that Jim was in prison. With her dying breath, my sister was trying to tell me that someone named Jim had poisoned her.