There Was an Old Woman

Chapter Twenty-seven


Evie had gratefully accepted Finn’s offer to call a local mechanic, a buddy of his, he said, and get the car towed. Once it was up on a lift, Finn assured her, they’d find the leak and patch the tank. It shouldn’t cost much at all.

Evie barely had to turn the key for Mrs. Yetner’s Mustang to roar to life. She shifted into reverse, released the emergency brake, and backed out of the driveway. In seconds she was past Sparkles and on her way.

Like the house, Mrs. Yetner’s car was in its own spotlessly clean time warp. Not even a corner of the faux wood laminate on the dash was curled or missing. But it wasn’t perfect: the springs in the driver seat were shot, and Evie needed three of the four cushions Mrs. Yetner had piled on the deep bucket seat to see over the leather-clad steering wheel. She hand-cranked the window down and reached out to adjust the side mirror.

A tow truck passed her, going the opposite way. She wondered if it could be heading over to pick up her mother’s car already. How long had it been, she wondered, since her mother had tried to drive it?

Evie was lucky that Mrs. Yetner had pressed her car keys on her. What would have taken forty minutes by bus took ten, and still she was going to get to the hospital barely in time to catch the doctor. Halfway there it started to drizzle, and by the time she pulled into the parking lot, rain was coming down hard. She parked and ran into the building.

When she got to her mother’s room, wet and out of breath from running, she found the curtain drawn around her mother’s bed. From within, she heard voices. She backed out of the room and waited in the open doorway.

Finally the curtain drew back. A woman in a white lab coat turned around. Beyond her, Evie’s mother lay propped up in bed, unblinking, staring off into space. Her skin was tinged yellow against the white linen.

“Dr. Foran?” Evie said.

“You must be Sandra’s daughter.” Dr. Foran offered her hand. Her nails were cut short, polished clear, and she wore a thin gold wedding band. She had a file folder tucked under her other arm.

“Evie Ferrante,” Evie said, shaking the doctor’s cool strong hand.

“I’m glad you’re here.” Dr. Foran’s voice was low and her direct look unnerving. “Let’s go somewhere we can talk.”

Evie followed her down the hall, anchoring her gaze on the long dark ponytail that snaked down the back of the doctor’s white lab coat.

Dr. Foran led Evie to a visitors’ lounge and pulled up two chairs opposite each other in a corner. Evie sat in one. Dr. Foran sat in the other and leaned forward. She looked very young, no older than Evie. In the harsh artificial light, the dark circles under her eyes grew even darker.

“You know, of course, that your mother has late-stage liver disease.”

Late stage. That was what Ginger had said. Evie’s pulse pounded in her ears, and she wished Ginger were there.

“It’s cirrhosis,” Dr. Foran continued. “Her liver function is very compromised. The liver detoxifies the body, and your mother’s is no longer doing its job. That’s what’s causing the fluid buildup in her abdomen. Her mood swings and agitation. Weight loss. Jaundice. Fatigue. Nausea.”

Jaundice. Fatigue. Nausea. The words seemed to float in front of Evie. She opened her bag and found a little notebook and a pen. “I’m sorry, what did you say? I need to write this down.”

As Dr. Foran repeated the symptoms, Evie copied them down. Dr. Foran added, “She shows signs of chronic malnutrition, that much is obvious. But her liver function tests turned up additional abnormalities. Whenever a patient presents with liver failure, we compare the levels of two liver enzymes, AST and ALT.”

“AST. ALT.” Evie wrote the acronyms.

“Aspartate aminotransferase and alanine aminotransferase.”

Evie didn’t even try to write that down.

“Her AST and ALT would be between two hundred and four hundred if she had liver failure from alcohol alone. But they’re over a thousand.”

Evie wrote down > 1000 and circled it. “What does that mean?”

“It’s an indication of paracetamol overdose.”

“Paracetamol.”

“Acetaminophen. Same thing. It’s in a lot of over-the-counter drugs. People take a Tylenol and a Nyquil and a Coricidin, not realizing they all have acetaminophen. More than two grams a day can be lethal for someone with a compromised liver. That’s just three Extra Strength Tylenol. You can see how easy it is to overdose.”

“Especially if you’re drinking and losing track of time.”

“Especially. Acetaminophen toxicity is the second-most-common cause of acute liver failure requiring transplantation.”

A liver transplant? “Would my mother be a candidate for that?”

“We do many of them here. But your mother is so weak she might not survive the operation. More than that, she’d have to really want to stop drinking. Make a serious commitment.” Dr. Foran tilted her head and gave a tired smile.

No, Evie didn’t think her mother could stop drinking either, not even if she realized it was a question of life or death. “Is there no other treatment?”

“What we can do is keep her calm and comfortable. That’s what we’re doing now. She’s taking medication for anxiety and delirium. There’s more we can give her as the disease progresses.” Dr. Foran put her hand on Evie’s arm. “But you know of course, no one survives without a functioning liver. The damage is irreversible.”

Irreversible. Evie wrote the word down. Read it. And even though it was what she’d expected to hear, she felt as if she’d been sucker-punched.

“Does she know?”

“It’s difficult to tell what your mother”—Dr. Foran drew quote marks in the air—“knows. I’ve scheduled a brain scan for tomorrow. I’m guessing that will show that she’s already suffered significant brain damage.”

“Significant brain damage,” Evie murmured. She couldn’t bring herself to write down those words.

“The problem is that we have no baseline to compare. Your mother hasn’t been seeing a physician regularly. But a decline like this is generally gradual. Up to a point.”

Since when had her mother been beyond that point? Evie wondered. Years ago when she’d shown up drunk at Ginger’s wedding? Or ten years before that when she’d fallen down the stairs? Or what about when she’d run the family station wagon into a tree?

No one had put a gun to her mother’s head and forced her to drink. At first it had to have been a choice. At some point, though, Evie knew it hadn’t been.

“How long does she have?”

“You’d think with all the cases like this that we handle, we’d know the answer. But it’s surprisingly variable. Maybe a few months. Maybe weeks. What often happens is that the kidneys fail and the patient falls into a hepatic coma. After that, it’s usually a matter of days, depending on whether the patient wants us to use extreme measures to prolong life.”

“Extreme measures?” Evie’s voice was barely a whisper.

Dr. Foran shook her head and pursed her lips. “There’s no easy way to say this. There’s a good chance that she’ll linger. Possibly for weeks. It will be up to you and your sister to determine the course of treatment at that point.” She handed Evie some stapled pages. COMPASSION AND TREATMENT CHOICES was printed on the cover sheet.

Evie tried to swallow the lump in her throat. She’d known that this moment was coming, but now that it was here, she wasn’t ready for it. “What should we do?”

“Get her affairs in order. Be here for her. Watch and wait. She may surprise us all and rebound. But you need to prepare yourselves. Now is the time for you and your sister to talk to your mother about what will happen when she can no longer tell us what she wants. And this is important. Write down exactly what she says. It will make it easier for you later to respect her wishes.”



After Dr. Foran left, Evie stood at the window of the lounge, alone with her thoughts. As fat raindrops pelted the glass, the doctor’s words sank in. She and Ginger were not going to be able to prop their mother up on her pins this time. There’d be no miracle cure. No liver transplant. Not even a temporary reprieve until the next emergency, drop-everything-right-now phone call.

She called Ginger.

“So you talked to Dr. Foran?” was the first thing Ginger said.

“Yes, Ginger, I talked to Dr. Foran.” The words came out sharp. “I’m sorry. Yes. Just now. She says—” Evie’s insides wrenched, and a sob escaped from nowhere.

“Evie? Honey?”

“Hang on.” Evie put the phone down for a few moments until she could breathe again. Then she started over. “It’s not good.” She told Ginger what Dr. Foran had said, glad that she had taken notes.

“Significant brain damage,” Ginger said. “But I thought you said she recognized you?”

“Yesterday she did.”

“So how can they tell? I mean, they’ve got her on all kinds of drugs. And she’s in withdrawal. She’s got the DTs. How can they be sure that whatever this is isn’t temporary?”

“They’re giving her a brain scan.”

“When?”

“Tomorrow.”

“And what if—”

“Ginger, she’s dying. And Dr. Foran says it could be soon.”

“Oh, God. How soon?”

Evie stared at her notes, the words swimming on the page. “Weeks. Maybe only days.”

“Days? I don’t believe it.”

“Ginger—”

“Oh, God. We should have done something. Dragged her to AA meetings. Gotten her a sponsor.”

“You know it doesn’t work like that.”

“Insisted that she see a therapist, then. I don’t know. Done something.” Ginger paused, then added, “And maybe, just maybe if you hadn’t checked out months ago—”

“Stop right there,” Evie said, suddenly furious. “And maybe if her father hadn’t been such a shithead. Maybe if her mother hadn’t been depressed. Maybe if Daddy hadn’t died. And you’re right. Maybe if I’d been a better daughter.” She stopped and took a deep breath, counted to five, then added, “Do you really think anything either of us could have done would have made a difference? She’d have had to want to stop drinking.”

Ginger didn’t say anything, but Evie could hear her raspy breathing.

“Ginger?”

“You’re right. I’m sorry. Of course it’s not your fault.”

“It’s not yours, either.” Evie stared out the rain-streaked window. Cars were still going up and down the street. The red light on the corner turned green. As if nothing had changed.

“And I’m sorry, too,” Evie said. “Even if I couldn’t be there for her, I should have been there for you.”

Ginger sniffed. “Yeah, you should have been.”

“All right already, I get it, Gingey Wingey.”

“Sticks and stones, Fungus Face.”

“Oh, very original.”

“Brat,” Ginger shot right back.

“I’m rubber, you’re glue.” Evie tried to laugh, but she just couldn’t make it happen.

“So,” Ginger said, taking a long, audible inhale, “moving forward.”

“Moving forward,” Evie repeated. “We need to talk to her. Both of us. Together. And find out what she wants. For now. For later. The doctor said we shouldn’t put it off for even another day.”

After a long silence, Ginger said, “I wish Daddy were here.”

“Me, too.”

“I’ll be there as soon as I can.”