The Life That Comes After
The cluttered interior of Maggie’s Toyota Corolla was testament to her dedication to the job. Wrappers from a week’s worth of lunches on the go. A dual USB charger so she could keep her work cell and digital netbook going all day long. And a duffle with a fresh change of hospital scrubs, spare deodorant, and a hairbrush so she didn’t scare the inevitable family members who answered the door at her patients’ houses when she was on call.
Hospice had always been considered the bastard child of the nursing profession. The stench of death had a way of infecting everything around it. And while Maggie wouldn’t state things so baldly, her quiet life with her two cats in a cramped one-bedroom apartment in a not-so-great part of town did sometimes feel like it was on life support. Not dead, but missing some ineffable essence of life.
But then again, this was what she had signed up for. Not when she became a hospice nurse, but when she committed herself to The Life That Comes After.
Safely ensconced in her car, Maggie patted the passenger seat until her fingers closed over the metal casing of her netbook.
Logging in, she located the case file for Mr. Maccaulay, the gentleman who lived in the colonial in front of her. Age 68, terminal lung cancer patient. She navigated the interface until she found the section to record her observations.
“Patient exhibiting classic signs of terminal agitation. Family members exhausted trying to keep him comfortable. Suggest checking in with them ahead of their next scheduled—”
A shrill ringtone filled the car, vibrating the windshield. Work phone. Maggie grabbed it and answered.
“Oh, good. I didn’t know if you’d be with a patient.” Father Rodriguez’s voice filled the small car with his presence. Warm and welcoming, putting her immediately at ease. Even though they’d been working together for years now, she still retained a touch of reverence for the shepherd, left over from their very first meeting where she confessed the impossible things she’d seen.
“No, I just finished up.”
“Then you must not have heard the news yet. Gavril Nursing has found a replacement for Malcolm since he was forced into early retirement. They’ve decided to promote one of their home care case managers.”
“You’re kidding.” Home care was nothing like hospice. Most people couldn’t make the transition from dealing with the sick and infirm to those with only months or weeks left to live.
“I’m afraid not, Maggie.”
She choked back a curse. “I take it he’s uninitiated?”
“That’ll be up to you. If you don’t get him on board, we’ll have to figure out a way to get rid of him.”
“Shouldn’t be too hard if he’s used to working in-home care.”
Burnout in hospice was a matter of when, not if. That Maggie was still going strong made her a bit of a local legend. But most people didn’t know it was her dedication to The Life That Comes After that kept her strong in the face of so much death.
“Yes, well, I heard he volunteered for the position.”
“So be careful with this one.”
“And Maggie, know that we were all pulling for you to get the position, but…”
“My record, I know. And thanks for the warning.”
Maggie hit the end call button and stared down at her netbook. The screen had timed out, leaving just the Gavril Nursing logo bouncing back and forth. She’d known she was a long shot for the position—that wasn’t the upsetting part. That she was responsible for convincing the new hire to look the other way like Malcolm had for years was.
The tightly shuttered Colonial started back at her bleakly. This case was exhibiting all the classic signs of transference into The Life That Comes After.
Maggie vowed she wouldn’t let this new director mess it up.
“And who has our last case—a Mrs. Wilkinson?” Ian Johnson asked the table.
The new hospice director was a go-getter, all right. He started two days ago, and already insisted they all meet in-person to get him up to speed. A reasonable request, perhaps, but it upset all the nurses’ schedules—with all of them working crazy hours to accommodate the needs of different patients, the email thread alone to find a good time was migraine-inducing, and the meeting itself wasn’t much better.
Maggie cleared her throat. “That one’s mine.” It wasn’t supposed to be, but Callie’s son got sick and someone had to cover for her. “Age 55, congestive heart failure. Complicating factors include sleep apnea and her weight. She needs two of our home health aides to bathe her properly.”
“That’s not company policy.”
Maggie shrugged. “I’ve already had one aide refuse to handle her case if she doesn’t have help.”
Ian frowned but gave Maggie a nod to continue.
“She has all the medical equipment she’s eligible for, but since she’s too young for Medicare…” She wouldn’t have enough money to pay for the second aide let alone anything else if her condition worsened.
Ian sighed. “Right. Well, anything else?”
“Just that I’ll be transferring the case back to Callie since it was going to be hers originally.”
“No. I want you to stay on it.”
“Begging your pardon, but I only handle cancer patients.”
Ian shook his head. “Sorry. The son requested you specifically. Apparently you two hit it off.”
Great. Maggie bit her lip as he finished going over the remaining administrative bullshit on the agenda.
One of the nurses’ work cell rang. She answered, then held her hand over the mouthpiece. “Gotta run. Torn surgical sutures.”
Ian gave her a nod. “All right, that’s enough for today anyway.”
Maggie and the others collected their things and pushed in their chairs around the cramped conference table.
“Maggie, a moment.”
She took a breath before facing the new director. “I have an appointment across town in an hour.”
“This won’t take long. I just wanted to say I’ve been reading all the personnel files.” Ah. Here we go. “Your work’s been exemplary. The other staff members like you, families too. I’ll be relying on your…experience to help me get up to speed.”
What else was there to say? “Sure.”
“There’s just one thing. The missing medications. There was no hard evidence, and I’d like to hear your side of the story.”
That was surprisingly decent of him, but Maggie couldn’t afford questions, not until she knew where he stood. “I’m sorry. That was a really hard time for me, and I’d like not to dredge it back up. I hope you can understand.”
“Of course.” Some of the friendliness drained out of Ian’s face, but he gave her a cordial nod as he saw her out of the conference room.
Thursday nights were for the local library. Cancer support groups. Family members and caregivers primarily. But in helping them through the process, Maggie could sometimes identify which patients were preparing for transference and ensure the proper resources were in place to assist them into The Life That Comes After.
“The nurse actually yelled at me for not holding the bed sheet properly.” The young woman sitting in front of her was verging into hysterics.
Maggie had seen it before—once you start venting, even about the little things, all of it had a way of stampeding out. “She was wrong to do that,” she said as soothingly as she could. “Everyone understands you’re doing the best you can.”
“She never even showed me the right way. And then she started typing something into her assessment file, and…” The woman took a deep, hiccupping breath. “What if she thinks I’m an unfit caregiver? What if…” Tears finally made their way down her face.
“I’m sure she was just inputting the required information, don’t worry. But you should know you do have a choice in which hospice agency you use. Medicare?”
“You should have no problem switching then,” Maggie said.
“What, ah, one do you work for?” She did everything she could to avoid having to say “hospice.”
Maggie fished out one of her cards. The Gavril Nursing logo followed by her contact info. “Talk things over with your family first. If you still feel the same way after that, give us a call, and we’ll get you onto the schedule.”
She gave Maggie a watery smile then sleepwalked her way out of the library meeting room, grief and exhaustion from caregiving marring her face.
“Maggie, how goes it?” Father Rodriguez had come up next to her, wearing a black dress shirt and slacks, his clerical collar visible even though he no longer ministered for the church, at least not exclusively.
“Do you really want to know?”
“Just the part about the new hospice director.”
Maggie chuckled and led the way outside to her car. Father Rodriguez situated himself in the Toyota’s passenger seat.
“Well, he’s everything you said he’d be. Seems to be making an honest effort at getting up to speed.”
“What about initiation?”
“Don’t know yet.”
He made an impatient sound in the back of his throat.
“I’ve barely had a chance to work with the guy. He’s been tagging along on some of the nurse visits, but hasn’t done one with me yet. Probably next week sometime, if I had to guess.”
“We’ll see. He might be too much a stickler for the rules.”
“But if he saw transference for what it is…” The raw oratory power Father Rodriguez could turn on at split-second’s notice always made her feel like she was capable of more than she asked of herself. “If he understood what we’re all working for…”
Maggie bowed her head. That moment certainly changed a person. But it was a moment of profound risk, too, whether that person saw it for what it was—life on a new plane of existence—or chose to explain it away with the mythology of their choice.
“Maybe. I can make no promises,” Maggie finally said.
“But the patients…”
“Don’t think I don’t know how important it is to have someone sympathetic to our cause in the director’s chair. You have no idea how bad it’s been without Malcolm here.”
“I know, Maggie. I know.” He patted her hand. “But The Life That Comes After must be protected at all costs.”
A young man opened the door to Mr. Maccaulay’s colonial on Monday. Son-in-law. He wouldn’t meet Maggie’s eyes, but he was unfailingly polite as he lead her and Ian who had decided to tag along today down the hall. Mr. Maccaulay lay on a hospital bed in the converted dining room.
One of his daughters got up from her chair when they entered, all business as she ran through his symptoms over the last forty-eight hours with clinical precision. Not everyone could learn the lingo. Quick study or coping mechanism. Either way, it made Maggie’s job easier as she went through her assessment, hyperaware of the director’s presence as he observed.
When the daughter ran out of things to say, Maggie gave her a smile. “Our director Ian Johnson wanted to join us today to see how things were going.” With a nod to Ian, Maggie handed the daughter off to him while she got out her stethoscope and penlight and moved on to vitals.
Once the period of restlessness was over in the active dying phase, most patients entered a comatose or semi-comatose state. Mr. Maccaulay roused slightly but didn’t wake as she listened to him breathe (slowly, but still within the normal range) and checked his eyes (sluggish pupil contraction, but contraction nonetheless).
Behind her, Ian was giving the daughter the company line in comforting tones. Maggie finished her assessment and disinfected her instruments before storing them in her bag. “Did the comfort pack arrive?”
“Oh, it came yesterday. We put it in the fridge as instructed.” The daughter turned toward the kitchen as if to fetch it.
“You don’t have to get it, but remember what we talked about last time?”
She nodded and leaned in. “The morph—I mean Roxanol?”
“That and the medicine to help with the fluid build-up in the chest.”
She nodded again, more slowly.
“Why don’t we go ahead and get the kit,” Ian said. “Surely it’s easier to review everything that way.”
Maggie glanced back at Mr. Maccaulay. “Sure. We’ll give your dad a break and talk things over in the kitchen.”
The daughter retrieved the comfort pack from the fridge and laid it out on the kitchen counter. Ian stood on one side, Maggie the other.
“I only looked at it briefly,” the daughter said with an apologetic glance at both Maggie and Ian.
“That’s all right,” Ian said.
Maggie crossed her fingers as the daughter pried up the cardboard box top. The new pharmacy did good work, swapping the traditional morphine for pain management and the atropine for the throat secretions to the medicines that helped prepare the patient for transference. Patients could move into The Life That Comes After without them, but the stress on the body and the risk of failure was often too high.
Ian scrutinized the vials and droppers and the foil-wrapped packets of suppositories then lost interest as Maggie went over the timing and dosage requirements with the daughter. She’d done it once already, to give the daughter an overview of what to expect.
“So you think he’s at the point where…” The daughter closed her eyes for a long moment.
Ian looked at Maggie helplessly.
Maggie cleared her throat. “Right now, our main concern is keeping your father comfortable. As to the rest, well, we can’t give you a precise timetable. But on average, I’d say you have three days, maybe more, maybe less.”
“The active dying phase,” Ian added.
Maggie wanted to kick him, but the daughter just nodded. “I read about that.” She tidied the medicines in the comfort pack with precise little movements, then returned it to the fridge.
“The home health aide is scheduled for tomorrow morning.” Maggie found it easer to talk to the back of her. “If you need anything, you have the Gavril Nursing hotline and my personal cell.”
The daughter turned back around and gave Maggie a dutiful nod. “Right. Thanks.”
Maggie followed Ian back down the hall and then outside into the fresh air. No matter how tidy caregivers kept a home, it was always a relief to leave, even if she was headed to another home, another case, another person rationing out their last breaths.
“We’ll be in touch,” Ian told the daughter over his shoulder.
Maggie adjusted the strap to her medical bag. Ian clicked the unlock button on the key fob to his SUV, and they got in.
Ian scrolled through his texts and sighed as he set the phone into the cupholder. “What pharmacy did that kit come from?”
“Smithington’s. We were in the process of switching over to them before Malcolm left. Why?”
He thumped the steering wheel with his hands as he pulled out of the driveway. “It’s just that the doses seemed awfully high.”
Crap. The dosages were high if they were the traditional medicines that came in the comfort pack. But the dosages were just right for someone on the verge of transference. “Really? I’ve never paid much attention to them since we usually have to tailor the dosing for each patient anyway.” That was true enough. Some patients didn’t need the full amount to stay comfortable, others needed double or more to meet death peacefully. Maggie counted the seconds.
Father Rodriguez’s words floated to the top of her brain. The Life That Comes After had to be protected at all costs. “I’ll probably stop by here tomorrow and take a look if you’d like.”
“You aren’t scheduled.”
Maggie shrugged. Didn’t matter, not when it came to transference. “You should come, too.” She gave him a hard look. “I saw you in there. You could barely look at Mr. Maccaulay. Need to cure you of that if you’re going to stick around.”
He pulled off onto the side of the road, the abrupt change jerking Maggie against her seat belt.
“I’m only going to say this once, so listen good. I’m sorry you got passed over, but that doesn’t change the fact that I’m here now, and we need to figure out how to work together.”
“I don’t want your job, Ian.”
“Then why are you—”
“Because you aren’t ready.” And she needed him to be. She needed him to understand. To see that these patients were on the path to something more and to be willing to do what it took to protect the Life That Comes After. Like Malcolm had.
“What the hell?”
“The Maccaulay case is a special one. We’ll see this through, and then we’ll talk.” She raised her voice over his protests. “About everything.”
He frowned into the dashboard, but he was thinking it over, she could see it. “All right, Maggie.”
The slight wrinkle in Maggie’s plan meant she and Ian had to spend more time together as they waited for Mr. Maccaulay’s passing.
To Ian’s credit, he tagged along with her on her other case visits and didn’t protest the clutter in her Corolla.
At the office the next day, Ian called her over to his desk. “No change?”
Maggie shrugged. “The more stubborn patients sometimes take a little longer to let go.” He’d learn that eventually, with enough cases under his belt. Her cell blew up a moment later, and she briefly met Ian’s eyes before answering.
“Is this Maggie? It’s John, Sandra Wilkinson’s son. She just stopped breathing. I think…I think this is it.”
“All right, John. We’ll have someone there right away. Just sit tight, okay?” Maggie chucked the phone into her medical bag. “Of course, Mrs. Wilkinson decides to kick it now. Not two weeks ago or two months from now.”
“What’s the big deal?” Ian asked.
Maggie didn’t answer, just plucked the schedule off his desk. “Who else is on call today? Callie? Susan?”
Ian pulled the schedule out of her hands. “You are. It’s your case, and they need you.”
“I agreed to indulge in this little game of yours, Maggie, but not at the expense of our other patients. We clear?”
Maggie nodded reluctantly. “Then let’s get going.” She checked her watch. “We need to stay ahead of rush hour.”
“Yes, you. Someone has to check in with the Maccaulays while I drive.”
Maggie sat with John Wilkinson at the kitchen table while Ian went through the medicines, throwing some into the trash bag of kitty litter and dumping others down the drain. Too often caregivers were inundated with medicines they never ended up using. To ensure proper disposal, they often assisted with the clean up. If nothing else, it gave them something to do with their hands as they waited for the funeral home to arrive.
“She looked peaceful,” Maggie said. “You did a good job taking care of her. Don’t forget that.”
John nodded, fingering the wide-grain of the tabletop.
Ian snapped off his latex gloves and threw them in the trash. “Looks like they’re finally here.” He indicated the headlights of a hearse shining through the front window.
John got out of his chair like a sleepwalker. Maggie patted his shoulder. “We’re going to go now. The funeral home will handle everything else. But if you have any questions, you know how to reach us.”
Ian shook his hand. “Our chaplain will be in touch in case you or any family members want to talk.”
Another nod, because what else was there to say?
Maggie and Ian slipped past two burly gentlemen in full fig wrestling a stretcher down the front walkway.
“Now what?” Ian asked.
Maggie fished her cell out of her smock pocket. No news. “I’m starving.”
Ian buckled himself into the Corolla. He sighed like a man resigned to his fate. “Sure. Why not.”
They ended up at a small diner halfway between the Maccaulay home and the office. If Ian noticed, he didn’t say anything. In fact, he hadn’t said much at all as they waited for their burgers and shakes in the half-empty restaurant.
Ian looked up from his plate. “You lied to me, Maggie.”
She had just taken her last mouthful of burger and bun and had to spend the next few seconds trying to chew and swallow without choking. It took concerted effort. “What…” She had to stop and take a sip of water. “…are you talking about?”
“The medicines at the Wilkinsons. Same Smithington pharmacy, but with the right dosing instructions.” He folded his hands primly and rested his elbows on the table. “Start talking. Now.”
Maggie frowned. “Early on, I told you I only handle cancer patients. That’s because they’re the only ones capable of transference. You ever heard of that term?”
He shook his head, still stony in demeanor. She swirled a french fry in her shake and munched on it thoughtfully. “Are you a religious man, Ian?”
“What does that have to do—”
“Just humor me.”
“Then what do you believe happens when we die?”
He held up his hands. “I don’t know. No one does, not really.”
Maggie picked up another fry and dragged it around her plate. “Well, some believe in a Life That Comes After.”
“No. Maybe.” She popped the fry in her mouth. “All we know is that for some reason, cancer patients are the most likely to cross over. Something about the mutations cancer creates preparing the person for life in another phase.”
“That’s…” He shook his head. “You know how crazy that sounds.”
“I do. But I’ve seen too many cases to rationalize it away.” Her gaze flicked to his face. “Malcolm, too.”
Ian blinked rapidly, processing. “Are you saying the two of you…colluded to give cancer patients on hospice a different level of care to facilitate this transference bullshit?”
“It’s not bullshit.” She stabbed a french fry in his direction. “You haven’t seen it yet. But when you do, you’ll understand.”
His jaw tightened, and he looked away, then back at Maggie. “And the medicines?”
Maggie sighed and pushed her plate back. “Those who seem most likely to achieve transference get a slightly different mix of medicines.” She held up her hand before he could protest. “We still make them comfortable. But with additional medications mixed into the traditional comfort pack meds to provide transference support. We get them from a special pharmacy. The paperwork hadn’t been finalized yet when Malcolm was forced out. One of my cases was showing all the signs of transference and I had to…improvise.”
“The inquiry on your record.”
Maggie nodded. “Improper disposal of controlled substances I think is what they settled on.”
“How do you determine which patients are most likely to…” He waved his hand.
“People with the more aggressive forms of cancer or those who find out too late. They’re the ones less likely to have been subjected to massive rounds of chemotherapy in a bid to stave off the inevitable, which for whatever reason affects a person’s ability to transfer over.”
Maggie shook her head. “They’re other signs. Intense cases of terminal agitation suggest the stubbornness of the mind over a failing body. All those ‘classic’ signs of death? Vivid dreams and seeing people who aren’t there? We think the mind sometimes catches glimpses of that other plane, but the person is too far gone to articulate that in a way we can understand.”
“You keep saying ‘we’.”
“Well, I didn’t figure out all this myself. There are hundreds of us shepherds across the country.”
“Then how have I never…”
“It’s not easy to understand unless you experience it firsthand…” Even then, she’d found herself at a church study group looking for answers before Father Rodriguez took her aside and told her the truth of what she’d witnessed. “And you know how big the cancer treatment business is,” she continued. “Do you honestly think they’d get on board if their so-called treatments actually interfered with achieving a new plane of existence or the next rung on the evolutionary ladder?”
“But this changes…everything. If it’s true,” he added hastily.
Maggie shrugged. “I’m not a researcher. I’m just a hospice nurse who’s seen too much that cannot be explained.”
Ian sighed. “What am I supposed to do with all this, Maggie?”
“Take it on faith.” At his frown, she held up her hand. “Sorry, that was in poor taste. But I do need your support. I need you to give me the authority to handle the cancer cases that have the best shot at transference. If not…”
“You and this mystery organization you work for will take me out?”
Maggie pinched her nose. “Listen. I’ve given my whole life to hospice. I live out of my car—you’ve seen it. I have two cats at home because my schedule, my commitment to my patients, means I can’t take care of a dog. Friends?” She snorted. “As someone who shepherds the dead, I make people uncomfortable. Surely you’ve noticed that since you took the job.”
His frown deepened.
“I don’t do this lightly, Ian. I love being a nurse, but protecting The Life That Comes After is—”
Maggie’s work phone went off. She and Ian blinked down at it as it buzzed and flashed against the linoleum tabletop. She took a deep breath. “Hello?”
“Maggie?” Mr. Maccaulay’s daughter’s voice—Maggie would have recognized it anywhere. “My dad… He’s…”
Maggie met Ian’s eyes across the table. “We’re on our way.”
“So what’s the game plan?” Ian asked.
Maggie sped through a yellow light and made an aggressive left into the Maccaulay’s neighborhood.
“I’ll see to the daughter while you check on Mr. Maccaulay.”
“But what am I supposed to do?”
“Just…go to him, and I’ll be in as soon as I can.”
They parked in the driveway and briskly walked to the front door. The daughter had it open for them before they could knock.
“We’re so sorry for your loss,” Maggie said. “I have a few questions I have to ask you while my colleague checks in on your father.” She gave Ian a subtle nod, and he ducked into the quiet living room while she followed the daughter into the kitchen. “Are you here alone?”
Her face crumpled slightly. “Ben, my brother, locked himself into his room shortly after…”
“I see.” Maggie checked her watch. “You called twenty minutes ago. Was that immediately after he passed or just when you happened to check in on him?”
“No. I was there when…”
Maggie noted that in her netbook. “All right. We need to examine your father one last time for the record. Just sit tight, and we’ll be back in a few minutes, okay?”
The daughter gave her a helpless little nod and sat down.
In the living room, Ian hovered over Mr. Maccaulay’s bed uncertainly, but he was staring at the gentleman hard enough to peel back skin.
“Have you done the exam?” Maggie asked. They had to go through the motions of confirming the death even though Mr. Maccaulay’s stillness told her everything she needed to know.
Ian jumped and clutched his chest. “No, not yet. I thought…” He collected himself and shifted to the head of the bed. “Mr. Maccaulay, can you hear me?” No response. Ian took a deep breath and pushed open Mr. Maccaulay eyes, his penlight eliciting no response. “Mr. Maccaulay?” Ian checked his reflexes. Nothing. Finally, he took out his stethescope and placed it to Mr. Maccaulay’s chest.
Everything in Maggie tensed, from her muscles to her mind.
Ian’s brow furrowed as he listened, repositioning the scope, and listening some more. He fumbled for Mr. Maccaulay’s wrist, fingers searching out the pulse. The stethescope hung forgotten from his neck. “Maggie…”
“Shh. Look.” She pointed to Mr. Maccaulay’s mouth, parted slightly.
Something flashed between his teeth, golden and beckoning. Ian reached out as the light seemed to effervesce out of Mr. Maccalay’s pores. With a disbelieving look, Ian gathered the strands of energy flowing out of the corpse of Mr. Maccaulay. It merged together, pulsing against his hand like a small star. Then it dispersed outward like an explosion. Leaving a loss that was almost tangible, along with a tiny thread of hope that worked its way into Maggie’s DNA.
Ian must have felt it too as he looked at her wonderingly. “Is it always so beautiful?”
She nodded past the sudden lump in her throat. “Yes. Always. But I’d give anything to have my first time back.”
“When was it?”
“Rotation, children’s wing. Young girl with leukemia. I had been working double shifts for so long, I almost didn’t believe my eyes, but when the light touched me…” She shrugged and saw some of that raw longing on Ian’s face.
Maggie bit her lip. “You understand now? There’s no going back.”
“I understand.” He blinked a few times, then looked up at her. “I think we’ll be able to work something out.”
It would be enough.
Lauren C. Teffeau is a writer from New Mexico. Her short fiction can be found in a wide variety of speculative fiction magazines and anthologies. laurencteffeau.com