“God’s Providence”, a short story by Michael Fine

By Michael Fine

© Michael Fine 2019

This is a work of fiction. Names, characters, businesses, places, events, locales, and incidents are either the products of the author’s imagination or used in a fictitious manner. Any resemblance to actual persons, living or dead, or actual events is purely coincidental.

She came from money and was used to getting what she wanted, and most of what she wanted was to have a good time.  She wasn’t weird or kinky, nothing like that.  For Elizabeth, a good time meant shopping with a girlfriend, or walking into a dinner on Ev’s arm at the beautiful home of one of their beautiful friends, or getting tipsy on Prosecco as they hung around a fire after spending the day on the slopes at Vail or sat at an outside restaurant on the beach at Nantucket.  She loved those friends because they were so much like her that they could almost read her mind.  Of all her friends she loved Meredith best, because Meredith had what she had and knew what Elizabeth knew, as if they were sisters from another mother, which was what they sometimes called themselves, even if Meredith lacked Elizabeth’s depth and insight, and some of the drawing power in a room Elizabeth had.  Nothing matters more than knowing you are not alone, than knowing that how you see the world is how the world is, and that was what Meredith did for her: Meredith confirmed that everything Elizabeth believed was true because Meredith believed it too. When Meredith saw what Elizabeth saw and felt what Elizabeth felt, Elizabeth knew what she saw and felt was real.

Elizabeth also loved to be the center of attention, and she liked it most when she walked into a room and all eyes turned toward her, the men all wanting to be with her, consciously or unconsciously, and the women, all a bit jealous, seeing the eyes of the men, and then all determined to be her friend so their men wouldn’t ever dare, and so they themselves could learn how to do what Elizabeth did, and how to have what Elizabeth had.

Elizabeth was sixty, but you’d never know that unless you were close enough to see the crow’s feet around her eyes, or how the skin on her neck had loosened over time.  Her eyes still sparkled when she looked at you, which she did without any hesitation, taking in all of you at once, and holding nothing in herself back.  She was still thin and willowy, almost catlike.  The simmering fluidity of her body and her frank speech drove men, particularly tall men, to distraction, or, at least, once had.

These days men still looked but without abandon, although now Elizabeth also commanded respect.  Ev, who had left a wife and three children for Elizabeth twenty years ago, was still proud of how she looked and the attention she commanded when she entered a room, even if his interest in what she said and how she said it had flagged somewhat after twelve years of their own marriage.  She was childless – her own choice, a choice she had never doubted – but that meant Ev and Elizabeth had little to talk about, other than the passions and dramas of Elizabeth’s friends, the deals and connections made by Ev’s colleagues and buddies, and getting their calendars to match for social engagements and brief vacations or weekend trips to the beach house or to the mountains in the winter.

So, Elizabeth wasn’t surprised one weekend when Ev couldn’t join her in Boston for the symphony.  Meredith was in Vail that weekend, so Elizabeth decided to go alone, and spend the weekend walking and thinking.  It had been years since Elizabeth spent any time alone.  She was a little disappointed at first, because she loved walking into Symphony Hall with Ev, and attracting the attention of the other concert goers, many of whom Elizabeth knew or knew her.  She loved being that so elegant couple, so refined and well dressed, so confident and self-assured.  But it was also kind of a prison, looking like that, living up to so many other people’s expectations, and Elizabeth could imagine another life, a life where she was free to be who she wanted to be at the moment, free to live only for herself. She began to look forward to that weekend alone, to slipping into the concert free and unencumbered, as if she was a spy looking in on her own life.  It was a breath of fresh air, almost a vacation from what Elizabeth did and had to do every day, the first time in memory that she could make her own choices and be completely invisible.

The weekend itself was even better than Elizabeth imagined it would be.  She took Friday afternoon off from work, drove to the city, took a room at the Ritz Carlton, and ate dinner at 9 Park, a slow, sumptuous dinner of many tastes and too much excellent wine, bought by the glass.  She brought Anna Karenina to reread and read it slowly and carefully from a table in the window looking out on Boston Common, savoring each word.  In fact, a little snow began to fall, and it dusted the Common with unusual beauty, white snow against the dark night, the lights of the city twinkling in the background, with men and women dressed for winter bundled in overcoats, hats and scarves, hurrying across the Common, the warmth of their inner lives almost palpable as they walked together, eyes on the ground in front of them so they could maintain their footing, with their purpose – getting from place to place quickly, before they took a chill – clearly defined.  Elizabeth let herself get more than a little drunk, and took a cab back to the hotel, even though it was only three blocks away, and she enjoyed the image of herself, staggering out of the cab, immensely.

The next night, Elizabeth wore black pants, a black top, simple pearl earnings and a simple pearl necklace – and no makeup –to the Symphony, to hear Andris Nelsons conduct Bartok, Mozart and Ravel. She snuck into her seat at the last moment, just as the conductor was raising his baton, closed her eyes, and let herself dream with the music.  Something was changing in her life.  She missed Ev, to be sure, but she didn’t miss the formalism of their life, the way they did the same thing the same way, year in and year out, doing what worked once over and over the same way, as if they were owned by their past. Now Elizabeth felt strangely free, and at the same time she recognized with a start that Ev wasn’t really present anymore, that neither of them were present, that the life they had built shaped them and contained them, but neither of them were really alive within it.  Huh, she thought.  Fancy that.

Some weeks later, Elizabeth asked Ev about going to New York. Visit Ev’s daughter Abby in Brooklyn. Do the show at the Met and see a musical. Too busy now, Ev said, offhandedly.  And I don’t do musicals, remember.  But feel free to take the train down yourself.

I can do that, Elizabeth thought, and wondered for a moment about asking Meredith.  But what the hell, she thought, I’m better on my own.  She took the train down, met Abby for lunch, breezed through the Met and then took in the musical, all in one day.  She stayed over at The Algonquin, slept late and took a midafternoon train home.  Mission accomplished.

It was not the next week, or the week after that, but the third week that Meredith called and asked Elizabeth if she minded if Meredith dropped by for a drink after dinner. Come for dinner, Elizabeth said, and stay for a drink.  No, Meredith said, I’m tied up for dinner.  I’ll see you at eight.

Elizabeth was in the kitchen and Ev was reading in the living room when the doorbell rang.

“That’s Meredith, dropping by for a drink,” Elizabeth said.

“I’ll get the door,” Ev said. Elizabeth heard the door open before she had time to dry her hands, which was unusual, because Ev rarely even raised his eyes once he had settled into his club chair and began to read.

Then Meredith was in the kitchen.  She hugged Elizabeth and held on a little and lifted the glass of white wine Elizabeth poured her.

“Come and tell me things,” Elizabeth said, knowing the things Meredith had to tell were inconsequential, and led Meredith into the living room to sit.

Ev was standing near the couch.  Meredith went to stand next to him, leaving Elizabeth standing next to Ev’s club chair.  Elizabeth looked at Meredith and Ev, standing together, and understood everything in that instant.

“Let’s do this sitting down,” Elizabeth said, and sat on the edge of Ev’s chair. Ev and Meredith sat down on the couch together.

“How could you?” Elizabeth said. “But all that doesn’t matter now, does it?  Let’s figure out what comes next and in what order, and see if we can all come out on the other side with a little of our dignity intact, shall we?  Not that my dignity mattered much to either of you up until now.”

When it was done and she had moved into a beautiful condo in Providence overlooking the harbor and downtown, a place with a thousand amenities, Elizabeth took to her bed for a week.

There had been no rancor.  Ev paid for everything.  Moving was Elizabeth’s wish.  The house was just a place.  The marriage had been a stage, and illusion.  Better to start anew, start from the top, and leave the past behind.  Still, Elizabeth had wounds to nurse.  Truth be told, she had looked down on both of them.  Ev was good looking and had aged well, but there was no there there.  Elizabeth had been everything in the marriage, the decider and the decision maker.  It was her taste that chose and decorated the house, her initiative that made their calendar and took them to events, the theatre and openings, and her friends who made up their social life.  There would have been no marriage if not for Elizabeth, and truth be told, no relationship, although in retrospect, perhaps there had never been a marriage or relationship at all. Even so, losing Ev still smarted, just because Elizabeth had lost something she took to be hers.  But Meredith?  Meredith was just Elizabeth’s alter image, the Elizabeth reflection, the woman who had no original ideas of her own. She succeeded by talking like Elizabeth talked, by dressing like Elizabeth dressed, and by going where Elizabeth went.  And to think this woman, who Elizabeth trusted, would turn on her like that, could inveigle her way into Elizabeth’s home and Elizabeth’s life and then, while her back was turned, move into Elizabeth’s marriage, empty as it was? Talk about trust betrayed. This woman who Elizabeth didn’t really think very much of had just supplanted her. That was what hit Elizabeth hardest. There just wasn’t much to Meredith, and somehow, Meredith had come out on top. It made Elizabeth lose her faith in the natural order and justice in the world, in any kind of rationality or order in the universe, and made her feel unsafe, upended, as though there was no one she could trust and nothing she could love without fear of betrayal.

But after a week in bed in her new home, after a week binge watching empty television, Elizabeth dusted herself off, stood herself up and went back to living again with a vengeance.

Or at least that was what she told herself.  She started to take long walks, to explore Providence, this small city that she lived outside of but didn’t really know.  She took up yoga and got serious about having a weekly massage. She haunted day spas, libraries and bookstores.  She attended lectures at the university, had lunch at the Art Club, and made it known that she might consider an appointment to the Council on the Humanities under the right conditions.  True, single and married men weren’t falling all over her the way they once did, but Elizabeth was a woman of many abilities, and she was in no rush.  She’d be ready if and when the right man appeared.  If and when.  She made no apologies and planned to take no prisoners.

One day in the late spring, Elizabeth took herself to the ocean.  She brought a beach chair, a hat and a book.  I’ll walk out among the piers at Point Judith, she thought, to look at the fishing boats and charters, then drive over to Matunuck, take a long walk on the beach, and then sit and read, and then go over to the Oyster Bar for a glass of wine and something to eat, where the oysters are salty, fresh and sweet. 

I’m ready for an adventure, she thought.  A woman alone.  Intimidating to some, perhaps. And I’m not 22.  Or even 40. But there are fishermen on the boats, runners on the beach, college boys waiting on tables and parking cars, and the odd UPS man or plumber or carpenter driving about for work.  Oysters are an aphrodisiac, Elizabeth said to herself, so one must be careful.  Elizabeth knew that no oysters were needed to intensify what Elizabeth wanted, however unconscious and self-indulgent her feelings about the day were at that moment.  It was time for a small fling.

But there was no one around to take the bait.  Even so, it was a glorious day.  Elizabeth walked out on the piers.  Most of the fishing boats were out at sea.  There were a few overweight men in their sixties who were working on the pleasure boats that were tied to the dock, men in torn tee-shirts with thinning hair and potbellies who smoked and swore as they worked, as they sawed, hammered, and drilled.  The sun was bright and clean, and its heat had kicked up a gentle breeze from the shore so the air carried the sweet smells of pollens from all the trees that were in bloom, and that sweet smell mixed with cooking aromas from the clam shacks on the shores, the smell of deep fried fish and potatoes and stuffed clams, fishy and clean at once.  The boats sang as they came against the dock, lifted by wavelets and the lapping water, itself stirred by the wind.  And the colors of the day, the red pennants flapping in the wind, the orange life jackets stacked on the dock, the green and blue netting of the lobster traps, and the yellow and white signs of the clam shacks felt alive to Elizabeth as colors had never felt alive before. The hell with Ev and Meredith and all of her life before that moment, she thought.  So, what if no one much was around.  It was good to be alive, glorious to be there, and the hell with all the rest.

Then Elizabeth drove over to East Matunuck.  Surely there would be men working on restoring the beach, working to build a breakwater and a stone or concrete seawall to protect the thin slip of road and that little peninsula of beach town from the rising seas, the end product of the climate change Elizabeth kept reading about and had no reason to doubt, because she knew one could never underestimate the stupidity and greed of the human race.  There was hammering and nailing as people worked on their summer cottages and trailers, preparing the village for its summer inhabitants, people from Cranston and Worcester, Framingham, Woonsocket and Pawtucket, the children and grandchildren of millworkers, who all now worked in banks or in IT but kept coming to these cramped little cottages each summer, and there were pickup trucks parked on the street or driving back and forth on East Matunuck Road, but everyone was focused on their work or in a hurry, and no one noticed Elizabeth.

Still, the beauty of the day was overwhelming.  Elizabeth loved the weather-beaten shingles on the houses that lined the street, grey and strong against the sea and the wind, and she loved how the sea made the sand on the beach glisten, and she loved the rocks that stood out in the surf, the waves crashing over them, and the arch of the water thrown up by the waves, and the spray about the rocks, and she loved the way the sunlight bounced and was refracted by the spray and the mist when a wave hit the rocks, the colors of the rainbow and the churning of water, waves, wind and sun — the stuff of life itself.

The town beach was only a few blocks away; she drove over to it.  The beach was empty. She saw a few determined walkers, who were mostly women younger than Elizabeth and who looked like high school teachers, determined women with weathered tanned faces, wearing windbreakers and carrying small weights on each hand, walking quickly just above the waterline as if they had someplace they had to be in just a few minutes, as if they were counting their steps and needed to get to 10,000 before they hurried off to make dinner or to pick up a child or to stop in at the assisted living facility to check on Mom.  There was an old couple walking the beach, walking slowly as if lost, as if they had forgotten what their purpose in coming to the beach was, other than to meander, and a mother who was a woman of color in a beach chair, with children who played in the sand while their mother talked on a cell phone.  Elizabeth worried for a moment about why the children weren’t in school, and worried that the mother might be in some sort of trouble, until she saw a well-dressed man in his late thirties walk up to them quickly and speak to them in Spanish, in a way that suggested that they were tourists, visitors from another country who had come to be together in a place they felt to be exotic, and for a moment Elizabeth was ashamed about her unconscious judgment, and then she was glad to see that all was well, and that this was a family that was happy to be on holiday together. 

Elizabeth laid her folded beach chair and book on the ground.  She took her sandals off and curled her toes in the warm sand.  Then she began to walk near and in the water.

The sand was glorious, silky and warm, and embraced her feet as she walked, welcoming them.  The ground shifted a little with each step, so she had to concentrate on walking, to think about maintaining her balance and to throw her hands out to maintain that balance, but even that tiny struggle was good – it let her feel all the muscles of her thighs and her back, and feel the strength she still had, and to take a certain pleasure in the victory of being upright, something she never thought about as she went from place to place or idea to idea or even from passion to passion. The sea water was cool and bright in its way, a shock when it came up and flowed over her feet.  The water was far too cold to swim in, but still could wash away the lint between her toes, the crusty old skin from her ankles and any exhaustion Elizabeth carried from the changes of the winter and spring.  The cold of the water woke Elizabeth and let her feel every nook and cranny of her feet and her toes, the soles and even her calluses.  The waves erased her footsteps from behind her, so that every step was a step on new soil.  The waves compacted the sand and gave Elizabeth a smooth surface to walk on, a surface she loved after the struggle to keep her balance when she walked on the warm but shifting sand.  When her feet got too cold, she let herself drift back to the sand, which warmed and embraced her feet again.

She studied the seabirds as she walked, the plovers, scurrying along the sand, darting toward the sea when the waves receded and scurrying out of the way when the waves returned, pausing only long enough to peck at the beach, looking to capture something Elizabeth couldn’t see; or the gulls, which drifted on the sea winds, cawing as they flapped and twisted or suddenly dove at the water, fishing, their eyes scanning the surface and into the depths, aware of what Elizabeth didn’t know existed – or sometimes coming to rest on the beach, white and specked with brown, their yellow beaks proud and manly, the red crust of flesh at the top of the beak evidence of the power of blood that flows through the veins and arteries of living creatures, evidence that everything alive is connected just by being alive; the gulls sometimes resting, sometimes standing, their bodies pointed into the wind, ready to alight and flap away as soon as Elizabeth came near.

Then the sun started to set, the temperature dropped precipitously, and Elizabeth took herself to the Oyster Bar. The Oyster Bar sits on a salt pond.  They have surrounded their outside deck with plexiglass which shields you from the cold night breeze, and they have gas fired heaters on the deck, which allows you to be inside and outside at once, so you can see the sun setting over the lime green sea grasses, so you can sit outside and still be surrounded by the real life of the planet, and still be warm. 

Elizabeth sat at the bar itself with a glass of wine, savoring the moment, and ordered dinner.  You meet people when you eat dinner at a bar.  All kinds of people.

A couple sat at the bar together, watching the TV.  They were in their forties, the man trim with neatly cut graying hair, the woman blond with hair that was colorized, neatly made up and wearing a pearl necklace but still appeared relaxed. The man looked like a middle manager of some sort, perhaps at an insurance company — the woman was perhaps a real estate agent or a high school principal.

The Oyster Bar is a sophisticated place with valet parking that is crowded in the summer, where you might wait two or three hours for a table in season, and people come from Watch Hill and Weekapaug, summer people and weekend visitors, but generally not the people who stay at the little cottages near the beach, so you never know who you will run into there.

A man sat down.  He was old enough to know better but not too old, and well dressed, balding with a shaved head. He wore wire rimmed glasses, a dark tweed jacket and a grey vest.  He sat straight and had muscled shoulders. Stocky, as if he’d been in the military, but looked smart, so perhaps he now taught at URI or the Naval War College or even at Brown.  Interesting.  Possible. Perhaps all was not lost, that day.

The news came on the television. A story about the president, Russia and Syria.

“Make us great again, big boy,” the man who was part of the couple said, talking back to the television but loud enough that everyone at the bar could hear, his voice deep and tremulous as if he had had a little too much to drink.  “Not my president.”

“He’s everyone’s president,” the man alone, sitting to Elizabeth’s left, responded, talking right over Elizabeth, softly but firmly and loud enough so that the man who was part of the couple could hear him.

“Goddamn traitor.  Goddamn Russian spy,” the man who was part of the couple said.

“You don’t know the half of it,” the man alone said.

“Oh yeah? I know what I know,” the man who was part of the couple said, too drunk to understand that the man to Elizabeth’s left was agreeing with him.

The last thing Elizabeth needed was to be in the middle of a bar fight. The woman wearing pearls, who had been looking away and pretending not to know her partner now put her hand on that man’s shoulder.  And Elizabeth instinctively put her hand on the man alone’s forearm, and that man looked at Elizabeth for the first time, in the ancient language of men and women.

“He’s out of his mind,” she said quietly. 

And then Elizabeth felt herself swoon.  The room spun, and Elizabeth held onto the man’s forearm for balance.  She couldn’t see light, for an instant.  How curious, she thought. Just a single glass of wine. Something isn’t right.  And just as the day was looking up. But she caught herself before she fell over and straightened up.

“Not a problem,” the man alone said. 

And then he ordered dinner.

Elizabeth wondered if the man next to her noticed her swoon.  Got to get that checked out, she thought to herself.  Tomorrow.

They talked and he noticed her more then.

They left together. A night cap at my place.

But in the parking lot, waiting for the valet, Elizabeth felt herself swoon again.  She reached again for the arm of her new friend; whose name was James.

She heard voices and had a dim memory of flashing lights. And awoke under bright lights, wearing a hospital gown.

The diagnostic vortex.  The whirl of thoughts, ideas, threats, presumptive diagnoses based on testing.  Retesting.  More testing.  Second and third opinions. Late night consultations with friends of friends in distant cities. What is it?  What does it mean?  Why wasn’t it recognized before?  Can it be treated?  What is the treatment like?  Risks and benefits.  The world’s expert in….  US News and World Report’s best hospital.  NIH and clinical trials.  It happened more quickly than could be imagined, and it happened in a way that was agonizingly slow.

First it appeared that Elizabeth had mononucleosis, as strange as that sounds for someone who is sixty.  Then it appeared that Elizabeth had porphyria, a poetic sounding name for an obscure disease associated in history with werewolves, with people whose illness made it so they could only come out at night.  Then it appeared that Elizabeth had Hepatitis C, a condition that was treatable and had likely been contracted from an old lover, because Elizabeth did not and would never have injected drugs, but love opens you to the choices and foibles of all your lovers and their lovers and their lovers’ lovers.

Then there was a CT scan and a hurried phone call.  Please come by this afternoon — Dr. Strauss wants to talk to you today. 

And so, the drain opened. The water of the self-swirled around as the self-disappeared down the drain.  Tumors first, in the liver. Then cancer.  Of the liver.  The liver gone, replaced by tumor. No real hope.  People you know and trust, people you know and love who won’t look you in the eye. The self, shrinking, the picture on the TV shrinking to a dot as the power is turned off. The inescapable truth of a terminal illness, of death arriving on the shuteye flight from LA, of life vanishing in the blink of an eye.

You tell yourself stories as it’s happening.  This can’t be real.  They’re wrong.  They couldn’t find the lab test and I had to wait 90 minutes to see the doctor so clearly they are incompetent – they can’t know what they are talking about. I get different stories from everyone I talk to, Elizabeth thought they keep changing the diagnosis. First they say there is chemotherapy and we’ll start next week.  Then they talk about radiation, but then they drop that idea.  Then they start talking about new drugs that use antibodies.  Then they start talking about clinical trials and the NIH.

I just want to crawl into a hole, curl up and die, Elizabeth thought.  Do you know what it’s like to be stuck in traffic when you feel like crap, when your energy’s gone, and everything hurts, and you can barely hold your head up?  Know what it’s like to have to park a car and walk the distance of three football fields just to get in from the parking lot? I don’t want to spend every goddamn day in some doctor’s office, one doctor after the next, she thought.

And it takes a PhD just to remember what they’re all called and what they all do: gastroenterologist, hepatologist, hematologist-oncologist, radiation oncologist, surgical oncologist, pharmacologist, pain and palliative care specialist, psychiatrist.  Our team.  Right.  This isn’t Sunday and I’m not playing football. They want to make sure that I’m not depressed and that I’m coping.  I’m dying at 60.  Hello?  My husband just dumped me for my best friend. And now my liver has been eaten up by tumors which keep growing while you people argue amongst yourselves about what to do next. Nero fiddles.  Rome is in ashes on the ground. They have a whole crowd of social workers and nurses who want to feel my pain – now every emotion even has its own specialist. Could they please wait until I’m dead before they start dissecting me? 

James, the guy from the Oyster Bar, was nice enough and would have been fine for one night.  But he turned out to have a wife from whom he was “estranged” though they lived in the same house.  Separate bedrooms, he said.  No secrets.  All on the up and up, so called.  But he faded fast after the first little hospital sent her to Boston, as soon as the so-called experts in Providence started arguing with one another. 

It was the third or fourth week, when Elizabeth knew there was trouble but didn’t know which kind, before she talked to Ev, who called because he needed her signature on paperwork for the mortgage.  She didn’t want to tell him.  She didn’t want to give him the satisfaction.  But she backed into it anyway.  Hard to get to the lawyer’s office for the notary.  Kind of busy.  Having tests.  Blood tests and CT scans and MRIs.  They said porphyria and Hepatitis C.  But now they think there might be something in the liver.  She was waiting for an MRI appointment, which hadn’t been scheduled yet.  One doctor’s office needed to talk to another doctor’s office.  They needed some kind of permission for the health insurance company, who wasn’t calling back.  Something like that.

And Ev, despite their history and his guilt and his spinelessness, jumped in with both feet.  Ev was a pretty connected guy.  On boards.  The maker of deals.  So, he knew people who knew people.  And the guys at the top, the hospital CEO and the insurance company CEO, they would take his call.  Or they would take the call of one of his friends, who all knew how to make people sit up and listen.

So, they hopped to, those hospital people.  In five minutes Ev had them scheduling a conference just about Elizabeth, everyone in the same room, and they got the MRI done the same day, no questions asked.  How in hell, Elizabeth wondered, do regular people, the people who clean houses and fix boilers and drive pickup trucks, the beauticians and the plumbers and the grocery store clerks of the world cope with getting sick, when they have no Ev and no one to make phone calls to rich friends and throw their weight around?

And then Meredith was back.  She came to Elizabeth’s house one night at about eight, unannounced.  She carried a pot of beautiful white calla lilies and a bottle of very good Chardonnay, which got awkward when Elizabeth opened the door and Meredith tried to hug Elizabeth to comfort and forgive herself, but the flowers and bottle of wine got in the way.  Meredith was crying.  Meredith put the flowerpot and the bottle on the floor, and they both laughed, because of the clumsiness.  And then they both cried and held on to one another, despite everything.

In Elizabeth’s last days, it was Meredith who moved into Elizabeth’s house to be with her.  Ev came every day, and flitted from place to place, trying to be helpful.  But Meredith stayed the night and was there in the depths of the night when Elizabeth awoke from her medicated sleep, dreaming or hallucinating.  There was an aide from a home health agency who they hired to be there with them – three aides, actually, because they came in shifts, a woman from Liberia, a woman from Guatemala, and a woman from the Dominican Republic, and these women helped to the extent they could but were mostly silent, like ghosts, and came in an out to bring in something to drink, a little something to eat, to answer the door when visitors came, to help reposition Elizabeth in bed and to change the bed.  There was a hospice nurse, who came once a day with medications and to check vital signs, although Elizabeth didn’t see the purpose of the temperature and blood pressure taking – because it should be plenty obvious when she was dead after she died.  But she put up with it all graciously, understanding that these were the ways in which people showed their love, as inadequate as that love was, now.

Then quickly, mercifully, Elizabeth fell into a deep sleep, because her liver had failed and all sorts of drugs and toxins accumulated in her blood stream, recalibrating the chemistry of her brain.  Her chest moved in and out very slowly, as if whatever small mechanism drives breathing had stopped working, as if Elizabeth herself had left the room and kept forgetting to remember to breathe or to sit up and talk. Her lips pursed when she did draw a breath, as if she was taking air in through a straw or was getting ready to kiss someone, and her skin was moist and unnaturally pale.  The hair around her face was wet with sweat, but even so she appeared to be at peace – the skin of her face was relaxed and smooth.

She dreamed.  She dreamed first about being sick. About the doctors who had some kind of new drug, some kind of a new treatment, just ready to be released.  Some doctor Ev had found who is the world’s expert and who knows how to treat it.  She’ll go anywhere, Ev said – Houston, Stanford, Pittsburgh or Seattle or the NIH. But in her dream all Elizabeth wanted was for Ev to be quiet, to go away, to stop playing the hero.  In her dream she wanted to sit in a chair on a balcony in the warm spring sunshine, see the green leaves, the insects flitting in the sunlight and hear birds chirp and sing.

Then she dreamed about Ev and Meredith.  In her dream they were each on a different rudderless boat in a storm, under a cliff, the sky dark and filled with thunderclouds, the wind wild and the sea churning, in a rock-strewn channel, each boat tossed by the huge surf toward the rocky shore.  In that dream Elizabeth was on the coast, at the top of a lighthouse that was on a cliff high above the water.  The beam of light from the lighthouse would find each of them, from time to time, as they each put on a life vest and dove into the water, hoping to swim to shore.  Elizabeth saw herself throw a rope over one shoulder and then dive from the cliff into the cold sea, certain that all three of them would perish.  It was so sad to end this way, Elizabeth thought as she flew through the air, diving to her certain death.  Still, it had to be done.

But mostly Elizabeth dreamed of her day at the beach.  She smelled the stuffed quahogs and fresh fish frying in oil.  She saw the colors of the signs, flags and banners, so green, so red, so yellow and so blue, snapping in the wind.  She heard the hollow hulls of the boats coming against the mooring, the strange water sounds ascending, like bells of the earth and bells of the deep.  And she saw the sun setting over the beach, red and brilliant orange, purple and blue. 

Her life was imperfect.  She had lived and tried to love but mostly failed.  There would be no trace of her.  Still, the earth was a good place. Elizabeth loved life itself, and she was so grateful for having lived after all, and for the beauty of everything.  She had partaken of God’s Providence, and it was good, so good.

When her breathing stopped, as the little color there was drained from her cheeks, Ev closed her eyes and kissed her forehead.  Meredith hugged her and then Meredith and Ev hugged one another, not certain what to do or what to say to one another since that what had been given to them both had now been taken away.

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Michael Fine, MD is currently Health Policy Advisor to Mayor James Diossa of Central Falls, Rhode Island and Senior Population Health and Clinical Services Officer at Blackstone Valley Health Care, Inc. He is facilitating a partnership between the City and Blackstone to create the Central Falls Neighborhood Health Station, the US first attempt to build a population based primary care and public health collaboration that serves the entire population of a place.

He has also recently been named Health Liaison to the City of Pawtucket. Dr. Fine served in the Cabinet of Governor Lincoln Chafee as Director of the Rhode Island Department of Health from February of 2011 until March of 2015, overseeing a broad range of public health programs and services, overseeing 450 public health professionals and managing a budget of $110 million a year.

Dr. Fine’s career as both a family physician and manager in the field of healthcare has been devoted to healthcare reform and the care of under-served populations. Before his confirmation as Director of Health, Dr. Fine was the Medical Program Director at the Rhode Island Department of Corrections, overseeing a healthcare unit servicing nearly 20,000 people a year, with a staff of over 85 physicians, psychiatrists, mental health workers, nurses, and other health professionals.

He was a founder and Managing Director of HealthAccessRI, the nation’s first statewide organization making prepaid, reduced fee-for-service primary care available to people without employer-provided health insurance. Dr. Fine practiced for 16 years in urban Pawtucket, Rhode Island and rural Scituate, Rhode Island. He is the former Physician Operating Officer of Hillside Avenue Family and Community Medicine, the largest family practice in Rhode Island, and the former Physician-in-Chief of the Rhode Island and Miriam Hospitals’ Departments of Family and Community Medicine. He was co-chair of the Allied Advocacy Group for Integrated Primary Care.

He convened and facilitated the Primary Care Leadership Council, a statewide organization that represented 75 percent of Rhode Island’s primary care physicians and practices. He currently serves on the Boards of Crossroads Rhode Island, the state’s largest service organization for the homeless, the Lown Institute, the George Wiley Center, and RICARES. Dr. Fine founded the Scituate Health Alliance, a community-based, population-focused non-profit organization, which made Scituate the first community in the United States to provide primary medical and dental care to all town residents.

Dr. Fine is a past President of the Rhode Island Academy of Family Physicians and was an Open Society Institute/George Soros Fellow in Medicine as a Profession from 2000 to2002. He has served on a number of legislative committees for the Rhode Island General Assembly, has chaired the Primary Care Advisory Committee for the Rhode Island Department of Health, and sat on both the Urban Family Medicine Task Force of the American Academy of Family Physicians and the National Advisory Council to the National Health Services Corps.