By Claire O’Halloran
The distant hum of an approaching vehicle cuts through the quiet of Westmore, Vermont. It vibrates off the frozen midnight air, air that is charged and heavy with soon-to-fall snow, air that holds more promise than the mess of metal and wire in front of me. I toss the instruction manual onto my desk, happy for an excuse to stop reading. It is meant to be a camera. A “foolproof” gift from my son that will record outdoor wildlife while I sleep. I leave the pieces where they are and head to the front door.
—
When Liam Sabatini steps out of the Subaru, my first impression is that he looks young—younger than twenty-nine. It’s mostly his frame, which is boyish and not quite fully grown, much shorter than his dad’s. His upper body is lost within a lumpy gray crewneck that reads CORNELL across the front in scarlet block letters. An old-school college sweatshirt, the kind you might save and pass to your kids.
I walk toward him to help with his bags, taking careful steps to avoid the icy patches.
“Liam, welcome. I’m Dr. Mark Burns.”
“Hi, Dr. Burns,” he says. He has a deep, slow voice and a firm grip. “Thanks for waiting up, sorry about the delay.”
I wave it off. “How was the drive?”
“It was …” His hand rises to massage his jaw and cover a deep sigh, “long.”
An understatement. The drive from Hoboken, New Jersey took at least seven hours. I mapped the route before he left. Given the two empty coffee cups in his passenger seat and the circumstances of his visit, I’m sure it felt longer.
“And they aren’t big on streetlights up here? Or visible road signs?” He tries to say it casually, in polite conversation, but it comes across robotic and self-conscious.
“No, not quite.” I keep my own voice at a calm, well-practiced level that says you’re doing great. There are hardly even stop signs in Westmore. There’s no real need. The small town is dispersed among acres of protected forest. It is calm, quiet, and predictable. The perfect location for Oakbend Care, where I help terminally ill patients die comfortably.
“The township keeps things as natural as they can,” I paraphrase.
“Huh.”
You can hear the silence out here, the way it sits on top of all the empty land. While it echoes, I look for similarities between Liam and his father, John. None are immediate. From what I’ve gathered, the two are quite different. John Sabatini, the wise-ass retired Brattleboro cop, is asleep inside. He is here because of stage four lung cancer. He will die on Sunday.
Liam looks towards the sky and sighs. His breath hangs there. Everyone has a different idiom for it, the dying part. Pass peacefully. Enter their eternal rest. Go with God. John calls it his Calculated Croak. I prefer Die with Dignity. The opportunity to say goodbye on your own terms, before the hospital-admitting complications, with the right preparations, while you’re still you. The nuances are many, but that’s the core of it.
“Let’s head in and I’ll show you where you’re staying,” I say, and lead Liam towards the door. “There’s a fire inside.”
He observes the entryway with a touch of tired surprise. Although technically a medical facility, Oakbend Care holds no resemblance to a hospital. It is cabin-like, with high ceilings, a set of leather couches, and framed maps of nearby ski mountains on the walls. There is no space for beeping or flatlining here. There is no rumbling of cart wheels, running of footsteps, frantic piercing of needles, defibrillator shocks, suction tools, unanticipated yells. There is no “keep them out of here,” “call a crash cart,” “ready, clear,” “the treatment isn’t working,” or “I’m sorry, there was nothing else we could do.” Instead, there is a mutually agreed upon date. For some, a last prayer, or meditation, or reading. Then, a carefully administered final drink, taken when ready.
“Different than you expected?” I ask.
“Yeah, it’s … I guess it looks like some of the pictures on the website?” He scratches his head, which is full of the thick brown hair his dad has in old photos. “You live here too, right?”
“In the small guest house out back.”
“Full time?”
“For the past three years.”
“Does anyone else?”
“Not full time, no.”
For a moment I let Liam try and fill in my story, try to figure out how a sixty-something-year-old New York City oncologist ended up here, alone, in the middle of nowhere.
“A couple of nurses rotate in during the day. Other than that, it’s just me and the current patient or family.”
Liam’s eyes veer to my hands. Most people look for a ring. They assume a “mourning widower” scenario. When I mention Laurie, my ex-wife, they’re relieved to learn that it was just divorce.
“I have a son, close to your age, actually, but he’s based out in San Francisco.”
The answer ebbs Liam’s curiosity slightly. People feel better when they know I have a life outside of helping people die. I could give him more, about the history of Oakbend, about the history of Vermont’s Act 39 Medical Aid in Dying laws. I could tell him that I don’t hate my ex-wife, that we remained somewhat close, actually, if that makes him more comfortable. Or that I didn’t start this place alone, that I opened it with my friend, Dr. Zachary Wood, back when his own “terminal” still felt like a suggestion. But it’s cold, and it’s late, and this visit isn’t about me.
“Do you need anything?” I ask. “Dinner, water? Let’s sit for a second, if you don’t mind.” Liam nods in subconscious repetition.
“Water, please, would be great.”
I leave him and walk towards the kitchen. The tap stream runs cold and steady into the glass. That’s how things are meant to be in Westmore, cold and steady, but my hand shakes slightly as the water nears the top. I’ve never liked the initial meeting of the family, and this introduction feels particularly paternal. Greeting the family was Wood’s specialty. He was the guy that got people talking. New York patients, their relatives, little kids, store clerks, my son, Joey. People opened up to him. I still can’t get Joey talking the way Wood could. Not about his weekends, or the intricacies of his wife’s pregnancy. Not about the East Coast job offer he’s sitting on, the one that would bring him back home. These details are transmitted only through Laurie. I press down on the tap handle and the water cuts off.
Liam sits upright on the couch with his eyes fixed on the diminishing pile of red embers. His hands are occupied, they trade tight squeezes from palm to palm, so I place the water on the table between us.
“I’ll go over a couple things quickly.”
His body stays still except for the hands, and I can’t tell if he’s heard me. When he opens his mouth, it takes a second for the right words to come out.
“This place feels … really normal? For a place people come to die, I mean.” He turns to meet my gaze, his eyebrows furrowed in concentration. Most family members have visited Oakbend before the Passing Day, but for Liam, this is his first time. His attendance wasn’t in the original plan. “I assume that’s the point?” He picks up the water glass and holds it on his knee, rubbing his thumb up and down the side in a nervous tick.
John didn’t want any close family to see him at the end—especially his only son, with whom he’d spent the past three months mending a deeply fractured relationship. I don’t like the idea of him plugging this address into a GPS, John reasoned with me. Of him knowing how to get back here.
It could be that, maybe, but my guess is more likely the fear that when asked to be there, Liam might still say no.
“It’s a comfortable place to be,” I confirm.
It was Liam who changed John’s mind about doing it alone. He personally requested to join. As John told me the change of plans, it was one of the few moments, in all of this, when he struggled to get the words out.
“The Passing Day is still planned for Sunday,” I say.
February eighteenth. John and Liam chose the date together for a few reasons. Logistically, it allowed Liam to drive up from New Jersey after work on Friday. No need for him to waste any vacation on my account, John told me with a wheezy laugh.
“I’m not sure how much he’s shared with you, but tomorrow morning we’ll all meet and go through some specifics.”
The eighteenth also gave John the right number of days to finalize his will and sift through his lifetime of belongings. It is a careful balance, the timing. It must be early enough that the patient is still of sound mind when they make the decision to die, a calculated prediction that ensures the terminal illness hasn’t yet infiltrated their clarity of thought. John spent the past three days sorting through boxes of old documents. Earlier today he gave me a thick folder of chronological newspaper clippings, funny police reports, and black and white photos to give Liam once it was all over. His version of a memoir.
“The rest of the day will be just you two. He doesn’t have an appetite, but his energy levels are surprisingly good, considering.” Liam nods and keeps purposeful eye contact.
Lastly, and perhaps the most important reason they chose the eighteenth, was that one plus eight equals nine. Joe DiMaggio, number nine, one of the greatest of all time. It’s surprising what comforts people, especially in the end.
“How are you feeling?” I ask, catching us both slightly off guard.
“Fine—or, weird? I guess?” Liam places the water glass, still full, back on the table. “Kind of nervous. This doesn’t feel real at all, you know? More like I’m just visiting him, since it’s been a while.” His shoulders relax a bit as he fills the silence. I wait a moment. Waiting a moment is usually best. It’s the part I’m good at, and what made me and Wood a great team.
“This is stupid,” he continues, “but when I stopped home after work, before the drive, there was this moment of figuring out what to pack. What do you wear to go watch your dad die?”
He looks down at his sweatshirt, then back up with a tentative smile. It reveals a closer resemblance to John, the way his eyes soften and his cheeks bubble up.
“He gave me this over a decade ago, when I left to start college there, and all I thought about in the car ride here was how informal it is for a guy that spent his whole life in uniform.”
He leans back against the worn leather. I want to offer him a blanket, or the water, again, or a hand on the shoulder, but I stay where I am. “You wouldn’t have been the first person to ask me what to pack.”
We walk down the long, carpeted hallway to the guest suite, where the door opens with a shrill squeak. There isn’t much to explain. A simple bed stacked with blankets, an old dresser, a bare-bones kitchenette. The highlight is a loveseat by the window. Liam wouldn’t be able to see it now, but in the daytime, on a clearer day, it offers spectacular views of the ridged Vermont mountains.
We agree on ten a.m. tomorrow to sit with John and talk through the final details. “One more question, actually,” Liam says, as I turn to leave. He scratches his head and keeps his hand there. “Will I have to be in the room with him when it all happens? Or do most people do it privately?”
It’s a common question.
“That’s up to you and John. People go both ways. Depends on the person, their wishes, the family.”
“It feels like I should be there with him, but—” An exhale. A hand through the hair, again. “I know I asked to be here—want to be here. But we aren’t exactly …” He searches for the right word and settles on “close.” I try and arrange my face in a way that shows I understand, that Liam doesn’t have to explain it if he doesn’t want to, that John already shared with me hints of an earlier life riddled with mistakes, regret, alcoholism, the works.
“I just don’t know if I want to watch it.”
“You don’t have to decide tonight.”
Liam nods a few times, then walks over and extends his arm. “Thank you, Dr. Burns.” He shakes my hand, again, with purpose. I see the resemblance a second time, like I did with the smile. There is some John in there. The way his jaw clenches and his eyes slightly squint. The air of respect that comes with each handshake.
I close the door behind me and leave Liam alone for what I know, personally, will be a difficult night.
—
“What a day to be alive!” John says, with a wink, leading Liam into my office five minutes before our scheduled meeting.
“Jesus, Dad.”
John has worked that phrase into a conversation every day of his two-week stay. He leans heavy into humor and the maximum dose of painkillers in the final weeks. It’s nice, the laughs, a part of his personal brand I know I’ll miss.
“Looks like they were right about the snow, huh?” John nods towards the window. His voice is gravelly and thin, layered with the usual positivity and a fresh hint of nerves. There’s a new audience member now. “Good thing it didn’t come down last night.”
He looks comfortable, slumped back in the cushioned loveseat, ready to talk through the pre-Passing Day details of attendance and timing and ashes. Liam, though, finally looks his age, the lack of sleep sits fixed beneath his eyes.
“Yeah,” Liam says. “Good thing.” I follow their collective gaze behind me, through the window, where flakes stream down like rain. The whiteness of it casts a filter across their faces and brightens the office. It’s the most formal room of the house, a place that makes it clear there is business to be done and decisions to be made. “Eva said you had a nice morning together,” I lie.
Eva, the nurse, didn’t mention anything. I watched them through the window. They took a slow laborious lap around the property perimeter, bundled in coats and scarves, Liam holding John’s oxygen tank. I tried to see if their lips were moving, curious if they had as much to say in person as they did over the phone. The snow made it too hard to tell.
“Yes, yes, good to get some fresh air together. Quite the dramatic frozen sendoff for me, though,” John says, and I hope he means the weather.
I keep us on track: attendance.
“For tomorrow, John, it will be just the two of us in the room when you pass.”
“Yessir,” John responds. He informed me of his decision this morning. No discussion with his son required, his one final act of service. Liam looks relieved, his steaming mug hovering in midair between his lap and mouth.
“I’ll come to your room around seven a.m.,” I continue. Timing. “Liam, you’ll have the chance to go in before then for goodbyes. There’s no rush, you can take as long as you need.”
Liam takes a sip and winces as the burning liquid runs down his throat. There is tension in the room that is somewhat expected. The John I know— funny, honest, at peace—is a different John than the one Liam grew up with. I consider, for a second, if Liam feels like he’s saying goodbye to a stranger.
“The process looks different for everyone, but it will be painless, as you know, and takes only about thirty minutes to an hour once you drink the solution.”
“I’ve got a high tolerance, doc, so plan for an hour before you throw me in the box.”
“Dad.” Liam cuts, his voice sharp. “What’s with the joking?”
The room is still and fragile. John lets out a shallow sigh.
“Liam,” he says. “We’ve got to get through it somehow.”
“Right, so let’s do that. Let’s get through it.” Liam gestures towards me. “There just isn’t a lot of time here, is all,” he adds, quieter.
I feel the olive branch between them splinter with each silent second. My priority is the patient, always. Give them enough information, make sure they are comfortable, protect their last wishes, do everything I can to help them die with dignity. For a moment, though, I think about what this looks like to Liam. This new version of his dad answering my questions like we’re old friends. A sense of humor he’s never seen before, the anger he remembered gone. Of course, none of this would make sense to him.
John nods toward the camera still sitting on the corner of my desk. “What’s with the cords, doc?”
“Ah.” I pick it up, a distraction. “A Christmas gift from my son. Night camera. ‘Foolproof,’ apparently,” I say to John in exchange for a laugh. “It’s supposed to acquaint me with the local nocturnal wildlife.”
“Well Liam can probably help you, right?” John looks towards Liam, who is blushing slightly from his outburst. “He’s good at that type of stuff. Works in the tech biz.”
Liam opens his mouth, to correct him, probably, about his role at “the tech biz” being that of the in-house accountant, but he closes his lips and reaches for the camera instead. He fiddles with the hardware and plays with the buttons while I move on to the final order of business.
Ashes. I inform Liam he won’t have to worry about them, that they will be saved here so someone can pick them up, or we can arrange for them to be shipped. It’s efficient, the way we talk about it. Like we’re discussing the fireplace remains from last night. It seems to be how Liam and John speak most comfortably.
“Have you thought about where you’d like them spread, John?”
Liam turns the lens and studies the model details.
“Not yet, but I told Liam about the memorial Mikey is planning.”
Mikey is John’s best friend, the head of the Brattleboro Police Department. He dropped off John at Oakbend but didn’t come inside.
“It’ll be at the station on March fourth—my birthday,” he continues, the room at peace again. “One last party.”
“Great, I’ll get a keg,” Liam says sarcastically.
John’s eyes light up, moved by the vision of Liam in a room full of people, good people, who have reason to celebrate him.
“Now look who’s joking, eh? Good. And tell your mom not to feel bad, she doesn’t have to come—”
“She’d co—”
“—and make sure to invite Cousin Ricky or he’ll kill me.”
“Da—”
“You know what, I’ve got an idea, when Ricky gets drunk enough, tell him he can throw my ashes around as confetti.” He throws a fake hand of it in the air, blessing us all with the visual. “That’s how we can spread ’em.”
The invisible ash settles around us. Liam chokes slightly on a sip of coffee. John starts in on another one of his wheezy giggles. I tilt my face down to hide a smile.
Eventually, Liam does laugh. Once he starts, he can’t stop. The two of them feed off each other. They laugh so hard their faces turn red and tears squeeze out of their eyes, John with his head thrown backwards, practically choking, Liam bent forward with his hand covering his face. They keep sneaking glances at me, like kids in trouble, the knowledge they shouldn’t be laughing like gasoline on a fire.
It ends when John’s body is racked with a coughing fit that pulls the life from his eyes. Liam puts the camera on the desk and stands to offer help. He hands him the portable oxygen, his hands on John’s shoulder and forearm, protectively, until the hacks slow to a stop. As they catch their breath, I’m struck by how much older Liam looks when arched over his dad’s frail frame. I avert my gaze. The moment is private, a signal that we’re done here.
On their way out, Liam turns and points to the camera. “I think you actually had it set up right,” he says. “It might have something to do with the porch lights you leave on. This version only works when it’s fully dark.”
—
“What a morning to be alive, Mark,” John says, his eyes rimmed red, a soft smile on his lips.
And so, we begin.
A glass of water. A bed with pillows. Lots of them, with soft outer cases that are gentle against his fragile skin. Protocol. Simple instructions: the prescription must be ingested in its entirety. “Music?” “No, thank you.” Silence. Empty space. A police badge enclosed in his palm. Gold and green. Liam’s fresh fingerprints on the doorknob, his goodbye already complete. Snow falling through the window, still.
The solution. Next to the water. “There when you’re ready.” Final thoughts. Memories, maybe? Prayers? Replays? Joe DiMaggio’s fifty-sixth game of consecutive hits? Mikey. Liam. Fathers and sons.
Eventually, the glass. Not the water one. Heavy in frail hands. Tired Hands. Wrinkled hands. Hands with many lives. A couple re-dos.
Eventually, a grimace. “Disgusting,” he says, the liquid fresh on his lips. Greedy, gracious gulps. Bitter aftertaste. Medicinal. Not pleasant, so I’ve heard. “Thank you.” Settling in. Leaning back. Eyelids closed.
Inhale, exhale.
Time, slow moving.
Inhale, exhale.
Time, ephemeral.
Inhale, exhale.
Inhale, exhale.
At 7:23 a.m. on Sunday, February 18th, there is a split second too long of silence. A whispered puff of air without the next corresponding inhale, like the final flake of a heavy snowfall, landing softly somewhere, holding the invisible weight that it is the last of its kind, the end of something brief and complex and beautiful.
—
I breathe in and out. Rhythmic puffs of air crystallize in front of me when they meet the cold. The snow kept falling after Liam left, dropping three more inches of hard-packed powder on Oakbend’s nearby trail. Each step demands a purposeful puncture of the hardened top layer, a series of sharp cracks that cut through the early morning quiet. It makes the short hike feel impossible. My pace is slow and arduous, but tradition is tradition.
John Sabatini was a hard one. Medically, his experience wasn’t unique. Liam, though, was unexpected. After a gracious “thank you,” he left immediately, in that sweatshirt he arrived in. When he got home seven hours later it would look like nothing had changed. That can be the hardest part. Monday’s alarm still goes off, the clock on the wall keeps ticking, the kitchen faucet still has a leaky drip. When Wood finally passed, I had his family here to take care of, I had people to help and keep me busy. I worry about what Liam will do.
The wind whistles and I inhale Westmore’s signature scent: damp wood, freshly frozen ice, clean snow. The trees creak themselves awake around me, stretching their own limbs and shimmying off loose dustings of powder that glitter as they fall. When I first started Oakbend Care, the change of scenery and fresh mountain air had smacked me awake like a shot of epinephrine. It was so different from the stuffy congested sidewalks of the New York hospital, the windowless rooms on our Emergency Unit. Usually, this trail reminds me of that beginning, that sense of purpose. It feels labored today.
Joey was with me the first time we discovered this path, when we cleared the excess brush and snapped the branches in our way. He’d flown from California to help me move, had been equally impressed with the place and with my “old man” energy levels.
You walk like you’re on a time trial.
Save some energy, Dad, this house of yours needs more work than you think.
A bird calls somewhere and I stop to look for it. Above me, the spindly arms of beech trees fight for space, overlapping each other. Against the deep blue of the slowly brightening sky, it looks like they’re glowing.
I waited until Joey was in New York, on a work trip, to share the news about Oakbend. It was three and a half years ago. We talked over morning coffee at a diner outside the hospital, where the steam from our thick-handled mugs swirled in the empty space between us.
So, you’re going to help people die. Why haven’t I heard of this Act 39 before? he’d asked.
It’s new for Vermont, just became legal there.
And it’s your idea, but Wood is helping? Does mom know you’re moving yet?
The scratch of spatulas on griddles and the hollow clunk of ceramic plates filled the gaps of my insufficient answers. There is no protocol for telling your newly divorced but long-time-gone wife that you are moving to rural Vermont, that you bought a deteriorating fixer-upper you will transform into an end-of-life Medical Aid in Dying facility, that the first patient, the root of this all, is someone you both know. Someone Joey knows. Someone who is like family. Someone who is Wood. Eventually, I chose email. It’s how we’d politely communicated on divorce logistics for months. As transactional as a prescription. We saved text messages for sparser, more metaphorical correspondence—when I said things like, Noticed Angelina’s on York is closing in case you want to stop by, which meant, We had a good thing once and what a shame it couldn’t be resuscitated. I’m sorry for that. Did you hesitate at all before signing the Papers?
I answered Joey’s questions on Act 39. He seemed more concerned about the legality of it all than with my actual uprooting. When we left the diner, he still wasn’t convinced. Two weeks later he texted me a link to a new model of ergonomic snowshoes. A month later, when I used the word “terminal” in an update on Wood, he stopped asking questions and started asking if I needed help. Joey stayed for a full week the summer I moved in. The most time we’d spent just the two of us, with silence I wished I was better at filling. He’s visited only once since. When Wood died. Otherwise, the trip is too far.
The bird calls again, farther away this time, my signal to keep walking. I lean forward and push against the final incline, feel my sturdy boots make contact with the padded earth. I move quicker, still thinking of Joey. Thinking of the camera I need to hang up. Thinking about the photos it will take that I can share with him. Thinking of his East Coast job offer. Thinking of why he hasn’t told me about it yet, if it’s because he’s not sure he’ll take it, or because he’s not sure he wants to be back here, near his dad, who he thought would be done grieving by now, back from his stint alone in Vermont, but is still throwing himself so deeply into helping patients die that he’s forgotten to make time for anyone else. Beads of sweat cling to my bottom thermal layer and my throat burns with the exertion in the cold. I will hang the camera after the hike. I will see if it makes a difference when the lights are fully off for the night.
Head down, steady breaths, a hand on a tree when I need it. Then, a pocket of sunlight that signals I’ve arrived. I let out a deep exhale. This trail is a special occasion hike for good reason. Short, steep, and a little less than a mile in length, it culminates at a small clearing with an extraordinary view of Vermont’s Green Mountains, now draped in white. The clearing faces the sunrise head on, and on cloudless mornings it offers the type of breathtaking spectacle that catches in your chest. So private and delicate you must hold your breath to keep from disturbing the universe. Today, the orange sun rises clear and bright in apology for the previous days of gray.
This story originally appeared in Stonecoast Review Issue 20.
Photo by Mesh