The Night

Eleven Rooms

Chapter 16: The Night

The building changed at night. Not structurally -- the walls did not move, the ceiling did not lower, the floor did not shift -- but essentially, in the essence, in the quality of the space, the building becoming a different building when the sun went down and the east-facing windows held the darkness instead of the light and the corridors switched from day mode to night mode, the indirect fluorescent giving way to the amber LEDs at the base of the walls, the light dropping from the ceiling to the floor, from the reflected to the direct, from the general illumination that made the building visible to the specific illumination that made the building navigable, and the difference between visible and navigable was the difference between day and night in a hospice, the day being the time when the building was seen and the night being the time when the building was moved through, the seeing replaced by the moving, the eyes replaced by the feet, the visual architecture replaced by the tactile architecture, the architecture of surfaces felt rather than surfaces seen.

Thea worked nights. She worked the twelve-hour shift from seven in the evening to seven in the morning, the shift that most nurses avoided, the shift that was harder on the body, harder on the sleep schedule, harder on the social life, harder on everything except the nursing, because the nursing at night was better, was purer, was nursing reduced to its essential elements -- the patient, the nurse, the room, the dark -- and the reduction was what Thea valued, the stripping away of the daytime distractions, the visitors and the phone calls and the deliveries and the administrative tasks that the day shift required, the stripping that left nothing but the care, the care in its most concentrated form, the care that happened in the dark, in the quiet, in the hours when the building was navigated rather than seen.

She walked the corridors. She walked them every two hours during the night shift, the rounds that took her from one end of the building to the other, past every patient room, the walking systematic, the route the same every night, the same sequence of doors and rooms and the pausing at each door to listen, the listening the first assessment, the assessment that happened before the door was opened, the assessment by ear rather than by eye, and the ear told Thea things the eye could not -- the rate of the breathing, the regularity of the breathing, the depth of the breathing, the sounds that the breathing made as it passed through the airways that the disease was narrowing or the medication was relaxing, and the breathing was the night's language, the language the dying spoke in the dark, the language that Thea had learned to read over ten years and four hundred patients, the language that said: I am here, I am breathing, I am still in the process, the process continuing through the night, the process not pausing for darkness, the dying not pausing for darkness, the dying continuous, the dying the one thing that did not change when the building changed from day to night.

The cork floor held her footsteps. The cork absorbed the sound of her shoes -- soft-soled, the shoes of a night nurse, the shoes designed for the walking that the shift required, twelve hours of walking, of rounds, of the continuous circulation through the building that was the night nurse's practice -- and the absorption was the floor's gift to the night, the floor's contribution to the quiet, the quiet that the night required, the quiet that said: the building is here but the building is gentle, the building is walking softly, the building is respecting the sleep of the patients who can still sleep and the threshold state of the patients who cannot.

The threshold state. Thea had learned this term from a palliative care physician at a conference in Seattle, the term for the state between sleeping and waking that the dying occupied more and more frequently as the dying progressed, the state that was not sleep because the brain's electrical activity did not show the patterns of sleep, and not wakefulness because the brain's electrical activity did not show the patterns of wakefulness, but something else, a third state, a state that the physician had described as the brain's rehearsal for the permanent state, the brain practicing the absence that was coming, the brain dimming its lights the way the building dimmed its lights, incrementally, from the full illumination of the day to the amber navigation of the night, the brain transitioning from the seeing to the moving-through, from the visible to the navigable, and the transition was the threshold, and the threshold was where Lin was, more and more, the threshold state occupying more of Lin's hours, the waking hours contracting, the sleeping hours contracting, the threshold hours expanding to fill the space the others vacated.

Thea entered Room 6 at eleven o'clock. She opened the door slowly -- the hydraulic closer working in reverse, the door opening with the same four-second gentleness with which it closed, the opening quiet, the thirty-six inches of solid-core wood swinging on its hinges without sound, the hinges oiled, the mechanism maintained, the door performing its night function, which was to open without announcing, to admit the nurse without waking the patient.

The room was dark. Not entirely -- the bedside lamp was on, the warm amber LED at its lowest dimmer setting, the light a glow rather than an illumination, the glow sufficient for Thea to see Lin and the bed and the monitors and the IV stand and the four pillows and the blanket that was loosely draped across Lin's chest, the blanket's position telling Thea what she needed to know before she checked the monitors, the blanket saying: the patient is in the threshold state, the body is past the temperature regulation of the living, the body finding its own temperature, the blanket not gripped but draped, the hands not holding but resting, the fingers relaxed on the sheet.

She checked the monitors. She checked the oxygen saturation: ninety-one percent, lower than last week's ninety-four, the decline gradual, the numbers declining the way all numbers declined in the dying, slowly, incrementally, each number a step down a staircase that had no landing, no plateau, no place to rest, the numbers descending, and the descending was the process, and the process was the dying, and the dying was proceeding through the night with the patience of a thing that does not hurry, that does not rush, that takes its time because it has all the time, the time not running out but running down, like a clock, like a mechanism whose spring is unwinding, the energy dissipating, the oscillations slowing, the ticking quieter.

She adjusted the blanket. Not pulling it tighter -- Lin was past the stage of wanting the blanket tight, past the cold-and-frightened stage when the blanket was the defense against the cold that was the metaphor for the dying -- but smoothing it, straightening it, the adjustment a gesture of care that the patient might not feel but that the nurse performed anyway, the care not dependent on the patient's awareness of the care, the care its own justification, the care performed because the care was the thing, the care the nurse's practice, the care the reason Thea was in this room at eleven o'clock on a November night.

She stood at the foot of the bed. She read Lin. The three-second reading, the reading that took in everything -- the color, the breathing, the hands, the blanket, the jaw, the eyes -- and that produced the assessment, the assessment that said: the patient is in the threshold state, the patient is stable within the decline, the patient is proceeding through the night, the night holding the patient the way the day held the patient, with walls and ceiling and floor and the light from the bedside lamp, the room's holding unchanged by the darkness, the room holding in the dark the way it held in the light, because holding is structural, holding is in the walls, and the walls do not change when the light changes.

She left the room. She continued her rounds. She walked the corridor, the amber LEDs at her feet, the light pooling at the base of the walls, the pools of amber light like stepping stones in a garden path, the light leading her from one room to the next, and the leading was the night's navigation, the building guiding the nurse through its spaces the way a house guides its inhabitants through its rooms, by the familiar, by the known, by the repetition of the path that the body has memorized, and Thea's body had memorized Evergreen House the way a hand memorizes a keyboard, through repetition, through the daily -- nightly -- practice of walking the same corridors and opening the same doors and reading the same patients and adjusting the same pillows and checking the same monitors, the practice continuous, the practice the nursing.

Outside the building the Portland night was dark and wet. The November rain falling on the roof, the rain audible inside the building as a faint percussion, the sound of water on the roofing membrane, the sound muffled by the layers of insulation and the sheathing and the ceiling, the sound reduced to a whisper by the time it reached the patient rooms, the whisper the building's way of letting the patients know that the rain was there, that the weather was happening, that the world outside the building was continuing its processes while the world inside the building continued its own process, the rain falling and the dying dying and the two processes simultaneous, the two processes occupying the same night, the same November, the same city.

The night was the time when the dying did their deepest work. Thea knew this. She had seen it four hundred times -- the changes that happened in the dark, the transitions that occurred between midnight and dawn, the body's preference for the night as the time of its most significant adjustments, the breathing changing in the dark, the consciousness shifting in the dark, the hands opening in the dark, the threshold deepening in the dark, the body choosing the night for its most important decisions the way animals choose the night for their migrations, the night providing the cover, the privacy, the darkness that the body needed in order to do the thing it needed to do without the watching.

The watching was the day's practice. The families watched during the day. They sat in the visitor's chairs and they watched the patient and the watching was the vigil, was the love's expression, was the being-there that the families needed to perform and that the patient needed to receive, and the watching was good, was necessary, was the thing that the room's design supported -- the chairs positioned for watching, the light designed for watching, the proportions calculated for watching. But the night was not for watching. The night was for the patient's private work, the work of the body adjusting to the dying, the work that happened in the threshold state, the work that the building facilitated by dimming its lights and quieting its corridors and sending only the nurse, only Thea, only the professional watcher, the watcher who watched without watching, who read without staring, who assessed without imposing, who entered the room and gathered the information and adjusted the blanket and left, the visit brief, the visit professional, the visit the night's version of care, which was the care that gave the patient the privacy to do the work.

Thea completed her rounds. She returned to the nurse's station. She sat at the desk beneath the task light, the cone of white light on the charts and the paperwork and the computer screen, the desk an island of visibility in the amber navigability of the nighttime corridor, and she noted her observations -- the oxygen saturations, the breathing rates, the blanket positions, the hand positions, the assessments -- and the noting was the record, the record the evidence, the evidence the professional practice of the nurse who tracked the dying through the night, who followed the process through the dark hours, who maintained the vigilance that the building required, the building needing the nurse the way the nurse needed the building, the collaboration between the designed and the human, the building providing the conditions and the nurse providing the care, the conditions and the care together constituting the thing that the dying needed in the night, which was the holding, the quiet holding, the dark holding, the holding that did not watch but that was there, was present, was the warmth of the cork floor and the glow of the amber LEDs and the soft-soled footsteps of the nurse who walked the corridors every two hours and who entered the rooms and read the patients and adjusted the blankets and checked the monitors and left, quietly, gently, the door closing on its four-second closer, the closing the last sound, the sound absorbed by the cork, the cork holding the sound the way it held the footsteps, quietly, warmly, the building and the nurse and the night holding the dying, the holding enough, the holding the architecture of the hours when the light was gone and the dark was the condition and the condition was the thing the building was designed for, the thing the building did, the holding, the holding in the dark.