My birthday twin died today. I knew almost nothing about him, except that he and I were born on the exact same date. We were the same age until around 11am this morning when I began to grow steadily older than him.
Every morning at the hospital where I work as a physical therapist, I check the electronic charts of the ICU patients in preparation for our daily rounds. Who has PT orders? Who should have PT orders but doesn’t? Several new patients moved into the ICU overnight; my birthday twin is one of them.
The first thing I see when I open his chart is his birthday—my birthday—in the upper left hand corner of the screen. His name is Sam (not his real name), and like many other patients in the hospital, he has pneumonia from COVID-19. I scroll down to his vital signs and shudder. Dangerously low blood pressure. Unsustainably high heart rate. Intubated, ventilator on the highest settings. I scroll back to the top and squint at the tiny picture in the corner—probably from the day he was admitted over a week ago. His face is round and pale, his short dark hair standing up a little on the left. His lips are pressed together in what strikes me first as defiance, but could be pain, fear, or something else altogether. I scribble a note on my list that he has no PT orders and close the chart, resisting the urge to read as much as I can about him.
***
It is November, 1978, a few minutes past midnight. My mother screams and I take my first wet breath and begin to wail. Outside of the delivery room’s fluorescent lights, it is snowing, and I am here, finally, after a nearly three-week wait past my due date. Somewhere, maybe at the exact same moment, Sam enters the world, and his first cries join mine.
I am eight months old, taking my first lurching steps to my mother’s exuberant applause. I am a year old, toddling around our small house. I cry when my mother leaves, stopping only when my exhausted father puts me in the swing and lets it rock me into a stupor.
I’m two and won’t stop talking. My mother pulls me to the library in a red wagon. When we return I insist she check the mailbox for my invitation to the ball. I am two and a half and my sister arrives, tiny, crying, sent to confuse me.
I’m three, starting preschool. I’m four and it is summer. My best friend, Wendy, and I sit on the front steps of my house eating popsicles, our lips stained purple and red. Her birthday is in May and mine isn’t until November, so this is the time of year when she’s older than me, which I don’t like. I want us to be the same age, always.
***
At 10am, we meet in the ICU for rounds. The doctor, pharmacist, charge nurse, dietician, social worker, chaplain, and I shuffle from one nurse to the next, clutching our lists, jotting quick notes about patients as the nurses update us. Sam, my birthday twin, is one of the last we hear about.
“Here we have a 42-year-old gentleman, admitted eight days ago to the medical floor, COVID positive, who came to us yesterday evening after developing respiratory distress and worsening kidney and liver failure. He was intubated, central line was placed, his pressures have been low, are still low, even maxed out on pressors.” While the nurse runs through her list, bouncing a little on the balls of her feet, I watch Sam through the large window of his room’s closed door. He looks so different from the tiny picture in his chart. He’s jaundiced, his face no longer pale but a surreal yellow, and swollen. His eyes are closed, the skin around them puffy, distorted. His lips fall open, slack, around the breathing tube, and there is no sign of the defiance I thought I glimpsed in his picture. Under my mask, I press my lips together in a weak attempt to summon some of his energy from a week ago.
“Thanks,” the doctor says, nodding to the nurse. He looks at his shoes, clicks his pen a couple times, then sighs. “I talked to his father and we’re going to transition to comfort care after rounds.” Around me, people murmur or nod in acknowledgement. Comfort care means withdrawing the breathing tube, the ventilator, all medications except ones specifically focused on relieving suffering. The doctor predicts he will survive no more than a few minutes after the breathing tube is out. Out of the corner of my eye, I see the social worker draw a line through his name on her list. It’s something I’ve done before, with other patients, consumed by my own workflow, but today the casual violence of that quick pen stroke catches me like a knife in my gut, and I want to take back every line I’ve drawn through someone else’s name on my list.
***
I am six and start public school. When I decide that I hate it and refuse to go, the school secretary drags me into class by my wrists as I cry and kick. I start to understand that there are some things I can’t control.
I am seven and I take gymnastics and swimming and every night I curl up next to my mother and she reads to me. We read all of Beverly Cleary, Louisa May Alcott, L.M. Montgomery. We read The Hobbit and Mrs. Frisby and the Rats of NIMH. We read and read and read, and it is here that I feel the most myself, deep inside the stories of others.
I am eight and at school we watch a film strip about train safety. I have nightmares for weeks, full of shrieking brakes and children with limbs severed from bodies. This world, I’m learning, has so many ways to hurt you.
***
Sam’s hair is short and dark, matted to his head with sweat. His room is dim. Blinds closed, lights off. On his monitor, glowing green, red, and yellow lines stretch across the screen like rows of jagged teeth. He is surrounded by equipment: a ventilator wheezing on his left, IV tubing stretching from his neck and forearms to IV poles, then extending like vines to the doorway and beyond to the many pumps just outside his room so the nurses can make adjustments without having to don all of the necessary protective gear. A catheter attached to a bag hanging at the foot of his bed collects the little urine he is still making. I wonder if, like me, he thought all of these machines would save him, even if he knew they might not be enough for someone twenty or thirty years older.
A different nurse is talking about the next patient, who is my father’s age and also dying, but we stay huddled outside Sam’s door. I try to focus on what the nurse is saying, but I keep stealing glances at Sam, trying not to cry. I want him to see sunlight one more time before he dies, or at least feel it on his skin. I wonder how he celebrated his 42nd birthday, if he had any idea it would be his last.
***
I am twelve and have my first kiss at a swim meet in between races. Two weeks later, the boy breaks up with me. Three weeks after that, the US goes to war in the Middle East. My friends and I obsess over whether the draft will be reinstated, whose brothers and fathers and cousins and friends will have to fight, how we will grieve if they don’t return.
I am thirteen and write stories about teenagers whose friends or siblings die in horrible accidents—falling from bridges, crushed in car accidents—or by suicide. I don’t realize until later that what I am really trying to write about is how to keep moving in a broken world.
***
Rounds end, and everyone moves away from Sam’s door. I linger for a moment watching his broad chest rise with each breath the ventilator delivers. I can’t remember if the doctor said any family would be coming. I wonder if he has a partner, or any children. I imagine him with a younger sister and a couple nephews like mine. I picture him as a fussy baby in his father’s arms, kicking and crying, until his father, like mine, wearily places him in the baby swing. The same father who, this morning, listened to the doctor’s dire update and made the impossible decision to make his son comfortable by letting him go.
I take one last look, his whole life unspooling in my mind—chubby baby Sam speed-crawling across brown shag carpet, dirt-smudged Sam traipsing through a damp creek bed, freshly-bathed Sam snuggling into his mother’s side as she reads about Bilbo Baggins trading riddles with Gollum, Sam in a Nirvana t-shirt making mixed tapes on his bedroom floor, Sam fidgeting in a suit before a job interview, Sam hoisting a giggling toddler onto his shoulders, Sam staring at a sea of cubicles and wondering what he’s doing with his life, Sam watching the world shut down, arguing with his parents about staying home, worrying what will happen to them if they catch this new virus. Sam—aching, feverish, coughing—begrudgingly coming to the hospital. I make myself turn and walk away, my steps slow and heavy as I head to my next patient.
Evelyn, thirty years older than Sam and me, with bright red fingernails and a framed picture of her dachshund on her bedside table, is here after her stomach ruptured, necessitating emergent abdominal surgery and causing a serious infection. The doctors expect her to recover, but now she’s too weak and in too much pain to move on her own, and I’m helping her rebuild her strength and mobility.
***
I am fifteen, heartbroken after my first serious boyfriend dumps me for an eighth-grader, when I hear Kurt Cobain’s suicide reported on MTV News. For weeks as I fall asleep, I imagine the heft of the gun in his hand, what he was thinking as he pulled the trigger, what I would be capable of if the pain of living became too much. I dream of bottles of pills, sharp blades, stepping in front of buses, but I always wake in that moment between decision and action, my frantic breaths reminding me that I’m alive, that I want to live.
I am sixteen and the girl I sat next to in English class the year before dies of meningitis. I spend months thinking of her empty desk in our old classroom, how strange it is that I am still here and she is not.
***
Evelyn and I stand three times. Her knees don’t buckle like they did yesterday. She takes a few shaky steps to a chair, leaning heavily on a walker, and her blood pressure remains steady. Afterwards, she presses my hand to her cheek and thanks me, tells me her dog, Peanut, is anxious to have her home. I smile, thinking of my own dog and his joyful full-body wag when I come home from work. I wonder if Sam has a dog longing for him to return, what’ll happen to the dog when he doesn’t. I tell Evelyn she’s getting closer, that I’ll see her tomorrow.
As I leave her room, I look at the monitor in the hall that shows the ICU patients’ vital signs. On Sam’s monitor, a flashing red zero. Asystole. No heartbeat.
***
I am twenty-seven, eighteen weeks pregnant with my first child, and my husband’s best friend’s wife is also pregnant, due twelve days before me. Early in our pregnancies we wonder if our babies could arrive on the same day. But her water breaks too early and she has to birth a baby she knows cannot survive. He weighs less than a pound and lives for eight minutes. Five months later, I give birth to a healthy baby girl. The nurse places her in my arms, and my daughter’s warmth and weight and breath seep into me. I start to laugh and cry—she’s real! She’s here! At the same time, the ghost of our friends’ baby, the one we’d hoped might arrive on the same day, settles like dead weight on my chest. I didn’t think it was possible to hold so much love, guilt, grief and relief at once.
I am thirty-six and a boy from high school who I avoided because someone said he liked me, even though he was always so nice, shows up on my patient list. He is dying of brain cancer, too slowly and too quickly at the same time. I put off seeing him until the end of the day, then run out of time. He goes home on hospice. I never see him again, but I read his obituary a few months later and wish I’d been brave enough to get to know him.
***
The nurse and CNA prepare Sam’s body and transport him to the morgue. A woman from environmental services comes to clean his room, to erase every trace of him in preparation for the next patient.
I can’t stop thinking, But he’s my age—exactly! As if this shared birthdate somehow grants me inside knowledge. In the void of his story, my assumptions run wild, filling the unknown with slightly altered versions of my own life. Scenes from his life—the imaginary life I’ve created for him—flash recklessly through my head, and I have to remind myself that I know almost nothing about him. I don’t where he was born or under what circumstances. I don’t know if he had any siblings, where he grew up, what hurt him, what brought him joy. I think of our shared age and want it to mean something. Something more than the reminder that people my age—our age—can die.
***
I am forty-two, and I come home from work dizzy with gratitude, heavy with guilt. I tell my nine-year-old son that my birthday twin died today. “We were exactly the same age,” I say. “Born the same month, day, year.”
“Wow,” he says. “I bet that feels weird, realizing that someone your age could die.” He looks at me closely, perhaps assessing my physical health, the likelihood of me dying anytime soon. “Like maybe it could’ve been you.”
“Yes, exactly,” I start to say, but he has already moved on, wrestling with the dog over a sock toy on the living room floor.
This year so many of the patients who died were my parents’ age, mid-60s, and, like my parents, independent and relatively healthy. I have lost patients who could easily have been my mother or father over and over. I lost my birthday twin, who could easily have been me. To have both of my parents still here and thriving, both of my children, my husband, myself, after a year of so much death, makes me almost sick with my luck, with the capriciousness of it all.
My son leaps to his feet, giggling, brandishing the sock toy over his head triumphantly. The dog bows, his tail a wagging blur, and barks once, then plops onto the floor and starts licking my son’s toes. I realize that Sam will never again sit in a living room filled with laughter and light, savoring the sun on his arms as he watches his son or daughter play tug-of-war with their goofy dog. I hope he experienced this, or something that gave him this feeling of abundance, at least once in his short life.
Before bed, I lean close to the mirror, elbows resting on the counter, and study my reflection. Sam’s face, jaundiced and swollen, flashes in my mind; I guiltily blink it away. I don’t want to think about him, because I can’t think of him without thinking of death, and myself, and my own death, whenever that may be. I imagine him studying himself in the mirror, maybe on the day he decided to go to the hospital. Did he see how fragile and temporary all of this is—the abundance, the pain, our faces, their reflections? I watch my forty-two-year-old face until my elbows ache against the counter and my face seems to float away in pieces like clouds on a windy day. On my last birthday, it occurred to me that I’d grown too old to die young. I see now that I was wrong.
Lindsay Rutherford is a hospital-based physical therapist and writer in the Seattle area. Her work has appeared in Literary Mama, Lunch Ticket, The MacGuffin, Mothers Always Write, and elsewhere, and has been nominated for a Pushcart Prize.