Monday, May 19, 2008

The End Stage

I think I told you that I took the kids to the airport. What I didn't tell you was that they put me in charge of the grandfish.

D said, "I think the Butterfly fish is sick. I don't know. He may die while we're gone."

I'll take good care of him, dear. Go and have a good time.

There are three fish in his modest tank, one more beautiful than the next, each with a different personality. Blenny, who hides in a rock lest Humah eat him, is skinny, about three inches long and half an inch wide. The anorexic model of tropical fish, Blenny resembles a long, flat, blueish-silvery worm, which is why he can escape into a rock. I'm very fond of him, as is Cham, his primary care-taker. Humah, the Picasso trigger, is virtually a person, he's so big, the Labrador retriever of fish (likes to be pet), or perhaps a pit bull, when hungry.

The Butterfly, delicate and quiet, has never really responded to me. We haven't particularly bonded.

Things looked pretty good there for awhile. I'd drive over, or walk over, once or twice a day and feed them. They were so happy to see me. Humah always acted as if he hadn't eaten in weeks. I felt like I was feeding that plant in The Little Shop of Horrors.
Feed Me.

But yesterday I got there late. I dropped in after lunch. After my lunch.

I'd skipped breakfast, pedaled to and from the office to see patients from 9-1:30 that Sunday. At home I grabbed a bite before running over to feed the fish. As I parked the car I thought,

I'm so glad they gave me this job. No one could love these fish more than me. We're developing that certain closeness. And yet, I should have come here before work, not after. They've got to be starving.

But Blue, my fish, manages on very little, like a certain minority of people I know.*

I took the stairs the short five flights, just because they're there, and my heart beat a little fast as the key to the apartment clicked in the tumbler. My head turned to the tank and immediately I sensed: Something's wrong.

I didn't see the Butterfly.

He's been murdered! I thought. Humah couldn't wait. He killed the Butterfly to eat him. The pig!

(You have to understand, says FD, these are essentially wild animals. Or was it my son, B who said this, the original family aquarist, the one who got us started with this fish nonsense. A good friend of mine, a psychiatrist, Michael, so impressed with how B,at that time a very little guy, took care of his fresh water fish, gave my son his huge salt water tank and all of the equipment, the filters, the pumps, even some fish I think, because he was upgrading to a better tank. Wild, indeed. Michael should have warned me of the heartache, being a mental health professional. He knew.)

And sure enough, as I watched the show, Humah pulls the butterfly out of a rock to show me the corpse. He drops the dead fish in front of me on the rocks as if to say, Either get him out of here, or he's lunch.

All kinds of thoughts run through my head. I killed him. I killed the Butterfly. I should have fed the fish first, before myself. I should fast. I can't be trusted with fish. Why oh why would I take on so much responsibility? They could have had someone else do this, someone who lived on their floor.

I composed myself. I had to arrange for the funeral, obviously. I called the father of the fish, expressed my condolences.

"I think I told you he was on his way out," D replied upon hearing the news. "Yeah, he was sick. Fish him out and if you don't mind, add some of that de-nitrate stuff to the tank."

"You don't sound upset."

"I expected this," he said.

"So you go out of town for a good time and leave me with a dying fish?"


"But he looked so good yesterday!" I cry.

He wasn't.

I fished him out with a net and dumped him into the toilet, wished him farewell. Then I returned to feed the other two. Before leaving the apartment I decided to check to see if the Butterfly made it to fishy heaven.


I flushed a second time. He wouldn't flush. He was clearly too big for this tank. Irony of ironies!

I got the net, fished him out and bagged him, took him with me. But where do you put a tropical fish? Where do you put a dead tropical fish in a Ziplock bag?

The trouble was, I was late. I had an appointment in a suburban office and this was Sunday and traffic impossible. I put the Ziplock on the floor in front of the passenger seat and headed north.

At work it's easy to forget my troubles. But after the appointment, as I'm about to start the car, something on the floor catches my eye. The dead Butterfly! I pick him up gently and throw him into a dumpster in the parking lot. Bye Bye.

That night, over dinner (we do not have fish) I tell FD everything, very embarrassed. Do I fast? It's my fault. Even if he was dying, I'm sure Humah either scared him to death or took a fatal imperceptible nibble out of him. If Humah hadn't been hungry. . .my voice trails off.

FD reassures me.
You took care of an end stage fish. It's not your fault. Have you any idea how many people drop off their parents to me, all in the last years of their life? As a family practitioner I'm prepared to care for them from cradle to grave, and I do, when they're my patients, established patients. It's the drop-offs that are hard to manage, when all I get is grave.

They send them to expensive specialists for the good years, and when it's finally time to give up, they choose me to become the pri-care. And more than half the time I review the care they've had and get upset, disgusted, or both.

It's called care-taking the terminally ill. And it's not fun. And it makes you worry constantly, caring for the terminally ill. You have no control, really, because the pathology is out of control and the patient is not going to get better no matter what you do.
I still feel badly, I say.

I know.


*Blue, my fish, will go 24 hours and not complain. Such a mentch. But I won't let him go that long, usually. He eats pretty well.


shrink on the couch said...

I revisited your previous post, and video, on Humah and Blenny and Blue. Is the Butterfly in that tank? I'm beginning to wonder if we aren't beginning to see why Humah's former owner gave him up so cheaply? Maybe he's a bully?

In any case, its sad to lose a fish, any fish, and especially under your watch. But I think your dh put it in perspective.

Isle Dance said...

Oh no. I'm sorry. Totally relatable.

therapydoc said...

Yeah, you know how it goes, here today, gone tomorrow.

It's really for the whole idea of the helplessness of End Stage that I wrote the post. I never cared much either way for the Butterfly :)

Anonymous said...

as I am sure FD has heard us joke in our family before:

we have a running joke in our house, when the paint dr gets to that stage, we hand him a scotch, time magazine, and a couch, and he goes out into the backyard till the end. we figure he won't know the diff anyway!

(for those who will be offended, i'm sorry, but our fams sense of humor is a bit out there. my dad just laughs, and says so what, the grandkids get the inheritance anyway!)

Anonymous said...

Interesting post. Much like the moments surrounding the time that we enter this world, the moments surrounding our departure send ripples throughout the universe, inspiring, painful, loving, tragic -- gazillions of possibilities. And it IS about not having control -- because, ultimately, we have so little control anyway. And when we have to give up that tiny bit of control, when it's time to "let go", how does it happen? Panic and fear? Grace and peace? Resignation? Fighting to the bitter end? I imagine that FD takes his role in that process seriously... which is why he makes the distinction between his own patients and the drop-offs, the people who end up in his care because they had nowhere else to go to "let go". For a doc who takes that part seriously, that's gotta feel yucky.

The fish analogy, esp a fish who ends up in a ziplock bag in a dumpster, didn't work so well for me. I'm sure there are families who respond to death as Humah did. And caregivers who feel responsible, as you did. Still, the analogy didn't work for me. Sorry.

therapydoc said...

Maybe it's an aquarist thing.

Anonymous said...

I think one thing you realize when you have enough fish for long enough is that, inevitably, they die. It was hard getting used to, and took some harboring of the SO calling my tank the "tank of death" before I realized that a couple years for a freshwater fish, for example, is a really long time. These are wild fish in a human-manufactured environment. :)

Don't feel bad. I'd love to see a pic of his tank, though! I'm thinking of moving into saltwater in a few years.

therapydoc said...

You don't look back.

Anonymous said...

Ouch. That is harsh. Having to take in a terminal fish, without being aware of that.

Having to witness the death not once (in the tank), not twice (in the toilet) yet three times. Involving a Ziplock bag.


I did enjoy the story and the analogy, however. Sometimes it is time to let go, whether we're ready or not.

And sometimes, after a while, there's a story attached that makes you smile. In retrospect.

Dee said...

My aquarium has been empty for 3 years largely because my husband just cannot deal with the frequency of death.

By the way did you wash that net after you fished him out of the toilet? Hmm

therapydoc said...


porcini66 said...

Just had to put my cat down after 13 wonderful years - keep telling myself that death is a part of life and that, as a pet owner, I have a responsibility to make sure that they don't suffer...still, there is grief and questions about the big picture. Most say, "It was justa cat". I know better.

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