The Knot

The Knot

Tracy pulled, worked and wormed her nimble fingers through the tightly knotted material until, finally, it loosened and unraveled, spreading meekly into a circular kaleidoscope of wrinkles beneath her hand. There were, Tracy knew, a number of superstitions surrounding a nursing staff. Most of them, well, she could understand. Deaths coming in threes. Opening doors and windows of a deceased resident’s room to let their spirit out. But the one Tracy Shepherd had the least patience with was tying a resident to the earth; tying a knot in the bed sheets to keep a resident from dying. It couldn’t be comfortable, having a big knot in your sheets, and the one that she had just struggled with had been so tight it had restricted Mr. Malone’s movements.

“There, Mr. Malone,” she said, turning her gaze to the sullen, aged face of the resident. “That’s better, isn’t it?”

The old man did not reply, but glared at the young woman with unwarranted dislike. Tracy didn’t take offense at this; age had not treated him kindly. She doubted very much if she would be jovial, if their positions were reversed.

Most of the people that she cared for could remember her face from one day to the next. There were some that greeted her with wrinkled smiles, some knowing her, some only thinking of her as a half-remembered friend from a long-forgotten past. But many seemed as oblivious to her as they were to the other CNAs, whose ceaseless ministrations could only keep them so dry, so warm, and so clean.

These were the ones that haunted her. They were souls held captive in prisons of flesh and blood and bone. Their bodies had become lockdown, their minds solitary confinement. They were handled with such care, so as to avoid ripping their fragile, papery skin, fed pureed food that they could neither smell nor taste, and tucked quietly back into their beds, to be turned every so often to prevent bedsores.

Despite this, Tracy truly enjoyed her work. It gave her a soothing kind of satisfaction to provide those poor souls with some measure of comfort, no matter how small. And no matter whether she believed the stories or not, she had no intention of “tying” someone to the earth, especially someone that seemed desperate to escape it.

“Hey, Trace,” said Shelly Watts, Tracy’s long-time CNA partner, as she came into the room. “Margaret wants us... Hey, what are you doing?”

“Someone from last shift tied a knot in the sheet,” Tracy replied. “Again.”

“And you’re untying it? Are you sure that’s a good idea? I mean, I really don’t want anyone passing on my shift.”

“Shelly, don’t be such a twit,” Tracy said, rolling her eyes. She turned to look at her partner. “Even if you do believe in that stuff, why would you try to keep someone alive when they’re in such misery?”

Shelly looked uncomfortable. “Fine, untie it. But you’ll be the one taking care of Mr. Malone if he dies. Not me.”

“I don’t mind,” Tracy said. “If it makes you that uncomfortable, maybe you should think about another line of work, though.”

Shelly shrugged. “To me this is a job, not a career.”

“What did Margaret want?” Tracy asked, smoothing the sheets back over a glaring Mr. Malone.

“She’s ready to give report.”

Tracy nodded, and followed Shelly down A hall to the nurse’s station fixed at the junction of A, B and C. Margaret Johnson, a charge nurse for the evening shift, sat behind the long counter looking over a chart.

“Well, guys,” she said, as everyone approached. “It looks like we actually have a full staff tonight, so I want Tracy and Shelly on A, Cammy and Jane on B, and Jeffrey on C, Char and Kathy on showers and hospitality.

“Sara’s not feeling well tonight, so she’ll want a room tray, and probably to go to bed early, so keep that in mind Cammy and Jane. Richard’s rash is much better today, good job guys. Keep gooping it up and it’ll be gone in no time.

“Sammy didn’t eat much for lunch, so whoever feeds him tonight, try to get him to eat a good supper. He may be coming down with something, so that’s something to watch out for. No skin tears, no C-dif, no falls, looks like they had a pretty uneventful day. The only other thing I need to talk to you about is Mr. Malone.” Margaret looked around at the CNAs and Jacob, the CMT. “It looks like he’s worse, his doctor expects him to go anytime. So keep checking on him every so often.”

“So it’s a death watch,” Jane said. She looked at Shelly and Tracy. “You’re hall’s going to be fun tonight.”

Shelly flipped a lock of honey blond hair out of her face and threw Tracy a filthy look. “When is there not a death watch?”

Margaret gave Shelly a warning look. “That’s enough. You know how it works, it could be tonight, it could be in a day or a week. He could pull through it completely and outlive us all. Regardless of what happens or when it does, I expect you to do your jobs.

“Okay, that’s it. Don’t forget the books, record your BMs, and all that good stuff. I don’t care who does it as long as it gets done. You know what happens when the CMTs don’t see a BM recorded for a while. No one wants to see the place get milk of magged.” A shudder went through the CNAs gathered around the nurse’s station at the thought. “I want hospitality to go ahead and pass water and ice, and everyone else checking the pants on the residents that are up. Tracy, I need your help with Mr. Simmons, his feeding tube needs changed.”

Everyone went off to their tasks and Tracy followed Margaret down A hall to Mr. Simmons room.

“What’s up with you and Shelly?” She asked.

“Nothing, really,” Tracy replied. “Just a difference in opinion.”

“Do I need to separate you two?” Margaret asked. “I need my staff to be able to work together. If they can’t, then everything goes to hell and the residents are the ones to suffer.”

“No, it’s nothing like that,” Tracy replied. “I just found a knot tied in Mr. Malone’s sheets, and Shelly didn’t want me to untie it. I agreed to take care of him if he goes, though, so I don’t think there’s a problem.”

“Ah,” Margaret said. “I see.”

“Yeah, well, I don’t,” Tracy said. “I don’t understand what the big deal is. I mean, sometimes residents die. It’s happens, it’s inevitable. But, there’s always a knot in Mr. Malone’s sheets. Even before he got this bad. I’ve seen residents get much worse, and no knot.”

“Well, to understand,” Margaret said. “You’d have to have known him before he ended up this way.”

“I take it he wasn’t a real nice guy, then.”

“That’s one way to put it,” Margaret said. She sighed, and stopped just outside of Mr. Simmons door. “The fact is, he scared the shit out of everyone. He wasn’t like, an annoyance. The staff didn’t get irritated by him, or feel sorry for him. He was hated.” She leaned closer. “He was feared.”

Tracy stared at her charge nurse in shock. “You mean that he was what? Like, combative or something.”

“Look,” Margaret said. “It’s hard to explain. Let’s just say that there was something strange about the man.”

“I’m sorry,” Tracy said. “I just don’t understand.”

“I know, and I’m sorry,” Margaret replied. “I wish I could explain it to you.”

“We’d better get in to change that feeding tube,” Tracy said, with a stiff smile.

Perhaps Margaret realized that her CNA was questioning, not only her judgment, but her very sanity, because she reached out and touched Tracy’s arm.

“What it really comes down to is, do you believe in good and evil?”

Tracy blinked. “I guess so.”

“I mean evil like Satan is evil, like serial killers are evil.”

“What are you trying to say? Mr. Malone is like a serial killer?”

“No,” Margaret said. “I mean Mr. Malone is like Satan.”

Tracy blinked and dropped her gaze. “We really need to change that tube.”

Margaret smiled. “You don’t believe me, but it’s true.”

Without another word, Margaret turned and marched inside Mr. Simmons room.

Tracy assisted Margaret without comment, then went to help the rest of the staff as they all went about the business of making sure the residents were as clean and dry and comfortable as they could get, and then as well-fed as they cared to be.

“Excuse me, miss,” said Ethel, as Tracy wheeled her to her room after dinner. “My father’s supposed to pick me up right after the dance. Could you tell him where to find me?”

“Sure, Ethel,” Tracy said. “I’ll tell him.”

“You’re such a sweet lady,” Ethel said, smiling. “And so pretty.”

“Thank you, Ethel,” Tracy said, her lips twitching upward in a smile.

“I hope I’m pretty like you when I’m all grown up.”

Tracy didn’t even attempt to tell Ethel that she had grown up, and grown old, a long time ago. Strictly speaking, they were supposed to bring the residents back to reality when they regressed, but Ethel lived in a constant state of regression, and it only frighten her when the staff insisted that she was an old woman, with grown children and grandchildren. Instead, Tracy just helped the arthritic woman back into bed and smoothed her hair back. “You’re very pretty now, Ethel.”

The elderly woman giggled, sounding for all the world like the child she thought herself to be, before assuming a worried expression. “Where’s Sarah?”

“Oh, Ethel,” Tracy said. “Did you lose your doll again?”

“I can’t find her anywhere,” Ethel said, with an anxious look on her face.

“Don’t worry, honey,” Tracy said with a sigh. “We’ll find her.”

She met Shelly outside Ethel’s room. “That’s everyone,” Shelly said, grinning. “Let’s take our dinner break.”

“Might as well,” Tracy said. “Ethel lost the doll her daughter got her for Christmas. You know what that means.”

“Damn,” Shelly groaned. “We’ll be chasing her all over A hall, even if we do find it.”

“We’ll just have to try and keep an eye on her. She’s down right now, she usually doesn’t get back up and wander around for at least an hour after she goes down the first time.”

“Then we’ll have time for dinner and maybe first bed checks. Let’s go.”

They had started down the hall when Tracy thought that she had seen a shadow move in room A12, Mr. Malone’s room. “You go on ahead,” she said. “I just want to check something.”

“All right,” Shelly said. “I’ll be waiting, so don’t be long.”

“I won’t,” she promised.

Tracy waited until Shelly got down the hall a little before turning and entering Mr. Malone’s room. He was laying in his bed, glaring at the ceiling. When he saw Tracy he began to babble incoherently, gesturing wildly with his gnarled, arthritically twisted hands, spittle flying from his thin lips.

“It’s alright,” Tracy said, looking around. She didn’t see anything. “I’m just checking on you, that’s all.”

Instead of calming him, it only seemed to agitate him more. Seeing no sign of the shadow that had drawn her attention, she decided it was a trick of the lights combined with a powerful dose of imagination. Holding up her hands in a placating gesture, she backed out of the room, leaving Mr. Malone in the cold comfort of his solitude.

“You shouldn’t be in there alone,” Shelly said from behind her, causing her to start violently.

“My God,” she breathed, turning. “You scared the hell out of me.”

“You should be more scared,” Shelly said. “You just don’t realize it yet.”

She turned and walked down the hall so fast, Tracy had to jog along just to keep up.

“Don’t you think you’re overreacting just a little bit?”

“No,” Shelly said. “And neither would you if you knew half the things I do.”

They walked into the break room together. “So, tell me about it,” Tracy said.

Shelly stalked across the elongated room to the pack of menthols she had left on one of the tables. “Sometimes you work in a place like this and you get attached to the sweet ones like Ethel, or the clowns like Old Joe. They make it a pleasure to come to work. Then sometimes you have to take care of the ones that pinch and pull your hair, or even clock you in the face. They make coming to work a pain. But we put up with them, we take care of them, and we try not to blame them for their actions because they’re old and we know, really, that they’re not in their right minds.” Shelly took a long pull from her cigarette and blew the smoke out. “But every great once in a while, you might come across one like Mr. Malone.”

Tracy shook her head. “Everyone keeps hinting at some great nasty secret, but no one has come right out and said what’s really on their minds. If you want to tell me what’s up, do it. Otherwise, there’s no point in beating around the bush.”

“Fine,” Shelly said, stubbing out her cigarette. “He can do things, really bad things. Things that people shouldn’t be able to do.” She held up a hand as Tracy opened her mouth. “I know how it sounds. I just don’t care. I know what I’ve seen. I know that residents that have gone off into his room and come out different. There was a girl that worked here about a year ago, before Mr. Malone lost his ability to speak. Me and her were partnered up a lot. We were friends. His call light went off one night and she took it. Alone. We still don’t know what the hell happened to her.”

Tracy gave her partner a startled look. “What do you mean?”

“She never came back. Her car never moved. She didn’t return for her last check. She just disappeared. She went into that room to answer a call light and no one has seen her since.”

“That doesn’t make any sense,” Tracy said, after a long moment. “Even if she did disappear, then it just seems obvious to me that someone other than the frail old man in that bed was responsible.”

“Yeah,” Shelly said, her voice dripping with scorn. “That’s what the cops said. But the rest of us here know better. She’s the only one that ever disappeared, but I’ve seen residents and staffers go into that room with him alone and come out tainted. Some come out like my uncle Jeffery, the ’Nam vet, spooked like they’ve seen things they can’t unsee. Some come out so quiet, they seem to have a foot in the grave. There was one that came out and went home to kill his wife. The cops ended up shooting him. To you, it might sound crazy, but I’ve seen shadows move in that old man’s eyes that terrify me down to my bones.”

Tracy dropped her gaze. “It sounds like this is a more exciting town than I would have thought.”

Shelly lit another cigarette and pulled deeply on it as though the smoke that filled her lungs might wash away some of the terror that stained her soul. “You have no idea.”

A steady beeping of a call light went off, and Tracy jumped to her feet. “No, you finish your cigarette,” she said. “I’ll get it.”

A glance at the nurse’s station told her that it was, indeed, Ethel’s room, just as she had suspected. She walked briskly down the hall and tapped on the door frame as she went inside, but, finding the bed empty, she stopped in confusion. She flipped off the call light and looked around the room and found Ethel hiding in one of the corners, her face a mask of terror.

She slowly approached the cowering woman and knelt down beside her. “What’s the matter, honey?”

When Ethel didn’t respond to Tracy’s coaxing voice, the first waves of panic began to wash over her. She took the old woman’s hands and helped her to her feet. She moved compliantly, but her expression did not change. Tracy helped her into bed and tried to talk to her in soft, soothing tones. When that didn’t do any good, she tried waving a hand in front of her face. Her eyes remained unmoving, staring straight ahead as though there she was watching a terrible scene unfold there.

Trying to set aside the fear she felt for the old woman, Tracy reached over and flipped the call light back on. In moments Margaret strode into the room with quick, competent steps. She took one look at Tracy’s face and asked, “what’s wrong?”

Tracy motioned toward Ethel, whose expression had not changed from the time she had found her.

“I answered her call light and found her hiding in the corner. She hasn’t spoken a word since I came in and she acts like she can’t hear me or even see me.”

Margaret’s lips pursed as she walked over to the resident and sat gently on the bed next to her. “Ethel,” she said, moving her finger in front of her face. “Can you hear me? Can you tell me what’s the matter?”

Tracy picked up Ethel’s fragile hand and rested her index finger against the blue-hued veins there. She counted out a strong, steady pulse along with the ticking second hand of the clock that hung on the wall.

“Her pulse is normal,” Tracy said, resting a hand on Ethel’s back to help her keep time with her respirations. After another minute, Tracy shook her head, “Her breathing is normal, too.”

“I’ll check her blood pressure, but I doubt we’ll find anything different there, either,” Margaret said. “Has she acted any different than normal this evening?”

Tracy shook her head again. “She lost her doll again, but she hadn’t been out wandering the halls yet, as far as we can tell.”

Margaret looked at her sharply. “As far as you can tell,” she said.

Tracy’s eyes narrowed. “Don’t start that. There’s no way you can blame this on him.”

“Believe what you want,” Margaret said. “But similar things have happened in the past, and the residents never recover.”

Tracy opened her mouth to reply, but what she might have said was lost in a loud keening sound that caused her to jerk her gaze to the elderly woman reclined on the bed. The expression on her face was still the same, and she was crying out in heart-wrenching terror. Tracy wrapped her arms around her and hugged her close.

“It’s okay, Ethel,” she whispered against the woman’s wispy, white hair. “We’re right here.”

Margaret stared at them with sad eyes for a moment, then stood up. “I’ll go get the blood pressure cuff. I’ll be right back.”

Tracy watched her go and was torn between going after her and comforting the woman in her arms. Ethel had been her favorite from the time she had started working at the retirement home and she couldn’t bring herself to leave the woman when she so obviously needed someone to take care of her. After a long while, Ethel’s whimpering cries ceased and Tracy looked down to see that her fragile eyelids had closed and her breathing seemed deep and even, though she still wore a frightened look and her frail muscles tensed periodically.

Tracy eased the old woman onto the soft bed and raised the guardrails, making sure the call button was within easy reach, and went in search of the charge nurse. She stepped out into the hallway and paused to see a dark figure move, with sure, professional steps, out of a room just down the hall to the left, and walk in the direction of the nurse’s station away from her. She knew without having to take a closer look that it was Margaret, and that she was leaving Mr. Malone’s room. She hesitated in the doorway for just a moment before drifting silently down the hallway and through Mr. Malone’s open door.

The old man lay in his bed, eyes open, his breathing labored, his face gone an ugly purple. Tracy rushed to his bedside and looked closely at what she was sure was a dying man. At first, she thought that Margaret must have certainly killed him, using her medical expertise. Then she saw the knot, and she knew. It wasn’t that she had tried to kill him. She was making him live, against his will, against nature itself, and in that moment, all of her doubts melted away into absolute belief. The pain and pleading in his eyes made her heart ache. She never could stand to see such suffering, not when it was in her power to relieve it.

She reached down and grasped the knot in her sure, nimble fingers and began to work the fabric loose. As she worked, her eyes found another, and another, knots tied all around the twisted figure in the bed. The sheet loosened and finally spread in a small spiral of wrinkles. She moved along the bed and worked on the next one, then the next one, until she had left a trail of tight wrinkles along in her wake, like a small ruffle.

The old man stared at her with those faded, pain-filled eyes and reached out a shaking, gnarled hand toward her, index finger extended as far as the arthritis would let it, to point downward, just where she was standing. Tracy looked down and, seeing nothing, knelt to lift a blanket that brushed against the cold, white-tiled floor. There she found what she hoped was the last knot, the final string that tied this suffering old soul to the earth and his failing body. She reached out to it with shaking fingers, took a steadying breath, readying herself to end a life that had wanted to let go for too long. She grasped the tightly bundled edge of sheet in her hands and began working it, loosening it. It was bound so tightly, much tighter than the others, the last defense against opening the cage and releasing the monster within. Finally, with one final tug, the fabric unraveled. Tracy sighed out a breath that she hadn’t realized that she had been holding, and started to stand when a small bundle under the bed caught her eye. She reached into the dark shadows beneath and half expected something to grab her searching fingers. Instead, her hand closed around the soft bundle and she pulled it out. Blinking down at it, she realized it was Ethel’s lost doll.

Tracy rose slowly to her feet and her accusing eyes snapped to the old man lying in the bed. She could see shadows moving there, like the slithering of many snakes, trying to escape the body that had held it captive for so long. The pale, faded gray of Mr. Malone’s eyes slid to Tracy’s and suddenly she knew. The second their gazes connected, she understood that this man, this creature, was responsible, not just for Ethel’s transformation from happy child to frightened shell, but for the disappearance of the CNA the year before. For so many tragedies that took place there, in that very room. Some how, some way, he had done those things, and had done them intentionally.

Like a projector going off in her head, she could see Ethel rolling herself gleefully down the hall. Something, perhaps some kind of noise that Tracy could not hear, tempted her to go near the one room that most of the residents and staff alike avoided. In her fragile hands she held her beloved doll. For a terrifying moment, Tracy was sure that the Ethel would enter that forbidden domain, but something else easily attracted her attention and she turned to wheel herself away. But the doll fell from her grasp and she left it forgotten in the doorway outside of the old man’s room. Tracy saw the bundle stir and, as though the doll were the baby it resembled, it began to crawl inside.

Her vision flashed and, before she could fully comprehend what she had just witnessed, the projector was rolling again, this time it started inside Mr. Malone’s room. A pretty girl with dark hair, dressed in colorful scrubs was walking inside. She strode over with the competent movements that so many in the healthcare field possess. The old man seemed much better at this point. He was up, sitting in a wheel chair next to the bed. He looked at the CNA and Tracy saw his lips move, his expression demanding. The girl watched him, listening patiently to his words, then shook her head, her face expressing disgust. She turned as though to leave, when Mr. Malone spoke again, this time gesturing toward the call light. The girl walked to the bed to turn it off and the old man’s hand snaked out and latched around her wrist. Her eyes widened and she opened her mouth to scream. Tracy saw the shadows moving in Mr. Malone’s faded, gray eyes and wanted the girl to be able to scream as well, but then her vision flashed once more and she was staring into Mr. Malone’s face, mottled with purple and knew she was back in the present. This was no projector picture, this was the real world. And he was going to die, to be finally set free.

Tracy stood there and thought about watching him die, watching the light of life fade from those terrible eyes with the knowledge that he would be free at last from his earthly hell. Her hands reached down and smoothed across the bedding, feeling the wrinkles in the sheets where one of the knots had been tied. Whatever he was, whatever he had done, he was a human being after all, and he had been suffering for a lot of years.

The intelligence that reflected in his eyes began to blur and fade, and a look of relaxation came over his face. He had hurt for so long, so very long, that the dying felt good. Like sinking into a deep sleep, like succumbing to a lover’s embrace, it was a relief. Tracy looked at the doll in her arms, and thought of Ethel. Margaret had told her that none of the residents ever recovered from his strange attacks. She knew now, after seeing what she had seen that this was true. She would never see the innocent, pure joy on Ethel’s finely wrinkled face. She would never, never hear the tinkling laugh that sounded so like a child’s.

Tracy balled the sheet in her hand and sat the doll on the chair next to the bed. Mr. Malone’s eyes had gone from a long, hard fall to settle finally in winter. From the dying season to sweet, icy kiss of death. He was just nearly gone when the light flared back into his eyes, the escape that he had been so close to, blocked. His shocked gaze locked onto Tracy’s, where he read the hot anger and cold determination there. Her hands were busy, her fingers moving quickly and concisely, as she moved down the bed. Tying knot after knot after knot.