As Dad lay brain dead in the ICU that short week, three nurses remarked on his beautiful toes. So smooth, so clean, the nails so perfectly clipped and squared off. Nothing in-grown, no dark corners, no fungus. Doctors say the state of an old man’s toes will tell you the state of his mental and physical health. An old man can’t clean what he can’t see—or reach, maybe—and will stop tending to things like toes if he’s forgetful, or if there’s no one left to impress. These were not the toes of a man ready to die. Living alone, free to do as he pleased. “Every day’s a Saturday,” he said to me, after retiring. Time! Time to run to fish to golf to bike. Tend to his tulips, tend to his toes. On league nights, a beer or two at Mingles. There are still bowling leagues where he lived, where he competed. At home he sipped a single malt over pictures of fish caught and released. They all looked like the same damn fish to me, date-stamped photos or not, but Dad could point out the distinctions. Like a nurse can talk about an old man’s toes. Bigger dorsal fin, redder near the gill covers. “Oh look,” he said, “a hook scar on the lip—maybe you’re right, maybe it is the same damn fish.” We laughed about that, and sipped some more.
Watching the respirator hiss, trying to see life in the quiver of a finger, I might not even have noticed his beautiful toes but for the nurses. Nurse Jeanne, a mousey thing, searching for kind things to say. Toe admiration seemed to come easy to her. Or Nurse Dale, the handsome Haitian, who admired Dad’s toes and his calves, too, the morning before the MRIs. Before the lost nun stopped in with her Bibles. Before the team unhooked and re-hooked him to take him mobile, for scans on another floor, his arms and legs spasming like a malfunctioning robot, as if demanding to be left still, alone and quiet in the dimmed room, to heal or to die on his own, who could say. “He was a runner,” I said, dry at the irony of finding in his jacket pocket a meticulous log-book noting his times in a 10K race and two twenty-nine-mile bike rides the same week he dropped dead on the sixth fairway in a twilight round of golf.
A cardiologist checks toes, too. There when I arrived, he told me EMTs often break ribs restarting a heart, and he explained “induced therapeutic hypothermia.” Twenty-minutes dead is long for a brain but not for a heart. Maybe it was errant plaque, a sudden blockage. Surgery—or an autopsy if that’s how it goes—might or might not confirm anything. And he mentioned hair loss on the toes can be a sign of peripheral arterial disease. Other than that Dad was essentially healthy. At which point the cardiologist and I exchanged a look that said, “Except for being dead.” Dad would’ve got a kick out of that. Sometimes that week I heard Dad laughing from somewhere. But not from that smooth-toed vessel in the ICU, despite the whirr and blink of the monitors.
Beautiful or not, toes are also part of a neurologist’s exam. Imagine that. The pain point farthest away from the brain. “Even a minimal response is a response,” she said over her clipboard and under her eyeglasses, perched oddly but tightly against her forehead. Her face was open and bright, but there was no hope in her eyes. She guided me out to wait in the hall, then breezed back into the room, beginning the exam even before her lab coat came to a rest. Before the door slammed shut. She pinched his toenail with brute force and a Bic pen cap. I wasn’t supposed to see that. Not that the exam was cruel, just sort of shocking, meant as it was to get a rise out of a dead person. Still, some things a son shouldn’t see happen. Or not happen, really. Her eyes were kind, though, days later, at the team meeting with all the specialists reporting results. She used phrases like “no residual cerebral function” and “zero withdrawal from noxious stimuli.”
It being a Catholic hospital there was always a nun around to tell you about the miracle in the next room. Someone emerged from a persistent vegetative state. Walked out of the hospital on his own, she said and genuflected unostentatiously. But they don’t let the nuns in to the team meeting. Unless you ask, I suppose. We didn’t ask. “Religion is a mild form of mental illness,” Dad said, when we were old enough to decide for ourselves. And in the team meeting we talked about sad ironies. That science is less definitive than faith. That a man with fighting spirit would have a Do Not Resuscitate medical directive. EMTs had restarted his heart—they couldn’t have known not to, people don’t wear their DNR orders tattooed on their chests, though perhaps they should. That way, children wouldn’t have to decide whether the memory of beautiful toes is enough to hold onto, whether letting them go is okay.