Below is an excerpt from With and Without Her: A Memoir of Being and Losing a Twin.  The piece begins the day my sister, a psychologist, was fatally shot by one of her patients.  My husband, Dan, and I have traveled from Knoxville, Tennessee, to the Lowell, Massachusetts, hospital where my sister lies dying.

It is past twelve, a starless night when we reach St. Joseph’s Hospital. A black cross rises from the roof cornice, and from inside, the dimmed lights of night duty add a blue cast to the windows. We are bending the rules, violating the regular rounds of the hospital.

An attendant in reception directs us to the floor where my parents wait. Deane’s friends who have driven us remain behind. The elevator doors open, and I see my parents leaning against the wall opposite the elevator, their leaden faces, and I realize what I already knew: my sister is dying.

My sister’s estranged husband, Art, walks toward me. “Where is she?” I ask. “I want to see her.”

My father hesitates. But all of us walk down a hall into a small room with a single bed, and there, her head swollen and swathed, her face bruised, her chest inflated by the ventilator that keeps her alive, is no one who resembles my sister. She looks grotesque, inflexible, huge-shouldered, dark, and battered. Beside her, a respirator rises and falls, its end pieces winding into her throat. Her brain has no activity, but the rhythm of her heart repeats on the green monitor next to her bed. I bend close to her, close enough to whisper in her ear. The machine keeps up its pumping. I hold her hand, more like her now than her face, my face. This cannot be Deane. I want to do whatever the doctors did not, cross whatever border biology has set, see if I can wriggle past the barriers until I find her and pull her back.

I look up and see my father first, his face slack with sorrow. He is watching me, but he is silent, his disbelief crashing into mine. My mother too is silent, her head down, her face pale with fear. She cannot look at me, as if she is already far away, too afraid to be fully present. She places her hand on the foot of the bed, not quite on Deane’s foot but close enough. My father takes my elbow to pull me back out of the room.

We walk down the hall to another hospital room that the nurses have lent my family—a kind of drawing room to receive friends and flowers. But tonight the room is empty. In fact, the whole floor is dark and silent. It is 1 a.m., and the quiet heightens our sense that we have left the accustomed world. Dan and I sit on the edge of the bed, my mother on a chair, her profile to us.

I am shaking and cold. As my parents and I talk, what we say makes no more sense than Deane’s swollen head. Our words pool together and hover on the floor between us.

In a while, I walk out of the room, and a nun comes toward me. She takes my hands and looks into my face. Her own face is cupped by her habit, distilling her features, the round, clear eyes, the soft, aging skin. She bends her head toward mine and says what no one else can hear, says what no one else could have said: “Congratulations. Your sister is in paradise.” I want to step inside her, to be that certain. I envy her belief. What do I feel at her words except reassurance; here at last is someone who knows something about Deane beyond brainwaves and .357 magnums and death. For months afterward, I assume that Deane can color the sky pink or control the songs on the radio or open up a parking space or turn water to glitter on a fall day. She is everywhere because I know she would not leave me. My certainty makes the world’s mysteries thin enough to pass through.

My sister did not die for eight more days, although her brain died the moment she was shot. That first morning, we return to the hospital and the nurses have moved her out of a private room into intensive care, and when we tiptoe in to see her, we find ourselves in public, with other dying or gravely ill patients and their families, each patient separated by gauzy curtains and the machines that pump out life. I walk down the hall to see Deane, although I am unable to speak to her in front of strangers.

The intensive care unit, despite its opaque separations, is crowded and chairless like a small grocery where people have to turn sideways to get past each other, the steady beat of machines, the Musak. My mother follows me and, strangely, this angers me, even in this space where privacy is not possible. And for that moment, Deane seems unreachable. My mother sees my spurt of rage and turns back. But I am dead to her sorrow, to anyone’s sorrow but the dry space newly mine. I stand by Deane, holding her hand, watching her face, wondering how I can fall into whatever space she has retreated to. Her silence is a script I read, and we leave our mother as we always have. When I walk back, my mother sits in our hospital room, turned away from me. Together we move back into the dead, impartial air.

We have yet to see a doctor, but today, day two, the nurses say one is coming. He is a brain surgeon who meets with us in an empty hospital room. I look closely to memorize the face of the man who let my sister go. He has dark eyes and hair, and he is brief.

“The back of your daughter’s head was hit by a .357 magnum bullet.”

We stare at him, waiting.

“Is there any hope?”

“A .357 can destroy the engine of a car. If we take her off the respirator she will die.”

“Did she know? Did she feel anything? “

“Her brain died instantly.”

“But her hands and feet, they move.”

“Her movements now are like the movements of a chicken with its head cut off.”

We already hate him, but that ugly sentence makes us wonder what news he thinks he is delivering. He stares back at us, as if bewildered by our anger. That night we go to a restaurant for dinner—my family; Deane’s husband, Art; her best friend, Sarah, and husband, Gary.

“What did you think of the doctor?” my mother asks me down the long table.

“He is a dirty fucker,” I answer, and my Southern mother, who has never carried fuck, even close to her beautiful lips, smiles at me. 

By Monday, I have developed a case of poison ivy, picked up the day before my sister was shot, as I trimmed the hedge, readying my yard in Tennessee for her visit. My sister would not care about the hedge, but clipping seemed to bring her sooner. I didn’t see the poison growing among the leaves. So I too go to the emergency room, to the same doctors and nurses who had cared for my sister only three days ago. Yes, you look just like her, they tell me.

Already I love any word of her, any connection I make to those who saw her, who know what happened to her, who tried to save her. They feel it, too. They like seeing me, to help her. But I hate being there. My own body is beside the point; poison ivy is nothing, an embarrassment. And yet the poison keeps pumping into my reddened face. The medics give me a shot and prescribe ointment, and they talk to me about Deane. They regard me with sorrow, but they are skilled at death and loss, and so they also let me see a simple happiness: their pleasure in how much we look alike. They were the last to see it. They fetch me her ruined clothes. I look into the bag and realize the clothes are as changed as her face, so darkened with blood I cannot recognize them. I throw the bag away.

I go to a drugstore near the hospital to get the ointment. The clerk smiles, asks me how it’s going, makes a joke about poison ivy, the crisp weather. I am supposed to say something, but I can’t. I can only speak in a tongue that will make me seem crazy. I am glad to climb back into the car with my mother and father and Dan, where it is normal for life to be unspeakable.