ann is lying on her left side in the hospital bed in the living room. Joe has just gone to work. Before leaving, he helped me turn her and take off her impractical frilly nightgown. He wants her dressed normally, though she’s way beyond caring. Now I’m watching TV, waiting for the suppository I gave her to work. If it does and she begins to have a bowel movement, I’ll have to run two fingers around the inside of her rectum, stimulating what nerves are left, to help her damaged body force the feces out.

I’m watching a talk show about immensely fat people who have managed to lose more than two hundred pounds apiece. I don’t usually watch TV in the morning, so the spectacle seems quite novel to me. “Before” pictures of each subject appear on screen, and they stare out at the audience like prisoners held captive in cells of flesh. Their recorded voices describe the misery of their former existence: they weren’t able to walk much, or fit in plane seats, or tie their shoes, and had to sleep sitting almost upright.

Ann coughs weakly, phlegm snapping in her throat. I listen with one ear to make sure she clears the blockage. If she doesn’t, I’ll have to suction her. Her throat and her anus, the first two orifices to form after conception, are faltering. Since she can’t speak and seems not to comprehend what anyone says, she must rely on her body to clue us in. Right now, I’m only half listening, because I’m riveted to this talk show. The former fat people are beginning to emerge from behind a screen — not thin, but reasonably sized, apparently vigorous, polished and pampered by the talk show’s makeup team.

It’s popular, among the arbiters of taste, to despise talk shows, to complain that they are voyeuristic, sensational, calculated to flog our jaded sensibilities. Watching now, though, I think perhaps they aren’t so bad. Perhaps 2 million really fat people are watching this show. They are eating something unhealthy, like doughnuts or danishes; their chests are flecked with crumbs. Their jaws are slowing bit by bit as they listen to these former fat people tell the world about the humiliation of weighing more than four hundred pounds. These viewers are thinking that there may be hope for them; there may be a way out of this.

There is no hope for Ann. She’s in the last stages of multiple sclerosis. There is nothing she can do for herself, not even shit. So she must suffer the humiliation of having me, a relative stranger, lift the sheet draped over her flaccid buttocks and insert my gloved hand, anointed with KY Jelly (kept in a saucer near her bed, like holy water in a font), into the rosy sanctum of her rectum, where I circle my fingers around and around like a priest dispensing a benediction.

Perhaps I am not pure enough for this work, because I cannot help but think that Ann’s anus looks very strange, like the center of a flower, a primitive bloom from someplace wet and hot. Folds of pink and red intestinal tissue emerge in rows from the hole, like petals. She seems to be turning herself inside out. Ann’s rectal vault is lax but intact. Her stool is pasty, like baby poop, because all she eats is a milky liquid pumped directly into her stomach through a tube.

Ashes to ashes, dust to dust, shit to shit, I think flippantly, scraping the feces into the compost bucket Joe keeps under the sink. Most nurses wad it up in the diaper and send it to the landfill, but I can’t bring myself to consign Ann’s rich waste to static oblivion.

Once Ann has had her bowel movement, I wash her, but not as well as Joe does. He swabs every part of her body and slathers her skin with lotion. I just hit the important areas and brush her teeth. Then I go to her closet, where matching leisure sets from JC Penney hang in a long row. I select a shirt and a pair of socks. (She never wears the pants.) The Enquirer, which some other nurse has left on the coffee table, has a section on what the movie stars are currently wearing. I can’t imagine Ann in a dress by Donna Karan or Versace, her face made up, her hair styled and flopped over one eye. It’s impossible. For one thing, I’ve never seen her standing upright. I console myself with the thought that her soul gets to be beautiful, buffed by suffering. And perhaps the souls of those screen goddesses are gnarled and paralyzed by unwarranted adulation.

My mind wanders while I’m at work. My shift is from 8 A.M. to 5 P.M., no break. It’s just me and Ann and the TV. The one moment of excitement each day comes when I put her in the lift: I roll her body onto the sling, hook the sling’s edges to the rolling lift, and pump the lever. She rises off the bed, twirling in the air. I wonder if this is fun for her, like a ride at an amusement park. “Just be glad I’m not one of those tattooed carnies,” I tell Ann. (Sometimes I talk to her, just in case.) Then I throw back my shoulders and say, in a deep voice, “ ‘Don’t worry; I’m fully licensed to operate this ride, ma’am.’ ”

I roll the lift over to her chair, position her body above it using my rump, and hit a button; she descends with a hiss. I make her comfy, hang her urine bag, and open her feeding tube. Then I go back to contemplating daytime TV and the meaning of life. I’m beginning to feel irritable.

When the food is gone, I grind up Ann’s meds and put them through the tube, dissolved in water. For a second, I consider taking her tranquilizer myself, but it’s just a fleeting thought, one I shouldn’t admit to. I flip through the satellite channels and wait for Joe to come home for lunch. When he arrives, he gets a cold Dr. Pepper from the fridge and leans over Ann in her chair, murmuring sweet nothings. I wonder why he doesn’t just stick her in a nursing home and get on with his life, or else smother her out of love. I have come to the conclusion that she gives meaning to his existence.

After Joe leaves, I take down Ann’s feeding bag and rinse it. We are supposed to measure what goes in and what comes out and record both, precisely, in cc’s. This seems ridiculous to me, like some arcane ritual.

Now all that is left is to put Ann to bed at 4 P.M. I have three hours to kill. “Time to kill”: such an odd expression. Shouldn’t we value every second of our short lives? If I had the discipline to meditate more often, I wouldn’t be so afraid of long stretches of empty time. I could tune my mind in to the station called the universe, become a receiver for the beautiful white noise of eternity. I turn off the TV, make a meditation cushion out of one of Ann’s pillows, sit down on it in a half lotus, and close my eyes. Ahhhh. This is better. I breathe deeply, counting my breaths.

You’re thinking.

I can’t help it. How can I not think? I’m a thinking machine.

Shhhhh, brain. Quiet.

I am suddenly self-conscious. I open one eye and look at Ann. She’s not the least bit interested. I close my eye and breathe deeply.

You are a child of the universe. Inhale. Exhale.

What’s that smell? The poop in the compost? No way; I took that outside.

I stand up and peek under Ann’s sheet. Her diaper has leaked, and a liquid stool lies pooled in the chair between her thighs. OK, I can handle this. I’m an expert. I sop up as much as I can with paper towels, then use the lift to put her back in bed. There, I roll her onto her left side, fold up the pad and diaper, put down an interim pad, go around the bed, and pull out the soiled pad and diaper. Then I roll her onto her back, wash her front, roll her over, wash her backside, put down a fresh pad and diaper, remove the interim pad, and roll her onto her back again. By the time I’m done, half an hour has passed, and I’m sweating from exertion.

I return to my pillow and try again to meditate. This time, I keep my eyes open, fixed on Ann. She looks peaceful, clean, empty. I’m always surprised not to detect any response to my prodding and shoving, my matter-of-fact violations. I can’t even feel her in the room with me, don’t sense her soul nearby. It occurs to me that maybe Ann has learned to leave her physical body and is no longer really here. She’s had ten years to perfect this trick, after all. Her warm flesh waits for Joe, because he needs it still, but her astral body roams free. Well, perhaps it returns occasionally, falling into Ann like a weary traveler into a lumpy bed. Right now, though, it’s outside looking at the lawn and gardens Joe lovingly tends. It’s watching a bird light on the clothesline where Ann’s stained washcloths flap in the breeze. And now it’s taking off, flying over the Connecticut River, soaring over the tilted barns of Vermont, running between the tall rows of cow corn, the long, sharp leaves and soft tassels.

The sky is bluer than it’s ever been. The air smells like golden apples.