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As the grandfather clock chimed noon, he tried to reconcile himself to the idea that she needed more care than he could provide. And yet, how could he balance that against the responsibility he had taken on when he agreed to take her away? Was that not a till death do you part commitment? There were no extenuating circumstances that could possibly override it.

 “Oh, God! Malcolm, help me! He’s here! He’s trying to kill me!”

 Emma’s scream tore Malcolm from the seesaw battle of his thoughts. He rushed to the bedroom and took Emma in his arms. But she fought him and pushed away.

“Emma, it’s me. It’s Malcolm. It’s alright, I’m here.”

“Help! He’s hurting me. Malcolm, where are you!”

 Emma struck him in the face in her frantic state. Malcolm fell backwards on to the bed as they struggled. He tried to take hold of her arms but she flailed wildly. In that moment, he realized that she was no longer Emma. What little grasp of reality she had been clinging to was gone.

“Get away from me! Malcolm! Malcolm! Where are you? I need you!”

He tried again to subdue her. But she fought him with a strength he did not know she still had left in her. There was terror in her eyes as she gasped for breath between screams. He had waited too long. Emma’s screams came in waves. Her right arm struck the headboard as she flailed. Malcolm heard the distinct crack of a bone breaking. From somewhere within him came the realization that she would not survive this episode. He had a choice: Watch her die slowly and painfully , or mercifully end her suffering. He could not fail her now.

Malcolm reached for the pillow, levered himself back onto his feet and sidestepped Emma’s flailing arms. But his will faltered as he raised the pillow over her head. It was impossible. He could not take her life. Malcolm was about to pull the pillow away when Emma saw it. Calm descended over her as she looked up. The veil of delusion lifted and she stopped resisting. He could not deny what he saw in her eyes now— gratitude and a deep, abiding trust in him to do what was needed.

He expected her to struggle as he pressed the pillow gently over her face. But she remained perfectly still. How long did it take to suffocate someone? It would be terrible to pull away too soon. He held the pillow in place for several minutes until there could be no doubt.

Malcolm stumbled into the living room, his heart pounding in his chest, and collapsed in a chair. What have I done? Dear God, what have I done? Grief and horror rose in an accusing tide within him. As he fought to keep from being swept away by it, the reality of what had happened lost its clarity. Surely he had not done such a thing. It was no more than a trick of the mind. Emma must still be alive.

Malcolm crept back into the bedroom and listened for her breathing. But the room was veiled in silence. He staggered back into the living room, fell into the chair and passed out.