by Sandra Shaw Homer
When it became clear my grandmother could no longer live alone, I was the one who took the initiative to find a place for her, and I wanted it to be near me. She refused to go to the only facility in Albany, where she lived, because there was a patient there she intensely disliked, and she loathed the idea of going to Florida, near her two sons, so we found a “life-care” facility in a pretty, rural area outside Philadelphia. My sister, also nearby, handles our grandmother’s affairs while I visit and occasionally deal with the staff. This division of labor falls to each of us naturally, and I’m happy with my share.
My grandmother was only forty-seven when I was born, but because she was my grandmother, I always thought of her as old. It was only thirty years later that I began to observe that there are degrees of old. Her shoulders got smaller suddenly, her bones collapsing together. She developed an uncertainty in her step that I realized was a fear of falling (although she never stopped wearing her low-heeled pumps). To me she had always been proud and fearless, but with this new vulnerability of hers I started to assume a larger role. The shift was gradual, but my awareness of it cataclysmic. The love had always flowed unconditionally toward me. Now it was flowing the other way. It frightened me to realize that I was going to lose her. Returning that love I’d always had from her took on a special urgency, and I was grateful to be able to do it.
She enriched my life in so many ways: her frequent “rescues” from my unhappy family to her little cabin on the lake with its rag rug and bright yellow upright piano (the cabin was her trysting place—divorced before I was born, she and her lover, my “Uncle Tom,” met there for years); her constant and patient encouragement of my music (she taught voice and sang professionally); the summer orchestra concerts in Saratoga; the contented moments fishing in her little rowboat (we always tossed the sunnies back to be caught another day); the time we coasted her big old Pontiac with the amber Indian head on the hood all the way down the hill when it was out of gas (“Wheee!” we shouted.); her daily calls to me when I was in the hospital, alone in New York; her always knowing when something was disturbing me, even when I didn’t know myself; her sneakily arranging for me to take singing lessons with a colleague from Temple University. Once, when we were floating on a Thames barge through the English countryside, I looked up to see my grandmother, an unopened book in her lap, absorbed in her thoughts with a look of such serenity on her face it jerked my heart.
Every time I walk up to the door of the medical center, her new “home,” I feel all the ambivalence of someone about to visit a relative in prison. Even though it’s now called a “medical center,” everyone knows it’s really a nursing home, and we all know that nursing homes are places where people go to die. My grandmother lives on the top floor, the fifth floor (the last stop on the way to Heaven), where the patients are prisoners in more ways than one. Few eyes are turned to Heaven on the top floor, few souls prepared for death, because, in needing the greatest “medical and behavioral supervision,” most are, to one degree or another, losing their minds.
Coming off the elevator I see patients strapped into their chairs watching (and understanding nothing of) television. A gentleman in a wheelchair is facing the wall screaming unintelligibly. Near the nursing station a patient tries to engage me in nonsense conversation. Another simply grabs hold of my clothes, so fiercely that I wonder if, to these benighted souls, outsiders represent some desperate hope of escape. I feel pity, revulsion, a desire to escape this twentieth-century Bedlam myself. But for my grandmother I come. I come for myself, too, even though she’s not sure who I am. Recently, she looked up at me from her pillow and said, “There’s always been something special between us two,” even though she can’t remember my name. Her extraordinary smile, a palpable thing like a stone bridge, was ever an invitation for my soul to cross over and give hers a hug. Nobody else in my life ever had a smile like that.
I am visiting the medical center today for a quarterly meeting of the staff to review her “case.” In these meetings, I ask, and they answer, a series of questions about my grandmother’s health, her mental deterioration, her physical needs, her participation (or not) in social or recreational programs. Four staff members and I are assembled in the “reality orientation room,” where patients come every morning to hear what day it is, where they are, who they are, what holidays are coming up, what activities are planned. All this information is spelled out neatly in large block letters on the blackboard, reminding me of a first grade school room. There are no decorations in the room whatsoever. A few plastic chairs and tables have been pulled into a rough circle for our meeting. It is a sunny winter day outside the window.
The charge nurse is just beginning to answer my first question when the fire alarm sounds. As one, the staff members rush out of the room. I sit there alone, irritated by the repeated honking of the alarm, wishing I could have a cigarette. I look out the window at the sun glare on the snow, which is still three or four inches deep, and I think that it is not a good day to take my grandmother anywhere. Even though she is having her hair done so we can go out to lunch, and even though the sun is warm, there are too many patches of ice on which an old woman could slip and break a bone.
Suddenly, a strident male voice sounds through the closed hall door: “Evacuate the building! Everyone evacuate the building!”
For the first time, it occurs to me there might really be a fire. I slip on my jacket and hat and pick up my purse, just as a male patient shuffles with agonizing slowness through the door from the recreation room. I say, “We must leave the building,” and my heart sinks as I realize he doesn’t know what I’m talking about. The charge nurse returns and, taking the old fellow by the arm, directs us both to the fire exit.
In the hall, all is pandemonium. Even the ambulatory patients are incapable of making it to the fire exit on their own. The staff is operating on adrenaline and rote training. At the exit, I hold the door open for the wheelchairs and aides guiding the patients on foot. One grand dame holds up traffic by asking me what I’m laughing about. There is a twinkle in her beautiful gray eyes. Perhaps she sees a joke and wants to share it. Perhaps there really is a smile on my face. Someone from behind gently pushes her forward. Feeling a little useless where I am, I ask one of the aides what I can do to help.
“Check the bathrooms!” she gasps. I prop open the exit door and methodically check the ten rooms along the hall. Emerging from the last one, I see an aide trying to get an ambulatory man into a wheelchair so he can be moved faster. Meanwhile, other patients are simply milling about unaccompanied. I grab the back of the wheelchair: “I’ll take him,” I say. She gives me a relieved look and dashes off to help someone else. My passenger is tall and unshaven and wearing a baseball cap and flannel shirt. I tell him to keep his feet up so they won’t trip under the wheels of the chair. I have to keep reminding him of this. Even at this sedate speed, he could break an ankle.
There is a bottleneck around the exit. The walled terrace outside the door is still covered with snow, except for a narrow path that has been cleared around the edge. The snow makes it impossible to maneuver the wheelchairs, and there is no more space to stack people up. Fortunately, the building is set into the side of a hill, and an aide forces open the gate at the other end of the terrace and begins guiding people down the muddy slope toward the fourth-floor terrace and paved walkway beyond.
It is a bizarre collection of people out here. Some are naked, or only half dressed. Not one has a coat, gloves, or hat. In the sun, the temperature might be as high as forty degrees; even so, these frail beings will not survive out here for long. Someone comes through the door with an armload of rolled cotton blankets. I busy myself wrapping blankets around shoulders, legs, bare feet. One woman keeps up a shrill animal complaint that her blankets are wet. She’s sitting half naked in her wheelchair, a pile of soiled linen on the ground beside her. From her contorted shape I can see she is incapable of moving; I try to snake a blanket behind her bare buttocks and wrap it around her hips. Finally, I spread a blanket over the knees of the old gentleman I had wheeled down the hall. He says, “Thank you,” and I marvel at his lucidity.
The fire companies are arriving, adding their shrill sirens to the insistent honking of the building alarm. A nurse comes scrambling up the hill and breathlessly asks one of the fifth-floor aides if there is any oxygen up here. The aide shakes her head. “But I’ve got to have oxygen. Some of my patients won’t last long without it!” I tell her I have just seen one of the fire company ambulances come down the road. Surely they will have tanks. She races back down the hill.
Slowly the fifth-floor situation is brought under control. Someone does a headcount. Someone else checks names against a logbook. One by one, patients are being maneuvered off the terrace and down the hill to get farther away from the building. One of the female patients is screaming as two aides try to walk her through the muddy snow. There is still no sign of smoke or flame, but there is a rumor that a small fire in the kitchen tripped the alarm. I pray that it will be brought under control quickly before anybody catches a chill.
Finally, a breathing space. I decide to find my grandmother, who had been in the beauty salon on the fourth floor. She is standing with her back to me a little way down the hill from the fourth-floor terrace, holding herself perfectly erect, a cotton blanket draped over her head and shoulders like the Virgin Mary. I come up behind her and put my arm around her and give her a big kiss on the cheek. Her head is covered with curlers. She gives me that joyful smile and says to no one in particular, “Oh, my loving sister is here!” I whisper, “Granddaughter,” into her ear so she won’t feel embarrassed if anyone nearby has heard her.
People say she has outlived her life. Not as long as that smile is still there for me. Its shadow is on her face now, as I hug her against the cold on the snowy grounds of the medical center. If she doesn’t know exactly who I am, she knows I love her, and she knows she loves me.
Organic brain dysfunction syndrome, clogged carotid arteries, not enough oxygen to the cells. The fire in her mind is being damped out, along with the light in her eyes. Even her oldest memories are failing her now. Words fail her; sometimes they come out like nonsense syllables. The woman who stood up in front of audiences and sang Schubert Lieder in a clear, controlled contralto now can’t remember a song.
Even though I’ve got two blankets wrapped around her and my hat stretched over her curlers, she tells me that her bottom is cold. I learn later that she is finally incontinent and that she won’t wear her diapers. “She’s a lady,” the charge nurse says, which is her way of telling me that what shreds of dignity remain to my grandmother will not abide the wearing of diapers. She doesn’t resist having them put on; she simply takes them off when backs are turned. So, standing out here in the bright early March sun, my grandmother is without any underwear.
But we are giggling together now over the whole predicament. There is always confusion inherent in moving large numbers of people around, and when those people are physically or mentally disabled, it can be mayhem. When the obvious danger has passed, the whole scene takes on the quality of the ridiculous. Together we look back up the hill at all the old people milling around in the snow. My grandmother utters a rare complete sentence: “I would say they look foolish if I didn’t try so hard not to look like a fool myself.” I laugh and hug her tighter.
Philadelphia native Sandra Shaw Homer lives in Costa Rica, where for years she wrote a regular column, “Local Color,” for the The Tico Times. Her writing has appeared in several print, online literary, and travel journals, as well as her own blog, writingfromtheheart.net. Her first travel memoir, Letters from the Pacific, received excellent Kirkus and Publishers Weekly reviews. A brief inspirational memoir, The Magnificent Dr. Wao, was published as a Kindle Book, and a second travel memoir, Journey to the Joie de Vivre was released in 2016.