Assisted Living

On the first night that my father ate in the dining room of the Cypress Gardens nursing home, he was seated across from a trim woman with soft white wavy hair, smooth pink cheeks, and radiant blue eyes.
     "Simon, meet Florence," said Jennifer, the Nursing Assistant who had five minutes earlier put her hands under my father's arms, slid him out of bed, held him up just long enough to turn him around, then sat him in the wheelchair that bore him out of his room for the first time in almost a week.
     "Pleased to meet you, Florence" my father dutifully croaked, warm and gallant as always, seemingly oblivious to the fact that he was sitting in front of a linen-draped table wearing nothing but a bathrobe covering a soft blue cotton hospital gown tied by a single frayed set of strings in the back; that a pick line - a single thick needle with three IV ports hanging from it like dreadlocks protruded from his neck.
     "And this is Florence's baby," Jennifer said, gesturing grandly towards a jammy-clad rubber doll the size of a four-year old, with bright blue eyes that mirrored and twinkled back at Florence as she held it to her chest.
     "She's adorable," my father politely offered.
     Jennifer gave him an approving wink. "Florence," she said loudly, "why don't you let me take care of the baby while you have your dinner?"
     Florence gave the doll a tender pat on the back, then cupping the back of its floppy rubber head in her palm, she carefully handed it over to Jennifer. "I guess I should have a few moments peace while I eat my dinner," she said in a lilting, faintly Southern-tinged voice.
     "Well, she seems very well-behaved," my father said.
      "Oh, she is," Florence agreed, cutting daintily into her intact chicken breast. "She's a good girl."
     Meanwhile, my father had sunk back into his wheelchair, exhausted by just the effort of this simple if daffy exchange, and was staring dully at the food in front of him.
     "What do you say, Dad? Are you ready to give this a try?"
     "Oh, I can't, chooch. I don't want to be difficult, but I just can't eat this stuff."
     "This stuff" was not food as he had known it for 78 years, but rather a tan-colored pulverized heap of "mechanical soft" chicken (though it could have been apples or turnips or compost in its vague state of mush.) It was what they served to people who lacked the physical or mental ability to properly chew their food before swallowing, to help prevent them from aspirating the food into their lungs. Up until a few days earlier, my father had been one of those people. He'd spent almost two weeks in a state of quiet delirium brought on by a broken hip, the surgery to fix it, a nearly fatal post-operative morphine overdose, and a host of medical sequelae that should have killed him. His major organ systems had largely shut down in shock. His limbs had become grotesquely swollen with edema caused by starvation, which in turn was caused by the multiple myeloma that had caused the fracture in the first place. My father, a PhD psychologist, had lain in bed staring blankly into space for hours on end. When asked to read the "Keep this Door Shut" sign on the hospital bathroom door, he could only get as far as "Keep." When asked to play Go Fish or Gin Rummy, he could not identify two cards of a kind. When my mother tried to get him to eat, he would open his mouth, close it, and let the food simply sit there, neither chewing nor swallowing.
      After several albumin infusions to replenish his depleted stores of protein and near force-feeding of three high calorie, high protein beverages a day, my father started to emerge from the fog. His gaze lost its terrifying deadness, and while he was still fantastically weak - too weak to roll over in bed without assistance -- he was once again oriented. He was oriented enough to recognize that he was one of a handful of men in a nursing home largely populated by paraplegic, aphasic, or demented old women, and on this, my first visit since he'd been transferred from the hospital to the nursing home, I almost wished he wasn't so aware.
     Instead, with a forced tone of ordinariness, I urged him to try the chocolate pudding. "You've got to get some protein into your body, Dad."
     "I know. I know I do," he answered, but made no move to eat it.
     "You're pretty tired," I said, trying to preemptively spare what was left of his dignity. "Let me help you out." And then, resisting the crazy impulse to soar and swoop and guide the spoon towards his mouth while making zooming airplane noises, I fed him a small dollop of chocolate pudding, then another.
      "All we need is the fried eggs," he said after three mouthfuls, alluding to the daily lunches of eggs, pudding, and orange juice that he used to feed me in sixth grade while my mother was at work. At that time he was a full-time graduate student and stay-at-home dad, learning to cook for the first time, and I was a miserable outsider at school, kept afloat in that first year in a new town largely by the half-hour respite that those awful lunches provided. Now once again we were both in new roles in a new world.
      After dinner, Jennifer took him back to his room, and tactfully suggested that I go get myself a cup of coffee while she got him "settled." What she meant by getting him settled was giving him a sponge bath, tending to the bed sores he'd developed, and swaddling him in the diaper he now needed to accommodate the urinary incontinence resulting from weeks of catheterization.
     At first I'd felt guilty at leaving a total stranger (and let's be honest, not just a stranger but a black woman working a 12-hour shift and earning at best $10 an hour) to provide such intimate care to my father. I knew it was her job, but fifty years ago, this used to be a family's job. Letting Jennifer and the other nursing assistants bathe and feed and toilet my father initially felt like yet another slip down the slope of upper middle-class self-indulgence, especially when I knew that my father and grandfather had, unassisted, nursed my grandmother in their living room for several excruciating months up until her death. But during the previous two days, I'd had to position and hold the plastic urinal as my father lay in bed because he was too weak to do so himself, gingerly manipulating it while desperately trying to honor the last shred of propriety and avoid actually touching his penis with my hands.
     "I bet you never imagined yourself doing this for your old man," he said, sadly and kindly when the procedure was complete.
     "Nope," I answered, looking in vain for comforting lies.
     "Me neither," he agreed. Then, almost as a musing after-thought, with a wonder and acceptance that almost took my breath away, he said "Life is always offering up something new, isn't it?"
     So now I was happy and relieved to let Jennifer do her job. She did it well, with kindness and a professional confidence that made it much easier for my father to allow himself to be cared for than did my mother's or my own distraught and bumbling efforts. And as she worked, they talked.
     "I see you've got the Bill Clinton book," she said one morning, noticing My Life sitting atop a stack of books that sat, still largely untouched, on his nightstand.
     "Yup," my father answered. "I haven't made much progress yet since the damn thing weighs too much for me to hold up for any length of time, but I'm looking forward to it."
     "I've got it too, and I haven't opened it either," she laughed. "But one of these days . . ." Then, anchoring her palm on one side of the mattress, "Can you grab onto my arm and roll towards me a little?"
     My father weakly reached for her forearm, his hospital bracelet sliding down his wrist like an elegant bangle. "Are you a Clinton fan or a Clinton hater?" he asked.
     "Oh, I think he's a great man," Jennifer answered, swiftly but gently wiping his backside, then applying a thin, transparent medicated strip of self-dissolving plastic to his bedsores. "I tell my son - he's going off to community college next year - I tell him 'Now there's a self-made man who doesn't forget where he came from.'"
     Just then Robert, my father's ancient, somnolent roommate gave a loud, startled snort.
     "Time to wake up, Robert!" Jennifer bellowed, but to no avail. Robert, white and dried as a beached crab, fell back into silence.
      Jennifer left my father and checked Robert's pulse. After confirming that he was alive, she gave us a brisk but friendly wave goodbye.
     This was the rhythm of his early days there - periods of being attended to (dressed, fed, bathed, injected, turned, raised, lowered, spoken to, undressed, encouraged) punctuating longer spells of sleep or simply lying in bed, too overwhelmed to sleep, too weak to do anything else. He was awakened and dressed at 6:00 a.m., just before the shift change, wheeled into the dining room for breakfast, then waited in the queue of chairs with mounting, desperate fatigue until he could be returned to bed and rest in preparation for physical therapy.
     In the PT room I watched as this shrunken, frail man who used to carry me on his back, who built my daughter a treehouse, who took mile-long walks on the beach every morning in his 60s and returned home with fresh bagels and cream cheese to bring to my mother in bed, focused all his concentration and strength on rotating his ankle, raising a foot off the floor, bending and extending a leg. Observing from the corner of the room, after he completed each task or set of repetitions I'd pump my fist like some juice-crazed athlete and he'd give me a firm nod or thumbs up, our ironic clowning infused with the giddy heartbreak of recognizing that in fact these efforts were taxing and these accomplishments real.

Today, my father has little memory of that period. His cancer is in partial remission and he's been home for seven months. His strength is restored to the point that he can move around the house and even walk a few blocks with the aid of a walker. He dresses and shaves and toilets himself, goes out for dinner and to cultural events with friends, and the limerick that he wrote for my husband's birthday this year (as he does every year) was his all-time best. He still reads the travel pages of the Sunday paper looking for a good deal on a cruise to Alaska, wryly joking that "I'd go back to Europe but I'm afraid your mother and I would fight the whole time about who was going to push who in the wheelchair."
     During his recuperation, as the 2004 election campaign was unfolding, he'd turn down the volume on CNN long enough to say of George Bush "This guy's a real motivator. I've got to stay alive long enough to see the son of a bitch lose." Now he looks forward to the day when the son of a bitch leaves office. Five years ago he and my mother were traipsing around Paris; today every time he feels up for going out of the house or talking with friends, it's cause for a small celebration. While we think about how to pay for the additional home health care we know he's going to need again when the cancer reasserts itself, he talks about how sad he'll be to see Enid, their home health aide, go when he no longer needs her.
     Although intellectually he knows that he is terminally ill, he lives each day with unfathomable optimism. But more than that, this hobbled man whose bones are fragile and broken as twigs lives with a kind of grace that I can only aspire to. He is as accepting and compassionate to himself in his infirmity as he was to Florence. At the end of the day, when my mother must help him remove his shoes, lift his still-emaciated legs onto the bed, and coat his edematous feet in lotion and lamb's wool booties so that his heels don't bleed during the night, he accepts her help with thanks, willing to let go of pride and shame. He doesn't rage, as those who love him still sometimes do, that this is what his life has come to. This is what his life has come to, and he forgives it.
     One awful morning last year, when his lungs were filling from the Thalidomide used to treat his multiple myeloma and he was wasting away both from the disease and the cure, my father looked at himself - once 5'11' and 190 pounds, now 5'4' and 120 pounds -- in the mirror.
     "My god," he said to my mother, "I think I must be dying."
     "Are you afraid, sweetheart?"
     "No, not afraid," he answered thoughtfully. "Just surprised."