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Chapter One

"Damn, when do I get to be old?" I think resentfully as I drag myself out of bed just after dawn. It's one of those beautiful San Francisco mornings when a billowy fog bank hangs over the ocean, its lacy tendrils creating magical forms as they spill over the Golden Gate Bridge. But I have no time to linger.

    Forty-five minutes later I'm hurtling down the freeway in a taxi, heading for the airport to catch the eight o'clock flight to Miami, where my ninety-four-year-old mother has been in a nursing home for the last year. I look out at the bay, the water cool and green in the morning light, and brood, "I'm too old for this, too tired. These trips take too much out of my aging body, not to mention what they do to my psyche."

    Twenty years ago, it was fifty-year-old "children" taking care of their seventy-year-old parents; now it's seventy-year-olds looking after their ninety-something elders. Last Sunday the New York Times did a story on "assisted living" places for the aged that featured a photograph of a daughter helping her mother get settled in one of them. I couldn't tell without reading the caption who was the mother, who the daughter.

    At the gate, I hand over my ticket in return for a boarding pass and prepare to wait. I've lost count of how many of these trips I've made this year, four or five maybe. My husband and daughter keep asking why I go. "She doesn't recognize you anymore," they argue, "and even when she did, it didn't make any difference to her. All she wants is your brother, and he's dead."

    They're right; myrelationship with my mother has been troubled since I was a very small child, and my being there now doesn't seem to offer her much comfort or consolation. Yet I go, not so much for her but for me—for the child inside who still hopes for something, not approval exactly, but some way to define the relationship more positively; and for the adult who knows she has to do it "right" now to avoid guilt later.

    The plane is due into Miami at 5:30 in the afternoon, too late, I tell myself, to go to see my mother. It's not too late, of course, but it's the excuse I need to have dinner with a friend. He's my gift to myself whenever I make this journey—a long, leisurely, lovely dinner among the young and the beautiful who inhabit Miami's South Beach, my antidote to the absurdity of life and death in a nursing home.

    The next morning, I dawdle over breakfast, putting off my visit as long as conscience allows. It isn't just seeing my mother that's so difficult; it's the whole atmosphere: the sights, the sounds, the smells. Worst of all is the confrontation with my future. At seventy-three it's impossible to be here without asking, "Is this what's in store for me?" I shudder and tell myself that I'll never let it happen, that I'll take my life before I live this indignity. Brave words. But can we ever know what we'll do when the moment is upon us?

    Finally, I enter the building, check in at the front desk, and take the elevator to my mother's third-floor room. As I step into the corridor, I'm greeted by five wheelchairs facing the elevators expectantly. For a moment, my mind trips out on an image of the chairs gliding off by themselves into some adventure. In reality, the chairs are occupied by three women and two men, all clearly living in some other universe in their minds. Their bodies, slumped in the chairs, are so limp they seem to have no bones. One woman mumbles incoherently, a nonstop rhythmic set of sounds that no one understands; a man's palsied hands shake uncontrollably; the others sit quietly, their eyes closed, their heads lying lopsided on their shoulders as if the muscles and tendons that used to hold them in place have worn out.

    "What are they doing here?" I ask an attendant at the nurses station nearby.

    "It's recreation time," she replies cheerily. "They're waiting to go down to the rec room" Recreation time! Am I crazy, or are they?

    The scene at the elevator and the explanation follow me as I make my way down the hall to my mother's room. When I came to make the arrangements to move my mother into this place, I was impressed when the director showed me around and outlined all the activities available for residents. Now I wonder fretfully whether I blinded myself to the reality that these "activities" are little more than a bureaucratic response to state licensing requirements. But perhaps I'm being uncharitable. It's possible, too, that this pretense that some semblance of normal life exists here is the only way the staff can cope with the incongruity of dealing with the living dead.

    I enter my mother's room preoccupied with the realization that if I had allowed myself to "see" then what is so obvious now, I might have been forced to look for another solution. But what would it have been? My mother couldn't live alone, nor was the euphemistically named "family residential center" in which she had resided for two years able to continue to care for her. It was a nursing home or my home, and that I couldn't do. I flinch when I see those words staring back at me, fearful that the world out there will know me for the selfish daughter my mother always said I was.

    My attention is diverted by my mother's new roommate. She's younger than most of the people here and seems fully competent as she sits up in her chair, a tray table in front of her. "I'm Pat," she says, her right hand patting her chest as she speaks. "I can't walk."

    I smile, say a few of words of greeting, and turn to my mother who lies still and frail in her bed. "Hi, Mom" I say.

    Her eyes flicker open and look at me vacantly. "Mom, it's me, Lillian, your daughter."

    She turns away, mumbling, "I have no daughter; she died."

    "No," I insist, even as I understand the folly of my attempt to penetrate her fog, "I'm here, right here."

    She rouses herself, looks at me with a brief flash of recognition, then sinks back into the pillow and mumbles in Yiddish, "Gottenyu, why did you take my son and leave her? It's him I need, not her."

    I've heard these words often since my brother Leonard's death (Len, we called him as an adult, Lenny when he was a child), but they still jab at my soul. I sigh, caught, as I have been for so many years, between my hurt and anger (What kind of mother thinks such things, let alone says them?) and my struggle to understand this woman who birthed me. I remind myself that it was Len, not I, who never moved very far from my mother's side. Never mind that he suffered his own love-hate ambivalence about her, or that their relationship was marked by often cruel and hateful fights. He was emotionally, even symbiotically, linked to my mother in ways that I was not—not even when I was a child. Who knows who was at fault? I've often thought we were simply mismatched—a mother and a child who shouldn't have had to live in the same family. What I do know is that when my brother moved from New York to Florida a few years before he died, he couldn't rest until he brought her there as well. I left for California nearly fifty years ago and never looked back.

    I'm relieved to be distracted from my thoughts by Pat, who keeps thumping her chest noisily and repeating, "I'm Pat, I can't walk"—a mantra meant perhaps to remind herself that she's still a person. "Maybe if I talk to her, she'll settle down," I think. But there is no conversation; she has no other words, at least none she's willing or able to share with me.

    I sit at my mother's bedside, Pat's words like a soft drumbeat in the background, and feel the anger rising inside me. My mother is dying, yet she won't give an inch. If I were my own patient in therapy, I'd ask, "So why would you think it would be different now?" I don't think so, but I can't help wishing it were so.

    It's hard seeing this woman, once so all-powerful in my life—the person I feared, hated, loved—now lying helpless before me. It isn't that I want her to live; rather it's nearly intolerable to see her so diminished, so demeaned. She was so tough, so fiercely independent, so unyielding. Now here she is, broken, her mind wandering in and out of a reality that seems to me insufferable, kicking, clawing, biting, cursing at the attendants who come to clean her up. To change her diapers. The image is blinding, incomprehensible. My indomitable mother, a woman for whom control seemed to equal survival, now suffers the ultimate loss of control. Who wouldn't want to kick and scream, to curse the helper instead of the God who abandoned her to this living death?

    I, too, want to scream my protest, "This isn't a fitting end to her life." Or to mine. It's impossible to sit here without conjuring with my own demons about aging, without confronting my own pained understanding that I'm not far behind.

    Anita, my mother's attendant for the day, interrupts my thoughts. "You're her daughter, huh?" she asks as she comes into the room. "She's tough, your mama; she don't do nothing she don't want to do."

    On the inside I think angrily, "Boy, don't I know that." Outside I shrug my assent wordlessly.

    Anita turns toward the bed and shouts, "It's time to get dressed, Rae." No answer. Impatient, she shouts louder, "Rae, did you hear me, Rae. It's time to get dressed."

    "Why doesn't anyone here talk to these patients in a normal tone of voice?" I think irritably. Aloud, I say, "She's not deaf; you don't have to shout so loudly."

    "Well," she says, vexed at the perceived criticism, "you can't always tell."

    But it isn't only an inability to "tell" that makes people shout at the old. It has to do also with our cultural assumptions about the aged, with the deeply held, if unarticulated belief, that the aged are also infirm, not just physically but mentally. So we shout because we feel helpless in the face of infirmity, because somehow shouting seems to give more force to our words, to offer more hope that we'll be heard and understood. Even more discomfiting, the old are a mirror on our future, a terrifying image that threatens our denial of our own mortality, one from which we turn in angry disgust as we try to shout it down.

    After a brief struggle, Anita gets my mother dressed and into a wheelchair while I prepare to take her for a walk by the beach. We walk in the warm sunshine until it's time for lunch, which, I remember from previous visits, is served in what they call the recreation room. When we arrive there, I see a semicircle of wheelchairs, all occupied by people like those who greeted me at the elevator. Inside the circle an attendant sits beside a portable stereo that's playing music so loud that those in the room who are still competent are covering their ears.

    I settle my mother in a corner as far from the music as I can get, but neither thought nor conversation are possible in the din. Unable to stand the noise for very long, I go up to the aide, tap her on the shoulder to get her attention, and shout, "The music is much too loud, can you turn it down, please."

    She looks at me offended, draws herself up to her full height, and says, her sweeping gesture taking in the near comatose people around her. "I can't turn it down; this is their music lesson." Then, as I stand there wide-eyed, wondering if I've entered a loony bin instead of an old-age home, she says, as if it explains this bizarre scene, "We do it every day at this time."

    I cross the room to where my mother sits, thinking, "Maybe it does explain it." Not the music lesson, but the attendant's prideful response. We all do it in one way or another. We make sense out of senseless events by imbuing them with meaning. It's God's will; it's nature's way; it's fate, kismet—anything that allows us to avoid confronting the inexplicable, the mysterious, the randomness of so many of life's events.

    For this woman, as for others who work in nursing homes, life on the job is filled with the senseless, for the senselessness of both life and death is particularly acute in this setting. It's easier to come to work every day if she can make herself believe that she's doing something useful, that her activities here have some meaning. So when she gathers her charges together, she's not just surrounded with people who long ago lost consciousness, she's bringing them pleasure with her music lesson. Who's to say she isn't? I muse as I take a seat next to my mother. Do I know any better than she what's going on in their heads and hearts? I shake my head, impatient with my thoughts. Am I, too, determined to make sense out of the senseless?

    My mother refuses to eat any lunch, so I take her back upstairs. I sit at her bedside, Pat's unending mantra providing the background music to my thoughts, when a woman wanders into the room, plops down on my lap, and puts a finger in her mouth. She's a small person, dressed in a kind of clown's outfit—brilliant green shirt, hot pink skirt, harlequin stockings, and no shoes. My astonishment strikes me dumb for a moment, then I gently stand both of us up and say, "Hello, what's your name?" She beams, with a brilliant smile that lights up her face, and replies with an incomprehensible stream of sounds. She's young looking, middle fifties, I imagine, too young to fit my classic image of the Alzheimer's patient.

    I don't know if I've made contact with her, but she seems perfectly happy to be babbling at me. Not knowing what else to do, I sit down again and so does she, taking her place once more on my lap. Soon an attendant comes looking for her, "You can't stay here, Lita; you know that," she scolds. Then, as she takes her by the hand to lead her down the hall to her own room, the attendant turns to me. "She wanders," she says apologetically.

    But wandering Lita won't stay put. So we replay the same scene repeatedly through the afternoon as she comes for the comfort of my lap and the attendant comes to take her away.

    "Let her stay," I finally say, "she's not doing any harm."

    "I can't," the attendant replies. "It's against the rules."

    "What rule says a patient can't find comfort somewhere; I don't mind if she's here."

    But the rules say no and there's no give.

    I sit there angrily, thinking of the time when my mother fell out of bed and broke her hip two days after she'd been admitted here. "Why weren't the rails up on her bed during the night," I demanded to know.

    "The state of Florida has a rule against any restraints," explained the director.

    "Even when it jeopardizes the health and safety of the patients?" I asked, incredulous.

    "Yes, if an inspector came and saw the rails up on the beds, we'd lose our triple A rating."

    It's easy to understand the thinking behind the rules. Nursing homes have been known to abuse their patients with unnecessary restraints—physical, chemical, or both. But as with so many rules that are designed to correct such problems, their bureaucratic application often creates new difficulties, sometimes as bad as the ones they sought to cure.

    Now that Lita is gone, my attention turns to a man, probably in his late seventies, who, with one foot, has been propelling his wheelchair up and down the hall. Up and back he goes, each rhythmic energetic push scooting him along at an impressive pace. What does this journey to nowhere mean to him?

    I move toward the hall and watch from the doorway. After a few trips, he stops before me and, his voice edged with hostility, asks, "What're you looking at?"

    "You," I reply. "I can't help wondering why you do that all day."

    "What would you do if you were in this crazy place?"

    The question pulls me up short as I search for an answer. Reluctantly, I finally say, "I don't know; maybe I'd read a book."

    "I can't do that; it's too hard to concentrate on anything here," he counters.

    "You look and sound pretty good to me. What are you doing here anyway?" I ask.

    "What am I doing here?" he snorts, a bitter anger suffusing his features. "What am I doing here? Ask my damn kids. They'll tell you. I had this stroke, and as soon as I couldn't take care of myself like they thought I should, they shoved me in here, threw me away like a piece of garbage."

    I shudder, thinking, "That's what my mother said when I brought her here." Almost before the thought is fully formed, I reassure myself, "But she needed to be here; she couldn't take care of herself anymore." Words that don't still my guilt which asks, "Is that what we 'children' always tell ourselves? Is that what we need to believe so we can live with the choices we make?"

    I turn back to my mother and leave the man to his frantic pacing. The day is gone, and by now I feel as if I'll go mad if I don't get out of here. I'll be back tomorrow morning for a couple of hours before I have to catch my noon flight to San Francisco. But right now it's time to leave.

    I walk the mile or so to my hotel, enjoying the balmy evening air of Miami that's so unlike the chill that descends on San Francisco as soon as the sun goes down. South Beach is alive with people and, as the restaurants and clubs turn their sound systems up to attract attention, the music of Cuba spills out on to the street. I'm restless, feeling at odds with myself, and know I'll have trouble settling down in my hotel room. So I stop at one of the sidewalk cafés to watch the action and sip some wine. I tell myself I should eat something; I've had nothing since my bagel and tea at breakfast. I order a seafood salad, but my stomach rebels, and I can do little more than pick at it indifferently. An hour or more passes; the crowds grow thicker, the noise louder. It's time for me to leave.

    Back in my hotel room, I pick up the novel that held my attention all the way across the country. Now I find myself reading the same paragraph over and over without comprehension. I dig around in my suitcase and find the mystery I brought with me as well, thinking I can always get into one of those. But I don't do any better with Patricia Cornwell than I did with Charles Frazier's Civil War tale. I flip on the TV and watch some inane program in the hope that it will put me to sleep. It doesn't.

    I spend a long, restless night, dozing off and being jolted awake repeatedly by unpleasant dreams I can't remember. I'm relieved when I finally see daylight peeking through the spaces in the blackout curtains on my windows. I dress, pack up my things, and go out for a long walk before breakfast. Afterward, I pick up my small suitcase and take a cab to the nursing home.

    My mother is still in bed when I arrive, so I help her nurse dress her, put her in the wheelchair, and push her down to the beach where we sit in the sun listening to the gulls squawk and relaxing into the hypnotically rhythmic sight and sound of the ocean as the tides do their work. I talk to my mother, looking for something I know isn't there, but trying anyhow. I don't want a lot; I'm not hoping for some rapprochement that will heal the pain of the past, just some connection however small, some last gift I can give her, take from her, so that the end won't feel so empty. But there's nothing there, at least not for me. Her only comprehensible words are the mantra she repeats every time she becomes aware of my presence. "Gottenyu, why did you have to take him and leave her?"

    It's time to go, not because I have a plane to catch, but because there's nothing left here for me. It will be easier to wait at the airport than to mark time punishing myself with the pretense that we're having a visit.

    I wrestle the wheelchair up a slight rise and finally get my mother back to her room. When she's resettled in bed, I lean over and kiss her dry, weathered cheek. "I have to leave," I say into her ear.

    She turns away and so do I. It's the same in death as it has been in life. We have always turned away from each other, my mother and I, always since I was a small child.

    I collect my things, reach out to stroke her hair one last time but let my hand fall away instead. I don't want to touch her! Outside I hail a cab, sit back, and expect to be flooded with relief at the prospect of being home in a few hours. Instead, I begin to weep, quietly at first, then in big gulping sobs.

    "Anything I can do for you, lady?" the cabdriver asks, looking anxiously in the mirror.

    But there's nothing anyone can do. I know I've said my last good-bye to my mother—a farewell that was as painful and unsatisfying as our lifetime of hellos have been.