by Tracy Kidder
6
Earl sat on the edge of his bed, the blue nose catheter across his upper lip, his hair mussed up in back as always after lying down. Holding his shoulders erect, he picked up the silvery, helmet-like cover from his lunch. He stared at the plate of stir-fry. He drew air between narrowed lips and said, “I don’t know what it is.” He stared down at it. “That’s enough to make me not eat.” He picked up the fork and paused again. He had to eat or he’d have no chance of beating the doctor’s prediction, or at least of getting well enough to go home. He scooped up a small bite and quickly slipped it into his mouth. The food had no taste to Earl, but he ate on, a thoughtful pause and a deep breath preceding every forkful, every swallow strenuous.
The all-important diuretic was tormenting him with diarrhea. He couldn’t go home this week, not in this condition. Meanwhile, his doctor thought it best that Earl not make the trip to the dining room. He would eat in his room. He didn’t mind. It meant fewer trips past that lineup at the nurses’ station. In the dining room, he’d shared his table with a hearty fellow who told him that he himself had trouble eating when he first came here, and that Earl’s lack of appetite would surely pass. But there was also a woman at their table who had seemed perfectly rational until one day Earl saw that she was trying to eat her soup with a fork. She began complaining that her utensil didn’t work. Another time she mixed her ice cream with her mashed potatoes. Earl missed the company, but not the dining room. He just wished that he had appetite, and that his diarrhea would go away.
Earl got the last wish. The next morning, when the Sunrise daytime charge nurse, Mary Ann, came in with his pills, Earl grimaced and said to her, “Now I have the opposite problem.” Mary Ann, buxom and jolly, was Earl’s favorite nurse here. She was one of those who believed that older, simpler forms of medicine should supersede drugs. “You’ve got to touch,” she liked to say. “I kiss the women, too, and the other day one said to me, ‘Do you know how long it’s been since I’ve been kissed?’ It’s part of the healing therapy.” Now she sat down on the bed beside Earl and put her arm around his shoulder. She sat there for a few minutes, talking with Earl about nothing of consequence, until he seemed somewhat cheered up.
The next day, his diarrhea returned. Earl lay on his bedspread after another attack. “Sometimes I don’t want to live,” Earl said. “I want to live. But not in this condition. I was an athlete. I was involved in every civic activity known to man.” He shook his head. He looked down at himself, at his now baggy trousers. “We had the Florida trip all set up. A month. All of March. But unless there’s a big turnaround, we’re not going. I would like Jean to go with one of her children. She probably won’t want to. She’ll be afraid I might die while she’s gone. Of course, I could be gone by that time.”
Earl didn’t want to think too much about that. He wanted to be busy. He always wanted to be with Jean. Color returned to his face in the mornings when she appeared at the foot of his bed, especially when she carried mail. “I love going through the mail.”
Sorting through it, Earl found a check, a small refund on their car insurance. He wet his lips, found a pen on his bedside table, which served as his desk, endorsed the check, and told Jean not to forget to deposit it. Today.
“A banker and a Scotsman,” said Jean.
“I don’t like checks sitting around,” Earl said. “Oh, it irks me!”
Earl had a large capacity for vicarious enjoyment, especially when it came to Jean. He liked to hear that she was going out to lunch with friends. He’d discuss the details with her, where they’d go and what she’d eat, often insisting that he pay through her. Afterward, he’d want a full account, and out of long habit, knowing this imaginative capacity of his, she would oblige, telling him every detail, down to a description of the view from the restaurant table.
It didn’t take much to make Earl happy. Among some of the Sunrise staff, however, Earl had begun to acquire a reputation for being troublesome. “Demanding” was the word of choice for residents like Earl. In the staff break room or within the enclosure of the nurses’ station, that word sometimes acquired a cold significance. Earl had now been here for going on three weeks, and nurses’ entries full of irritation had begun appearing in his chart:
Very demanding of staff—ordering them to do things for him that he is able to do for himself, i.e. change TV control buttons. Otherwise resident had an active day w/ visitors.
Each of the three separate nursing units had its special reputation. Meadowview was toughest emotionally, because of the many deaths that occurred there. Forest View was toughest psychologically, because of its many demented residents. And Sunrise was toughest physically, because of its many heavy, inert residents. That was the general and by now conventional assessment, but some staff, including some who worked on other units, would say that Sunrise was just plain tough in every way, the toughest of the three.
Many of Sunrise’s residents presented special difficulties, especially to the nurse’s aides, who in any nursing home stand near the bottom of the pay scale and do the most arduous work. The aides cleaned and dressed and often fed the residents. They lifted and transported them. Often they received harsh words or worse for their pains. Sunrise had several notable curmudgeons who growled at the staff. It had only a few residents who could do much for themselves. It had some fussy residents, including one old schoolteacher whose bedtime preparations alone could consume an hour of an aide’s time. It had Winifred, very unhappy now because of the Hoyer Lift. It had the bellowing man with no legs, and a stroke victim who couldn’t speak or walk but whose arms were still strong—he had injured several aides by punching them or shoving them away.
The problem wasn’t that the work revolted the nurse’s aides. Those who couldn’t stand the smell of other people’s excrement rarely made it through their probationary period. The work was simply hard, and harder now since the staff cuts. These had begun after New Year’s and, to none of the aides’ surprise, had fallen heaviest on them. “That’s the way it always is. No one ever takes people off the top, just off the bottom,” one remarked. On Sunrise the cuts meant that every aide had at least one more resident, and often two more, on her list, and the difference for them was profound. For most aides, the cuts meant they had less time to spend consoling residents and listening to their life stories. For a few, the cuts just meant more work, and more work left undone. One day around this time, the daughter of a resident of Sunrise found that her father had been lying in his own excrement for about two hours. That was not supposed to happen at Linda Manor. The administrator was furious. Nothing excused such negligence. Eventually an aide was fired. Morale had never sunk so low, especially on Sunrise. Earl had arrived at the wrong time, in the wrong part of Linda Manor.
The last thing the Sunrise staff thought they needed was another demanding resident. When a resident rang the call bell, a beeper went off at the nurses’ station and a white light went on above the resident’s door. To the aides on Sunrise, it seemed as if every time they looked, Earl’s light was on. Sometimes it was Earl’s roommate who pressed the call bell. Sometimes Earl pressed it on his roommate’s behalf. But even then, it seemed, Earl had something he wanted done for himself as well. What did he think this was, some of the aides asked each other and the nurses, a hotel?
As Earl’s stay had lengthened, some of the staff had decided that Earl was dominating his often inarticulate roommate, answering questions for him and assuming command of the television, even though the set belonged to his roommate. And Earl seemed upset when the staff didn’t answer his bell right away. The policy was that they should answer the routine bells within fifteen minutes. That was the best they could do. Earl ought to understand that.
But to Earl, fifteen minutes could mean eternity. He kept his alarm near at hand—a small capsule with a nipple-like red button on the end, attached to a white electrical cord that snaked out from the wall. This was Earl’s umbilical now, but it didn’t make him feel safe, the way the sam
e alarm device had made him feel inside the hospital. “Here, they come when they get a chance,” Earl fretted.
Earl’s Medicare coverage had run out. He paid out of his own bank account to stay here now—$130 a day, nearly $5,000 a month, counting the additional costs of oxygen and medications. Earl understood, as most other residents did not, that he was helping to subsidize the residents on Medicaid. He paid more for his care than its actual cost, to make up for the fact that the state paid less than the full costs of some others. Having his call bell answered promptly didn’t seem too much to ask in return, especially when his life might depend on promptness. The other evening an aide, answering the call bell, said to Earl, “Boy, this is the busiest room.”
“Not on my account,” Earl said. He felt offended at the insinuation. About half the time, it seemed to him, he rang to get assistance for his roommate.
Then last night a nurse came in and took the TV’s remote control away from him and placed it on his roommate’s table. “You’re not supposed to have this,” the nurse said.
She seemed to think Earl had stolen the control, when in fact his roommate had asked Earl to keep it. True, Earl sometimes put on programs that he wanted to see, especially golf tournaments and evening mysteries, but he always asked his roommate’s permission first, didn’t he? He didn’t want to buy his own television. He didn’t plan to be here long enough for that. But Earl resolved that he would offer to pay half of his roommate’s cable TV bill. He wished he’d done so sooner. Earl had not dared to protest to the nurse, though. “I’m afraid if it got around, even though I was right, some of the nurses would take it out on me.” He wasn’t sure to whom he might complain. He wasn’t always sure which of the staff were aides, which nurses. He wished that they wore uniforms.
From the perspective of bed, every aide looked large and infinitely powerful. “You have to be careful,” Earl thought. “If you get on their wrong side, they won’t do anything.” He felt safe in the daytime and completely safe during the many hours when Jean sat with him in the room. When she left late in the evening, he’d remind her to be sure to watch their favorite TV mystery, telling her that he’d be watching, too. In this way, he felt, they’d be together, sort of. The TV mattered now. It took his mind away from here, and it connected him to Jean.
He needed something to get his mind away from here. Many of his old friends from Holyoke hadn’t visited yet. Maybe some of them still didn’t know where he’d gone, though he’d called many of them. A few old friends had visited, and his children came whenever they could. He loved to see them all. He hadn’t seen that old fellow Lou for a while. He’d enjoyed Lou’s visits, but they were brief. He preferred the company of people he’d known before he came here. They made him feel he hadn’t been taken permanently from the world. Indeed, their visits promised restoration to the world, because they made him feel much better, both in mind and body. He preferred Jean’s visits above all.
She had come early this morning and had stayed until long after dark. He’d had a very good day, the kind of day that made him think his condition might have stabilized at last. But when Jean left, his spirits drooped. “I think about kicking the bucket. But not much. I want to get home,” Earl said. “I could go in five minutes. I don’t want to do any suffering. I want everything, I guess. I just want to get out of here. I’m not really a patient like the others. Jean thinks it’ll be too much for her. It will be a chore. But she won’t be without help.”
These were the worst hours, after dark, when Jean had left. If he lay on his bed without his roommate’s television on, he’d hear televisions in other rooms and the aides discussing their own lives away from here, the coughs and moans from nearby rooms, and that low, purring, underlying sound, like a ship’s engines, like the building’s sustaining force, which was the ventilation system. Five minutes could be a long time if one lay in one of these narrow beds and stared at the rectangular panels of the suspended ceiling. He kept the alarm device near at hand, clipped to an edge of his blanket. But if he had to press that little red button in an emergency, would these busy, businesslike young women—the ones on these after-hours shifts seemed the least congenial—answer it in time?
It was always this way now, before he got his sleeping pill. Thank God for his roommate’s television and a sleeping pill. Without them he would lie here all night locked up with his own worst thoughts, thrown back at him, like the images of hospital beds and privacy curtains and medical furniture—metallic, functional, disposable looking—reflecting in the night-blackened window.
The last few nights a certain aide had made these hours almost unendurable. Whenever she came in, she looked cross and seemed impatient. He’d been trying to think of a way to let her know who he was. No one around here seemed to know who he was. This aide didn’t seem to think he was even human. But the thought of offending her, and the possible consequences of that, chilled Earl. He’d held his tongue and suffered her coldness.
The windows across the room were black. His diarrhea had abated, but Earl wanted to wear a diaper just in case. The aide answered the call bell—that same cold, unfriendly aide. He made his request. She said, “No, you cannot have one.” No explanation, just that curt answer.
Confrontation had never been Earl’s style. He thought he ought to speak up, but just the thought in his mind frightened him. And yet he felt he couldn’t bear this, being denied a simple disposable brief. Should he or shouldn’t he? He took a quick breath and said, “You know, young lady, you don’t like me very much.”
The aide seemed surprised. “Why do you say that?”
Earl felt safer now. “Well, you come in here, you never wear a smile. It’s almost as if you’re doing me a favor.”
***
Earl told Jean the whole story the next morning. “She took it pretty well. She said she was sorry she was acting that way. She didn’t realize it. I was afraid to do it, but I figured I’d better take the bull by the horns.”
“That’s good,” Jean said. “Because, you know, you sometimes have a grouchy expression and people don’t know how sweet you are inside.” She sat in the armchair beside his bed. Earl sat on his bedspread, upright against the pillows, fully dressed as usual, as if he were merely resting for a moment here.
“You sing your happy song so people know how sweet you are,” Jean went on. “I might be afraid of you if I didn’t know you.”
“Yeah, sure.” Underneath the blue tube Earl’s lips curled in a little smile.
Domestic routines survive even in foxholes. Jean had brought in Earl’s laundry. Now she put it away for him in his photo-wood-grain-finished Linda Manor bureau, took off her coat, and, leaning down, gave him his morning kiss. She offered him her hands, to feel the coldness of the air outside, and did up a couple of the shirt buttons that Earl had missed.
“What did you have for lunch yesterday?” he asked.
“Veal, which you know I love. And we sat near a sunny window…”
“A long lunch,” said Earl, dreamily and smiling. “But when the girls get together, it takes a long time.”
These mornings on the way to the nursing home, Jean always stopped at a favorite diner for breakfast. “Tomorrow,” Earl said now, “when you leave the diner, get the paper automatically.” This was his way of reproving her for not having brought today’s paper.
“I would have,” she said, “but it was so cold. My hand would have frozen to the machine.”
“We can’t have that.”
“Besides, you just throw it away,” she said.
“I scan it,” Earl said.
“Whatever you say, dear. You’re the boss.”
“I love that statement.”
“Enjoy it while you can.”
This was what a wife would say to a husband on the mend. Earl beamed. The morning sunlight shone on the floor, improving it. For now Sunrise seemed aptly named. Earl and Jean might have been just another well-matched couple, savoring the start of another day together. Musingly
, Earl said he thought he’d go to hear Lou’s daughter read at Literary Hour next Tuesday. Then he turned to Jean, his eyes searching her face, and said, “If I’m not home by then.”
Jean looked away toward the bright window.
“Hear that, dear?” Earl said.
“Well, I don’t know. I heard you.” She looked at him and placed her hand on his leg. “I have to go to the dentist Tuesday. So you just have to take it easy.”
“Okay,” Earl said, “Wednesday.”
Jean didn’t answer, and soon changed the subject. Jean couldn’t say yes, she’d take him home next Wednesday, because she believed in keeping promises. But she didn’t believe in telling him everything that was on her mind. She often visited Earl three times a day and stayed for several hours each time. After her last visit, she’d go out to her car in the dark. She would not let herself begin to cry until she was safely inside the car, but would cry all the way home to her empty house.
7
The state bureaucracy had done a lot for residents of nursing homes. It had curbed the worst of the real estate scams through which unscrupulous proprietors used to loot the Treasury. One Linda Manor nursing supervisor remembered from the bad old days a case in which a dentist was caught extracting healthy teeth from aged, helpless residents of another nursing home, in order to increase business and get the gold embedded in those teeth. The state’s nursing home bureaucracy had greatly curtailed such egregious sorts of crimes. But policing always has a price. One was lots of paperwork. It seemed that there was always more, never less. The new monthly forms, for instance, that obliged the nursing staff to describe the ways in which each resident’s care had improved. Those forms took up so much time they virtually guaranteed that no improvements could take place. And the array of regulations was bewildering, even to the people who enforced them. Recently, a state inspector had ordered Linda Manor to make alterations in the dining room. The inspector cited regulations—wrongly, as it happened, but no one knew that then.
