M. Hirschbueler- An Excerpt

Mrs. Hirschbeuler had lived in the unit for years.  She was ancient, skeletal.  There was something about advanced age that sucked almost all the flesh off a person, like the body was burning off all reserves to keep itself alive, leaving just the bare minimum of flesh as a barrier between the skeleton and the outside world, out of politeness, like your bones were too shy to reveal themselves in company.  Your blood vessels, however, shared none of the same compunction as you aged, and Mrs. Hirschbeuler’s were no different than anyone else’s.  Her blood vessels shone boldly through her veneer of flesh, blue and white and red from her bloodshot eyes, making her a parody of patriotism.  She had German ancestry, although she spoke very clear English without an accent at all.  Her speech was clear but the thought content was garbled, a side effect of her illness.  She was not as far advanced in her illness as many of the other residents of the lockdown unit, as Mrs. Hirschbeuler could answer the simplest of queries.  Her answers often revealed a sense of humor that could have been described as “kind and irreverent” when she had full mental capacity.  “How are you doing today Mrs. Hirschbeuler?” I would often ask, and she would usually respond “Oh, I am doing pretty well, for a little old lady.”

Mrs. H would often answer questions in song lyrics, although the song was usually Meet Me in St. Louis. Which, oddly enough, had more applications as a relevant answer for questions than a lot of songs.  It was strange, the way people with her illness often lost the capacity for rational and ordered speech long before they lost the ability to recall song lyrics from a lifetime ago.  It probably revealed more about the way the brain developed than neurological researchers had fully realized.  Dementia was fascinating to watch as a clinical progression, as the brain began to unravel itself, with higher cognitive functions disappearing first, such as forgetting how to get somewhere you had been before, and how to play complex card or board games, followed by a varied if somewhat predictable progression downward.  Mrs. H seemed to be caught in the moderate levels of dementia, and had been that way the entire time I had been familiar with her case.

Mrs. H had no living relatives we were aware of, besides a son who lived in her native Germany, and who would perfunctorily contact us the 3rd of every month, to see what needed ordering in the way of toiletries and personal items, as well as inquire about her health and mental state.  He paid her fee to remain there twice yearly, in February and July.  Every other week a Catholic priest would visit and she would dutifully take communion, and pray the Hail Mary with him.  Other than that, she had no visitors, and I knew very little about her past, except what she would reveal in her directive speech: “Mrs. H, where are you trying to go?”  Mrs. H “I am going to the bus stop, I have to go home, my father is waiting.  My father is a pharmacist, did you know that?”   “Where did you get this doll, Mrs. H?”  “I got that doll when I was 5 years old, and did you know that was 90 something years ago?”  It was strange, the way she would sometimes reveal that she knew how ancient she was and other times she would look for her parents, as if they hadn’t died last century.

In her room was the aforementioned doll, which I took to be German, since she was German.  I had googled “German Dolls” one day after work on a whim, and one of the first image search results that popped up was a doll almost identical to Mrs. H’s.  Same disproportionately large eyes, that almost seemed to be in focus, the same too round cheeks, like someone had stuffed a small orange under the cheeks, the same too curved nose and too small mouth.   I marveled at the difference between her generation and mine, musing on how I had hung onto hardly anything from my past, not even a HS yearbook or old school uniform.  My generation is like that, the disposable generation.  The doll wore a simple linen smock and was about 2 ½ feet tall.  The doll sat in a rocking chair in her room, like a sphinx guarding her possessions.  Not that she had many. Just clothes, that she had apparently made the majority of herself, the rocking chair, a bed, a dresser and a few other odds and ends.  The doll was the oldest thing in her room, and the most unique.

Mrs. H had a roommate when I first began my stint at the elder home, another ancient by the name of Charlene Hill.   Charlene was around the same age as Mrs. H, but her appearance lacked the skeletal sparseness of Mrs. H’s.   She was stout, with gray hair and milky brown eyes.  She was pleasantly, beautifully confused.  She also received communion every other Sunday from the same priest.  We would trot them down there together and they would sit on the bench and patiently await bread and wine and benediction.  They remembered the shallow physical rituals of religion, if not the spiritual depth behind them.

Charlene was much further advanced in her dementia than Mrs. H. She had no coherent speech or thought patterns, and very little purposeful movement beyond walking with a walker and eating and swallowing.  She would sit and hum and move her fingers back and forth, like she was playing the world’s tiniest violin.  It was eerie and beautiful how sometimes her rolling fingers would match her humming perfectly, almost like an orchestra director.   We all cried, or at least teared up, when we found her dead one morning, cool for at least an hour.  Her hands were like twin claws drawn up into her rigid form.  It was like all the flesh melted off of her the night she died, leaving only the bare minimum stretched across her bones.

It was strange how much life could be found in the dementia unit, with all the death that hovered around the place constantly.  There were the physical signs of life, of course, the fingernails and toenails that continued to grow and had to be clipped, the hair that had to be trimmed, the rise and fall and breath sounds of respirations, the pulses that hovered just beneath the surface of the skin.  The walking and the talking, other indications of life.  And the stories behind the usually pleasant patina of dementia.   I read somewhere that stories are what separates us from animals.  I don’t buy that. I am almost positive that any kind of communication, whether it is a bee telling the others where the nectar is richest or a monk relating a parable to a spiritual seeker, is a story.  I also read that the teller of the story has to respect the listener/reader enough to let them figure out the meaning of the story themselves.

*****

My boss dropped a blue file on my desk.  “You’re getting a new resident next week.  Moving in with Mrs. H.”

“Great!”  I said, not really meaning it at all.  So much paperwork.   “What is her name?”

My boss fingered the file.  “Emily Wright.  She laughs at everything you say.  Fairly high functioning, but needs help with dressing and bathing, and has episodes of incontinence.  She’s sweet.  She’s a redhead.”

I did love redheads.  There had been this redhead one time, younger than me by a few years,  three times my size in muscle and so incredibly strong and tender…..I shook myself out of my reverie.  To go there in front of others was dangerous.  Those thoughts were best left for later, beneath the sheets, where a kind of benediction could be had.  Plus, weird.  It’s weird that a sexy thought had been triggered by the description of an elderly, decrepit human.  The mind is a weird place.  “If she’s that high functioning, why is she moving in here?” I asked my boss.

“Well, she’s not so high functioning she can live on her own.  Forgets to eat, drink, change clothes, that kind of stuff.  Also, she has rashes from not keeping herself clean.”

Eww.  “Does she have an order to treat that?”

“Yeah, it’s being taken care of.  This was going on for months before someone intervened.  It’s shameful how these families will let some of these people get.”

“Oh, I know.  You would think they would care more about the person that reared them.”   I just tended to agree with the director of nursing about whatever.  Yes’mum, uh huh, you are always right, oh it’s SHAMEFUL the way this group or that group acts, oh yes, that person does NOT do their job, yes yes ma’aam, and can I do anything else for you?  I wonder how much of my personality was being subsumed to her demands for agreement.  You wonder when someone talks so much shit about others to you, what they are saying behind YOUR back.  “Do you know what kind of rash it is?”

“Ummm….I think its shingles.  That’s actually why we are putting her with Mrs. H.  Hirschbeuler has a history of shingles, although its been inactive for 15+ years.”

Jesus Christ. I thought.  That’ll spread like a fucking wildfire.  This is just friggin great.  But all I said was “Okie dokie.”

Okie dokie? Really Char?  Are you suddenly a yokel in an old country western?

Mrs. Wright was sweet.  She had an easy laugh at most anything, although inappropriate at times.  She had a twinkle in her eye, and graying red hair.  She was pleasantly and jollily plump.  She would make the fourth roommate Mrs. H had since she I had been down in the unit.

Mrs. H did seem to have poor luck with roommates.  Of course, most people her age tended to.  It was funny how someone with advanced age could be fine one day, get what seemed to be a cold or a fever, and quickly deteriorate into death.  People under 75 were not like that, on the average.  Only the very old had that particular distinction of such a quick progression into death.  Of course, if you looked at their entire life before as their slow and steady decline, then the quick deterioration did not seem to be so quick, but rather an inevitable end to a process that had been in motion since conception.

The roommate Mrs. H had when I first came here was Charlene, the previously mentioned Catholic roommate.  Charlene lived with Mrs. H about 9 months, and her condition declined from walking and talking (incoherently) and being mostly continent to not eating, refusing to be bathed or changed, and having to be wheeled around.  And of course, when a dementia patient gets like that, the end is usually near.  I believe she lasted about 2 months in that dilapidated state.

The next roommate lasted even less time than Charlene, and I hate to admit that I cannot even remember her name.  I remember her face.  It can appear that the elderly all look alike, but I believe that is only because we choose to look quickly away from them, because they make us uncomfortable.  I could go on a rant about our culture choosing to lock away aging and death from the flow of society, but, it’s been done, and by better thinkers than I.  I don’t remember much about this roommate but her face, and her gray hair.  She was pleasantly confused and would rarely interact, so she did not stand out.  I do remember what she ended up dying of.  Gastrointestinal bleeding.  That major mesenteric artery in her belly burst and she bled out, quickly.  Our bodies become ticking time bombs as we age.  That woman had probably lasted about 3 months in room 209.

The third roommate, Mrs. Chou Ramses, had actually lasted about a year and half.  Mrs. Ramses was funny.  She was an Asian woman, Korean I believe, who had married an army man ages ago.  She and the army man, Bob, had been hard drinkers who had led fast lives, according to their only daughter, Mary.  Mary disclosed to me that she really disliked both of her parents, especially her father, but that she felt obligated to care for them.  I can still remember the pain lurking beneath the surface of her tightly controlled tiger mother demeanor, and wanting to reach out to her and give her a hug or at least touch her hand, and say “Hey, it’s okay not to like your parents.  Sometimes I can’t stand mine.  You are doing the right thing by caring for them.  Believe me, you would regret it later.”  But I did not, because you can sense when someone will accept your compassion and empathy, and when they will reject it.  She was a rejecter of strong emotions and tender feelings.  It would have burst the control she had over her life, the rigid discipline she had inflicted with routine and workouts and rituals and rules for her life.  No out of control binging on food or substance overuse for Mary.  Just cool, tight routines.  I bet her jaw was tight as hell.  I bet it ached worse than mine did about halfway through the day, and her perfect teeth were surely veneers since I was sure she had worn hers down by grinding, just as I had done with my own.  Someone said to me one time “People weren’t meant to live as long as they do.  Look at their teeth.  Teeth last, what, 40 years or so?”  While not entirely true that teeth have such a truncated lifespan, (Mrs. H, for example, had better teeth than me), I agreed that he was probably correct.  Also, he was good looking, and I am a young human woman.   A young human woman surrounded by keen reminders of her own mortality 4 days a week.  Ugh, depressing.

Mrs. Ramses’s most interesting characteristics was her crawling along the floor and picking at unseen things, which we finally figured out was her miming picking rice.  Surely she had done that in the rice paddies of her youth.  Also, she swore a lot.  At hilariously inappropriate times.  The best was during a visiting church service, she called the minister a goddamn motherfucker during his sermon.  I hurried her out of the service, barely stifling a loud and inappropriate laugh.  She would chant and sing in Korean, which my coworkers and I found fascinating.  She was yelling at Mrs. H one evening in their room, sitting on her twin sized bed while Mrs. H. stood confused in the doorway, clutching her walker like it was a life raft.  She was babbling incoherently, which was of course interspersed with swearing, when her eyes just rolled back in her head and she fell back on the bed, clutching her red sweater, and died.  LaDonna and I, who had been trying to calm her and remove Mrs. H, looked at each other.

“Is she a DNR, Char?”

“Ummm—let me check the chart real quick, and you get in CPR position.  Stay here, I will be right back.”  LaDonna nodded affirmatively.  She was a brick, an awesome nurse’s aide who I depended on for help and support.

I walked briskly to the nurse’s desk, and indeed, saw the purple sticker on her chart.  Thank god.  I thought. In my opinion, anyone with moderate to severe dementia should be an “Allow natural death” patient, also known as DNR.  I was always surprised at the amount of our patients who were not.

I reentered the room, and noticed movement out of the corner of my eye on Mrs. H’s side.  I looked to see if it was a resident who had wondered in there, and saw Mrs. H on the bed, stroking the hair of her creepy German doll and singing to it quietly, a German lullaby.  She was making eye contact with the ancient toy, and smiling at it, as a mother smiles at a baby.

I shuddered at the creepy little scene, but what was I going to do about it right now?  I turned toward LaDonna and the body of Chou.  “She’s a DNR.  Thanks for your help.  Let’s clean her up real quick and I’ll go call her daughter Mary.”

“Mary’s gonna have a throwdown tonight,” LaDonna laughed.

“You know that woman hasn’t ever had a throwdown in her life.”

She laughed again.  “I hear ya.  What should we dress her in?

“Well, obviously that red sweater she’s holding on to for dear life.  Didn’t seem to help her much, though.”

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