Nursing homes, we all know, are terrible places — the forgotten precincts, overcrowded and understaffed, the ghost towns where two-and-a-half million Americans live, in varying degrees of boredom and loneliness and neglect. Nursing homes, we all know, are not where we want to end up, not where we want to put our parents.

Is it possible, as Sallie Tisdale suggests in her new book, Harvest Moon: Portrait Of A Nursing Home (Henry Holt), that “so much of what appears terrible, smells and sounds and looks terrible, is not the fact of the nursing home, but the fact of age and illness”? In this insightful and deeply compassionate work, Tisdale takes us into the “foreign land” of the aged, skillfully bringing us face to face with our own fears about aging and dependency, and illuminating with details both tender and grim the odd, self-contained world of a nursing home — the pseudonymous but real Harvest Moon.

Tisdale is a registered nurse whose writing has appeared previously in The Sun. We’re thankful to her and Henry Holt and Company for permission to reprint these excerpts.

— Ed.

 

© Copyright 1987 by Sallie Tisdale
Reprinted with permission of henry Holt and Company, Inc.

 

Florence taught me to sing, not well, and we would sing and skip and laugh out loud. I knew her years ago, in my first job in a nursing home. I was a nurse’s aide, I was seventeen, and she was in her seventies. Florence was confused, happily so, unsure from moment to moment of her age, her history, her condition and status in life. She was not inclined to wonder, happy to accept whatever explanations I and others would offer for the apparent inconsistencies in her life. She sang a few songs many times: “I ain’t had no loving since January, February, June or July!” And skipped a step on her walk to the dining room.

One afternoon she beckoned me over to her room, where she waited in the doorway. She leaned over close to me to whisper in my ear, pointing surreptitiously to her roommate, an obese and balding woman sleeping in a chair by the window. “That woman,” Florence told me, enunciating carefully. “She told me her family put her in a nursing home.” She widened her eyes in proper shock at such a thing. “Can you imagine? Isn’t that awful?

And oh, yes, Florence, I wanted to say. Oh, it is awful.

 

We all die, and most of us grow old, and for a certain inevitable number of us age brings its sisters: dependence, frailty, and a gut-wrenching perishability. Age is the last place and time most of us will inhabit, and the fact that age seems so foreign to most of us, as though cleft from the known world, is one of life’s sly tricks. It is outside the compass points, outside the native land we dwell in till we reach it. The time comes, for most of us, when we have to consider — for ourselves or someone we love — those awful places, those terrible, necessary institutions, those nursing homes.

This terribleness is not always obvious. Ordinary, even familial things happen here, though often unwitnessed. Wounds are healed, muscles strengthened, faces washed, and hands held. Each small movement is tiny in its fruition, huge in its absence. But in spite of these gestures, to most people the nursing home remains a cockeyed slanting world, without common reference, begging despair. Finding no one to blame for old age, why not blame those who house it?

This despair — felt not only in the presence of such things but simply from the knowledge of such things — is both personal and organic. “I pray to God I die before this happens to me,” murmurs the wife or the son, gazing sideways at the old and irrevocably dying relative. It is like an experience of others’ pain giving life to one’s own before it is felt. The death of other people, witnessed in slow, trivial steps, becomes the death of oneself, too soon. The queer conversation of the confused telegraphs one’s own inevitable, terror-struck annihilation. All these losses are like giant secrets, or errors, in the machinery, that take place not with a dramatic excitement — it would be almost more bearable if they were accompanied by fireworks and lightning — but with a plodding, daily dullness.

I can see it all another way. The sameness of each day shaves away the apparent passage of time. It makes something different of time, something insignificant, until the day’s routine is the simple facts of bodies, people, dependence, and the paring down of borders that hold us separate.

 

I like nursing homes. I have since I first took a job in one, and learned, without knowing what I was really learning, how to change a bed with a person in it — a very old, fragile, dying person who watched my every move from silent eyes. At seventeen, I was struck by the intimate knowledge of age’s force. I was too young to know how young I was, to know I should have thought of myself apart, separated, from the old people I tended. Without knowing what I was learning, I learned about age as though I, too, would grow old in the course of things. Old age, and the delicate, powdery skin, the brittle bones and coarse hair — the outward signs of an internal passage of time — quickly became normal, even ordinary, things, and in a vital way unimportant.

This is our world, for better or worse. By their nature, nursing homes are self-justified worlds, concerned with problems, crises, and solutions of no concern to the culture at large. They exist precisely because their concerns aren’t shared by the culture at large; they were created to manage those unavoidable concerns abdicated by that same culture.

Standing apart in this way, almost parenthetically removed from its environment, the nursing home becomes a kind of tribal village, a place of misfits. It has a language of its own, customs of its own. It is slightly out of plane, not quite polite, designed for people who have no other place to go, no other place to be, who don’t mingle with the rest of us. Nursing homes are communities of people incapable of claiming more than they receive, utterly at the mercy of our goodwill. I have been in enough nursing homes for enough years to become a part, a participant in a world of unexplained noises and strange sights, odd appearances and mysterious events, which at their heart are the most mundane of things. Nursing homes hold all the force and drama of life and death and the movements between, made manifest in earthly banality. This is where I travel, this is my family, my culture, where I live. I guess I have become a kind of expatriate here, hoping for visitors.

So, I have written a kind of travel guide, a gentle introduction to a foreign land. I often felt curious about how the whole mechanism worked — how communities of 50, 100, 350 people worked together, with the added piquancy of long-term illness and need. What are the shifting relationships like? What is communicated, what forgotten? What are the little moments, tiny things half-seen, glimpsed from the side as though driven by at top speed: Did I really see that? Did she really say that? All these things are mysteries, all familiar. I found a nursing home gracious enough to open its doors to me, and I watched. In the course of my months in Harvest Moon I found myself caught up not only in big concerns, in questions of considerable size, but in many small concerns, too — in a single step, and how to take it, a single bite of food, a glass of water, a snowfall, a memo, a glance.

I am still surprised by how much there is to see that I’d missed in my headlong rush of nursing, and how much I had to miss still because so much happens at once. What immensely detailed lives we lead, each of us, even in bed, even shuffling down a bare hall, even sleeping in a chair, dreamy, confused. This is a kind of picture, angle and line, gleam of light, shape, with empty spaces and shadowed corners. Pictures always have frames, and something outside them; stories always have silences, and this one is no exception.


She is a little foreshortened now, her bones drawing slowly into themselves, taking up less space. But Anna Rosenbaum was always short. She grew up in the streets of Brooklyn, poor, tough, leading with her dramatically hooked nose. Anna came to San Francisco more than fifty years ago and worked as a waitress in all-night cafes and bars on Fisherman’s Wharf.

Anna never married; she hints at bad affairs and back street, window-breaking lovers’ spats. She is an alcoholic, and has spent most of the last ten years in and out of welfare hotels, sleeping in the unkempt beds of other restless people; sleeping, sometimes, in doorways. Anna never stopped to imagine her future, which came too slowly to see, edging up behind her and fueled by long nights, hard drinking, and faithlessness.

Anna’s hips, like other things, have failed her. One, porous and weak, was replaced surgically with a shiny promise of steel — a broken promise. The other hip became so badly infected that, in the end, the surgeons threw up their hands and cut the whole joint out. Her legs are different lengths now, twisted unnaturally sideways and back. In the last year, no longer able to walk, she has checked herself in and out of several nursing homes, playing each time the part of the perennial bad girl at parochial school — smoking in the elevators, climbing over the bedrails, disappearing for hours, and, always, mocking those around her with a stream of abuse.

Her cheeks hang loose and jowly from a dry, emaciated face. Her eyes bulge in exophthalmic surprise on either side of a nose broad and long as a bridge abutment. She has no teeth, won’t wear dentures: her tongue is chronically inflamed. “My tongue’s a mess, see?” she says, sticking out the swollen, yellowed muscle. “They tell me I got a bacteria. I can’t urinate. I can’t move my bowels. I’m crippled. It’s a helluva way to live, I tell you.”

Decades of smoking have coarsened and lowered her voice to a trembling tenor, still thick with Brooklyn. At night she sings to herself, old songs from earlier years, the ones that men in San Francisco bars would use for raucous serenades, before bursting into loud laughter. She entertains herself by deriding the nurses — “They kick me and I kick them” — and giving her jewels of wisdom to her visitors, who are all professionals, all social workers and their ilk. Her family is gone, her friends dead or lost.

Every day the physical therapists here strap a three-inch block of wood to her shorter leg, brace it around into a semblance of order, and help her to stand. She must make progress, must leave her wheelchair behind or her Medicare will be cut off. Today she insults the aide, shaking her head, then insults herself. She stands in the doorway of the therapy room, a little woman frowning in a crowd of well-wishers, and counts out loud to three before rising. The change is abrupt and complete. Her face falls into ruins and she cries.

“I can’t do it, honey, I can’t do it.” Her legs tremble, she slides backward into the chair with strong hands guiding her. “Oh, honey, you get old too soon and smart too late.”

Harvest Moon Care Center is a nursing home for 100 people, located in a residential neighborhood in a medium-sized West Coast city. The architecture is undistinguished, the landscaping ordinary and not quite finished. The walls inside are broad and painted in cheap, dull colors, decorated with amateurish oil paintings of fruit bowls and flower vases. In these characteristics Harvest Moon is like most of the thousands of nursing homes in the United States. In some respects, though, Harvest Moon is different, even unique. It is owned by a large fraternal organization with a long-standing interest in caring for the elderly, and has a good reputation in the community. People sometimes wait months for a vacancy here. In a market turning toward for-profit corporate control at an almost frantic pace, Harvest Moon remains decidedly non-profit, surviving partly on donations and second-hand equipment, and run by a board of directors determined not to sink in an increasingly cut-throat market.

It is mid-October, a Tuesday, and at ten-thirty in the morning the sky over Harvest Moon is still overcast and cold. I stand at the central core of four hallways by the long nurses’ desk, called the station. Each of these hallways is populated by a shifting assortment of people and equipment. The walls are decorated with posters, two different kinds, all cartoons. One kind reminds workers to wash their hands; the other exhorts the reader to quit smoking. On the corner of one wall is a felt-penned sign with an arrow, saying CATHERINE’S ROOM THIS WAY. There are people walking, people riding in wheelchairs, people with canes, and they detour around tall shelves of empty, littered food trays, housekeepers’ carts neatly stacked with white bottles of bleach and disinfectant, and cupboards with locked drawers full of medicine. An old woman sits on a high plastic chair with a hole cut out of the bottom. She is naked under the flannel sheet that wraps around her and cocoons her arms in against her body. Her withered feet and mottled, pale legs hang unprotected below the hem of the material. She stares ahead, unblinking, waiting to be showered. From behind a closed door comes a loud giggle. People break across the rock of the nurses’ station, dispersing in every direction. In the odd corner created at the intersection, where the two halls don’t quite meet, hangs a birdcage with a silent parakeet. Below the cage an old man in a wheelchair whistles a tuneless, wheezing song to the bird.

Paula Schulz is writing rapidly in a thick chart propped open on the chest-high counter at one end of the station. Paula is the nurse practitioner at Harvest Moon, a registered nurse with postgraduate training — in Paula’s case, almost two years — in medical diagnosis and treatment. Paula is certified as a geriatric practitioner, specially trained in the care of the elderly. She works under the nominal supervision of Harvest Moon’s medical director, a physician who visits briefly once every week or two. It is Paula’s job to manage the medical care of the patients from day to day. She is a department of one, independent, moving through every department with equal dispatch. She wears red stretch pants over her full hips, a polka-dot red blouse with a big, silky bow tie, and a dark sweater. Over her clothes she wears a lab coat; its left breast is decorated with a half-dozen medallions and pins of honors and associations. She has short, dark, wavy hair flecked with gray, and bright, dark eyes in a face both fit and attractive. On her wrist she wears a digital watch with a shiny vinyl band that matches the red of her pants.

When Paula finishes her writing, she grabs an orange chart from a wall of files, each with a stripe of orange or blue or green, and strides quickly down the matching orange hall till she finds Phoebe White lying in bed. Phoebe White is ninety-one years old, a fine-boned, tall, white-haired woman with square glasses. She is pleasant, polite, almost patrician. She is confused, too, and struggles to explain the perplexity around her.

We had breakfast recently, Phoebe White and I, and I asked her if she would eat her eggs. “Are you going to eat your eggs?” I asked, pointing to a yellow mound in front of her. “Eggs?” she asked me, stalling, and I pointed again. “Well,” she finally replied, pulling herself up, “I don’t know what they are, so I’m not going to eat them.” Across her face passed a kind of relief, at another obstacle conquered, another scene averted with minimum fuss.

Several days ago Phoebe fell into a slumber and wouldn’t wake. She became feverish, and was taken to a local hospital for observation. The hospital released her a few days later, without an explanation, an I.V. needle stuck in her arm to provide fluids. Since that time she has refused to eat, and her weight has dropped. When the I.V. stopped working two days ago, she refused to allow another to be put in.

Paula asks her without preliminary if she has changed her mind about the I.V. Paula asks Phoebe every day; she is bound by law to offer food and water to every patient, every day. Phoebe smiles thinly with a trace of humor; she is sitting upright in bed and dressed in a flower-print housecoat. She has a delicate, almost vulnerable strength, like a long-dormant athlete. She looks capable of holding out for a long time.

“Don’t you touch me,” she answers Paula.

Paula is silent a moment, then smiles slyly herself, happily, and slowly reaches out with her index finger and pokes Phoebe in the arm. Phoebe sneers at her.

You know what I mean.”

Paula laughs and leaves, opening the chart as she passes out the door, already scribbling a note of the conversation.

 

Cathy Bosley, a plump, blonde woman in her late twenties who works as the activity assistant, heads briskly down the hall a half hour later. It is almost eleven and time for the weekly Trivial Pursuit game she conducts with a passion. As she passes Phoebe White’s room she sees an aide helping Phoebe into a wheelchair; Phoebe, too, has a passion for the game, when she remembers. Cathy stops at the central hallway beside a small woman in a wheelchair.

“Are you coming to Trivial Pursuit?” Cathy asks, leaning down, hugging her arms possessively around the woman’s shoulders. She speaks in a loud, cheery voice. Verna Livingston looks up at her from a few inches away with a sour face.

“All right, all right, I’ll go,” she finally answers. “You go first, then I’ll go. All right, all right.” She starts to turn the chair toward the dining room where the game is played. “I don’t have anything else to do.”

The dining room borders the double front doors, which open to a crowded parking lot bordered with a hedge. Visitors enter the front hallway beneath a windblown American flag, pass a receptionist at a desk, and face the smokers’ table in the dining room a few yards away, before they turn. Near this table a small, quiet group gathers.

A sullen man in a white uniform positions the many wheelchairs in place at the table. When Phoebe White arrives, she beams happily as she is parked beside Max Kleiner, a white-haired, lump-faced man with jug ears that pitch wildly out from his head. Since a stroke several years ago he has been unable to walk. Max talks in a stream of diphthongs and phonemes repeated in happy verbosity. Now he sits at the table laughing continually, head turning rapidly from face to face, following the movements of each person in the room.

“Wee-wee-wee, bay-bay-bay!” he cries. “Woo-woo, wee-wee-wee.” Each phrase is uttered with maximum expression, the sounds of an infant discovering his toes, sounds of delight and invention, lewd in their insinuation of sensual promise. Max Kleiner’s fat vowels are so close to actual words that listeners strain to understand until, with reflection, they finally turn to something else.

Phoebe turns to Max now and her face brightens with memory.

“That’s him! That’s the man! They had me married to him this morning!” she cries at the table, pointing to Max with a long finger. Then she turns to Verna Livingston beside her. “I’m Bernice’s sister. She owns this place.”

The sullen young man announces that the players should separate the tiles in front of them into piles, and leaves the room.

“Why separate them?” asks Phoebe.

Verna answers, still sour. “I don’t know. I don’t know why.”

“It doesn’t make sense.”

“No, it doesn’t make sense.”

“What’s the point?”

“I don’t know the point,” says Verna, and reaches for a mound of tiles, beginning to stack them. Max reaches, too, but the aide has placed the tiles out of his grasp. He plays with his hands.

“If they’re going to give us tea, I have a cookie,” announces Verna. She holds up a pink napkin she has kept hidden in her lap. “Here’s my cookie. I have one cookie and it’s cracked.”

Cathy Bosley, meanwhile, has pulled a stack of cards out of the Trivial Pursuit box and is ready to begin. The game requires only that Cathy read the question to the group; whoever knows the answer calls it out. The first correct answer wins the speaker a tile, and when one person has collected three tiles, they are gathered back and the game begins again.

“Who was the 1960 Sports Illustrated Sportsman of the Year?” Cathy asks, speaking in a loud, ringingly cheerful voice. She glances around the table, then repeats the question.

“Bobby Orr.” The voice belongs to Maude Davis, a ninety-three-year-old woman who rarely attends activities, preferring in her irritation the solitude of slow prowls and her room.

“That’s right! Goodness, that’s correct!” cries Cathy, shaking her head. She hands Maude a tile and Maude retreats into silence.

“Buddy, are they going to give us tea?” says Verna loudly. “I have a cookie.”

“No,” replies a husky, dark-haired young man down the table.

“Well, I guess I won’t get to have my cookie, then.”

“Who was Sherlock Holmes’s smarter brother?” Cathy calls out. No one answers. Two nurse’s aides walk in and head for the vending machines in the corner. Smoke drifts to the table from the three patients sharing a newspaper and a smoking break nearby. Overhead, four electric fans turn in lazy imitation of the slow pace below. Cathy repeats the question.

“Um, um, eighteen, um, eighteen seventy-nine!” says a woman hunched down in her seat.

Phoebe suddenly grabs Max’s hand and smiles hugely; Max Starts babbling with excitement. “Whoo-whoo!” he cries like a train whistle. “Whoo-whoo, ha-ha-ha, whoo-whee!”

Phoebe laughs happily. “Ouch! Ouch!” she giggles.

 

And this is how the days go, in dreamy conversations of unclear intent, jokes without punchlines, sorrows without end. The patients who retain their wits often avoid as much as possible these gatherings, the odd meetings in the hallways, the chaotic winds of damaged cerebrums. But they are here, too, and sometimes here to stay.

Here there is a constant going on, and a constant staying the same. Phoebe and Max and Verna lead lives of sameness disturbed by tiny and constant stimulations of brain and body. When I am in their midst it seems a world in continual refinement, even renewal. It is as though each member were almost, but not wholly, complete, and sought through the repeated, inactive days a final harmony, a topping off. Someday it will be my turn — to be old, to be sick, to feel my own dying surround me in a cloud of soft certainty. Perhaps someday I’ll rock myself to sleep like Anna, singing old songs creakily in the dark, and the young face that passes briefly over mine like a revenant will pay no heed, bear no mind to the meaning of the words. It won’t be that young girl’s fault; she’ll be too young to know.

A hum of activity underlies the passiveness — it is velocity without motion. It is, after all, a community of human beings going about their complicated and inexplicable business. But the climax is never reached.

A Greek chorus murmurs in the background, and now and again individuals step forward, as though on cue, and deliver brief and poignant lines. These are the questions no one else thinks to frame.

 

Gertrude Werner is wearing a shiny pink raincoat, made of a nylon material that glistens in the fluorescent light as though already wet. Her hair falls lankly below her stooped shoulders. A nose flares out of her bony face, deepening her already sunken eyes. She steps up to the counter like a Fate, her stockinged legs peering out of the raincoat into pink slippers. She addresses the nurse on the other side.

“I heard you might have some scissors for sale,” she says in a nasal German accent, politely, without hope.

“No, I don’t,” answers Bonnie Pereira, without looking up from the mound of paper in front of her. She gives the rapid response of one who has answered the same question before, a litany in unconscious memory.

“I didn’t think you would,” replies Gertrude, disappointed, unsurprised. She waits a moment, blankly, and just as she turns to go her face takes on a brief glow of animation. She turns back and manages to catch Bonnie’s attention one more time.

“Yes?” asks Bonnie, weary, amidst the PA. announcements and ringing phones and conversations that swim around her.

With hope now, with a slight concern, even with mild wonder, Gertrude leans over the counter and asks, “Do you know enough about why I’m here to tell me?”


Another day, new questions, new voices, but always a poignant familiarity. I like to think these things, these little rivulets of interaction occurring on the periphery, are efforts to explain, to illuminate. Sometimes I tell myself that the very obscurity of these layered relationships is an explanation of a kind.

Phoebe White, propelling herself in her wheelchair by scooting forward with her feet, is hurrying as fast as she can. “Sister! Sister!” she cries to Verna Livingston ahead of her. I push her to catch up, but when she sees Verna’s face she does an exaggerated double-take and says, dismayed, “That’s not the mother! What’s, what’s the name of, of the man?” She points around her, upset.

Verna looks at her with disdain and wheels slowly off in the opposite direction, down B Wing. Phoebe is visibly disturbed by the desertion.

“Come on, come on!” she pleads to Verna’s back, and an aide, annoyed, takes hold of her chair from behind and pushes her toward the dining room, telling Phoebe, “She doesn’t want to go that way.” Phoebe, in tears, shakes her head.

“Yes, she does. Yes, she does.”

And before Phoebe is safely down the hall — but after her tears are dry and the scene forgotten — another scene begins, a sibling squabble.

Gertrude Werner has begun to chastise Angela Gonzales, a silent, acquiescent woman, severely retarded. She has been in Harvest Moon so long as to have taken on a kind of absence; uncomplaining, apparently comfortable, she is as present as a file cabinet or the scale. She has a hump in her back that bends forward in a curve. Gertrude has somehow become convinced that Angela is a recalcitrant little boy with bad posture; she takes this act of defiance personally. When she finds her, she berates her. As an aide steps forward to intervene on Angela’s behalf, Gertrude starts pushing and tugging on her shoulders.

“Come on, little boy,” she implores. “Hold your head up!”

 

It is a bickering family, a family in which cousins speak only to each other, the aunts only to the sisters- in-law. A certain amount of misinformation is inevitable. Grudges simmer, rumors turn somehow to unmitigated fact, accusations creep quietly underfoot. Every family has its secrets, and its sororities; every family its own magnetic center. Harvest Moon is bottom-heavy with unskilled labor paid the lowest wages, overseen by a small group of well-educated, well-paid professionals.

Walking the halls, one sees almost a caricature of social delineation, a stew of race and age and education, culture and language, motive and intelligence. Almost all the darker faces belong to housekeepers and janitors and kitchen aides, who include Filipinos, Hawaiians, blacks, and Vietnamese. Almost all of the management is white and over forty years of age. Lying in bed are housewives, plumbers, retired nurses, schoolteachers, a symphony violinist, a ham radio operator, and a pediatrician in his nineties who claims to have delivered over two thousand children and disliked each one of them personally. Every person’s image of every other person, of each event, is so different as to be incongruent with any other. Each person has at least one goal at odds with that of another person. The parceling out of power is most uneven.

In this place people who are very different from one another come to see their similarities, and also to see the subtle differences in people assumed to be the same. It is possible, this way, to find one’s place in the community, a proper place of the correct size and shape. To work in a nursing home with any kind of contentment requires a balancing of the needs of self and other, an ability to give without expecting gratitude. My contentment comes and goes, and often seems to disappear completely; I feel bitter and acerbic and snap at the people I pass, hurriedly, in the halls; I am weighted by work never done and events never explained. And then it returns as suddenly, lit by moments when I pass out of myself into a continuum without a beginning or an end, at last a member and not a watcher. I search almost compulsively for this contentment — unlike any other — and the clues along the way. It drives me back to sounds and smells that might, without association, be unpleasant, but which have become through the years the sounds and smells of home. Wherever I travel within the culture I am at ease.

 

There are two sides to the terribleness of the nursing home: one is the fear that the patients are not well cared for, their needs not met. There are bad nursing homes out there, unfortunately, and I wouldn’t put my own mother in a lot of facilities I’ve seen. But the most vehement arguments against bad nursing homes come from nursing home employees who fight this steep battle of bad press. It is not always obvious how well a nursing home cares for its residents, because so much of what can be seen — so much of what appears terrible, smells and sounds and looks terrible — is not the fact of the nursing home, but the fact of age and illness. A visitor may see only a restraint, and a small woman pressing pitifully against it; the nurse nearby sees the woman’s confusion and weakness, the broken hip lying in wait past her next step. The visitor hears the cries for help and the ringing of bells, and senses neglect, laziness; the nurse finishes one task and moves to another, and another, making mental notes, and knowing all along that the cries for help often don’t cease when help is given. The cries for help have an almost metaphorical place in the work being done. They are the work-songs in the field.

It is an imperfect design, but the nursing home — both conceptually and physically — is designed for dependence. It is, in its way, both economical and precise — and more. Many of the people who come here to work for brief spells, to pass time between other, more desirable jobs, find themselves unable to go. By joining the community they become party to a compulsive concern for the patients, a hunger to know what happens to them, to affect what happens. A lot of people call it love, without apology. I call it community, and membership. It is a most comfortable and touching familiarity, a gut recollection of an unremembered, not yet experienced past.

 

Paula Schulz remembers almost every patient she has known in seven years at Harvest Moon. They are, after all, hers in a way few people can become the property of another person — through the memory of skin and powerlessness, a kindness offered without return. She loves them in all her pragmatic busyness. I understand; I read the obituaries every day, seeking the names of people I might have known for only a few days, never to see again. And when I find a familiar name, I feel a bit of pleasure at the nostalgia, in the very moment I feel sadness that now I will, truly, never see them again.

It is a measure of the familial, as well as the very long infirmities borne by some, that I recognize people when I come to Harvest Moon, patients I have cared for in other places, other buildings. Anna Rosenbaum is one; I saw her face, proud, ugly, and a little frightened, and knew her without hesitation. I had cared for her months earlier in another place, until she signed a release and left one day, unannounced. The first day we met I helped her sign for a Social Security check; making conversation, I asked her how she planned to spend it. She melted me with scorn. "Why, honey,” she said, rasping through a cigarette, “I’m going to get drunk, what else?”

There are others who remain rooted in my mind, frozen at the moment I last saw them — leaving work, waving good-bye, already distracted by other things, errands, babysitters. They are moved by family or condition or act of God and the body to another place, another form; so many hundreds of people passing briefly under my hand — a body washed, a back touched or mouth cleansed, and then gone. I am unreasonably happy, then, to see on the wall of files at Harvest Moon a few familiar names. No illusion, they won’t remember me — but to duck my head in a door and see again a face in memory is a fine thing.

Laura Lembke is falling off the pillow — the big, fluffy, white-cased pillow her devoted daughter gave her. She is falling sideways, one eye closed, the other half-open. Her hospital gown is crooked, exposing a soft, fat shoulder, and her thin, dry, white hair flies around her head like a crown. She is round, squat, and all her parts are the same: small, perfectly round, apple eyes in a round, pink, powdery face. She looks like a snow creature shaped by careful, dreaming children. Her right hand holds a delicate Japanese fan. Her little, pink mouth is dusted with food stains.

I lean over her bed. “Laura? Laura, are you all right?” She looks quite dead, but when I say her name louder her eyes flicker.

Laura tells her daughter, who visits every day, long stories — that she has won the lottery, that the “nice people” who work here take her out to dinner every night. One employee calls her Scarlett O’Hara.

“Are you all right, Laura?” I call, even louder, and then she wakens, exactly the woman she was six months ago, twelve months ago, a little surprised, as though she’d suddenly had the breath knocked out of her. Her voice, when she answers, is wispy and slightly whining, a child’s voice, and very soft.

“Oh, I’m fine, dear,” she says slowly, so that it’s clear she is not, and the arm slowly rises until she can begin fanning herself. She still lies sideways between the bedrail and the pillow, watching me. She is a five- year-old girl in dress-up clothes: today she is pretending to be a sick old woman and this, she imagines, is how a sick old woman acts. She retains a remarkable sense of the melodramatic. I help her upright and soon leave, her attention wandering to the window, the fan slowly beating a breeze across her cheek.

On the way out of her room I see Cecil Lunt, restrained in a wheelchair by a broad mesh vest tied behind him. He is well over six feet tall, and was gaunt when I first met him more than three years ago, a diabetic with heart problems and Alzheimer’s disease, his health rapidly failing because his confusion interfered with his medical care. He would not eat or take medication, gritting his teeth implacably against such intrusions. He careened down the halls, striding perilously and headlong across the floor, zigzag, rushing. We let him wander until he started to fall. As the disease worsened so did his behavior, deteriorating into biting, hitting, kicking, fits of yelling.

Today he is, surprisingly, still alive, shuffling his feet, bonier, thinner than ever, silent. His mouth is open in an expression of perpetual disbelief; his scalp is utterly bare, shiny, mottled with age spots. When the nurse arrives with his medicine, he drinks it without protest. I touch his hand, his arm, call his name, and he doesn’t respond. He stares ahead, shuffling his feet and going nowhere but on and on, never moving when I straighten up and walk away.

Is it all just unbearably sad, dreary, wrong somehow to find pleasure of a kind in such scenes? I am not supposed to, I know; my dark jokes, the laughter, is sometimes viewed with a slightly horrified scorn. It would be better to be grim, to settle for a bleak despair beside Cecil Lunt, an embarrassed blush for Laura Lembke. How can I explain the gratification, the sense of a hunger fed by such simple contacts? I need the absurdity, the quirks as much as the caring; they provide the balance so essential. It works for me in part because of compassion — not sympathy, not empathy — but something made of equal parts love and disinterest. The love is nothing distant, either, nor academic, but love born of experience, sweaty in the embrace of the real and immediate. It is made bearable by dispassion. To do otherwise is to love another’s pain, for the pleasure of not feeling it. I am learning to love and be present in the face of someone I love without interest, without an agenda of what I need or expect from that moment of contact. I am learning to love disinterestedly. Disinterest is a kind of respect — a recognition of another person, separate and complete, and not so very different. I cannot forget them, so nearly newborn, cannot stop following their trembling course through an unforgiving, short-sighted world. Brief conversations that never conclude, small moments suspended — these are the only rewards to be found. And they are great, precious, gleaming jewels of satisfaction that take me out of myself and into a blurred world where age and youth are the same.