A History of the Present Illness

by Louise Aronson

  “You drink more now,” the nurse said, gently patting Edith’s arm with one hand as she squeezed the box with the other.

  There was a gurgling sound and the hint of a cough, but soon enough Edith drank more.

  On a paper taped to the wall above the head of the bed under the word “In,” the nurse noted the time, the product name, and the amount consumed.

  “She doing good,” the nurse announced to the family with a big, encouraging smile.

  “Now can we go home?” asked Frankie.

  *

  Sunday morning, the family met for breakfast before heading to the nursing home. When they got to Edith’s semiprivate room, her bed was empty.

  “Holy . . . ,” said FJ as Melissa grabbed their children and pushed them back into the hallway. On their way out, they had to squeeze between the doorjamb and Frank, who stood frozen in the entryway, staring at the naked mattress.

  He was sixty-seven years old and wholly unprepared to become an orphan.

  Maybe his mother hadn’t been the best parent—certainly she hadn’t been as attentive to him as he and Jean had been to FJ—but he felt sure she’d done her best. On the second-to-last day of the war, when his father died—not from the injuries he’d sustained in France, which had included the loss of half of his left leg, most of his hearing, and all of his sense of humor, but from a car accident—his mother had become a pregnant thirty-one-year-old widow. Ancient by the standards of the day when she married for the first time, there seemed no chance she’d get lucky a second time, so she’d gone to work. As he grew up, her job had changed from telephone operator to sales clerk to ticket agent to office girl. The office job, her last and best, was where she met James Michael McMurray, the closest thing Frank had had to a father. Mac taught him how to throw a curveball, how to check the tires and change the oil in his mother’s car, and why he might want to consider shaving a second time on Friday and Saturday evenings. For the better part of a decade after Mac moved in, Frank hadn’t caught on that the reason his stepfather spent so much time away from home had less to do with job-related travel than with his wife and six children across town. After Mac’s death, his mother retired and shifted her focus from people to pets. The sculpting had come later but with equal passion.

  Frank heard the rapid, staccato click of heels on linoleum and turned to see Melissa hurrying toward him, flushed and excited.

  “I found her,” she panted. “She’s out here. She’s fine.”

  He closed his eyes and exhaled. Then, for only the fourth time in the thirteen years since Melissa Wong had joined the family, Frank Picarelli smiled at his daughter-in-law. She took his hand and led him down the hall to a bed-shaped chair by the nurses’ station.

  Jean watched Frank latch on to Melissa and had a vision of him—of herself—debilitated and dependent in one of these places. They were nearly old enough already. If it weren’t for Edith’s characteristically stubborn hold on life, they’d already be next on the chopping block.

  The family stayed all day, though there wasn’t much to do but watch TV, flip through magazines, or play card games.

  Pillows and blankets hung off the recliner’s edges like the drooped leaves of a dying plant. Edith’s hair, tinted and usually perfectly set, resembled the surface of a once-beloved throw, bobbled in some places and desperately worn in others. Unlike the previous evening, she no longer moaned or sighed or swatted away the aides who returned at regular intervals to poke a thermometer under her tongue, wrap a blood pressure cuff around her arm, and clip an oxygen sensor to the tip of the one finger from which the hospital had removed the polished fake nail.

  “I’m so glad she’s more comfortable now,” said Melissa. Edith, unlike Frank, had welcomed Melissa into the family, giving advice on the care and feeding of Picarelli men and sending small checks for the kids whenever she could afford to and whether or not it was Lily’s or Frankie’s birthday or Christmas.

  In the late afternoon, a nurse told them that the doctor would be in early the next day and suggested that they head home for dinner and a good night’s sleep.

  Edith Picarelli hardly noticed when, one after the other, her family kissed her good night.

  Just before noon on Monday, most Picarellis having now missed a half day of work or day camp, the doctor ambled into the semiprivate. His stylish goatee and round, rimless glasses glistened in the fluorescent light, competing for the family’s attention with a Grant Wood American Gothic necktie.

  He leaned over and loudly announced himself to Edith’s right ear.

  “She hasn’t been doing much talking,” offered Frank.

  FJ snorted. “Much? She hasn’t spoken since the day before yesterday.”

  The doctor examined her, then went into the bathroom to wash his hands.

  FJ picked up a sculpture, one of the recent ones, judging from the asymmetric shape and unglazed, clay-orange color. He’d already missed two meetings and a deadline at work.

  “How is she, doctor?” Frank asked when the doctor reappeared.

  “She’s great, Dad,” said FJ. “She’s really having a bang-up week.”

  The doctor draped his stethoscope over one shoulder like an ornament.

  “I think what Frank’s trying to ask,” said Jean, “what we’d all like to know, is how long—”

  “She’s always been a very active person,” interrupted Frank. “It will be a problem if she can’t get around on her own.”

  “Dad,” said FJ. He looked over at his children and lowered his voice. “Mom. Jesus Christ. Look at her. She’s dying.”

  The doctor held up a hand. “Now, hold on. This is a fracture, not a stroke. She’s dehydrated. We give her some fluids, and she may perk right up.”

  “Right,” said FJ. “Like a plant someone forgot to water.”

  The doctor smiled. “Exactly.” He and Frank shook hands.

  FJ looked at his parents. “Mom, Dad, please. Listen to me. Maybe—for Gran’s sake . . .”

  Though it hadn’t beeped, the doctor swept the edge of his jacket to one side and touched the pager hooked onto his belt. “Pain medication, some salt water. We’re not talking about heroic measures here.” He nodded at Frank. “And now, if you’ll excuse me . . .”

  With the doctor out the door, Frank looked at his son. “Over my dead body.”

  And just like that, the crisis ended. The next morning, Edith sat upright in the reclining chair, eyes open. The day after, she began drinking again, and on the third day, after dispensing the other residents’ bedtime medicines, the nurse they’d met the first evening removed her IV.

  Lily and Frankie went back to day camp, FJ and Melissa returned to work, and Jean drove to check on the Napa house, a two-hour trip in stop-and-go traffic past a nearly uninterrupted series of strip malls and cookie-cutter houses, most of which hadn’t existed fifteen years earlier when she and Frank had bought the property so they could eventually retire to the country.

  Frank, often but not always accompanied by Jean, continued to visit Edith daily, reading the newspaper while she dozed and, when she woke up, wheeling her along the corridors and through the tastefully planted garden before leaving her in the fluorescent-lit atrium by the nurses’ station.

  As days collected into weeks, Edith seemed neither better nor worse. The recliner became her home—she ate, slept, and bathed in it. “Chocolate,” she said sometimes when the box the nurse gave her was green and the liquid food inside it vanilla flavored. “No,” she said when the aides asked if she wanted to go to the art room or to a concert in the main auditorium. “No,” she said when they informed her that her grandson was on the phone and wanted to talk to her. Otherwise, she didn’t speak.

  Two months later. Still in the recliner. Still drinking.

  Three months. Four. Seven.

  Her hair grew long and straight, until only the tips still had color, as if she’d been turned upside down and dipped into a near-empty well of platinum paint.

  “That’s not Gr
an,” Frankie whispered loudly to Lily one Sunday afternoon on what his parents decided would be his last trip to the facility. “That lady doesn’t even look like Gran.”

  Eventually Edith Picarelli stopped talking altogether. She ate little, though apparently enough, and made few spontaneous movements. The aides bathed her once a week, tied her wispy white hair into a bun each morning, changed her diapers five times a day, and turned her every two hours—left side, back, right side, and so on.

  On the one-year anniversary of the fracture, when FJ called the doctor’s office, the nurse told him that according to the doctor’s notes, his grandmother’s skin was in great shape, her heart strong, and her vital signs entirely normal.

  “What does that mean?” FJ asked.

  “Well,” said the nurse, “I’d say it means she’ll be around for a while longer.”

  * * *

  By the Labor Day weekend of his fourth and final year of emergency-medicine training, Quentin Chew knew that he could handle whatever came through the hospital doors: overdoses with obscure, nefarious poisons; bones and organs crushed by two tons of accelerating steel; screaming babies with projectile vomiting; and violent psychos in drug-induced frenzies. What he couldn’t handle were days like this one, shifts so slow even the medical students had time to eat, take a piss, and text their friends about the latest of their youthful Saturdays lost to the hospital.

  To kill time, Quentin checked labs on a couple of patients in holding patterns pending the daily discharges and deaths that would free up beds upstairs. Next, he invented reasons to talk to the unit clerk, a kid still in college who thought he might want to be a doctor someday and whose huge blue eyes followed Quentin around the department. Quentin enjoyed the flirtation but hoped the boy understood they were just playing around. As soon as the state completed its inspections, he and Ralph were set to become the parents of one-and two-year-old half sisters whose repeatedly incarcerated mother had relinquished custody.

  “Hey, Quentin,” called one of the nurses. “You might want to get in here.”

  The patient was ancient, a nursing home dump in the eleventh hour. The single sheet of paper accompanying her listed a questionable diagnosis of pneumonia and the name and phone number of a son.

  “I called already,” said the nurse, a woman so smart and experienced that Quentin always felt like the frosting to her cake in patient care. “Left a message on the machine. It sounded like a landline to me. Let’s hope they’re just out to lunch and not out of town for the weekend.”

  “A landline.” Quentin laughed. “Who the hell still has a landline?”

  The nurse looked at him over her bifocals as she secured the IV. “You need to get out more, Dr. C., mix it up with the over-forty crowd. Besides, this lady’s a hundred and one years old. Her baby boy could be pushing seventy or eighty himself.”

  “Tell me she’s DNR.”

  “She’s DNR.”

  He couldn’t hear a blood pressure. He inflated the cuff again and this time felt for the pulse with his fingers.

  “You’re saying that to make me happy.”

  “I don’t like you nearly enough to do that. I called the nursing home. She’s okay for antibiotics, no for everything else.”

  Quentin ordered antibiotics and increased her fluids. “She must have been okay for hospitalization, too. Just our luck.”

  The nurse shook her head.

  “You’re shitting me. Then why’s she here?”

  “Staffing issue at the SNF. Apparently they have a rule not to do palliative care unless they can do it right.”

  Quentin watched the patient’s heart on the monitor. She was already having runs without beats. He turned off the machine.

  “On a theoretical level, I’m all for that. But who gave them the impression that we could do it right here? I’m calling the team now. They need to get their asses down here.”

  Quentin did the handoff quickly, reading the patient’s name and unit number to the resident, then giving her a one-liner on the patient’s precarious situation. He didn’t recognize the name Edith Picarelli, and since she was dying, there was no reason for him to read the chart in which he would have found his note from the first time he met her, when she’d come in three years earlier wailing like an injured wildebeest.

  As they did every year over Labor Day weekend, the Picarelli family had gathered at Frank and Jean’s house in Napa. Every now and then over those three days, while flipping burgers on the barbecue, taking a walk along one of the grapevine- and tree-lined lanes, or watching a baseball game on the tiny television with its rabbit ears antenna and six viable channels, one or another of the adults—usually Frank—would mention that they missed Edith, and shortly after that, someone else—usually FJ—would wonder aloud whether they should have done things differently from the very beginning. But each time the subject came up, at least one other person—usually Jean or Melissa—pointed out that they hadn’t done much of anything at all, and nothing other than what had been recommended by the doctors and nurses, so they shouldn’t blame themselves for what had and hadn’t happened to Edith since her fall and fracture. Invariably then, someone—most often Frank but sometimes also Jean, since they were at that age when conversation often turned toward symptoms and illness—told a story recently told to him or her by a friend or acquaintance with a supposedly similar experience that sometimes really was similar and ended in the same way but other times became either a litany of suffering followed by death or an almost evangelical tale of months of intensive care and constant worried vigilance that were not called torture, because they were followed by a miraculous recovery, the ancient relative stronger and healthier than they had been before the heart attack or infection or surgery. And it wasn’t clear to FJ and Melissa, who were already anticipating having to deal with the decline of Frank and Jean, whether the ultimate outcome of these stories depended on the older person him- or herself, or on the doctor or nursing care, or even on the underlying problem and its treatment, or whether it all came down to less tangible factors such as luck and timing and personality and imagination. But the entire family agreed that in any case, at this point, there was nothing they could do about their outcome, which was, of course, also and especially Edith’s outcome, and which, while thankfully devoid of torture, had become—at least according to Jean’s niece Pam, who was visiting, having flown north from Mexico to finalize her divorce—a different sort of tragedy: a life that wasn’t much of a life in a home that wasn’t much of a home, a place of so many bodies in so many beds, a place where some people went to live and others went to die—or not die, as the case might be.

  “At least she’s comfortable,” said Melissa.

  “Amen to that,” added Frank.

  At dinner, Frankie—hoping to make up for having kicked his soccer ball into his grandmother’s favorite rosebush earlier in the day—raised his glass. “To Nana,” he said, and the rest of the family followed suit, lifting their glasses high and taking big sips of wine, Scotch, juice, or milk, each of the adults hoping to remain healthy forever or, failing that, to die quickly, without warning or prelude.

  Days of Awe

  For weeks he’d been planning. By the morning of Rosh Hashanah, the pieces had fallen into place: his election to the Residents’ Council, an open room in the Jaffa building, and a signed contract for his trio, We Three Hebes, to play at the Hardly Strictly Bluegrass festival in Golden Gate Park. Now only two obstacles remained between Harold Chaikin and a happy ending—the small challenge of telling his wife and the larger one of securing his room change.

  He felt badly about Ruth, but he refused to feel guilty. They had lived at the New Israel Care Home for seven months already, and she hadn’t once made an effort to adjust. Instead, she let it be known—to him, to the staff, even to other residents—that debilities notwithstanding, only fools willingly gave up the real world for an institution. She would leave in a heartbeat, he knew, would prefer to live almost anywhere else, but they
hadn’t had children, and most of their friends were in similar straits or worse, so he’d reasoned they’d be better off here than alone at home with only each other and paid help for company. But since their arrival, while he explored the New Israel’s possibilities, Ruth wallowed in their losses. As he worked to adapt, always encouraging her to do the same, she chose, again and again, to give up on life.

  The sun was barely over the horizon when he made his announcement.

  “Moving?” Ruth repeated, pushing up from her bed. “Where are we going?”

  “Not we,” he said. “Me.”

  Her hair, unbrushed for days, hung limp at the sides of her face.

  “Nearby,” he said. “Another building, one closer to the music room and gym. That way I won’t keep disturbing you with my practicing and comings and goings.”

  She put on her glasses. “Wait a minute. You bring me to this prison, then leave? Is that what you’re telling me?”

  He’d promised himself he’d be patient and kind. “Not so loud. You want everyone to hear our business?”

  She laughed. “These people? Who the hell cares? Oh, it’s great to be you, isn’t it? Able to see and walk and do what you want. You self-serving bastard . . .”

  He pressed the call light. On and on she went, as if that kind of talk would make him want to stay. She never took responsibility for her part in their mess. Plenty of others at the home had every one of her admittedly many medical problems, which were real and horrible to be sure, but which the doctor himself had said might slow her down but wouldn’t kill her. And slow he could have lived with, slow he would have been happy to help with. But Ruth had chosen to stop. All day she stayed in bed, whining and watching TV. She refused to accompany him to concerts or services or on any of the field trips the home arranged to the symphony or the Marin Headlands or, just last week, to the new exhibit at the Academy of Sciences in Golden Gate Park. Instead—again—she was making a scene.

  The door to their room opened, and an aide stood in the entryway. It was the short, almost deformed-looking one who often took care of Ruth. She had one of those crazy names like Lovey or Peachy or Happy.