by David Dosa
“It was like one minute, my mother was fine, and the next month she was lost. She just wasn’t herself anymore. We took her to the best doctors, the best specialists, and they would give her pill after pill. She must have tried them all at one point. The doctors thought she was depressed, so they gave her antidepressants. She couldn’t sleep, so they gave her sleeping pills. Her memory failed, so they gave her a memory pill. The more medications they gave her, the worse she got. Eventually, things got so out of hand that your colleague finally admitted her to a psychiatric hospital just to wean her off the medications. Turns out, they probably were just making it worse.”
She shook her head at the irony of it all. “Kind of strange that we had to admit her to a hospital to get her off medications.”
It’s actually not so strange. Over one-quarter of hospitalizations today result from the collective effects of overmedication. The fact is that all medications, even herbal and over-the-counter drugs, are potentially dangerous in certain clinical situations. Elderly patients today are exposed to more and more medications all the time.
“When she got out of the hospital,” Donna continued, “it was obvious that she couldn’t come home. From that point on she went from one nursing home to another. What an eyeopener that was!
“When my mother was in the first nursing home, I got a phone call from the nurse at the facility telling me they were sending her to the emergency room for evaluation. I asked them why and she told me that, at eighty-four years of age, my mother had hit an aide while they were trying to change her. Now, my mom was feisty, but she never would have done this if it wasn’t for her disease. I rushed off to the ER and they did the workup. The doctors ended up finding nothing, but when they tried to get her back to the facility, the nursing home refused to take her. In the end, my mother stayed in the emergency room for three days while we tried to find a place for her to go.”
Donna got up from her chair and walked nervously around her kitchen.
“You know, David, this is what really gets me. It was like no one in the hospital really cared where my mother ended up. They just wanted to get her out of the ER as soon as possible. I had to fight tooth and nail; finally, I was able to pull strings and get my mother into a nursing home like Steere House. To this day, I know that the only reason they took my mother was because I knew all of the doctors who worked there. Imagine if I hadn’t had those connections or hadn’t known how to find information about those different nursing homes? The whole system is just plain bad.”
Donna became quiet. The memories washed over her and again tears came to her eyes. This time she let them flow.
“Sometimes, when I think about those days, I don’t know how I did it. I had a plan every day that was minute-to-minute; I had to have a strategy just to be able to work, care for my son, and be there for my mother.”
“That must have been hard on you.”
Donna looked at me as if I’d just said something like “It must snow a lot in New England in the winter.”
“David, unless you go through it, you truly have no idea. I had no life for myself.”
In anyone else this might have seemed like self-pity. With Donna it was just the facts.
“I had no life, but that wasn’t so bad. I could deal with that. I understood that this was my cross to bear. The worst part was the guilt about not being there for someone else. When I would miss my son’s swimming meet because something was going on with my mom, I would feel terrible. When I would go to the swimming meet, I would feel guilty that I was not visiting my mother. Sometimes when I left Steere House, I would feel so guilty about putting my mother in the nursing home that I would drive home crying the whole way. ‘Good Italians’ are not supposed to put their parents into nursing homes.”
Donna managed a halfhearted smile and shrugged her shoulders.
“In the end, I guess I didn’t have a choice. I just did the best I could.”
She looked at me and I could tell that we had gone as far as she intended to go.
“Doesn’t stop the guilt, though?” I asked.
“It never really goes away. And those dreams…”
WE TALKED for another two hours, about everything from her job to her social life as a single parent, and then I told her about the recent birth of my daughter. Eventually I glanced at my watch and realized how late it had become. I got up off the kitchen stool and began to gather my things.
“Wait!” Donna said. She looked at me with the hint of a smile. “You came here wanting to find out about Oscar and you almost left without asking me.”
“I guess our conversation seemed to go in a different direction,” I said. “Or maybe I’m not as open to the idea of Oscar as I thought I was.”
She laughed and gestured for me to sit down again.
“So, Ms. Richards,” I said, putting on my best reporter’s voice, “what do you think about our four-legged friend, Oscar?”
Donna laughed and gave me her Oh brother! look, an expression I hadn’t seen since we worked together.
“First off, my mother hated cats! Earlier in her life, I would have half expected her to poison Oscar had he jumped on her bed. It wasn’t just cats. My mother really didn’t like animals, period. Didn’t see the point of them. Yet, as she got worse and worse with the dementia, she seemed to take more comfort from the animals on the unit. I don’t know what it was about them, or about the changes in my mother, but something really had changed. It was like she was more receptive on some deeper level. Does that sound strange?”
“Not at all. In fact, lately I’ve been wondering a lot about the true nature of our connection with animals, especially when we’re very young and very old. My son has always been drawn to animals, even before he could talk. I’ve seen that same intense curiosity with some of my patients, too. It’s as if the relationship somehow transcends language. I’m just now learning how smart animals are.”
“Well, Oscar was smart. That much I’ll say. He generally kept a safe distance and left my mother alone, but when he’d wander by and she would stop to talk to him, well, he stopped too. He never stayed long and he never cuddled up to her—Oscar was more like a visiting dignitary than a house cat—but he always stopped as if to hear her out.”
Visiting dignitary indeed.
“What did you think of the animals at Steere House?”
“Well, in a way, it was strangely comforting. A distraction of sorts. I mean, it didn’t change the fact that my mother was in the nursing home, but it did make her surroundings a little more bearable. More like home than a home, you know? In a way, I think the presence of the animals also helped my son.”
“What do you mean?”
“Well, nursing homes are not easy places for kids. Sometimes he’d come up to the floor and go off in search of the cats. It was better for him, playing with Billy or Munchie on the first floor rather than sitting in a straight-backed chair swinging his legs. And it would give me a little more time to spend with my mother.”
“Was Oscar there at the end?”
“Absolutely. When my mother got sick for the last time, Oscar spent more and more time in the room with me. It was as if he knew I needed the support. It was truly bizarre. He seemed to warm toward me. More than that…he seemed to understand.”
Donna gauged the look on my face and continued.
“Well, I was at the bedside for pretty much the last seventy-two hours of my mother’s life. I even slept in the recliner next to her during that time. When I would try to rest, Oscar would wander into the room and snuggle up next to me. Then he would jump over from my chair to my mother’s bed and sit down beside her. He did that for pretty much the entire time that my mother was dying.
“The thing I can’t get over is that Oscar always seemed to know when he was needed, and he never seemed to want anything in return. Oh, he’d let me stroke under his chin and rub his little ears, but even that—well, it was as if he knew that it was helping me. Which it did. There’s something really c
alming about petting a cat…”
“Was he there when she died?”
“A few hours before my mother died, one of the nurses came to talk with me and convinced me to go home for a little bit. I wasn’t sure if it was a good idea, but the nurse persuaded me to go. Sure enough, my mother died shortly after I left. Oscar never left, though. He was there when she drew her last breath.”
“Were you upset that you left before she died?”
“No. Quite honestly, my mother probably waited for me to leave before she let go. That was just her style.”
Donna smiled.
“Besides,” she said, “she wasn’t alone. My mother had Oscar.”
CHAPTER NINE
“A cat is a puzzle for which there is no solution.”
HAZEL NICHOLSON
IT WAS AS IF I HAD STUMBLED ON A SCENE FROM THE Summer of Love. A small group of interested onlookers, residents, and staff had surrounded the front desk of the unit, blocking my view of the spectacle. Like a small child trying to get a better look at a passing parade, I picked my way through the morass of walkers and residents. All eyes were on Oscar and Maya, who appeared to be in the throes of ecstasy. Both cats were charging around the desk at breakneck speed, stopping occasionally to roll around, flailing their limbs in the air. It was like watching a drug-fueled pas de deux, with cats instead of dancers.
I pushed my way to the front, where I found Mary.
“Who put the Benzedrine in Mrs. Murphy’s Ovaltine?” I said.
“Catnip,” she said.
Watching their whirling-dervish routine, my inner veterinarian took over. “Are they sick?” I asked.
Mary laughed, and then launched into an explanation, almost shouting to be heard over the yowling of the cats and the laughter of the staff and patients.
“Cats love it—it makes them crazy. There’s some kind of chemical in the herb that gives them an almost sexual high.”
I looked at Oscar, whom I had been thinking of as this wise, Sphinx-like creature with all the answers. He was chasing his tail. “What, do they smoke it?”
“Don’t you know anything about cats?” asked an aide who overheard me. I was joking but honestly, I had little idea what catnip was.
“I’ve never owned a cat,” I said to the aide.
She laughed. “Nobody owns a cat, Dr. Dosa. They own you!”
Mary came to my rescue.
“The cats don’t smoke it, David,” she said. “They just roll in it. You can see the results.”
“But they do act like little drug fiends!” said the aide.
As the hilarity died down, the novelty of seeing our two resident cats acting like clowns wore off even before the catnip did. People began to drift off and I stole into Mary’s office to check my messages. She followed me in.
“How was your meeting with Donna?” she asked.
“Interesting,” I said. “She told me that her mother really hated cats, all animals really, until she met Oscar.”
“Isn’t that something?” said Mary. “That you could even forget what you once hated.”
“An old Irish patient of mine asked me if I knew the definition of Irish Alzheimer’s,” I said.
Mary cocked an eyebrow, waiting for the joke. “And?”
“He said, ‘You forget everything but the grudges.’”
Mary laughed. “Well, I don’t think the Irish have a lock on resentment.” She looked out the window at the thinning crowd. Oscar and Maya were lolling about on the floor now, a couple of old hopheads coming down off their high.
“But Donna also told me how glad she was that Oscar was there at the end,” I continued. “It was as if he gave her permission to leave. She said later she figured her mother wasn’t going to die with her daughter there, so Oscar did a service for both of them, in a sense.”
“Like a bridge between the mother and daughter,” Mary said.
“Yeah, like a bridge.” I looked through the glass with her at this ordinary house cat, passed out on the carpet. Maybe I was the one who’d been smoking the catnip.
“So, are you going to talk to some more family members?” Mary asked. “Remember those two sisters who lost both their parents here? Oscar was with their mom when she died.”
“Rita and Annette,” I said. “I thought about them. Though I’m not really sure what I’m trying to discover.” I looked at her again.
“You could always go see Jack McCullough…or what about Mrs. Ferretti? Didn’t you have a good relationship with her?”
I could sense Mary prodding me on with my journey of discovery. “Did you ever see Citizen Kane?” I asked.
“Oh, God, ages ago.”
“Maybe I’m like that reporter, you know, the one who goes out to discover the meaning of ‘Rosebud.’”
“That’s right!” said Mary. “And in the end it turns out to be the name of his sled.”
“Yeah, that’s what the audience finds out when they show them burning it at the end,” I said. “But the reporter never learns anything.”
“You never know, though, until you try.”
I smiled and changed the subject, “So, who do I need to see today?”
YOU KNOW WHAT THEY SAY about the weather in New England? “If you don’t like it now just wait a few minutes.” My day at Steere House turned out to be just as fickle as our climate. Less than an hour after the hilarity of the crazy-cat carousel, no one was laughing. In fact, the atmosphere had become toxic.
Just an hour or so before everyone had been laughing as if they were at the circus. Now it seemed I had stepped right into the midst of a heated battle between Mary and a well-dressed, middle-aged woman I recognized to be Saul Strahan’s daughter, Barbara. Two nursing aides were standing silently beside the desk, watching the two of them go at it, apparently over a pair of slippers.
Mary was trying to placate Barbara Strahan. “I appreciate this may be upsetting, but if we can keep this in perspective…”
“Don’t you tell me about perspective! I don’t need—” and before I could slip past she recognized me as her father’s doctor.
“Can’t you do anything about your staff up here?” she said to me. “This is the third pair of slippers that they’ve lost in the last two years.”
Finding myself in the middle of a conflict I knew nothing about, I said nothing. Barbara threw up her hands, then turned her fury back to Mary and the aides.
“Is it too much to ask that you keep track of my father’s stuff?”
Mary offered a cautious explanation.
“I’m sure that your father’s slippers will show up soon. One of the other residents probably just took them from his closet. We’ll find them eventually. We almost always do.”
“Why can’t you keep the other patients out of my father’s room?”
“We try, Barbara, it’s just that it’s very hard to control what they get into when we’re not watching.”
“Well, try harder!”
As if to emphasize her point, Barbara made eye contact with each of us one by one, and then stormed off. But before she did, she took one last look at Lydia, a Spanish-speaking aide.
“You guys need to get better help around here,” she said. “Or at least someone who speaks better English!”
With that parting shot, she stormed off down the hallway toward her father’s room.
I looked over at Lydia. A tear had come to her eye, one that she quickly wiped off with the back of her hand.
Mary put her hand on Lydia’s shoulder.
“She doesn’t mean it,” she said. “She’s just upset.”
Lydia nodded and attempted a smile, but the insult had stung deep and I could tell that it would take some time for her to recover. She turned and walked away. The rest of us remained in awkward silence. Mary shook her head and then turned to an aide.
“See if you can find those slippers,” she said quietly.
“Well, as always, I timed my arrival perfectly,” I said as the young woman left. “What was
that all about?”
“That was Saul Strahan’s daughter. I thought you two had met.”
“Only once, when her father was admitted. Mostly we just talk on the phone. We’ve been talking a lot lately.”
I sat down at the desk and looked directly at Mary. A perfectionist in her work, she was probably seething inside. Aside from her own pride, injured by the accusation that she didn’t run a tight ship, I knew that she felt even worse for the aides.
“I need to go outside for a cigarette,” Mary said. She walked back into the nurse’s office and spent several minutes searching for her pack. When she emerged without her coat, I could tell that she had already calmed down.
“Seriously, Mary, doesn’t that get on your nerves?”
She sighed. “It’s hard to believe sometimes, but I’ve worked here for almost ten years, and at a lot of other nursing homes before that. At this point in my career, I can pretty much put every family member I meet into one of four categories: those who are angry, those who feel guilty, those who are afraid, and those who are all three. We try to work with everyone to eventually accept this,” she said, holding up her hands to encompass the ward, the residents, and the finality of it all. “In time, most of them do. Sometimes we just can’t get them to accept this reality quickly enough.”
“So, what is Barbara Strahan?” I asked. “Which category does she fall into?”