Posts Tagged ‘eldercare’

Anna

November 26, 2013

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I was drawn to Anna’s room this morning because I missed her in the dining room at breakfast. She was always there before me. As I clocked in at the nursing home each morning, and walked through the big open room, no one would be there but Anna. She’d wave me over, and make me twirl in front of her old eyes so she could marvel at my outfit for the day. If she absolutely loved the entire ensamble, she’d clap her hands, and reach out to kiss me. Otherwise, she’d give me a compliment on the bit of pink in my scarf, or the buckle on my belt, or tell me the blue of my blouse matched my eyes.

She wasn’t there this morning. At ninety-six, she’s been like one of those proverbial cats with nine lives. She’s fought off every cold and pneumonia that came her way, and continued to smoke through it all. “When you’re my age, honey, and you’ve lost all your real loves, your twin sister, your husband, your friends, who cares if you die from lung cancer? There’s no one left to grieve for you, and I love me a cigarette.”

I went to her room where I found her small frail body nestled among blankets and pillows. The oxygen tubing ran from her nose to a whirring machine at her bedside. Her eyes were closed and she struggled with every shallow breath.

I pulled up a chair, and took her hand. I sat for a long time rubbing my thumb across the fragile vein-lined skin of her hand. I remembered our trip to the football game where her husband’s University of Virginia Cavaliers played her Virginia Tech Hokies. She stood and cheered and laughed about how her husband was frowning down on her antics from heaven. “He never was a good loser,” she’d said.

At times Anna searched for Virginia, her twin. When reminded that Virginia had passed away some years ago, Anna would say, “Oh hell, that’s right. Once you’re connected with someone from the start, it’s hard to let go.”

As I got up to leave Anna’s bedside, I leaned over and hugged her one last time. I whispered in her ear that it was alright to let go, that Virginia and that Cavalier husband of hers were waiting for her with their arms outstretched, all she had to do was let go. I kissed her forehead and told her I loved her.

Anna completed her journey on this earth today. Godspeed my friend

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Jane

October 5, 2010

Most days, Jane sits slumped.  When alert, she shuffles her feet to propel the wheelchair forward. She wanders without purpose.  People pass her in the hallway on their way to meetings or in their haste to give a pill.  Sometimes she watches them.

“Good morning Jane,” the nurse says.

Jane looks up, and in about thirty seconds time, she responds,  “good morning.”

The nurse doesn’t hear her.  She’s turned the corner. Jane’s response is delayed. She has Alzheimer’s Disease.

Every day, we have a small group activity for residents with severe dementia.  We gather in a small circle in a quiet place at eleven o’clock in the morning.  We take turns introducing ourselves.  Sometimes members surprise us and say their name. 

We offer rhythm instruments.  Billy always takes the drum. He was a bass guitarist in an R&B band fifty years ago.  Pete likes the vibrating sizzle of the cymbals, Beth shakes a tambourine, Mary rings a bell, and Jane pushes the box away.  We turn on the CD player and an old familiar tune starts to play.

“You are my sunshine, my only sunshine.  You make me happy when skies are gray.  You’ll never know dear how much I love you.  Please don’t take my sunshine away…”

These five people cannot put a coherent sentence together. If words come, they don’t fit.  Sometimes one word in a mouthful of sound is intelligible.  Music makes a difference though. It comes from another part of the brain.  Maybe music comes from the heart, because every one of these people with advanced dementia, sings this song, every word of it. It’s the same with Amazing Grace, Don’t Sit Under the Apple Tree, Over the Rainbow and Will the Circle Be Unbroken.  When the music is playing, they keep time.  Heads lift, eyes open, and voices sing.   

Jane dislikes this part of the program.  Noise bothers her, and although she mouths the words to songs, it’s easy to tell that she was not interested in attending the Municipal Band concerts in her home town. Acapella is more her style.  She jumps when Billy comes down hard on the drum, and sends a disgusted frown in Mary’s direction when the bell rings. 

We turn off the CD and put the instruments away.  This segment of the activity is always different.  Sometimes we pass around a prop for everyone to see and feel.  Yesterday, it was an old tin measuring cup.  We handed it to each person and asked what it was, if they remembered using one, what they did with it. 

Pete put the cup to his mouth.  We reminded him  about his years of drawing water from the well and taking a cool drink.  Beth said, “baking cakes.” She turned the cup over as if pouring measured milk or sugar. Mary held the handle, smiled, and closed her eyes. She likes coffee.  Billy banged the metal cup on the table with a beat, like a drum.  Jane said, “Stop that.”

This morning,  we chose a close up picture of a three month old baby to share.  He was smiling and his bright blue eyes sparkled from the page.  His fat cheeks invited a pinch and drool was shiny on his chin.  A wisp of hair stuck up on his round head. Jane was offered the prop first.  She took the laminated photo, brought it close to her face, smiled, and with no hesitation at all, said, “baby.”  Then, she  kissed  him. 

Today, we found what Jane likes best.

Build a Green House, They Will Come

January 11, 2010

Our community needs a Green House. Not one for gardening, but one for growing the lives and minds of frail, dependent, elders. One that promotes cultivation of people in a warm environment. Currently, too many of our seniors with physical and cognitive challenges are planted in cold warehouses.

Two of my grandparents died in nursing homes. They had no choice. My grandfather had a massive stroke, lost the use of one whole side of his body, his speech, and his ability to control bladder and bowel.  Days spent in a wheelchair, dribbling food and drink from the corner of his mouth, trying to speak with his eyes alone, made my grandfather the saddest person in my life.  I visited and tried to bring a little light back into his existence, but failed in my attempts. I always left him, crying. A lifetime of fly fishing for trout, growing Beefsteak tomatoes in his garden and building homes from the ground up, only played as old movies in his head.  No one in the nursing home talked to him about his life; no one knew; no one cared to know.

My Grandmother lost her mind to dementia.  She didn’t recognize me.  Looking through me, she mumbled words that made no sense to either of us.  She dressed in backward layers and searched for home.  In her day, she raised five children, cooked meals that fed not only her own family, but others in the neighborhood who were hungry.  She pieced quilts to keep those she loved warm, and braided my long hair while telling me stories of her childhood.  To the staff in the nursing home, she was a wrinkled body that had to be fed, bathed, and chased down the hallway because she wandered, looking for purpose.

When my great-grandparents were elderly and unable to live alone, they spent six week intervals with each of their nine children. When the elders visited, they helped as much as they could with cooking, cleaning, watching the children, doing yard work and small repair jobs around the house.  When they were no longer able to be of assistance in a physical way, they used their knowledge to share recipes and gardening hints. They rested in rocking chairs, and at the end, took to the bed until it was time to ‘go home.’  Family gathered at the bedside, caring for basic needs and listening to last stories. When God and others before them called, this generation was sent to the next life surrounded by love.  Nursing homes didn’t exist.

In the 1960’s family units began to change. Women worked outside the home and children no longer lived in close proximity to their parents.  Something had to be done with Mom and Dad when age took their bodies or minds.  As elders became unsafe in their own homes—leaving pots on the stove, wandering winter streets at night with no shoes, forgetting to eat—families, children, and communities, needed a ’safe’ place.  There was no model.

The early architects of nursing homes looked to the hospital as their model.  Semi-private rooms, long halls, starched staff, polished tile, stainless steel, and shiny linoleum suddenly became ‘home.’  Kitchens were placed far away from living quarters. No one’s mouth watered from the smell of baking biscuits. Laundry swished and swirled in industrial machines and came delivered in folded stacks, with a scent of Clorox. Baths, meals, therapy, activities and laxatives came on a set schedule. For the sake of safety, doors locked, walking discontinued, bodies with weak legs were tied down and when voices rebelled, chemicals in the form of antipsychotic pills hushed them. In caring for elders, quality of life was sacrificed. Staff ‘cared’ the life right out of the wisest ones.

During a visit to the ‘home,’ visitors met with scenes of drooped heads, drooling mouths, calls for “help” and “bring me a pair of scissors to cut this strap.”  Bingo was the only activity that promised a surprise ending in a long and tedious day. Elders didn’t have a say in their care. Their feelings and knowledge were ignored.  They suffered alone in a building filled with people rushing about, or vegetating.

Laws in 1987 tried to regulate care, bringing rights to nursing home residents. It’s a sad commentary on a society that has to pass laws to protect its eldest citizens.  Each of us has these civil liberties—we are born with them, but because of rampant abuse and neglect, Congress passed a ‘Nursing Home Bill of Rights.’  Included in this mandate were the following rights:

  • to be treated with respect and dignity;
  • to receive care, treatment, medicines, and services in compliance with laws;
  • to be free from mental and physical abuse, restraints;
  • to open and read one’s own mail, have access to a telephone, and writing materials;
  • to manage financial affairs;
  • to enjoy privacy in one’s own room,  with a spouse and for the couple to share a room;
  • not to be expected to work for room and board;
  • to have personal belongings.

We, as youthful humans, take for granted and expect these rights. We become outraged if these freedoms are yanked from us.  In 1987, fundamental human rights had to be spelled out and enforced in nursing homes. Legislators developed a three inch thick ream of rules to regulate care facility practice. Nursing homes became the second most regulated industry in the United States behind nuclear power plants. Twenty two years later, there is change, but not nearly enough.

The medical model still exists.  Nursing home residents continue to suffer from loneliness, helplessness and boredom.  Institutions are large and every room, every hallway, looks the same.  Breakfast sits on the plate in a yellow mound. Lunch and dinner are ground into unrecognizable meats and vegetables. Sliced bread is the only piece of normalcy on the plate. There are few spontaneous activities, while choices are limited.

Elders are no longer tied down or given  pills to shut them up, but body alarms have taken the place of restraints.  If someone chooses to rise from a wheelchair and their legs refuse to hold them up, a screeching alarm alerts staff.  In most cases, the noise startles the elder into moving too quickly, and they sprawl on the floor anyway.  As soon as most residents arrive, they are presented with wheelchairs.  The halls in the building are long and the walk to the dining room for meals is quite a hike for arthritic bones. Loss of mobility comes quickly. Loss of self comes even faster. A person’s diagnosis becomes his name, his disability, a nickname, his frustration, and a staff member’s annoyance.

~~~

“There’s a new admission in 208, he’s a fractured hip, a feeder, and a screamer at night.”

~~~

Not all facilities are warehouses for broken, old people.  A reform movement called ‘Culture Change’ is making some progress.   It’s slow in coming, but all needed change seems to crawl when it should sprint. The main principle of culture change is person centered care.  Individuals in these homes are encouraged to thrive in a community environment, not decline. ‘Home’ becomes the operative word, not the residence that each person remembers, but closer than the institutions that exist today.

A social model replaces the medical one. Each resident’s room reflects her personality. Family photographs and artwork recognizable to the individual decorate the walls. Familiar furniture, a favorite chair, a vanity with a dresser set, and a four poster bed with a soft mattress make life more livable.  Memory books, with cards and notes from children and grandchildren, stories from the past, and love letters from a spouse provide comfort. Residents choose when they wake, when they want to rest, what foods they wish to eat, and when they bathe.  Staff members have consistent assignments—they learn the history, interests, likes and dislikes of the elders in their care.  More importantly, the elders recognize their caregivers and relationships develop. Nursing assistants begin to understand that care is not the physical act of bathing and dressing, cleaning and making beds. Care is about the individual, and helping to make her life worth living.

“Clara helps me get dressed for the day, then we can sit and talk a few minutes about the red bird couple visiting my bird feeder this morning,” says Joan, a recipient of culture change care.

Unfortunately, the rules that came in the 1980’s, designed to protect and care for elders, have discouraged a rapid jump into culture change.  Administrators and Healthcare companies are fearful of the new direction. Regulations are strictly enforced and severe monetary penalties are imposed for noncompliance. ‘Infection control’, limits family style dining, homemade foods brought in by the community, and the adoption of pets.  Medical care and treatment still supersedes a resident’s right to eat and drink what he enjoys, or have a peaceful night’s sleep without being awakened for turning, positioning, and care needs.

~~~

“I’m 96 years old. Sure I have diabetes, but I’d rather die from the sugar in a Hershey Bar than die from wanting one,” says Earl, a three year resident in a care facility.

~~~

Staff are so concerned with documenting care , that they don’t have the time to deliver it in a way that makes the resident feel like an individual.

“If services are not documented, they did not occur.” This statement comes directly from a State inspector.

“Get it done, write it down,  that’s what I have to do in eight hours with a caseload of ten residents,” says an overworked C N A. This rushed approach leaves the elder feeling like a piece of furniture to be dusted or a wilted plant needing water.

A forerunner of the Culture Change movement is The Eden Alternative.  It’s a small not-for-profit organization which is turning eldercare on its gray head.  This organization embraces the belief that aging is a stage of development and a person can continue to grow well into the age of elder-hood.  The Eden Alternative has developed new models for housing those in our society who are frail and dependent on others for care.  These communities are called ‘Green Houses’. They promote growth in their inhabitants.  When an alternative Green House is built, instead of an institutional design with long foreboding hallways, smaller, residential housing units are organized.  Each unit houses no more than ten private bedrooms with private baths.  The rooms have doors that open to a short hall or a great room. Each house has its own kitchen, dining room, laundry, front porch, mailbox, backyard with grass, bird feeders, a cat or a dog, and a garden.  There are upwards of fifteen units in a Green House community. Each house has ten elders, and a family of care staff.  Residents can assist as they are able with meal preparation, cleaning, laundry, gardening, pet care—all activities they would normally participate in at home. Recreational pastimes, calendared events, interests and hobbies are pursued with passion or not, depending upon the likes of each individual. Elders feel needed, valued and activities are meaningful. Each house is run separately from the others.  Each small community within the larger, is autonomous.

Where are the nurses?  Where are the administrators, social workers, business office personnel, maintenance workers, housekeepers, and dietitians?  This innovative living concept does away with some positions. Those that are necessary, are housed in a separate unit within the confines of the community. Care staff in the Green Houses are cross trained to provide personal care. Staff cook, clean, assist with activities, budget household expenses and shop for needs.  There is one ‘Administrative Building’, which houses offices and the nursing staff.  Nurses travel from house to house like home health workers. They come at a specific time, provide medications and treatments, then leave. The housekeeper comes once or twice a week for deep cleaning, and the bed and bath linens are taken to a separate building for washing. They are delivered back to the house when clean, reminding elders of the old time laundry services.  Personal laundry is washed, dried, folded, and ironed in each house with the assistance of the residents.  The elders rule their homes. They plan meals, celebrations, spur of the moment ice cream making, trips to the store, or poker nights.

Green Houses in existence have waiting lists. The concept is innovative and studies show that elders thrive in these communities.  Costs are lower, staffing needs are less, and quality time between elders and caregivers increases. With the Baby Boomer population reaching retirement age, society needs a new and better way to care for those who will be unable to care for themselves in the near future.

In a prime example, the City of Charlottesville prides itself on being a mecca for retirees.  Cultural, educational, medical and community based services for seniors abound in this city.  Yet, when a certificate of need is granted for an eldercare facility, an old medical model nursing home is built.  Isn’t it time that we, as an innovative community, take the reigns in the Culture Change movement.  Shouldn’t we set the example of improved quality of life for our frail elders?  Shouldn’t we make the difference before we are placed in a medical model facility and wish we had done something about care when we had the ability?

26″ Snowfall

December 26, 2009

 

     I usually spend too much money at Christmas.  By December 24th I realize that I’ve overdone it and start focusing on my bank balance to see how I can eek out the bills. All of my impulse buying happens the weekend before Christmas.  My self control freezes and I spend my savings trying to buy love.  This year we had a 26” snowfall the weekend before Christmas. The storm started at rush hour on Friday evening and the last flake fell pre-dawn Sunday. Snowflakes are tiny crystal miracles.  I wondered how many were in our 26” on the ground.  Traffic stopped, people walked in hip waders to the mailbox, only to find that the postman couldn’t keep his promise.  This year, instead of throwing myself into the shopping frenzy,  I sat at home, writing Christmas cards the old fashioned way because the electricity went out.  I read a book by the woodstove. I watched my children play in the snow. I drank hot chocolate with little marshmallows. I fed the birds.

     I wrapped the three presents I had for my husband and the boys, a hand-tooled belt with a hammered silver buckle, an 1865 volume of Virginia History, and a telescope for universe gazing. Presents were few, but special because they reached out to me from artisan booths, an antique book store and the pages of the Buck Saver earlier in the year. These gifts spoke to my heart in May, August and September and it listened, compelling me to shop for Christmas when the sun was warm.

     I spent eight months creating a photo book for my mother.  My camera and I chased sunsets west on Rt. 250, rested on our elbows, eye level with dandelion blooms, waited for raindrops to hang like tiny crystal balls from pine needles, and made old, abandoned houses feel like Home and Garden cover girls.  These treasures, along with my best words were bound in leather. The book was under the tree.  If I was stuck in the snow, my family would understand that at least I loved them a little bit.

     I had to work all week, early mornings and late evenings.  The holiday season in the nursing home is busy.  People in our community want to do nice things for old people at Christmas.  Citizens come in flocks to sing carols.  They buy boxes of fruit and sugar free candy to distribute.  Each elder receives a new pair of socks and a bottle of generic lotion in a plastic fishnet Santa stocking from the Salvation Army. If the resident has no feet, the toe ends of the socks are cut off and they are slipped over the arms as “geri sleeves” to protect fragile paper-thin skin.  Staff members gather, sort, box and label gifts so each resident receives at least one item on December 25th. A special menu of ground ham with glaze, instant mashed potatoes and mixed vegetables is planned for mid-day Christmas. It will be served to a lady at the dining table with the sparkly silk centerpiece.  She will sit with a woman who takes her teeth out and licks them between courses.  Christmas is not what anyone remembers.

     Work was especially difficult this week. Extra hours because of the snowstorm, and the holidays are sad for many of our elders.  Their pain extends to enfold us in its intensity.  We find ourselves offering more hugs and tissues than at any other time of year.  For some, we are the only family they have and most often, we don’t measure up. Some residents are related of our staff. It’s hard when your job and caring for your dying mother are the same.   A nurse, cook and CNA lost their mothers this week.  Three of our residents died and left three of our staff members orphaned at Christmas. So, we prepared for the usual Christmas sadness wrapped in glittery paper and curling ribbon, and we planned to attend three funerals.   

     It rained today. I got in the car at 7:00 this morning and drove on isolated roads to the nursing home.  I delivered gifts and stockings room to room, offering a “Merry Christmas” and a hug.  Some voices welcomed me.  My Santa hat received smiles.  Several residents said, “put it over there,” while others dug into the stocking, like it was their last breakfast. Some didn’t understand it was Christmas. That was a blessing.

     My boys met me at the door when I got home.  They were ready for Christmas to begin. They waited for me.  We gathered at the tree and the youngest played Santa. Packages were meager, and I worried about disappointment.  I shouldn’t have. It seems that my heart picks out good presents, and my impulse buying is unwarranted.

     The skies cleared tonight and the universe spread out, over, and around us.  We set up the telescope and pointed it at the Pleiades star cluster. Ryan calls it his “night diamonds.”  We took turns gazing at a gift eight light years away, not a video game, i-touch screen, or text message on a cell phone, but a miracle of nature, just like the snow the weekend before Christmas.

On the Inside Looking Out

December 26, 2009

      It’s morning again in room 207. Irene wakes to a knock at her door.  She turns on the bedside lamp and calls, “Who is it?”

      “Your breakfast is here,” a woman’s voice answers.

      “I’ll be right there.” Irene answers.

      Irene puts on her robe and opens the door to the nursing assistant with a tray in her hands.  “Come on in dear, you can set it right over there on the table.”  She lifts the dome lid from the tray and finds her favorite, two hard boiled eggs and two strips of crisp bacon.  A hot cup of black coffee rounds out the meal and Irene is ready to start her day.

      She looks in her closet and pulls out her business suit, the navy pinstripe that makes her look slimmer.  She chooses the white silk blouse because the feel of it against her skin reminds her of the time Lester was home more often. His fingertips liked silk. She can’t afford the bracelets that she sells at Miller and Ashby Jewelers, but she has a nice gold one that looks, from a distance, like it might have come from there.  Her hair has been set, her stockings are fresh, with no runs, and her heels are stylish.  She turns this way and that at the mirror, making sure that she sees perfection.  She may have some wrinkles on her face, but there will be none in her clothing.   She is ready for work.  Unlike most women of her generation, she’s a working girl.  She has to be, because Lester comes and goes as he pleases.  She can’t remember the last time he was home, or helping to pay the bills.  She’d be glad if he did come home though, even for just one night.

      Irene closes the door to her room and walks down the carpeted hallway past the doors of other residents.  Several of the doors are open, which seems odd to Irene, who thinks, “I always close and lock the door to my apartment.”  She finds herself looking into the lives of the people who allow examination.  Some are neat; some hoard, with newspapers, mail and boxes stacked or spilling over onto the floor.  For a moment, Irene wonders if intelligence depends on the amount of important papers you save.  She is tidy and organized. She cannot tolerate one thing out of place. She is meticulous.  She prides herself on it. She shakes her head in pity for the clutter of others. 

       Irene looks at the clock in the hallway.  It’s 8:30 already. She hurries her step; she doesn’t want to be late for work.  She looks into her purse for her keys. They are not there.  Before she can turn to go back and look for them, a woman passing her in the hallway says, “Good morning,  “I.”  Irene’s sister was the only one who called her “I.”  Was that Mary?  Irene’s attention diverts from the open purse.  She turns and walks in the direction of the voice. 

      “Mary, Mary is that you?  Mary?  Did you just pass me?”  She squints, looking for the dark haired woman who passed her. Irene raises her voice, calling loudly, “MARY!” She begins running as best as she can in her heels, calling Mary’s name.

      “Whoa, Irene, slow down, honey, why are you running?  Those heels are going to throw you,” a nurse dressed in a white uniform says as she puts her arm out in front of Irene to slow her pace.

      “It was my sister Mary. She called to me and I was trying to catch up to her.  Let me go find her,” Irene says, trying to push through the arm holding her back.  “Let me find her before she’s gone.  MARY!” Irene yells down the hallway.  The dark haired woman has rounded the corner, disappearing from Irene’s sight, but other people in the hallway stare at Irene as if she’s lost her mind. “Now look at what you’ve done,” Irene accuses the nurse.  “Mary’s gone and I’ll never find her.”

      “I’m sorry Irene. I was worried about you falling. Let’s walk in that direction and see if we can find her.  Tell me a little about your sister Mary.  What was she like?”

      Irene starts walking, but stops as she thinks.  “She was my little sister. I was born in 1919 and she was born six years later.  She looked up to me and always wanted to do what I did and go where I went.  She died right after Lester and I were married.  It nearly broke my Mother’s heart.” 

      Irene remembers that Mary was buried at Oak Lawn. It was a nice funeral, a beautiful day, Irene and Lester had sent pink gladiolas, Mary’s favorite. The preacher spoke about how love holds a family together.   Lester wasn’t at the funeral. He was “working” out of town that week.  Lester “worked” at a lot of things, lying mostly, and cheating. Irene’s jaw clenches.  Mary’s voice used to soothe her.

    Irene turns away quickly from the nurse and the stares and shaking heads of the strangers in the hallway.  She collects herself and her thoughts.  Where is she? What is she doing? She takes a deep breath and closes her eyes, thinking, pushing the organization she loves to the forefront of her brain.  Opening her eyes again, she looks down at her business suit.  Oh, that’s right, she is going to work, Miller and Ashby Jewelers.  She can’t be late. She’s the breadwinner. She takes another deep breath, this one to calm her nerves.  She pulls the open purse up again and looks for her keys.  They are not there.  She must have left them on her dresser.

      Irene spots the Exit sign, clicks her purse closed, cutting off thoughts of the keys, and walks toward the sign.  She sees the parking lot and street beyond the lobby door.  There’s a mirror at the front door. Irene stops and looks at her reflection.  She looks good in her business suit,  professional, put-together, smart.  Her lipstick is smeared, though.  She reaches in her purse for a tissue, dabs at the smear and reapplies from the tube of rose color. Rose looks best with this suit.  She notices the reflection of the lobby receptionist in the mirror.  She smiles and waves at the nice young woman on the phone.  As she puts the lipstick away, she searches for her keys. They are not there. 

      The lobby door opens and the cool air catches Irene’s attention.  A good looking man in a suit holds the door open for her.  She closes her purse, smiles up at the man holding the door and walks out past him.  “Thank you very much sir, there are not many gentlemen left in the world today.”

      “You’re welcome, have a nice day, Ma’am.”

      Irene returns the sentiment and walks toward the cars in the parking lot.  She opens her purse, searching for her keys.  Now, where has she left her keys?  She must have left them in her apartment.  She turns back toward the building.  She opens the lobby door and walks inside.  The young woman who is the lobby receptionist hangs up the phone, smiles and says, “Good Morning, Irene.  Were you outside?”

      Irene turns and looks at the lobby door, thinking what an odd question.  “Yes, I just got here,” Irene says, placing her purse on the desk and signing the nursing home guest book.  The receptionist looks puzzled.

      “Are you alright, dear?” Irene asks.

       “Oh sure, I’m fine,” the receptionist says, shaking her head a bit.  “I just need to check that door and make sure that it’s working properly.  There’ve been some problems with it lately, usually it alarms when….”

      “Well, it was working just fine when I came in,” Irene says.  “How is my mother?  Have you seen her this evening?  I have been running my legs off today, working and running errands.  I’ve only just gotten an opportunity to get here to see her.”

       “This evening? Your mother? Your mother doesn’t…” the receptionist stumbles over her words.  “I, I don’t believe I’ve seen your mother.”

      “That’s alright,” Irene says, chuckling. “Why don’t you get a cup of strong coffee to perk you up, dear, and I’ll go look for her.  She can’t have wandered too far, can she?  It’s not like she can run away.”   Irene turns and walks into the carpeted hallway of the nursing home.  She shakes her head and thinks that no matter how many times she comes to visit, she is still depressed by the dazed looks and drooped heads.  She regrets the day she had to put her mother here.  If Lester wasn’t so selfish, she could have stayed at home and cared for her mother like a good daughter.  Her mother and father had warned her about Lester when she first took up with him, but she didn’t listen.  Her mother’s voice echoes in her head, “If you can’t listen, you have to feel.”  She had spent most of her life “feeling”, feeling cheated, taken advantage of, responsible for everything, and angry.  Those feelings beat at her, over and over again.

      She walks down the hall and spots a woman in a wheelchair, the one she calls Mama.  From the back, the woman’s wavy gray hair hangs to her shoulders.  Irene reminds herself to speak to the nurse before she leaves about getting her mother a cut and set.  She rounds the wheelchair and stops to look at the old lady.  Irene remembers the woman who knew every inch of her at one time, the one who used to sing “Irene Goodnight” to her when she was a little girl, the one who put a cool cloth to her head when she was sick and kissed her nightmares away, the one who now, never remembered who Irene was.  “Hello Mama,” Irene says.  “How are you feeling today?” 

      The woman looks up at her with angry eyes and says, “I’m not your Mama.  I’m not anyone’s Mama.  I never had children.  Get away from me you crazy old bat.  I don’t know why you insist that I am your mother; you’re older than I am.  Every day, you call me Mama, and every day, I tell you I’m not your Mama. Stop calling me that and leave me alone.”

       Irene reaches her hand out to the woman,  her eyes pleading for recognition, for a mother’s understanding.  This woman, who is no longer the mother she remembers, slaps Irene’s hand away and turns the wheelchair,  so that her back is to her only living child.  Irene has never felt more alone than she does at this moment.  A man’s love can come and go. Lester’s love was like that; she had come to expect that; but a mother’s love should stay.  Your mother should never forget you. Irene looks down at her hand, pink now and still stinging from the impact of her mother’s rejection.  She turns it over, staring at her palm.  She had it read one time by a fortune teller who told her that she would find perfect love, not money as she had hoped, but perfect love which she hadn’t expected to hear.  That fortune had given her hope at a time when she needed it.  She wanted that love to be Lester’s.  She now wishes that she had wanted it to be her mother’s.  Irene’s shoulders curve inward.  She feels tears well in her eyes as she rubs the back of her hand.   

     Irene attempts to console herself with the thought that her mother is not responsible anymore.  She’s confused. Confusion is an awful thing.  Having your mind stolen from you is the last insult you can be dealt.  Irene sends up a small prayer thanking the almighty that she is still in her good mind.  

      She sees a nursing assistant coming toward them in the hallway.  Irene motions for her to come closer and whispers, “Has anything happened to upset her this morning?  She just hit me.”

      “I don’t think so Irene, but you know how we all have good days and bad days.  This could be a bad day for her.   Sometimes it’s best just to leave people alone for a while, let them work it out.  Why don’t you give her a little space and come back later.  Are you hurt?”

      “Only my pride, dear,” Irene says with a shaky smile.  “Sounds like good advice.  Thank you for your help.  I’ll be back tomorrow.”

      Irene knows that her mother would be appalled and ashamed if she was in her right mind and could see how she was behaving.  “There for the Grace of God…,” Irene says out loud as she straightens her back and collects her purse from the table in the dayroom.  She needs to leave before dark.  She can’t see to drive in the dark anymore.  She opens her purse and looks for her keys.  They are not there.   Maybe she left them at the reception desk when she signed in.

      Irene walks toward the lobby.  The workers call her by her name and ask her how she is.   Some reach out and pat her or grasp her hand.   If she had to put her mother in a nursing home, at least this one is clean and has nice people.  She stops and asks the receptionist if she’s found a set of keys.  “Sorry Irene, no keys.  Maybe they’re in your room.”

      “You mean my mother’s room? No they can’t be there, we visited in the day room.  I think I may have left them in the car.   Goodness, I hope not.  Some poor confused soul could have gotten in my car, thinking it was theirs.  I’ll go out and check the car,” Irene says as she turns toward the front door.

      “Let me go with you, Irene,” says the receptionist. as the phone rings.  “Wait just a second for me to answer the phone and then we’ll both go look for your keys.”

      “Alright,” Irene says.  

      The young woman answers the phone and turns to look in a file drawer.   “You’re busy, dear, I’ll be fine,” says Irene.

      Irene steps to the door and puts her hand on it.  There’s a beeping sound.  Irene looks around, shrugs and pushes the panic bar at the door.  It’s locked, that’s strange; this is the front door. The parking lot is just on the other side of the door, the handicapped parking spaces, right there on the other side of the porch.  The beeping is coming faster.  Irene pushes harder and shakes the panic bar.  The beeping has become a shrill siren now and the door still won’t open.  Irene pushes harder, throwing her weight at the door.  “What is wrong with this door?” She breaks out in a sweat.  Her heart pounds.  Suddenly, the door gives, opens and Irene’s weight carries her headlong onto the porch.  She grabs for the railing as her ankle twists, and the heel of her shoe snaps off.  “Damn,” she says, catching herself on the railing and bending to inspect her shoe.  

      She hears the siren still shrieking , and feet running, pounding behind her, pounding like her heart, pounding like Lester did at the door when she locked him out of the house.  She turns her head to see two men in hospital uniforms running toward her.  They look harried and stern.  She expects them to run past her, to some medical emergency down the street, to answer that siren. Instead, they stop in front of her.  The burliest one says her name.  “Irene, where are you going?” 

      She doesn’t recognize him.  “I don’t know you.  How do you know my name?  And it’s none of your business where I’m going or what I’m doing,” she says, her eyes flashing anger.  “You must have me confused with someone else.”

      “Come on Irene, of course we know you. We see you every day, talk to you, help you out when you need it.”

      Irene stops and frowns. This worries her.  She wonders how these men know her name.  Why are they asking her questions? She doesn’t recognize them or understand why they are lying to her.  Fear fills her. She should run or scream, but doesn’t want to make a fool of herself.  She wonders if this is a joke that Lester is playing on her.  This would be something he would do.  “Did Lester put you up to this?” she asks.

      “No, Lester sent us to find you,” says the younger, smaller one.  “He’s inside waiting for you.”

      Irene stops.  Lester sent for her?  He’s home?  He missed her?  “He’s inside?” she asks, forgetting her fear, remembering Lester.

      “We saw him.   Let us help you back inside and we’ll look for him,” the burly one says.

   “Oh look, your shoe is broken,” says the younger man.  She can’t remember it breaking.  The young man picks up the heel. “Why don’t you put this in your purse so you won’t lose it.  That broken shoe will throw you off balance.  Let us help you back to your room so you don’t fall.”

      Irene puts the heel in her purse and snaps it shut. She slides the handle onto her arm and allows the men to assist her into the building.  “Lester’s there?  He sent for me?”

      “Let’s go check.  He’s probably there waiting for you now,” says the burley man.

      At the door to her room, the two men bid her farewell.  “Thank you for your help,” she calls.  They wave goodbye. “Such nice boys,” Irene says.  

      She opens the door of her room to the darkness.  The drapes are drawn against the sun and shadows cover the order of Irene’s world. As usual, Lester is not home.   She turns on the bedside lamp, slips off her shoes, and sits on the edge of the bed.   She picks up the shoe with the broken heel, wondering how it happened.  She will have to take it to the repair shop tomorrow.  She’ll have to leave a little early to drop it off on her way to work. Irene wonders what she did with the heel.  She gets up and takes off her business suit, hangs it and her blouse in the closet. She puts her underclothes in the hamper and opens her nightgown drawer.  She slips on the green silk one.  It feels good against her skin.  “Who knows,” she says.  “Lester may come home tonight.”  She pulls back the covers and slides between the crisp sheets.  She turns off the bedside light.  She closes her eyes, waiting. 

       Irene is awakened by a knock at the door.  She opens her eyes and pushes back the covers, gets up and takes her robe from the hook on the door. She slips it on and calls out, “Who is it?”

      “Your lunch is here,” says a man’s voice on the other side of the door.

      Irene opens the door just a crack to see a waiter with a tray.  “I didn’t order room service,” she says, “but since you’ve brought it, I believe I’m hungry.  Thank you.  Just put it on the table over there.”  Irene opens her purse to tip the waiter from room service.  She pulls out the heel of a shoe.  “Now I wonder where this came from?” she says.   She looks up at the waiter who shrugs.  Irene shrugs too and smiles at the nice young man, who looks just a little like Lester when he was younger and was home more often.