£ aud is eighty-six years old and weighs just that many pounds. She is nearly bald; her thin, fine, white-gray hair has been rubbed nearly away by all her years in bed. At her age she is balding around her genitals as well, worn and loose where the catheter tube emerges. She is bare like a young girl, but the work of decades has left its erosion. Maud had a stroke years ago, and then another and another. She doesn't open her eyes, never speaks. She is fed with a big plastic syringe that the nurses slip past her resisting lips; the right amount of pureed chicken or spinach tickles the back of her tongue and makes her swallow, involuntarily. Tonight I discover that Maud has cellulitis, an odd but common infection under the skin. Her right hip and buttock are red, swollen, hot; she has a temperature of 104 degrees. I call her doctor. He asks me, “ If you were her granddaughter, would you want me to treat her?” “ I’m not her g randdaugh te r,” I answer. “ You know,” he sighs, alone in his office, wanting to go home, “ I promised that lady years ago that I wouldn’t keep her alive like th is.” He pauses, and I wait. “ I promised her.” Eventually he orders an antibiotic, because of the slight chance Maud’s infection could spread to another patient, and her temperature drops in the evening, and she goes on. I am often asked how I can stand my work, and I know that it is this very going on that my questioners mean. Not only the uninitiated, but other nurses and physicians often dislike this “ gutter work” that I do: part-time charge nurse in an old, not very good, urban nursing home, working with the sickest patients, the ones who won’t recover from an unfortunate age. Some of the nurses I work with are always looking for a “ be tter” job, com pe t ing w ith thousands of o the r nurses for the hospital positions grown suddenly scarce in recent years—hospital jobs where patients come and go, quickly, and sometimes get well. I feel a measure of peace here, a sense*, of belonging, that is rare for me anywhere else. Partly it is because I know what to do, because I am competent here. Over the years, though, the ease that I’ve felt since my first job as a nurse’s aide when I was eighteen has become layered with Illustration by Mary Robben fondness, the way one grows used to a house and its little quirks, the slightly warped kitchen floor, the sighing upstairs window. Here all is aslant, and I have to tilt my head a bit to see it clearly. Coming in to begin a shift, I pass the a c t iv i ty room , c rowded w ith hum p backed, white-haired people asleep in wheelchairs, facing a man playing the “ Star-Spangled Banner” on a musical saw. In the corner, one upright, perfectly bald man spins slowly round and round in his chair, like a wind-up doll, bumping the wall at last and spinning back the other way. This is a scene of astonishing absurdity, and no one is paying any attention to it. We take it for granted, like the faint, l inge r ing sme ll o f urine tinged w ith kitchen steam and disinfectant. I leave the elevator on the third floor and step into furnace heat—July without air conditioning—and the queer conversation of the confused that will dog my steps all evening long. They give me this g ift of skewed perspective like a g ift of non-Eu- clidean sight, so that I become as willing to dip and bend with the motion of a damaged cortex as a tree in wind. I pass medicine room to room, and in each room the televisions are tuned to the same channel. For my 4:00 pass, it is “ People’s C ou rt,” p la in tiff and de fendant, as I travel down the hall. At 6:00 we watch “Jeopardy.” “What is the only military medal that can be given to noncomba tan ts? ” asks the host, in Mon te ’s room; then I pass next door to Sylvia, and to g e th e r we guess : “ The Meda l of Honor.” And we are right. Bent over a task, preoccupied, I am startled by the peculiar speech of the nerve-worn, its sudden clarity. Up here each day is the same, a refrain, and nothing can be taken for granted, nothing. I know how many people hate nursing homes—hate the word, the notion, the possibility. A friend of mine lives next door to a local nursing home, and she tells me she hears people screaming in the evening, unseen, their voices leaping the tall fence between. She assumes the worst, my friend: that they scream from neglect, from abusa, from terror. She says it is a “ terrible place,” never having been inside. I tell her that in every nursing home, there are people who scream; that they scream without warning, at private phantoms. I ask her where such people should go, I ask her how she would stop them from screaming. She listens and I know she is uncon v in ced . N u rs ing homes are terrible places, she says, and it is because what happens there is terrible. (I am similarly fearful around big machinery, in boiler rooms and factories. I am out of place, adrift, and fear the worst: is that shower of sparks routine, or does it signal disaster? What is that loud noise?) I enjoy my work, but I enjoy it in moments tha t are separated from each other by long stretches of fatigue and concentration. I enjoy it best when it’s over. I catch myself, hot and worn at the end of the day, hoping the man I keep Other nurses and physicians often dislike this "gutter work" that I do: part-time charge nurse in an old, not very good, urban nursing home, working with the sickest patients, the ones who won't recover from an unfortunate age. expecting to die will live until the next shift. I get irritable, and the clock creeps past 11:30, past midnight, and I’m still sitting with my feet propped up, trying to decipher my scribbled notes. The undone tasks, the unexplained events that want explaining, badger and chafe. And everybody dies. / ^ y ideals twitch on occasion, like a dog’s leg in dream. I want no one to lie in urine a moment, I want every ice pitcher filled at every moment. For a long while, for many years, I disliked the use of sedatives and antipsychotics to knock out the wound-up chatter of restless, disoriented souls. The orders read: “ p.r.n. ag itat io n ” —as necessary—and th is is the nurse's power to ignore, and the power to mute. So easy to misuse, so simple. But like a shot of morphine can break the spiralling cycle of pain, so can a spiral of panic be broken—not for my comfort, but for the comfort of the panicked. Sadie screams at me from far down the hall: “ Help! It’s an emergency!” And she screams over and over, rocking back and forth, till I come to see; she leans over and points at the blazing fire under her bed, a fire she sees and hears and smells, raging out of control. I see no fire. I coo to her, hushing; she babbles on. Finally I lie beside her on her bed; she is stiff and yearns to leap up. And, at last, I go to prepare the syringe: “ From the doctor,” I tell her, because Sadie loves her medicine, and she falls asleep. The responsibility is mine, the consequences are mine. I have to be sure about choices no one can be sure about. I call for nurse’s aides to come and hold the flailing arms and legs of Charlie, more than six feet tall, furious at the world that confounds him so. He squirms and tries to bite me when I hit his hip with the needle. We all fall across the bed together, grunting. And I know that the visitor, passing by, sees only the force, the convenience, the terrible thing we have done to this person: the abduction. The same is true of the smell, just barely there, acrid in the heat. It’s true of the drooling, the patter of nonsense in the dining room. Visitors tremble, knowing Grandma is here, and wish they had the courage to bring her home, out of this awful place. Could this inadvertent audience, my patients’ families, see these scenes and believe me when I say it is a labor of love? Some do; they bake blueberry pastries and doughnuts for the nurses, pat us on the arm, cluck the ir tongues. “ I don ’ t know how you can stand it,” the niece says, after an afternoon at Aunt Louise’s bedside. The difference here is in what we call love, the gap of definition between their words and mine. Their burden—and they seem to really want to know— is a burden of despair, a personal burden, bred of fear and impotence in equal amounts. This personal despair imagines as its opposite, its anima, a personal love and a Clinton St. Quarterly 19
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