It has been an entire week of aged care. That’s 4 days of referrals for rehab vs. residential care and a visit to Alzheimer’s Australia.
What I hadn’t expected about site visits was the element of field trip it had to it. The Alzheimer’s Australia office is in an old colonial house, one of 3 bought in neighbouring properties by the organisation and done up (or preserved). The gardens were spectacular, although the back had been converted into a car park. Inside, it reminded me exactly of the building in its sister organisation in my hometown. A stairwell, a resource cupboard converted from an old side room. The stained glass windows. Wooden walls. Even the smell was the same.
Back in school in New Zealand, I used to volunteer for Alzheimer’s Auckland. Sue had had me making up information packs and in this way, nothing I’d learnt on the day was completely new. In my spare time back then I’d read through them all. Alzheimer’s Australia used similar font and layout.
I’d been passionate about geriatrics then (I must have been 16, 17). My immediate neighbours were mostly elderly. I’d visit Gloria sometimes after school, for fun. She played scrabble every Tuesday. She had many photos in her home. I had grandparents, whom I loved. They hid chocolate in their room, and it was always a game to find it. When an elderly woman down the street moved away to a nursing home I hand wrote her a note. We didn’t know each other, but she would give me lily cuttings when I walked past her garden - a beautiful garden, with the prettiest white lilies. They demolished her house after she left.
Sometimes, I remember my great-grandmother from when I was 5, in China, and that room in the corner where she lived. She liked to comb her hair. I would clamber to her in the morning demanding hard salted crackers in return for kisses.
It reminds me of House Of God - the book by S. Shem: I used to love old people. Now, I feel tired whenever I think of them.
“Never grow old,” one woman said this week. She was over 100 years old and as sharp as a knife, although her hearing had also gone a little. Her eyes were blind. She had reached up to me to touch my face but had found the stethescope prongs in my ears instead. She meant to feel me for age, I knew. She’d said, shocked, when she realised I wasn’t some nurse and that I was part of the medical team, “A doctor?! You sound awfully young to be a doctor.”
It’s true. I know I have a young sounding voice, although one of my family friends had remarked when I was 13 that I’d lost the baby quality to it. A woman’s voice. What I learnt over the years was that it sometimes took on a naive, guileless lilt and that knocked years off it.
There are only three times in my life that a patient has tried to reach for my face. This was the third time. All were elderly. First had been an old man in Emergency who suddenly cupped a hand to my cheek when I finished taking his history - I had been 19, taken by surprise. The second time had been years ago in Haematology, when the other lady had required sedation to undergo a bone marrow biopsy, deliriously joyful (an unusual thing to be delirious with).
The woman this week - the centurion - had looked so anxious. I was visiting her to assess her for discharge placement: rehab vs nursing home care. It’s at terrible thing to remove someone from their houses forever. On Aged Care I’ve had time to think about it more. What it’s like to give up all your possessions and live in a room. A little like my life - everything crammed into the bedroom. Except worse. They only have a few shelves, that’s it. A few shelves for all of their lives. Reminders, trinkets.
I tried to placate her with the truth: “When I’m your age, I only hope to be as sharp as you.” I said, bending down over her to listen to her heart. Her bedside cognitive score was completely normal.
She clasped her hands around both of mine. “Never live to my age.” she rasped, pulling me down. The conversation had been pleasant before then, but now she appeared to be tearing up. “It’s a terrible thing, to be old. To outlive your contemporaries.”
“Never get old,” another man had said to me the other day. “It’s at terrible thing.”
“Stay beautiful,” another had said once in outpatients, in front of Dr. L. “Stay a pretty little thing forever. Don’t age.”
Some people say that they cried when they visited the Alzheimer’s organisation. I had sat in the room wondering what about, until they put on that DVD, ‘The Long Goodbye’. It’s a documentary about people living with Alzheimers, and the impact it has on their families.
I teared up. Loving the ghost of someone - an echo of who they were. Carers are amazing people.
Perhaps all that’s left after that is our rawest nature. Sometimes I wonder, who would I be once the rest of me has been stripped away?
They always say that dementia is disinhibiting. People revert to underlying personalities, underlying instincts. I met a man once in a neuropsychiatric ward who was obsessive about clocks. In his younger days he’d always run his household like clockwork, fixing things, tinkering with odd jobs. Now he was here because his wife was being driven nuts by his constant taking things apart and putting them back together wrongly. He hoarded parts that somehow he couldn’t fit back and got angry when she tried to move them. Everything had an order, but he no longer understood it.
The second patient I ever met, Val* (not real name), had the biggest bluest eyes in a nursing home at the base of a snowy mountain. She’d cried and told me not to let them take her mother away in a little girl’s voice and I’d held her hand. She was in her late 90s. It was a sunny afternoon but it had chilled me to the bone. She had the look of a terrified child, and I had just lost my childhood. It was a strange moment.
Looking back, that visit had shaken me. I’d had an awful thought that I’d be just like her when I am her age, returning to the me that I had been when I was sitting with her. At that time, I’d been spending most of my nights crying either on the inside or outside. I’d loved someone a lot — too much. A kind of love that changes a life, in some way. I’d loved someone else in a different way. Both were people who couldn’t love me the way I wanted them to. I’d suddenly seen myself as a 90-something year old mumbling to strangers: “It hurts. I love you. Come back. Tell me you love me. You made a choice. You can’t say there was no choice. You chose her.” Helpless phrases. Helpless things.
‘What would I cry about at 92?’ I’d written, ‘What memory would I be stuck in? The time when I was 15, in the summer? One evening sitting in S’s car beneath the streetlamp? In the park with N on the grass, feeling well fed and lying on my front saying, “You always seem to know what you’re doing.” Or drying the wildflowers and weeds upside down off my door handle with ribbon? Would it be the night I was floored by this desire to cease to exist, simply (not morbidly)? I want to do something to fix myself up. (But what)?’’
It seems like a lifetime ago.
I’m glad things have changed for the better, with the help of some of the best people in the world by my side. :) I’m ever gladder that it’s Spring and that the sun was out today again. It’s always better to do the more difficult jobs in warmer months. Then you have something to look forward to, like daylight when you go home, and sangria if you are like me and can hop off at any time really (I always seem to stay though).
Aged care is a hard job, and requires a lot of patience. I admire geriatricians everywhere.
That afternoon she asked him, “Is that an old habit, the way you talk to yourself?” She raised her eyes from the table and put the question to him as if the thought had just struck her, but it had obviously not just struck her. She must have been thinking about it for a while. Her voice had that hard but slightly husky edge it always took on at times like this. She had held the words back and rolled them around on her tongue again and again before she let them out of her mouth.
The two were sitting opposite each other at the kitchen table. Aside from the occasional commuter train running on a nearby track, the neighborhood was quiet — almost too quiet at times. Tracks without trains passing over them have a mysterious silence all their own. The vinyl tile of the kitchen floor gave his bare feet a pleasant chill. He had pulled his socks off and stuffed them into his pants pocket. The weather was a bit too warm for an April afternoon. She had rolled up the sleeves of her pale checked shirt as far as the elbows, and her slim white fingers toyed with the handle of her coffee spoon. He stared at the moving fingertips, and the workings of his mind went strangely flat. She seemed to have lifted the edge of the world, and now she was loosening its threads little by little — perfunctorily, apathetically, as if she had to do it no matter how long it might take.
He watched and said nothing. He said nothing because he did not know what to say. The few sips of coffee left in his cup were cold now, and muddy-looking.
He had just turned twenty, and she was seven years older, married, and the mother of one. For him, she might as well have been the far side of the moon.
Her husband worked for a travel agency that specialized in trips abroad, and so he was away from home nearly half of every month, in places like London or Rome or Singapore. He obviously liked opera. Thick three- and four-record albums lined the shelves, arranged by composer — Verdi, Puccini, Donizetti, Richard Strauss. The long rows looked less like a record collection than a symbol of a world view: calm, immovable. He looked at the husband’s records whenever he was at a loss for words or for something to do; he would let his eyes wander over the album spines — from right to left, from left to right — and read the titles aloud in his mind: “La Boheme,” “Tosca,” “Turandot,” “Norma,” “Fidelio” … He had never once listened to music like that, had never had the chance to hear it. Not one person among his family, friends, or acquaintances was an opera fan. He knew that a music called opera existed, and that certain people liked to listen to it, but the husband’s records were his first actual glimpse of such a world.
She herself was not particularly fond of opera. “I don’t hate it,” she said. “It’s just too long.”
Next to the record shelves stood a very impressive stereo set. Its big, foreign-made tube amp hunched down heavily, waiting for orders like a well-trained crustacean. There was no way to prevent it from standing out among the room’s other, more modest furnishings. It had a truly exceptional presence. One’s eyes could not help fixing on it. But he had never once heard it producing sound. She had no idea where to find the power switch, and he never thought to touch the thing.
“There’s nothing wrong at home,” she told him any number of times. “My husband is good to me, I love my daughter, I think I’m happy.” She sounded calm, even serene, as she said this, without a hint that she was making excuses for her life. She spoke of her marriage with complete objectivity, as though discussing traffic regulations or the International Date Line. “I think I’m happy, there’s nothing wrong.”
So why the hell is she sleeping with me? he wondered. He gave it lots of thought but couldn’t come up with an answer. What did it even mean for there to be “something wrong” with a marriage? He sometimes thought of asking her directly, but he didn’t know how to start. How should he say it? “If you’re so happy, why the hell are you sleeping with me?” Should he just come out with it like that? He was sure it would make her cry.
She cried enough as it was. She would cry for a long, long time, making tiny sounds. He almost never knew why she was crying. But, once she started, she wouldn’t stop. Try to comfort her though he might, she would not stop until a certain amount of time had gone by. In fact, he didn’t have to do anything at all once that time had gone by her crying would come to an end. Why were people so different from one another? he wondered. He had been with any number of women, all of whom cried, or got angry, but each in her own special way. They had points of similarity, but those were far outnumbered by their differences. It seemed to have nothing to do with age. This was his first experience with an older woman, but the difference in age didn’t bother him as much as he had expected it to. Far more meaningful than age differences, he felt, were the different tendencies that each individual possessed. He couldn’t help thinking that this was an important key for unlocking the riddle of life.
After she finished crying, usually, the two of them would make love. Only then would she be the one to initiate it. Otherwise, he had to be the one. Sometimes she would refuse him, without a word, shaking her head. Then her eyes would look like white moons floating at the edge of a dawn sky — flat, suggestive moons that shimmered at the single cry of a bird at dawn. Whenever he saw her eyes looking like that, he knew there was nothing more he could say to her. He felt neither anger nor displeasure. “That’s how it goes,” he thought. Sometimes he even felt relieved. They would sit at the kitchen table, drinking coffee, chatting quietly. They spoke in fragments most of the time. Neither was a great talker, and they had little in common to talk about. He could never remember what it was that they had been saying, just that it had been in little pieces. And all the while one commuter train after another would go past the window.
Their lovemaking was hushed and tranquil. It had nothing that could properly be called the joys of the flesh. Of course, it would be false to say that they knew none of the pleasure that obtains when a man and a woman join their bodies, but mixed with this were far too many other thoughts and elements and styles. It was different from any sex he had experienced before. It made him think of a small room; a nice, neat room that was a comfortable place to be. It had strings of many colors hanging from the ceiling, strings of different shapes and lengths, and each string, in its own way, sent a thrill of enticement through him. He wanted to pull one, and the strings wanted to be pulled. But he didn’t know which one to pull. He felt that he might choose a string and have a magnificent spectacle open up before his eyes, but that, just as easily, everything could be ruined. And so he hesitated, and while he did, another day would end.
The strangeness of this situation was almost too much for him. He believed that he had lived his life with his own sense of values. But when he was in this room, hearing the trains go by and holding the silent older woman in his arms, he couldn’t help feeling confused. Again and again he would ask himself, “Am I in love with her?” But he could never reach an answer with complete conviction.
When their lovemaking ended, she would glance at the clock. Lying in his arms, she would turn her face slightly and look at the black clock radio by the head of the bed. In those days, clock radios didn’t have lighted digital displays but little numbered panels that flipped over with a tiny click. When she looked at the clock, a train would pass the window. It was like a conditioned reflex: she would look, a train would go by.
She was checking the clock to make sure it was not time for her four-yearold daughter to be coming home from kindergarten. He had happened to catch a glimpse of the girl exactly once, and she seemed like a sweet child. That was the only impression she left him with. He had never seen the opera-loving husband who worked for a travel bureau. Fortunately.
It was an afternoon in May when she first asked him about his talking to himself. She had cried that day, again. And then they had made love, again. He couldn’t recall what had made her cry. He sometimes wondered if she had become involved with him just so that she could cry in someone’s arms. Maybe she can’t cry alone, and that’s why she needs me.
That day she locked the door, closed the curtains, and brought the telephone next to the bed. Then they joined their bodies. Gently, quietly, as always. The doorbell rang, but she ignored it. It seemed not to startle her at all. She shook her head as if to say, “Never mind, it’s nothing.” The bell rang several more times, but soon whoever it was gave up and went away. Nothing, just as she had said. Maybe a salesman. But how could she know? A train rumbled by now and then. A piano sounded in the distance. He vaguely recognized the melody. He had heard it once, long ago, in music class, but he couldn’t recall it exactly. A vegetable seller’s truck clattered by out front. She closed her eyes, inhaled deeply, and he came with the utmost gentleness.
He went to the bathroom for a shower. When he came back, drying himself with a bath towel, he found her lying face down in bed with her eyes closed. He sat down next to her and, as always, caressed her back as he let his eyes wander over the titles of the opera records.
Soon, she left the bed, got properly dressed, and went to the kitchen to make coffee. It was a short time later that she asked him, “Is that an old habit, talking to yourself like that?”
“Like what?” She had taken him off guard. “You mean, while we’re … ?”
“No, no. Not then. Just anytime. Like when you’re taking a shower, or when I’m in the kitchen and you’re by yourself, reading the newspaper, that kind of thing.”
“I had no idea,” he said, shaking his head. “I’ve never noticed. I talk to myself?”
“You do. Really,” she said, toying with his lighter.
“It’s not that I don’t believe you,” he said, the discomfort of it affecting his voice. He put a cigarette in his mouth, took the lighter from her hand, and used it to light up. He had started smoking Seven Stars a short time earlier. It was her husband’s brand. He had always smoked Hope regulars. Not that she had asked him to switch to her husband’s brand; he had thought of taking the precaution himself. It would just make things easier, he’d decided. Like on the TV melodramas.
“I used to talk to myself a lot, too,” she said. “When I was little.”
“But my mother made me stop. ‘A young lady does not talk to herself,’ she used to say. And whenever I did it she got so angry! She’d lock me in a closet which, for me, was about the worst place I could imagine, dark and moldy-smelling. Sometimes she’d smack me in the knees with a ruler. But it worked. And it didn’t take very long. I stopped talking to myself completely. Not a word.”
He couldn’t think of anything to say to this, and so he said nothing. She bit her lip.
“Even now,” she said, “if I feel I’m about to say something I just swallow my words. It’s like a reflex. But what’s so bad about talking to yourself? It’s natural. It’s just words coming out of your mouth. If my mother were still alive, I think I’d ask her, ‘What’s so bad about talking to yourself?’ “
“Uh-huh. But I wish I’d gotten it straight. I wish I’d asked her, ‘Why did you do that to me?’ “
She was playing with her coffee spoon. She glanced at the clock on the wall. The moment she did that, a train went by outside.
She waited for the train to pass. Then she said, “I sometimes think that people’s hearts are like deep wells. Nobody knows what’s at the bottom. All you can do is imagine by what comes floating to the surface every once in a while.”
Both of them thought about wells for a little while.
“What do I talk about when I talk to myself?” he asked. “For example.”
“Hmm,” she said, slowly shaking her head a few times, almost as if she were discreetly testing the range of movement of her neck. “Well, there’s airplanes … “
“Uh-huh. You know. They fly through the sky.”
He laughed. “Why would I talk to myself about airplanes, of all things?”
She laughed, too. And then, using her index fingers, she measured the length of an imaginary object in the air. This was a habit of hers. One that he had picked up.
“You pronounce your words so clearly, too. Are you sure you don’t remember talking to yourself?”
“I don’t remember a thing.”
She picked up the ballpoint pen lying on the table, and played with it for a few seconds, but then she looked at the clock again. It had done its job: in the five minutes since her last look, it had advanced five minutes’ worth.
“You talk to yourself as if you were reciting poetry.”
A hint of red came into her face as she said this. He found this odd: why should my talking to myself make her turn red?
He tried out the words in rhythm: “I talk to myself / Almost as if / I were reciting / Po-e-try.”
She picked up the pen again. It was a yellow plastic ballpoint pen with a logo marking the tenth anniversary of a certain bank branch.
He pointed at the pen and said, “Next time you hear me talking to myself, take down what I say, will you?”
She stared straight into his eyes. “You really want to know?”
She took a piece of notepaper and started writing something on it. She wrote slowly, but she kept the pen moving, never once resting or getting stuck for a word. Chin in hand, he looked at her long eyelashes the whole time. She would blink once every few seconds, at irregular intervals. The longer he looked at them, these lashes which, until a few moments ago, had been wet with tears, the less he understood: what did his sleeping with her really mean? A sense of loss overtook him, as if one part of a complex system had been stretched and stretched until it became terribly simple. I might never be able to go anywhere else again. When this thought came to him, the horror of it was almost more than he could bear. His being, his very self, was going to melt away. Yes, it was true: he was as young as newly formed mud, and he talked to himself as if reciting poetry.
She stopped writing and thrust the paper toward him across the table. He reached out and took it from her.
In the kitchen, the afterimage of some great thing was holding its breath. He often felt the presence of this image when he was with her: the afterimage of a thing he had lost. But what had he lost?
“I know it all by heart,” she said. “This is what you were saying.”
He read the words aloud:
Airplane Airplane flying I, on the airplane The airplane Flying But still, though it flew The airplane’s The sky?
“All of this?!” He was stunned.
“Uh-huh, the whole thing,” she said.
“Incredible! I can’t believe I said all this to myself and don’t remember any of it.”
She flashed a tiny smile. “You did, though, just like that.”
He let out a sigh. “This is too weird. I’ve never once thought about airplanes. I have absolutely no memory of this. Why, all of a sudden, would an airplane come popping out?”
“I don’t know, but that is exactly what you were saying, before, in the shower. You may not have been thinking about airplanes, but somewhere deep in a forest, far away, your heart was thinking about them.”
“Who knows? Maybe somewhere deep in a forest I was making an airplane.”
With a small thunk, she set the ballpoint pen on the table, then raised her eyes and stared at him.
They remained silent for some time. The coffee in their cups clouded up and grew cold. The Earth turned on its axis while the moon’s gravity imperceptibly shifted the tides. Time moved on in silence, and trains passed over the rails.
He and she were thinking about the very same thing: an airplane. The airplane that his heart was making deep in the forest. How big it was, and its shape, and the color of its paint, and where it was going, and who would board it.
She cried again soon after that. This was the very first time that she cried twice in the same day. It was also the last. It was a special thing for her. He reached across the table and touched her hair. There was something tremendously real about the way it felt — hard and smooth, and far away.
‘Airplane’ — Haruki Murakami. Translated from Japanese by Jay Rubin. Originally published in The New Yorker, 1 July, 2002, p78 (source)
Spring crept up on me in the form of blossoms on the skeleton trees and mornings of not waking up freezing to the core. The first time it happened had been a dream. The second day it had been a wonder. The third, it had been joy.
I came home one afternoon to discover that the skeleton trees outside each house on the boulevard was in fact an apple blossom tree. I’d moved during Autumn and they had already been bare by then. A week later the entire place was filled with white flowers and petals on the driveways. The sunsets are later now, and when I come back the sky is molten gold, drowning me; drowning everything.
It’s almost a month since I last wrote anything but the time has passed by so quickly. I’m doing Aged Care now, which at this particularly hospital that I’m in, is actually a nurse-run assessment service for appropriateness to rehabilitate/place.
I’m so bored that I literally spend up to 4 hours of the day sitting and staring into space, waiting for the phone call to tell me when to turn put to the once-a-day Geriatrician ward round. Inevitably it’s at the end of the day and I’m expected to hang around on call until whenever he/she comes in.
Respiratory medicine has been … for lack of any word to better describe it… fun. Extremely fun. The consultants were all individually lovely - especially Dr. L, who had been my registrar three years ago. He’d had a reputation for being stand-offish amonst the students and most people didn’t like his service, but I liked Respiratory then and so I persisted.
It turned out that he was just one of those people who took time to warm up to people, and when he did open up he was extremely personable. He would become one of my favourite registrars. We had bonded over common hobbies. Even after I rotated off to another specialty he would sometimes come up to me in the corridor and ask if I had seen this or heard of that, all related to the things we liked doing.
I’d not expected to see him. In fact the surprise was evident in both our faces when I walked in one Radiology meeting and there he was - same person but in a grey suit. Coke Zero in his hand (there is never a time - not even on ward round back then - that he would be without this installation). When I left his wife had been expecting their first child within weeks. This time when I came on it turned out that he’d just had his second one within weeks too.
Watching him as a consultant — I felt so proud, even though I had nothing to do with it. He was a good consultant. Someone I would want my mother to see if she had a Respiratory/sleep problem. When I left we had both hovered around Outpatients chatting to each other, to the team about irrelevant things. I wanted to say something unprofessional and personal like that I’d miss him, but it could be misconstrued. Besides. You never hug or say you will miss your consultant.
But I would. Miss him, I mean.
It lead me to think about the registrars and various colleagues who I’ve had over the years, and the teams I’ve been on. Perhaps I have been watching too many historical films these last few weeks - the old English and Middle Ages ones, about loyalty and people dying for each other in gorey battlefields and on quests. It always made me wonder (because I’m selfish, and it seems ridiculous to my generation in general) - what sort of person could possibly inspire the kind of loyalty that would make people willingly do things like lose life and limb for them (in the Middle Ages) or go out of their way to do things for them (in the work place/in life).
Dr. L. made me realise that there are some people you meet in life, who leave some kind of impression on you that you can’t explain. Dr. L. himself hasn’t really inspired me to do anything/be anyone, and hasn’t particularly affected any event in my life. He didn’t do much teaching, trusting me to do my own learning. He taught me about MSLTs once and now whenever I think of them, I think of him. I wouldn’t want to die for him obviously…but I would just want to work for him/with him and do jobs with great enthusiasm and willingness even at some personal cost. He is just someone who I was happy to be around.
Dr. A., the Respiratory registrar also reminded me of that kind of person for his effect on others - his workers. Nancy, the visiting consultant from China, who has duties just like a medical student but with the experience and brain power of a consultant, specifically was saying that one of the things she had learnt was Dr. A.’s profound effect on his environment. His unique way of getting people to do things for him, and want to do it.
You don’t have to be a loud, rousing leader to inspire that kind of loyalty in others. Like a patriotism to a distant homeland that one has never seen.
I guess the more you’re exposed to the work place, the more you see it.
Perhaps there are these kinds of people in our personal lives too, but then I think it is called something else.
Either way, it’s a privilege. :)
- Chuan Tai: Hey Mel. How's your rotation going?
- Melissa: Not bad. I LOVE RESPIRATORY. Love. How's Emergency?
- Chuan Tai: You seem to love everything you do.
- Melissa: Haha you're onto me. :)