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ABOUT AGING: Part 4
Posted Jun 22, 2008
Last Updated Jun 22, 2008
In 1954, my sweetheart, Neva Gail Hill, and I married. She was 25, I was 28. Young, but old enough. It seemed to me we (1) were biologically, socially, and spiritually mature, and (2) would always be young and healthy physically. Intellectually we knew that with a little luck, we'd be physically old someday, but it wasn't really real, at least not to me. As for being mature, we had a lot to learn about ourselves, each other, and the world. I still do, and Gail, I believe, was learning as long as she breathed.
Thus this project, this sorting and examining.
One evening in 2004 or possibly late 2003 — and no longer 28 and 25; more like 78 and 75 — Gail and I went to an Outback grill in Spokane WA. The parking lot was crowded, but there was an open slot immediately out front, with a landscaped border of ground holly. When Gail got out into the holly, she fell. Stumbled on a sprinkler head, I thought. I hurried around to her. "Are you all right?" I asked.
"Yes, just give me a minute." Meanwhile she just lay there, not moving. After a minute I tried to help her up, but she was dead weight, seemingly unable to contribute to the effort. And my four degenerated vertebral disks limit what I can lift.
Which left me clueless! I suspect she was too.
Meanwhile a large athletic-looking young man came over; he may have played cornerback in college, or outside linebacker. "Are you hurt?" he asked. "No, I'm all right." Then she raised up on hands and knees a little, and he picked her up and stood her on her feet.
"Can you walk?" I asked. "Yes, I'm fine."
We thanked the young man then, and I helped her inside. She seemed pretty wobbly, but I presumed it was simply the shock of falling. Inside we ordered our drinks: a Bud for Gail, O'Doul's for me as driver. But before the beers arrived, she told me she wanted to go home. The shock of falling, I told myself again. When the beers arrived, we about half drank them, then left. She was still pretty unsteady as we walked out, although ordinarily a single beer wouldn't have affected her. When we got home, I rustled up some supper and we ate.
She seemed all right, and I, at least, more or less forgot about it. A week or so later we went back and had those prime ribs we'd intended to have before. The incident seemed closed. About which more later.
On December 10, 2004, I was in my basement office and heard a heavy thud overhead. A fall! It had to be. I went up the stairs two at a time. This time too she lay essentially motionless. "Can you get up?" I asked. "I'm not sure. Give me a minute."
After a minute or so she said "I may have broken something." So I dialed 911. She had indeed broken her left femur. After a few days in the hospital, she was transferred to a rehab center, to discover the joys of rehab therapy.
So far this story is common as dirt, a scenario initiated many times a day among senior citizens, just in America. The main variation is based on whether the hip joint needed to be replaced. In her case it didn't; it was pinned, instead.
But the rehab wasn't biting. After the month allowed, she was sent home, there to be visited twice a week by a large young man, a physical therapist — very nice — who guided her through therapy. It wasn't working very well. Didn't work any better on the inbetween days, either, when I worked with her. The two steps down from porch to sidewalk was really tough. We'd toddle down the walk from the steps to the main sidewalk, slowly and uncertainly, then down the main sidewalk to the property line — maybe 40 feet. But that was as far as she was willing to go. Then we'd turn around and toddle back.
Getting into and out of the car was a real project.
She seemed reluctant to try. But she didn't marry me to nag her, so I didn't say what I thought. Thank God for moments of good judgment, for there was more to this than we knew.
Meanwhile son Jack had flown up from Dublin, Ohio, and stayed for several days, observing. He's very good at that. A week or so after he got back to Dublin, he and Jill (yes, Jack & Jill) phoned. Would we be willing to move there? They'd move us. They had a place in mind, a seniors condo development, and would have a place built for us. In Plain City, a little farmer village in a largely Mennonite area undergoing a transition from agrarian to exurban. "You'll like it," Jack said. "There's a cornfield right across the road. No stairs, an attached garage, the lawn gets mowed, the snow shoveled, and just a few minutes drive from our place."
What's not to like? We agreed, and I emailed the news to our landlord, in Thailand. Our new home was to be ready in mid-August, and meanwhile every week or two, photos arrived via email, showing external and internal progress, along with photos of a show house.
Our place in Spokane was a rented duplex with a nice yard. Our landlord lived in the other half — when he was in the States. He was a good landlord and a good neighbor. When he retired, he bought a golfing condo in Thailand to avoid Spokane's long snowy winters. In May he'd fly back to Spokane to avoid Thailand's very rainy summer monsoons — and to play golf. I looked after things in his absences, and he made it worth our while. It was a good arrangement for us both. So when we decided to move, Herb decided it was time to sell the property.
Within a week of arriving, he'd sold it. And I'd helped! The buyer had been charmed by the flourishing yard trees I'd planted. But after 20 years in one place, I was terminally lethargic, could hardly stir my bones. So much to deal with!
Jill arrived about the first of August to help us prepare. She did the work, went through stuff by the ton, sorting essentially into keep? Yard sale? Toss? then showed me her sorts. And I'd say yes or no, but mostly yes. It's much easier to let go of stuff when someone is standing there waiting for your decision. Also she had help. Two old pals from her own Spokane days pitched in, not just now and then, but serious hours.
She even found a buyer for our car, so I wouldn't have the 2,400 mile drive. "Buy a later model when you get to Ohio."
Herb was setting up a yard sale too, so we had one big yard sale. It went on for days. When we weren't at hand, he'd sell our stuff, and vice versa. The next thing I knew, the city hauled in a king-size walk-in dumpster — Jill had arranged it — and the "toss" items went in there.
Jack arrived several days before D-Day. The local science fiction community sprung a surprise farewell party on Gail and me, and on D-Day helped load the rental truck. While grampa, the ex-professional mover, mostly just watched. Then Jill and Gail flew to Ohio, while Jack and I left in the truck.
So what does all this have to do with getting old? At some point in the aging process, your energy level gets seriously low. Partly this seems to be physical, and partly, I suppose, a function of psychological factors interacting in a positive feedback cycle. When overwhelm kicks in, apathy rears its ugly head, apathy or serious recklessness.
In our case, family intervened. (In the background, a bugle can be heard, blowing "Charge!")
The Plain City condo worked nicely for us. Jack helped me shop for a car, and I set about learning my way around the Columbus area (metro Columbus population 1,725,570). Learning my way around was fraught with irritation, partly a result of age — and partly of the interactions of developers balancing costs with interconnections and modern ideas of municipal design — and partly of politicians eager to accommodate them.
Over most of the country there's been a basic pattern of locating roads on the straight north-south and east-west lines of the US Geological Survey system. Ohio was, I believe, the first state surveyed by that system, but roads were located any old where, changing directions freely, and often sneakily it seemed. I'd never lived anywhere like that before, so my aged habits of orientation required softening up. Which I did by getting in the car and starting out, getting lost, then trying to get unlost. A nuisance at first, then an adventure.
If you must get old, you might as well go with the flow and enjoy it.
For Gail, life became a round of being taken to the therapy center twice a week, and doing therapy at home daily, with my help. Her progress went in reverse though, her toddling about with her walker got slower and more uncertain. And before long, incontinence appeared. My mornings began with stripping her bed and doing laundry. Then, one morning, she couldn't stand, even supported. Or even sit upright, though that would pass. I called 911, and the world changed.
Jill found a suitable nursing home in Dublin, and when Gail left the hospital, "the Home" became her home. She was reluctant: "Casey (my nickname) takes good care of me." Jill's reply: "If Dad tries to take care of you now, we'll soon have to put him in a nursing home."
Oh! Reality adjustment. End of subject. Gail was a pragmatist.
For her, life became the institutional round of physical therapy, wheelchair, walker and bed. The walker less and less. I made the 20-25 minute drive from Plain City daily; 45 minute round-trip. Jill dropped in frequently, and Jack, with a job and a half, and lots of travel, semi-frequently.
I'd arrive, often timing it so I could eat supper with her. We'd chat, without any sign of dementia on her part, maybe watch some TV — an inning or two of baseball perhaps, then she'd say "read to me." We went through a lot of books — novels, biographies, histories — including, at her request, a number of my own novels. For a while she was more or less depressed, but eventually became quite cheerful. And still no sign of dementia. After my mom's history, that was a blessing.
In fact, sitting with Gail was a very pleasant part of my life.
Nursing homes provide professional care, but those professionals look after quite a few people. They also change shifts, and the same nurses and aides aren't on every day. Nor are they perfect. Some come closer than others: I think most fondly of Dee Dee, Shy (a ringer for the NFL's Tiki Barber), Carolyn, and C.J. And of course there is turn-over.
Gail's therapy progress continued to be gradually backward. She'd gain a little, here and there, then lose it. Clearly she would not be returning to the condo. So I began looking for an apartment near the Home. It was (guess who) Jill who found one an easy and pleasant 12-minute walk distant, and I moved. (Guess who did the heavy work. Hint: it wasn't me.)
One day I arrived at the home to something new: Gail's right eye was closed, and her smile was a bit one-sided. I asked if she could open her right eye. The question surprised her; she hadn't realized it was closed. So I went to the nursing station, and told them I thought Gail might have had a stroke. They seemed skeptical — "I was down there just a few minues ago. She seemed all right then."
So I phoned our family ex-nurse. "Jill, I'm at the Home. I think Gail may have had a stroke."
"I'll be right over."
When she arrived, she talked with Gail briefly, then to me, in the corridor: "You're right, Dad, mom's had a stroke." We went together to the nursing station. Knowing Jill's background, they did some quick tests, and called the doctor in. A wheel-chair van took Gail and me to Riverside Hospital, to Imaging. They found active intracranial bleeding — and scars from at least 20 previous small strokes! Which explained the lack of progress through two years of physical therapy! (In fact it ended the therapy.) Actually I suspect a mini-stroke triggered the fall that broke her leg; maybe even the earlier fall outside the Outback grill. It surprised me that the brain scarring hadn't reduced her cognitive function.
Meanwhile I'd learned a few things to ask, if I wondered if she'd been visited by another stroke. "Stick out your tongue," was one. She'd barely stick out the tip.
"Naah! Stick it way out."
She'd smirk and stick it out farther.
Then: "Speak me a sentence."
Grin. "What would you like me to say?"
Dementia? No way. And her earlier depression had died a clean death. I skipped the third test: "Raise your arms overhead" was beyond her in any case.
Over the months, we'd evolved a sort of ritual. I'd arrive, we'd greet, she'd make a sort of nest in the bedding over her stomach, then say "candy." I'd take a bag of peanut M&Ms from a drawer and put 7 of them into the nest. She'd eat them and we'd talk. Sometimes we'd repeat the performance.
The visit would end silly. Gail liked it when I was silly. She'd had foot trouble for years, with a couple of surgeries. So I'd uncover her feet and play variations of "little piggy" with her toes, often flavored with "Old Mother Witch." It always pleased her.
Silly can be healthy.
Inevitably her narrowly circumscribed life narrowed her focus, and her awareness of the world. I do not know what occupied her mind during her solitary waking hours, but I suspect she sorted out more than a few issues for herself. She was always action oriented — to "do" was her preference — but by that time, physically, she was severely hampered in "doing." In her final months she had more and more trouble even speaking. But she was always pragmatic. And as long as she could communicate, she made sense.
Also, she was very independent minded: she drew her own conclusions. So I strongly suspect that during her decline, she did a lot of sorting, positing, analyzing — and surely in her case, kept her conclusions to herself.
A nephew and his wife stopped by from Delaware in May of '07. Gail still did a pretty fair job of conversing, and enjoyed the visit. But her voice was weakening and blurring; her sentences got shorter. And my hearing is impaired, so as often as not, I had to ask her to repeat, often several times. She never showed any impatience with me, none at all, repeating as often as need be.
In mid-September, daughter Judy and her husband Stanley, arrived by car from California. They stayed for several days. By that time, a sentence of 5 or 6 words was a long one for Gail to get out, thus conversations tended to be one-sided. But she listened very intently, and her replies made sense. They quickly adjusted their comments and questions to enable succinct replies. (That intentness had been noticeable even before Gary's visit in May.) I wondered then if it resulted from the concentration necessary to keep track of who said what, processed via channels scarred by many strokes. Was her functioning so well the greatest mental/emotional performance of her 78 years? Or was she so intent simply to drink it all in? In any case it was impressive.
In November she developed a swallowing problem; could eat only pureed food and drink only thickened water. Her hands had become useless to her. In December she developed a cough, and staff became very attentive. Soon it was diagnosed as pneumonia, and she was put on an oxygen feed. She still whispered, but mostly too softly for my ears. I phrased my questions for yes and no answers, and read her lips.
She and I both knew, I have no doubt, that the end was closing in. I would tell her "I love you"; she would tell me the same.
I continued to read to her.
One morning my phone wakened me. Gail was on her way to the hospital. I dressed and drove there at once. When I get there, she was wearing an oxygen mask. She'd also completely lost her ability to swallow — and her gagging reflex — so water and nutrients were being administered intervenously. She still looked at me, and moved her lips for yes and no. Jack and Jill were there, and granddaughter Kristen, home from Indiana University for Christmas. At times it was standing room only. Grandson Ian flew in from Seattle. Sometimes Gail seemed aware, sometimes not.
After several days, the prognosis worsened. Short of a miracle, Gail would not recover. Her advance directive stated that when her condition was terminal, she did not want treatments to delay her death. So she was put in a hospice room. The oxygen mask was replaced by a tube feed. Application of water and nutrients was discontinued; besides oxygen, only pain control was administered.
About then — it was after the oxygen mask had been discontinued — I was alone with her when she startled me. Her eyes opened, and her face distorted with deep creases, like a Greek tragedy mask. "Are you in pain, honey?" I asked.
She answered clearly enough I could hear. "I don't want to die yet." Then her eyes closed, and her face smoothed out. I went to the nursing station and told the nurse she'd grimaced, but not what she'd said. No trace of the grimace remained.
Hospice provided a sofa and bedding for me, and I stayed there with her. Kristen and Ian were there much of the time, and when I went to the cafeteria, one or more of the others were generally with her.
Her skin seemed translucent, her face pure and peaceful. There was no sign of pain or struggle. This continued for, I believe, four days. At about 5 PM on December 30, 2007, Neva Gail Jones quietly stopped breathing. We were all there. Apparently her vital signs told the staff something. At any rate we were told that some patients didn't want to die when family was with them, and we were inviteed to go a few yards down the corridor to an alcove to wait. In 15or 20 minutes a nurse came to us with word that Gail had died. It seemed like an anti-climax. The Hospice lady talked with us. Then the chaplain came. I have no recollecction of what was said: no doubt the requisite bureaucratic information, and their best judgment on what might help us through the situation. Theirs was not an easy job. And when they'd finished, we left in two cars. Ian drove mine. We gathered at Jill and Jack's for KFC finger food, and Kristen thoughtfully put the animated penguin movie, "Happy Feet," into the DVD player, to take our attention and lighten the mood.
I knew perfectly well, intellectually— we all did — that for Gail, death was a relief and a release. Only afterward did I come to realize how very interwoven we'd become over our years together. I still find myself thinking "Gail will get a kick out of that," or "I need to tell Gail about that," or "what would Gail think?" Needing a new kitchen calendar, I went to a bookstore to buy one, and on the "remainders" table saw a 1992 Pulitzer Prize book about how Lincoln handled the civil liberties issues of the Civil War. Gail had been both a Lincoln fan and a Civil War buff, so I bought it to read to her. It didn't hit me till I got back in the car that I wouldn't be reading to her anymore. (Actually I could, of course, but she's got other things to do and learn that I can hardly imagine from this side.)
Two or three evenings after she'd died, I was sitting in my recliner with my bedtime jigger of wine, tears dripping on my shirt front, and it occurred to me to talk to Gail, so I did. "Sweetheart," I said, "if it's all right, come visit me in my dreams tonight."
I don't remember any dream, but I woke the next morning feeling positively exultant. Feeling as good as I had at any time in my life.
I intend one more post in this series About Aging. Number 3 was about my mom's decline into dementia, and Number 4, here, about Gail's very different, physical decline. I hope you've gained some insights in the reading. Number 5 will examine my own decline, seen through my own "mind's eye."
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Sep 17, 2008