The check is in the mail—and the hell with it

Although my mom has lost much of her eye for detail—the fine points of writing out big numbers on a check, say—she retains a good sense of the big picture. When I worried aloud about whether the home-aide agency would accept a check where the figure and the spelled-out number didn't match, she was nonchalant. "They need me more than I need them," she said. And she's right.

Elderville

So I have an idea for a sanwich-gen video game: Elderville. In it, a woman of a certain age has to race against the clock averting eldercare disasters. It goes something like this:

--Slow-mo shuffle to assist mother in walker to toilet.

--Crash! Something has broken in kitchen, but player cannot abandon slow-mo walk till mother is safely deboarded onto toilet.

--Rush to kitchen, where father stands barefoot among contents of shattered quart jar of rice.

--Ask father to move aside (he's on blood-thinners, so cut can be dangerous), and grab broom and dustpan.

--Ting-a-ling! Bell from bathroom indicates mother has finished tink-a-ling. Tell father to stay put and rush to bathroom before mother can lurch for walker.

--Brrrring! The phone! It's probably doctor you've been trying to reach all day about medicine that's on mother's hospital-release chart but not in medicine caddy.

--Yell to father and mother to stay put, and rush for phone.

--Miss call, and rush back to bathroom to catch mother as she hurtles floorward.

And so forth, with many timed challenges, including fetch the paper, fetch the glasses, fetch the pills, pillow placement, doorbell answering, food-mishap-averting ...

The land that time forgot

I've been living in the land that time forgot, or, more accurately, the land where time has been forgotten. There is a timelessness—or, rather, too much time—in the San Francisco duplex apartment of my aged parents. For there are three time zones here: Pacific daylight savings time downstairs, where we spend most of our day; Pacific standard time upstairs, where no one has gotten around to setting the clocks back; and Eastern daylight savings time on my various electronic devices that do not automatically reset. And then there's the way one day slips into another when you're engaged in a monotonous, slow-motion cycle of tasks (shuffle along beside your mother's walker as she makes her way to the bathroom to the bedroom to the dining room to the bathroom to the bedroom to the bathroom; prepare a meal, eat a meal, wash dishes, prepare a meal, eat a meal, wash dishes), and you don't go outside for days on end. "Who needs the outdoors?" says my mother. "I grew up in New York, where nobody ever goes outside." And the lights are never fully on ("What a waste!") and never fully off (since there are many trips to the toilet in the night).

My mother struggles with aphasia—she lost her nouns in a stroke five years ago—and she can get stalled on a word for several minutes or an entire day, so thoughts start off brightly, flicker, then gutter out, sometimes to be relit later, sometimes days later. Conversations course along a verbal mobia strip, stretching into eternity.

Food, too, follows its own clock. There were so many possible origins for the bad smell that ranked up the kitchen whenever my dad or I opened the fridge that finally we spent an afternoon sniffing every item, and threw out a third of the contents. Most appalling was a plastic container of six-month-old boiled beans that emitted a sinus-clearing stench. Most dramatic was the eerily beautiful cream cheese draped with mold. 

The hierarchy of needs is inverted here. The old advice about putting on your own safety mask first, then your child's, doesn't apply. The fit are second-class citizens. The feeble come first. The weak have inherited the world. If you, say, need to use the bathroom at the same time that your elderly infirm parent does, it doesn't matter how many bathrooms there are in the house, you have to hold off till you've taken her to the loo. To do otherwise would be to risk embarrassing her, and having to clean up after your selfishness.

My father used to describe war as incredible boredom interspersed with sheer terror, and that's what eldercare is like. Repetitive mindless tasks, punctuated by the horror of watching your mother teeter in her walker, knowing her bones are so hollowed out by osteoporosis that one more fall could turn her into a sandbag. 

And so it goes for eight days a week, a Saturday-to-Sunday visit.

What would you do?

So three weeks ago, my 82-year-old mother fell and hurt her knee, and she hasn't been able to walk since. She lives with my 85-year-old father in San Francisco, and I live in Manhattan. Several days elapsed before she told me about her fall and subsequent "bed rest." But that's nothing. When she got hit by a bus and broke her arm 10 years ago and when she had a stroke four years ago and when she fractured her pelvis a year ago—each time it took at least two weeks before she was willing to tell me. "I don't want to worry you," she said.

Because she cannot put any weight on her leg, she has had to scoot along on her bottom to get from the convertible couch in her office, where she's been sleeping since her fall, to the toilet. "It's nothing," she said. "Don't get all worked up about it." 

But Dad must be exhausted taking care of you night and day, I protested. "It's fun," she said. 

He sounds a little worn out, I said. "Oh, don't listen to him!" she said.

I told her I wanted to fly out right away so I could oversee her care. "No!" she said.

I wanted to call their best friend, the guy whose name I extracted from them the last time she disappeared into the emergency-care system. "No!" 

I wanted to call her doctor, with whom I have been in occasional touch in the past. "No!" 

I wanted to call a visiting-nurse practice to arrange a home visit. "No!" 

I wanted to call the home-care agency to arrange additional household help to supplement the aide who has been coming two mornings a week since she cracked her pelvis. "No!"

My mother is not demented. My father is not demented. And both are adamant that her wishes be respected. So he has been helping her to the bathroom, shopping and cooking and serving her meals in bed (using her old walker to wheel in her food) or helping her to bump along on her bottom to the dining room. I'm afraid that if I defy their wishes and take ordinary commonsense action, they will not tell me the next time there's an adverse event. So I have been calling every day, getting more and more agitated every time one of them divulges a new detail of how they're managing, and I've been consulting elder-care services and collecting brochures on assisted living and home care so that when I arrive on November 15, a visit that was previously scheduled, we can duke it out.

Finally, yesterday, I got a phone message from my mother's doctor, who had been alerted to the situation by the physical therapist, who had called my mother in alarm because she had missed several appointments (claiming she was "too busy"). Long story short: the doctor persuaded my mother to call 911 to request an ambulance to take her to the emergency room at St. Mary's. Great news! Less great news: the doctor was taking the day off for Halloween (!). I told my parents to bring their cell phone, and said I would also try to keep in touch by calling St. Mary's.

All afternoon and evening I waited to hear from them. I didn't want to intrude if they were being shuffled around for tests. Finally, at about 11 p.m. EST, I started calling: the home phone didn't answer, and the machine didn't pick up; the cell phone was turned off; St. Mary's had no record of her arrival and indeed was full to capacity and had been refusing ambulance drop-offs all day. 

Somewhere in the City by the Bay, an elderly couple, one utterly disabled and the other fairly feeble (heart condition, bad knees), were adrift. Dozens of emergency rooms: Where to begin? Smart idea from my sister-in-law: Call the emergency room of the hospital where my mother had last been treated—California Pacific Medical Center. Eureka!

Turned out her patella was broken and she is scheduled for surgery today. Why didn't she or my father call me to let me know where she was? "There was nothing to tell you," she said. "I told your father not to call you till after the surgery." 

What is wrong with these people?!