Grandmother's deterioration

We knew things were not right because she would go through as many as a dozen packs of sugar at every meal. It would go into her prune juice, onto her apple sauce, her scrambled eggs - anything. If there was no sugar, she would use saccharine or nutrasweet with equal pleasure. If there was nothing to pour it onto, she would pour it into her mouth. Apart from sugar, the main thing she ate was scrambled eggs. Every meal, scrambled eggs, topped with sugar.

We would ask her why she did this. "I can't taste anything!", she would shout, in a high monotone. We asked her doctor if her medicine might be affecting her sense of taste - could he adjust it? He adjusted it. She continued to eat sugar. Her pocketbook was filled with stolen packs of sugar. Could it be a nutritional deficiency? A zinc deficiency? Experts offered opinions; the retirement home staff promised to make changes. She continued to eat sugar. A gerontologist working for a rival nursing home told us that eating nothing but sugar and eggs is a common characteristic of Alzheimer's patients. But a thorough search of the Internet and a medical database turned up nothing conclusive about this. Who should I believe?

My grandparents could never agree to move from Providence to New York, to be near my mother. My grandfather, a man of the world in his own way, wanted nothing more than to be in New York. But my grandmother couldn't countenance a move, and we couldn't leave New York. So they stayed in the house in Providence. In 1990, a hit and run teenage driver injured them and destroyed their car, and my mother convinced them to move to the retirement home - still in Providence. They had fun there for a while. There were few men there, and my talkative grandfather was a center of attention. And my grandmother found herself a social butterfly, becoming more active than she had been in 20 years. In 1992 my grandfather fell into a sudden, rapid decline and died. He was in his 90th year, one of the most unusual people I have ever known. Sudden death is a blessing.

My grandmother lived on in the retirement home. Suddenly she found she was no longer so popular, now that she was just another widow among widows. My mother thinks it was only at this time that she realized how much she had loved him. They had been married 66 years, and for many of those years she fought bitterly with him, said cruel things to him, ridiculed him to her sisters behind his back. He adored her and ignored it all gracefully. Now that he was gone, she would cry when she remembered him. She began to say she was unhappy and wanted to die. She was 88, then she was 89. My mother suggested moving her to New York, but she refused unless she could live with us, and my mother felt that caring for her had become too heavy a task to take place outside of an institution. So my grandmother stayed in Providence.

Now she began worrying: would she live forever? Her own grandmother had lived (it was said) to 109, and died in 1918 of a heart attack when an explosive shell hit the stable behind their house. The old woman saw the horses and chickens fly up into the air as the wood and bricks crashed all around, and she simply went to her bed and died there. The idea of living forever became a great fear to my grandmother. She began asking us to kill her. When we explained that this wasn't possible, she began asking strangers to kill her - sometimes as soon as she met them. The retirement home staff tried to get her to talk to a psychologist, but as soon as she found the psychologist would not agree to kill her, the conversation came to an end. She shut her mouth and wouldn't say another word. She began to lose her hearing, and it became hard to communicate with her by phone. We bought her a hearing aid, but she had trouble keeping it working and often lost it. We paid the staff to change the batteries regularly, but somehow she still couldn't hear us unless she was in the mood.

She had been the spoiled youngest child of her merchant family, famous in their little shtetl for her great beauty. My grandfather always pampered her. So she was accustomed to her selfishness being tolerated, but now it went further. She discontinued her newspaper subscription, but would venture out in the early mornings and steal other people's. She would hide used kleenex among the potted plants in the common areas of the retirement home. She stopped changing her clothes, stopped bathing. We washed her clothes, hired someone to bathe her several times a week. She knew us by sight, but as soon as one of us turned our backs she would call to us as if we were strangers: "Miss!" "Sir!" New York was attacked by Mohammed Atta and company, and my grandmother (in spite of her stolen newspapers) knew nothing about it. She has been prone to hysteria all her life, but this time she didn't even try to call to find out if we were all right. To her, September 11th never happened.

And there was other, more disturbing behavior. She would eat huge mouthfuls of food, swallowing it half chewed, and often choke, spitting it out onto the carpet and then taking another huge mouthful. There began to be complaints about her by other residents to the staff, and then by the staff to us. We moved her to a "full-care facility" owned by the same company, a sort of half-way house on the netherward grade from retirement home down to nursing home. When I emptied her nightstand for the move, I found the bottom drawer quite full of stolen packs of sugar.

She had been in the new place a few months, less than half a year, when she fell out of bed and broke her hip. Or maybe she didn't fall out of bed - maybe she tripped on a rug. The staff changed their story several times. My mother and my wife rushed back to Providence to be with her, but they have found her a stranger to them. She has taken to scratching or hitting anyone who comes near her. The nurses tending her all have fresh scabs on their arms. The doctors do not know what to do with her except confine her to a tiny nursing home room and wait. We made the nursing home put bars on the sides of the bed so that there would be no more mishaps, but two days after my mother left Providence my grandmother somehow fell out of bed again. The staff's explanations are confusing.

We have come to doubt that the place she is staying is taking competent care of her, but the truth is that any other would be just as dubious. Where she is now at least she has doctors she recognizes from their past 20 years' attendance. To change her doctors would be to remove the last regular element of her daily life. I see to my sorrow that the care of the old and dying is a money-making racket in this society, and the interests of the patient and her family are minor considerations. But unless things get substantially worse, we can't see moving her. If she dies soon, it will be a blessing to her. But none of us feels this is in our power to control.

She is 97. People congratulate me when I tell them this number, but I don't want any part of it. I want my grandmother to close her life quickly.

Everyone who thinks about the matter wishes there were some way to bow out of life at just the right moment, after the inevitable decline begins but before it has progressed to grotesqueness and horror. Those of us who have read the saga of Sensei's last postings see a gentleman who bowed out successfully, vanishing quickly while there was still time enough, and leaving behind only his lingering smile. Every philosopher's hope is to pass quietly from visibility this way. But the thing is not always so easy to plan. In the stock market it is called timing the market, and wise investors counsel that to do so is chasing after the wind.

So in the end, after all the accidents of life, even a graceful exit is something beyond our control.

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