Bedtime Routine: Wheel Alice into the bathroom. Position the wheelchair perpendicular to the toilet and put the brakes on. Help her undress.
My eyes darted from the instruction sheet to the 102 year old woman reading a Jack Weyland novel in the living room. She was shrouded in a hand-crocheted afghan, the pale blue of the yarn contrasting with the wispy whiteness of her hair. Her face sagged slightly in the lamp light, causing the wrinkles of her face to cast long shadows. Her senses seemed numb to the intensity of my stare, so I read on.
Fold her clothes neatly and place them in the box on the counter. If the pants are soiled, put them in the laundry hamper.
“Grandma,” I said, “Would you like to get ready for bed now?”
“Grandma!” I barked. Her eyes met mine.
“Yes?” Her feeble voice produced tinny vibrations within her throat, almost as if it had developed a patina over the years.
“Would you like to get ready for bed?” I asked again.
“Well, yes, that would be fine,” she replied.
I watched as she methodically marked the page and then closed the novel. She paused, only slightly, to look at the cover again and then lifted her gaze to me.
“He isn’t one of the great writers—but you know something? I like him. He writes—lightly. I don’t care for the heavy stuff these days.
I nodded in agreement, quickly unlocked the brakes and wheeled her into the bathroom.
The smell of illness was strong. I winced. The white porcelain sink gleamed sterilely against the old yellow linoleum counter, which was cluttered with medicine bottles and pill boxes of assorted shapes and sizes. I pushed the wheelchair up to the designated area in front of the toilet and fastened the brakes. She seemed acutely aware of my presence as she began to unbutton her blue gingham blouse, her fingers trembling and tripping over the buttons. I watched her struggle, each button taking fifteen seconds of tedious attention. My desire to help her was overpowered by the consciousness that intervention on my part would compromise a sense of dignity she was trying to retain. I instinctively knew that this was as uncomfortable for her as it was for me, but that knowledge didn’t dull the painful reality of the circumstance. She finished, and I helped her remove her arms from the blouse, then placed it in the box. She then braced herself in preparation for a much more taxing undertaking: the removal of her pants. Slowly, she inched herself to the edge of the chair, as if she was lugging deadweight. Within seconds she was breathless, but the work had just begun. Next she planted her feet firmly on the ground and gripped the arms of the wheelchair with such force that the blue veins in her hands and arms rose up out of her sagging flesh. Slowly and shakily, she straightened her bent elbows, raising herself up out of the seat. Her labored breathing rattled in my ears as I bent over to pull down the elastic pants and remove them from her legs. My stomach churned as I exposed her naked legs, which quivered under the weight of her upright body; her knees knocked together, shaking the cellulite of her shapeless thighs. I swallowed, hard. Hurriedly, I pulled the pant legs over her feet and folded the slacks to be put away. As she lowered herself down, she gasped in relief, and slowly her breath found its natural rhythm.
Alice must have her diaper checked before bed. If it is soiled, remove the inner pad and place it in a garbage sack to be disposed of later. Replace it with a clean one. If it is clean, let her know and remind her to use the toilet.
She sat there, in her underwear, waiting quietly for me to locate the box of diaper inserts. Nervously I fumbled through the contents of the cabinets until I found them. I cringed as the sound of the crinkling plastic wrapper filled the room. When it was ready, she hoisted herself up yet again, making her diaper accessible to me. Biting my lip, and trying not to breathe, I pulled the diaper down, revealing its contents to us both. Alice looked down, but she seemed to be staring past the soiled diaper, past the floor, staring deeply into something that was intangible and distant. I made quick work of changing the pad and soon she was clean and sitting properly in her chair.
Alice’s pajamas are located in the second drawer on the left. In the summer she likes to wear the nightgown and a thin pair of socks.
The nightgown was a faded cornflower blue, a delicate floral print from the 1950s. Without much difficulty, we managed to pull the gown over her head and body until she was finally fully clothed. After locating the socks in the third drawer, I gently inched them up her feet, careful not to aggravate the arthritis in her ankles. She watched me in silence, but I sensed a sort of approval in her steady gaze.
Alice will clean her dentures, rinse her mouth, and wash her face at the sink. Her facial cleanser is located on the windowsill. She may need help brushing her hair in the back. After her hygienic preparations, supervise her medication. Record the specific drug and dosage in the medication log.
I rolled her over to the white sink where she immediately went to work, removing her dentures and scrubbing them with an old yellow toothbrush and soap. She seemed to take pride in her ability to do this alone. I watched her sit a little taller as she finished washing herself. After drying her face, she reached out for the wooden hairbrush, and with shaking hands took it to her snowy hair. In staggered strokes she smoothed the feathery strands, but she could only reach as far back as her ears. From behind, I could see the matted mess at the nape of her neck. I smiled at her as I took the brush in my own hands and gently untangled the knots. Suddenly I felt her cool hand upon mine, signaling me to stop. I looked up and saw my reflection standing behind hers in the mirror. I was seeing her and me together for the first time. I considered our hands, hers still holding mine. It was pink against pallid, smooth against sagging, strong against shaky. But they were both hands, holding each other. We smiled, communicating unspoken understanding. She then proceeded to take her pills while I, in tandem, recorded the dosage, date and time.
Alice goes to sleep in the living room. You must turn down the bedding for her and then help her get into bed. She sleeps with the nightlight on. Be sure to move the portable toilet to the bedside where she can access it in the night. Help her remove her glasses and place them on the nightstand next to the bell. She will ring the bell if she needs you. Turn on the baby monitor. This is how you will hear her in the night. When Alice is in bed, turn on the CD player, which is programmed to play her bedtime music. Turn off the lights before you leave.
I wheeled her into the living room. She asked to watch the Food Network, so we sat together and learned how to julienne carrots and squash. She talked about planting summer squash in California with Jay. His large portrait hung above her bed and as I lifted her onto the mattress, I noticed her staring at his large oval face, a simple sadness in her eyes. She was distant, lost for a while.
In her absence I switched on the little nightlight in the eastern corner and moved the hospice toilet to the left side of the bed. I powered the CD player which played instrumental tracks of her favorite hymns.
“I can’t hear the music,” she breathed.
I turned the volume dial to the right. She seemed content. Closing her eyes, she sunk into her pillow and lay still.
I looked back at her one more time before switching off the light, and smiled.
“Goodnight Grandma. I love you.”
“I love you,” was all she said.