Progress Notes

The first time I visit her, she lies in bed at the far end of the hall where residents with the worst kinds of dementia are placed, where the man in room 308 rigidly slumps in a geri-chair, eyes and mouth open wide as if in a trance, where the wild-haired woman in room 309 clasps a soft-bristle brush to her breast and rocks back and forth, tied to her wheelchair with a blue padded belt, where the bed alarms never stop beeping and the questions are endless, Where am I? Who am I? Will you help me? Two knocks on her door, room 310, and I enter. A radio sits on her bedside table. On the shelf across from her bed, a rubber snake coils against a pink ballerina music box. She stares up at a poster tacked to the ceiling above her bed, a photo of wildflowers on a high mountain slope. I wonder what she thinks about, if she can still think at all.

Her name is Rita. She is in her mid-fifties, decades younger than most residents, admitted for wound care because bedsores have broken through the tender skin on her backside, and her husband can no longer care for her at home. Her thin body is contracted, bent knees wedged between the bedrails, hands curled into tight fists. She can tolerate sitting in her wheelchair for an hour a day when her husband comes on his lunch break. After he leaves, an aide puts her back to bed and a nurse pours milky-brown, high-protein liquid into the tube in her belly to keep her hydrated and fed.

Her care plan goals are to get her to track with her eyes, move her head, or change her expression.

I know a little about advanced multiple sclerosis: she may suffer from painful spasms or burning sensations. She may have a lucid mind or significant memory loss, clear vision or blurred. Because I’ve heard she can no longer speak, I have no way of knowing for sure. According to her Activities Care Plan, I’m supposed to provide one-to-one visits three times a week for sensory stimulation: play music and ring bells, wave cinnamon sticks and rosebud sachets beneath her nose, or show her objects from my cart—bright fabrics, silk flowers, rhinestone jewelry—the types of activities I do for residents with severe cognitive deficits. Her care plan goals are to get her to track with her eyes, move her head, or change her expression.

Her long wavy hair, deep brown with a hint of silver at the temples, fans across her pillow, and several tendrils stick to her damp forehead.

I rub her arm.

She screams, high-pitched wails that rise from deep inside, as if with all her strength she pushes out the noise.

I turn on the radio.

I know staff can hear her in the hallway and residents listen through the walls. When I push their wheelchairs past her room on my way to a social program, they glance toward her door. One resident may shake his head and say, “Poor kid.” Another will yell, “Shut the hell up!” She annoys me too.

Each one of her screams is punctuated by a moment of silence before beginning again. I pull a picture book from my cart and hold it up to her face. She bares her teeth.

*     *     *

I spend my workdays serving coffee, painting fingernails, conducting exercise groups, and calling Bingo. A year has passed since I graduated from college with a bachelor’s degree in English, got married, and moved five hours from home. When I tell people that I work in the Activities Department of a nursing home, the same type of job I had all through high school and college, I always add that I plan on returning to college to get my master’s degree, that I intend on doing something else with my life. And before the move, I seriously did consider graduate school, even took the GRE, but my scores were so low that I lost my nerve. I threw away the admissions packets I sent for and said I needed a break. I said I needed time to study, to read and to write. Besides, I said, I was a college graduate and could find a good writing job anywhere.

But after the move and weeks of filling out applications, I realized I wasn’t going to get that writing or editing job. Just one company called for an interview, and it was for a position in collections at a bank. I let the machine pick up and continued to scan the Classifieds until I saw the ad for an activities assistant, a job I knew I could get.

So I help the residents plant flower gardens in the courtyard and paint birdhouses. I sing to them, songs like “Bicycle Built for Two” and “You Are My Sunshine.” I take them shopping at the dollar store and help them place two dollar bets on horses at the racetrack across town. I also read to them, sweet stories with happy endings. When I conduct the nursing home’s monthly poetry group, I photocopy lighthearted poems from Reminisce or Good Old Days magazines. I sit at a table with eight or ten residents and read the verses aloud. Then I ask them what they would like to write about.

Some stare off into the distance. Others nap.

“What happens this month?” I ask.

“Kids return to school,” one resident says.

I write down their words:

September first, and back to the red brick schoolhouse,

skipping or dragging summer-feet

in ugly brown Oxfords.

A far cry from black patent leather,

but “they’re practical.”

Their poems fit well inside the Resident Chronicle, the facility newsletter I put out each month. They see their words in print, next to the birthday list. Some cut them out and post them on the corkboards in their rooms; others carry the newsletters with them, tucked inside the waistbands of their sweatpants, ready to read to visitors, or again to themselves.

For a while, after work and on weekends, I write too. My husband works nights as a security guard at an abandoned factory on the outskirts of town, so I spend evenings alone, and those first few months I draft essays, laptop balanced on my knees, notebooks and journals strewn across the floor of our one-bedroom rental. Free from the demands of college homework, I write whatever, whenever, I want.

This doesn’t last long.

Tonight, get in bed and watch television. Tomorrow, write.

Blame it on the lack of deadlines to keep me motivated, blame it on the demands of a forty-hour work week, but after a while I am no longer writing. I watch television. The Dick Van Dyke Show, The Mary Tyler Moore Show, and I Love Lucy fill my evenings. When I think about writing, I manage to talk myself out of it: I am too tired, I have to clean the bathroom, go to the laundromat, walk the dog, wash dishes, mow the lawn, sweep the garage, trim the shrubs, grocery shop. I begin frequenting craft stores, learn to make oatmeal soap, plaster trivets and cement stepping stones decorated with cobalt sea glass and bits of broken mirror. I make dog biscuits and roll out egg noodles for chicken soup from scratch. Or I just don’t feel like writing. Tonight, get in bed and watch television. Tomorrow, write.

*     *     *

Three times a week, I show Rita photographs of horses and cats, wave vials of citrus and peppermint beneath her nose, stroke her arm with a peacock feather, even read to her from Chicken Soup for the Soul—anything to get her to respond—but she screams or stares at the ceiling, not once indicating she knows I am there. When I record our interactions in her chart’s Progress Notes, I consistently write “No response.” One afternoon, the charge nurse asks me to give Rita’s contracted hands range of motion therapy, so I smooth lotion over the top of her right fist and stroke her fingers down to the tips, where her long nails burrow into her palm. She whimpers, and when I slip my thumb beneath her curled fingers to straighten them, she shrieks. The undersides of her fingers are gummed with sweat and smell like sour milk. I try to ease her hand open a little more, to rub lotion around the joints, but she screams louder. Afraid I’ve hurt her and that I’ll break her brittle bones, I let her fingers spring back into her palm.

In the hall outside Rita’s room, the charge nurse smiles sympathetically. “What did you do to that poor woman?”

I know she’s only teasing, but I don’t feel like laughing. I go next door for a visit with a catatonic man in the end stages of Alzheimer’s. I lean over the man’s bed, carefully wipe the sleep from his unblinking eyes with a warm washcloth, and listen to Rita wail through the wall.

Later, at home, I wonder if she cries out clear into evening, or if she’s finally stopped. I curl up in my own bed and let Lucy Ricardo’s terrible singing lull me to sleep.

*     *     *

I meet Rita’s husband after I’ve been visiting her room for a month. The conference room is cramped with a large table and a dusty, ceiling-high ficus tree. The state requires that the care plan team meet every few weeks to review and update the progress of new admits. I ask her husband, a small man with dark hair and a thick mustache, about her past interests.

“She used to like poetry,” he says, adjusting the bill of his baseball cap. “Used to write it too, even went to graduate school for her MFA, but never finished because—well, you know.”

And I’ve been reading her Chicken Soup for the Soul.

“Who are her favorite writers?” I think of the books high up on my shelves at home, the dog-eared covers and tissue-thin pages filled with blue ink and pink highlighter.

He folds his hands and shrugs. “The usual famous ones, I guess.”

Impatiently, I wait for the other departments to finish giving their reports—Nursing: her bedsores have almost healed. Dietary: she maintains a healthy weight. Social services: she screams on a regular basis—and after the meeting, I hurry to Rita’s room.

As usual, she lies on her back, staring at the ceiling.

“So you’re a poet,” I say.

I lean over her bedrails. “I used to study writing, too. Who do you like? Plath? Dickinson? Wordsworth? Blake?”

She turns her head and looks at me.

*     *     *

I scoot a chair up to my bookshelf and pull down dusty copies of Keats, Cummings, and Bishop. I leaf through my Norton and Heath anthologies, the comments I penned as an undergrad, the loose papers tucked inside, a quiz on “The Wasteland,” notes on “Do Not Go Gentle into that Good Night.”

When I was in college, I used to take my textbooks with me to the nursing home and study on my breaks, sometimes when I was supposed to be doing quarterly activity assessments and care plans. During music performances, while the residents listened to fiddlers strum “Tennessee Waltz,” I critiqued essays for workshop, and during church programs, I scribbled ideas for essays on napkins. Back then I filled every spare moment with reading and writing, some mornings rising at 4:30 to fit a few more hours into my day. I wouldn’t turn on the television all semester. Now, a year later, I scoot a chair up to my bookshelf and pull down dusty copies of Keats, Cummings, and Bishop. I leaf through my Norton and Heath anthologies, the comments I penned as an undergrad, the loose papers tucked inside, a quiz on “The Wasteland,” notes on “Do Not Go Gentle into that Good Night.” I’ve grown into the habit of sleeping in until the last possible minute, hitting the snooze button so many times that I’m nearly late for work each morning. On my lunch breaks I drive home and settle into the Game Show channel, after work TV Land.

I wipe off my book jackets with a damp cloth. It is fall, and classes are in full swing. Right now, students hurry across campus on their way to the library, backpacks weighted with binders and books. Maybe a young student heads up to the second floor, to the quiet cubicle in the northeast corner, the heart of the literature stacks overlooking the sprawling lawn and administration building, my favorite place to study. Maybe this student opens an American lit book and begins to read. It is nearly seven o’clock, dusk, and through the branches of the giant elms lining the sidewalks, the streetlights dully gleam. Then the clock tower begins to chime, and almost 300 miles away, kneeling in front of my old textbooks, something stirs inside.

*     *     *

Her eyes are closed and she moans the afternoon I read Sylvia Plath’s “Tulips.”  I’ve spent the morning at the copy machine with a heavy pile of books, filling a three-ring binder with my favorite poems. I glance up from the page. The vertical blinds are drawn, and the leaves on the cherry tree outside her window have turned deep gold. Sun glints off the metal light poles in the parking lot, off the windshields of the parked cars, and she’s stopped groaning. She watches me, studying my face and hands, and for once, I can also really see her, the intensity of her green eyes.

When I reach the concluding lines—

The water I taste is warm and salt, like the sea,

And comes from a country far away as health

—I hesitate. Should I be reading something this grim to her? But she remains still, staring at me, as I skim the pages of the binder. I ask who she would like to hear next, Williams, maybe Blake?

She opens her eyes wide and inhales, and so softly I almost miss it, she mouths a “B.”

Doctors, nurses—everyone—say she’s nonverbal, so I’m not sure I hear her correctly.

She tries to lift her head from the pillow, but her hair is pinned beneath her shoulders. “B— Bla—,” she whispers.

“Do you mean Blake?”

Perspiration flecks her upper lip, and she closes her eyes. “Yes,” she breathes.

I suppress the urge to run out of her room and tell my co-workers they were wrong—she can talk. Instead, I flip through the notebook and find the Songs of Innocence and of Experience. I turn to the first poem and start to read:

Piping down the valleys wild,  

Piping songs of pleasant glee . . .

And then I lose track of time. I read about bright tigers, little lambs, and chimney sweeps, about laughing meadows and London town, bleak fields and children’s cries of weep, weep, weep, weep. When I finally look up from the binder, I’ve read through most of the Songs, poems I haven’t read for a long time, that she hasn’t heard for an even longer time.

Before I leave her room, I turn on the radio. The announcer gives the weather report, and Rita stares at the ceiling, but I believe she sees something else. Instead of the mountain scene on the poster above her bed, she sees the words she still knows.

*     *     *

I would like to say it is the poetry that inspires me to fill out the application for graduate school, but it’s more complicated than that. Rita couldn’t finish school because of the rapid progression of her disease, and I know it sounds cliché to say that I feel my own life slipping away when I visit her room and see her deteriorated body, the days she passes in bed, but how else can I put it?

That fall, when she is able to sit up for an hour, and her husband doesn’t make it in, I brush her dark hair so that it falls in thick waves over her shoulders. She purses her lips so I can apply her lipstick, and I show her how beautiful she looks in a hand mirror. Then I take her outside. The courtyard is in the middle of the nursing home, surrounded on all sides by windows and resident rooms. I wheel her to the rose garden and pull up a patio chair next to hers. Inside, residents sit in wheelchairs waiting to be invited to an activity program or a meal. Some watch television. Others are dying. But I don’t look at the banks of windows encircling us. The roses are four-feet tall and we face them, white with pink trim, deep red with velvet petals. I read to her, and for a short time pretend we aren’t in the nursing home, in the center of the city, caught in the same routine. The howls of an ambulance at the hospital across the street, the beeping of the facility bus, disappear, and if only for a few minutes, we live somewhere else, immersed in the language of some other time, breathing in the sweetness of the last of the season’s roses, wisps of hair skimming our flushed cheeks in the crisp breeze.

But then one dark winter afternoon I visit her room, and from her bed she looks at me with what I can only describe as despair. The nursing staff has shaved her head nearly bald with clippers.

When I stop Rita’s nurses’ aide in the hall and ask why, she says the long hair was too hard to care for and that Rita’s husband gave his consent.

“But did you ask her?”

The aide continues down the hall, her arms filled with bed linens, and does not respond.

Several weeks later on New Year’s Eve, I apply to just one school, one thirty miles north of my hometown that doesn’t require entrance exams.

*     *     *

It’s early spring, and the cherry tree outside Rita’s window is thick with pink blossoms. The day before, I received the phone call I’ve been hoping for—I’ve been accepted into graduate school—and just like that, my life has changed. The binder overflows with hundreds of photocopies, some I’ve enlarged so she can read along with me though I never know if she can actually see them.

I’m not really thinking about poetry. I’m thinking about packing and moving, about registering for classes. I’m thinking about how to describe the stuffiness of Rita’s room, the rash of broken capillaries on her cheeks, and the flecks of dried blood on her chapped lower lip.

I need to tell her I am leaving.

Her room feels too warm, so I crack the window. “Is that better?”

She stares at the poster on the ceiling.

“Your hair’s really growing back.”

She raises her eyebrows. An inch of dark stubble covers her head. I haven’t shown her a mirror in a long time.

I begin to tell her that I wrote the night before, but then stop. What will she think if I tell her I am writing about the residents in the Alzheimer’s Unit, how they try the doors all day, insisting they need to get home, how when I take them for rides in the facility van, they beg to go back inside? What will she think if she knows I will also one day write about her?

I finally blurt out that I am going back to school to get an MFA. Then I hesitate. Maybe I shouldn’t have said anything at all. Part of me feels as if I’m rubbing in what she will never have.

Dense white clouds drift past the sun, and the plastic blinds clack in the breeze. She doesn’t look at me, but there is no mistaking what I hear. “Good for you,” she whispers.

*     *     *

I brush her dark hair so that it falls in thick waves over her shoulders. She purses her lips so I can apply her lipstick, and I show her how beautiful she looks in a hand mirror.

It isn’t always good those months before I leave. There are days when she cries out during the entire visit, days when I sit beside her bed and her screams drown out the poems I read aloud, when I lose my temper and ask, “Do you want me to read to you, or not?” One afternoon she spits in my face. I glare at her and leave her room, though when I return to my office to record our interaction in her progress notes, I don’t know what to write. What is it like when a woman half her age bounds into her room with poems she’s picked out for her to hear? How does it feel when she tells her she’s going to graduate school to study writing while her hands, no longer able to grip a pen, have curled like dead leaves? When her husband visits once a day for an hour, and she’s so lonely for his touch, but can’t ask him to lie down beside her and hold her or even demand that he stay, when the old man in the hallway outside her door won’t stop asking where he is, and the woman in the room next door rhythmically thumps her wheelchair into the wall behind her head, and the whole place smells like piss and shit, and she is young—only in her fifties—and should be doing anything but lying in a bed, staring at a poster of wildflowers someone tacked to the ceiling.

Twice before I leave, she scrapes her fist against her G-tube until it pops out of her belly and liquid food soaks her sheets, pooling on the white linoleum beneath her bed. Nursing staff considers the first time an accident, but they scold her the second time.

“What are you trying to do?” I overhear her nurse say. She and an aide tape the tube down along her side. They smother her stomach with a pillow so she can no longer work it free.

When I show the binder to the middle-aged woman hired to take my place, she glances at a stack of care plan assessments in her hand instead. I flip through the photocopies, pausing at the pages with the corners folded—Wordsworth and Keats, Coleridge and Blake—trying to explain Rita’s preferences. “Don’t worry,” the woman says, “I know just the kind of inspirational poetry she needs.”

Then I stop trying to explain. I know she isn’t listening, and I tell myself I don’t really know what Rita needs anyway. I used to ask her husband to bring in her own poetry from home, but he never did. At first, he told me he forgot. Then he said he couldn’t find it. Maybe he wanted to keep that part of her for himself. I used to imagine him sitting at her desk, sifting through her notebooks, reading her words, remembering. Or maybe he kept the notebooks shut, tucked away on the top shelf of the bookcase. Maybe he thought the poems would awaken something inside that she would never be able to regain. Maybe he knew something I didn’t, that it would hurt too much, and it was best if she forgot. She once mouthed a B, maybe a D, when I asked her to tell me her favorite poet, and I listed off names. Blake, Bishop, Dickinson, Donne? She shook her head. Dickey, Berryman, Bly? No, she said loudly, her face red with effort. Doolittle, Browning? Spit gathered in the corners of her mouth, and she screamed.

I am leaving soon, starting a new life, but until then, I visit her room three times a week. The pink privacy curtain surrounding her bed is drawn back, and her folded bedspread neatly covers her feet. My mind these days is elsewhere, already focused on the future. Still, I sit beside her bed and flip through the notebook, choosing poems I think she wants to hear. The lazy slant of afternoon sun shines on her face and perspiration beads her forehead. Her light blue hospital gown has slipped off her shoulders, and the white sheet bunched up at her waist hides the tube in her belly. She listens to me read, her hands balled into tight fists against her heart, and stares up at the poster on the ceiling, looming peaks of snow-flecked mountains, sparse stands of subalpine fir, and a lush meadow of wildflowers, tiny lavender daisies and white tufts of bear grass, their pale faces forever turned toward the sky. For her, delicate fingers of lupine hold everything.

Jennifer AndersonJennifer Anderson is an English instructor at Lewis-Clark State College, and her work has appeared in The Missouri Review, the Colorado Review, Hayden’s Ferry Review, The Cimarron Review, and Open Spaces Quarterly, among other places. She also collaborates on documentary films with her husband, Vernon Lott; their latest project, “The Act of Becoming,” explores the recent international success behind John Williams’s 1965 novel Stoner.