Muzak & Dead Fish

Muzak & Dead Fish: After church services and dinner the Caregiver helped the old woman put the birds to bed. She sat with the woman at least once a week for six hours at a time. It was one of the most onerous cases in late life care she'd ever had, but the two had become accustomed with each other, and though difficult, it was not entirely unpleasant. They both had the same nickname, and they both liked to read. These were simple similarities which made the differences less of a labyrinth. The Caregiver liked putting the birds to bed. It was a brightly colored, beautiful distraction from everything else on the shift. The process involved taking thick tablecloth fabric and covering the cages after being sure all the birds were safe and ready for sleep. In one cage perched a half dozen brightly colored yellow and white birds, and in the other a larger gray, yellow and white bird with many toys hanging all throughout the inside of the fairly small cage. The fabric was too heavy, and the cages too high for the old woman to tend to by herself.

This one particular evening the older woman noticed a small amount of water in front of the fish tank, quite near to the bird cages. She was on her way to show the Caregiver that there were actually two suckerfish in the aquarium, as opposed to one suckerfish, as the Caregiver had thought. She knew the Caregiver thought the black suckerfish interesting, though the woman herself preferred the pair of angelfish. One of the angelfish, however, went missing. The old woman tapped the glass when the one swam by, inquiring to the fish as to the whereabouts of the other. "Where is your friend little angel?" In response, foamy water bubbled out from beneath the tank.

The Caregiver looked to the water forming beneath the tank and onto the wood, and immediately ran to the activities room for the Med Nurse, the only supervisor left on the floor. It was Sunday evening after 7 pm. Most of the practical staff was home.

The fish tank was installed, as is popular in many of these types of environments, within a fine wood wall of shelves, complete with soft lights and a fine selection books on every point of interest. It was part of a lovely, casual sitting area outside of the chapel where residents could read, visit with friends or family, or simply relax and look at the animals. All very natural. Just like home. The outlets were all a part of the wall, and water was beginning to rise around the cords, leading to the outlets. The entire wall was vulnerable to fire. As calmly as possible the Caregiver and the Med Nurse returned to the tank, but upon seeing the impending problem, the Med Nurse frantically ripped the cords from the outlet before disappearing to find help.

The Old Woman stood silent watching everyone run around. Two young Personal Care Assistants - or PCA’s as they were more commonly called - came to view the leaking tank. A pleasant looking heavy-set girl of about 20 announced quietly that there was a fish flopping around behind the tank. The brightly colored fish were somehow leaking out, obviously dead. The Caregiver bent awkwardly to see the view from the PCA's perspective, and saw two dead fish sitting in the leaking water, along with one just about to die. Yes, there was the one of the Angelfish pair that went missing. There was Mel's favorite fish flopping around desperately in need of air. Any sort of the death inside of the facility was cause for deep contemplation, alarm even. It made people dwell on the inevitable. It made clear that reality that these homes prevented people from fearing. Death is real regardless of how pretty the room where we spend our final days.

Someone went to find the resident who took care of the tank, and then the room cleared out as all the employees whom had gathered remembered they had tasks to do on a schedule. There was no more time to spend contemplating the dead fish. All the plugs were pulled. The wall would not catch fire. The immediate work was complete. Saving the fish was another person's responsibility. There was a shift to keep on schedule.

The tank sat in dark silence, the dead fish that had mysteriously escaped with the slow creeping water, hidden from view. The birds, for the first time during the day, were silent as they prepared for sleep. The old woman asked the Caregiver if there were really dead fish in a puddle behind the tank - if the fish that went missing was also lying there dead. The Caregiver said they should go or the old woman would be late for bed.

They walked to the old woman's room. She weighed 100 pounds, if that. Her once athletic and lean physique delicate and pained. The years were working with a gravitational force too great to fight. Gripping her walker she took slow, careful steps. The Caregiver, thirty years younger, walked slowly, paced, very conscious of every small step. It was as painful for her to walk with such a slow gait as it was for the other woman to move as quickly as she could to her room. They were late. The commotion with the fish has taken them off the carefully outlined and regimented schedule by which the old women lived: every minute of every hour had to be accounted for - had a distinct purpose and action - and they were now at least seven minutes behind schedule.

Once back in the small apartment within the facility, the Caregiver sat down carefully and quietly on the small love seat. There was a blue cushioned chair with large arms which rocked a bit, but it bothered her back to sit in the soft cushions on the hard chair. All the other Caregivers apparently sat there, but she never found it comfortable. It generated much conversation when she first sat on the black, brown and cream plaid love seat. No one ever sat there. No one at all. Maybe it would be better to sit in one of the straight back chairs at the miniature kitchen table, or maybe it would be better to sit on the white hard backed chair different from the other two chairs by the table, or maybe it would be better to just sit in the blue chair, except that it was uncomfortable, so yes, yes - okay, yes, it was fine to sit in the love seat. After the ten minutes of deliberation over which chair in the one living area of the two room apartment she should sit in, the Caregiver could never quite get comfortable regardless of where she sat; still she preferred the love seat. She could see into the bedroom, in case the woman needed assistance, and she could see the clock which would dictate so much of the shift, and she could easily get up and down which she would do at least fifty or more times in the six total hours they'd be together.

The woman went immediately into her bedroom to change for bed before washing up. She asked the Caregiver to sit since she would not need help for a few minutes. Three and a half minutes later she asked for assistance. There was a small shoe cloth on a case inside the open closet door that she needed to clean the one shoe she wore. On the other foot was a temporary brace to protect and balance the foot which had just had an infectious toe removed. The Caregiver bent down and handed the woman the shoe cloth. The woman then asked for the shoe tree. The Caregiver handed her a bent metal stick with two egg shaped ovals on the ends, and watched as the woman aggressively stuck the stick into the shoe, and meticulously scrubbed the shoe with the soft cloth. A moment later the Caregiver placed the cloth back into the closet, exactly as it had been, and then placed the shoe and the brace under a chair near the bed. The shoe and the brace had to be placed exactly the same distance apart as they were placed each and every night, and they had to extend beyond the chair a certain amount, as opposed to sitting underneath the chair. Everything always had to be returned to the exact place it had been, and nothing could be in anyway astray; not even a Kleenex left lying unfolded on a night table. Once that was done the ritual of removing the clothing began. A new shirt was removed from the closet and hung on the inside of the bedroom door. A Kleenex was placed inside the front breast pocket. The hanger placed back in the closet, and then a few moments later removed so that the shirt which had been worn that day could be hung on the appropriate colored hanger, and then buttoned on the second button down, before hanging the other shirt on the inside of the door. She removed her pants and asked for a cream colored hanger, folded the elastic waist band pants over and had them hung on the outside of the door. She removed her undergarments, asking for a plastic market bag inside of the closet. The Caregiver brought the bag over for her to drop the dirty socks, bra and underwear into, as opposed to taking the clothing in hand. "No one else does that." The old woman commented, "and you've not put the bag back in the same spot of the closet. It must be exactly as it was before you moved it, please." The word 'please' had an extended accent in it, a bit of an affected intonation so that is sounded like an apologetic: puh-leeeeze. Whenever the woman realized she might be asking more of the Caregiver than was appreciated, she added that 'please' in a tone of soft-spoken royalty. She did it quite often. The Caregiver looked down to where she had placed the bag. It was approximately a quarter inch off from the original position. Slightly, oh so slightly, she moved the bag. The bottom of the bag leaned toward the corner inside of the closet, the handles floating a bit and then flapping over. The handles needed to be against the wall also. She took a deep breath, smiled and smashed her hand against the bag so that it lay flush against the wall. "I am sorry to be so difficult, but it has to be an exact way, you know."

The Caregiver smiled, distracting herself by attempting to establish how the fish got out of the tank: The water could have spilled over, bringing the fish over the top - except there was a tank cover; the filter could have gone bad and the water and the fish could have been sucked out by accident, like in Nemo, the animated film about the lost little fish and his father fish's desperate search through sea and high water for him….

"Are you listening? Please pull my Depends up in the back, and then go sit while I wash." The Caregiver stood up and adjusted the ruffle of paper pantie on the woman's bottom, and then went to sit down on the loveseat. Within three minutes of sitting the woman asked her to read from the Christian novel series on the round little kitchen table. The Caregiver stood up, walked three steps to the table, sat, picked up the book, and read two paragraphs before the women came through with her walker, announcing she was ready to wash up. The Caregiver placed the bookmark back between the pages, closed the book, turned it upside down, and placed the Kleenex box on top of the book to prevent the pages from bending away from the binding. It was a ritual to be performed with each and every reading. She then went back to the love seat and sat very still, listening to the various levels of silence and slight sound.

The walker made a slight shuffle sound on the carpet before the wheels clanked on the tile floor of the bathroom. The device didn't fit in the bathroom, but had to be turned around and parked outside the door. Once the walker was parked, the weight of the woman's body on the toilet seat echoed and then silence. For the next ten minutes the silence was broken only by the explosive sounds generated by prunes, Metamucil and a speedball combination of narcotic medications.

Out in the hallway muzak was playing on an overhead speaker. The retro 1950s elevator music drifted into the room. Usually the music in the hallway was light and airy, never heard outside the hallways in the rooms. On this particular evening it was not only audible, but was heavy like old music in a smoke filled dive style bar on a rainy afternoon. It droned of lost love and sadness. In the room next door a television was on. The volume was too loud. A man's deep, steady voice kept on talking about something important: maybe talking about the news, or maybe an historic documentary, or maybe an evening sermon. The radio and the television seemed to meet in light waves around the living area of the apartment creating a surreal, dream-like ambiance. In the bathroom the toilet flushed loudly , and then water faucet went on and off at short, regular intervals. The sounds from the bathroom were matched occasionally by a heater on the wall which clanked heavily on and off every few minutes.

Within it all was the sound of subconscious thought and memory and diminishing activity. The Caregiver was accustomed to the strange rhythms, sitting for quite a long while, inactive but alert. It had taken her years to fulfill such a need, and she sometimes wondered if that was a positive asset acquired, or something about which she should be somewhat concerned; after all, it was not natural - it was part of the process of life slowly ending as opposed to life being lived.

The old woman broke the surreal non-silence by announcing that she was taking her medication. It did not have to be logged, simply acknowledged so that she didn't forget she already had taken her pill. "The" pill was actually a combination of ups and downs that were taken first, at hourly intervals, and then, at the end of the evening, in fifteen minute intervals. It was part of the reason she lived for the clock. Everything had to be coordinated to accommodate the medications. After the meds, the cold packs on her right knee. Though the left toe was recently removed, the right knee swelled from arthritis that curled and writhed liked snakes through the woman's body. Every hour, except if a walk down the corridor was required or a meal was happening or an unexpected bathroom trip occurred, a cold pack had to be administered for fifteen minutes. Not 13 minutes. Or 14 minutes. 15 minutes. And the minutes had to be logged exact to the second.

The old woman finished her Oxycontin. She stepped out of the bathroom, her walker announcing her presence before she said a word. "I'm so sorry to bother you, but could you pleeeeeeeeze check to see if my Depends are alright?" The paper underwear was most problematic. The rippled edges got caught in the folds of loose skin on the hips. Lifting up the oversize pajama shirt, the Caregiver ran a finger through the edge of the paper product, making sure it was above the pajama bottoms. "Okay. Thank you. I don't need you for a while. You can sit". Two and a half minutes later, "I need your help now, pleeeeeeeze". It was like this for the entire shift - each and every shift - as each pill kicked in and out of her blood flow. It was why the caregiver did not see her more often. Could not even consider it though she was requested for many more hours. The up and down of it were enough to drive her mad. Up and down. Over and out. Again and again.

The old woman suffered obsessive compulsive disorder and high anxiety neurosis. Her medications exacerbated it to the point where the assisted living program demanded her family hire waking-hour one-on-one assistance for her.

The aides did the best they could to keep her maintained and away from the staff employees. The Caregiver wondered what sort of eccentric she herself may be if she were to live to be 85 or 90. Or worse. She shivered with the thought of PCA's constantly sitting in her personal space like stray dogs and lounge lizards. Many of the women chatted endlessly about nothing whenever she worked with a second person. She forced herself to be kind in case she was viewing a potential point of her own future.

The immediate problem now was that the old woman's left leg was wrapped in an ace bandage, and the woman needed to put a sock over it. She could not bend over far enough, nor could she lift her leg quite high enough, and besides - when she attempted this feat the sock crumpled! And who wants wrinkled socks? Especially not these socks; electric green with a frog face sticking out its electric pink tongue on the toes. It was an odd dichotomy the old woman and her socks. Another pair, which must have been in the wash, had ladybugs faces on them. The Caregiver fixed the sock over the foot with ease, and after checking her toe and the bandage a half dozen times the woman placed a wrist brace on, and then asked for a hug. "Puhleeeeeeezzze."

Smiling and shaking her head, the Caregiver reached down and gingerly wrapped her arms around the little woman, careful not to squeeze the pain back into action after all the work it took to get it to go to sleep. "Thank you so much for all you do for me. Thank you for being here. An angel. My Angel. I am so grateful." Her hug was sincere, lasting quite a few seconds. Then, with the lights out, and all of her nightly needs tended to, she laid like a corpse in the middle of her little twin bed. Directly in the center of the bed. Stiff as a board. Like the fish probably were by this time. Arms crossed over her chest to protect her from a chill. She was embracing death.

The Caregiver lifted the sheet up to her neck, said goodnight and left the room. The woman still thanking her and wishing her sweet dreams and a good week even as the door closed behind her. For a moment the Caregiver felt badly about being annoyed by the case, but then she dismissed the thought, and became grounded on a strange sort of indifference that others might mistake for compassion. Her head ached from the stuffiness of the room and deprivation of the shift.

As she walked through the abandoned sitting room, next to the chapel, the fish tank sat in silent darkness with towels all around it. The birds safely covered from chaos, peacefully asleep. No one was around except for the pleasant looking, plump, young woman vacuuming the dining hall, and a PCA at the elevator on her way down to the dementia unit. The A.M. radio muzak playing strange old sad songs of loved lost and days of joy long gone.