birth, JANUARY 21, 1918, were stenciled in block letters on a rectangular piece of paper at the top of the corkboard. Each letter had been cut from construction paper and meticulously decorated with beads and other trinkets, the loving effort of some grandchild no doubt. Underneath the artwork there was a black-and-white photograph of a beautiful young woman in her early twenties. She wore dark lipstick that contrasted with her pale face, and she was fashionably dressed in a 1940s summer outfit. She was walking arm-in-arm with a handsome man in a Navy uniform. A parasol hung on her other arm. I imagined them in a park on a warm summer’s afternoon shortly after the war. I studied their faces. They were happy, and clearly in love.
Beneath that picture was a second photograph of the same couple years later with two young children. This one was in color, the faded stock of an earlier day. His hair had receded some and hers now revealed a few streaks of gray. This picture contained a promise of a different sort. They weren’t just young lovers now; they were proud parents, thinking of a future larger than their own.
The last picture in the collection was of Mrs. Smith in her later years, meticulously dressed, her silver hair neatly pulled back below a tastefully chosen hat. Her husband was gone, but she was surrounded by several generations. A banner hung in the background proclaimed HAPPY 80TH BIRTHDAY, GRANDMA. Eight years had passed since then.
I knocked again and made my way inside where Mary was tending to her patient. Gone was the vibrant, well-dressed grandma of the birthday picture. In her place was a smaller replica of the woman that was. Until I worked with patients in the late stages of Alzheimer’s the expression “a shadow of her former self” was just a cliché. This is what I saw with Mrs. Smith and so many of the other residents here. But behind that shadow I still saw the substance, even if she seemed no longer to see me.
“Do you need me?” Mary asked, a little annoyed by the intrusion.
“Yes,” I replied. “I need to know who has to be seen today.”
“Let me finish up here and I’ll meet you at the front desk.”
As I turned to leave, Mary stood up from her stooped position at the bedside, arching her back against the strain.
“On second thought, David, I’m going to be busy here for a little bit. Why don’t you go take a look at Saul’s leg? It’s red and angry looking. I think he has that skin infection again.”
“Fair enough. I’ll go see him.”
I left the room and headed off in search of Saul Strahan, an eighty-year-old man who has lived on the unit for many years. I found him dressed in his usual garb—a Boston Red Sox sweatshirt and baseball cap—in his usual place, a La-Z-Boy recliner in front of the TV. The television was tuned to a morning talk show.
“What’s on TV?” I asked, not expecting a reply.
I sat down beside him and glanced at the television. A young actress was telling the show’s host how annoyed she was by the paparazzi that followed her everywhere.
“Everyone’s got problems, right, Saul?”
I looked at him more closely. In addition to his progressive Alzheimer’s, Saul had been the victim of a nasty stroke that had robbed him of his language four years ago. His eyes stared back at me with life, though, and I could sense that he was trying to speak. I placed my hand on his shoulder and told him that I was there to examine his leg.
As Mary had said, Saul’s legs were both swollen with edema, a result of his twenty-year battle with congestive heart failure. Yet his right leg seemed angrier and decidedly warm to the touch. Mary’s concerns seemed justified.
“Saul, my friend, I’m sorry but it looks like you’re going back on antibiotics.” I made a mental note to call his daughter.
I returned to the nurse’s station where Maya remained hard at work cleaning her fur. Startled by my return, she leaped off the countertop, but not before giving me one of her this place isn’t big enough for both us looks.
I finished my note and sat at the desk waiting for Mary to return. A nurse for most of her life, Mary started as a nurse’s assistant when she was in high school in the seventies and in nursing school discovered she loved working with old people. Not only