she looked uncomfortable. A young boy sat on the bed next to her, playing with a pair of action figures. He had one in each hand and they were fighting each other.
“Hello,” I said to the family. “I’m Dr. Dosa.”
I introduced myself to each of the daughters, Gabriella, Caterina, and Ana. As I shook their hands, I studied each of their faces. You can learn a lot from faces, particularly the eyes. Happiness, worry, excitement, fear—it all shows up there. The eyes of these three women were filled with a profound sadness. Whether they had admitted it to themselves or not, these dutiful daughters knew their mother had arrived at her last stop.
“Who’s this?” I asked, referring to the little boy. He was no more than five and he reminded me of my own son. Gabriella, the daughter I presumed to be the oldest, answered.
“That’s my son, Freddy.”
I walked over and sat down on the bed next to him.
“Hi there, Freddy. I’m Doctor Dosa. How old are you?”
Freddy put up one hand to indicate that he was indeed five years old. Then he showed me his action figures.
“This is Spider-Man and this is Superman.”
“Are they helping to take care of your grandmother?”
Freddy nodded and then slipped back into his pretend world, pitting the two action figures against each other in mock combat.
I turned my attention to the daughters.
“Tell me about your mother.”
Gabriella was the first to speak. “Doctor, we feel terrible about moving our mother from home. She always told us…” Her voice trailed off and became almost inaudible. I moved in closer.
“It just got to be too much for us to take care of her,” Caterina said, picking up where her sister left off.
They probably felt like they had let their mother down by not heeding her wishes. Looking at Mrs. Matos and her degree of discomfort, I was reminded that circumstances sometimes make that wish impossible.
An aide entered the room to do her admissions assessment. I suggested that we relocate to the family room down the hall so we could talk. The youngest daughter, Ana, launched into an explanation.
“Our mother was always fiercely independent. She stayed to herself so we didn’t see it coming until it was too late. Three years ago, Caterina and I went back to our country, the Dominican Republic, to see her. Her apartment was a complete disaster. Newspapers were everywhere, unwashed dishes sat in the sink. It was clear she hadn’t washed her clothes.”
Ana looked over at Caterina and I could sense that they were reliving the memory together.
“Doctor, we both went outside and just started to cry. My mother had always taken such pride in her home. You couldn’t put so much as a coffee cup on the table without her taking it away to rinse it. And now? How could we let our mother live this way? Right there we decided to move her to the United States and we put her on a plane with us. That was two years ago. Since then, we’ve done the best we could to take care of her, but—”
Ana put her hands up toward her head as the history became too much for her to relate.
Gabriella picked up the story. “When my mother got to Rhode Island, she became confused. Her English was not very good, and I think the language barrier only added to her confusion. She had no idea where she was. At night, she would get up and wander. One time we even had to call the police to help us find her. You can’t imagine how frightening it is to wake up and realize that your mother isn’t there. One night about a year ago, she walked out of my sister’s house and fell down the stairs. She didn’t get hurt—thank God!—so they sent her home from the ER. No one ever suggested we needed help or offered us any advice.”
Caterina jumped in. “A few weeks later, my mother stopped eating. Then she developed pneumonia. Each time, we talked to her primary care doctor and he just sent us home. She’s depressed, he told me, and he gave us a medication. She has pneumonia, he told Gabriella, so here’s an antibiotic. He just gave us pills. None of us knew what to do. We started sleeping next to our mother on the floor to make sure she wouldn’t get up in the middle of the night. It was just so exhausting. Finally, a few months ago, Mom stopped walking so