O.W. and Jason
In Monterey, a city by the bay on the central California coast, the darkness was still thick as dawn had not yet arrived. Out in the streets of the mostly residential city, birds were awakening and gradually adding more of their song to the shadowless night of the very early morning. Also breaking the silence, every five minutes or so, was the abrupt sound of a car door and an engine starting. These calls of the suburb were the solitary signals of early risers. The drivers had to commute from Monterey to Silicon Valley but the birds only had to commute from tree to tree. Both groups wanted the basics; food, sex, shelter, and big-picture lifetime accomplishments like procreation.
The commuter’s cars ripped through the morning fog at speeds unsafe. With cold metal and smooth painted exteriors, they tore the moist wind and passed the shores of the Monterey Bay on their left sides. Continuing on, over the Santa Cruz mountains, single file like ants through the redwoods and sequoias, their upholstered and heated cocoons cut their way under the forest’s canopy. If the trees could see them, they might feel pity for the plight of these metal things, for the trees will outlive them by a dozen generations, not having to go anywhere for comfort or procreation. The commuters, with their custom coffees sloshing on plastic dashboards, these resolute road warriors, had a lot of ideas that had motivated them out of bed at four-thirty in the morning. They each had vision, but few of them really knew what they were doing, because so few were secure that their dreams would result in the future of their choice. It was dog-eat-dog out there, up there, over that monolithic mountain pass, where someone else’s business plan held their fate.
On the second floor, in a small rented room, above the dark streets a young man named Jason heard the commuter’s morning callings each weekday as he yielded to a waking state. As for his car door slamming neighbors, he swore he wouldn't trade ten times the pay for their positions. Out of the weathered window frames of the small room, the low buildings and pleasant rolling hillsides of the small city could be seen, covered in pine, street lights marking the menagerie of roadways that turned and twisted. The building had been converted years ago into an eight room rental apartment house for single men, and its wood was at least seventy-five years old. It was rumored to have housed a large Italian family whose lifeline was the sea, that for them, began two blocks north at the docks. Inside the forty-eight square foot room, Jason was snoring loudly from underneath a pile of blankets, his body pressed against a wall. The color computer monitor on the small desk next to the window suddenly came to life and glowed bright blue, with a display in large letters and numbers in the center of the screen: “Good Morning Jason: 6:00 a.m. Tuesday, March 6th, 1996.” Before his senses alerted to reality, the phone rang, signaling with an annoying electronic chirp like a robotic bird. Jason rose up out of the pile of blankets and pillows, his reddish blonde hair jutting outward behind his head in a display of static cling in the shape of a party hat. Annoyed at being awoken, he threw one pillow against the wall and he kicked his legs to throw blankets off his body, and he rolled over to the side of his heavy wooden fold-down bed and picked up his phone that had been within arms reach.
“Hi Jason it’s Judy, I hope you were awake.” Judy was chipper and wide awake.
“Barely, what’s up?”
Jason replied with a groggy voice. He could have cleared his voice before getting on the phone but he faked it, thinking it best that the schedulers at the office feel as if they were intruding when they called him before the birds were awake, before the sea lions over at Fisherman’s Wharf started their days work of males barking at other males. Judy continued, getting right to the point, Jason appreciated the abrupt end of small talk.
“We have had a loss of a regular for the day shift for, an Alzheimers patient. If this works out, this might be the regular patient shift you were looking for. We need you there just prior to seven this morning, write down this name, address and phone number.”
In forty minutes Jason arrived at the retirement home. The sharply contrasted beams of morning sunlight, in stripes with no two alike, carved their way through the atmosphere over the San Gabriel mountain range, across the Salinas valley, and fell on the pine-smothered enclaves and driveways of the peninsula. Freshly shaved, his hair still wet and combed, Jason wore a windbreaker over a casual golf shirt. White slacks and white “nursey” shoes completed his “fine young man working in health care” uniform. Carrying a small back-pack with some books, his lunch and vital-signs equipment, he paced across the parking lot, approaching an L-shaped cement apartment tower. Glancing upward, he noticed on the painted and aluminum-barred balconies of the residents within, lawn chairs, hanging plants, bird feeders, window safety decals on sliding glass doors, and little tables of glass and metal. Most of the balconies were bare, curtains closed or interiors barely lighted. This made sense to Jason. “Hmm, why go out if you can’t go out, or shouldn’t go out. Or perhaps it is shame and embarrassment, for just having to live here, that keeps so many residents off their balconies,” he thought. He entered the vestibule of the Park Place building at 350 Glen Woods Lane. He was seen on the video surveillance camera as automatic doors closed behind him and another pair of doors opened in front of him. He approached the front desk. This was a luxury apartment rental building for senior citizens, with one floor dedicated to “assisted living.” It was clear right away he had entered a corporation, “A Luxury Residence by Hyatt,” proclaimed large gold painted letters in back of the front desk. He was greeted by a pleasant, tall and bulky man, who to Jason’s surprise, had been expecting him:
“You must be Jason for Mr. Irwin. Do me a favor Jason, when you come back tomorrow, don’t wear those nursing looking things like those pants and those white shoes. It makes the other residents nervous to see medical people walking around. We’re here to help them pretend death is no where to be seen, if you know what I mean. You can wear jeans, tennis shoes, and a decent collared shirt and that would be fine.”
The security man smiled and showed Jason the elevator to the sixth floor. Jason swiftly walked off the elevator, then turned left towards the south wing, its corridor plush with red and gold patterned carpeting, dimly light by frosted glass twin-lamp wall fixtures casting their weak light spots on the flooring every ten feet or so. At the last door on the right side Jason lightly lifted the small metal door knocker handle above the peep-hole. Within moments the overnight aide answered the door and let Jason in. He was a Filipino immigrant, about twenty-five years old, who spoke some English. It was clear he was glad to see Jason, it meant he would not have to work a double shift. He introduced himself as “Mike.” He showed Jason the medications he was to give, the phone number list he was to call for various types of emergencies, and the patient’s “No Revive,” order. The name on the prescription bottles read, “Orenthal Winfred Irwin,” and “d.o.b. 07/13/1909.” There was little fresh air in the apartment, the heat was on and the air felt dry and stuffy. The smell in this apartment was a concoction of moth balls, Old Spice cologne, foot powder, and the lingering trace of coated medication tablets. Moth balls are never to be seen no matter how hard one looks for them, they shrivel-up and disappear, but they leave a residue, their smell travels with the patient from his wife’s laundry care and his and her mother’s laundry care, from decades beyond the grave and so on.
“Aren’t you going to introduce me to the patient?” Jason asked of Mike.
“Oh no, he not there, he is gone. It makes no difference. Beside, he will think you are me when he gets up. He’s still sleeping. We let him sleep whenever long he want. When he get up, cereal, milk, maybe grapefruit, orange juice, and medication. He called “O.W.” by everybody.” Mike stated hurriedly, with no attempt to keep his voice low.
Mike quickly left and Jason made himself comfortable. He wandered into the kitchen and examined the food to see what O.W. had been eating. Mostly frozen dinners of macaroni and cheese dominated the freezer; in the refrigerator Ensure protein drinks, apple juice, “all the usual suspects,” he said aloud into the refrigerator. Spots of dried-up fluids were on every surface on the inside of the refrigerator, typical for this home-care situation, the aides do not really observe the insides, their supervisors do not look there, so why clean it? All the same stuff he had seen in all of the other “old man,” homes he had worked at. Jason situated his magazines on the table in front of the couch in the living room, a place he would spend most of his time, a place where the buttocks of every other home health aide had already made their permanent indentations. Jason could see that this care situation had been going on for at least a couple of years. This was evidenced by where the dust was, in the places where a regular house-cleaning person or the home health aide would never dust, like on top of cabinets, on top of picture frames. He could see this dust from the other side of the room. “Pretty thick,” he thought. Perhaps this explains the stuffy atmosphere in this two bedroom apartment. Jason put on his Walkman radio headset and found his local Public Radio station. He drew open the curtains to reveal a beautiful view of the Del Monte Forest pine trees. Swaying at their tops in the morning wind of March, they seemed to be as high as this seven-story building. He wondered why these curtains would be closed with this great view out there. He walked over to O.W.’s bedroom to see how he was. He was sleeping in a straight line as if he had to share his big bed with three other people, his mouth was hanging open as if catching flies, and his head sunk back into a downy pillow, as he breathed audibly. Jason smiled at seeing this sight of human comfort. People look so at peace in deep slumber, vulnerable and without a care, humbling to the casual observer.
Twenty minutes later O.W. came wandering around the living room corner. From the couch near the balcony in the living room, Jason saw his walking cane first and heard some mumbling and was a bit startled by this sudden activity. Then O.W. came into his view. As he came around the corner from the bedroom hallway he was looking very bewildered and determined to find immediate answers to questions, of which Jason had barely heard him ask. O.W. had already put on his glasses, a heavy dark red robe, untied and dangling over his cotton pajamas and well worn morning slippers. Jason had not even heard him getting up. O.W. was a hunched over, barely five foot tall, mostly bald, old man, a man who did not know where he was, who Jason was, or most puzzling where was a person named “Ida?” Jason reacted quickly to orientate him and relive his anxiety:
“Good morning O.W. I’m Jason, how are you this morning?” Jason practically yelled towards him.
A bad habit of caregivers is to address all old patients at ten to twenty decibels above normal, as if it is a given that they are hard of hearing. Jason was not above that bad habit. He had startled O.W.. From across the room, O.W. quickly examined Jason head to toe, Jason could tell that O.W. had taken notice of his white pants and white shoes. “Ooops,” Jason thought, he was now a medical authority in O.W.’s mind, the man at the front desk was right. O.W.’s facial expressions changed rapidly. Like a practiced con-man or a Hollywood actor, he could contort his face in a variety of poses when asking a question. It was a cute characteristic for an old man. Without reply, O.W. hobbled over to Jason and sat in the upright chair next to the couch. He stood his cane up between his legs and grasped the top of the cane like a king would his scepter. Pulling the slack up on the pant-legs of his pajamas, he then adjusted his glasses and looked right over at Jason with serious intent. Suddenly Jason was the subject of an intensely important interview to be conducted by a very confused mind. The questioning began that Jason would later learn was a daily requirement to settle O.W.’s internal torment:
“Now let me, let me just say that I don’t know who you are. But I figure you are one of those care, ehh, medicine giving, uhh people who hang-out around here.”
O.W. pointed his finger at the apartment’s interior, left to right, to illustrate this apartment that he apparently was only barely familiar with.
“Did my son send you here? I need to call him and that, that wife, of his. This is not the home that I have been living in! Ida is not here and you seem to be some sort of doctor or something.” O.W. looked at Jason puzzled, his tone one of upset.
O.W. had made his opening statement. Using his cane for emphasis at the peak of an emotional point, several times he would lift it and quickly thump it down into the carpet.
“I’m not a doctor O.W., I was sent here by the home care agency. I haven’t met your son. This is the Park Place building, your apartment here.”
Jason replied in a much lower voice now, trying to keep his answers simple and his intonation reassuring. As soon as Jason had replied, O.W.’s expression changed from frustration to relief. He had quickly realized that Jason was capable of talking with him, and more importantly, listening to him.
“Oh, oh. You are not sent by my son John? He is the one who usually, usually sends people to do all kinds of things to me. Lets see now, I was sleeping and I was lying there and you were in here all that time? You are not a Mexican fellow are you? You’re from here like me and my son. The other guy that was here, I don’t know when, I don’t know when he left, but he was not like you.”
“No, O.W., I was sent by the people that John hired to care for you. I just now arrived here. I’ve never been here before. I’m not a Mexican person, I’m a white fellow like you and your son, yes.” Jason was making effort to appear straightforward.
Jason replied with a frankness that O.W. seemed to appreciate. It was now apparent that O.W. can comprehend conversation, at least in the current moment. Because this clear moment of conversation seemed so important to O.W., it quickly became important to Jason. Additionally, O.W. himself was very reactive to everything being said. It was a pleasure of sorts for Jason to satisfy the questions and to watch his reactions and his nodding, squinting, frowning, smiling, raising one or two eyebrows in interest, dismay, and sometimes puzzlement. O.W. definitely held an actor type of personality.
Alzheimers disease is perhaps the most cruel of all chronic and degenerative sicknesses. O.W. appeared to be in an early to mid-stage of the illness, when memory is lost day after day, only coming back in fleeting moments. The more firmly engrained memories, those of loved ones, of best friends, and of long lived places seem to hang-on more stubbornly, in this early stage.
Our memories are our lives, and without them we are nothing but bags of useless bio-matter made up mostly of water. Alzheimers is the label for the symptoms in the battle against the destruction of your life’s memories. At the end, your body gives up, having lost the support of its most important organ, the brain. O.W.’s brain was engaged in a losing fight against nothingness, against becoming only a bag of water that breathes. At the end of an Alzheimers sickness, perhaps as long as ten cruel years, the body fails miserably, as most functions of voluntary control are lost forever, and the brain stem succumbs to the wasting. Fortunately for the Alzheimers patient, at that point later in the disease, he or she does not care. They are incapable at that end stage of caring, mercifully incapable, of the knowledge of their own deterioration.
Does he deserve less dignity, respect, interaction or exposure to sights, sounds, warm and cold, wind and rain, touching, and tastes because he may not remember it five minutes later? No. Jason had decided this two years prior while caring for the last Alzheimers patient in his charge. There was no way Jason was going to spend eight or ten hours a day with an Alzheimers patient and not pay him these simple acts of respect. To Jason, in that diseased mind’s precious few moments of alertness, in a brief state of inquisition, in pain, in delight, or in sorrow or joy, he would appease O.W., and if before tomorrow’s beginning, Jason’s own empathetic efforts were lost in that weakened memory, then so be it. Jason’s conscience would know that he treated the human being that was left in O.W.’s mind to the best of his ability.
“I want to know why, why this place is not my home, my home in Pebble, my home is much bigger, this room is, is just tiny compared, compared to my home. Where is Ida?”
Again a stern look of inquiry, is now cast in Jason’s face, as O.W. demanded an immediate answer, to this complicated and serious question.
“Who is Ida O.W., was she your wife?” Jason tried to simplify the interrogation.
“Oh no, no no, Ida did all these sorts of things that you people are doing. Ida should be here right now!” With frustration he thumped is cane into the carpet.
He now had an agitated expression and looked straight forward at the inside of the front door. Jason understood this answer to mean Ida was the house help, a sort of maid, cook and perhaps a personal assistant.
“O.W. was Ida your maid or your personal assistant?” Jason asked.
“Yes, yes! Ida is usually here and I don’t know why she is late. By this time she is usually always here!”
O.W. replied with relief, adamantly stating the truth, as he knew it. Jason was not yet comfortable enough with him to give his tormented mind bad news about the present. News that Ida may be long dead or moved away. Either way it would probably greatly upset O.W., so Jason chose to wait.
A painting of about eighteen inches wide, framed and under dust-covered glass, was on the wall across from the couch where Jason sat. It portrayed a quaint Southern-style home with five or six bedrooms, which had a colonial design with Corinthian columns. There was a woman riding on horseback trotting toward the foreground from the right rear of the painting. She rode English with helmet and crop and was in a trot. Just to the edge and in the front left view was a Monterey Cypress pine tree, its lanky branches and low height, distinctive from all other trees on this Pacific Coast.
“O.W. is that your old house in that painting on the wall there?”
Jason pointed at the painting. O.W. quickly stood up, wobbled a bit
on his legs, and walked over to the painting.
“Yes! Yes that is my home, where is that home now? We all lived in Pebble Beach near the stables and that’s Con on her horse. Yep sure enough, hehe hee. She would ride it all the time. Yep.”
O.W. gazed at the painting, lifting his glasses for a close examination. His reaction to it spoke mountains about the house, that his time there was so happy and so comfortable, that just the sight of it in a painting invoked smiling and chuckling. He was smiling so much his old cheeks actually rose up to his eyes. He turned back towards the chair, grinning:
“Oh she loved that blue house! Nineteen-Hundred and Thirty-Six, I think. Morse himself and my Pa got me that place right after the wedding. Where is that house now? Why are we here in this . . . this little room and not over, over in, sitting in there, in my house?” With a stern thump of the cane his smile had left and his frustration returned.
“I don’t know O.W., does John, your son, live in it now?
“Oh, yes John Jr.. Where is John? He and that wife of his put me in here. Do you know where he is? I need to call him and see about all this, this mess. He must be at the office. I retired and they threw me a party. Where is the phone?”
“O.W. lets get dressed and get some breakfast and then I’ll see about calling John and you can talk with him. Sound good O.W.?” Jason suggested.
“Well OK, that sounds like a good plan. You are a different sort of fellow than the ones that I’ve seen hanging-around in here. You’re not a foreigner are you? You’re like me. I guess that’s okay.” He remarked grudgingly.
The two walked together to the bedroom where many choices of clothing hung neatly in the closet. Jason flipped through the tightly packed hangers in the dressing closet that was at least twelve feet long. It appeared that O.W.’s fashion stopped being updated sometime around the mid-1960s. There were even some clean pinstriped pants hanging neatly, and more ties than any man should want. Even in his dementia O.W. was good at getting dressed. He liked to choose colors carefully, vests and or sweaters, ties and shoes, he focused on fashion like a laser, taking more than an hour to get himself dressed. Jason was impressed. Later in the small bathroom, his grooming was as equally focused. He wanted privacy. He shaved with an electric razor, long and carefully. The buzzing sound from behind the closed door seemed to go on for twenty minutes. Outside the bathroom Jason listened carefully for any signs of a fall, or items crashing to the floor. In healthcare these tasks that are mundane but necessary to the healthy are referred to as “Activities of Daily Living,” or ADLs. In these activities it was as if O.W. did not have a degenerative brain disease at all. O.W. swung open the bathroom door and emerged fumigated by Old Spice, and he looked at Jason sitting on the couch and it was clear that he had completely forgotten where he was, who Jason was, what he had just done and what was the next activity. He looked over his clothing, picked off some lint, straightened out his tie and collar and the two proceeded into the kitchen for Corn Flakes and strawberries. O.W. wanted to help with something, so Jason directed him to some clean dishes that could be put away. While haphazardly stacking plates and cups in the cabinets, O.W. supplied some narration in the kitchen:
“In Salina my dad used to make me get all dressed up all the time. Me and Sydney hated to get dressed up, heh he he! It meant we couldn’t, you know, go out and get dirt on us after school, getting our clothes dirty was, well it would get my dad really mad. Hehh! You didn’t want to get my dad angry at you cause he’d make us stay inside and hit the books, even when we didn’t have any homework! Gee whiz!”
O.W. had a facial expression he reserved for reminiscing moments such as this, it was a hardly noticeable double-eye squint that seemed to look back, easily into time past, combined with a side of the mouth smile that showed he was content that the topic was in the past, yet yearning for it to be the present. As an aged old man in his last days, O.W. stood in the kitchen stacking plates, and he was also just as vividly in a place called Salina, Kansas, standing just three and a half foot tall, and getting his clothes dirty, and being made to do homework alongside his older brother Sydney.
Like a good waiter at a half decent breakfast diner, Jason gathered breakfast to the small dining table in the living room, medications laid out, orange juice, placemat, napkin, a bowl of sugar and the morning paper. The two sat down together and O.W. began stabbing with a spoon at his cereal and strawberries. He could not remain quiet, as if he had started something he had to finish:
“Yep, we were all in Salina.”
He ate some of his breakfast cereal, chewing, milk dripping down his chin, he looked straight at the wall in front of him, squinted a little bit, and smiled just a bit while swallowing.
“Is that where you were born O.W., Salina?” Jason asked as he reached for the newspaper.
“Yep, Salina, Kansas . . .” O.W. gave a far-away look.