Fred Marmorstein
Island of Water


I.

Mary flopped. Both hips were broken. She stared up at me from her plastic mattress, her rubber sheet, her spongy pad for extra comfort and her own blanket. Hand knit. Italian white.

"Maaa Maaa. Maaa Maaa." Yelling like nobody existed.

I heard those wails when I first started here at the nursing home. No Mama. Just me.

"Mary, what's the matter?"

It was just after 3:30 in the morning. Three and a half-hours to go for me. It was 15% more on third shift, and I needed the extra money. But did I need Mary screaming and moaning, waking everybody up including her poor roommate, Christina? I had just changed Mary's whole bed. Pissed all over.

"I wanna glass a wattah. Who's there?"

"It's me, Tom."

"Oh. Oh, Tommy. Bambino. Get me some wattah. My throat."

"OK. You, okay?"

"I'm thirsty. I'm dyin'."

Why did she want water now? This was something she did every night since I got here. Always crying for water. She wanted to piss the bed up again, so I would have to change it. I kept thinking: Mary, you're not in Sicily. Stop drinking so much damn water. We don't do that over here.

I brought Mary her water. With a straw. Had to have a straw. When I first started at The Haven Nursing Home, I was sufficiently warned to keep people quiet and whatever you do on 11-7 get Mary a straw with her cup of water. What would happen if I didn't? Never mind, I was told.

"Thank you. Grazie. Molto grazie."

"Piacere," I responded. Mary taught me that.

Mary held her cup while I cranked the bed a little higher. She was like a buoy in the sea. But I couldn't understand how she was anchored there. How could she lay there day after day? Asking for water at night. Drinking it. Cup after plastic cup, sipping that cold water. Pissing it all out again. Tomorrow night I'll bring Mary another cup, water, straw.

I didn't call Mary by her last name. I'm sure it was probably on some chart somewhere, and I probably saw it but I didn't ask Mary. A lot of the patients weren't even referred to by their real names. The nurses and aides had nicknames for everyone. Like Uncle Adolph, the meanest patient at Haven. And there was Bull. That was a woman on the other wing.

"Good. This is good. Molto bene. How you tonight, Tommy? I not so good. See these hips? No good."

"Yes."

"My daughtah not come today. Where is she?"

"Maybe she'll be here tomorrow. Try to get some sleep now, OK?"

"You a good boy."

A month and a half of this and I almost felt like quitting. I mean, it was different when I was in training. None of it was actually happening because you're with another person who is just showing you what goes on. Then, one night, you're finally alone. You're wiping their shit off them and changing the pissed on pads underneath and taking temps and bringing them water.

I'm scheduled to check all beds at 5:00 am. Those are the rules here. Three times a night you check and see if anyone needs changing and cleaning. You use gloves. Before you bring your cart around each time, you make sure you have enough towels and sheets and piss pads and nightgowns and soap. These piss pads are pretty clever. About two-foot square, somewhat thick but soft and extremely absorbent. The trick is placing it under the patient in the exact right place. Sometimes you use two or three underneath. If you're lucky, you can get away with one. But you have to know exactly where to put it.

When I got back to Mary, I knew she would be wet again. Why can't she hold it in for at least half the night? It just keeps coming out. Where does it all come from?

"Mary? Are you wet?" I didn't know what to say, but you had to say something before you turned on the light or pulled back the covers or anything. Don't startle the patients. It could get a little startling being woken up three times a night. I felt near the pad and it was wet. I don't know why I kept doing that. Every night since I started working here it's the same. Maybe once I wouldn't have been needed.

"OK, Mary. Time to change you. You're all wet again."

"You gotta change me?"

"Yes. That's right. Wait a minute so I can get some water to clean you."

I stripped off the blanket and the sheet and took off Mary's cotton nightgown. I kept saying "almost done, almost done" even though I wasn't. It was very hard getting used to old naked bodies. I never saw one before I started working here. All that flabby skin all in folds everywhere. Some of it was purplish and some of it was like old newspaper stacked in some room for years and years. Old men wouldn't have been too bad. But old women? Washing old naked women and their crotches?

Changing the bed wasn't bad except with Mary. A lot of the patients I could just push on their sides without much worry. Some didn't even know what I was doing. But Mary had two broken hips. What I did was this: Mary holds onto the rail of her bed and, as fast as I can, I roll up the pissed on sheet and pads and then halfway shove clean ones under there, then Mary rolls over to the other side of the bed while I pull the dirty stuff out and pull the clean stuff through. Once you get the hang of it, it's still hard.

After I put the clean nightgown on, I washed Mary's hands. I always felt better after washing her hands.

"Feel better, Mary? Now you can sleep."

"No. It hurts, Tommy. What can I do? My hips."

Sleep, Mary. What else could she do? What else could I do? I had to get to my other patients, clean them up.

There were three patients left to finish before six-thirty. That's when I filled out all my charts on all the patients. You had to write down how they slept, if they ate, did they get up to the bathroom (that one was easy), did anyone have a restraint on and did anybody take a crap. This last one was really important. It was so important that they had a special book called the "BM BOOK" where you had to chart everyone's crap. You put a zero if they didn't go, and you put a "Y" down if they did. And it had to be an actual piece of crap. Not some small time thing. But it made sense, because the ones who didn't crap for three days in a row had to get an enema.

"MaaaMaaa. MaaaMaaa."

C'mon. Not now.

I remember asking some of the aides and nurses what do I do when Mary starts yelling like this. This was not in some manual or book. "When patient screams for her mother, attempt to calm her down using cool washcloths." Everyone said to just ignore her. She'll stop.

"Maaa Maaa. Maaa Maaa." I started down the hall.

"Mary, what's the problem? I just changed you. You're fine. Go to sleep and I'll see you tomorrow night."

"Tommy. Bambino. I need something for the pain."

"All right. I'll tell the nurse. Stop the yelling. Other people are trying to sleep."

Actually, it was almost time for everybody to get up. A lot of them got to sit in chairs and some even walked after a night in bed. But Mary had to stay in her bed. An anchor tied to the bed.

I finished cleaning and wiping and charting.

On my way out, I asked the nurse to look at Mary and give her some aspirin or something. Most of the nurses knew Mary and her history. I had never looked at her chart or file.

II.

Tonight, before I even punched in, before I listened to the nurse's report on all the patients and their problems, I went to Mary's room. She was sleeping. There was some peace for her, I thought. Wine, long spongy loaves of Sicilian bread, cheese that gave the heart an extra beat - all were dreams for Mary. Maybe she even dreamt of walking.

Uncle Adolph was in an especially bad mood tonight. He had pulled off his colostomy bag three times during second shift. I wanted to know if he was given something to calm him down.

The nurse said, yes, but they could only give it to him every six hours. The last time? Two hours ago, she said. So around four o'clock I would be picking crap off the walls. I needed some excitement.

I went into his room with the hand restraints. They were only supposed to be used on violent patients. My definition of violent had to do with making my life miserable. So, as long as I had to deal with people pulling off their crap bags, I would tie their hands down.

The nurses told me that this man had once been a professor of English Literature at the local university. He was completely senile and asked for his wife, Martha, at least ten times a minute. "What are you doin'?" he would scream when you hadn't done anything yet. Sometimes when I had to take his temperature, I just made it up.

He was a large man. His feet went almost over the edge of the bed. They were like twice-baked turkey skin, and they were totally dark purple like he soaked his feet in wine every night. You could have washed Uncle Adolph with sandpaper. His skin was that tough.

"Hey, Uncle Adolph, are you sleeping?"

Nothing.

I walked over, slipped the gloves on his hands, and tied them to the bed railing. Nothing.

"Tom. Mary wants you," the nurse informed me as I came back down the hallway to get my cart ready for my first round. I shook my head. Wasn't she asleep? Didn't she know she wasn't the only one here who had to be taken care of?

"Mary? What's wrong? I thought the nurse gave you something for the pain."

"My daughtah. Tommy. She no come today. You call her and say to visit."

"I can't call her up. Not now. It's really late. Why don't you call in the morning?"

"They no help me in the day. I lay here and nothing."

"I'll try to find out where she is, okay?"

"Thank you, Tommy. Grazie. You good boy."

I wondered if the shift nurse could help me.

"Where's Mary's daughter? Can you leave a note and ask one of the day shift nurses to give her a call?"

"I don't think Mary has a daughter," the nurse said.

"What're you talking about? Mary talks about her all the time. She's getting cards and letters and visits, right?"

"There're never any letters. And the cards are from the staff and residents. Do you want to see her history?"

Her history? I saw it every damn day I walked into this place. Her history was pain and nothing. But I thought her daughter gave her some relief.

I took Mary's file from the cabinet. All the case histories were there, and I had never read one. A whole life in a three-ring binder.

I read everything: medical, personal, nursing home, hospital. All the histories were there in one huge packet of papers and forms and signatures. What Mary brought in with her, the kind of pills and medicine given over 11 years. 11 years! In this "home?" Symptoms, ailments, food intake. A psychiatric profile. Questions asked and answered. Where was Mary?

For eleven years Mary Pelagrini lived in the nursing home because she had no relatives. After being admitted with one broken hip, which had not healed correctly due to incompetent surgery, Mary remained in the nursing home for two years in the wing with the less serious cases. She used a wheelchair and was partially mobile. She was fifty-two years old when she entered and became a resident.

She was sixty-three now. Mary was only sixty-three?

During those two years, Mary underwent corrective surgery four times. What did they do? I skipped that part. What didn't they do?

In August of her third year, she was outside waiting to be helped back in for dinner. The case history states: "Mary got increasingly belligerent and impatient as each resident was helped inside. At one point Mary refused to wait any longer and attempted to make herself ambulatory of her own accord. She fell and broke her hip." Her other hip. The good one.

She was operated on again and finally moved to the incontinent section of the nursing home where she remains. Mary failed to do her exercises and slowly began to lose her "grip on reality." She stopped participating in group activities, and the activity director could not coax her into any kind of community spirit.

Her hip healed slowly but not completely. She could not be motivated by anyone.

Mary's husband had died during the Second World War, and she had not remarried. She had no children. She had a sister who lived in Sicily. No mention of any other relatives. There was nothing about her life before she entered the nursing home.

I decided I was not going to read any more patient histories as long as I worked here. I couldn't make their memories mine.

As I approached Mary's room tonight, I knew everything I had to do. Change her bed, her clothes, wash her, give her some water. Nothing was different. But I didn't know what to do about her daughter, about her sinking. I was wrong. Mary wasn't a buoy or an anchor. She wasn't someone lying in a bed for 11 years. She was a drowning woman. Or drowned.

"Mary? Mary?"

I thought she was sleeping, so I went over to her roommate, Christina.

Christina was an easy one. Never bothered about anything. She was kind of a blob because she had Alzheimer's. I could easily pull her and push her, and she would remain gentle, passive. Always looking at me with recognition, like I was someone else. Who? I didn't know. I didn't need to.

Mary's eyes were closed, and she was breathing slowly. Mary had pissed her bed, herself. I had to wake her.

"Mary. Time to get up," I called.

In her sleep she said, "Mama."

"Mama's gone home. Tommy's here," I whispered.

You're not a corpse yet, Mary. You're still warm.

"Who's there? Tommy? I'm so thirsty...my hips."

"I'll get you some water in a minute. You're wet. I gotta change you, make you clean."

"Where my daughtah? You good boy, Tommy. Bambino. It hurts."

Yes, it does. But all I could do was whisper. Almost done. Almost done.

~