From FINAL CHAPTERS: Book by Evelyn & Shelley R Amdur, ed. by Ellis Amdur

We Drank Together—We Need To Be Old Together

The voice on the office phone was ragged with quiet frustration. This was a man at the end of his rope. “Help!” said the hoarse voice. “The visiting nurse gave me your number and she said you’d come. I need you to come over now!”

I had a full day of appointments planned, but this sounded like a possible emergency. I responded, “Yes, I can possibly come, but who are you? Where are you? Who is your nurse? Can you tell me just a little about your problem?”

His voice was soft and dull, with a tone of despair. “Ian Ross. Help! We need you! We’re both sick. I can’t take care of her anymore. I’ve had it up to here.” I asked him if I could call him back in forty-five minutes. I had some jobs I needed to finish at the office. “No, you can’t. We don’t have a phone. I’m calling from the manager’s office. I’ll give you the address. We need you here now!” I had dealt with situations like this all too often. These days, with the ubiquity of cell phones, we forget how, only a few decades ago, one had to be tethered to one’s home phone in order to communicate. Even today, some impoverished clients have neither a cell phone nor a land line. The way to reach them is by calling on a neighbor who might have a phone, or the manager of their apartment or shelter.

I couldn’t tell from his voice whether Ian Ross was angry or just exhausted, but I felt this case possibly immediate attention. I went to the area where we kept the active charts, and found the one for Ian Ross. The diagnosis read: “Cancer of the larynx, probably due to abuse of alcohol and tobacco. Partial laryngectomy. Treatment: daily radiation. Nearest relative or friend: Serena Jones—see S.J. chart.”

Serena Jones’ chart read: “Liver disease, severe and debilitating. Probable cause: abuse of alcohol.” Nearest relative or friend: Ian Ross—see I.R. chart.”

A twenty-minute drive took me through a run-down area full of overgrown, junk-strewn yards. In contrast to the ill-kept homes, the grounds surrounding Ian and Serena’s high-rise were landscaped with a few nice green shrubs. There were some men and women loitering on the streets, some intoxicated, and several involved in what looked to be drug deals. I was glad that the doorman had been alerted to expect my arrival, not only for my own well-being, but because this meant that the residents of the building lived in a safe(r) environment.

The elevator took me to the twelfth floor. My sharp knock was answered by a slight man with a serious face and bald head. His neck was very red, showing surgical scars. He looked about 70, but his chart had said he was 57 years old. The disease had taken its toll.

I extended my hand and said, “Hello, you must be Ian. I am Evelyn, the social worker you just spoke to.”

“Hello,” he said distractedly. “Help. That’s what we need. But I don’t have time to stay and chit chat with you. I got to go to the hospital for my treatment.”

I was so annoyed at his apparent self-centeredness that I flared, “I dropped everything to come out here because you sounded so urgent, and you can’t even talk to me for a few minutes??”

He shrugged, as if he’d done nothing out of the ordinary. His entitled attitude was so sublimely arrogant that I found it funny, and I started to calm down. “Just stay a moment or so. You have to tell me how I can help you. Introduce me to Serena. We’ll talk and then I’ll let you go.”

“She’s in the bedroom. I only have a few minutes. My bus . . . it’s always on time.”

“OK,” I said, “I’ll say hello to Serena later. Let’s you and me talk for just a moment.”

Ian seated himself on one of the four unmatched chairs that surrounded the small wooden kitchen table. The kitchen was clean enough, but it looked as if no one ever cooked there. A stack of paper plates sat in the corner, with a pile of napkins nearby. No pots or pans were in evidence. He tapped his fingers and jiggled his feet.

“Ian, before I can help, I need to know something about you two. Tell me briefly about you and Serena. I know you just have a few minutes.”

Once again, he shrugged. His eyes looked stonily ahead, knowing he was not about to escape. “We’re common-law. We have each other, and we’ve took care of each other for years. But now things . . .”

From the bedroom came a weak voice crying out, “No Ian! We can still help each other. Yes, we can. You can’t send me away. You know I won’t leave. The world outside is too big for me. I’d be lost.”

Ian spread his arms helplessly, “I can’t take care of her. I’m sick. I can barely manage for myself. I gotta go to get radiation treatment every day. It’s a good thing the hospital sent Meals-on-Wheels here for Serena, and Carnation Instant Breakfast for me. But I can’t lift her to change her—sometimes, she pees the bed. At least I can still swallow liquids. We don’t have anybody to help. I got to go now. My bus is here soon. Can you come again?”

I felt rushed, but this was clearly all I was going to get out of him today. “Sure, Ian, thanks for talking to me. I know you have to go. Yes, I can come back. How about tomorrow morning, about 9 o’clock? Is that all right with you?”

“Good,” he responded, “that’ll work. I got to go take my treatment now.”

“Wait a minute, Ian, before you go. Do you have any appointments around that time, or will we have enough time to talk?”

He waved me off with one hand, like I was an irritating bug. “Yeah, yeah. I’m good.”

I raised an eyebrow at him, and he shrugged and smiled. “Sorry. Yeah, I have nothing going on then. We’ll have time.”

I couldn’t help liking him—he was both supremely entitled and self-aware, at least when he was called on it.

I walked him to the door and he left quietly, calling out, “Bye, Serena. I’ll be back.”

I turned and walked down a small hallway to a back bedroom where I found Serena, stretched out in a hospital bed. The white walls were bare, with no decoration. No photos, no pictures, no knick-knacks. The one personal touch, an inexpensive bottle of perfume and matching hand cream, sat alone on the dresser. A pile of grocery-store tabloids lay scattered in a pile on the bed, along with a television remote. She lifted a hand slowly in greeting. I pulled in a kitchen chair, so we could talk.

I looked at a pretty, rounded face, with smooth cafe au lait skin. Her eyes, dark brown, had no sparkle. Serena’s black hair was marcelled, a short wavy cap on her head. The chart said she was in her mid-forties.

She spoke, “I won’t leave. I’m telling you, God as my witness. We’ve been together too long. Those hospital people wanted to put me away, but I told them I wouldn’t go. I’m not crazy, I just have cirrhosis of the liver. It’ll probably kill me, but so what? That doesn’t give anybody the right to push me out the door.”

She looked at me, her anger subsiding, and sighed. “I’m so tired, I can barely move. Will you help me sit up?”

I helped her to a sitting position, then helped her swing her legs over the edge of the bed. “He’s so selfish. He just wants to kick back and relax. I heard what he said. I wet the bed one time. One time! And that was because he fell asleep and I couldn’t wake him, no matter how loud I hollered, and he wasn’t there to help me. One time! And the man can cook, but will he? No. He warms up a can of soup and cracks an egg in it. He just thinks I’m too much trouble for his easy life.”

“Serena, you already know that no hospital can put you away if you don’t want to go. And I’m not here to force you. But let’s talk truth.” She grimaced. “You seem to have no energy. You’re tired. What can you actually do for yourself?”

She looked at me and said, “When Ian brings me food, I can feed myself.”

“How do you get to the bathroom?” I asked.

She looked abashed, “Ian has to walk me there.”

“Who washes you and brushes your hair?”

Eyes down, she responded, “The nurse sends an aide a couple of times a week. I’m too weak to do that.” She look up with a smile then. “My hair does look pretty, though, doesn’t it?”

“Yes, it does. I love the wave. It really suits you.” We let the silence stay for a few moments, moments when I wasn’t merely quizzing her about her troubles. Then, “Who is there for you? Any children, sisters, brothers?”

A few tears escaped as she answered, “No one. Nobody cares. It’s a cold world out there. That’s why I need Ian so much. We each had two kids with other people, but who knows where they are! You raise your kids, they turn eighteen and they are out on the streets. Actually, my son got mad because I was on the streets so much! He cut me off, said I was dragging him down. My daughter probably turned out like me, but I don’t know. I haven’t heard from her for three, four years. She’s probably eighteen by now.”

I was shocked at this casual statement, more complaint than anything else. “Your daughter left home at age fifteen? Why?”

“I don’t know. Children. They drift away. I don’t know where they are. We lost track of them. Even if we knew where they are, they are too selfish. They think of themselves, not the mother who gave them life.” she finished petulantly.

There surely was much more history, but I was not there to do therapy. She had very specific needs now, and doing what I call ‘archaeology,’ digging up the bones of the past, was not what she needed now. “Serena,” I said, “did you hear Ian when he complained that he has trouble taking care of you? Do you believe him when he says he can hardly take care of himself?”

She searched my face, “No. He’s just getting lazy. He doesn’t seem that sick.”

“Well, Serena, I certainly couldn’t say. I just met the man half an hour ago, and he was in a hurry.” We both laughed. I continued, “When he was in the hospital getting surgery, were you in this apartment?”

She smiled craftily and said, “No, I couldn’t stay here alone. So, when he left, I left too.”

“Where did you go?” I asked.

“Oh, a nursing home near here.”

“A while back you said the hospital people wanted to put you away, but you said ‘no’ to that. Who made the arrangements for you to go to the nursing home in the first place, when you can’t even dress yourself?”

“The hospital people did.” She thought for a few moments. “When Ian was due to go in to the hospital, the people there asked him what he thought about me being in the nursing home. He told them to call me. I told those hospital people I would stay in the nursing home as long as he was recovering from surgery, but when he came home, so would I.”

“Do you think he’s changed his mind since that time, especially since he complains of not being able to care for you?”

Serena exploded, “Well, he might have changed his mind, but I haven’t. He’s selfish. All he cares about is himself. He can take care of me. He just doesn’t want to. We partied together for eighteen years, and now we need to be old together.”

This was touchy. “You really can’t bear to leave him, can you? But seriously. What would you do if you were in his shoes? Do you think he really wants to get rid of you because you’ve become inconvenient, or is he trying to look out for what’s best for you?”

I hoped that this ‘reverse psychology’ would force her to think less emotionally. I had no way of knowing one way or the other if Ian was incapable of caring for her, or simply unwilling; certainly the thought that one’s partner found one a burden would make anyone emotional. “Think about it. What would you do if you were in his shoes? We can talk about this some more when I come back tomorrow.”

“I’ll think about it,” she snapped, “but don’t count on me being in his shoes. That’s impossible. He’s selfish. I’m nice!” So much for reverse psychology.

I covered her, said good-bye, and let myself out of the apartment.

Two tasks faced me. First, if it was true that Ian could not care adequately for her at this time, I had to help Serena agree to the necessity of moving to a nursing home during the time Ian was receiving daily radiation treatments. Second, I had to locate a nursing home with beds available for indigent patients close enough to the apartment, so that Ian could visit as much as possible.

At my next meeting, I sat down with Ian and went over in detail how he spent his days, what he could do, and how much time his radiation treatment and travel took him. This was not easy, because Ian preferred tirades to details. Nonetheless, it was clear to me that, even with the best of intentions, Ian was not able to adequately care for Serena while he received radiation. It took three further visits for Serena to agree. She wavered from logically agreeing to move to a nursing home to angry weeping and hysterical accusations at the prospect of leaving Ian.

When Ian finally convinced her that he would continue to live in their apartment and visit her as often as he could, Serena assented with a warning, “When I’m better, I will come home. They won’t be able to keep me. Remember, I may not be able to walk too good, but I can talk. They can’t legally force me to stay. And I am going to get better! So don’t you think you’ve seen the last of me, Ian Ross.”

Finally I was able to begin the search for a bed. After several days, I found a bed in a suitable nursing home. Even with all of the arrangements and signatures, I really wasn’t certain whether she would go or back out at the last minute. I was only able to breathe easily after I checked to make sure that Serena had actually been admitted.

I thought I had heard the last of Serena Jones, but I was proven wrong. One sunny morning about three months after our last meeting, I picked up my office phone to hear a triumphant voice, “Hi, this is Serena. Remember me? I’m back home in our apartment. I’m stronger. I told you I’d get back here!

“Ian thought he could live without me. He said I was a burden for him to care for and he needed to tend to himself. Turns out he was wrong! He missed me and asked me to come back and stay with him. I told you; it’s a cold, cruel world, and he got a taste of that. He knows he needs me now!”

THOUGHTS ON “WE DRANK TOGETHER—WE NEED TO BE OLD TOGETHER”

It is not uncommon for men, especially poor men, to leave the women who have been their mates when those women become sick. Do women do this as well? Of course, but whatever the reason (Do women tend to nurture by nature, or due to societal expectations?), we do see this more often with men.

But ‘tends to’ in general doesn’t mean that it is so in this particular case. The social worker would be mistaken, however, to assume that he is merely selfish, abandoning Serena when she became inconvenient. That might be true, but in each case, the social worker must ask if the situation is more complex than her first reaction, which can be based on our own prejudices, whether or not we would use the term to refer to our own preconceptions. In many cases, such an assumption would be wrong.

The social worker has to work with the enormous emotionality, confusion, denial and ‘double-speak’ of this family situation and still honor the dignity of each of them. It was, in fact, a necessity (medical and logistic), that Serena go into a nursing home at that point in time. This was true whatever Ian’s motivation—but understanding that motivation may have been the linchpin in getting Serena to agree.

Serena was afraid of being abandoned. Ian definitely wanted her ‘gone,’ at least at this point in time. It was the social worker’s task to determine if this was due to Ian being overwhelmed and incapable, or coldly ‘cutting her loose.’ If the latter, it was important that the social worker didn’t, likewise, ‘cut him loose,’ as a churlish, selfish man. They may have many years of issues and grievances stocked up, and the larger question was what, within the capabilities they have, was best for them at that point in time.

Serena was poor and alcoholic. She may have sounded helpless, but in fact she was a survivor. She would do anything she could to manipulate Ian into staying for her physical and emotional survival. She was not about to accept him moving on without her.

Please note: ‘manipulate’ is such a loaded word that many readers will impute something negative in it, either towards Serena, or towards the writers who use the term. In this case, the word means using whatever strategies she had to in order to survive. Should Serena accept her lot with sweet resignation, or should she fight for herself? if the latter, fighting is never pretty.

Serena spoke like someone who was naive or even in denial. In fact, women who have known the harsh realism of the streets often have more wisdom (but fewer resources) than many middle-class women. Many more fortunate women subscribe to a kind of Cinderella myth: that Prince Charming (or a beneficent social services system) will care for them when things get bad. They have never had to develop the kind of strategies and coping mechanisms that Serena needed.

Serena had lived the hard life of the streets, and she knew it as a ‘cold, cruel world.’ Furthermore, she was a ‘most-of-her-life’ alcoholic. The ‘operating system’ of addicted individuals is “I can’t stand it!” “The ‘it’ being referred to in this sentence is any negative experience. Negativity is, of course, exemplified by withdrawal or other negative symptoms associated with the addiction. Serena was ill and felt terrible. Ian was ill and felt terrible. Both of them surely had a lifelong history of alleviating negative experience by ‘whatever means necessary.’ It was therefore quite natural and understandable for people such as Ian and Serena to gravitate to whatever provided them with a diminishment of negative experience, be it psychological or physical.

Far more than independence and self-reliance, Serena wanted connection and help, on any terms she could establish, because they meant her physical and emotional survival. She would do whatever she had to do to ensure her few relationships remained intact. Thus, even if Ian was drifting away, she would struggle to keep him, because he was her primary connection.

Likewise, consider Serena’s final call to the social worker. It was not a merely a case of one-upmanship, as if to say, “See. I did it, even though you said I couldn’t.” Beyond that, Serena called the social worker to re-connect and re-establish their professional relationship, however tenuous it was, because she knew she might need her in the future.

Often in cases of impoverished people, particularly those in urban environments, the sole support at the last phases of their lives are the professionals: social workers, nurses, and welfare workers. While some people may have family, often they are unavailable due to the many exigencies of being poor—including bad health, jail, estrangement, and lack of transportation or a place to stay nearby. One of our ‘story listeners’ who has done a lot of geriatric care grew impatient with the stories of working class and middle-class people dying in an atmosphere of love and goodness. When she heard the story of Ian and Serena, she emphatically said: “That’s how it really is. So many elderly face the end of their life in poverty, with no one around them to help them.”

Purchase at: Edgework Books