My mother-in-law is losing her marbles. They're just about gone actually, if you consider having marbles the ability to remember what happened five days or even five minutes ago. Margaret Wildhack's few remaining long-term memories embrace her sister and her brother, people whose histories she has shared for 70 years or more. Everyone else--including her own three children, their spouses, and grand-children--is a bit of a puzzle. She recognizes a few of us in some fundamental sense as people who are important to her, but the labels of "daughter," "son-in-law," and "grandchild" have disappeared.
While I don't want to suggest that her experience of Alzheimer's is in any way representative, I do think Margaret, who goes by the name Mig, isn't having all that bad of a time. She's physically healthy, she seems happy, even blissful, and most of her conversations revolve around how beautiful the sky is or how lovely the trees in autumn are. She's now living in the Alzheimer's unit of a retirement community, a place I consider exemplary.
You might recognize Mig's name, at least her last name. She was an Indianapolis journalist, as was her husband, Bill, now 20 years dead. But you might also remember a character called Montana Wildhack in Kurt Vonnegut's Slaughterhouse Five. Montana Wildhack ended up on the planet Tralfamadore living with Billy Pilgrim in a kind of zoo where the Tralfamadorians could observe the mating and cultural rituals of earthlings. Mig went to school with Vonnegut and has been his friend ever since, so the naming of Montana Wildhack wasn't coincidental.
In the book, after the initial horror of captivity has subsided, Montana falls happily into the rhythm of Tralfamadorian life. To Tralfamadorians, as Billy puts it, "All moments, past, present, and future, have always existed, always will exist." And so Tralfamadorians "ignore the awful times and concentrate on the good ones," a philosophy that describes Mig's worldview before and after Alzheimer's. Years ago, prior to the onset of the disease's symptoms, it was Mig's custom to never dwell upon the negative. She was deeply touched by any instance of misfortune and worked hard--as a schoolteacher, political activist, and journalist--to alleviate the suffering of others. Yet personal misfortunes were more or less glossed over. In fact, the closer the calamity was to her personal life, the more she held it at a distance. By the time I met her in 1985 she'd forgotten that she was married to Bill Wildhack for more than 20 years, let alone that they raised three children together.
I know something about Alzheimer's. Long before the diagnosis existed, people suffered from it, and I came into intimate contact with many of them in the convalescent center where I was an orderly for four years--far longer than average in this line of work. We had a variety of infirmities on our skilled-care unit, from patients with cerebral palsy to teenage car-crash victims in full-body casts to people simply exhausted by their long--sometimes century-long--lives. Those with Alzheimer's were termed "senile" or lumped under the general label of "organic brain syndrome."
Early on in my tenure I tried "reality orientation," a practice encouraged by the nursing home's upper hierarchy. No, Edith, I would point out patiently, this is not your mansion, I am not your servant. You are living in a nursing home in Bloomington, Indiana. In 1984. Sorry, Roscoe, you are no longer fixing omelettes in your breakfast diner. This is a convalescent center. You are 86 years old, long past retirement. Opal, the German army is not outside your room; it's only the nursing staff getting ready to treat the stump of your missing right leg.
It didn't take many months for me to question the practice of reality orientation. Sure, I still tried it a time or two. But if it didn't work, if Edith still thought she was in her mansion, who was I to argue her out of it? And why not act the role of her butler? That's essentially what I was anyway. For a time I wrote "butler" on a piece of tape and covered up "orderly" on my name tag. I soon stopped arguing Roscoe out of flipping invisible burgers and breaking imaginary eggs. Instead, I sat down to eat a plateful and handed out heaping invisible plates to the other patients in the dayroom. To persuade Opal the Germans had been turned away I became a World War II GI parachuting in to save her. Call it surreality orientation.
Of course there were many patients I never connected with. Bertha, who delighted in smearing her feces all over the room and herself, remained an annoying enigma to me. Mae talked for three straight days, unraveling an apocalyptic text of descriptions, including the unforgettable "lake of fire." I could do nothing to interrupt, so I spent every spare moment listening to her diatribe. She died at the end of those three days, apparently having talked herself to death. I could never fathom Betsy, who shuffled through the halls, her hair wild and flowing, her eyes, with their dilated pupils, bulbous. We never connected because I couldn't find a role in her madness. She stopped eating finally. I was holding her down while a nurse started placing a tube down her nose so she could be fed from a bag when she died. The nurse felt terrible of course, as did I, but we silently supported Betsy's impeccable sense of timing. That tube, after all, would have kept her alive for untold months. It was my job to bathe the body, and I watched the skin sink away from her bones, her rib cage rise in the shape of a spider.
I wish sometimes that I could have a more Tralfamadorian perspective on the years I spent working in the nursing home, but images like that stick. It's a relief that Mig is in great physical shape. In her mid-70s now, she delights in shooting baskets in our backyard--she's broken four garage windows. We take her on hikes when the weather is favorable. She's as strong as the proverbial horse. Last summer she scaled the seven-foot-tall fence at her nursing home in a dress. She walked several miles before randomly picking a house to ask directions. The house belonged to a minister and his wife, who were just sitting down to sandwiches. She lunched with the couple, and the minister, seeing Mig's identification bracelet, called the nursing home. This experience formed a marble in Mig's brain--she still talks about that incident, giggling at her ascent of the fence and waxing nostalgic about the minister's excellent sandwiches. He and his wife were so nice, she says.
Generally speaking, Mig has nothing ill to say about anyone. Even when her roommate hits her--for who knows what reason--Mig struggles to find an explanation. She calls this roommate "The Babe," and somehow perceives that this 80-year-old woman is no more than a toddler. Mig has frustrated the nursing staff several times by getting the Babe out of bed at all hours of the night and dressing her. She also has repeatedly tried to remove the Babe's apnea device, which is attached to her chest to monitor her respiration. Mig is convinced it's some kind of explosive device--an act of terrorism against innocent toddlers. If I'd been Mig's orderly I'm not sure how I would have dealt with this. Would I have thanked her for her heroism and put her to bed? Would I have told her that the device was actually a small video camera that protected the Babe from potential cat burglars?
During the holidays we were at a relative's house with a dozen or so family members. I was quizzing Mig about Vonnegut. She was adamant that she remembered him, though she couldn't present a specific memory. Then she peered up at me and a kind of light flickered in her eyes. "You were in the year ahead of us, weren't you?" she asked. I paused, thinking about my options--surreality or reality orientation?--then replied that I was her son-in-law, almost 40 years her junior. This was a shock to her, as was the information that I was married to her daughter, who was in the room with us. No, she said, it couldn't be. I pointed out Patricia to her, then led her over. Recognition was there, and they embraced. Within moments our three children had gathered, and Mig proceeded to meet her grandchildren. What a reunion. We had a group hug, laughing. Then she drifted off. The moment was gone.
We lived with Mig for more than three years before she began nursing-home life. During our time together we saw the memories tumble from her mind. We watched her begin to experience aphasia and disorientation. It was alternately frustrating, humorous, and horrifying. As Patricia and I began to have children, it became downright dangerous to live with someone whose mind was deteriorating. Like a good Tralfamadorian, I have trouble remembering how difficult that period was. Instead I recall how easy it was to get Mig to dance, how quick she was to smile, to sing to the children, how happy she was to be included.
The other day I drove her back to the Alzheimer's unit, the place she calls home, a place I call Tralfamadore. The sky was a brilliant blue and cloudless; the only marks were jet contrails--more than a half dozen of them forming complex hieroglyphics on the open scroll of the sky. Mig didn't take her eyes from the spectacle, pointing out the various shapes and squiggles. It was a transformative experience for both of us, this deciphering of the mysteries above. For every second of the 20 minutes to Tralfamadore we chatted about the mercurial sky. Mig lives in the present. Little else exists. But to be in the present with her in that unfolding beauty is to experience the marvelous rolling marble of the moment.
Art accompanying story in printed newspaper (not available in this archive): illustration/Mike Werner.