"Marge" was one of my all-time favorite patients. We first met when, at 83, she had both knees replaced at the same time and I was her visiting nurse. Over the years she developed a vitamin deficiency requiring monthly injections, a spell of high blood pressure that was challenging to control, a diagnosis of diabetes, various wounds, and occasional mobility issues resulting in falls and misbehaving body parts. I saw Marge for about a decade, with those monthly vitamin injections keeping her on my "active" list even when everything was going well. She lived in a subsidized senior housing building where I saw many other patients, so between our routine visits I often encountered Marge retrieving her mail, stopping to chat with workers in the building office, or popping in to see a friend.
Marge's apartment had big, sunny windows that faced east, and in the mornings the sunshine streamed in as Marge settled in her recliner, which was tucked in a corner of the living room with everything she might need arranged within arm's reach around her. Marge had been the personal secretary to a senior executive of a large company, and she was nothing if not organized and efficient. A stack of books, the phone, coffee and snacks, a pad and pen, and any projects in which she was involved all were placed carefully around her chair, convenient, but neat and not cluttered. The television was across the room facing the recliner, but in the mornings Marge had jazz softly playing. With the bright sunshine, soft music, aroma of coffee and breakfast, and Marge's smiling face looking up at me from her recliner "command post," I used to tell her that she was my role model for how to do retirement. "It's nice, isn't it?" she'd respond with a satisfied smile.
Marge was as efficient in selecting friends as she was with everything else. Her friendships were carefully nourished, and although she had cordial relationships with almost everyone, "Maude," "Alma," and "Dorothy" were her closest cronies. If one needed something the others stepped up to provide it. They sat together at activities in the building, and checked on one another by phone every morning and every night. "We don't talk," Marge once emphasized, "We've agreed. Five minutes, and then we all have things to do." Maude, Alma, and Dorothy all were my patients at various times, too, and I remember more than one frustrating evening when I tried to call two or more of them to schedule appointments for the next day only to find all of their phone lines busy. Of course I had hit upon the hour that they were checking in with one another, confirming that all were home safely and no one needed anything. In the mornings it would be the same thing: A tizzy of phone calls among the four of them to be sure all were awake and ok, and to pass on such messages as that Maude was taking the "shopping bus" and could pick up small items for the others, Alma had been baking and would stop by with cookies later, and Marge just had finished a book that Dorothy would love, so Dorothy should pick it up when she went out.
Visiting Marge at least monthly, I saw the seasons change through her big windows, and her observances with them. A few items adorned with red hearts appeared around Valentine's day, a green tablecloth with a spunky leprechaun atop it adorned her table in March, and a wreath of artificial pastel flowers hung on her door in springtime. And so it was throughout the year. Often I'd comment: The autumn scarecrow on a shelf was adorable, the red, white, and blue coffee mug was perfect for the fourth of July, etc. So when the Halloween-themed items were replaced with a cornucopia on the table and the kitchen towel sported caricatures of turkeys, I asked Marge about her Thanksgiving plans.
"I'll be right here," she said, smiling.
"You're not having dinner with your cousin or doing something with Maude?" I asked, surprised.
"No, I'll have my own dinner here. I like it that way."
Over the years I often thought about many of my patients who were home alone on holidays. Some were lonely and seemed to have contracted energy that turned inward and left them in dark places of self-pity, regret, and longing. Rarely did anyone ask anything extraordinary of me; nonetheless those living in their own dark clouds were hard to be around.
Marge and her friends were different. Maude's and Dorothy's families lived far away, and while Alma's family visited regularly she wasn't up to many long drives to their homes for hectic days of celebration. Many times as Thanksgivings, Christmases, and other holidays passed and Marge remarked that she would be home alone I considered taking a break from my own holiday to deliver a nice dinner from my own table. Other times I wondered about arranging a small gathering in the building's community room where residents could celebrate together. My colleagues and I could donate some food, and residents could bring dishes to pass as well. And once in awhile I thought about just taking something that Marge could share with whichever of her three friends were home on the day in question.
By the grace of God, something stopped me each time. I might have been called to work or had a last minute change of plans. Once or twice I may have been ill, and I know there were times when I had houseguests who kept me more than busy. Perhaps the car was in the shop or I just hadn't organized my time well enough. But I never assaulted Marge or her friends with my turkey, pumpkin pie, or good intentions. It took years and years of Marge saying quietly that she would be home alone and liked it that way before I truly heard her. This was the story that finally got through to me:
The day before that Thanksgiving Maude was taking the "shopping bus" to the grocery store, and Marge mustered the energy to take her walker and go, too. Once there she spied a thick, fresh pork chop in the butcher's case, with just the right amount of fat. She bought it to enjoy the next day. Then, in the produce department she carefully selected one small potato, just right for one person, and also saw containers of pre-washed mixed green salads. She bought those, too.
Marge always loved the Macy's Thanksgiving Day parade, and as November unfolded she looked forward to settling into her recliner with her coffee and delighting in the entire spectacle, with no obligation to help in the kitchen, no one moving in front of her and blocking her view of the TV, no distracting music or radio in the background, and no not-so-subtle hints to change the channel to the pregame shows before kickoff. When the parade ended Marge breaded and seasoned her pork chop and put it in the oven along with the potato. As they baked and with holiday music in the background she wrote her annual Christmas letter, and after dinner put away the turkey decorations and cornucopia and set about decorating her apartment for Christmas. A small ceramic tree went on the table, a red and green wreath on the door, Santa Claus towels hung in the kitchen, a stuffed reindeer wearing a red hat appeared on the sofa, and assorted figurines and mementos found spots around the home.
No homemaker or medical people came, nor did bills and junk mail appear. Maude and Dorothy called as usual; Alma was away with family. Marge's cousin called, as did her nephew in Phoenix. But the building engineer didn't need to inspect or repair anything in her home, and there were no responsibilities to other people that needed to be met.
Instead, Marge watched the entire Macy's Thanksgiving Day parade uninterrupted and relished every minute of it. Her own home smelled of good things cooking, a rarity for one who as a rule subsisted on frozen dinners, and her music brought joy to her soul. She loved the look of her apartment newly turned Christmasy, and felt a sense of accomplishment when the holiday letter was done. That night she watched an old movie on TV, and then went to bed truly thankful for a peaceful, happy day.
Had I appeared with a plate of turkey-with-all-the-trimmings, or pressured her into a celebration with friends or neighbors that I had orchestrated I'm sure she would have appreciated my efforts . . . and at the end of the day been tired, perhaps a bit out of sorts, and without her holiday season started in the efficient way she liked, apartment decorated and letter written. And the poor pork chop would have needed to wait another day, and then be hurriedly prepared when the homemaker wasn't in the kitchen, with Marge retrieving the mail and filing a work order in the office instead of listening to music and enjoying the aroma of good home cooking coming from her own kitchen.
I didn't appreciate it at the time, but now never will forget the smile on Marge's face and the light in her eyes as she told me, "It was a wonderful holiday. I had a pork chop, a potato, and a nice green salad."
Over time I came to recognize flaws in the common assumptions about holidays and how people do or don't observe them, and I learned to believe what my patients told me:
Widowed after more than 60 years of marriage, "Edna" had made more holiday dinners than she could count, and she was ready to be done with them. Just the thought of all the hubbub of a big gathering was tiring, and she preferred smaller, more personal visits or calls. If she was alone for a day she considered it a blessing.
"Elizabeth" had a tremor in her hands. Her doctors had been unable to come up with a diagnosis or cure, so whenever she reached for something her hands shook. As a result, Elizabeth was a messy eater. She spilled on the table, on the floor, and on herself. She didn't need or want to be fed ("Like a baby!" she said), but mealtime never was neat and clean. Embarrassed, Elizabeth did not want to eat around other people, and with the kitchen being the only other room in the family's small house she could access, Elizabeth chose to stay in her bedroom. She was not lonely or isolated; often I found three generations of family around her bed. For health reasons I wanted her up and walking; it was years before I realized that Elizabeth never would act on my encouragement to walk to the kitchen and sit with her family. There always was food being prepared and served in that kitchen, and Elizabeth was not about to put herself in a situation where she would be expected to eat in the company of others. Uh uh; not happening.
"Thomas" has diabetes and chronic cardiopulmonary and kidney disease. He must avoid sugar, minimize sodium intake, be careful of proteins, and watch how much fluid he drinks. He observes all of those restrictions perfectly, with his strategy being not to have inappropriate foods in his home, because, as he tells me, "If it's in front of me I'm going to have a taste. And then I have another one and another one, and before I know it I'm in trouble." Thomas now chooses not to attend most parties and family gatherings because he knows his own shortcomings and wants to avoid another stay in the ICU. Instead, he asks people to visit him at home, and he controls the refreshments.
Many people, particularly elders, don't hear well in crowds or can't filter out background noise. Some don't see well or can't manipulate tableware well with arthritic hands. Others worry about having ready access to bathrooms, or don't like taking portable oxygen or medications with them when they go out. Many have told me over the years that most of the family they knew have died or moved away, to the point that near-strangers surround the holiday tables as more distant kin bring in-laws and friends to celebrations. "It's more like making small talk with strangers than being home with family," one person told me, and for him that wasn't worth the effort. Some people are shy, some are socially awkward, and some find groups of people tiring rather than enjoyable.
To be sure, there are people who are achingly lonely, perhaps newly widowed, far from home, painfully isolated, people who would relish an invitation, a visit, or being remembered with a plate of leftovers. But in an unthinking hurry to have someone like Marge have the kind of holiday experience that someone like me assumes she would want and should have, there's a risk of doing violence to that person's way of life and creating more stress than joy.
With many wise elders to teach me, quickly before I began loading my car with holiday meals or planning parties few cared to attend, I (finally!) have learned a few things that may be helpful to others who wish to be generous as another season of holidays unfolds. These are some of my lessons:
(1) Instead of asking, "What are you doing for [holiday]?" ask, "Do you observe any holidays this time of year?" Let others tell about their beliefs and practices, and consider what might be offered that would fit in and be appreciated.
(2) Ask before making a gesture: "May I bring you a plate?"
(3) Respect the limitations that others establish. If they say that something is too much, too tiring, too far, too whatever, then it is so.
(4) Offer options: "We really want to see you at [holiday]. Will you come for dinner, or may we stop by over the weekend?"
(5) No one wants to be a "charity case" or afterthought. A call at the last minute to say, "If you don't have anywhere else to go you can come here" is a slap in the face rather than an invitation, as it appears that the caller waited as long as possible in hopes that the person being "invited" would have other plans, and further supposes rudely that she or he has less than a full social calendar.
(6) "I just don't want you to be alone for [holiday]" is offensive to someone who lives alone, as it implies that his or her normal way of life is inferior, ok, perhaps, for some days, but certainly not for [holiday]. Invitations should be issued and gestures made without judgment or comment about the recipient's lifestyle.
(7) Guests honor us with their presence; we do not rescue them by taking them in. Last minute or spur of the moment invitations work when they're phrased well. "George! We just came home and saw your television on. If you're home and have any time on [holiday] we'd love if you would join us for something. Dinner is at [time], or if that doesn't work if you could stop by for dessert or drinks or even just a cup of coffee in the morning or to watch the game we'd love it. We're sure you have plans, but if you could work us in it would make the day all the more special." George may decline altogether, or he may appear before the sun rises and stay until the last dish is washed and put away that night, or something else. But he will know he is a wanted and welcome guest rather than an afterthought or the subject of his hosts' pity or self-conscious guilt.
Soon the media and various social service and religious organizations will be admonishing us to remember those who are alone during the holidays. Thanks to the patient teachings of Marge in particular, and many others as well, I've learned there's, if not an art to this, at least a need to ride herd on assumptions and stereotypes and to muster up a load of respect and courtesy lest charitable intent breed less than comfort and joy. In the weeks ahead I will visit many patients who live by themselves while observing one or more of those 29 holidays celebrated this season. And for me the right gesture to make for days that are merry and bright entails visions not of Santas, angels, trees, creches, stars, candlelight, "winter wonderlands," or anything else, except mindfulness of once upon a time when on the day of a holiday there was in one home just
A Pork Chop, A Potato, and a Nice Green Salad
This made my day. Thank you.
ReplyDeleteThank you, Kate! "Marge" died several years ago, without quite making it to have the 95th birthday party she'd wanted, but her lessons live on. :)
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