Just Visiting

In the nursing home, my grandparents try to recall the past, while my parents and I begin to see the future

By STEPHEN FRIED

PHILADELPHIA MAGAZINE, MARCH 1992 (recounting the interior life of the Jewish Home of Greater Harrisburg, posted on 1/11/22 the day on which it was announced the home would be sold and the funds used to otherwise support the aging Jewish population of my home town)

It is not a very long walk from my grandmother’s room to the front entrance of The Home, but it is long enough to give you time to think too much. Nana’s room itself is fairly cheerful, and on a good day she is capable of more thoughtful, engaging conversation than almost anyone else in my family. My wife and I usually leave Nana’s room feeling good about the visit and the fact that, against all odds, Nana is still in our lives.

But the wave of good feeling dissipates in the fluorescent glare and the overly clean smell of the hallway. And by the time we’ve walked past the yearning, moaning, clenched faces of the patients who have been wheeled out for “hall time,” I am revisited by the insight that there’s a big difference between our having a good hour together and Nana having a good life. It makes me think of Monopoly and one of the first cosmic subtleties we learned as kids: how two players could be on the same space, but one was “in jail” and the other “just visiting.”

The suburban Home where my Nana lives is absolutely the nicest nursing home anyone I know has ever seen. It is clean and bright, and the people who work there aren’t monsters, and nobody there dies of abuse or malnutrition. Since it was built by the community I was raised in, The Home is actually integrated into life there: It’s the closest thing to being institutionalized in a wing of the local school or place of worship. It makes me wonder why every nursing home can’t be this nice, and whether I will ever live in a community (or a country) where such an institution is the norm. It also makes me realize that all my experiences with family-member institutionalization — and I’ve had more than my share at age 34 — are probably skewed by this Home Beautiful where three of my grandparents have, at one time or another, resided. What I have seen is clearly the best-case scenario of this worst-case scenario.

By the time my wife and I reach the lobby, our pace has quickened. We wave goodbye to the other Home people we’ve met over the years — patients, their families, and staff that have a way of becoming family — and race to get outside. Invariably my wife turns to me and says what nobody who lives in or with The Home can afford to even think too often.

“Shoot me,” she says, and sometimes I think she means it. “Just shoot me.”

***

I cried too hard the night I heard about Nana’s stroke. There’s probably no established standard for tears you’re supposed to shed over a loved one, but these tears felt excessive to me, even as I was unable to stop them. I think I cried so much because I knew I’d be losing something more than just my Nana. When people in your life die, at least you have your memories; when people in your life nearly die and end up in a home, your memories of them and all they touched are slowly leached out of you, replaced mostly by stuff you can’t wait to stop recalling.

My Nana, my paternal grandmother, was the ringmaster of a three-ring circus of a family (one ring for each of her kids and their spawn) that came together under her Big Top each Friday night for dinner. Outside of siblings and parents, I’d be hard-pressed to name anyone who has had a bigger impact on my life than Nana and Pop-pop — whom I think of as sort of the Jewish versions of Jessica Tandy and Cab Calloway.

If you had asked me six years ago what values they instilled in us, I would have been able to answer easily, quickly, and with no small amount of bragging. Today it would be much harder to reply. That’s not because they, especially my Nana, didn’t teach us loyalty and charity and duty and grace under fire-and-flood. But much of what they taught us seemed predicated on the idea that if you did all that right stuff, nothing as cruel as what happened to my Nana could possibly befall you.

Nana was felled by a massive stroke that could be treated only by similarly massive brain surgery, with a very low chance of success. The hotly debated decision to operate was made by my Pop-pop, alone, with everyone else on the record as nervously abstaining. After Nana survived the surgery, everyone took time off to sit and wait at or near the hospital — supposedly a final vigil, and the end of an era in our family. It was an oddly comforting wait, the first time in over a decade that all 15 of us had been together for more than an isolated holiday meal. As at a class reunion, people reverted to their earlier roles in life, which was weird for some, glorious for others. My mom got to be a full-time mom again, which even she would now admit she liked a little too much. I got to be a full-time son again, a part that got the same mixed reviews as the last time I played it. The fact that I had just met the woman I would eventually marry hung over the entire ordeal. It was a ray of hope for my future, but one twinged with sadness, because I knew Diane would never get to know my family the way I remembered them. I didn’t realize that eventually I would have a hard time remembering them that way myself.

After Nana was in a coma for about nine weeks, the most immediate of family — just her husband and kids — decided that she wouldn’t have wanted a life of vegetative deterioration. After many pained discussions — the ones that always somehow seem easier, or at least more cathartic, on TV hospital dramas — they stopped all of her medication. They decided to let whatever happened happen. She promptly woke up. And not long after, she went into a private room at The Home.

I note these details because the nursing-home experience is invariably colored by what led up to it: whether the decision to institutionalize was long and difficult or brief and obvious, whether the illness was sudden and extreme or long, lingering and debilitating, whether or not money was a major concern.

There was, for example, no question among any of us that my Nana would go to The Home, so we avoided the kind of teeth-gnashing that families with senile members or Alzheimer’s victims go through. She also went into The Home directly from major surgery, so there was no question she needed full-time nursing care, and subsequently no question about Medicaid picking up most of the tab. (They still evaluate her periodically, creating these wacky moments of suspended hope where we want the insurers to find her condition unimproved, so they’ll continue to pay.)

On the other hand, because Nana’s institutionalization was preceded by a period of “medical emergency mode” — when everything is dropped because the patient might not make it or might need your attention at any time — her transfer to The Home never sufficiently turned off our mental sirens and emergency blinkers. Nana is still visited nearly every day in The Home by relatives who, before the stroke, had been accustomed to seeing her once a week at most. And until very recently, she probably saw my Pop-pop for more waking hours at The Home than she did when they lived under the same roof. My mother was always a dutiful daughter-in-law, but now she sometimes passes as Nana’s surrogate mother — putting a heavy burden of responsibility on herself and, in the process, a bit of unwarranted guilt on Nana’s own children.

Nana’s condition ended up stabilizing on a pretty high plateau, all things considered. Six or seven months after her stroke, she was considered nearly fully recovered from the neck up. She could (and can) speak clearly, think clearly, and remember stories from far into the past. And although her short-term memory is less trustworthy, she has met and become close with my wife, and has formed relationships with the various Home employees who populate her new life — she knows them by name, remembers the last kindness they did for her, and keeps up with their current family struggles.

***

During the first year, we all thought we’d never get used to Nana being in The Home. Going there was like everything bad about visiting the ICU, without any of the hope that hovers over even the worst hospital stay. The first few holiday dinners without Nana were brutal — almost Bergmanesque, the way everyone seemed on the brink of tears with every bite of noodle kugel they remembered Nana making better. But eventually it grew predictable, if not exactly routine. For my parents, who live a mile from The Home and visit often, maybe the word “chronic” best describes the situation. My parents go through periods when the visits become easier, and then segue into times when the same circumstances — my Nana’s condition hasn’t changed all that much in six years — are nearly unbearable. When that happens, my mother goes anyway (she considers Home visits part of her maternal job description, I think) and my dad pulls back a little. I have watched my father’s sister and brother, who both live in town with their families, go through similar cycles.

Even at the peak of the cycle, the visits are never truly fun, and many of the laughs are forced-even when Nana’s in an especially nostalgic mood and tells you a story you’ve actually never heard before. Nana was always a situational person: She set up family events, catered them, and watched them play out, contributing whatever was necessary to move things along. She was more like a promoter than a star, and to me she now seems out of place as a center of attention. I imagine it is hard work for her to keep us entertained at bedside: It’s more focused personal pressure than she ever had as ruling matriarch.

For those who visit her, Nana’s condition has a way of initiating waves of future-shock. Every few months I’ll notice my parents — who aren’t even remotely old — making comments about what I’ll someday do with, or to, them. The wills they made out when I was born have now been amended to give me their power of attorney. The situation has also served to magnify a certain sadness my parents have that all their kids moved away from their hometown. For years they got a little misty over the reality that they would never see their (still theoretical) grandchildren as much as Nana and Pop-pop saw theirs. Now they also gulp over the realization that we probably won’t be nearby to follow in the family Home tradition. Theirs is a situation they wouldn’t wish on anyone, but deep inside I sense they still son of wish it on us — just so they don’t have to face it alone together.

There are also periods of intrafamilial squabbling. Without naming names. I’ll just say that some of the spouses of my Nana’s siblings learned the hard way that decades of being considered “part of the family” don’t necessarily mean you really are. Blood is thicker than commitment or duty, panic increases existing frictions, and the process by which certain people were dropped from the Supreme High Council for family decisions was as hurtful as it was predictable.

Some of the things that become “issues” are simultaneously absurd and oddly crucial, creating seemingly endless discussions you can’t believe you’re having — but know you must. One running controversy I have with my mother concerns Home protocol for sleeping grandparents. Mom says I should always wake Nana up, because she wants to see me, will feel bad if she knows I came by when she was asleep, and doesn’t sleep very well anyway. I say she deserves her rest and is usually so groggy when awakened that she can barely focus on who’s talking to her. It is easy to make fun of such recurring conversations as mind-numbing, which they are. But the immediacy of the situation has a way of turning what normally would be differences of opinion into life-or-death policy matters. And it is a million little discussions about the right way to handle situations that feel so damn wrong that sum up the experience of having relatives in The Home. There’s no such thing as problem-solving: Life is reduced to damage control.

I watch most of this from afar. I moved away from home after high school partly because I didn’t want the family scrutiny your adult life gets if you stick around. (It didn’t actually work, but that’s another essay.) Still. I wanted to be able to show up at home, offer my opinions, and have my brilliant insights solve my family’s squabbles. It took me a long time to understand that, like a lot of things a kid wants his parents to do, my suggestions were probably ways to improve my situation rather than the entire situation. I guess the value of my insights must be prorated by my percentage of contribution to the total care of Nana, which is small.

For nearly three years, our experience with The Home remained basically unchanged. Nana had an occasional seizure and had to be drugged up for a few days after each one. but she returned to whatever passes for normal. Then my Pop-pop, who prided himself on “just visiting” status, got ill and had to go into the hospital: upon discharge, he went to The Home to recuperate. This put a dent in his relentlessly upbeat attitude about Nana’s condition, and shifted the balance of responsibilities. Going from caretaker to convalescent did not sit well with Pop-pop — who was never known as a model patient — and the change in him reminded everyone that in The Home, life simply does not get better. Its quality is measured only by how much worse it doesn’t get.

Pop-pop did get out of The Home, and returned to his regular routine. but I think even he would admit that something had changed. It was harder to maintain his cheerleading of Nana, and he grew shorter with both family and Home staff. A year and a half later, he walked out of his house one morning and slipped picking up the newspaper. He broke his hip and found himself in the hospital, and then in The Home once again. This time his rehabilitation was much slower, and his aspect less pleasant.

In April of 1991, my Grandma in Pittsburgh — my mother’s mother — suffered congestive heart failure, which she survived. She had been living with my mother’s brother since her husband died years ago, and even when her health began slipping — mostly mechanical stuff, knees and hips — and the quarters grew a little too close, she refused to consider living anywhere else. After her heart failure, there was no question that she had to be institutionalized. She decided to come across the state to The Home, where she had been visiting my Nana for years.

For the grandchildren, this was an intriguing development: one-stop shopping for grandparent visits. It also put my mom in the interesting position of living in the same town as her mother for the first time since the mid ’50s. And even though 86-year-old Grandma was now actually, mechanically, the most sick of my three grandparents, she was one of the more functional and mentally interactive inmates at The Home. She was there. And because of all the groundwork laid by my family’s participation in Home events over the years — and also because my Grandma was a stately, gracious lady — she soon became Queen of The Home.

***

For some reason it wasn’t until Grandma checked in that all the issues swirling around The Home began to sink in for me. I don’t know why Grandma made the whole thing more real — especially since I was always much closer to Nana — but it did. I realized that as my parents, aunts and uncles got more mired in the experience, I had been distancing myself from it. Hearing the family discuss whether Grandma could afford the dignity of a private room — balancing her life expectancy with her bank account and what she wanted to leave her children — struck me more personally than all the more mundane aggravations of day-to-day Home life with Nana and Pop-pop.

I also came face-to-face with much of the guilt I felt over dutiful-grandson stuff. I had been averse to perfunctory grandparent-chats ever since I was a little kid and had to say, “Yes. fine, nothing, yes. fine, love you too,” on the phone to Grandma and Grandpa every Sunday evening. So I never got in the habit of calling Grandma regularly over the years, and the “She’s not gonna be around forever” my mother always warned me about seemed suddenly close at hand. But Grandma’s move to The Home also reminded me that I had never quite reconciled what happened the first year Nana went into The Home. Not only did I return to normal life; I got married, and I found that a lot of the weekends I once spent running home or to the beach with my family I now wanted to spend alone with my wife. But I never got over the guilt of breaking out of orbit around the family and The Home just as its gravitational pull was being exerted more strongly than ever on my parents, aunts and uncles. I know I had to make the changes I did to go on with my own life — and I hope my family forgives me — but I’m a first child, and I don’t take their disappointments lightly.

After Grandma recovered from her heart failure — and was told it could happen again at any time — she became the first family member I’d heard address directly “quality vs. quantity of life” desires. She was clear on not wanting to be put on a respirator, and more than willing to discuss all the Big Questions. The one thing I had never adjusted to about Nana’s illness was Pop-pop’s edict that nobody discuss such issues with her, for fear it would put a dent in her mental toughness. For years nobody was allowed to tell her where she was or what exactly had happened to her or how long ago it had happened. And to this day nobody is supposed to ask her the Big Questions. The biggest one, of course, is whether she would have chosen the operation and the six-and-counting years of life in a nursing home, with little use of her body (they still try to rehab her arms and legs) and even less hope for improvement beyond just being allowed to slip away. The next biggest question, I guess, is how she feels about the life she has today and whether it changes the way she perceives the life she had.

Why do we want to know these things? Well, besides basic existential nosiness, we’re looking for some frame of reference for making our own choices. And much as I find it somewhat insane to be thinking about this in my mid-30s, there are too many judgment calls to be made — especially in Pennsylvania, where, unbeknownst to many, “living wills” are still not valid — to leave loved ones without guidance.

On the other hand, our experience with Grandma showed that confronting the Big Questions doesn’t make the actual life-and-death decisions any easier. From April to October of last year. Grandma’s heart stopped three times — once in a turnpike Howard Johnson’s. Each time, she was revived and briefly put on a respirator. Like a classic old car, every time you jump-started her, the engine seemed to run fine. I’d get calls that she was near death, and then be talking to her on the phone the next day. Just under the surface of those conversations was a question I always had. When she said “No respirator,” did she really mean she preferred not to live another day — even if the day could be spent having another conversation to thank me for the flowers? Or did she associate the respirator with a permanent vegetative state? When there’s no way of knowing how much of the person you can revive, are the “stated wishes” of the patient truly useful? Do they circumvent catastrophe? Or are they mostly a way to create the illusion of preventive medical decisions?

While neither Nana nor Pop-pop ever talks about death. Grandma was very clear on the fact that she had come to The Home to die. And in retrospect I can honestly say that the last year of her life was one of the best. After all that time living in my uncle’s house and seeing only a shrinking group of old friends, she met dozens of new people in The Home who quickly took to her. She and my mom enjoyed some of the closest times they ever had in their lives. I probably talked to her more in those few months than I had in ten years. For a while, when Grandma was in The Home, Nana’s stable but saddening condition and the fact that Pop-pop’s hip was healing more slowly than anticipated seemed strangely acceptable. Grandma was spry and in her element; it was a dazzling sprint to the finish line for a woman with two bum knees, a bum hip and a bum heart. And her surprisingly positive experience made the entire Home a little happier.

The last time I saw my Grandma, she was sleeping in her bed at The Home. I didn’t wake her up. So the last time I saw her and she saw me was a week or so earlier. I kissed her goodbye before dashing to catch a cab to the train station. She was weakened from her most recent heart stop-start but smiling broadly, her gray hair beautiful, her lipstick perfect, her private room fastidiously appointed with framed photos.

At her funeral three weeks later. I waited around the graveside after nearly everyone else had left, to say my final goodbyes. As I stood in front of the casket. I noticed that somebody had forgotten to remove the sticker that identified its wood style: “Appalachian Oak.” I asked the rabbi if it would be all right if I peeled it off. It just seemed like something Grandma would have noticed.

***

Things at the home have not really been the same since Grandma died. Pop-pop surprised us all by making good on his promise to break out and move back to his house — which he had briefly put on the market last spring. He has hired people he knows through The Home to stay with him at night and for part of the day. It may very well cost him as much to stay out of The Home as it did to stay in; it is definitely more of a strain on my parents and aunts and uncles, of whom he now demands considerably more. But it gives him great peace of mind to be living in his house, even though he can’t visit Nana as often as he used to.

And since he moved home, he calls if we don’t call him. He rang us on New Year’s Eve to wish us a happy and healthy, and when I hung up it occurred to me that he had phoned more in the past six months than in the past 16 years. That was always Nana’s job. And every time he does it himself. I’m reminded there are glimmers of hope even in the most relentlessly hopeless situations.

My family has done as well as it could with all of this, some of us even a little better. People have surprised themselves with their capacity for anger and depression, but also with their ability to learn, adjust, and find alternative simple family pleasures to replace the ones we’ve lost. We’ve stopped mourning for ourselves, and learned how to remind each other that we’re still “just visiting.”

And through it all, we have remained together as a family. We still love each other. As in marriage, there are times when the only thing left between us is our commitment. But while The Home has been a highly unstandardized test of that commitment — it’s all essay questions, and the answers seem to change constantly — we all get passing grades. We always fancied ourselves A students in family solidarity. Now we’re thrilled with Cs, because we realize we live in an F of a world.

Originally appeared in Philadelphia Magazine, March 1992

Selected as a “Notable Essay of the Year” by Best American Essays