She smells like sour milk and she looks like loneliness. I am tasked with meeting her and coming up with a written plan. She is all of 80 pounds sitting on a faded-pink wingback chair and wearing only a tattered top. No underwear, no pants, just a camisole. I hold her 90-year-old wrinkled hand and look at her. The dangling skin from her thighs looks like old white shirts draped on metal hangers.
With both of her hands, she grasps my hand with a surprisingly steady tight grip as if I were all that was keeping her grounded for the moment. I wonder who she once was and what she did in her life. She has no idea who I am, that she is exposing herself, that she has soiled her chair, or that her name is Erma. She can’t remember if or when she ate or if she took any medication. Her words don’t quite make sense, but, in looking around, I see that her life doesn’t quite make
I walk around this small condominium in Bethesda. A hurricane of dust dances in the light from the window, landing on layers upon layers of her belongings. I find passports with stamps from around the world, and I find dated correspondence. There are utility bills, perfume bottles, and a collection of small pewter animals all mixed together. In one pile, there are blackened lemon peels and coffee grounds lying on gold-framed photographs of various children and adults.
I help her gently climb into a pair of Depends, and we just sit. Our two chairs are an island in the middle of the chaos of what her life has become. I am the Adult Protective Services social worker assigned to assess if she is neglecting herself. Holding hands and sitting is the protocol of the moment. She needs me, and, truth be told, I need this moment, too. There is something about sitting with a person in silence, just sitting, that comforts as much as a warm embrace.
After a few minutes of silence, she asks, “You want some tea, dear?” She has no tea, no kettle, no cups, and no clue.
“Sure,” I say. She grins, and her few teeth make her mouth look like an abandoned skyline. We continue to sit, her feet propped up on the box of Depends. To her, we are having tea. To me, it is delicious.
I know I need to write up a plan for Erma; but how do you describe such a person or such an experience? I start to write, “Client is a 90-year-old single woman who exhibits signs of dementia….” And signs of beauty, and signs of the frailty of existence — of hers, of mine, of all of ours. She exhibits signs of spiritual connection, of survival in being able to ignore all the horrors around her, signs of, of….
In my mind, an accurate description of her condition would be “pleasantly demented,” but I am charged with providing a report with a more clinical definition, a report that will determine her future.
I start digging through her piles of belongings, but I find no sign of current family. I ask Erma about photos of various people and she smiles, but she clearly does not know who they are. I check wallets within the piles, and I look at a few letters with no legible contact information. I even check my smartphone for any leads, but, alas, I find nothing. So I know what my task at hand is, but it hurts to do what I have to do. “Social worker called 911 to get client evaluated for dehydration, malnutrition, and competency,” I write, after I hang up the phone. If I could, I would take her home and feed her a diet of hearty soup, real tea, and a large dose of my toddlers’ hugs.
“Client needs evaluation for placement in a skilled nursing facility.” The words move painfully from my fingers onto the computer; my words mean that her beauty and charm will be lost. The beauty of her sweet dementia and hands that reach out to strangers will be translated into paperwork: symptomology and Medicaid eligibility. My words will lead to placement in whatever nursing home I can get her into immediately; her vulnerable body will most likely be at the mercy of the rough hands of nursing assistants who get paid way too little to wipe feces from little old women.
The paramedics take Erma down the stairs, and I go out to my car. I sit for a moment thinking about all the Ermas of my career. I hope I am always about that tea.
Liat Katz, a clinical social worker, lives in Rockville, Maryland. She is the author of an unpublished memoir, Creatively Maladjusted: Essays of a Broken Life.