Recessional: A Novel (56 page)

Darkness had now settled and as he and Noble looked at the outline of the Palms in the late glow, he said: “Thanks to your work today, Judge, the people in there are a little more aware that they must respect the natural world. Thanks.”

As they went indoors to prepare for dinner, the birds flew off to their nests and the manatees moved ever closer to the warm waters in which they would spend the winter.

In early October, when Berta Umlauf turned eighty-one, it seemed as if the accumulated burdens she had assumed during the three prolonged deaths in the Umlauf family came roaring back for a delayed
attack on her general health, her teeth, her eyes and her nervous system. Of course, prudent woman that she had always been and now a wealthy one, too, she took care of herself. She consulted an ophthalmologist, who gave her good news: “Strong eyes, no glaucoma, no cataracts, no detached retinas, but tired nerves. While there’s no danger of your going blind, you will never again see as well as you used to, but with better glasses you’ll be more than able to function.”

She also went to see Dr. Velenius, the skilled dentist in the village east of Tampa. Learning from his allies in the Palms that she was truly a wealthy widow, he did some basic work for her and charged her outrageously, but she was inattentive and paid it. When Andy learned that she had become a patient of Velenius he did an imprudent thing: “Am I being too nosy, Mrs. Umlauf, if I asked what your dentist charged for his services?” and she thought so little of the inquiry that she showed him the bill. For routine services that would have cost, at most, two hundred dollars in Chicago, he had charged eight hundred, convincing her that she was on the verge of losing important teeth, which had been her suspicion all along and the reason she had gone to him in the first place. Had he been asked about his fee he would have said: “Giving her reassurance and eliminating certain real dangers was worth every penny she paid.”

But the danger to her nervous system was real. She suffered dizzy spells, unsteadiness in her legs and flashing spots before her eyes that did not arise from ocular problems. On two occasions she fainted in her room without having received even the slightest warning of such a collapse. In fact, she scarcely knew that she had fainted, and had she not found herself on the floor she would have been unaware of it.

She was frightened and consulted immediately with Dr. Farquhar. As always he was thorough, perceptive and helpful: Berta, since that day you visited me when your life seemed an overwhelming tangle, I’ve been aware that you were susceptible to nervous exhaustion. You push yourself too hard, and your two fainting spells alert me to the fact that you may be pumping an inadequate supply of blood to your brain. If that’s true, and you persist, you could be a candidate for a stroke. I’m going to give you the full battery of tests starting tomorrow. First the stress test, to see if it’s coronary in cause. Then a standard EKG to check your heart. Then I want you to go into Tampa for a test of your carotid arteries, to be sure you’re getting enough blood upstairs to the head. After that, and we hope those signs will all be satisfactory, I want you to have an MRI scan of your
brain to check on any obvious problems, and again I feel confident we’ll find nothing grievous.”

“Is that the one where Ludwig tore the place apart?”

“No. The CAT scan isn’t as sophisticated. The MRI is a very advanced test that produces excellent, clear images of the brain. It isn’t as easy a test to take, but we have highly skilled technicians who make the experience quite tolerable.” He reflected for a moment and added: “Of course, if you are subject to claustrophobia, tell us now, because you’ll never be able to endure the locked-in feeling. No shame to beg off. Are you susceptible?”

She laughed: “What I’m susceptible to is Brussels sprouts,” and the regimen of tests was scheduled, but before it could be half completed she awoke one night in a sweating, gasping panic, for she seemed unable to breathe. Obviously oxygen was getting through to her lungs, for she did not faint or collapse, but the sensation of strangulation continued, making continued sleep impossible. By frantic experimentation she learned that she could resist the attack by propping pillows behind her back and head and sleeping with her torso in an upright position. As a woman used to facing crises, she did not tug on the alarm cord, which would have summoned help from the main desk.

She did, however, go next morning to consult again with Dr. Farquhar and realized anew what a difference a good doctor can make. After much thumping and listening, he told her: “I hear liquid in your lungs, not such a vast amount as to scare us, but there it is, and it’s got to be driven out or real complications will set in,” and it was only then that both the doctor and the patient discovered her ankles were badly swollen.

“That confirms it, Berta. Congestive heart failure,” but before these ugly words could frighten her he added, almost with a chuckle: “Horrible name for a very common ailment. We have drugs to drive the excess liquid out of your body and another medication to calm your heart. I have patients who’ve had congestive failure for thirty years.” When he handed her the two prescriptions he warned: “There’s one danger in the diuretic I’m giving you, that’s the liquid expellant. It carries away not only the excess liquid but also the body’s supply of potassium. So you must supplement your diet with BOB—plenty of bananas, oranges and beans—especially bananas.”

“No problem. I like them all,” and when the swelling in her ankles
subsided and the accumulation of liquid left her lungs, her spells of constricted breathing vanished and she had no more midnight bouts of terror.

But her hard life and her continued assistance to others had depleted her physical reserves, and controlling her treatments could not attack her basic problem: that her genetic clock, which had been set at birth to allow some eighty years of arduous exertion, was sending signals that it was about to run down. Curiously, it was she and not Dr. Farquhar who interpreted these signals properly. So when Noel and his wife, Gretchen, paid their regular visit to the Palms, she told them, with no dramatics: “I feel the power supply is draining away. Too many demands in too many areas.”

“Mom!” Noel protested, “you’re the type who begins to slow down in her late nineties.”

“But if I’m reading the signals correctly, I’ll be moving in the not-too-distant future to the second floor over there, Assisted Living, and when that time comes I want you to dispose of this fine apartment. No regrets. I’ve had a damned good time here, it owes me nothing.”

“Mother,” Gretchen cried, “you’ll be living here till you’re ninety-five. Remember I said so.”

“No, I’ve observed that movement from Gateways to Assisted Living is usually irreversible. Dr. Zorn and Mr. Krenek deny that. They always say when a resident moves over: ‘This is temporary. We’ll hold your apartment.’ But they know and we know that the movement is always in the other direction. We don’t return here. We move upstairs to Extended Care.”

“Mother, don’t talk so fatalistically. You’re decades removed from the third floor.”

“No, Gretchen, I’ve worked there. I know the probabilities,” and four days after Noel and Gretchen left, she had a major setback, which made continued living in Gateways, with no assistance at night, impractical. The ominous first step in the long retreat from life had become inescapable, but she did not grieve when two male helpers from the main desk arrived at her apartment with a stretcher to transport her to the Health building. She laughed and told them firmly: “I refuse to ride in your carriage through the buildings. It would depress my friends,” and she insisted that they take the stretcher away. Assisted by only one of the men, she walked with a steady step to the elevator on her floor, then along the length of the
corridor leading to the Health building and into the elevator that would take her to her future home, a nicely furnished two-room suite in Assisted Living. Had she disposed of her apartment in Gateways, she could have made the switch from normal to Assisted at minimal additional cost, but her family had adamantly refused to let her abandon her quarters: “You’ll be back here,” they had argued, and since she could afford the double cost, she did not demur, but she did resolve to get rid of that apartment as soon as they were not looking.

It was when she settled into the routines of Assisted Living that she appreciated what this halfway house had to offer, and one morning when she watched the trained nurses perform their functions so effortlessly, caring for the needs of a dozen patients, she burst into tears.

“Mrs. Umlauf! What’s happened? Sudden pain?”

She reached out and grasped a nurse’s hand, pressed it to her lips: “I was thinking of the needless agony I suffered in that house over there on Island Five, the one by the water with the red roof.” As other nurses gathered at the window to see the old Umlauf house, Berta said: “I went through hell in that little paradise, helping two miserable people die, with me their only aid, responsible for everything, when all the time this facility was over here, just waiting to be used.” She shook her head: “It was as if you young women were screaming in the night air: ‘Hey, dummy! Here we are, eager to ease your burden.’ ”

“And you never heard us?” the nurses asked, and Berta said grimly: “Oh, I heard you all right. Loud and clear. The voices of reason. But the ones who were dying refused to listen or allow me to listen. They rebuffed me with one of the cruelest phrases I’ll ever hear: ‘What would the people back home think if we were put in a nursing home?’ They were more concerned about supposed friends in Marquette in northern Michigan than they were about me, or, really, about themselves. And Marquette was nearly a thousand miles away.” She paused, chuckled sardonically and told the nurses: “And I’ll bet there couldn’t have been six people in Marquette who would have given a damn if my mother-in-law and my husband had been over here in these fine quarters.”

One of the advantages of life in Assisted Living, she was discovering, was that Dr. Farquhar stopped by two or three times a week and could spend more time in a patient’s room than he had ever been
able to manage in his crowded office: “You’re so available, Doctor, and you’re so reassuring.” He was more than that, a paradigm of what a doctor should be, willing to make new diagnoses if earlier ones proved nonproductive, always prepared to ask for the opinion of another doctor, and not unwilling to look into new drugs that his patients had read about in
Reader’s Digest
or
Prevention
. One day he laughed at a suggestion Berta made: “I should subscribe to both those magazines. They account for about half the calls I get: ‘Dr. Farquhar, did you read about this new miracle drug for bronchitis?’ The new drug rarely accomplishes anything, but also rarely does any serious damage, so I prescribe it. Makes them happier.”

Berta felt he performed minor miracles in keeping her alive and able to function, shifting medication when she failed to respond to what she was taking and monitoring her vital signs. One day she told her nurse: “When I watch Dr. Farquhar, I have the feeling that I’m looking over the shoulder of Hippocrates, the father of you all.”

But as before, Farquhar could accomplish only so much, and the time came in early November when he had to summon her children, Noel and Gretchen, to share with them the bad news: “Your mother is declining rapidly. She no longer responds to normal medication, and we see no probability that her vital responses will improve.”

Noel tried to put the doctor at ease: “She predicted quite a while ago that her genetic clock, as she called it, was running down and would one of these days stop ticking altogether. She’s highly satisfied with what you’re doing to help her, so let’s continue. You may be sure you have the full confidence of the whole family.”

“But things aren’t going as well as you and she might think. She may have a relapse.”

These words were so chilling, coming from a low-key person like Farquhar, that the two Umlaufs had no immediate response. But the crucial question had to be asked: “Dr. Farquhar, are you trying to let us down easy, that Mom hasn’t much longer to live?”

“I’m making no predictions as to time, but yes, she is fading.”

“And you’re preparing us for the fact that she might, one of these days, have to be moved upstairs to Extended Care?”

“Yes, that was my next point.”

Noel broke down and could not speak, but Gretchen said: “We’ve never talked about this among ourselves, but I guess we’ve always known. You think it’s inescapable?”

“Yes. The system in Assisted Living is not able to provide the necessary care. We’ll have to move her.”

“This relapse—can you guess how soon it might occur?” Gretchen asked as the take-charge member of the Umlauf team.

“We never know. It could be postponed indefinitely, but we must play the averages, and in Berta’s case—what a fighting little woman she is—”

The three sat silent, no one wishing to probe the next inevitable problem, but after some moments Noel, recalling the oath they had taken in Berta’s living room, said quietly: “Mom prepared a living will. My copy is in a safe back home and I believe hers is in her room. Should I bring it to you?”

Dr. Farquhar responded reassuringly, “Noel, she’s nowhere near that extremity—could be even years from it. She’s a tremendous fighter. Ordinary rules don’t apply to rare individuals like her.”

“If she might have to move up to the third floor—”

“Noel, you haven’t heard me. She must be moved up by tomorrow night. There is no option.”

The two Umlaufs sat silent. They were prepared emotionally to hear these words, had even speculated on them when Dr. Farquhar summoned them, but they found it difficult to accept the fact they applied to tough little Berta Umlauf with her record of fighting off the inevitable.

Seeing their downcast faces, Farquhar tried again to reassure them: “She’s moving to Extended Living, but it’s not a death sentence. Berta may have many happy, full years ahead of her.”

But it didn’t work out that way, because shortly after midnight the older Mrs. Umlauf underwent what one of the aides termed “a humongous heart attack,” which left her near death and so incapacitated that she had to be taken by ambulance to a local hospital. When Dr. Farquhar rushed there to tend her he saw at once that recovery was improbable. But subsequent days proved what a determined fighter Berta was, for she rallied, reestablished satisfactory heart rhythms, and in time became stable enough to be transferred back to the Palms, where accommodation was provided in Extended Care on the third floor.