Now ninety, she sits each day at the Alzheimer’s facility thinking of who knows what.   It has been five years since she ran her car through a fence and then professed not to have known she was driving.  Tests were conducted, and it was concluded that “compos mentis” no longer described her.  The moldy food filling her refrigerator added further confirmation, if any were needed.

Nothing much changes at the facility from day-to-day.  The patients, ninety percent female, are wheeled out to breakfast.  Only a few walk themselves, and those usually have canes or walkers.  After breakfast, the televisions cater to those who appear interested.  Others slump and sleep in their seats in the common area.  Most are wearing diapers beneath their clothes.   Conversations are few since the patients are generally too befuddled to formulate a question or an answer.  An eerie silence is pervasive, except for an occasional buzzing sound at the attendants’ station when any patient touches an exit door.  The noise is activated by the electronic bracelets they wear to assure there is no escape.

The staff, composed entirely of Caribbean women, circulates in pastel scrubs adding a touch of the exotic to a scene otherwise dominated by shades of gray.  Their lilting accents can sound charming, if you do not focus on the content, which often involves bed-pans or infections or even death.  The workers do not appear emotionally invested in the decay that surrounds them; perhaps, it is necessary for their self-preservation that they remain uninvolved, largely oblivious.  It is just their job.

In her day, and, in fact, up until she was in her late-seventies, she was an athlete.  She played tennis and hiked.  She loved music and art and gardening.  She was politically involved, and there was a sparkle to her blue eyes.   However, her broad range of enthusiastic interests was accompanied by a powerful self-centered narcissism that left friends and relatives confused about their feelings.  Did they like her?  Well, yes, she was so “energetic” and “positive.”  In the end, most of her relationships ended in disillusionment and disengagement on the part of the acquaintances, as they realized, finally, that she truly only cared about herself.

The rare visits to the center by relatives or remaining friends provoke a similar confusion.  There is a slow, inexorable decline in her functions, juxtaposed with identical surroundings where nothing seems to change except, occasionally, the cast of characters.

“Did she recognize you this time?” someone will ask.

“Yes, perhaps.  It’s hard to tell.  She asked how the family is.”

“They often cover that way, with general questions.   Was she alert?”

“She hasn’t been alert for several years.  But she still moves her arms.  Her neck supports her head, sort of.   She seems tired.  But if she sees ice cream, she revives.”

“She still has an appetite?”

“Yes, for sweets.”

Doctors rarely enter the building, unless there is an emergency or Medicaid allows payment for a “mental visit.”  But a slew of other service providers arrive each day to trim hair and nails, lead exercise, or sing folk songs, etc.  There are church services on Sunday for those who are interested, and even those who do not know if they are interested.  Instead of the television room, they are wheeled into a small chapel to hear a simple sermon after breakfast.  It is ironic that she, an adamant atheist throughout adulthood, is usually among the audience.

Some of the patients have numerous visitors, particularly when they first arrive.  Children come with grandchildren in tow, bringing gifts and food and flowers.  With some exceptions, these visits slow over time as the families realize that their ministrations are not acknowledged or, worse, not comprehended.  Alzheimer’s generally is not an acute disease.  It works faster on some than on others, but its progress is, so far, unstoppable.

“Oh, I’m just on vacation,” she used to say, when she first arrived.  “I’ll be getting back to my apartment any time now.”   More recently, with a decreasing grasp on reality, she will say:  “I’m just visiting a friend for lunch,” or “I wonder about some of the people here.”

Such pronouncements were greeted with humor in the beginning.  They showed her fighting spirit.  In time, they were less amusing as futility outweighed hopefulness.  When she asked if she lived in California or Connecticut, it emphasized her lack of mental function.  Instead of repeating these stories to show how positive she was, visitors regarded her confused questions as disturbing, as indications of how far she had fallen.  After three years or so, she stopped asking about leaving.  Optimism finally disappeared under the grinding tedium of a diminishing mind.

It was surprising, therefore, to receive a call last month from the social worker at the facility.  It seems that, in what must have been regarded as a fit of enlightened humanism, New Jersey passed a law requiring that each patient be asked to reaffirm, annually, that they wish to remain at the facility.

“We asked her if she would like to go home,” said the caller, “and she said she would.”

“Do you think she is capable of going home?”

“No, I don’t,” said the social worker.  “But we have to ask.”

“What do you want us to say?”

“As her guardians, you have to instruct us to keep her.”

“Okay.  Please continue to keep her.”

“Thank you.  We’ll check with you again next year.”

“Is this really necessary?”

“It’s the law,” was the reply.

So, she will remain at the facility for another year.  Barring a miraculous cure or a merciful death, she will not be going home.