All Hallow's Eve

Most of the patients that I see are elderly and frail. While Halloween might have been a holiday that they enjoyed in the past, it is not so now. The idea of getting up out of the recliner, adjusting the oxygen tubing and shuffling to the door multiple times an hour to admire the costumes of toddlers doesn't hold the appeal it once did. So, by the time I arrive at my fifth patient visit of the day, I have almost forgotten that it is Halloween.

I am going to see Stuart, a life-long schizophrenic who has developed a colon cancer and has been in our hospice program about three months. Stuart lives in a skilled nursing facility that specializes in the mentally ill. Most of the residents here have disabling mental illness such as severe chronic depression or schizophrenia. Many have been wards of the state for most of their adult lives. The state pays for their care at the facility, which has a disheveled, shabby, faded appearance, much like the residents. Because of their illness and medications and the occasional electroshock therapy, most have a glazed, unemotional countenance that is described in the medical lingo as flat affect.

I have grown used to this community of folks and their odd ways during my years of coming to this facility. I know many of the non-hospice residents as well. There is a middle-aged gentleman, Tom, who is tall and has an elegant face. He had a business in town, until his mother fell ill, with what became her terminal illness. When he needed help to care for her at home, Visiting Nurses sent a nurse and a bath aide to help with her care. As she continued to decline, he became increasingly depressed. When she died, his depression deepened. He could not work. His physicians were unable to help him pull out of it, and he lost his business. Eventually, he lost his home and came here. My name tag has the Visiting Nurse logo prominently displayed, and every time he sees it, every time he sees me, he is reminded of that terrible time in his life. Over the years, he has told me his story several times. Each time his sadness and his tears are as fresh as the first time I reminded him of the year he lost his mother and work and whatever glue held him together.

Sometimes, I bring a milk shake to my patient. He is losing weight, a common problem for cancer patients, and a McDonald's milk shake is a highlight in the grayness of the facility's balanced, nutritional, pureed meals. There is a lady there, Madge, who is diabetic in addition to her schizophrenia. She asks me to bring her a milk shake too. Sometimes, she will try to con me into buying her a candy bar out of the machine in the dining room. Madge has the flat affect of the profoundly mentally ill, so her features read the same most of the time. When she is wheedling me to buy her a soda, when I tell her I can't, same non-expression. If there is hope, expectation, disappointment, rage, I can't read it in her face. I think of my son, who will put on a big-eyed, pleading pout to convince me to give him what he wants. He will tilt his head down, open his eyes wide, push his lower lip out, and beg, "Pllleeeaassee?" It may not get him what he wants, but he is awful cute when he does it. These kind of social interactions are lost to Madge and her nursing home neighbors, but they do have social interactions of a sort. The Activities Director of the facility schedules things for these folks to do every weekday. They sing karaoke, play Bingo, make crafts. Some are just too ill. One woman at the facility sits in a chair in the dining room and rocks back and forth, chanting, "Memememememememe." I have never seen her interact with another resident, and she requires a lot of patience from the staff just to get her meals down.

When I enter the facility dining room, the Halloween party is in full swing.

I have a hard time finding Stuart, as most of the residents are in Halloween costumes. The "memememe" lady is sitting in her regular chair, rocking back and forth with a glittery witch hat on her head. With each pass back and forth, the hat flops up and down and the overhead light catches the sequins like a disco ball. Tom is wandering the room, taller than usual with a Cat-In-the-Hat striped top hat, taking small shuffling steps. His face is expressionless. Madge is wearing a medieval-style dress, with trumpet sleeves and a fitted bodice. Her ample, aging bosom all but spills from the low-cut neckline. She is playing Bingo and when she gets a line of numbers covered with the ancient poker chips, she calls out, "Bingo" over the music, but there is no excitement, no inflection in her voice. She gets up to get her prize, a banana, and takes it back to her seat. She eats it in three bites. The music playing I recognize as the same tape that is used for karaoke: Harper Valley PTA, Love is a Rose, Elvis's Teddy Bear. I can't tell if anyone here is having fun; I'm not sure what passes for fun in the severely depressed.

I finally see Stuart in the crowd. He is non-verbal most days and will strike out at caregivers who attempt to get him to do things he would rather not (like taking a shower). I can't imagine what kind of a costume he would tolerate, and I see that he does not have to endure one. Someone has taken face paint to his cheeks and forehead in a farce of Native American design. Stuart as warrior seems as appropriate a disguise as any. He is getting agitated, probably from the commotion of the party, and I take him back to his room for my visit with him. I help him into bed and check him over. He curls up into a fetal position and goes to sleep. As I head to the nurses station to complete my documentation I get a wide angle view of the party again. It is the most macabre gathering I have ever seen, all these unemotional faces, the garish costumes, the loud '70's music.

The Activities Director is either oblivious or inspired. I can't decide.

Fawn Hoener
Community

3rd place prose