DIED OF OLD AGE.
The phrase stuck in her mind like a thorn—all the way to Rose Hill Cemetery.
Well, my father didn’t die of old age. I let them pull the plug on him.
Rose Hill was located in Paxton, a small town outside of Peterborough, N.H. The place consisted of narrow tree-lined lanes like an arboretum. Since her father’s death, René had been coming here maybe once a month and on special days such as Memorial Day, Father’s Day, or Christmas. This day would have been his eighty-second birthday.
Her mother was also robbed of her golden years, dying of cancer three years before her father, two years after he was diagnosed with Alzheimer’s. She was buried beside him.
René had always been close to her father, but never so much as when he began to fade and especially after Diane died and his dependency fell full-weight on her, his only child. She had made regular visits each week to her parents’ home. She had arranged for visiting nurses, then hospice when her mother’s condition had begun to worsen. After her mother’s death, René moved her father into a long-term-care home, where he rapidly declined into the disease. She cleaned her mother’s headstone and laid down a pot of geraniums, then moved to her father’s.
“Hi, Dad.”
With paper towels she wiped the headstone, a black marble speckled slab that still glistened like glass in the sunshine. She removed some dead leaves and set down the second geranium pot.
THOMAS S. BALLARD BELOVED FATHER AND HUSBAND
She wished they had picked a less generic inscription. Three-quarters of the headstones had the same wording, just change the gender terms. She wished she had selected lyrics of one of his favorite songs—maybe a few bars
of “As Time Goes By” or “Let Me Call You Sweetheart” or “Bridge Over Troubled Waters” or a hundred others. But the funeral director had talked her out of it, which made sense, since they’d probably have had to get copyright permission. And wouldn’t that look cute: a footnote with something like “© 1931 Warner Bros. Music Corporation, ASCAP, Music and Words by Herman Hupfeld.” Dad would have appreciated that.
“Well, eight weeks on the job, and I’m caught up in a murder investigation because one of my patients escaped from a locked ward and killed a guy. Half her records are incomplete, there are patients on the ward that shouldn’t be, and everybody’s stonewalling while my head’s on the block. Otherwise, it’s been a great week.”
She finished buffing the stone.
The end was in sight when he began to stop eating, something common with dementia patients. Most of his cognition was gone, but he had had no medical condition and was strong enough physically to shuffle about the ward on a walker or to sit up in a wheelchair. Hoping to stimulate his appetite, the nursing home staff treated him with antidepressants, which worked for a while. But eventually he refused food no matter how much they encouraged him. Sometimes he’d spit it out or he’d keep it in his mouth, not chewing. Or he’d chew it and not swallow, pocketing the mash in his cheeks. Because René was at pharmacy school fifty miles away, she couldn’t visit as often as she wanted—a fact that ate at her heart like acid. But when she did, his mood would perk up and he’d eat a little for her, sometimes recognizing her, sometimes just responding to a smiling face that encouraged him to cooperate. But without her, staff just could not get him to eat.
Eventually the options wore down to two: aggressive invasive measures—tube feeding and IVs—or letting him starve.
Because René was a pharmacy student her father had given her power of attorney. She had discussed the options with her father in the early days of his disease. Emphatically he said he did not want aggressive medical treatment. He did not want to simply hang on with tubes down his throat and wait to become riddled with infections. He did not want to put her through this.
“Promise me this,” he had said, taking her shoulders in his hands. “When I get really bad, you’ll let them do what has to be done to let me go out with dignity, okay? Promise? I don’t want to end up just some gaga thing attached to a diaper.”
She could barely get out a yes.
She told the nursing staff that she knew how her father viewed life and that he wanted it this way. So she signed the papers:
Do Not Resuscitate—DNR
Do Not Intubate—DNI
Do Not Hospitalize—DNH
Some days her recollection of her father was so vivid that she could not accept the fact of his death. And she could still recall that first day as if it were last week, when she realized that her father—former mechanical engineer, a man of extraordinary discipline, a book lover, a good-time piano player and crooner, an avid fisherman, a jokester, and a gentle, loving, fabulous parent—was beginning to bump down the staircase.
And in an instant René was in the backseat of his Lincoln Town Car, listening to him.
“You must remember this, a kiss is just a kiss, a case of do or die. The fundamental things in life as time goes by. Dah DAH dah DAH dah DAH …”
“Come on, Dad, you’re spoiling a great song. For old time’s sake.” It was his birthday, and she was home from college.
“Only if you lead.” He had pulled up to the stop sign at the top of their street.
“Yeah, like you don’t know the words. You could have written them, for God’s sake.” She was hoping he’d kick into an old sing-along as they did on long trips when she was a girl. But for some reason he wasn’t interested. And her mother sat in the passenger seat looking tense. “‘You must remember this, a kiss is just a kiss, a sigh is just a sigh …’”
“Oh, that version,” and he gave her a wink in the rearview mirror.
Her dad was still such a kidder. “You big goof.”
“What time are the reservations?” Diane had asked, her voice devoid of inflection.
Because of traffic, René had arrived late, which probably explained Diane’s mood. Her face was out the window and she dug in her handbag for a cigarette.
“Seven-fifteen.” René tried to ignore Diane’s grimness, especially on her father’s birthday. “Okay, from the top. ‘You must remember this, a kiss is just a kiss …’ Mom, feel free to join in. ‘A sigh is just a sigh …’”
Her father sang along haltingly, as if waiting for René’s prompting.
“‘No matter what the future brings …’ Dad, you’re punking out.”
“He doesn’t want to sing.”
“Yes, he does. Right, Dad?”
“Actually, I’m a little fuzzy on the lyrics,” he said to the mirror.
“How could it be fuzzy? It was your wedding song.” It was also part of their “repertoire”—old Sinatra, Bennett, and Johnny Mercer numbers.
He didn’t respond.
“Right,” Diane said under her breath.
His head jerked and he turned into the northbound lane of 6A. They were heading for the Red Goose, a favorite restaurant near their cottage in East Sandwich. It was a glorious midsummer’s evening with a soft, sultry sea breeze. In spite of a growing uneasiness, René persisted. “Then how about ‘I Remember You’?” She could hear the note of desperation not to let go of their old-time ritual.
“Sorry, Honey. My voice isn’t what it used to be.”
“You’ve got a great voice, Dad.”
Diane snapped her head around and hissed, “He doesn’t want to sing.”
It was as if she had stung René with venom. All she had done was try to lighten the air. Then she saw something in Diane’s eye just before she turned forward again. Something was wrong. Diane muttered under her breath to her father.
“What?”
“Next left.”
“You don’t have to tell me, for chrissake.”
“You passed the street.”
For a split second it occurred to René that her father was joking, that this was one of his elaborate charades to twist Diane’s tail—something he’d do when she was in a bad mood. It was slightly perverse but it always got her laughing. Like when he’d pretend that his leg had fallen asleep and that he’d have to limp to the movie or restaurant, stopping every so often to whack his thigh awake, then suddenly stop limping as if he were one of those miracles at Lourdes and look up to the sky in a gaze of beatific gratification. It would send both of them into laughing jags. Or the time he spent the entire evening speaking like Peter Sellers’s Inspector Clouseau because René was taking French lit. And the more Diane asked him to stop, the more he pretended he didn’t understand English until she cracked up. That was it: One of his routines
—
playing Daddy Dumb-Dumb.
“Christ!” He hissed and he slammed his hand on the wheel.
René felt her insides clutch. No, something else.
He pulled over to the side to let traffic pass. He had driven by the turnoff. For several seconds he stared through the windshield as silence filled the car like toxic gas.
“What’s wrong?” René could hear the fright in her voice. Ever since her arrival, she had detected a low-grade anxiety
—
her mother’s nervous distraction, her father’s forced cheer. A horrid thought slashed across her brain: Her mother’s cancer was back. During a regular check-up they had found a spot on her lung.
And Dad was so distracted by worry that he got confused on a route he could navigate in his sleep.
“Everything’s fine,” her mother snapped.
“I’m just a little tired, Honey.” When the traffic cleared, he made a U-turn, approached the intersection again, then turned.
“Dad, it’s the other way!”
He slammed on the brakes and nearly collided with an oncoming car. Horns blared as they sat in the intersection, her father looking stunned. “Pull over. Pull over!” her mother shouted. He pulled over, the car facing the opposite way and on the wrong side of 6A. René’s chest was so tight she could barely breathe and her mother was crying. Her father sat staring straight ahead. “I don’t know what I’m doing.”
“What do you mean?”
“I’m getting senile. I forgot how to get there.”
“You’re not getting senile. You’re not.” But she could sense the ugly snout push its way up. “You just got a little confused, people blowing their horns like that. We don’t have to go, if you don’t want to.”
“We’re going,” her mother snarled. “You can turn now.”
Her father checked the road. “What happens when you get old.”
“You’re not old. Seventy-two is not old,” René insisted.
“Straight,” Diane said under her breath. “Straight.”
And her father pulled through the intersection up toward the restaurant.
And in the backseat René uttered a silent prayer.
Please, God, no.
Seven years later they buried her father under that stone. By then he had forgotten he had once been a full human being.
René finished cleaning the headstone. “I’m doing better, Dad,” she said. “Making an effort to stay active. Even Nick is after me. ‘You’re too holed-up with your computer.’ ‘You have to end this self-exile,’ he says. ‘Meet a nice guy.’ Well, I’m going to a party tomorrow. Should be some interesting people there besides Nick.”
Birds fluttered overhead and changed direction with a flick. She watched them swirl around and return overhead, then blow away toward the west.
“Remember the time we went fishing off the pier at Scusset Beach? Caught a striper the size of my leg. Missed being a keeper by two inches, but you let me bring it home and scale it. You said they looked like quarters flying off it. Always had a way with words.” She touched the stone.
“I miss you, Dad.”
I miss us.
RENÉ ARRIVED AT BROADVIEW AROUND NINE the next morning. The receptionist told her the old 3-2-1 security code had been replaced by 63082, which struck her as excessive given that the ward was for dementia patients, most of whom were bereft of short-term memory. She tapped the code on the keypad and the door to the AD unit clicked open. She passed through and the door closed and locked behind her as it was supposed to. Just as she started down the hall, her attention was arrested by something above her head—the ceiling security camera.
Even though it was Sunday, Alice was in her office. “Her records aren’t back, if that’s what you’re wondering. The police still have them. Sorry.” She looked away and began shuffling papers.
“Okay. Then maybe you can call me when they’re back,” she said, wondering why Alice was acting as if René were a giant botulism spore.
“No problem,” Alice said without looking up.
“Oh, one more thing,” René said, as Alice started away. “The patient census you gave me? There are forty-two names and forty-six patients on the ward.”
Alice looked at her blankly.
“Mary Curley, Louis Martinetti, Anthony Marsden, and Gloria Breed. According to my records, none of these people are residents.”
Alice gathered her things. “Well, they’re under Dr. Carr’s care.”
“Meaning what?”
“Meaning you should speak to him.” She began to move away from the desk.
“But you’re head nurse on the unit.”
“And Dr. Carr is head physician,” she snapped.
She tried to get away, but René stopped her, “Alice, are you telling me there are patients here whose medical records I don’t have access to?”
Alice took a deep breath, puffing up like a bird in defense. “Really, I have to go.”
“Sure, but maybe you can tell me about the security cameras.”
“What security cameras?” Alice’s voice skipped an octave.
“Outside the unit doors. Has anybody checked them?”
“Checked them?”
“To see who might have let Clara out of the ward?”
“Let her out? Nobody let her out.” Again she tried to get away.
But René took her arm. “Alice, I don’t know what’s going on here, but let me just say that if word got out to the state and federal regulatory boards that there are irregularities in the medical records of a patient arrested for murder, that there are more patients on the ward than listed, that critical pharmaceutical documentation is missing or locked away—there are going to be questions about patient neglect and patient abuse, and we could see a SWAT team of regulators come down on us like banshees demanding to know what other irregularities Broadview is up to, raising questions about patient security and wondering all sorts of things about the nursing staff and criminal negligence or, worse—that somebody here let Clara Devine out of the home, intent on murder. And since I’m professionally responsible for reporting irregularities in patients’ status, my job is on the line. So maybe somebody should tell me what’s going on or I’m calling the state.”
Alice stared at René for a long moment, her face rippling with expressions under the glare of René’s threat. Finally she sighed, and her body deflated like a balloon. She glanced down the hall to an aide. “Bonnie, I’ll be right back.” Then she nodded René inside a small back office and locked the door behind them. “They’ll probably have my head, but I’m sure you’ll find out anyway.”
“Find out what?”
“You know nothing about this,” she whispered, her eyes full of pleading.
The axes of the room felt as if they had shifted a few degrees. René nodded. “Okay.”
Alice unlocked a desk drawer and removed a videocassette. On a table behind them was a television monitor and VCR where they often viewed patient behavior or educational videos. Alice popped in the video, and after some flickering the screen filled with a grainy black-and-white ceiling shot of the unit’s security door from maybe ten feet back. For several seconds nothing moved, as if they were looking at a still. Then a figure appeared in the jerky time-lapsed motion of security cameras. Clara Devine.
She was alone and carrying a shopping bag. She looked about her, then, unbelievably, she went to the wall and with a finger she tapped the keypad and pushed her way through the door, which closed behind her. It happened so fast that René just said, “What?”
“Yeah, I know. She let herself out.”
René felt a flash of gooseflesh across her back. What she was seeing could not be—like witnessing a dog suddenly speaking English or seeing someone levitate. Dogs don’t talk, and Alzheimer’s patients don’t recover their short-term memory. The disease, like gravity, was a downward, persistent force.
“I don’t believe this.” René’s mind raced for a rational explanation: Clara had been misdiagnosed all along. She had faked her dementia. It was somebody else. None of the above.
“There’s more,” Alice said, her voice grim. She hit a few buttons and the tape switched to another venue. The main entrance outside. Again a shadowy figure, but with Clara’s face and body, and this time she was dressed in a rain poncho pulled over her head.
“We think she changed in the elevator and slipped by the front desk. It was raining out.”
On rare occasions, a patient managed to elope from a nursing home, usually because of understaffing. Two winters ago a man wandered outside and froze to death. As a result, Broadview had installed an elaborate security system. But no Alzheimer’s patient was capable of figuring out a pass code or remembering it even if she had heard it from one of the staffers. Nor were any of them capable of long-range planning of a disguise on a rainy night.
“My guess is she must have watched one of us use the keypad, and she memorized the combo.”
“Alice, she has middle-stage Alzheimer’s. She’s not capable of memorizing anything longer than a second, and you know that.”
Alice didn’t respond.
“Do the police know about this?”
“No. They never asked. Their job was to solve a murder. Broadview’s security is Broadview’s problem and not a police matter.”
“If they ask?”
“The system was down, the cameras weren’t working. Not my area.” Alice popped out the cassette and locked it in the drawer again. Then she got up and put her hand on the doorknob to leave.
Not my area.
“Alice, what the hell’s going on up here?”
“I think you’d better ask Dr. Carr. He’ll be in tomorrow.” And she hustled away.