Martha shifted uncomfortably on the seat of her walker.  She was sitting outside the side door of her apartment building at precisely one PM.  Cognizant of the fact that the side door was hidden by the contour of the brick wall, Martha was determined to ensure that I would not miss her, that I would not be confused, possibly approaching the wrong door at the side of the building.  She was eighty-two, struggling to hear and understand what the world was spitting out in rapid fire staccato sounds and she was worried that I would be confused.  I was the caregiver.  I was the one who was supposed to be worried about her.  I was the one who was supposed to ease her worried mind but there she was, displaying the quality so typical of that generation, insisting on being the least amount of trouble possible.

She gazed responsively at me as I approached, searching desperately for some clue that might ignite her memory as to who I was.  “Hello Martha.”  “I am Helen …. Sean’s mom …. I have picked up your groceries for you…” Nothing.  The hard drive in Martha’s brain had begun to delete useless information for some time now and a memory of someone delivering groceries was hardly a valuable piece of information.  Sean on the other hand was well entrenched in the hard drive, his status in her required “needs for living” data base was solid, and memories of his service were vivid.   So that was where we connected, we both knew Sean.  If I was Sean’s mother, then I also must be reliable, trustworthy and most importantly dedicated to her wellbeing.

I awkwardly tried to assist in helping her rise from the walker.  Accepting my novice experience, she brushed away my hand and rocked herself to an upright position.  Again, I impeded her progress by trying to direct the walker.  Good God Helen! I thought to myself, try not to hurt her before she even gets to the car!  Her laughter was gentle and generous as she watched me scoot from side to side, providing as much assistance as an overly eager puppy under foot.  I opened the car door and let her back up to the seat.  She steadied herself onto the edge of the seat as I tried to show her where the overhead handle was placed.  “You scootch your bum back, and I will lift your legs into the car” I said with false confidence.  “OK” she replied.  With one clean and snatch movement I lifted both legs and jammed her feet into the space between the door and the car.  How is that possible?  Why don’t her legs fit into this car?  “Do you have the seat all the way back?” she asked.  Idiot! Idiot! Of course…move the seat back!  I ran to the other side of the car, started the ignition.  I ran back to her door and pushed the automatic button.  Now, now it would be easy.  No, no they still don’t slide into the car.  “I have had a knee replacement and I have arthritis, so my legs don’t bend very well” she said apologetically looking at me with clear blue eyes.  “Why don’t you try lifting under my knees and perhaps they can bend enough to get them in the door”.  Yes, yes, absolutely, I can do that.  I had visions of myself in the middle of a Monty Python sketch, where the next option was to simply cut them off.  No, Helen, focus …. Lift…gently…and….in they go!  Success!

Summer in Edmonton is a very special time of year.  It is a warm time of year.  It is seldom referred to negatively because it is a short time of year and again I reiterate, it is a warm time of year.  I am a “mature” caregiver and by “mature” I mean in menopausal.  The ability of the female body to instantaneously combust is still a complete mystery to me, but there I was, 150 pounds of burning flesh, feverishly seeking parking at the Cross Cancer clinic.  I had all the windows down and Martha’s carefully combed grey hair was now blowing in all directions without any sense of real direction.  I pulled up to the front doors and made my way to her side of the car.  She had recovered her hairdo to be at least within an inch of her scalp and managed to open the door without my help.  Again, she shifted her body to allow me to lift her legs onto the pavement.  I am a quick study.  I remembered to lift her knees.  Smooth as silk!  This time I suggested that she lock onto my forearm and I would pull her up from the car seat.  Again…success!  I was giddy with my new found competence.  I have always believed that the bubble of energy that you are walking around in, determines the outcome of your experiences.  I was so elated to have transferred Martha from the car into the hospital without causing any physical trauma, that I found a parking space in record time and was presenting Martha to the receptionist at the precise time of her appointment.  That’s karma!

As we proceeded to register for the appointment, I realized that this appointment was a follow up to surgery that Martha had previously.  I then remembered that Martha’s surgery was a mastectomy.  Sean had previously told me that in response to a cancerous lump, Martha’s right breast had been removed.  How could I have forgotten that?   How could I have been so consumed with my own experience that I had neglected to even think about why we were going to the Cancer Clinic?  Throughout the entire ordeal of transferring this fragile little elder to the clinic, she had not mentioned once the ordeal or trauma that was the cause for the trip in the first place.  Stoic, that is another descriptor for this generation.

If transferring Martha to and from the vehicle was a fiasco, it paled in comparison to my skills in defrocking a seated senior with one breast.  Because Martha insisted on walking the two miles of corridor to Section C, she was fatigued by the time we arrived in the change room.  I suggested that she sit on her walker and I would help her take off her blouse and put on the hospital gown.  It was a joint decision that we would undo the top two buttons and then lift the blouse over her head.  Arms up…and pull… pull more…just a bit more…and there we are!  “Oh, my goodness” she exclaimed, sitting there completely exposed.  Hurray up Helen, get the dam gown on!  She’s cold and naked!  Again…Arms in….and tie.  Another joint decision was to jam the gown down the back of the walker seat.  We were ready.  A couple more miles to the weighing station and now we wait.

Martha was given a clip board with several pages of required information.  This was the first time that she showed any sign of the toll this experience was having on her.  Her hands started to quiver as she pressed her hand against her brow.  “Let me read this to you and I will write down the answers” I volunteered.  “I can’t hear very well” she sighed “so you have to speak loudly ok?”  “We are a good match Martha because I don’t hear very well either” I reassured her.  And so, I came to learn about Martha.  She was one of nine children and the second of the only two still alive.  Her sister’s nick name was “Toughie”, she was a tom boy and Martha was the recipient of much of her sister’s aggression.  Her sister also had breast cancer, but died of lung cancer, as did Martha’s brother.  In 1955 both Martha and her husband John went to a Grey Cup game in Vancouver, where they were so enamored with that urban cool that they both began smoking.  Martha smoked for forty years.  She finally stopped smoking at the prodding of her doctor following a stroke.  Martha had two daughters and a son.  None were breast fed.  John couldn’t stand the sound of a baby crying and his mother issued the verdict that Martha’s milk was not sufficient enough to satisfy the baby.  She gazed past me with a look of both regret and disdain and said “Can you believe that?  What baby doesn’t cry?”

Martha had a knee replacement due to the severe arthritis in her joints, but the greatest source of sorrow was clearly the early onset of dementia that swallowed John.  She didn’t provide a lot of detail, but clearly the dementia had been aggressive and rapid, and her life was so severely altered that she listed medication for depression as a result of her lonely, separated and isolated existence.  Her wistful blue eyes clouded over with tears that were not allowed to spill over.  We completed the forms and waited silently for the nurse to enter the room.

The follow up session is geared to review the data collected after the surgery and create a plan for the future.  Criteria exists to determine what that plan might be.  Age is a vital criterion.  It can determine whether chemotherapy is a strategy for fighting the cancer.  At 82, it was not a viable choice for Martha.  The condition of your lymph nodes is another criterion.  It determines whether radiation is part of the program.  In Martha’s case, they tested positive, which meant that radiation was not required.  Given that the immediate treatment for Martha’s cancer was a mastectomy, which hopefully removed the cancer cells, the only thing left to decide was what medication to use to prevent the cancer cells from returning.  As she had experienced a stroke, there could be no medication that might threaten her circulation and heart.  There was a medication that could be implemented but it had side effects that could cause severe joint and bone pain.  At this point in the delivery there was a pregnant silence.  It was clarified that this medication had to be taken for five years to prevent cancer cells returning within a ten year period.  I could tell that Martha was missing the underlying premise to this discussion.  Why would you jeopardize the quality of your life and endure pain when the longest you could hold off the cancer was ten years.  In ten years Martha would be 92.  From a younger person’s perspective what would be the point?  But from Martha’s perspective … she wanted to live as long as she could!  It suddenly became clear to me that it does not matter how old you are… we all feel the value of our life is vital, whether we are 20 with 80 years to live or we are 80 with 20 years to live.  Somehow, society has taught us that it seems more important to want to live when your life is young than when it is old.  We say things like “well they had a good life”.  I can assure you that is not how Martha sees it.  Her life is worth fighting for whether she has ten seconds or ten years.  The compromise was to have a bone density test done to see if Martha could accommodate the medication.  And so, the follow-up was over.

In our great haste to exit the Cancer Clinic, we had organized a wheel chair for Martha so that I could simply wheel her down the four miles of corridors to the exit.  I was so pleased with myself in my ability to maneuver both the wheelchair and her walker that we were virtually flying down the hallways waving to everyone as we made our retreat.  Upon reaching the exit doors, Martha innocently looked at me and asked, “What about my clothes Helen?”

Visons of Monty Python sequels, complete with runaway wheel chairs and naked seniors were racing through my head as we wheeled our way back through the four miles of corridors.  Retrieving Martha’s blouse, we didn’t even bother getting all the way into the change room.  Here we go…. Untie… arms out…pull…lift your bum Martha, it appears you are sitting on the gown … good….and you are naked…. again!  Hurray up Helen! and ……arms up…….head through the hole…..arms in the sleeves…..pull down… buttons done up…..hair patted down…..and we are off!  Yup!  Off like a prom dress!

The drive home was relatively quiet as I could see her physical being drained from the ordeal of the trip.  I asked her if she was tired.  She glanced at me sideways and shrugged in agreement.  It occurred to me that she was indeed tired.  Tired of the drama of her own existence.  Tired of how hard everything had become.  Tired of trying to manage a life that she didn’t seem to have much control over.  Mostly I think she was tired of the struggle that being old presents to everyone in that category.  And yet there was absolutely no sign of retreating or quitting.  This generation of seniors, the post war generation, has no concept of any direction but forward.  I could almost see her in a smartly pressed uniform right out of a world War Two movie, sweeping aside tears as she smiled and walked briskly down an empty street in stoic Lauren Bacall fashion.

Half an hour later I safely deposited Martha in her home.  As I was leaving, I reached over and gave Martha a hug.  She hung onto me for several moments and softly kissed my cheek.  I walked out the door and realized that though Martha may not install my name in her hard drive, she was very much entrenched mine.

Written by Helen Wright