"Whenever I go into a restaurant, I order both a chicken and an egg to see which comes first"

Sunday, November 4, 2012

Seeing And Hearing Things

My aunt was near 90 when she decided to leave her small beachfront condo on the Connecticut Shore and move into an assisted living facility.  She had been in good health her whole life, but a fall and a broken hip began a series of medical complications which would force her out of the house and town she had lived in for most of her life.

My aunt, her two sisters – one my mother – and her brothers were all born and raised in the New Haven area.  My aunt was the socialite, the Pearl Mesta of the Shore who never seemed to mind organizing and preparing the five course Italian meals for us all at Easter and Christmas.  Those holiday dinners were something I looked forward to for weeks.  First, there was the antipasto composed of freshly-sliced mortadella, capicola, salami, cheese, oil-cured olives, roasted red peppers.  Then came the pasta, usually a lasagna with spicy tomato sauce and bubbling with three kinds of cheese; then finally the main course of roast chicken, turkey, or ham accompanied by corn fritters, eggplant, and pasta fagioli, a rich dish of navy beans, garlic, celery, and ham.  Dessert was a large Italian ricotta pie with lots of sweetmeats.  The adults then had espresso with anisette, and the kids wandered off to eat the nougat candies my uncle had placed all around the house.

My aunt and her family were the only relatives we visited.  My uncle was a Yale graduate, remarkable for an Italian graduating in the late 20s, and although he was as far from the Martha’s Vineyard set, he knew a lot more than the WASP airheads I grew up with.  As a young boy I was amazed that Uncle Joe had n answer for any question I asked.  Not only did he answer my queries about stars, the universe, wind, and electricity, he enjoyed talking about them.  “Now, that’s a good question, Ronnie”, he would begin. 

In retrospect I think my cousin, Richard, was too dim to even conceive of any questions, and my cousin Jean was too deep into her very early pre-pubescent girlie thing to look up; and maybe Uncle Joe liked the fact that one young relative took the same interest he had had in the world when he was a boy; but in any case, going to Aunty Ona’s was a treat.

There were always relatives on my uncle’s side who scared me.  His two maiden sisters were as warty, ugly, hook-nosed, and bitter-spirited as any witch.  They always sat next to each other and ate in unison.  They stabbed their meat, and raised their forks with the same coordinated but jerky, palsied movements. Lou Lehrman was a Jew, related by marriage to some long-dead relative of my uncle’s, and talked about product, patterns, lines, and rents.  He pushed at his food and was even creepier than my uncle’s sisters.  Harry Grelli was, I later found out, a gay man who lived across the street.  I knew that he wasn’t an old-fashioned Italian like my aunts; but unlike Lou Lehrman, Harry was funny.  He pranced, cackled, swished and showed off like a performer, and in retrospect I think he must have felt at home only with us where he could he come out of the very dark and limiting 1950s closet that West Haven had shut him in.

After my aunt’s injury she went from the hospital to a rehabilitation clinic, and then finally to a tiered assisted-living facility.  You moved wings as you deteriorated mentally or physically, so St. Margaret’s was your last stop.  St. Margaret’s did a few things to de-institutionalize the place – plastic flowers and vinyl potted palms – but there was no disguising the fact that it was an old people’s home and that everyone there would die there.

My aunt, however, never was depressed by it.  Just like she did when she lived in West Haven, she became the center of social attention; and often when I visited her, I found her in the lobby surrounded by men and women in wheelchairs all gabbing just like the old days.  Most of the clientele were Italians, so they had a lot in common.

I noticed her sliding grip on reality slowly and reluctantly.  I didn’t like the fact that my aunt was moving somewhere else.  My father, a doctor who had many patients at what was then called The Convalescent Home, told me about his patients who couldn’t remember what they had eaten an hour before, or didn’t recognize their children when they came to visit.  I experienced my first existential shock – if people lost their memories, they never existed.  It was as though they had never lived.  My father reassured me.  “It’s only the short-term memories that go”, he said.  Most of these old folks can tell you what they wore to their First Communion”.

What he didn’t tell me was that even the long-term memory could be distorted and altered; and that fictitious memories could replace real ones.  As my aunt progressively lost her grip, she began to mix what she saw on television with her own memories. At first I, like my mother and my cousin tried to snap her back; but perhaps because I was not so closely related, I could appreciate my aunt more as an individual than a mother or sister.  I had no difficulty entering her hilariously mixed-up world because the personality of my aunt never changed.  She was always the same ironic, funny, and blunt woman I had always known.

“The Pope came to visit St. Margaret’s yesterday”, she once told me.  The Pope had indeed come to America that month, but had visited only New York and Boston.

“What was he wearing?”, I asked.

“Oh, just what you’d expect”, said my aunt. “All dressed in white robes embroidered with gold that rustled when he walked.  He was shorter than I expected, kind of close to the floor; and since he had to wear that big hat, he wobbled and almost tipped over”.

Another day she told me that she was awakened one night be the sounds of a raucous party downstairs.  “It was a male stripper”, she said, “And it was like these old biddies had never seen a man’s set-up the way they howled and grabbed at him.”

I always looked forward to visiting my aunt.  My mother always refused to come because she said she couldn’t bear the sight of her sister who no longer resembled the girl and woman she knew; but I loved these crazy, unpredictable conversations. At first, reality poked in every so often – my aunt would comment on the weather outside or what was being cooked for dinner – but then it totally receded; and our conversations were nothing but strings of non sequiturs and hilarious juxtapositions of men and animals, rooftops and bums, pointed shoes and Indians. 

I know my aunt liked these conversations, because I could make her laugh; but whether or not I was essential to the conversation or to the laughter I could never say.  I knew only that I could happily check my cognitive reasoning, logic, and mental discipline at the door.

I recently told the story of my aunt to a psychologist friend of mine.  “She is lucky”, said Caroline. “Many patients with severe dementia do not see anything funny or hilarious. This altered life of theirs is sheer terror from morning to night.  They see their worst demons, and their worst nightmares become very real.  Dementia is not all you have cracked it up to be”.

Oliver Sachs, the noted psychologist who has written extensively about altered mental states, wrote about hallucinations in the New York Times (11.4.12) and noted that they are not all bad:

Working in old-age homes for many years, I have been struck by how many elderly people with impaired hearing are prone to auditory and, even more commonly, musical hallucinations — involuntary music in their minds that seems so real that at first they may think it is a neighbor’s stereo.

People with impaired sight, similarly, may start to have strange, visual hallucinations, sometimes just of patterns but often more elaborate visions of complex scenes or ranks of people in exotic dress. Perhaps 20 percent of those losing their vision or hearing may have such hallucinations.

Most of these people, when the reasons for their hallucinations are explained, take them calmly and as a part of getting old

I was called in to see one patient, Rosalie, a blind lady in her 90s, when she started to have visual hallucinations... I explained to her that if the visual parts of the brain are deprived of actual input, they are hungry for stimulation and may concoct images of their own. Rosalie was greatly relieved by this, and delighted to know that there was even a name for her condition…

Sachs goes on to talk about ‘hearing voices’:

While many people with schizophrenia do hear voices at certain times in their lives, the inverse is not true: most people who hear voices (as much as 10 percent of the population) are not mentally ill. For them, hearing voices is a normal mode of experience.

He concludes by saying:

My patients tell me about their hallucinations because I am open to hearing about them, because they know me and trust that I can usually run down the cause of their hallucinations. For the most part, these experiences are unthreatening and, once accommodated, even mildly diverting.

I loved my aunt until the day she died, and still think about her often.  To me she was always the same Aunty Ona that I knew as a child and as an adult.  Her personality – her being - never changed.  She reacted to her wild hallucinations no differently than if she had seen her neighbor, Roland Pelli, directing traffic at Easter, doing his best to keep drivers from chewing up the front lawn – with humor, insight, and resignation. 

The moral of the story is that despite our laudable efforts to stave off dementia and to retrieve older people from the precipice of another world; there may be times to go with our Aunty Ona’s and visit with them there.

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