The Nurse Engineer, age 88
The Melba Notebooks, Chapter III
Melba is home recovering from a broken hip, and Bob assumes the household chores and much of the nursing care. The notebooks, for the first time are heavily populated with Bob’s entries. His handwriting has a prominent forward slant, is written in fine point graphite or red pencil, or rarely, in pen… never ballpoint. The tightly written words, despite idiosyncratic pruning, flow easily. His family letters have always been warm, newsy. Though sprinkled with light clever humor there is no idle gossip and little that is revealing or intimate. His regular writingnow fills the pages of the Notebook with grammatically spare details. In an ironic twist the entries, seem almost like hospital nurses notes: crisp, detailed, abbreviated, and detached. The nurse’s uniform, however, consists of baggy soiled khaki pants, an exhausted old short sleeved shirt and incredibly old dirty tennis shoes, unlaced in teen fashion. Bob never wears his new clothes, saving them for- What? Unlike the Walden Pond philosopher, he sees no point in mending them.
12/29/95 Bob: 6:30 AM passed about 120 cc Drank ensure and ice cream. ½ percocet I waked her from a very sound sleep.
10:30AM Visting Nurse: all morning meds + ½ percocet. Walked about the house well. Took 1 can ensure and ½ can apricot juice.
1:00PM Li: Please check loaf of french bread. Don’t give any to Melba:moldy, but Bob didn’t want to throw away. Both in great spirits. Happy New Year All!
2:00PM Bob: Small bowl of clam chowder and finishing an ensure. Icecream from this morning. ½ pill at 2 PM
4:00PM S: Asked for pain pill. ½ percocet. sliver of pie and ice cream.
10:00 PM percocet ½ ensure I can.
12/30/95 Bob:
3:00AM went to bathroom
4:00 AM 1 can ensure plus ice cream
7:40 finished ensure ½ percocet
8:00 AM started to bathroom before I heard her.
9:00 AM small porridge orange juice, finshed ensure
11:10 Sophie: All meds and ½ percocet. Wgt 92 lb 1 ensure, ½ piece peach pie
1:30PM Dot: ½ grilled cheese sandwich and juice. To bathroom by herself.
1 percocet. To bed listening to Emily Dickenson tape. Recorder runs slow; can anyone fix it? Also, Melba can’t quite push buttons. Is there an easier one around?
4:30 PM Bob: Had one can apricot during afternoon and at 4:30 one ensure with ice cream.
6:00 PM small serving of pea soup, two small crackers, and a fair sized dish of vanilla ice cream in dining room.
10:00 PM Sophie: Took her outside and gave 1/2 zoloft. Also 2 tylenol ext caps. ½ cup ice cream, ½ cup H20
12/31/95 Bob: 4:30AM Made ensure with ice cream but only about 1/3 taken.
7:30 AM ate very small serving grapenuts and drank a little more of the ensure-only abut half altogether.
The old year passes without a nod from Bob, and the newborn year begins much like the one gone by. Bob’s dutiful entries continue, interrupted by those of daughters Dot and Sophie, visitors, Li a housekeeper, Jen , and hairdresser the visiting nurse. Li is loyal, thoughtful and kind, a Norwegian not given to loquacity. She leaves the home brightened by her gentle quiet humor, and thoughtful attentions. Moreover she is trim and attractive. Bob, who sometimes resents intruders, is putty in her hands. Jen appears for the first time. She is Melba’s long time hair dresser, and moreover her friend, has a beauty shop in her home a few blocks away, where Melba has been a frequent customer. She is heavy set, direct, offers no quarter, and ignores the fact that Bob doesn’t approve of beauty parlors or hair dressers. He is out of the loop as far as all the ladies are concerned, and when Jen appears to do Melba’s hair she adds other tasks as she feels are needed.
1/1/96 7:30 -8:30 Sophie: Took herself to the bathroom. Said she didn’t feel well. ?diarrhea.
10:45 Visiting nurse: Meds and percocet and ensure. I took the DOSS out because of the loose stools. After the percocet took hold Melba felt a lot better and got up walking. We will watch but I don’t think the loose stools are from the Zoloft.
3:00 PM Bob: Melba had one ensure, also one at 11 AM. I gave her squash and broccoli. She ate a pretty fair amount of squash but hardly any broccoli. She ate a all but the lower crust of a small piece of pie.
Sophie: Dad is doing such a terrific job!
1/2/96 Bob: 1:10AM Bedpan wi b m. some spilled.
4:20 AM up to bathroom with bad bad spill
8:30 AM up to bathroom. Gave ½ percocet and placed hot water bottle and afgan. She’s cold. Gave hot tea.
10:30AM Visiting nurse Temp 97.5 States she feels better. All meds given. Milk toast given. Had a tub bath. Tylenol est tab, 2 given. Ensure, 1 can given.
12:30 Bob: Not hungry.
2:00 Di: brought chicken noodle soup but none eaten
“ squash and broccoli ” ”doesn’t want ensure.
4:00 PM Sophie: ½ percocet. Ate milk toast-almost all of it. Ate ice cream off top of pie.
½ can ensure c ¼ cup milk
5:00 PM Out on porch. Walked there. ½ snicker bar. Watched K-9 movie, liked it/laughing. No diarrhea from 4 to 6:00 and Bob thinks (recalls) no more that day. 8:00PM ate ensure.
Bob: 1:30AM to bathroom to urinate
3:30AM same
7:30AM “ “½ percocet
9:00AM a small porridge. ½ ensure.
Noon visiting nurse: -Took all meds ½ percocet had a tub bath and did Very well. Took ensure and 1 candy wgt 90 lbs today.
5:15PM Dot: Balanced Check book. Paid bills.
1/3/96 Bob: 1:00AM To Bathroom urinate
4:10 “ “
7:30 “ and BM
9:15 Moderate serving of oatmeal porridge. ½ tangerine, and ½ small piece of toast, coffee, very little of blended banana left over from 10 PM, refused pineapple juice.
10:15 Di ½ ensure plus all her pills. Doesn’t want to get dressed yet.
Watching TV
11:45 All dressed. Finished ensure. Ready to party!
It is Melba’s 88th Birthday, and a celebration is in order!
5:30 Up for dinner. Lamb chops and cheese cake. She even got herself a drink. Liked the idea better than the taste.
7:30 Tired. Off to bed.
8:15 Bob Church Choir singing Happy Birthday. To bedroom.
10:30 gave ½ percocet and Tylenol
11/4/96 Bob: 3:20 AM bedpan with about 120 cc. Gave 1 ensure plus ice cream but about1/3 taken.
9:00 AM She ate a tangerine, half cup coffee, and less than half of a moderate serving of oat meal porridge. Gave ½ percocet.
Noon visiting nurse: Gave all meds except for lasix + kcl- had a bath + shampoo-finished ensure had second can of ensure and 1/4 banana c ice cream + 1 cup of hot choc made with milk-walked about the house-getting around much better.
4:30 PM Bob: Gave ensure and ice cream
7:15 Half a lamb chop and a good serving of scalloped potatoes
8:15 Sophie: Percocet and one tylenol est relief. Has had a good day.
Seems to be in a good mood. Up to bathroom. Wgt 90 lb in night shirt
1/5/96 Bob: 3:40AM went to bathroom for urine. Gave ½ sustacal plus ice cream of which half was taken.
8:00 breakfast, one shredded wheat, toast.
10:00 Jen: Changed bed did laundry. Pill container needs filling.
10:30 had pills, finished can of super insure, all washed and dressed for day
1:00PM Bob: Small serving clam chowder
3:40 PM half sustocal and ice cream
7:30 PM ate most of one small lamb chop and 1 piece toast
10:30 PM Half sustocal + icecream, drank her down.
1/6/96: Bob: 4:00 AM Had Sooster Booster (Sustacal) and ice cream. To bathroom7:30 AM to bathroom
8:30 AM Small oatmeal, one piece of toast, orange juice and ½ coffee
9:30 Jen: Did laundry, cleaned kitchen, bathroom. Melba back in bed.\ watching TV. Called Sophie about filling pill container. Melba’s not ready to get dressed yet.
10:30 AM Visiting nurse: Gave Melba her medications-set up 7 day medication box with lasix + KCl every other day. No lasix or KCI today. KCl almost finished-will have to reorder if she continues on this-had a tub bath +shampoo drank 1 can of sustical-does not have much energy today-wish she would eat more.
1/7/96 8:00 AM Bob: all AM meds 1 tylenol + percocet ½ tab before leaving off to church! 1 sustacal and shredded wheat for breakfast Did very well at church- Took her walker and she walked in c walker then up to Fellowship Room. She ate a donut at church.
At church: As adults, perhaps partly as a reaction to childhood experience, neither Bob nor Melba have been churchgoers. Now, however, a Lutheran church is across the street, and they have been attending there for several years. To the amazement of the worshipers, Bob mows the one acre lawn with his old push mower. Fellow church members are actively concerned and supportive of them in their old age. Now, within two months of her hip fracture, and shortly after the church choir sang for Melba for her 89 the birthday, she is able and motivated to attend the service.
9:30 PM Sophie: up at table. Good mood. Wt 92 lbs- reading Reader’s Digest to us. Has her humor back. Asked for water when dad was giving us a medical report from Reader’s Digest.
1/8/96 Bob: : 1:00AM up to bathroom. Gave ½ sooster booster.
3:40 AM Same, little taken.
7:40 AM took a bit more of S B, also ½ percocet.
10:30 AM Di: Clean up things changed bed did laundry gave Melba her pills with can of juice. She drank it all.
4:30 PM Di: Dressed up and off to have blood test. Melba and Bob have a good system for stairs, using walker. Fixed dinner-fish + string beans +bread in bread maker.
7:00 PM Bob: Yes we got blood test and a report to Dr H is promised tomorrow morning in time for our appointment at 1:30. Di had prepared a tasty dinner, much enjoyed.
1/9/96 Visiting nurse: All medications taken. Had a tub bath – For the first time I did not have to get in the tub too! Had 2 vicodin then off to lunch in town. She ate a half a cup of soup and some pasta- Then to Dr. H- wt 95 lbs! He is very pleased with her progress-Yes we may continue giving percocet- he ordered more. Bob will pick them up.
1. Yes we can discontinue lasix and KCl- watch for swollen ankles etc.
2. He ordered an Xray of pelvis + we went to N W Radiologists + had that done.
4. He wants her to try pool therapy- I will phone for an appointment- I phoned they can’t start until 1/23 at 2-4 PM-Home to bed- I gave her ½ percocet + 1 tylenol + a glass of juice + a glass of sustical- It’s been a long day but she did well I took lasix + K Cl out of medication box.
1/10/96 Bob: 1:15 AM Up to urinate. Gave 1/2 sustical and ice cream
6:00 AM ” “ “ Didn’t want sustical
8:10 AM Up for breakfast in breakfast room. Small serving of porridge and
a slice of toast.
10:00 AM Di: Got things wiped down swept up laundry done. Melba watching TV. Bob’s outside somewhere. Pills were gone so Dr. Bob must have already gave them to Melba. I made up some imitation jello (with unflavored gelatin) in fridge with blackberrys and cherries in it. Hope no one gets sick on it. See you Friday.
5:10-7:30 PM –Dot: Watched TV, read magazines. Ate turkey wi pears Pretty spunky today. Hooray, Hip Hip! Good work by lots of loving, kind helpers and dad and S.
8:00PM Bob: small gelatine & part of banana for dessert.
10:00 PM Sophie: Reading at D. table- Looks great! No swelling of feet or ankles. No SOB. Pain meds as HS. Dr. H sent word that the X Ray shows that the break is healing well.
As Melba recovers she wants, to reassume her duties as homemaker, those Bob has taken on. His entries end, and the former pattern of caregiver notes reappear.
A Christmas Gift
The Melba Notebooks* chapter IV
The Notebook entries of 1996 accurately portray the ankylosis of elder- time. They shuffle stiffly through the pages, days, nights, meal menus, medications, in the handwritten words of caregivers who come and go. The sameness revealed there is only broken by unexpected events and by the sharp and colorful voice of the writers, like Di, the principal caregiver. Her regular morning entries begin innocently with introductory remarks differing only slightly from like one about her arrival, cleaning up, and the preparation of meal.
11/7/96 Di: Got here. Put away groc. Cleaned up, did laundry.
made jello
made muffins
Beef stroganoff
Carrots, broccoli, tomatoes, jello, muffins.
made cole slaw[1]
The particular notation above, for the seventh of November, is followed by a recurring Di-ism:
“Dinner still in oven from last night”.
Bob left the hot dish she had prepared the day before in the oven, and fed himself and Melba left-overs for supper. He does this rather frequently.
11/8/96 Di: We are doing an experiment. Old hamburger. Old salad. If they both get ill, it was the hamburger. If only dad gets ill, it was the salad. (here there is a happy face!) …They say it is really good!
11/9/96 Di: Well…no one was sick- so I guess they are tough! Their stomachs are used to it since they use the oven as a ‘fridge!
Di takes a dim view of men in general, having experienced abuse in her own life. After Melba broke her hip the year before, this particular man, Bob, took control of Melba’s kitchen, bathroom, laundry, medications, and body. The leftover problem is only one of an endless string of insults Di does not tolerate quietly. Like his objections to the use of the clothes dryer instead of the clothes line; his preference to serve left-over rather than newly prepared food, and to cook up great quantities of bulk produce and then eat the same dish, from the same dish, for many days; his machinations to save soap and water by not using either, and by trying to limit toilet flushes to one-a-day; his voiding in the bathroom sink since his prostate surgery ( He says it takes a long time since his surgery, is at a convenient level, and saves water! ); his using old pieces of cloth to catch leaking urine, then drying them on the windowsill after rinsing in a thread-thin stream of tap water; ( When Sophie buys him ‘Depends’ and Melba uses those blue pads to protect her own bed, he cuts them up and… what else? Washes them to be reused!); all these are personal insults to Di, Melba, and to the entire female universe.
But Bob is indelibly green for reasons antithetical to most 21st century green dogma. He was indelibly dyed green to the core by his parents’ family values, Thoreau’s abstemiousness, and by the great depression that drove him out of the country to find work. Melba wishes he were not so abstemious, but she understands; her own parents were both from Northern California farming families. They were the green of farmers who know or learned that any coming year can be disastrous. Her mother and father had 15 brothers and sisters between them; they were the only ones on either side to survive the depression relatively intact. Waste not want not was one of a long litany of their rules for green living.
11/10/96 Sophie: Came to get Melba to go to church. She wasn’t dressed yet. Dad went ahead so I think she didn’t want to go! I’ll take her to my house for a shower.
Dora, 4PM: House is warm and restful. Cat here and very happy. I reminded mom that he has a sensitive stomach and can’t eat people food or milk. He urps it up.
11/17/96 Sophie: Here for short visit. Dad mad because Cat won’t go out the kitchen door- thought I’d better check on it. Dad did get into a hassle w/cat; hand is black & blue & scratched.
Bob is forever incensed by a cat that he tries to bar from the house, but can almost never corner or catch. After he chases the cat outside they glower and hiss at one another until Bob gets too close and the cat scats. It is revealing that without exception, caregivers are defenders of this intrusive stray tomcat; that twists Bob’s tail. Yet entries about the cat, while solicitous, are not very affectionate. There is no fond description of his character, his endearing traits, no mention of his color, because he is more than a mere pet. His formal and proper name is appropriately archetypical like Man; it is: Cat.
Dora: This is a great new notebook! Thanks!
12 15 96 Dora: Good morning. Cat here and very happy. I reminded mom that he has a sensitive stomach and can’t eat people food or milk.. He urps it up. Mom not going to church this morning. Didn’t realize it was Sunday. Messiah today. Need to be at the MB Theater at 2:oo. Will meet Nick and Will there. Both Melba and Bob seem down though.
The first 15 years of their marriage were lived on the economic margins of life, yet they seemed unaware of that, living like educated poor, who were never in want. Their four children all worked their way through school without help except by example: they are a nurse, a chemist, a physician, and a high school counselor. Now, however, Melba has an inheritance, and can indulge herself, paying the bills Bob feels are frivolous, which is most of them. Bob accumulates the money he saves that way. They each manage their own a stock portfolio. Yet while Bob and Melba are no longer poor they don’t or can’t alter their values or priorities. One is books; in the most modest mining tent, one or the other always read to their children or to one another. They still can recite poetry by the hour, in the way only their generation does. Another priority is music. In the worst and the best of times they spent whatever it took to take four children to an opera or a symphony.
A performance of the Messiah on a cold winter day in the North Latitudes, when nightfall is in afternoon, might be rejected by many people 90years old. For Bob and Melba it is basic to who they are.
Bob drives his old Plymouth. (When I last visited, I had not the heart to ask him not to drive me to and from the airport. In reality, I reasoned, he may not hear well, but since his cataract surgery he sees better; he is a more cautious now, probably a safer driver than long ago when he drove always at the edge of speed, time, and route, relying on his reflexes, but straining the sphincters of his passengers.)
As they leave the Church on that cold evening, after a long performance of The Messiah. As usual, Bob steps out to return to his Plymouth, leaving Melba behind to catch up. But he is pre-occupied about something; he doesn’t recall where he parked. They walk on. And on. At last Melba becomes cold, exhausted, and falls, fracturing her pelvis; yet fortunately it is not a severe injury this time, and she will quickly begin the familiar slow process of healing.
12/16/96 Di: Did up laundry. Cleaned up kitchen. Vacumed. Cleaned
out litter box and fed cat. Made jello and meat loaf. Sorry about Melba. Will do whatever I can to help. Bob thinks every other day will be enough ( for me to work) until Melba gets back.
Indeed he does. In fact, when Di takes time off, Bob manages very well alone. The notebook voices fall completely silent until Melba is brought home from the hospital; they are not about Bob.
Since her two hip fractures, requiring many weeks in an Extended Care Facility, Melba has been very fearful of being buried alive in such a place. She has repeatedly insisted she will die happily before living through it again. Yet now the same future faces her.
Several days later, in the hospital, she is up in a chair with help. Sophie, Melba’s youngest daughter, is a nurse, and tries very hard to convince Melba’s doctors to allow her to go home rather than to an allegedly Skilled Nursing Facility. Sophie has installed the hospital equipment needed for Melba’s care at home. She has requested regular home physiotherapy; yet despite the great reduction of net cost that would result, the bureaucracy, filled with fear of known or imagined danger, cannot agree.
Sophie has no power of attorney, but Melba is clear-headed and adamant. Based on Melba’s iterated wish, and many prior family conversations there is no need to consult with anyone. Very early on the 24th of December Sophie simply goes to the hospital, commandeers a wheelchair, and abducts Melba from her hospital bed, taking her back to her familiar home and to that difficult man who is still the love of her life. Sophie’s intervention is her most transcendental act of faith, and her greatest Christmas gift to her mother, to Bob, and to her family in 1996.
* Five spiral bound Melba Notebooks, dated from 1995 to 2002, containing the hand written entries of numerous caregivers and family who make it possible for an aging couple, Bob and Melba, whose lives spanned the entire last century, to live in their home until their ashes are scattered in places meaningful to them. The notebook entries are dialogue, the way caregivers communicate with one another. Some details, including names and places are altered, but the voices are genuine. Spelling is generally preserved. Italics are the author’s comments.
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