Everyone Goes Upstairs

The first floor is for new arrivals, for those who can still walk, still talk, who still have family who come daily, weekly, monthly, with forced grins, clean laundry, anxious eyes. If you stay there long enough, which means, if you don’t leave by ambulance, if you don’t leave by hearse, if your relatives don’t remove you in protest, then sooner or later you can’t walk so much, you can’t walk at all. You can’t speak. Your family stops coming.

Or, you move upstairs.

When I was a student at Wellesley College, I worked the eleven-to-seven shift three summers, at various nursing homes. The work was difficult and unpleasant, but when I walked home—in the early mornings, smelling of cleaner, my colleagues’ cigarette smoke, the contents of my patients’ diapers and the indefinable smell (both blood and bleach?) surrounding the preparation and cooking of kosher chicken which clung to my hair and polyester uniform—I felt I had made a difference. Someone who had been dirty was clean. Someone who had been wet was dry. I had daubed open bed sores with Betadine solution and had said kind words to people who could no longer talk. I took the job because I needed money, but discovered more compelling reasons to keep it.


There is an art to changing the sheets of a bed while someone is still in it:

If he is asleep, if she is asleep, you approach him or her silently.

If he is awake, if she cannot sleep, you say something kind and cheerful while moving him, while shifting her.

Turn him to the right.

Turn her to the left.

Fold the dirty sheet, the dirty pad, and roll beneath the patient.

(Hi, my name is Ann, I’m here to make you feel better.)

Undo the diaper. Clean a stranger’s bottom, and clean it well.

Search for sores. Treat them. Chart them. Tell the nurse later.

Spread and tuck the clean sheet, but not over the mess, not over the patient.

Spread half the pad, folding the rest. Put the new diaper on half a bum.

(Here we go, this will be over soon! Is that your grandson in the picture?)

Turn the patient the other way, so he, so she, lands on the clean linen on the clean side.

Quickly undo the rest of the diaper, clean what you see without talking about what you’ve seen.

(Beautiful sunset tonight, hope it won’t rain tomorrow! That’s my day off!)

Whisk away what’s dirty without letting it touch what’s clean.

Check for sores. They hide in the folds of the skin, which, on Alzheimer’s patients, is strangely youthful, surprisingly firm.

Pull the folded clean things, upon which your patient rests, over toward you.

Finish making the bed, finish taping the new diaper; spread the clean pad, tuck the patient in.

You shouldn’t kiss the patients, but there is a medical gesture, a pat on the upper arm, two pats, between the region one inch below the shoulder and one inch above the elbow. That demonstrates institutional affection.

Do that.

(Sweet dreams.)


I tried to avoid having male patients. I was an unmarried virgin, and while I thought I knew about male anatomy, from having brothers, from changing diapers, I did not recognize this new terrain. My first male patient was a retired obstetrician whom I walked to the bathroom, where I was to point his penis toward the toilet for him and escort him back to bed.

But when presented with three members equal in length and width, I steered the wrong one. Or perhaps I held too many. He peed toward the ceiling, and I had to wipe the walls.

I pulled up his pants and walked him toward his bed, but he stopped, and put his hand on the belly of the patient in the bed next to his. He looked the man intently in the eye, and said,



When I first met Dr. Khan, he was downstairs. I was young.

He thought I was the activities director. I was a nurse’s aide.

He was harnessed to a chair, his head drooping. I was running to get home.

He thought we were on a cruise. It’s true that we were being carried places, though our destinations were different.

Neither of us could stay where we were for long.

The next time Dr. Kahn and I met, I came to his room in the dark, toward dawn. Doctors rise early for rounds. In all the years, he had not lost the habit, though he had lost his wife, his practice, his memory, his home. When he saw me he said, “Oh, good, you’re here! I need you to take something down.”

I thought that something on the wall of his room disturbed him. But no. He said,

“Take a letter.”

I was holding a diaper, not a pen. I said, “Let me do this first.”

He said, “No, this is important. I want you to write a letter about this idea I have to give the children of New York City free ice cream for breakfast. Because, you know, some of them don’t have enough to eat. And they might not like school lunches. But everyone loves ice cream.

You know how to spell my name, don’t you? I’m Doctor Mordecai Kahn. K-a-h-n. Have you got that?”

When I nodded, he sighed deeply, and I was able to change his bedding. He settled into the sleep of the just, and I took off my gloves.

Another night, he thought I was the patient. He shook my gloved hand.

“The name is Doctor Mordecai Kahn. K-a-h-n. You’re going to be fine. You have nothing to worry about.”

And even though I needed to earn a thousand dollars for college before the end of the summer, when I was with him, I didn’t worry.

Because he was an early riser, whenever I came by his floor, he was sitting in his wheelchair, his chest tied to the back of the chair so his head did not slump too far forward, wheeling his way toward the Day Room, a vacant area toward the front of the building, where everyone who was dressed was parked, whether in a wheelchair or on a plastic-covered seat, to give the illusion of conversation and company. Some talked to each other. Many talked to themselves. A few talked to God. There was a pay phone on the wall. No one but the staff talked on that.

We went out the back way, but Mordecai – Dr. Kahn – often drifted back there, and greeted us, introducing himself (“K-a-h-n”), shaking our hands, wishing us a good day. We traded stories about who he thought we were, where he thought he was. It brought the staff together. “He called me ‘Officer,’” said the orderly who shaved him. “I got a promotion – he called me ‘Nurse’ and discussed a case!” said an aide. And a male nurse, in his white uniform, sighed, “He tried to buy a Good Humor bar from me.” We could smile because in all his imaginings, Mordecai was safely tethered where we could care for him. He was grounded.

I was assigned to a different station for several days. When I came back on duty to Dr. Kahn’s room, I was happy to see him, and so perhaps, I was smiling, as I pulled back his covers.

In a nursing home, people cover and uncover you at will. Men are assigned to clean women and women to clean men. Strong young men with foreign accents hustle naked old men who have numbers tattooed on their arms into wheelchairs. The young man throws a sheet over the old, wheels him toward the hallway, and says, loudly, “Okay, Harold! Time for your shower!” And we wonder when he shivers?

So, I entered his room with perhaps a smile, and I went to pull back his covers, because I thought he was sleeping, but hoped he was awake.

When he saw me, he looked startled, severe. He clutched the covers, and looked me in the eye.

“Oh, no, Honey,” he said, “I can’t let you do that.”

“But, I have to.” I said, “It’s my job.”

“No, no,” he said dolefully, clutching the covers tighter. “I know you. You’re a good girl, from a good family. If you need money, I’ll give you the money, but we’re not going to do it like that. I just can’t let you.”

You don’t kiss the patients. You don’t cry in front of them. So, I walked out of the room – slowly, backward.


In winter, I still needed money. There were new books to buy, and I had a wedding to plan. The nursing home needed extra staff for the holidays, so I went back for two weeks.

“Where’s Dr. Kahn?” I asked, my first night back.

“What? You didn’t know? Oh, Sugar, they moved him upstairs!”

Flashes of lucidity are unpredictable.


It was a quiet autumn night at the nursing home when two of Boston’s finest came in the front door. They strode toward the nursing station and said, “We understand that one of your doctors is being held hostage.”

“Doctors?” the head nurse asked. She was as Irish as they, and twice as skeptical. “We don’t have any doctors on staff. Just nurses. When we need a doctor, we call them.”

“Well, one of your doctors certainly called us. He used the pay phone. He said that he was in some kind of chair, tied up. He said he couldn’t see the kidnappers, and he didn’t know when they would be back, so we should trace this call, and hurry. He spelled his name for us. He said he was Dr. Kahn….”

And a nurse and three aides spelled, in unison, “K-a-h-n.”


Sooner or later, everyone goes upstairs. Before this, every time Mordecai saw me, there was a flash of recognition. Even when he didn’t know where he was, or who I was, he instantly recognized me. This time I went to his bed, on the second floor. During first rounds he was awake, but he said nothing.

“How are you, Dr. Kahn?” I asked, as I turned him and cleaned him, and folded the dirty, and spread the clean. “I was away, but I’m back for a few weeks.”

He stared, vacant eyed, and said nothing; he had a bed sore. People who talk usually do not have bed sores. They can tell you if you’ve missed something. I daubed the bed sore with Betadine solution. I turned him on the other side, and cleaned some more. Then, I spread lotion, lots of lotion, to make up for anything else he didn’t have in his life. I greased him, slathered him, polished him, kneaded him.

Except for the bedsore, his skin was still beautiful.

I turned him back to where he had been, as he was, laid him flat. Took off the gloves. Pulled up the covers. Pat, pat. I looked again, into his eyes, just once more. He did not look back at me. He kept staring blankly at the ceiling.

But, in a rumbly, quiet voice, he said, “Thank you.”

At the end of my shift, I took the elevator down, walked out the back door, glad to be cold, glad to be young, glad to be out of there.